Sustained Problems Research Articles

Minimally invasive surgical approach in children treated for oesophageal atresia is associated with attention problems at school age: a prospective cohort study

The long-term neurodevelopment of children born with oesophageal atresia (OA) is unclear. Therefore, we assessed the neurocognitive domains and their predictors. Patients born with OA between February 2006 and December 2014, who were routinely seen at eight years as part of a structured prospective longitudinal follow-up program, were included. Main outcome measures were need for school support, performance in various neurocognitive domains and potential predictors of neurocognitive problems. We analysed data of 65 children with a mean (SD) age of 8.1 (0.2) years, of whom 89% with OA type C. Thirty-five (54%) surgical corrections were minimally invasive; the median (interquartile range) duration of exposure to anaesthetics in the first 24 months was 398 (296 – 710) minutes. Forty-four (68%) attended regular education without extra support and intelligence was within normal range (99–108). More than 50% had z-scores ≤ -2 on one or more neurocognitive domains, of which attention was the most frequently affected domain. The speed on the sustained attention task was significantly below normal (z-score -1.48 (2.12), p < .001), as was fluctuation of sustained attention (z-score -3.19 (3.80), p < .001). The minimally invasive approach and a lower socio-economic status (both p = 0.006) proved significant predictors for sustained attention problems in multivariable analyses. Conclusion: Children who undergo minimally invasive surgery for OA correction are at risk for sustained attention problems at school age. Future studies unravelling the effects of perioperative events on neurodevelopment should lead to optimal surgical, anaesthesiological, and intensive care management in the neonatal period.What is Known:• School-aged children born with oesophageal atresia have normal intelligence but problems with sustained attention at eight years.What is New:• Oesophageal atresia patients, who undergo minimally invasive surgery or who have a background of lower socioeconomic status are at serious risk for sustained attention problems at school age.• Moreover, those who have been intubated for a longer period are at risk for stronger fluctuations in sustained attention.

Early self-control and sustained attention problems: Associations with youth achievement, motivation, and engagement

Research has yet to understand the extent to which early indicators of self-control and sustained attention are associated with long-term measures of academic motivation and engagement in adolescence. Furthermore, multi-informant assessments of self-control and sustained attention are rarely considered. Using a longitudinal sample (N = 1364 children), teacher and mother reports and direct assessments of self-control and sustained attention problems in early childhood were examined for associations with achievement, motivation, and engagement at age 15, both before and after controlling for early measures of achievement. Teacher ratings and direct assessments predicted achievement, while maternal ratings of self-control predicted engagement. After controlling for early achievement, most longitudinal associations with achievement were reduced to nonsignificance. Only the pathways modeling teacher-rated sustained attention problems onto achievement and maternal ratings of self-control onto engagement remained. Fifth grade math achievement mediated the association between teacher-rated attention problems and adolescent achievement. Implications of findings are discussed.

Behavioral Improvements but Limited Change in Callous-Unemotional Traits in Adolescents Treated for Conduct Problems

Callous-unemotional (CU) traits have been linked to more severe and sustained behavior problems among adolescents. The aims of this study were to examine the treatment impact and malleability of CU traits among adolescents and explore potential moderation effects of treatment condition and CU sub-typology. A sample of 159 adolescents (45.9% girls; M age = 14.7 years, SD = 1.47) and their parents participated in a randomized controlled trial of Functional Family Therapy with three assessments (baseline, 6-months and 18-months) of behavior problems, CU traits, prosocial skills and the parent-youth relationship. Latent growth curve model (LGCM) analyses revealed that children with higher CU traits had greater reductions in aggressive and rule-breaking behavior and greater improvements in social skills (|standardized coefficients| = 0.27–0.32). Similarly, higher CU traits were linked to larger increases in parent-ratings of family cohesion and youth-ratings of maternal support (standardized coefficients = 0.26–0.27). Reliable Change Index summaries showed that CU traits remained unchanged for the majority of participants (73.6% and 72.6% had no reliable short- and long-term change, respectively). Baseline anxiety linked to CU sub-typology moderated some of the study results. Findings show that adolescents with co-occurring behavior problems and elevated CU traits can obtain improvement in behavioral and relational outcomes in out-patient treatment. Strikingly, such improvements can occur notwithstanding a limited reduction in CU traits. Future work should investigate whether the treatment gains would be more substantial and stable if treatment adjuncts modifying the CU traits themselves were concurrently deployed.

Orthotic and Prosthetic Options after Diabetic Foot Amputation

Diabetic foot ulcer is a risk factor for amputation. Infection and ischemia in diabetic foot ulcers are common causes of foot amputation. After minimal amputation of the involved lower extremity, precise and cautious application of orthoses and prostheses is very important to recover function of the foot. In this context, several factors including the patient’s general condition, level of amputation, preoperative ability of gait, contracture of adjacent joints, and wound healing potential must be considered. Most orthoses for diabetic foot amputees are used as an off-loading strategy to relieve pressure from the foot and ankle. Total contact cast is the standard treatment for forefoot off-loading. Footwear and insole design orthoses for off-loading in diabetic foot amputees have a low level of evidence and controversial effectiveness. Removable pressure-relieving ankle foot orthoses can be used as an alternative to total contact casts in selective situations. Metatarsal pads can be used effectively to decrease plantar pressure at a low cost. Prostheses after lower extremity amputation must be used with caution for rehabilitation factors due to sustained wound problems and change of stump size.

0117 Two-Year Memory Change is Associated with Sleep Disorders in a Survey of Older Adults

Abstract Introduction Insufficient sleep and sleep disorders have been previously associated with worse cognitive outcomes, such as worse memory performance. This analysis aims to assess the relationship between diagnosed sleep disorder and memory change over a period of two years. Methods N=17,156 older adults residing in the United States were assessed using the Health and Retirement Survey (Core) in 2018, with additional variables obtained in the previous wave (2016 on the same participants). Those who reported no sleep disorder in either wave were categorized as “no sleep disorder,” and they were compared to those who reported a sleep disorder in both waves (“sustained sleep disorder”) or one wave but not the other (“new sleep disorder” or “remitted sleep disorder.” Memory change was assessed using a survey item asking if the respondent’s memory was “worse”, “better”, or “the same” as compared to two years prior. Multinomial logistic regression was used to assess the relationship between these variables, and results were adjusted for sex, age, race, ethnicity, and depression. Results In adjusted results, those who reported that their memory improved were 124% (OR=2.24; 95%CI[1.51, 3.31]; p&amp;lt;0.001) more likely to have a sleep disorder that was remitted in the past 2 years. Those who reported that their memory worsened were 103% more likely to have a new sleep disorder (OR=2.03; 95%CI[1.65,2.50]; p&amp;lt;0.001), and 58% more likely to have a sustained sleep disorder (OR=1.58; 95%CI[1.40,1.77]; p&amp;lt;0.001). Interestingly, those whose memory worsened were also 39% more likely to have a remitted sleep disorder (OR=1.35; 95%CI[1.10,1.77]; p=0.006). Conclusion In older adults, there is a relationship between change in memory function and sleep disorders, such that improved memory is associated with improved sleep and worsened memory is associated with worse sleep or sustained sleep problems. Unfortunately, the specific sleep disorders associated were not reported. Future work should examine these effects in terms of specific sleep disorders, additional effect modifiers/covariates, and the role of sleep health in improving memory function. Support (If Any) The HRS (Health and Retirement Study) is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan.

Attentional problems occur across multiple psychiatric disorders and are not specific for ADHD.

Attentional problems are common and have been associated with multiple psychiatric disorders. This study examined problems of sustained attention across a range of psychiatric disorders using a validated computerized trans-diagnostic attentional paradigm (a continuous performance task). We hypothesized that multiple psychiatric disorders, particularly attention deficit hyperactivity disorder (ADHD), would be associated with pronounced attentional problems. Totally, 576 non-treatment seeking participants (aged 18-29years) were enrolled from general community settings, provided demographic variables, and underwent clinical assessments to detect mental health disorders. Each participant underwent the rapid visual information processing task, a validated computerized test measuring sustained attention. The two measures of sustained attention were the sensitivity index and target detection (proportion of targets detected). The profile of attentional deficits was examined across different disorders using z-scores relative to controls. Participants with social phobia, obsessive-compulsive disorder (OCD), bulimia nervosa, and intermittent explosive disorder showed the greater impairment in target sensitivity, all with effect sizes of at least 0.8. Target detection was impaired across multiple disorders, with OCD and binge eating disorder exhibiting the most pronounced impairment. Post-traumatic stress disorder (PTSD) and compulsive sexual behavior were associated with particularly spared performance on both measures. These data indicate that impaired attention is non-specific for ADHD and in fact several other disorders are associated with markedly larger deficits. Instead of clinicians assuming sustained attention problems are due to ADHD, a variety of disorders should be screened for when people report attentional problems. Future work should examine the contribution of comorbidities and psychoactive substances (prescribed or illicit) to the profiles identified.

34.1 DYSCONTROL, DYSPHORIA, DISINHIBITION, AND DYSREGULATION: MEASUREMENT CHALLENGES FOR CLINICAL MANAGEMENT AND RESEARCH

“Emotion dysregulation” (ED) is invoked to both characterize and, at least implicitly, to explain several clinically pernicious affective states and behavioral symptoms. However, the conceptual and empirical relationships between these components (eg, irritability, anger, frustrability, dysphoria, impulsive aggression) remain hazy. In addition, generalized impulse control deficits, diagnosed as ADHD, are ubiquitous among youth with ED. However, it is unclear if the underlying abnormalities in ED involve emotional expression (disinhibited behavior following affective arousal) or emotion generation (propensity for negative affect or mood). We present reports on the development of the Retrospective Modified Overt Aggression Scale (R-MOAS), its use in research and clinical care settings, and data on its multivariate relationships with ADHD, emotional reactivity, mood abnormalities, and conduct problems. Intake evaluations for 3426 children and adolescents in a collaborative care, pediatric-behavioral health setting included the R-MOAS, the Conners Global Index (ConnGI), and the Child Behavior Checklist (CBCL). The joint contributions of ConnGI and CBCL subscales in predicting total R-MOAS score was evaluated. Analyses were stratified by age group and sex. In multivariate models, children’s aggression scores demonstrated large and significant contributions of emotional lability, ADHD symptoms, and withdrawn/dysphoric ratings. Among adolescents, ADHD symptoms and emotional lability, but not withdrawn/dysphoric ratings, predicted aggression. In a large clinical sample with a broad spectrum of psychopathology, aggressive behavior reflects a fusion of emotional lability and impaired impulse control among children and adolescents. Only in preadolescents is there evidence that a broader construct of depression/withdrawal pertains to aggressive behavior. Children’s aggressive behavior may arise from both weakly inhibited reactions to noxious events and high susceptibility to emotional discomfort. By adolescence, aggressive behavior seems less linked to sustained mood problems and more influenced by momentary provocations with weak inhibitory control. For all age groups, high impulsivity seems elemental to the presence of aggressive behavior.

Fluid Migration Characterization of Full-Scale Annulus Cement Sections Using Pressure-Pulse-Decay Measurements

Abstract Fluid migration behind casings is a well integrity problem that can result in sustained casing pressure, undetected leaks to the environment, and potentially very challenging remediation attempts. Understanding the geometric dimensions and extent of annular migration paths is important for diagnosing and effectively treating fluid migration and sustained casing pressure problems in wells. In this study, permeability and micro-annuli sizes in two full-scale cemented annulus test sections are measured using transient pressure-pulse-decay and steady-state seepage measurements. One of the studied sections is a cemented 9 5/8-in. and 13 3/8-in. casing section from a 30 years old Norwegian North Sea production well. A model for predicting the transient pressure decay in annular sections with non-uniform permeability is presented and the permeabilities of the two sections are determined by fitting the transient model to pressure measurements at either side of the test sections and at selected axial positions. For both sections, measured micro-annulus sizes are within the range of effective wellbore permeabilities based on sustained casing pressure records and previous vertical interference tests from other wells. The test sections display measurable axial permeability variations with the bottom part of these vertical sections having the lower permeability. For the retrieved casing section, the axial permeability variation occurs close to the middle of the test section and is attributed to the top-of-cement. Increasing internal casing pressure is found to slightly reduce the equivalent micro-annulus size, indicative of fracture-like response of the migration paths. Using two independent test protocols, we have measured effective permeabilities as well as local permeability variations in full-scale test sections and found consistent results. The study suggests that the transient test procedure can be used to more effectively characterize low-permeable annular cement where it is otherwise time-consuming or difficult to establish steady-state flow conditions.

Changes in Biomarkers and Neurodevelopmental Outcomes Among Male Adolescent Pesticide Applicators and Non-Applicators

Background. Although organophosphorus pesticides are increasingly restricted for use in the United States, many of these pesticides are still being used in low- and middle-income countries. This may lead to adolescents being environmentally and occupationally exposed to pesticides. While most human and animal research has focused on exposures during the perinatal period, and a few studies have focused on exposure during childhood, there is a paucity of data examining exposures during adolescence, a critical period of brain organization.Methods. Male adolescent pesticide applicators and non-applicators in Egypt (N=249) were recruited to characterize changes in biomarkers and neurobehavioral (NB) outcomes across application seasons. Test sessions included the collection of biological samples and NB testing.Results. Urinary 3,5,6-trichloro-2-pyridinol (TCPy) metabolite levels, a chlorpyrifos-specific metabolite, increased in both applicators and non-applicators during the application season and recovered after application ended. Biomarkers of effect, e.g., butyrylcholinesterase (BChE) activity, showed a pattern of inhibition and recovery associated with chlorpyrifos (CPF) application that is repeated across years. TCPy levels, were inversely associated with BChE activity. Importantly, adolescents show BChE inhibition at much lower levels of TCPy (28.9 µg/g creatinine) than adults (&gt;110µg/g creatinine). Neurobehavioral deficits among male applicators increased during the application season and persisted after application ceased. These sustained deficits were present in the absence of red blood cell AChE inhibition. An exposure response gradient between symptoms of attention and hyperactivity/impulsivity and TCPy levels was identified.Discussion. These findings demonstrate that occupational exposure among male adolescents were predictive of sustained cognitive problems, while also demonstrating that youth living in agricultural communities in the Nile Delta are receiving significant environmental exposures. Due to the large number of adolescents living and working in rural communities worldwide, there remains a critical need to investigate the vulnerability of adolescents, who may be both occupationally and environmentally exposed to pesticides.

Help-seeking behavior among Danish veterans with self-reported mental problems – a 22 years register-based follow-up study

Purpose: To estimate the prevalence of utilization of mental health services (MHS) among Danish veterans with self-reported deployment-related mental problems and to identify predictors for help-seeking behavior for mental problems among veterans.Materials and methods: Data on deployment characteristics was obtained from a telephone survey in 2011 among a random sample of veterans deployed during 1996–2009. Only respondents reporting sustained or less sustained mental problems were included, and data from national registers on mental health service utilization and prescribed psychotropics covering up to 22 years of follow-up was obtained. Logistic regression analysis was performed to identify predictors of help-seeking.Results: Of 434 respondents with self-reported problems, 333 (77%) received any mental health service after deployment. Of those, 48 (23%) received any help within the first 2 years after deployment start while 128 (61%) did not receive help until after 4 years. Significant predictors for MHS utilization included sustained mental problems, combat exposure characteristics (being injured in combat, watching a fellow soldier suffer injuries), and deployment-related factors (being deployed to >1 mission and being deployed to Afghanistan).Conclusion: These findings highlight the importance of time, and hereunder of a long follow-up period, when measuring the prevalence of help-seeking behavior for individuals experiencing mental problems after military deployment.

Skin Problems Due to Treatment with Technology Are Associated with Increased Disease Burden Among Adults with Type 1 Diabetes.

In a 4-month follow-up survey, we examined whether treatment with continuous subcutaneous insulin infusion (CSII) and/or continuous glucose monitoring (CGM) in adults with type 1 diabetes was associated with sustained skin problems and whether skin problems were associated with diabetes-related emotional distress. A total of 111 adult patients completed a follow-up questionnaire concerning skin problems as a result of CSII and/or CGM use. The questionnaire included a patient-reported outcome measure, the Problem Areas in Diabetes (PAID) scale. Current visible skin problems caused by CSII or CGM use were reported by 51 (46.0%) participants, in 34 (66.7%) of whom skin problems had been reported more than 4 months earlier. Seventy-two (64.9%) participants reported skin problems as a result of CSII use, whereas 38 (74.5%) reported skin problems owing to CGM use at some time. Itching was the most prevalent complaint. CSII-related itching was associated with a mean PAID score >20 (P = 0.01), and patients with more than one skin problem had an increased PAID score compared with those with one or no skin problems (P = 0.006). More than half patients treated with CSII, CGM, or both had experienced skin problems during 4 months of follow-up that were associated with increased diabetes burden. Skin problems represent a persistent health issue affecting diabetes-specific emotional distress.

Post-stroke insomnia in community-dwelling patients with chronic motor stroke: Physiological evidence and implications for stroke care

Questionnaire studies suggest that stroke patients experience sustained problems with sleep and daytime sleepiness, but physiological sleep studies focussing specifically on the chronic phase of stroke are lacking. Here we report for the first time physiological data of sleep and daytime sleepiness obtained through the two gold-standard methods, nocturnal polysomnography and the Multiple Sleep Latency Test. Data from community-dwelling patients with chronic right-hemispheric stroke (>12 months) were compared to sex- and age-matched controls. Behavioural and physiological measures suggested that stroke patients had poorer sleep with longer sleep latencies and lower sleep efficiency. Patients further spent more time awake during the night, and showed greater high-frequency power during nonREM sleep than controls. At the same time the Multiple Sleep Latency Test revealed greater wake efficiency in patients than controls. Importantly these findings were not due to group differences in sleep disordered breathing or periodic limb movements. Post-stroke insomnia is presently not adequately addressed within the care pathway for stroke. A holistic approach to rehabilitation and care provision, that includes targeted sleep interventions, is likely to enhance long-term outcome and quality of live in those living with chronic deficits after stroke.

Predictors of persistent sleep problems among older disaster survivors: a natural experiment from the 2011 Great East Japan earthquake and tsunami.

To examine prospectively the associations of disaster experiences and social support with sleep problems in older adults. Data came from a natural experiment caused by the 2011 Great East Japan earthquake and tsunami. Participants in an ongoing prospective cohort (3547 Japanese individuals aged 65 years or older) were inadvertently exposed to the disaster due to their residential location (Iwanuma city) after the 2010 baseline survey. We conducted a follow-up survey in 2013 to inquire about disaster-related experiences and short sleep duration, sleep insufficiency, poor sleep quality, insomnia symptoms, and sleep medication use. Poisson regression models adjusted for baseline socio-demographic and lifestyle covariates. Financial hardship predicted increased risks of short sleep duration (relative risk [RR] = 1.40; 95% confidence interval [CI] [1.03, 1.90]), sleep insufficiency (RR = 1.29; 95% CI [1.01, 1.66]), poor sleep quality (RR = 1.47; 95% CI [1.26, 1.70]), and insomnia symptoms (RR = 1.13; 95% CI [1.01, 1.28]). Home destruction predicted sleep medication use while health care disruption predicted poor sleep quality. Loss of close relatives or friends did not predict any sustained sleep problems. Additionally, having instrumental support reduced risks of all sleep problems while having emotional support reduced risk of poor sleep quality. Approximately 2.5 years after the disaster, older survivors' sleep problems were more durably linked to material aspects of disaster damage than to loss of loved ones. Findings could inform targeted recovery efforts for groups with greatest need to promote older survivors' sleep health and overall well-being.

Analytical study on creep shear failures of RC slender beams without web reinforcement

Sustained load problems, which can cause excessive deformation and severe damage to concrete structures, have been considered in current worldwide design codes by applying reduction factors on the compressive and tensile strength of concrete. A reduction factor in the shear design may also be required due to the decrease of shear-transfer action corresponding to the increases of the shear cracks opening. However, only a few studies are examining the effect of creep on shear performance of concrete structures, and the results are still inconclusive. As a complement to the previous experimental works, this study aims to investigate the effect of loading rate on the shear capacity of RC slender beams by non-linear finite element (FE) analysis. A spaceaveraged constitutive model with fixed multi-directional cracks was employed in the simulation of diagonal shear failure. The present study analytically examines the time-dependent effects on the beams under different loading rates until the delayed failure and compares the results with the previous experimental ones.

Current Understanding of Dyslexia and Pilot Data on Efficacy of a Mindfulness Based Psychotherapy (MBR-RAM) Model

Background: Dyslexia, a heterogeneous syndrome, is the most recognized Developmental Reading Disorder (DRD) with 5-17% prevalence and poses as a significant disability. Its core deficits are: Phonological deficits, poor visual attention span, selective deficits in complex serial visual search tasks, sustained visual attention problems, visuospatial functioning and difficult image reproduction from memory. Much remains to be accomplished clinically to address these deficits. Methods: Mindfulness Based Rehabilitation of Reading, Attention & Memory (MBR-RAM©) is a translational mindfulness based cognitive behavioral therapy developed by the first author. MBR-RAM uses focused attention enhancement visual meditation techniques (Sanskrit: trataka) in therapist-assisted and home-practice formats to rehabilitate reading deficits, visual inattention, visual motor incoordination, information processing speed and visual memory. Visual motor incoordination indicates inability to control hand movements guided by the visual cues while reading letters. Three Caucasian subjects in this study included an 8-year-old girl and two boys aged 9 and 10 years. The objectives were to study the changes pre- and post-intervention with respect to their scores on the various clinical and neuropsychological measures. Results: Compared to the baseline, all three subjects showed clinical and statistically significant improvements in the outcome measures, which were sustained for at least 6 months after study completion. There were no adverse effects in them. Conclusion: Results of this pilot study indicate that MBR-RAM© is a feasible, low cost treatment, which is effective for rehabilitating some important deficits of dyslexia. The results need replication in future studies with better methodology to make definite conclusions. Keywords: Dyslexia, learning disorder, reading disorder, yoga, mindfulness, trataka.

Design Change Dynamics in Building Project: From Literature Review to A Conceptual Framework Formulation

Building construction projects worldwide routinely fail to meet their schedule and cost objectives. This paper focuses on design changes as the principal contributing factor to delay and cost overruns. Substandard project coordination and futile communication management are sustained problems with the construction industry, particularly as to the management of design changes. To rectify the captioned issues, this study is aimed at exploring the underlying causes of design changes, the resulting rework that is damaging to project performance, communication management process and collaboration in a project-based setting through the review of the literature. Qualitative analysis technique using content analysis method was employed to synthesise the literature and establishing relationships based on the key themes identified. A conceptual model for design change management was then formulated to be the notable outcome of this study. The framework describes the importance of applying effective communication process and informed management decision in dealing with design changes. It provides a coherent and holistic view to understand the dynamics of design changes in a building construction project. It aims to address the current methodological gap in construction management research that lacks demonstrable causality. The findings contribute useful starting point for future overrun causation and mitigation studies.

Sustained Obesity and Depressive Symptoms over 6 Years: Race by Gender Differences in the Health and Retirement Study.

Background: Although obesity and physical activity influence psychosocial well-being, these effects may vary based on race, gender, and their intersection. Using 6-year follow-up data of a nationally representative sample of adults over age of 50 in the United States, this study aimed to explore race by gender differences in additive effects of sustained high body mass index (BMI) and physical activity on sustained depressive symptoms (CES-D) and self-rated health (SRH).Methods: Data came from waves 7, 8, and 10 (2004–2010) of the Health and Retirement Study (HRS), an ongoing national cohort started in 1992. The study enrolled a representative sample of Americans (n = 19,280) over the age of 50. Latent factors were used to calculate sustained high BMI and physical activity (predictors) and sustained poor SRH and high depressive symptoms (outcomes) based on measurements in 2004, 2006, and 2010. Age, education, and income were confounders. Multi-group structural equation modeling (SEM) was used to test the additive effects of BMI and physical activity on depressive symptoms and SRH, where the groups were defined based on race by gender.Results: Group differences were apparent in the direction and significance of the association between sustained high BMI and depressive symptoms. The association between sustained high BMI and depressive symptoms was positive and significant for White women (B = 0.03, p = 0.007) and non-significant for White men (B = −0.03, p = 0.062), Black men (B = −0.02, p = 0.564) and Black women (B = 0.03, p = 0.110). No group differences were found in the paths from sustained physical activity to depressive symptoms, or from physical activity or BMI to SRH.Conclusion: Sustained high BMI and high depressive symptoms after age 50 are positively associated only for White women. As the association between sustained health problems such as depression and obesity are not universal across race and gender groups, clinical and public health interventions and programs that simultaneously target multiple health problems may have differential effects across race by gender groups.

Race by Gender Group Differences in the Protective Effects of Socioeconomic Factors Against Sustained Health Problems Across Five Domains.

Despite the existing literature on the central role of socioeconomic status (SES; education and income) for maintaining health, less is known about group differences in this effect. Built on the intersectionality approach, this study compared race by gender groups for the effects of baseline education and income on sustained health problems in five domains: depressive symptoms, insomnia, physical inactivity, body mass index (BMI), and self-rated health (SRH). Data came from waves 7, 8, and 10 of the Health and Retirement Study (HRS), which were collected in 2004, 2006, and 2010, respectively. The study followed 37,495 white and black men and women above age 50 for up to 6years. This number included 12,495 white men, 15,581 white women, 3839 black men, and 5580 black women. Individuals reported their depressive symptoms (Center for Epidemiological Studies-Depression (CES-D) 11), insomnia, physical inactivity, BMI, and SRH across all waves. Multigroup structural equation modeling (SEM) was used to compare black men, black women, white men, and white women for the effects of education and income in 2004 on sustained health problems from 2004 to 2010. In the pooled sample, higher education and income at baseline were associated with lower sustained health problems across all five domains. However, race by gender group differences were found in the effects of education and income on sustained insomnia, physical inactivity, and BMI, but not depressive symptoms and SRH. The protective effects of education against insomnia, physical inactivity, and BMI were not found for black men. For black women, the effect of education on BMI was not found. Income had a protective effect against sustained high BMI among white and black women but not white and black men. The intersection of race and gender alters the protective effects of social determinants on sustained health problems such as insomnia, physical inactivity, and BMI. Social groups particularly vary in the operant mechanisms by which SES contributes to maintaining health over time. The health effects are less universal for education than income. Race by gender groups differ more in SES determinants of BMI, insomnia, and physical inactivity than depressive symptoms and SRH.

Normalization of an ecologic organization and problem-solving test in a vocational rehabilitation setting: TEM-PRO

Standard neuropsychological evaluation after severe TBI (traumatic brain injury) often minimizes executive deficits, the latter are known to seriously impair return to work. Therefore, we developed an ecological organization and problem-solving test in a vocational setting called the TEM-PRO. In the present study, we aimed to normalize the TEM-PRO in a population of 40 control patients without neurological and psychiatric disorders. The TEM-PRO is based on the multiple errands test from Shallice and Burger (1991). It has been translated into French and validated in our institution. The adaptation of the original test in a vocational setting induces the addition of 4 activities of variable complexity, research and redaction of information and demands to follow well defined rules. Skills that are solicited are planning, selective and sustained attention, prospective memory, organization, problems solving and behavior adaption over a long period of time. The control cohort included forty French-speaking patients (36 men), medium age 35 ± 12 years, mostly blue collar workers without any neurological or psychiatric history, participating in a return to work program. The TEM-PRO is completed in 3 to 6 h depending on the capacity of the patients and shows a good sensitivity without ceiling effect. It allows a quantitative and differentiated evaluation, a classification of various error types (interpretation and judgment failure, rule breaks, task failures and inefficiencies) and provides a qualitative behavioral analysis. Analyses from the controls patients allowed us to establish a standardized error-rating system. The multiple errands test (TEM-PRO) is an ecological, original and sensitive test. In this study, a standardized error-rating system was obtained from a cohort of patients without neurological or psychiatric history, involved in a return to work program. Further research for the validation of the TEM-PRO on TBI patients is in progress.

Developmental problems in patients with oesophageal atresia: a longitudinal follow-up study

ObjectiveTo longitudinally evaluate motor development and predictive factors in school-age children with oesophageal atresia.DesignCohort study with prospective longitudinal follow-up.SettingOutpatient clinic of a tertiary university paediatric hospital.PatientsChildren with oesophageal atresia born...