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Applied Human Anatomy & Physiology II, 2780: 207: Appraising Articles

Instructor: Dr. Kristine Kraft, Spring Semester 2021

Cedervall, Y., Torres, S., & Åberg, A. C. (2015). Maintaining well-being and selfhood through physical activity: Experiences of people with mild Alzheimer’s disease. Aging & Mental Health, 19(8), 679–688.

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Abstract:
Objectives: To contribute to furthering the understanding of how people with mild Alzheimer's disease (AD) reason about physical activity as part of everyday life, with a specific focus on the meanings attached to such activity. Method: In-depth interviews were conducted with 14 individuals with mild AD. Qualitative content analysis was used to interpret the data. Results: The analysis revealed three sub-themes reflecting interrelated perspectives on how people with mild AD reason about physical activity: (1) striving to be physically active, mirrors the concrete approaches used for handling the consequences of having AD in relation to being active; (2) perceptions of physical activity, reflect how their thoughts and beliefs regarding written and tacit norms encouraged them to remain physically active, and (3) physical activity as a means to well-being, alludes to feelings and emotions related to the performance of physical activity. Interpretation of the underlying patterns in these sub-themes revealed one overarching theme: Physical activity as a means to selfhood maintenance, which suggests that physical activity can help to shift the focus from the dementia diagnosis (i.e. ill health) to a more healthy and able self. Conclusion: The findings suggest that physical activity, apart from maintaining body functions, can be a way to sustain well-being and selfhood in mild AD. This aspect of physical activity is important to consider in research, policy and practice when addressing the needs of people with dementia.

Dassa, A., & Amir, D. (2014). The role of singing familiar songs in encouraging conversation among people with middle to late stage Alzheimer’s disease. Journal of Music Therapy, 51(2), 131–163.

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Abstract:
Background: Language deficits in people with Alzheimer's disease (AD) manifest, among other things, in a gradual deterioration of spontaneous speech. People with AD tend to speak less as the disease progresses and their speech becomes confused. However, the ability to sing old tunes sometimes remains intact throughout the disease. Objective: The purpose of this study was to explore the role of singing familiar songs in encouraging conversation among people with middle to late stage AD. Methods: Six participants attended group music therapy sessions over a one-month period. Using content analysis, we qualitatively examined transcriptions of verbal and sung content during 8 group sessions for the purpose of understanding the relationship between specific songs and conversations that occurred during and following group singing. Results: Content analysis revealed that songs from the participants' past-elicited memories, especially songs related to their social and national identity. Analyses also indicated that conversation related to the singing was extensive and the act of group singing encouraged spontaneous responses. After singing, group members expressed positive feelings, a sense of accomplishment, and belonging. Conclusions: Carefully selecting music from the participants' past can encourage conversation. Considering the failure in spontaneous speech in people with middle to late stage AD, it is important to emphasize that group members' responses to each other occurred spontaneously without the researcher's encouragement. 

Olsson A., Skovdahl K. & Engstrom M. (2019). Strategies used by people with Alzheimer's disease for outdoor wayfinding: A repeated observational study. Dementia. https://doi.org/10.1177/1471301219896453

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Abstract:
This study aimed to describe the wayfinding strategies used during outdoor walks by people with Alzheimer's disease. Inspired by an ethnographic approach, observations and conversations during repeated outdoor walks with five people with Alzheimer's disease living in their own homes were conducted. Data were analyzed using qualitative content analysis. The wayfinding strategies the participants described were: (1) landmarks, (2) used their senses, (3) stopped, looked around, and thought, (4) walking the same way or loop and in familiar areas, and (5) only walked in places and on routes where they could see other people and houses. Using wayfinding strategies might help people with Alzheimer's disease to be independent during outdoor walks, and discussing these strategies with relatives and nursing care staff may help finding people with Alzheimer's disease if lost outdoors. Wayfinding during the winter might be facilitated if temporary and changeable objects are avoided in people with Alzheimer's disease's walking route.

Watson J., Saunders S., Muniz Terrera G., Ritchie C., Evans A., Luz S., et al (2019). What matters to people with memory problems, healthy volunteers and health and social care professionals in the context of developing treatment to prevent Alzheimer's dementia? A qualitative study. Health Expectations, 22, 504-517. https://doi.org/10.1111/hex.12876

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Abstract:
Background: Alzheimer's disease (AD) is recognized as one of the greatest global public health challenges. There is increasing consensus that optimal disease modification using pharmaceuticals may best be achieved earlier in the disease continuum before symptoms occur. However, more needs to be understood about what outcomes are meaningful to potential participants in clinical trials within this preventative paradigm and how people make trade-offs between risks and benefits. The Electronic Person-Specific Outcome Measure (ePSOM) programme is developing an app to capture person-specific outcomes and preferences in clinical trials. 
Objective(s): As one phase in the ePSOM programme, this study explored what matters when developing new treatments to prevent AD and how trade-offs are made between risks and benefits, from three perspectives. 
Design(s): Focus groups were conducted with people living with memory problems (n = 21) and healthy volunteers (n = 10), and telephone interviews with health and social care professionals (n = 10). Differences and overlap between the three groups were explored. 
Result(s): Outcomes that matter lie in five key domains in relation to what matters in everyday life: Everyday Functioning; Relationships and Social Connections; Enjoying Life; Sense of Identity; and Alleviating Symptoms. Insights were gained into the significance of reducing the risk of developing dementia with drugs and the processes of weighing up risks versus benefits. Discussion and conclusions: The key domains identified are being used to inform the next stage of the ePSOM programme which is to develop a survey to be distributed nationally in the UK to explore these issues further.

Morgan M., Cousins S., Middleton L., Warriner-Gallyer G. & Ridsdale L. (2016). Patients' experiences of a behavioural intervention for migraine headache: A qualitative study. Journal of Headache and Pain, 17, 1-7. https://doi.org/10.1186/s10194-016-0601-5

Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769711/
Abstract:
Background: Migraine headache has a high prevalence and a severe impact on personal, social and work life, forming a significant burden on patients, service providers and society. There is some evidence of the effectiveness of behavioural interventions to supplement drug therapy but a recognised need to identify an effective minimal contact approach to enhance access and provide a model for use in publicly funded health systems. This study uses in-depth interviews to examine patients' experience and responses to a behavioural intervention with relaxation and CBT components delivered in three individual therapist sessions with follow-up. 
Method(s): Qualitative study of 20 adults aged 18-75 years in London, UK, with clinically diagnosed migraine and at least four headache days per month. Semi-structured and tape recorded interviews were held post intervention based on a topic guide. Transcripts were coded and charted for all participants and analysed thematically. 
Result(s): The majority of participants cited the impacts of migraine and a desire for additional non-drug treatment as their main reasons for taking part and almost all completed the course. They valued contact with the therapist and almost all reported benefiting from the therapy. Post intervention they used those techniques they found most beneficial and implemented them flexibly in their daily life to reduce stress and risks of migraine or to respond to migraine. Relaxation training (deep breathing) was easily adopted and often used post intervention. The CBT components were mainly viewed positively but regarded as more challenging to learn and implement. 
Conclusion(s): Patients' selectively identified and employed the techniques learned as 'tools' to assist in preventing and managing their migraines, with reported benefits supporting the development of minimal contact behavioural therapy to increase accessibility for adults with migraine headache and the conduct of a definitive trial.

Rutberg, S., & Öhrling, K. (2012). Migraine—More than a headache: Women’s experiences of living with migraine. Disability and Rehabilitation: An International, Multidisciplinary Journal, 34(4), 329–336.

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Abstract:
Purpose: In this qualitative study the aim was to explore the meaning of living with migraine. Methods: In-depth interviews were conducted with ten women about their experience of living with migraine. Halfway through the interview, the women drew a picture of what living with migraine is like, and the interview continued with the conversation being guided by the picture. The interviews were analyzed using a hermeneutic phenomenological method inspired by van Manen. Results: The analysis revealed an essence 'Being obliged to endure a life accompanied by an unpredictable and invisible disorder' and three themes 'Being besieged by an attack', 'Struggling in a life characterized by uncertainty' and 'Living with an invisible disorder.' Conclusions: Migraine is a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others. The struggle of enduring life with migraine is worsened by the feeling of having an invisible disorder and of being doubted. There is a need to increase the knowledge among healthcare professionals about what it means to live with migraine, something this qualitative study offers.

Gunasekera, L., Akhlaghi, H., Sun-Edelstein, C., Heywood, J., & Sanders, L. (2020). Overuse of opioids for acute migraine in an australian emergency department. Emergency Medicine Australasia. https://doi.org/10.1111/1742-6723.13504

Full text: https://doi-org.ezproxy.uakron.edu:2443/10.1111/1742-6723.13504

Abstract:
Objective: Acute migraine is associated with significant personal, economic and work
related disability. Management guidelines advise the use of simple analgesia, triptans, chlorpromazine and antiemetics based on severity, with avoidance of opioids. We aimed to determine consistency of prescribing patterns in our ED with national guidelines. Methods: We performed a retrospective cohort analysis of migraine presentations (ICD10AM G439) between 2012 and 2016. Exclusion criteria included migraine without headache, other primary headaches and secondary headaches. Demographic and prescribing data were extracted from medical records. Results have been reported as proportions. Results: Of 4769 headache presentations, the application of exclusion criteria led to a total of 744 patients who received a migraine diagnosis (G439). Most were female (558/744, 75%), young (mean age 36.4 years) and had a selfreported migraine history (558/744, 75%). There were 54 different medications prescribed. Paracetamol was more frequently prescribed (385/744, 52%) than aspirin (134/744, 18%). Opioid prescription occurred in nearly half of all presentations (345/744, 46%). Similar opioid prescriptions were also observed in those with a documented history of migraines (253/558, 45%). A minority of patients received triptans (51/744, 7%). Overall, a quarter of patients (189/744, 25%) received no guidelinerecommended medications. Conclusion: We observed considerable polypharmacy in ED migraine management with inconsistent prescribing patterns. Recommended medications were infrequently used and opioid use was common. Factors influencing prescribing patterns require further investigation in order to improve rates of guideline recommended treatment.

Eckner J.T., Seifert T., Pescovitz A., Zeiger M. & Kutcher J.S. (2017). Is migraine headache associated with concussion in athletes? A case-control study. Clinical Journal of Sport Medicine, 27, 266-270. https://doi.org/10.1097/JSM.0000000000000346

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Abstract:
Objective: The purpose of this study was to investigate the association between migraine headache and concussion in athletes.
Design: Case-control observational study. Setting: A university-associated combined sports neurology and orthopedic sports medicine clinic. Participants: A total of 221 male (n = 140) and female (n = 81) athletes aged 12 to 24 years, including 115 concussion cases (52%) and 106 orthopedic controls (48%), were included in this study. Interventions: Participants completed a one-page questionnaire that recorded their age, sex, reason for visit (concussion vs any other injury), concussion history, and self/immediate family member migraine headache history. Main Outcome Measures: The odds of having a previous history of migraine headache were compared in the concussion group versus orthopedic controls. Results: Controlling for between-group differences in age and sex, there was a significant positive association between concussion group status and history of migraine headache [adjusted odds ratio (OR), 1.90; 95% confidence interval (CI), 1.03-3.50. P = 0.039]. However, when including a previous concussion history in the statistical model, this relationship failed to reach significance [adjusted OR, 1.68; 95% CI, 0.89-3.16. P = 0.107]. Conclusions: These results suggest that there is an association between migraine headache and concussion in athletes, but the cause-effect nature of this relationship cannot be determined. Migraine headache should be considered a modifying factor when caring for concussed athletes.

Creske, M., Modeste, N., Hopp, J., Rajaram, S., & Cort, D. (2013). How Do Diet and Body Mass Index Impact Dental Caries in Hispanic Elementary School Children? Journal of Dental Hygiene, 87(1), 38–46.

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Abstract: 
Purpose: The purpose of this observational study was to examine the association between body mass index and dental caries in Hispanic children. The research evaluated the influences of obesity, diet, parent education level, family acculturation, tooth brushing habits and gender as predictors of childhood caries. Methods: One examiner visually screened 177 third grade students from 3 elementary schools located in southern California's Coachella Valley. The children were screened for number of decayed, missing and filled teeth (DMFT). Height, weight, age and gender determined their body mass index. Primary caregivers completed a 30-point questionnaire for each participant. Multivariate analyses accessed the association between childhood dental caries and weight status and the influences of the measured variables. Results: Results indicate that those in the obese category had a statistically significant lower rate of DMFT than did children in the healthy weight category. Overweight children showed a higher DMFT than healthy weight children but the results were not statistically significant. Covariates that significantly influenced this association were diet and socioeconomic status. Conclusion: Results from this study provide oral health professionals with baseline data and literature to support development of preventive programs for this population that concurrently address both obesity and oral health issues in scope and design.

Joel, S. E., Galantino, M. L., Hutchinson, J., & Jeffrey, M. G. (2019). Health coaching for healthcare employees with chronic disease: A pilot study. Work, 63(1), 49–56.

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Abstract: 
BACKGROUND: Health coaching promotes healthy lifestyles and may be particularly helpful for employees with chronic disease. OBJECTIVE: Evaluate the effects of a health coaching program that targeted health-system employees with at least one cardiovascular disease (CVD) risk factor. METHODS: Fifty-four employees volunteered for a health coaching program (6-session, 12-week program, at least one cycle). 40 (74%) completed (mean age [SD] = 53.3 [10.3] years, Female = 95%, Caucasian = 83%). A certified and integrative health coach/nutritionist provided coaching. Self-reported outcomes were collected using a pre-post design. RESULTS: Participants reported high rates of obesity (75%), hypertension (52.5%), diabetes/prediabetes (47.5%), and hyperlipidemia (40%). In addition, 20% reported chronic pain/rehabilitation needs, 17.5% seasonal depression, and 30% other significant co-morbidities. Following coaching, participants reported significant weight loss (mean [SD] 7.2 [6.6] pounds, p < 0.0001, d = 1.11), increased exercise (from 0.8 to 2.3 sessions/week, p < 0.001, d =.89), reduced perceived stress (p < 0.04, d =.42), and a trend for improved sleep (p = 0.06, d =.38). Reduced stress correlated with both increased exercise (r = –.39, p < 0.05) and decreased fatigue (r =.36, p = 0.07). CONCLUSION: Health coaching for healthcare employees with obesity and other CVD risk factors is a promising approach to losing weight, reducing stress, making healthy lifestyle changes, and improving health and well-being.

Cha, E., Akazawa, M. K., Kim, K. H., Dawkins, C. R., Lerner, H. M., Umpierrez, G., & Dunbar, S. B. (2015). Lifestyle habits and obesity progression in overweight and obese American young adults: Lessons for promoting cardiometabolic health. Nursing & Health Sciences, 17(4), 467–475.

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Abstract: 
Obesity among young adults is a growing problem in the United States and is related to unhealthy lifestyle habits, such as high caloric intake and inadequate exercise. Accurate assessment of lifestyle habits across obesity stages is important for informing age‐specific intervention strategies to prevent and reduce obesity progression. Using a modified version of the Edmonton Obesity Staging System (mEOSS), a new scale for defining obesity risk and predicting obesity morbidity and mortality, this cross‐sectional study assessed the prevalence of overweight/obese conditions in 105 young adults and compared their lifestyle habits across the mEOSS stages. Descriptive statistics, chi‐square tests, and one‐way analyses of variance were performed. Eighty percent of participants (n = 83) fell into the mEOSS‐2 group and had obesity‐related chronic disorders, such as diabetes, hypertension, and/or dyslipidemia. There were significant differences in dietary quality and patterns across the mEOSS stages. Findings highlighted the significance of prevention and early treatment for overweight and obese young adults to prevent and cease obesity progression. 

Bodenlos, J. S., & Wormuth, B. M. (2013). Watching a food-related Television show and caloric intake A laboratory study. Appetite, 61, 8–12.
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Abstract:
Television watching has been positively associated with overeating and obesity. How popular food-related television shows affects eating behavior has not been examined. An experimental study was conducted to examine how exposure to a food-related television program affects amount and type of food consumed in adults (N = 80). Participants were randomized to watch a cooking or nature television program and were then presented with 800 total calories of chocolate covered candies, cheese curls, and carrots. Food was weighed before and after the ad libitum eating session to determine amount consumed. After controlling for dietary restraint, hunger and food preference, significantly more chocolate covered candies were consumed among individuals who watched the cooking program compared to the nature program. No significant differences between conditions were found for overall caloric intake or for cheese curl or carrot consumption. Findings suggest that watching food-related television programs may affect eating behavior and has implications for obesity prevention and intervention efforts.

Brown, F. L., Whittingham, K., Sofronoff, K., & Boyd, R. N. (2013). Parenting a child with a traumatic brain injury: Experiences of parents and health professionals. Brain Injury, 27(13–14), 1570–1582

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Abstract:
Objective: To qualitatively explore the experiences, challenges and needs of parents of children with traumatic brain injury (TBI) in order to inform future intervention research through incorporation of participant knowledge and experience. Methods: Parents of children with TBI (n = 10) and experienced health professionals in paediatric rehabilitation (n = 5) took part in focus groups or individual interviews. Audio recordings were transcribed verbatim and an inductive thematic analysis performed. Findings: Participants reported that, beyond the impact of the injury on the child, TBI affects the entire family. Parents need to adjust to and manage their child’s difficulties and can also experience significant emotional distress, relationship discord and burden of care, further adding to the challenges of the parenting role. Parents can feel isolated and the importance of empowerment, support and information was emphasized. Coping styles of disengagement and avoidance were often reported, despite acknowledgement that these were not beneficial. Conclusions: Parenting interventions may provide essential support for parents in adjusting to and managing their child’s difficulties and the efficacy of existing programmes needs evaluation. Addressing parent emotional adjustment and coping strategies is vital following paediatric TBI, given the impact on parent well-being and the potential negative effects on child outcomes through reduced parenting effectiveness. Group programmes may enable connection and support.

Stergiou-Kita, M., Grigorovich, A., Damianakis, T., Le Dorze, G., David, C., Lemsky, C., & Hebert, D. (2017). The big sell: Managing stigma and workplace discrimination following moderate to severe brain injury. Work57(2), 245–258.

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Abstract:
BACKGROUND: Misperceptions regarding persons with brain injuries (PWBI) can lead to stigmatization, workplace discrimination and, in turn, influence PWBIs full vocational integration. OBJECTIVE: In this study we explored how stigma may influence return-to-work processes, experiences of stigma and discrimination at the workplace for persons with (moderate to severe) brain injuries, and strategies that can be employed to manage disclosure. METHODS: Exploratory qualitative study; used in-depth interviews and an inductive thematic analytical approach in data analysis. Ten PWBI and five employment service providers participated. PWBI discussed their work experiences, relationships with supervisors and co-workers and experiences of stigma and/or discrimination at work. Employment service providers discussed their perceptions regarding PWBI's rights and abilities to work, reported incidents of workplace discrimination, and how issues related to stigma, discrimination and disclosure are managed. RESULTS: Three themes were identified: i) public, employer and provider knowledge about brain injury and beliefs about PWBI; ii) incidents of workplace discrimination; iii) disclosure. Misperceptions regarding PWBI persist amongst the public and employers. Incidents of workplace discrimination included social exclusion at the workplace, hiring discrimination, denial of promotion/demotion, harassment, and failure to provide reasonable accommodations. Disclosure decisions required careful consideration of PWBI needs, the type of information that should be shared, and the context in which that information is shared. CONCLUSIONS: Public understanding about PWBI remains limited. PWBI require further assistance to manage disclosure and incidents of workplace discrimination.

Visscher, A. J., van Meijel, B., Stolker, J. J., Wiersma, J., & Nijman, H. (2011). Aggressive behaviour of inpatients with acquired brain injury. Journal of Clinical Nursing, 20(23–24), 3414–3422.

Full text: http://rave.ohiolink.edu/ejournals/article/330741040
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Abstract:
Objective. To study the prevalence, nature and determinants of aggression among inpatients with acquired brain injury. Background. Patients with acquired brain injury often have difficulty in controlling their aggressive impulses. Design. A prospective observational study design. Methods. By means of the Staff Observation Aggression Scale-Revised, the prevalence, nature and severity of aggressive behaviour of inpatients with acquired brain injury was assessed on a neuropsychiatric treatment ward with 45 beds. Additional data on patient-related variables were gathered from the patients' files. Results. In total, 388 aggressive incidents were recorded over 17 weeks. Of a total of 57 patients included, 24 (42%) patients had engaged in aggressive behaviour on one or more occasions. A relatively small proportion of patients ( n = 8; 14%) was found to be responsible for the majority of incidents ( n = 332; 86%). The vast majority of aggression incidents ( n = 270; 70%) were directly preceded by interactions between patients and nursing staff. In line with this, most incidents occurred at times of high contact intensity. Aggressive behaviour was associated with male gender, length of stay at the ward, legal status and hypoxia as the cause of brain injury. Conclusion. Aggression was found to be highly prevalent among inpatients with acquired brain injury. The results suggest that for the prevention of aggression on the ward, it may be highly effective to develop individually tailored interventions for the subgroup with serious aggression problems. Relevance to clinical practice. Insight into the frequency, nature and determinants of aggressive behaviour in inpatients with acquired brain injury provides nurses with tools for the prevention and treatment of aggressive behaviour.

Grasset, L., Glymour, M. M., Yaffe, K., Swift, S. L., Gianattasio, K. Z., Power, M. C., & Zeki Al Hazzouri, A. (2020). Association of traumatic brain injury with dementia and memory decline in older adults in the United States. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 16(6), 853-861. https://doi.org/10.1002/alz.12080

Full text: http://rave.ohiolink.edu/ejournals/article/372527751
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Abstract:
Introduction
: To examine associations of history of traumatic brain injuries (TBIs) with loss of consciousness (LOC) with dementia incidence and memory decline. Methods: We studied 2718 participants from the 1992 enrollment cohort of the Health and Retirement Study (HRS) aged 65 years or older in 2000. History of TBI with LOC was self‐reported in 1992. Dementia was assessed using four algorithms established in HRS. Participants were followed from 2000 to 2014 with repeated measures of dementia and memory performance. Cox models and linear mixed‐effects models were used. Results: In 1992, 11.9% of the participants reported a history of TBI with LOC. In fully adjusted models for all four algorithms, participants with a history of TBI with LOC had no statistically significant difference in dementia incidence nor in memory decline, compared to participants without TBI history. Discussion: Our study did not find evidence of a long‐term association between history of TBI with LOC (of unknown frequency and severity) and dementia incidence or memory decline.

Renaud M.I., Klees C., van Haastregt J.C.M., Catsman-Berrevoets C.E., van de Port I.G.L., Lambregts S.A.M., et al (2020). Process evaluation of 'Brains Ahead!': An intervention for children and adolescents with mild traumatic brain injury within a randomized controlled trial. Clinical Rehabilitation, 34, 688-697. https://doi.org/10.1177/0269215520911439

Full text: http://rave.ohiolink.edu/ejournals/article/371975893
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Abstract:
Objective: To investigate whether the 'Brains Ahead! Intervention for children and adolescents with mild traumatic brain injury' was implemented as intended. In addition, involvement in and satisfaction with the intervention among patients, caregivers and professionals delivering the intervention were studied.
Design(s): Mixed methods, prospective study. Participant(s): Children with mild traumatic brain injury and their caregivers, allocated to the intervention group of the randomized controlled trial in the 'Brains Ahead!' study, and the two professionals providing the intervention.
Intervention(s): The intervention consists of a standardized and individualized psychoeducational session with written take-home information, and follow-up telephone call(s). Main measures: Registration forms, evaluation questionnaires for patients and caregivers and semi-structured interviews for professionals. Data analysis: Qualitative data were categorized based on content. Quantitative data were reported as descriptive statistics. Result(s): Fifty-five patients and caregivers out of 60 study-participants attended both sessions. All elements of the intervention were delivered to 53 study-participants. Evaluation questionnaires were completed by 21 of the 31 patients aged 12 years and older, and by 41 caregivers. Overall, the sessions were considered useful by 19 patients, 40 caregivers and both professionals. Reassurance, creating a better understanding and recognition of symptoms were rated as important aspects. On a scale from 1 to 10, the intervention was rated by children, caregivers and professionals with 7.6 (SD 1.2), 8.1 (SD.9) and 8.0 (SD.0), respectively.
Conclusion(s): The 'Brains Ahead!' intervention was largely implemented as intended and the process evaluation revealed that it is considered feasible according to patients, caregivers and professionals.

Oftedal, B. (2014). Perceived support from family and friends among adults with type 2 diabetes. European Diabetes Nursing, 11(2), 43–48.

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Abstract:
The aim of this study was to describe how adults with type 2 diabetes perceive support provided by family and friends and how such support can influence their diabetes management. Diabetes management behaviours have been described as challenging, and many individuals with type 2 diabetes fail to attain optimal glycaemic control. It has therefore been suggested that support from family and friends is critical for effective diabetes management. However, there is little empirical evidence from a patient perspective of how support provided by family and friends is perceived and how support can influence patients' diabetes management. The study was comprised of a descriptive qualitative design that included three focus groups, which were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data was analysed using qualitative content analysis. The findings revealed three themes reflecting perceived support from family and friends: mixed practical support; non‐constructive emotional support, and intrusive informational support. Furthermore, the findings indicated that participants' perceived mixed practical support, eg diet and exercise, from family and friends, as helpful and valuable. Thus, this kind of practical support stimulates effective diabetes management. However, many participants reported that they did not receive such support, which in turn, reduced their diabetes regulation efforts. Emotional support was perceived as non‐constructive and appears to demotivate participants' diabetes management. Finally, the findings indicated that informational support was perceived as intrusive and did not meet their needs for support in diabetes management.

Pyatak, E. A., Florindez, D., Peters, A. L., & Weigensberg, M. J. (2014). “We are all gonna get diabetic these days”: The impact of a living legacy of type 2 diabetes on Hispanic young adults’ diabetes care. The Diabetes Educator, 40(5), 648–658. 

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Abstract:
Purpose: The purpose of this study was to investigate how an intergenerational legacy of type 2 diabetes affected the knowledge, attitudes, and treatment strategies of Hispanic young adults with diabetes. Methods: Eight Hispanic young adults (ages 18-30 years) participated in a series of in-home longitudinal qualitative interviews, and 11 of their family members completed single in-home interviews, regarding their diabetes management practices. Interview transcripts were analyzed thematically by a team of researchers. Results: Five themes emerged that characterized the influence of an intergenerational legacy of diabetes on young adults: food and family (how meal preparation and eating are shared within families), doing together (activity participation is contingent on others’ participation), knowledge and expectations (expectations for the future and understandings of diabetes are shaped by family members), miscarried helping (well-intentioned actions have negative consequences), and reciprocal support (children and parents support each other’s diabetes care). Conclusions: Hispanic young adults’ knowledge, attitudes, and self-care practices related to diabetes are strongly influenced by the diabetes management practices of family members with diabetes, which often depart from current standards of diabetes care. Care providers should consider family members as a potentially significant influence, either positive or negative, on the diabetes self-care practices of this population.

Bhat S. & Kumar S. (2013). Comparison of reaction time in older versus middle-aged type II diabetic patients - An observational study. Indian Journal of Physiotherapy and Occupational Therapy, 7(1), 250-253.

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Abstract:
Introduction: Diabetes mellitus affects the various systems of the body like the somatosensory, auditory system and slows psychomotor and cognitive responses all of which together may affect the reaction time. Reaction time is the time taken by the individual to react or respond to a applied stimuli. Slowing of these reaction times affects the everyday tasks such as balance, increasing probability of a slip or a fall. 
Objective(s): The objective of the study was to evaluate and compare the reaction time of the middle aged and old age individuals with type II diabetes mellitus. Methodology: Thirty individuals having diabetes mellitus of age 40 to 60 were randomly allotted in two groups. The individuals between 40 to 60 years were allotted to Group A and those between 60 to 80 years were allotted to Group B. The reaction time of both the groups were evaluated by using Drop Ruler Test and compared. 
Result(s): Results showed that the reaction time in Group A was 0.19 seconds (+/-0.01) and in group B it was 0.21 seconds (+/-0.01). The reaction time was more in group B compared to group A but was not statistically significant. The co-relation co-efficient between age and reaction time of the two groups combined was r=0.605.