ABSTRACT. Objective. Most children enjoy healthy childhoods with little need for specialized health care services. However, some children experience difficulties in early childhood and require access to and utilization of considerable health care resources over time. Although impaired motor function is the hallmark of the cerebral palsy (CP) syndromes, many children with this development disorder also experience sensory, communicative, and intellectual impairments and may have complex limitations in self-care functions. Although caregiving is a normal part of being the parent of a young child, this role takes on an entirely different significance when a child experiences functional limitations and possible longterm dependence. One of the main challenges for parents is to manage their child's chronic health problems effectively and juggle this role with the requirements of everyday living. Consequently, the task of caring for a child with complex disabilities at home might be somewhat daunting for caregivers. The provision of such care may prove detrimental to both the physical health and the psychological well-being of parents of children with chronic disabilities. It is not fully understood why some caregivers cope well and others do not. The approach of estimating the "independent" or "direct" effects of the care recipient's disability on the caregiver's health is of limited value because (1) single-factor changes are rare outside the context of constrained experimental situations; (2) assumptions of additive relationships and perfect measurements rarely hold; and (3) such approaches do not provide a complete perspective, because they fail to examine indirect pathways that occur between predictor variables and health outcomes. A more detailed analytical approach is needed to understand both direct and indirect effects simultaneously. The primary objective of the current study was to examine, within a single theorybased multidimensional model, the determinants of physical and psychological health of adult caregivers of children with CP.Methods. We developed a stress process model and applied structural equation modeling with data from a large cohort of caregivers of children with CP. This design allowed the examination of the direct and indirect relationships between a child's health, behavior and functional status, caregiver characteristics, social supports, and family functioning and the outcomes of caregivers' physical and psychological health. Families (n ‫؍‬ 468) of children with CP were recruited from 19 regional children's rehabilitation centers that provide outpatient disability management and supports in Ontario, Canada. The current study drew on a population available to the investigators from a previous study, the Ontario Motor Growth study, which explored patterns of gross motor development in children with CP. Data on demographic variables and caregivers' physical and psychological health were assessed using standardized, self-completed parent questionnaires as well as a face-to-face home interview...

Objective Correspondence Analysis (CA) is a multivariate graphical technique designed to explore relationships among categorical variables. Epidemiologists frequently collect data on multiple categorical variables with to the goal of examining associations amongst these variables. Nevertheless, despite its usefulness in this context, CA appears to be an underused technique in epidemiology. The objective of this paper is to present the utility of CA in an epidemiological context. Study Design and Setting The theory and interpretation of CA in the case of two variables and more than two variables is illustrated through two examples. Results The outcome from correspondence analysis is a graphical display of the rows and columns of a contingency table that is designed to permit visualization of the salient relationships among the variable responses in a low-dimensional space. Such a representation reveals a more global picture of the relationships among row-column pairs which would otherwise not be detected through a pairwise analysis. Conclusion When the study variables of interest are categorical, CA is an appropriate technique to explore relationships amongst variable response categories and can play a complementary role in analyzing epidemiological data.

in community-dwelling older adults, foot problems, arthritis, cognitive impairment, heart problems and vision were the major determinants of disability. Attempts to reduce disability burden in older Canadians should target these chronic conditions; however, preventive interventions will be most efficient if they recognize the differences in the drivers of PAR by sex, age group and type of functional disability being targeted.

EnvIMS-Q has shown cross-cultural feasibility, acceptability and reliability in both patients with MS and healthy subjects from all sites. EnvIMS-Q is an efficient tool to ensure proper assessment of age-specific exposure to environmental factors in large multinational population-based case-control studies of MS risk factors.

Objective To examine the relationships among seven frailty domains: nutrition, physical activity, mobility, strength, energy, cognition, and mood, using data from three studies. Study Design and Setting Data from three studies were separately analyzed using Multiple Correspondence Analysis (MCA). The graphical output of MCA was used to assess 1) if the presence of deficits in the frailty domains separate from the absence of deficits on the graph, 2) the dimensionality of the domains, 3) the clustering of domains within each dimension and 4) their relationship with age, sex and disability. Results were compared across the studies. Results In two studies, presence of deficits for all domains separated from absence of deficits. In the third study, there was separation in all domains except cognition. Three main dimensions were retained in each study however assigned dimensionality of domains differed. The clustering of mobility with energy and/or strength was consistent across studies. Deficits were associated with older age, female sex and disability. Conclusion Our results suggest that frailty is a multidimensional concept for which the relationships among domains differ according to the population characteristics. These domains, with the possible exception of cognition, appear to aggregate together and share a common underlying construct.

Lignin, the second most abundant component after cellulose in biomass, has been examined in this study as a fuel for direct conversion into electricity using direct carbon fuel cells (DCFC). Two different types of industrial lignins were investigated: Lignosulfonate (LS) and Kraft lignin (KL), in their commercial forms, after their blending with commercial active carbon (AC) or after alteration of their structures by a pH adjustment to pH 10. It was found that the open circuit voltage (OCV) of the DCFC could reach around 0.7 V in most of the trials. Addition of active carbon increased the maximum current density from 43-57 to 83-101 mA cm 22 . The pH adjustment not only increased the maximum current density but also reduced the differences between the two types of lignins, resulting in an OCV of 0.68-0.69 V and a maximum current density of 74-79 mA cm 22 from both lignins. Typical power density was 12 (for KL + AC) and 24 mW cm 22 (for LS + AC). It is concluded that a direct lignin fuel cell is feasible and the lignin hydrophilicity is critical for the cell performance.

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Our results provide further evidence supporting the notion that frailty domains may belong to a common construct. Physical strength may be the most important discriminating characteristic.