SummaryAsthma morbidity in adolescents often results from inadequate asthma self-management. This study was to explore barriers to self-management perceived by adolescents and to examine the associations between barriers and psychosocial factors including knowledge, attitude and self-efficacy. This cross-sectional study included a total of 126 adolescents with asthma (13-21 years) representing diverse race/ethnicity groups with a wide range of socioeconomic status. Self-reported data were analyzed using descriptive statistics, factor analysis and hierarchical regression. The most frequently endorsed barrier (63%) was adolescents' unwillingness to give up "the things the doctors say I have to give up," followed by difficulty in remembering to take care of their asthma (53%), and then "trying to forget" that they have asthma (50%). Psychosocial factors accounted for 32% of the variance in total barrier perceptions. Factor analysis revealed barriers in four domains including negativity toward providers and the medication regimen, cognitive difficulty, peer/family influence and denial. Self-efficacy was found to be the most influential factor that showed strong negative association with all four barrier subscales independent of the levels of asthma control and sociodemographic characteristics. Poor attitudes toward asthma were also associated with barriers of cognitive difficulty and social influence after adjusting for other factors. Males consistently reported higher total barriers and barriers of negativity, social influence and denial. The gender differences were not explained by psychosocial and sociodemographic factors. This study suggests that psychosocial factors are strong predictors of barriers to self-management in adolescents. Particularly, promoting self-efficacy may be beneficial in addressing the barriers. Special attention is needed to address the higher propensity for barriers in males.

To evaluate the effectiveness of a peer-led asthma self-management program for adolescents.Design: Randomized controlled trial comparing a peerled asthma program (intervention group) and a conventional adult-led asthma program (control group). Each program was implemented at a full-day camp.

Background/Objectives Vision-based speed of processing (VSOP) training is a promising cognitive intervention for older adults. However, it is unknown whether VSOP training can affect cognitive processing in individuals at high risk for dementia. Here, we examined cognitive and neural effects of VSOP training in older adults with amnestic mild cognitive impairment (aMCI) and contrasted those effects with an active control (mental leisure activities; MLA). Design A randomized single-blinded controlled pilot trial. Setting An academic medical center. Participants Twenty-one participants with aMCI. Intervention A 6-week computerized VSOP training. Measurements Multiple cognitive processing measures, instrumental activities of daily living (IADL), and two key resting state neural networks regulating cognitive processing: central executive network (CEN) and default mode network (DMN). Results We found that, compared to MLA control, VSOP training led to significant improvements in trained (processing speed and attention: F1,19 = 6.61, Partial η2 = 0.26, p = .019) and untrained cognitive domains (working memory: F1,19 = 7.33, Partial η2 = 0.28, p = .014; IADL: F1,19 = 5.16, Partial η2 = 0.21, p = .035), and protective maintenance in DMN (F1, 9 = 14.63, Partial η2 = 0.62, p = .004). Additionally, VSOP training, but not MLA, resulted in a significant improvement in CEN connectivity (Z = −2.37, p = .018). Conclusion We identified both target and transfer effects of VSOP training and revealed links between VSOP training and two key neural networks associated with aMCI. These findings highlight the potential of VSOP training to slow cognitive decline in aMCI. Further delineation of mechanisms underlying VSOP-induced plasticity is necessary to understand in what populations and conditions such training may be most effective.

Aims The aims were to characterize a sample of 202 adult community-living long-term indwelling urinary catheter users, to describe self-care practices and catheter problems, and to explore relationships among demographics, catheter practices, and problems. Background Long-term urinary catheter users have not been well studied, and persons using the device indefinitely for persistent urinary retention are likely to have different patterns of catheter practices and problems. Design The study was a cross-sectional descriptive and exploratory analysis. Methods Home interviews were conducted with catheter users who provided information by self-reported recall over the previous two months. Data were analyzed by descriptive statistics and tests of association between demographics, catheter practices, and catheter problems. Results The sample was widely diverse in age (19–96 years), race, and medical diagnosis. Urethral catheters were used slightly more often (56%) than suprapubic (44%), for a mean of 6 yrs. (SD 7 yrs.). Many persons were highly disabled, with 60% having difficulty in bathing, dressing, toileting, and getting out of the bed; 19% also required assistance in eating. A high percentage of catheter problems were reported with: 43% experiencing leakage (bypassing of urine), 31% having had a urinary tract infection, 24% blockage of the catheter, 23% catheter-associated pain, and 12% accidental dislodgment of the catheter. Treatments of catheter-related problems contributed to additional health care utilization including extra nurse or clinic visits, trips to the emergency department, or hospitalization. Symptoms of catheter associated urinary tract infections were most often related to changes in the color or character of urine or generalized symptoms. Conclusions Catheter related problems contribute to excess morbidity and health care utilization and costs. Relevance to clinical practice More research is needed in how to minimize catheter associated problems in long-term catheter users. Information from this study could help inform the development of interventions in this population.

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