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D S Ward

Publications and source records attributed to D S Ward.

At least 19 recordsLinked to original sources

Factorial invariance and latent mean structure of questionnaires measuring social-cognitive determinants of physical activity among black and white adolescent girls.

BACKGROUND: We previously developed questionnaires based on contemporary theories to measure physical activity determinants among youth [Motl et al., Prev Med 2000; 31:584-94]. The present study examined the factorial invariance and latent mean structure of unidimensional models fit to the questionnaires measuring attitude, subjective norm, perceived behavioral control, and self-efficacy about physical activity among black and white adolescent girls. METHODS: Black (n = 896) and white (n = 823) girls in the 8th grade completed the questionnaires measuring attitude, subjective norm, perceived behavioral control, and self-efficacy about physical activity. The responses were subjected to analyses of factorial invariance and latent mean structure using confirmatory factor analysis with full-information maximum likelihood estimation in AMOS 4.0. RESULTS: The unidimensional models of the four questionnaires generally demonstrated invariance of the factor structure, factor loadings, and factor variance across race but not invariance of the variance-covariance matrices or item uniquenesses. The analyses of latent mean structure demonstrated that white girls had higher latent mean scores on the measures of attitude and self-efficacy than black girls; there were similar, but smaller, differences between white and black girls on the measures of subjective norm and perceived behavioral control. CONCLUSIONS: The questionnaires can be employed in interventions to test the mediating influences of attitude, subjective norm, perceived behavioral control, and self-efficacy on participation in physical activity by black and white adolescent girls.

Adolescent↗

Physical activity and determinants of physical activity in obese and non-obese children.

OBJECTIVE: To compare the physical activity (PA) patterns and the hypothesized psychosocial and environmental determinants of PA in an ethnically diverse sample of obese and non-obese middle school children. DESIGN: Cross-sectional study. SUBJECTS: One-hundred and thirty-three non-obese and 54 obese sixth grade children (mean age of 11.4+/-0.6). Obesity status determined using the age-, race- and gender-specific 95th percentile for BMI from NHANES-1. MEASUREMENTS: Objective measurements were collected of PA over a 7-day period using the CSA 7164 accelerometer: total daily counts; daily moderate (3-5.9 METs) physical activity (MPA); daily vigorous physical activity (> or =6 METs; VPA); and weekly number of 5, 10 and 20 min bouts of moderate-to-vigorous physical activity (> or =3 METs, MVPA). Self-report measures were collected of PA self-efficacy; social influences regarding PA, beliefs about PA outcomes; perceived PA levels of parents and peers, access to sporting and/or fitness equipment at home, involvement in community-based PA organizations; participation in community sports teams; and hours spent watching television or playing video games. RESULTS: Compared to their non-obese counterparts, obese children exhibited significantly lower daily accumulations of total counts, MPA and VPA as well as significantly fewer 5, 10 and 20 min bouts of MVPA. Obese children reported significantly lower levels of PA self-efficacy, were involved in significantly fewer community organizations promoting PA and were significantly less likely to report their father or male guardian as physically active. CONCLUSIONS: The results are consistent with the hypothesis that physical inactivity is an important contributing factor in the maintenance of childhood obesity. Interventions to promote PA in obese children should endeavor to boost self-efficacy perceptions regarding exercise, increase awareness of, and access to, community PA outlets, and increase parental modeling of PA.

Australia↗

Factorial validity and invariance of questionnaires measuring social-cognitive determinants of physical activity among adolescent girls.

BACKGROUND: There are few theoretically derived questionnaires of physical activity determinants among youth, and the existing questionnaires have not been subjected to tests of factorial validity and invariance. The present study employed confirmatory factor analysis (CFA) to test the factorial validity and invariance of questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity. METHODS: Adolescent girls in eighth grade from two cohorts (N = 955 and 1,797) completed the questionnaires at baseline; participants from cohort 1 (N = 845) also completed the questionnaires in ninth grade (i.e., 1-year follow-up). Factorial validity and invariance were tested using CFA with full-information maximum likelihood estimation in AMOS 4.0. Initially, baseline data from cohort 1 were employed to test the fit and, when necessary, to modify the unidimensional models. The models were cross-validated using a multigroup analysis of factorial invariance on baseline data from cohorts 1 and 2. The models then were subjected to a longitudinal analysis of factorial invariance using baseline and follow-up data from cohort 1. RESULTS: The CFAs supported the fit of unidimensional models to the four questionnaires, and the models were cross-validated, as indicated by evidence of multigroup factorial invariance. The models also possessed evidence of longitudinal factorial invariance. CONCLUSIONS: Evidence was provided for the factorial validity and the invariance of the questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity among adolescent girls.

Adolescent↗

Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia.

OBJECTIVE: Near-infrared spectroscopy (NIRS) has the potential for providing valuable information about oxygen delivery to the brain. However, questions have been raised about the accuracy of these measurements. This study was undertaken to compare noninvasive cerebral saturation measurements to jugular venous saturation under conditions of hypoxia and hypercapnia. METHODS: Data was obtain on forty-two subjects. Cerebral oxygenation was measured with a Somanetics INVOS 4100-SSA placed on the forehead of the subjects. PETCO2 was controlled to approximately 2 and 7 mmHg above resting values and PETO2 was controlled to 80, 45, 60 and 41 mmHg consecutively for four of five minutes each. Internal jugular blood gas measurements were made via a retrograde catheter. RESULTS: Both the cerebral oximetry measured saturation (rSO2) and the jugular venous saturation (SjvO2) were significantly increased by increasing the PETCO2 at all levels of hypoxia. The increase in the rSO2 was less than the increase in SjvO2. The rSO2 had a bias of 5.2% and a precision of 10.7% compared to the measured SjvO2. DISCUSSION: Cerebral oxygen saturation measured by cerebral oximetry compares well to the measured SjvO2 in normal subjects, despite multiple physiological reasons for differences. The closer relationship of SjvO2 to rSO2 than SaO2 under the conditions of these experiments indicates that the measurement reflects primarily intracranial saturation. However, outcome studies under clinical conditions are needed to determine the clinical utility of cerebral oximetry.

Adult↗

Gait and postural stability in obese and nonobese prepubertal boys.

OBJECTIVE: To examine differences in gait and postural stability of obese and nonobese prepubertal boys. DESIGN: Percentage of gait cycle in double support was examined to determine significant differences. Postural stability was compared using temporal and frequency measures of the center of pressure in static stance. SETTING: Gait was examined using videography on a 30-meter walkway. Postural stability was examined using a measurement platform. PARTICIPANTS: Ten obese (>95th percentile in body mass index) and 10 nonobese (15th to 90th percentile in body mass index) prepubertal boys aged 8 to 10yrs. INTERVENTION: Participants were examined at three walking cadences as determined by preferred gait cadence. Full vision, darkness, and visually confused conditions were used to accentuate static postural stability differences. MAIN OUTCOME MEASURES: In the presence of dynamic stability differences (gait), static stability measures further investigated stability differences. RESULTS: Obese boys spent significantly (p < .02) greater percentage of gait cycle in dual stance. Obese boys showed significantly (p < .01) greater sway areas, energy, and variability primarily in the medial/lateral direction. CONCLUSIONS: Dual stance differences suggest diminished dynamic stability in obese boys. Greater sway areas in medial/lateral direction in obese boys and the absence of significant frequency measures suggest that the instability observed in obese boys is caused by excess weight rather than underlying postural instability.

Child↗

Operating room utilization: the need for data.

Keeping the OR scheduled to satisfy all the various constituents is a complex dynamic process. The health care environment needs to be carefully analyzed to ensure that the services the OR offers are appropriate. OR utilization is not simply ensuring that the greatest number of cases are done. The cost of doing these cases must be considered and, in order to do so, compromises must be made. Creating information systems that track all aspects of utilization, including costs and revenues, will be vital for the future management of operating rooms.

Appointments and Schedules↗

Correlates of objectively measured physical activity in preadolescent youth.

OBJECTIVE: The purpose of this study was to identify the psychosocial and environmental correlates of objectively measured physical activity behavior in a diverse sample of sixth-grade students. DESIGN: Cross-sectional. PARTICIPANTS AND SETTINGS: One hundred ninety-eight sixth-grade students from 4 public middle schools in Columbia, South Carolina. The study group was 52.0% female, 55.1% African-American, with a mean age of 11.4 +/- 0.6 years. MAIN OUTCOME MEASURES: Time spent in moderate physical activity (MPA) and vigorous physical activity (VPA) was assessed using a uniaxial accelerometer (CSA WAM 7164) (Computer Science and Applications Inc., Shalimar, FL). Determinant variables included: age, gender, race/ethnicity (demographic); physical activity self-efficacy, social norms related to physical activity, and beliefs regarding physical activity outcomes (psychosocial); and perceived physical activity habits of parents and peers, involvement in community physical activity organizations, involvement in community-based sports programs, access to fitness/sporting equipment at home, and self-reported hours spent watching television or playing video games (environmental). RESULTS: For boys, physical activity self-efficacy, social norms related to physical activity, and involvement in community physical activity organizations were salient predictors of MPA and VPA. Among girls, only physical activity self-efficacy emerged as a clear predictor of objectively measured physical activity. CONCLUSIONS: These findings are consistent with previous studies using self-reported physical activity and suggest that interventions to increase physical activity in preadolescent youth should endeavor to boost physical activity self-efficacy by offering a wide selection of enjoyable, developmentally-appropriate physical activity options.

Child↗

Tracking of avoidance of alcohol use and smoking behavior in a fifth grade cohort over three years.

This study examined the maintenance of positive health behavior (avoidance of alcohol use and cigarette smoking) and factors associated with the maintenance of these behaviors from fifth through seventh grade by a cohort of rural students (N = 232). African American and White students showed similar patterns of high avoidance of alcohol until seventh grade. Although more girls avoided use than boys, avoidance decreased in both groups with progression in grade. Mothers', fathers', and best friends' drinking behaviors influenced avoidance behavior; drinking was less likely to occur among those whose parents and friends did not drink. Friends' drinking behavior influenced alcohol use as early as fifth grade. Smoking avoidance was maintained by 74% of the students over the 3 years. Although there were no racial differences in smoking, African Americans started smoking about 1 year earlier than Whites. During seventh grade, an increase in smoking occurred among boys and girls, but was particularly striking among girls. Avoidance of smoking was influenced by mothers' behavior but not fathers'. Best friends' smoking behavior exerted a major influence on avoidance between grades 6 and 7. In grades 5 and 6, those who avoided smoking were more physically active than smokers, but by seventh grade their physical activity declined to a similar level as smokers. Rural adolescent boys seemed to be at early risk for alcohol use and smoking, while rural girls delayed involvement by 1 to 2 years. Communities, schools, and families can help adolescents avoid alcohol use and smoking through early prevention efforts.

Black or African American↗

Determinants of physical activity in active and low-active, sixth grade African-American youth.

This study compared the determinants of physical activity in active and low-active African-American sixth grade students (N = 108, 57 F, 51 M). Objective assessments of physical activity over a seven-day period were obtained using the CSA 7164 accelerometer. Students were classified as active if they exhibited three or more 20-minute bouts of moderate to vigorous physical activity over the seven-day period. Relative to low-actives, active boys reported significantly higher levels of self-efficacy, greater involvement in community physical activity organizations, and were significantly more likely to perceive their mother as active. Relative to low-actives, active girls reported significantly higher levels of physical activity self-efficacy, greater positive beliefs regarding physical activity outcomes, and were significantly less likely to watch television or play video games for > or = 3 hrs/day. These observations provide preliminary guidance as to the design of physical activity interventions targeted at African-American youth.

Black or African American↗

Exercise training and intensity does not alter vascular volume responses in women.

PURPOSE: The effect of endurance training on vascular volumes in females has received little research attention. Further, the effect of exercise training intensity on vascular volumes is unknown. Therefore, we investigated the hypothesis that greater hematologic changes would be induced in women by higher exercise intensity during endurance training. METHODS: There were 26 healthy, sedentary adult females with the following characteristics (mean +/- SD): maximal oxygen consumption (VO2max) = 30.0+/-6.6 ml x kg(-1) x min(-1); age = 32+/-5 yr; body mass index (BMI) = 23.7+/-3.6 kg x m(-2)) who were randomly assigned to control (CON, n = 8); high intensity (HI, 80% of VO2max, n = 10), or low intensity (LO, 40% of VO2max, n = 8) cycle ergometer training groups. Training, conducted 3-5 (3.37+/-0.05) d x wk(-1) for 12 wk, was supervised. Estimated exercise energy expenditure was equated across training groups, progressing from 150-375 kcal per session (mean +/- SE across training weeks = 298+/-0.34 and 297+/-0.37 kcal per session for HI and LO, respectively). Plasma volume (PV, T-1824 dilution); calculated total blood (TBV) and red cell volumes (RCV); calculated total hemoglobin (THb); erythropoietin concentration ([Epo]) and selected hematologic variables were measured at baseline and weeks 2, 4, 8 and 12 of training. RESULTS: The observed relative (percent) changes in PV, TBV, RCV and THb from pre-training baseline values were not statistically significant. Decreases (p < 0.05) in hematocrit (Hct), hemoglobin ([Hb]) and RBC count were observed in both training groups. Mean corpuscular Hb (MCH) and Hb concentration (MCHC) increased (p < 0.05) during training. [Epo] was decreased at week 2 compared with baseline (p < 0.03), but was similar to baseline at weeks 4, 8 and 12. CONCLUSIONS: Within the limits of this study, endurance training did not increase PV, TBV, RCV and THb in previously sedentary females regardless of the intensity of training.

Adaptation, Physiological↗

Health risk behaviors of rural sixth graders.

The purposes of this study were to examine the frequency and risk factors (correlates) of single and concurrent health risk behaviors (HRBs) including obesity, physical inactivity, smoking, and alcohol use in a sample of 352 rural, predominately African-American sixth graders. This study was guided by Jessor's (1992) adolescent risk behavior conceptual framework. Data were collected using physical measures and a self-report questionnaire. Thirty-two percent of the sample had no HRB, 44% had one HRB, and 24% had two or more HRBs. Obesity and physical inactivity were more prevalent in this sample than in the general population. Gender differences in risk factors were evident. Our findings suggest the testing of interventions that focus on the social needs of girls and that influence behavioral modeling for boys to reduce single and concurrent health risk behaviors.

Adolescent↗

Exaggerated blood pressure response to dynamic exercise and risk of future hypertension.

This study examined the association between an exaggerated blood pressure response to treadmill exercise and the risk of developing hypertension. Subjects were healthy normotensive men (n = 5386) who had a baseline graded maximal exercise test between 1971 and 1982, and completed a mailed follow-up questionnaire. At follow-up in 1986, cases (n = 151) reported physician diagnosed hypertension and controls (n = 201) reported normotension. Those who had developed hypertension at follow-up were more likely to have had an exaggerated blood pressure response to exercise (OR = 2.4, 1.4-4.3). In multiple logistic regression analysis an exaggerated response was significantly associated (OR = 3.0, 1.5-6.1) with future hypertension after controlling for sitting systolic and diastolic blood pressure, weight change from age 21 to follow-up, entry age, family history of hypertension, body mass index, treadmill time, alcohol consumption, and years of follow-up. These results suggest that an exaggerated blood pressure response to exercise is independently associated with increased risk of future hypertension, and therefore, may be an important factor in determining hypertension risk.

Adult↗

Chloral hydrate sedation: the additive sedative and respiratory depressant effects of nitrous oxide.

UNLABELLED: The combination of chloral hydrate and nitrous oxide (N2O) is often used for sedation in pediatric dentistry. The purpose of this study was to determine the extent to which N2O increases the level of sedation and respiratory depression in children sedated with chloral hydrate. Thirty-two children, 1-9 yr, received chloral hydrate, 70 mg/kg (maximum 1.5 g), and then received N2O (30% and 50%). Hypoventilation (maximal PETCO2 > 45 mm Hg) occurred in 23 (77%) children during administration of chloral hydrate alone, in 29 (94%) breathing 30% N2O (P = 0.08 versus control), and in 29 (97%) breathing 50% N2O (P = 0.05 versus control). Mean PETCO2 was increased during 30% (P = 0.007) and 50% (P = 0.02) N2O administration. Using chloral hydrate alone, 8 (25%) children were not sedated, 10 (31%) were consciously sedated, and 14 (44%) were deeply sedated. Using 30% N2O, 2 children (6%) were not sedated, 0 were consciously sedated, and 29 (94%) were deeply sedated (P < 0.0001). Using 50% N2O, 1 child (3%) was not sedated, 0 were consciously sedated, 27 (94%) were deeply sedated, and 1 (3%) had no response to a painful stimulus (P < 0.0001). We conclude that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children. IMPLICATIONS: Pediatric sedation in the dental office often consists of nitrous oxide (N2O) after chloral hydrate premedication. We found that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children.

Anesthesia, General↗

Accuracy of a cerebral oximeter in healthy volunteers under conditions of isocapnic hypoxia.

BACKGROUND: A cerebral oximeter measures oxygen saturation of brain tissue noninvasively by near infrared spectroscopy. The accuracy of a commercially available oximeter was tested in healthy volunteers by precisely controlling end-tidal oxygen (P[ET]O2) and carbon dioxide (P[ET]CO2) tensions to alter global cerebral oxygen saturation. METHODS: In 30 healthy volunteers, dynamic end-tidal forcing was used to produce step changes in P[ET]O2 resulting in arterial saturation ranging from approximately 70% to 100% under conditions of controlled normocapnia (each person's resting P[ET]CO2) or hypercapnia (resting plus 7-10 mmHg). Blood arterial (SaO2) and jugular bulb venous (S[jv]O2) saturations during each P(ET)O2 interval were determined by co-oximetry. The cerebral oximeter reading (rSO2) and an estimated jugular venous saturation (S[jv]O2), derived from a combination of SaO2 and rSO2, were compared with the measured S(jv)O2. RESULTS: The S(jv)O2 was significantly higher with hypercapnia than with normocapnia for the same SaO2. The rSO2 and S(jv)O2 were both highly correlated with S(jv)O2 for individual volunteers (mean r2 = 0.91 for each relation); however, the slopes and intercepts varied widely among volunteers. In three of them, the cerebral oximeter substantially underestimated the measured S(jv)O2. CONCLUSIONS: During isocapnic hypoxia in healthy persons, cerebral oxygenation as estimated by near infrared spectroscopy precisely tracks changes in measured S(jv)O2 within individuals, but the relation exhibits a wide range of slopes and intercepts. Therefore the clinical utility of the device is limited to situations in which tracking trends in cerebral oxygenation would be acceptable.

Adult↗

Effects of alfentanil on the ventilatory response to sustained hypoxia.

BACKGROUND: The ventilatory response to acute hypoxia is biphasic, with an initial rapid increase followed by a slower decline. In humans, there is evidence that the magnitude of the decline in ventilation is proportional to the size of the initial increase. This study was done to define the role of exogenous opioids in the ventilatory decline seen with prolonged hypoxia. METHODS: Ten healthy persons were exposed to isocapnic hypoxia for 25 min, followed by 5 min of isocapnic normoxia and 5 min of isocapnic hypoxia. These conditions were repeated during a computer-controlled alfentanil infusion. RESULTS: Serum alfentanil levels were constant among the volunteers (38+/-12 ng/ml). Alfentanil decreased both the initial and second acute hypoxic responses (from 1.27+/-0.73 to 0.99+/-0.39 l x min(-1) x %(-1), P < 0.05; and from 0.99+/-0.70 to 0.41+/-0.29 l x min(-1) x %(-1), P < 0.05, respectively). The magnitude of the decrease in ventilation during the 25 min of hypoxia was not changed (10+/-3.3 l/min for control; 12.3+/-7.5 l/min for alfentanil). CONCLUSIONS: Alfentanil reduced the acute ventilatory response to hypoxia. The absolute value of hypoxic ventilatory decline was not increased, but a measure of residual hypoxic ventilatory decline (the ratio of ventilation between the second and first steps into hypoxia) was decreased, which supports the hypothesis that opioids potentiate centrally mediated ventilatory decline.

Acute Disease↗

Validity of the computer science and applications (CSA) activity monitor in children.

PURPOSE: The purpose of this study was to evaluate the validity of the CSA activity monitor as a measure of children's physical activity using energy expenditure (EE) as a criterion measure. METHODS: Thirty subjects aged 10 to 14 performed three 5-min treadmill bouts at 3, 4, and 6 mph, respectively. While on the treadmill, subjects wore CSA (WAM 7164) activity monitors on the right and left hips. VO2 was monitored continuously by an automated system. EE was determined by multiplying the average VO2 by the caloric equivalent of the mean respiratory exchange ratio. RESULTS: Repeated measures ANOVA indicated that both CSA monitors were sensitive to changes in treadmill speed. Mean activity counts from each CSA unit were not significantly different and the intraclass reliability coefficient for the two CSA units across all speeds was 0.87. Activity counts from both CSA units were strongly correlated with EE (r = 0.86 and 0.87, P < 0.001). An EE prediction equation was developed from 20 randomly selected subjects and cross-validated on the remaining 10. The equation predicted mean EE within 0.01 kcal.min-1. The correlation between actual and predicted values was 0.93 (P < 0.01) and the SEE was 0.93 kcal.min-1. CONCLUSION: These data indicate that the CSA monitor is a valid and reliable tool for quantifying treadmill walking and running in children.

Adolescent↗