Social anxiety is a common problem in psychotic disorders. The Liebowitz Social Anxiety Scale, Self-Rating version (LSAS-SR) is a widely used instrument to capture different aspects of social anxiety, but its psychometric properties have not been tested in this patient group. The aims of the present study were to evaluate the psychometric properties of the LSAS-SR in patients with first episode psychosis, to investigate whether it differentiated between active and passive social withdrawal and to test which clinical factors contributed to current level of social anxiety.
A total of 144 first episode psychosis patients from the ongoing Thematically Organized Psychosis (TOP) study were included at the time of first treatment. Diagnoses were set according to the Structured Clinical Interview (SCID-1) for DSM-IV. A factor analysis was carried out and the relationship of social anxiety to psychotic and general symptomatology measured by the Positive and Negative Syndrome Scale (PANSS) was evaluated. Possible contributors to social anxiety were analyzed using multiple hierarchic regression analysis.
The factor analysis identified three subscales: public performance, social interaction and observation. All three subscales showed satisfactory psychometric properties, acceptable convergent and discriminate properties, and confirmed previous findings in social anxiety samples. Self-esteem explained a significant amount of the variance in social anxiety, even after adjusting for the effects of delusions, suspiciousness and depression.
The study shows that the LSAS-SR can be used in this patient group, that social anxiety is strongly related to both behavioral social avoidance and to self-esteem. The results support the use of this measure in assessment of social anxiety in both clinical settings and in research.
Results from several national studies in the United States suggests that: (1) religious beliefs and practices are highly prevalent; (2) spirituality and religion are statistically and clinically relevant to mental health and symptoms; and (3) many patients have a preference for spiritually integrated care. However, existing protocols that assess for salient religious themes in psychiatric settings are time-consuming to administer, relevant only to specific populations (e.g., Christians), and have poor psychometric properties. Further, evidence suggests that religious beliefs can take on a positive and negative valence, and both of these dimensions are worthy of assessment. We, therefore, developed a brief (six-item) self-report measure of positive and negative core beliefs about God which is uniquely suited for use with a broad range of religious patients. Across three studies, we evaluated its psychometric properties and ability to predict symptoms of anxiety and depression. Results provide support for the validity and reliability of our measure and further highlight the salience of both positive and negative religious beliefs to psychiatric symptoms. It is hoped that this measure will help to decrease the burden of spiritual assessment in psychiatric and medical settings, and further have research utility for this area of study.
Family history (FH) is used as a marker for inherited risk. Using FH for this purpose requires the FH to reflect true disease in the family. The aim was to analyse the concordance between young and middle-aged ischaemic stroke patients' reported FH of cardiovascular disease (CVD) with their parents' own reports.
Ischaemic stroke patients aged 15-60 years and their eligible parents were interviewed using a standardized questionnaire. Information of own CVD and FH of CVD was registered. Concordance between patients and parents was tested by kappa statistics, sensitivity, specificity, predictive values and likelihood ratios. Regression analyses were performed to identify patient characteristics associated with non-concordance of replies.
There was no difference in response rate between fathers and mothers (P = 0.355). Both parents responded in 57 cases. Concordance between patient and parent reports was good, with kappa values ranging from 0.57 to 0.7. The patient-reported FH yielded positive predictive values of 75% or above and negative predictive values of 90% or higher. The positive likelihood ratios (LR+) were 10 or higher and negative likelihood ratios (LR-) were generally 0.5 or lower. Interpretation regarding peripheral arterial disease was limited due to low parental prevalence. Higher age was associated with impaired concordance between patient and parent reports (odds ratio 1.05; 95% confidence interval 1.01-1.09; P = 0.020).
The FH provided by young and middle-aged stroke patients is in good concordance with parental reports. FH is an adequate proxy to assess inherited risk of CVD in young stroke patients.
Children with chronic conditions often experience a long treatment which can be complex and negatively impacts the child's well-being. In planning treatment and interventions for children with chronic conditions, it is important to measure health-related quality of life (HrQoL). HrQoL instruments are considered to be a patient-reported outcome measure (PROM) and should be used in routine practice.
The aim of this study was to compare the content dimensions of HrQoL instruments for children's self-reports using the framework of ICF-CY.
The sample consist of six instruments for health-related quality of life for children 5 to 18 years of age, which was used in the Swedish national quality registries for children and adolescents with chronic conditions. The following instruments were included: CHQ-CF, DCGM-37, EQ-5D-Y, KIDSCREEN-52, Kid-KINDL and PedsQL 4.0. The framework of the ICF-CY was used as the basis for the comparison.
There were 290 meaningful concepts identified and linked to 88 categories in the classification ICF-CY with 29 categories of the component body functions, 48 categories of the component activities and participation and 11 categories of the component environmental factors. No concept were linked to the component body structures. The comparison revealed that the items in the HrQoL instruments corresponded primarily with the domains of activities and less with environmental factors.
In conclusion, the results confirm that ICF-CY provide a good framework for content comparisons that evaluate similarities and differences to ICF-CY categories. The results of this study revealed the need for greater consensus of content across different HrQoL instruments. To obtain a detailed description of children's HrQoL, DCGM-37 and KIDSCREEN-52 may be appropriate instruments to use that can increase the understanding of young patients' needs.
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Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.
This cross-sectional study involved 243 children aged 3-15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments.
Physicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child-parent agreement was moderate (Cohen's weighted ?=0.55), but low between child-physician (?=0.12) and parent-physician (?=0.17). Physicians significantly underestimated pain in all paediatric patients =3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians' pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS=7) received pain relief.
Paediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED.
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To compare the reliability and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Outcome Survey activities of daily living subscale (KOS-ADL), and the Lower Extremity Functional Scale (LEFS) in individuals with knee osteoarthritis (OA).
The WOMAC is the current standard in patient-reported measures of function in patients with knee OA. The KOS-ADL and LEFS were designed for potential use in patients with knee OA. If the KOS-ADL and LEFS are to be considered viable alternatives to the WOMAC for measuring patient-reported function in individuals with knee OA, they should have measurement properties comparable to the WOMAC. It would also be important to determine whether either of these instruments may be superior to the WOMAC in terms of reliability or responsiveness in this population.
Data from 168 subjects with knee OA, who participated in a rehabilitation program, were used in the analyses. Reliability and responsiveness of each outcome measure were estimated at follow-ups of 2, 6, and 12 months. Reliability was estimated by calculating the intraclass correlation coefficient (ICC2,1) for subjects who were unchanged in status from baseline at each follow-up time, based on a global rating of change score. To examine responsiveness, the standard error of the measurement, minimal detectable change, minimal clinically important difference, and the Guyatt responsiveness index were calculated for each outcome measure at each follow-up time.
All 3 outcome measures demonstrated reasonable reliability and responsiveness to change. Reliability and responsiveness tended to decrease somewhat with increasing follow-up time. There were no substantial differences between outcome measures for reliability or any of the 3 measures of responsiveness at any follow-up time.
The results do not indicate that one outcome measure is more reliable or responsive than another when applied to subjects with knee OA. We believe that all 3 instruments are appropriate outcome measures to examine change in functional status of patients with knee OA.
Fear of pain is highly correlated with pain report and physiological measures of arousal when pain is inflicted. The Fear of Pain Questionnaire III (FPQ-III) and The Fear of Pain Questionnaire Short Form (FPQ-SF) are self-report inventories developed for assessment of fear of pain (FOP). A previous study assessed the fit of the FPQ-III and the FPQ-SF in a Norwegian non-clinical sample and proved poor fit of both models. This inspired the idea of testing the possibility of a Norwegian FOP-model.
A Norwegian FOP-model was examined by Exploratory Factor Analysis (EFA) in a sample of 1112 healthy volunteers. Then, the model fit of the FPQ-III, FPQ-SF and the Norwegian FOP-model (FPQ-NOR) were compared by Confirmatory Factor Analysis (CFA). Sex neutrality was explored by examining model fit, validity and reliability of the 3 models amongst male and female subgroups.
The EFA suggested either a 4-, a 5- or a 6-factor Norwegian FOP model. The eigenvalue criterion supported the suggested 6-factor model, which also explained most of the variance and was most interpretable. A CFA confirmed that the 6-factor model was better than the two 4- and 5-factor models. Furthermore, the CFA used to test the fit of the FPQ-NOR, the FPQ-III and the FPQ-SF showed that the FPQ-NOR had the best fit of the 3 models, both in the whole sample and in sex sub-groups.
A 6-factor model for explaining and measuring FOP in Norwegian samples was identified and termed the FPQ-NOR. This new model constituted six factors and 27 items, conceptualized as Minor, Severe, Injection, Fracture, Dental, and Cut Pain. The FPQ-NOR had the best fit overall and in male- and female subgroups, probably due to cross-cultural differences in FOP.
This study highlights the importance on exploratory analysis of FOP-instruments when applied to different countries or cultures. As the FPQ-III is widely used in both research and clinical settings, it is important to ensure that the models construct validity is high. Country specific validation of FOP in both clinical and non-clinical samples is recommended.
Department of Nutritional Sciences, University of Toronto, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada. Electronic address: email@example.com.
Measuring ethnicity accurately is important for identifying ethnicity variations in disease risk. We evaluated the degree of agreement and accuracy of maternal ethnicity measured using the new standardized closed-ended geographically based ethnicity question and geographic reclassification of open-ended ethnicity questions from the Canadian census.
A prospectively designed study of respondent agreement of mothers of healthy children aged 1-5 years recruited through the TARGet Kids! practice-based research network. For the primary analysis, the degree of agreement between geographic reclassification of the Canadian census maternal ethnicity variables and the new geographically based closed-ended maternal ethnicity variable completed by the same respondent was evaluated using a kappa analysis.
Eight hundred sixty-two mothers who completed both measures of ethnicity were included in the analysis. The kappa agreement statistic for the two definitions of maternal ethnicity was 0.87 (95% confidence interval, 0.84-0.90) indicating good agreement. Overall accuracy of the measurement was 93%. Sensitivity and specificity ranged from 83% to 100% and 96% to 100%, respectively.
The new standardized closed-ended geographically based ethnicity question represents a practical alternative to widely used open-ended ethnicity questions. It may reduce risk of misinterpretation of ethnicity by respondents, simplify analysis, and improve the accuracy of ethnicity measurement.
High rates of substance use disorders (SUD) among psychiatric patients are well documented. This study explores the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) in identifying SUD in emergency psychiatric patients. Of 287 patients admitted consecutively, 256 participants (89%) were included, and 61-64% completed the questionnaires and the Mini-International Neuropsychiatric Interview (MINI), used as the reference standard. Both AUDIT and DUDIT were valid (area under the curve above 0.92) and reliable (Cronbach's alpha above 0.89) in psychotic and nonpsychotic men and women. The suitable cutoff scores for AUDIT were higher among the psychotic than nonpsychotic patients, with 12 versus 10 in men and 8 versus 5 in women. The suitable cutoff scores for DUDIT were 1 in both psychotic and nonpsychotic women, and 5 versus 1 in psychotic and nonpsychotic men, respectively. This study shows that AUDIT and DUDIT may provide precise information about emergency psychiatric patients' problematic alcohol and drug use.
Exploring parental mentalization in postnatal phase with a self-report questionnaire (PRFQ): Factor structure, gender differences and association with sociodemographic factors. The Finn Brain Birth Cohort Study.
Finn Brain, Institute of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, Institute of Clinical Medicine, University of Turku, Finland. Electronic address: firstname.lastname@example.org.
The objective was to explore the preliminary functioning of a self-report questionnaire designed to assess parental reflective functioning (PRFQ, Luyten et al., 2009, unpublished manual) during early postnatal phase and with a large population-based sample. Parental reflective functioning (PRF) refers to parental capacity to focus on experience and feelings, within self, in the child and underlying observed reactions. Individual differences in PRF reportedly affect child attachment and socio-emotional development. Cost-effective tools to assess key areas of early parenting are needed for both research and clinical purposes. The factor structure of a 36-item version suitable for early postnatal phase was explored using population-based data from the Finn Brain Birth Cohort Study (425 mothers and 237 fathers). Exploratory and confirmatory factor analysis resulted in a 14-item version comprising four factors capturing relevant aspects of early PRF. The factor structure was further tested with separate participants from the cohort (1030 mothers and 422 fathers). Mothers tended to score higher than fathers in PRF. Among mothers, parity, age, and financial situation were associated with postnatal mentalization. Level of education was associated with postnatal mentalization in both genders. The 14-item PRFQ-Fi has potential to serve as a new screening tool for very early parenting.