A psychometric evaluation of the interRAI Child and Youth Mental Health instruments (ChYMH) anxiety scale in children with and without developmental disabilities.

BACKGROUND: With 10 to 20% of Canadian children suffering with mental illness, the importance of early identification and accurate assessment systems is clear. Unfortunately, many do not receive the mental health treatment necessary and wait-times for assessment can span up to a year. In response, the interRAI suite of assessments were designed to comprehensively assess early signs of mental health impairments in children from birth to 18 years. METHODS: This study assesses the psychometric properties of the Anxiety Scale and addresses the identification of anxiety within children diagnosed with intellectual and developmental disabilities (IDD); a commonly underrepresented sample in mental health psychometric studies. Data was collected from children aged 4-18 years in three different samples. RESULTS: Results indicated reliable internal consistency and factor structure, as well as moderate-to-strong convergent validity. CONCLUSIONS: We conclude that the Anxiety Scale exhibits psychometric qualities which demonstrate its clinical utility for use within a child sample, as well as in children with IDD. The findings provide support to a larger body of research which show consistent psychometric rigour of the interRAI measures.

The determinants of service complexity in children with intellectual disabilities.

BACKGROUND: To date, little is known about the predictors of healthcare service utilisation in children with intellectual disability (ID). The aim of this study was to identify the factors associated with service complexity in children with ID in Ontario, Canada. METHODS: The population of this cross-sectional study consisted of 330 children with ID ages 4 to 18 years who accessed mental health services from November of 2012 to June of 2016 in four agencies. All participants completed the interRAI Child and Youth Mental Health and Developmental Disability Assessment Instrument, which is a semi-structured clinician-rated assessment that covers a range of common issues in children with ID. The outcome of this study was a service complexity variable based on (1) mental health service utilisation including any services provided to the child and (2) the management involved in providing that care. Eight individual items were summed, resulting in a scale that ranged from 0 to 8. Scores were then dichotomised into two groups: a score of 0-2 identified children with a low service complexity and a score of 3 or higher identified children with a high service complexity. RESULTS: After adjustment for other covariates, gender was not associated with service complexity. Children aged 11-14 years and children with autism spectrum disorder used over twofold higher levels of service complexity than children aged equal to or less than 10 years or children with other causes of ID. Moreover, victims of bullying, high scores on the family functioning scale or learning or communication disorder were associated with greater service complexity. CONCLUSIONS: The findings of this study indicate that a variety of factors are related to service complexity ranged from children's nonclinical (age and experiences of bullying) to clinical (e.g. aggression, learning/communication problems and autism spectrum disorder) characteristics.

Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis.

BACKGROUND: Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between 'poor me' and 'bad me' paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness). METHOD: We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive­behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness. RESULTS: Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of 'bad-me' deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness. CONCLUSIONS: This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.

Transversus abdominis plane block in robotic gynecologic oncology: a randomized, placebo-controlled trial.

OBJECTIVE: Although robotic surgery decreases pain compared to laparotomy, postoperative pain can be a concern near the site of a larger assistant trocar site. The aim of this study was to determine the efficacy of transversus abdominis plane (TAP) block on 24-hour postoperative opiate use after robotic surgery for gynecologic cancer. METHODS: Sixty-four subjects with gynecologic malignancies who were scheduled to undergo robotic surgery were enrolled into the study. They were randomized to receive a unilateral TAP block to the side of the assistant port via ultrasound guidance. The block was comprised of 30 cc of 0.25% bupivacaine with 3 mcg/mL epinephrine or saline. Opiate use was measured and converted into IV morphine equivalents. Patient-reported pain was measured using the Brief Pain Inventory (BPI) and Visual Analog Scale (VAS). RESULTS: The treatment group used a mean of 64.9 mg morphine in the first 24h compared to 69.3mg for controls (primary outcome, p=0.52). After age-adjustment, the treatment group used a mean of 11.1mg morphine less than controls (p=0.09). Postoperative pain scores assessed by the BPI (6.44 vs. 6.97, p=0.37) and the VAS (3.12 vs. 3.61, p=0.30) were equivalent. Block placement was uncomplicated in 98.4% of participants with mean BMI of 35.3 kg/m(2). Linear regression revealed an approximate 8.1mg decrease in morphine equivalents used per additional decade of life (p=0.0008). There was a positive correlation between the amount of opiates and BMI with an additional 8.8 mg of morphine per 10 kg/m(2) increase in BMI (p=0.0012). CONCLUSIONS: TAP block is safe and feasible in this patient population with a large proportion of morbid obesity. Preoperative TAP block does not significantly decrease opiate use. However; based on these data, a clinically useful nomogram has been created to aid clinicians in postoperative opiate-dosing for patients based on age and BMI.

The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT Self-Harm Rule.

BACKGROUND: Self-harm is a common reason for Emergency Department (ED) attendance. We aimed to develop a clinical tool to help identify patients at higher risk of repeat self-harm, or suicide, within 6 months of an ED self-harm presentation. METHOD: The tool, the ReACT Self-Harm Rule, was derived using multicentre data from a prospective cohort study. Binary recursive partitioning was applied to data from two centres, and data from a separate centre were used to test the tool. There were 29 571 self-harm presentations to five hospital EDs between January 2003 and June 2007, involving 18 680 adults aged ⩾16 years. We estimated sensitivity, specificity and positive and negative predictive values to measure the performance of the tool. RESULTS: A self-harm presentation was classified as higher risk if at least one of the following factors was present: recent self-harm (in the past year), living alone or homelessness, cutting as a method of harm and treatment for a current psychiatric disorder. The rule performed with 95% sensitivity [95% confidence interval (CI) 94-95] and 21% specificity (95% CI 21-22), and had a positive predictive value of 30% (95% CI 30-31) and a negative predictive value of 91% (95% CI 90-92) in the derivation centres; it identified 83/92 of all subsequent suicides. CONCLUSIONS: The ReACT Self-Harm Rule might be used as a screening tool to inform the process of assessing self-harm presentations to ED. The four risk factors could also be used as an adjunct to in-depth psychosocial assessment to help guide risk formulation. The use of multicentre data helped to maximize the generalizability of the tool, but we need to further verify its external validity in other localities.

The trajectory of change for children and youth in residential treatment.

This study examined the symptom response trajectories for 225 children and youth throughout a period of residential treatment. With the 10-item Conners' Global Index (CGI) as the primary outcome measure, assessments were completed on a bi-weekly basis during the average 4 month stay within the youth's residential treatment. Clients demonstrated an ongoing reduction of symptoms, and the severity of baseline symptoms influenced the trajectory of the symptom reduction. In addition, symptom reduction was characterized as logarithmic, particularly when controlling for the baseline severity of symptoms. Implications of these findings for administrators, practitioners, and researchers of residential treatment are discussed.

Peer review in MRI: A quality improvement programme and pilot study.

INTRODUCTION: The aim of this pilot study was to implement a peer review programme to evaluate MRI images and protocols, with the goal of improving quality and standardising protocols. METHOD: A plan-do-check-act method of action research was adopted. A checklist was designed and two radiographers scored the images (Optimal, Diagnostic or Suboptimal). A sample of five Lumbar Spine examinations were selected and reviewed on two separate occasions, one month apart. A consultant radiologist also scored the selected examinations. RESULTS: There was excellent intra-rater reliability for both observers. At first assessment, Cohen's weighted Kappa analysis indicated moderate inter-rater agreement (0.457) rising to substantial agreement (0.606) at second assessment. Variations in sequence parameter settings by the radiographers were noted. Feedback via educational sessions were implemented and enhancement of protocols were made. CONCLUSIONS: Radiographers manipulate many parameters during MRI examinations, and image quality can be degraded if sequences are not optimised. This may lead to misinterpretation. Initial results suggest peer review can result in improved image quality, better protocols, and improved staff confidence. There are opportunity costs involved in releasing staff from clinical work and time and resources required for image appraisal training, however we suggest this model can be extended to other departments and modalities as a healthcare improvement initiative. IMPLICATIONS FOR PRACTICE: Initial results suggest peer review processes performed by radiographers can result in improvement to protocols and image quality in MRI. With appropriate training, radiographers can implement and undertake appraisal of image quality in MRI as part of clinical governance. The purpose of feedback must be made clear, and good professional relationships should be forged to allow candid and supportive feedback with a focus on development and education.

International audit of simulation use in pre-registration medical radiation science training.

INTRODUCTION: Simulation-based education (SBE) can replicate the challenging aspects of real-world clinical environments, while providing a safe and less intimidating setting. Literature supports its use within medical radiation science (MRS) training for safe practice of psychomotor skills, development of problem solving, team working, interpersonal and decision-making skills and embedding awareness of patient safety. This project aimed to quantify usage of SBE resources and activities internationally and to evaluate how this changed during COVID-19 restrictions. METHODS: An anonymous online survey tool gathered data relating to programme demographics, simulation resources, simulation activities and future plans. A link to the survey was distributed to programme leads via social media, professional bodies and national networks. RESULTS: A total of 72 responses were received from a range of countries and representing a range of programme structures. Most respondents reported up to 100 h of SBE per student per year with low fidelity resources and image viewing software featuring most prominently. There was low reported engagement of service users within simulation activities. Respondents also indicated that COVID-19 had been a trigger for rapid uptake of simulation resources. CONCLUSION: SBE forms an important aspect of MRS training internationally with low-fidelity resources being widely deployed. Where available, high fidelity virtual reality and specialised profession-specific resources were used heavily. There was a low level of reported engagement with service users or expert patients in simulation activities. Future research will identify whether the rapid uptake of SBE during COVID-19 continues and clarify the role of service users in SBE provision. IMPLICATIONS FOR PRACTICE: Increased collaboration between MRS education providers may help to improve parity of SBE provision and identify additional opportunities to engage service users within SBE.

Sleep duration and psychotic experiences in patients at risk of psychosis: A secondary analysis of the EDIE-2 trial.

Sleep disturbance is common among individuals at risk of psychosis, yet few studies have investigated the relationship between sleep disturbance and clinical trajectory. The Early Detection and Intervention Evaluation (EDIE-2) trial provides longitudinal data on sleep duration and individual psychotic experiences from a cohort of individuals at risk of psychosis, which this study utilises in an opportunistic secondary analysis. Shorter and more variable sleep was hypothesised to be associated with more severe psychotic experiences and lower psychological wellbeing. Mixed effect models were used to test sleep duration and range as predictors of individual psychotic experiences and psychological wellbeing over the 12-24 months (with assessments every 3 months) in 160 participants. Shorter sleep duration was associated with more severe delusional ideas and hallucinations cross-sectionally and longitudinally. The longitudinal relationships did not remain significant after conservative controls were added for the previous severity of psychotic experiences. No significant relationships were found between the sleep variables and other psychotic experiences (e.g. cognitive disorganisation), or psychological wellbeing. The results support a relationship between shorter sleep duration and delusional ideas and hallucinations. Future studies should focus on improving sleep disturbance measurement, and test whether treating sleep improves clinical trajectory in the at-risk group.

Association between environmental factors including second-hand smoke and primary lung cancer in dogs.

OBJECTIVES: To estimate prevalence of exposure to environmental tobacco smoke and other environmental toxins in dogs with primary lung tumours and to analyse association between exposure and lung tumour development. MATERIALS AND METHODS: In this case-control study, an owner survey was developed to collect data on patient characteristics, general health care and environmental exposures. Dogs diagnosed with primary lung carcinomas formed the Case group. Dogs diagnosed with mast cell tumours served as Control Group 1 and dogs diagnosed with neurologic disease served as Control Group 2. Associations between diagnosis of primary lung tumour and patient and environmental exposure variables were analysed using bivariate and multivariate statistical methods. RESULTS: A total of 1178 owner surveys were mailed and 470 surveys were returned and included in statistical analysis, including 135 Cases, 169 dogs in Control Group 1 and 166 dogs in Control Group 2. An association between exposure to second-hand smoke and prevalence of primary lung cancer was not identified in this study. CLINICAL SIGNIFICANCE: Second-hand smoke is associated with primary lung cancer in people but a definitive association has not been found in dogs. The results of this study suggest that tobacco smoke exposure may not be associated with primary lung cancer development in dogs but study limitations may have precluded detection of an association.

Abnormal Pap smear follow-up in a high-risk population.

Low-income women are at high risk of developing cervical cancer attributable not only to the higher prevalence of risk factors in this population but also to the lack of timely follow-up of abnormal Pap smears. This study evaluates the efficacy of an aggressive follow-up strategy. Women with abnormal Pap smear results after screening in a public hospital emergency department were randomly assigned to follow-up either by a case-managed approach using computerized tracking and universal colposcopy or by traditional care. The main outcome was the proportion of women receiving follow-up in 6 months. A secondary outcome was the proportion of women receiving follow-up by 6 months and diagnostic resolution in 18 months. Of 54 women in the intervention group, 65% kept at least one follow-up appointment in 6 months compared with 41% of the 54 women in the control group (P = 0.012). Half the women in the intervention group versus 19% of women in the control group had follow-up in 6 months and diagnostic resolution in 18 months (P = 0.001). After adjusting for age, initial Pap smear result, and race/ethnicity, the odds of having follow-up in 6 months were four times greater for women in the intervention group (odds ratio = 4.0; 95% confidence interval, 1.6-9.7), and the odds of having both follow-up in 6 months and diagnostic resolution in 18 months were more than six times greater (odds ratio = 6.5; 95% confidence interval, 2.4-17.8). This study demonstrates that an aggressive follow-up strategy significantly improves the rate of both initial follow-up and diagnostic resolution of abnormal Pap smears among low-income women with atypical squamous cells of undetermined significance and atypical glandular cells of undetermined significance when compared with traditional care.

Iodine and thyroid cancer risk among women in a multiethnic population: the Bay Area Thyroid Cancer Study.

Research on the relationship between iodine exposure and thyroid cancer risk is limited, and the findings are inconclusive. In most studies, fish/shellfish consumption has been used as a proxy measure of iodine exposure. The present study extends this research by quantifying dietary iodine exposure as well as incorporating a biomarker of long-term (1 year) exposure, i.e., from toenail clippings. This study is conducted in a multiethnic population with a wide variation in thyroid cancer incidence rates and substantial diversity in exposure. Women, ages 20-74, residing in the San Francisco Bay Area and diagnosed with thyroid cancer between 1995 and 1998 (1992-1998 for Asian women) were compared with women selected from the general population via random digit dialing. Interviews were conducted in six languages with 608 cases and 558 controls. The established risk factors for thyroid cancer were found to increase risk in this population: radiation to the head/neck [odds ratio (OR), 2.3; 95% confidence interval (CI), 0.97-5.5]; history of goiter/nodules (OR, 3.7; 95% CI, 2.5-5.6); and a family history of proliferative thyroid disease (OR, 2.5; 95% CI, 1.6-3.8). Contrary to our hypothesis, increased dietary iodine, most likely related to the use of multivitamin pills, was associated with a reduced risk of papillary thyroid cancer. This risk reduction was observed in "low-risk" women (i.e., women without any of the three established risk factors noted above; OR, 0.53; 95% CI, 0.33-0.85) but not in "high-risk" women, among whom a slight elevation in risk was seen (OR, 1.4; 95% CI, 0.56-3.4). However, no association with risk was observed in either group when the biomarker of exposure was evaluated. In addition, no ethnic differences in risk were observed. The authors conclude that iodine exposure appears to have, at most, a weak effect on the risk of papillary thyroid cancer.

Predictors of misclassification of Hispanic ethnicity in a population-based cancer registry.

PURPOSE: Hispanic ethnicity is often used as a category for calculating population-based rates or assessing risk of epidemiologic studies. However, ethnic misclassification can lead to false conclusions unless the extent of misclassification and the characteristics of those misclassified are understood. METHODS: This study explored determinants of ethnic misclassification in a sample of 1154 cancer cases in the San Francisco-Oakland cancer registry, where ethnic classification is based on surname or medical record report. We compared the following: correctly classified Hispanics, persons classified as Hispanic who self-identified as non-Hispanic, and persons classified as non-Hispanic who self-identified as Hispanic. RESULTS: Among men classified as Hispanic, those most likely to self-identify as non-Hispanic did not speak Spanish, had non-Spanish surnames, and were recent immigrants. Women misclassified as Hispanic did not speak Spanish or have Spanish maiden names, nor did they have mothers with Spanish maiden names. Persons who called themselves Hispanic, but were misclassified by the registry, were likely to be non-Spanish speaking college-education males. CONCLUSIONS: Researchers using ethnicity should be aware of how ethnicity was determined and how this classification may bias or confound their results.

Sources of support and the physical and mental well-being of young women with breast cancer.

Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.

Child-rearing attitudes and behavioral inhibition in Chinese and Canadian toddlers: a cross-cultural study.

Behavioral inhibition data were collected from samples of 2-year-olds from the People's Republic of China and Canada. Information on child-rearing attitudes and beliefs was obtained from mothers of the children. Chinese toddlers were significantly more inhibited than their Canadian counterparts. Inhibition was associated positively with mothers' punishment orientation and negatively with mothers' acceptance and encouragement of achievement in the Canadian sample. However, the directions of the relations were opposite in the Chinese sample; child inhibition was associated positively with mothers' warm and accepting attitudes and negatively with rejection and punishment orientation. The results indicated different adaptational meanings of behavioral inhibition across cultures.

Quality of data in multiethnic health surveys.

OBJECTIVE: There has been insufficient research on the influence of ethno-cultural and language differences in public health surveys. Using data from three independent studies, the authors examine methods to assess data quality and to identify causes of problematic survey questions. METHODS: Qualitative and quantitative methods were used in this exploratory study, including secondary analyses of data from three baseline surveys (conducted in English, Spanish, Cantonese, Mandarin, and Vietnamese). Collection of additional data included interviews with investigators and interviewers; observations of item development; focus groups; think-aloud interviews; a test-retest assessment survey; and a pilot test of alternatively worded questions. RESULTS: The authors identify underlying causes for the 12 most problematic variables in three multiethnic surveys and describe them in terms of ethnic differences in reliability, validity, and cognitive processes (interpretation, memory retrieval, judgment formation, and response editing), and differences with regard to cultural appropriateness and translation problems. CONCLUSIONS: Multiple complex elements affect measurement in a multiethnic survey, many of which are neither readily observed nor understood through standard tests of data quality. Multiethnic survey questions are best evaluated using a variety of quantitative and qualitative methods that reveal different types and causes of problems.

Smoking acquisition among adolescents and young Latinas: the role of socioenvironmental and personal factors.

This paper examined the effects of socioenvironmental and personal factors on two stages of the smoking continuum--onset of smoking and regular smoking--among a sample of 1411 Latina clients, ages 14-24, at two federally funded family planning clinics. The socioenvironmental factors included cultural indicators, smoking behavior of family and peers, and norms. The personal factors were risk-taking behaviors and intention to smoke in the future. Results showed that the indicators associated with experimentation were different than those linked with regular smoking. Socioenvironmental factors associated with the transition from never having smoked to trying cigarettes included acculturation, as measured by language and familialism, and peer smoking behavior. Among the personal factors, risk-taking behavior (past use of drugs, alcohol, and general risk attitude) and smoking intentions were correlates of experimentation. The transition from experimenter to regular smoker was associated with peer smoking behavior (P< .05) in the socioenvironmental domain and drug use and intention to smoke in the future among the personal factors (both P values <.001). Age, years of education, marital status, norms, and parental smoking did not independently predict either of the smoking outcomes. Intention to smoke was the strongest predictor of experimentation (OR = 8.3, Cl 5.87-11.60) and regular smoking (OR= 19.9, CI 12.31-29.21) and could help identify those most likely to benefit from smoking prevention and cessation interventions.

Accuracy of racial classification of Vietnamese patients in a population-based cancer registry.

Racial classification of Asian subgroups is increasingly important for health statistics, given the growing Asian-American populations. This study reports the reliability of racial classification of Vietnamese in population-based cancer registry data from northern California. From the Greater Bay Area Cancer Registry, we selected 2240 persons diagnosed with cancer in 1989-1992 and whom the registry considered Vietnamese by birthplace and/or registry race and/or surname, or who were Southeast Asian or Chinese by race. One thousand ninety persons (49%) were interviewed. Sensitivity and predictive value positive, and cancer incidence rates, were calculated using different combinations of the classification factors (birthplace, registry race, and name). By registry-reported race alone, 74% of those the registry classified as Vietnamese agreed with this classification on interview, while 90% of those identifying themselves as Vietnamese were so classified. With classification based on 2 of 3 factors, 78% of those classified as Vietnamese agreed, and 91% of self-reported Vietnamese were correctly classified. Misclassification was associated with age, sex, year of immigration, education, and language use. Registry-based annual age-adjusted all-site cancer incidence rates per 100,000 for Vietnamese were 287.7 for males and 221.3 for females. Rates adjusted for self-reported ethnicity were 242.8 (male) and 213.7 (female). Registry classification of Vietnamese is currently problematic. Approximately 20% of cancer cases classified as Vietnamese are probably not Vietnamese. The higher incidence rates for Vietnamese in the United States than in Vietnam partly may reflect such classification error.