How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools.

BACKGROUND: Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. METHODS: First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. RESULTS: Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. CONCLUSIONS: We recommend further qualitative research regarding women's experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.

Dimensionality and psychometric properties of an Italian translation of the Intuitive Eating Scale-2 (IES-2): An assessment using a bifactor exploratory structural equation modelling framework.

The construct of intuitive eating is most often measured using the 23-item Intuitive Eating Scale-2 (IES-2), but previous studies have typically relied solely on confirmatory factor analysis (CFA) to understand IES-2 dimensionality. In contrast, a bifactor exploratory structural equation modelling (B-ESEM) framework offers a more realistic account of IES-2 multidimensionality. Here, we assessed the psychometric properties of a novel Italian translation using a combination of exploratory factor analysis and B-ESEM. A total of 950 adults completed the IES-2 alongside measures of positive body image, disordered eating, and psychological well-being. Results indicated that a 4-factor B-ESEM model had adequate fit to the data and that fit was improved when the correlated uniqueness of seven negatively worded IES-2 items was accounted for. This model of IES-2 scores showed adequate internal consistency and good test-retest reliability up to three weeks. Evidence of construct validity was good in terms of a global IES-2 factor, and broadly supported in terms of its specific-factors. These results highlight the utility of a B-ESEM framework for understanding the dimensionality of IES-2 scores and may help scholars better understand the extent to which the IES-2 adequately operationalises the construct of intuitive eating.

The Body Acceptance by Others Scale-2 (BAOS-2): Psychometric properties of a Bahasa Malaysia (Malay) translation and an assessment of invariance across Malaysia, the United Kingdom, and the United States.

The Body Acceptance by Others Scale-2 (BAOS-2) is a 13-item instrument measuring generalised perceptions of body acceptance by others. Here, we first demonstrate that a Bahasa Malaysia (Malay) translation of the BAOS-2 is psychometrically valid in a sample of 1,049 Malaysian adults (Study 1). Using exploratory and confirmatory factor analysis, we extracted a unidimensional model of BAOS-2 scores that retained all 13 items. BAOS-2 scores had adequate internal consistency and indices of validity (convergent, construct, concurrent, and incremental), and were scalar invariant across gender and ethnicity (Malaysian Malays vs. Chinese). Next, we assessed invariance of BAOS-2 scores across samples from Malaysia, the United Kingdom, and the United States (total N = 2,575; Study 2). Multi-group confirmatory factor analysis showed that partial scalar invariance was achieved. Participants in the interdependent cultural context of Malaysia had significantly higher scores - with small effect sizes - than their counterparts in the independent contexts of the United Kingdom and United States. In addition, women had significantly higher scores than men, but the effect size was negligible. The present study indicates that the Malay BAOS-2 is a psychometrically valid instrument and presents the first comparison of BAOS-2 scores across interdependent and independent contexts.

Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder.

OBJECTIVES: Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment. METHODS: The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points). RESULTS: Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level. CONCLUSIONS: This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.

Associations between weight status, body satisfaction, ethnic identity and self-esteem in Oceanian adolescents.

BACKGROUND: Self-esteem has consistently been observed to be relatively low in adolescents with obesity. In the Pacific region, the prevalence of obesity in adolescence is high, but few studies have considered issues of self-esteem in this population. OBJECTIVE: To examine associations between weight status, body dissatisfaction and self-esteem in a sample of New Caledonian adolescents and to test for moderation effects of ethnicity on predictors of self-esteem. METHODS: Objective anthropometric measures (height, weight, waist circumference and thickness of skinfolds) were obtained in a multi-ethnic sample of New Caledonian adolescents. Body mass index (BMI), waist-to-height ratio and the sum of four skinfolds thickness were used as proxies of weight status. Indices of ethnic identity, self-esteem, socio-demographic data (socioeconomic status, ethnicity, gender, urbanicity of residence) and body dissatisfaction were obtained using survey methods. RESULTS: Between-group analyses indicated that adolescents of European/white origin had significantly higher self-esteem than adolescents with Oceanian Non-European Non-Asian ancestry (ONENA). However, low self-esteem was significantly associated with weight status and body dissatisfactions in European/white adolescents but not ONENA adolescents. Ethnicity moderated the relationships of predictors (BMI z-score, body dissatisfaction, age, urbanicity and ethnic identity) on self-esteem, and the strongest predictors of self-esteem were ethnicity and ethnic identity. CONCLUSIONS: While self-esteem has important consequences for adolescent well-being and health outcomes, these results highlight the importance of applying different steps to develop and maintain healthy self-esteem in the Pacific region.

Oral symptoms in patients with advanced cancer: an observational study using a novel oral symptom assessment scale.

PURPOSE: The aim of this study was to utilise a novel oral assessment tool (the Oral Symptom Assessment Scale/OSAS) to investigate oral symptoms in a cohort of advanced cancer patients receiving specialist palliative care. METHODS: Participants were asked to complete the OSAS, which asks about the presence of 20 oral symptoms in the previous week (and, if present, about the frequency, the severity, and the amount of distress caused by the symptoms). Patients were also asked to complete the Memorial Symptom Assessment Scale - Short Form, and to rate their performance status. RESULTS: Two hundred fifty participants completed the study, and 244 (97.5%) participants reported at least one oral symptom on the OSAS. The median number of oral symptoms reported was five (range, 1 to 18), with dry mouth being the most common symptom (83.5% participants). The total number of oral symptoms was higher in younger participants (p = 0.012), female participants (p = 0.048), and those with a worse performance status (p < 0.001). No other oral symptoms were reported by more than two participants. Statistical analysis identified a number of potential oral symptom clusters. CONCLUSIONS: Oral symptoms (and related oral problems) are common in patients with advanced cancer, and are associated with significant morbidity in this group of patients. TRIAL REGISTRATION: CancerTrials.gov registry reference number: NCT04404920.

Exploring the Multidimensional Assessment of Interoceptive Awareness in youth aged 7-17 years.

OBJECTIVE: This study aimed to adapt the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire for younger respondents. METHOD: The language of the MAIA was revised and children aged 7-10 years (n = 212) and adolescents aged 11-17 years (n = 217) completed the questionnaire. RESULTS: The original eight-factor model was tested for fit using confirmatory factor analysis. The model had an acceptable fit in the total sample and younger subsample and overall fit in the older subsample was adequate following modification. Internal consistency was good, except for the Noticing, Not-Distracting and Not-Worrying scales. Results also demonstrated a negative linear relationship between the trusting scale and age, suggesting that youths may lose trust in their body as they age. CONCLUSION: The adapted MAIA can be used with a younger population and, depending on the research question, individual MAIA scales may be selected. The survey is available at https://osher.ucsf.edu/maia.

The Romanian version of the Intuitive Eating Scale-2: Assessment of its psychometric properties and gender invariance in Romanian adults.

The construct of intuitive eating is most often measured using the 23-item Intuitive Eating Scale-2 (IES-2). Here, we examined the psychometrics of a Romanian translation of the IES-2. Eight-hundred-and-thirty Romanian adults completed the IES-2 along with measures of positive body image, symptoms of disordered eating, and psychological well-being. Exploratory factor analyses (EFAs) with a split-half subsample (n = 420) indicated that IES-2 scores reduced to three factors in women and four in men, both of which diverged from the parent model. Confirmatory factor analysis with a second split-half sample (n = 410) indicated that the parent model had poor fit indices, whereas fit of the EFA-derived models were acceptable but not uniformly ideal. Scores on the 3-factor model - which had comparatively better fit of the models tested - had adequate internal consistency and evidenced scalar invariance across gender. However, evidence of test-retest reliability after four weeks (n = 205) was poor and evidence of construct validity, assessed through correlations with additional measures included in the survey, was weak at best. Based on these results, we question the degree to which the construct of intuitive eating can be applied to nations undergoing nutrition transitions.

The Body Acceptance by Others Scale: An assessment of its factorial validity in adults from the United Kingdom.

The construct of body acceptance by others (i.e., the degree to which an individual perceives acceptance for their appearance by others) is central to conceptual models of positive body image and adaptive eating styles. It is typically measured using the 10-item Body Acceptance by Others Scale (BAOS; Avalos & Tylka, 2006), but emerging research has suggested that a unidimensional model of BAOS scores may be unstable. Here, we examined the factor structure of BAOS scores in a sample of adults from the United Kingdom (N = 1148). Exploratory factor analyses indicated that BAOS scores reduced to two dimensions in women, of which only a primary 6-item factor was stable. In men, all 10 items loaded onto a primary factor. However, the results of confirmatory factor analyses indicated that both models of BAOS scores had poor fit. Although both the unidimensional 10-item and 6-item models had adequate internal consistency, our results are suggestive of factor structure instability. We conclude by suggesting ways in which future research could revise the BAOS to improve its factorial stability and validity.

An examination of the factor structure and preliminary assessment of the psychometric properties of a Hebrew translation of the Body Appreciation Scale-2 (BAS-2).

The Body Appreciation Scale-2 (BAS-2) is a widely-used, 10-item measure of a core facet of positive body image. To extend its use internationally, we examined the factor structure and conducted a preliminary assessment of the psychometric properties of a novel Hebrew translation of the BAS-2. A sample of 613 Israeli adults (362 women, 251 men; age M = 29.52, SD = 9.47) completed the BAS-2 alongside demographic items and previously-validated measures of life satisfaction, self-esteem, self-compassion, and body investment. Exploratory factor analyses with a semi-random split-half subsample (n = 377) indicated that BAS-2 scores reduced to a single dimension with all 10 items. This factor structure was equivalent across women and men. Confirmatory factor analysis (CFA) with a second split-half subsample (n = 235) showed the 1-dimensional factor structure had adequate fit following one modification and multi-group CFA showed that the model was invariant across sex. Men had significantly higher BAS-2 scores than women, but the effect size was small (d = 0.22). Evidence of construct validity was demonstrated through positive associations with indices of life satisfaction, self-esteem, self-compassion, and body investment. The availability of a validated BAS-2 Hebrew translation should advance future research of body appreciation in Israel.

Translation and validation of a Bahasa Malaysia (Malay) version of the Multidimensional Assessment of Interoceptive Awareness (MAIA).

OBJECTIVES: The 32-item Multidimensional Assessment of Interoceptive Awareness (MAIA) is a widely-used measure of multidimensional interoception. In the present study, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the MAIA. METHODS: An online sample of 815 Malaysian Malays (women n = 403) completed a novel translation of the MAIA. Validated measures of trait mindfulness and self-esteem were also completed to facilitate a preliminary assessment of convergent validity. RESULTS: Exploratory factor analysis indicated that the MAIA items reduced to a 19-item, 3-factor model. The 3-factor model was further tested using confirmatory factor analysis (CFA) alongside the parent 8-factor model. Both models had good fit on some indices, but less-than-ideal fit on other indices. The 3-factor model evidenced comparatively better fit, with fit indices being adequate following modification. Multi-group CFA indicated both the 3-factor model and the 8-factor model had full strict invariance across sex. However, evidence for construct and convergent validity was mixed. CONCLUSIONS: Overall the 3-dimensional Malay MAIA was demonstrated to be both internally consistent and invariant across sex, but further evidence of construct and convergent validity is required. Issues that affect the dimensionality of MAIA scores in the present and extant work are discussed in conclusion.

Stakeholder Education and Community Mobilization Garner Support for Sex Education.

PURPOSE: The University of Texas Health Science Center at San Antonio UT Teen Health (UTTH) implemented a community-wide teen pregnancy prevention (TPP) initiative in south San Antonio. This article describes how UTTH staff educated community stakeholders and mobilized community members to support implementation of evidence-based TPP interventions. METHODS: UTTH educated key stakeholders about the need for TPP efforts, strong local support for such efforts, and the value of evidence-based interventions (EBIs). The process of stakeholder education and partnership development leading to implementation of EBIs was lengthy with, for example, an average of 11 meetings and 13.5 months between the initial meeting and formal approval of EBI implementation among school partners. UTTH also mobilized the community by engaging community members on leadership teams that actively supported the initiative efforts. RESULTS: Partnerships to implement EBIs were developed with 16 middle and high schools across five local school districts, two divisions of the juvenile justice system, and five youth-serving organizations. From 2011 to 2015, more than 12,500 youth (51% female) aged 11 to 19 years received EBIs. Of the total served, 95% were served through partnerships with local schools, 4% by juvenile justice, and 1% by youth-serving organizations. CONCLUSIONS: Engaging and educating members of the community require notable time and resource investments up front; however, once strong partnerships are built, there is an ongoing opportunity to reach youth. In south San Antonio, schools provided the opportunity to reach the largest numbers of youth.

Out-of-hours prescribing: a survey of current practice in the UK.

This postal survey was developed to establish the current practice for out-of-hours (OOH) prescribing accepted in palliative care units throughout the UK. Around 144 palliative care units were sent a questionnaire and 94 units responded (65.3%). All of the responding units had non-resident medical on call cover. Although verbal orders currently appear to be the most popular communication method for OOH prescribing (84.1%), there was a wide range of other communication systems in use including email, fax and BlackBerry. There appears to be a lack of specific guidance and clarity relating to the use of remote prescribing. It seems that guidance has not kept up with changes in working patterns and technology, and in time this will hopefully change. In the meantime, all staff groups should be involved in the development of local procedures and policies appropriate to local circumstances, which pay due regard to the relevant legislation and clinical governance standards available at the time.

Biographical disruption associated with multiple sclerosis: using propensity scoring to assess the impact.

Chronic illness such as multiple sclerosis (MS) is often associated with 'biographical disruption', a concept that is derived from qualitative narrative analyses examining how people make sense of their illness in the context of their lives [Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health and Illness, 4, 167-182]. This paper attempts to operationalise the idea of disruption to one's life trajectory in quantitative analysis by examining the social, economic and emotional disruption associated with MS. A number of studies have suggested that it impacts negatively on employment, income and sexual relationships; however previous research has been based upon samples of people with MS (pwMS), with a dearth of studies comparing pwMS with the general population. This study reports a systematic comparison of MS and non-MS households to enable the impact of MS to be quantified in terms of household composition and marital status; household income; economic activity; and to determine whether biographical disruptions such as relationship breakdown or unemployment are more or less prevalent among those affected by MS compared to the general population. The MS sample came from randomly selected members of the UK MS Society (n=783) and those accessing the MS Society website (n=133). Data for the general population came from the 2001/02 British General Household Survey (GHS). Cases from the MS Society sample were matched using propensity scoring with cases from the GHS. The results of the matched analysis show that both men and women with MS are significantly less likely to be employed than those in the general population and are significantly more likely to have a 'below average' household income, despite the fact that they are in a higher social class and have higher educational levels than people in the general population. Differences between the MS and GHS samples in terms of marital status become non-significant when socio-demographic variables are controlled for using propensity scoring. This study provides robust evidence on how MS impacts on and disrupts the life of the person with MS and their household in terms of income and employment.

The psychological costs of unsustainable housing commitments.

BACKGROUND: The extended recession and stagnant housing market in the 1990s following the boom of the late 1980s resulted in more than half a million housing repossessions. This study explores the impact of unsustainable housing commitments on psychological well-being. We test the hypotheses that housing payment problems and housing arrears have adverse impacts on heads of households' psychological well-being over and above those caused by financial hardship more generally. METHOD: Data came from the British Household Panel Survey 1991-2003 and the samples for analysis consist of: (1) 5651 male head of households producing 26618 person-year observations, and (2) 2534 female head of households producing 9091 person-year observations. Summary statistics and multivariate, fixed effects regression models are used. Mental health was measured by the 12-item General Health Questionnaire. RESULTS: For male heads of households housing payment problems and entering arrears have significant detrimental effects on mental well-being and for female heads of households longer-term housing payment problems and arrears have significant detrimental effects on mental well-being. The sizes of these effects are in addition to and larger in magnitude than those associated with financial hardship more generally. The net effects appear to be relatively stable over the time of the panel data. CONCLUSIONS: This study provides evidence that housing payment problems have independent psychological costs over and above those associated with general financial hardship. The magnitude of the effect is similar to that shown for marital breakdown and job loss.

An assessment of the efficacy and tolerability of a 'double dose' of normal-release morphine sulphate at bedtime.

This study was a prospective, randomized, open, crossover study comparing a double dose (DD) of normal-release (NR) morphine at bedtime with a single dose (SD) of NR morphine at bedtime and 4 h later. Twenty patients completed the study. Four patients required breakthrough analgesia during the SD phase of the study, whilst 11 patients required breakthrough analgesia during the DD phase of the study (P = 0.01 6). Moreover, all of the pain scores were worse during the DD phase (overnight pain, P < 0.01; morning pain, P < 0.01), and some of the opioid-related side effect scores were worse during the DD phase (xerostomia, P = 0.033; vivid dreams, P = 0.05). This study does not support the European Association for Palliative Care (EAPC) recommendations on the use of a double dose of NR morphine at bedtime.

Vocational outcomes for persons with severe physical disabilities: Design and implementation of workplace supports.

Clearly, the need for a skilled labor pool is great in today's economy. Yet, many people with significant disabilities are struggling to find jobs with the majority of them unemployed or underemployed [6]. There is a need to develop strategies that can effectively empower these individuals to become part of the nation's labor force. This article describes one model project that used person-centered career plans, supported employment, and on-the-job assistive technology assessment and training to assist 21 individuals to become competitively employed. Customers worked an average of 15.66 months earning an average of $7,271 in total wages. They were hired by both small and large businesses to do a variety of tasks to include data entry, customer service, clerical assistance, as well as food prep. While the findings are preliminary, the results indicate that individuals with severe physical disabilities can maintain employment by combining supported employment and assistive technology within the workplace.