Dimensions of variation on the CORE-OM.

BACKGROUND: The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a self-report measure comprising 28 items tapping three domains; subjective well-being, psychological problems and functioning. In addition to the potential theoretical value of the domains for operationalizing the phase model of psychotherapy, when consulted, managers and clinicians considered the distinction between problems and functioning important for assessing case-mix and clinical outcomes. A further domain comprising six items was included to indicate possible risk. Subsequent analysis has suggested an alternative structure for CORE-OM with factors for risk and positively and negatively worded items (Evans et al., 2002). METHODS: This study compares models for the interpersonal factor structure in data from the CORE-OM in 2,140 patients receiving psychological therapy in the UK. RESULTS: A multi-method, multi-trait, nested factors solution accounted optimally for the CORE-OM item covariance, with a first-order general factor latent and residualized first-order factors of subjective well-being, psychological problems, functioning and risk and with positively and negatively worded methods factors. The general factor was labelled psychological distress. Scale quality for CORE-OM, using a scoring method in which non-risk items are treated as a single scale and risk items as a second scale is satisfactory. IMPLICATIONS: The CORE-OM has a complex factor structure and may be best scored as 2 scales for risk and psychological distress. The distinct measurement of psychological problems and functioning is problematic, partly because many patients receiving out-patient psychological therapies and counselling services function relatively well in comparison with patients receiving general psychiatric services. In addition, a clear distinction between self-report scales for these variables is overshadowed by their common variance with a general factor for psychological distress. An alternative strategy for operationalizing this distinction is proposed.

Diarrheal Diseases and Climate Change in Cambodia.

The DRIP-SWICCH (Developing Research and Innovative Policies Specific to the Water-related Impacts of Climate Change on Health) project aimed to increase the resilience of Cambodian communities to the health risks posed by climate change-related impacts on water. This article follows a review of climate change and water-related diseases in Cambodia and presents the results of a time series analysis of monthly weather and diarrheal disease data for 11 provinces. In addition, correlations of diarrheal disease incidence with selected demographic, socioeconomic, and water and sanitation indicators are described, with results suggesting education and literacy may be most protective against disease. The potential impact of climate change on the burden of diarrheal disease in Cambodia is considered, along with the implications of these findings for health systems adaptation.

Analysis of a care planning intervention for reducing depression in older people in residential care.

Approximately 40% of older people in residential care have significant symptoms of depression. A training and care-planning approach to reducing depression was implemented for 114 depressed residents living in 14 residential care homes in North Yorkshire, UK. Care staff were offered brief mental health training by community mental health teams for older people. They were then assigned to work individually with residents in implementing the care-planning intervention, which was aimed at alleviating depression and any health, social or emotional factors that might contribute to the resident's depression. Clinically significant improvements in depression scores were associated with implementation of the care-planning intervention as evidenced by changes in scores on the Geriatric Mental State Schedule-Depression Scale. There was evidence of an interaction between the power of the intervention and degree of dementia. These improvements were not accounted for by any changes in psychotropic medication. The training was highly valued by care staff and heads of homes, and they considered that the care-planning intervention represented an improvement in quality of care for all residents, irrespective of levels of dementia. Staff also reported improvements in morale and increased confidence in the caring role as a result of their participation. The limitations of this study are discussed. On the basis of a growing body of evidence, it is argued that there is an urgent need for a suitably powered randomised controlled trial and economic evaluation, to test the cost-effectiveness of personalised care planning interventions aimed at reducing depression in older people in residential care.