Using video observation in the family context: The association between camera-related behaviors and parental sensitivity.

Research on parental sensitivity often relies on video observation of parent-infant dyads. However, to date, no study has assessed both infants' and parents' interactions with the camera, and how this relates to parental sensitivity levels. This exploratory study micro-coded camera-related behaviors (CRB) by 4-month olds and their mothers and fathers on a 1-s time base, and examined the associations between those behaviors and parental sensitivity in 75 Dutch families. While parents' CRB made up only 0.8% of total interaction time, infants' made up 12%. Multi-level time-series analyses showed that infants' CRB predicted mothers'. Infants' CRB predicted fathers' CRB, and vice versa. Maternal sensitivity was significantly lower when children looked at the camera for over one-third of total interaction time (Cohen's d = 1.26). These findings indicate further research is required to better understand how video observation might threaten ecological validity.

Communication strategies to encourage child participation in an oral health promotion session: An exemplar video observational study.

BACKGROUND: The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team. AIM: To apply PaeD-TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child participation within an oral health promotion session. METHOD: A video observational study was applied. The sample consisted of a dental nurse and 22 children aged 2-5 years in a general dental practice in Scotland. Behaviours were catalogued with time stamps using PaeD-TrICS. Analysis of behavioural sequences with child participation as the dependent variable was conducted using multilevel modelling. RESULTS: Children varied significantly in their participation rate. The statistical model explained 28% of the variance. The older the child and longer consultations significantly increased child participation. Both nurse and parental behaviour had immediate influence on child participation. Parental facilitation had a strong moderating effect on the influence of the nurse on child participation. CONCLUSIONS: Child participation was dependent on nurse and parent encouragement signalling an important triadic communication process. The coding scheme and analysis illustrates an important tool to investigate these advisory sessions designed for delivering tailored messages to young children and parents. PATIENT OR PUBLIC CONTRIBUTION: The dental staff, child patients and their parents were involved closely in the conduct and procedures of the present study.

Development of a video-observation method for examining doctors' clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria.

BACKGROUND: Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients' department in Nigeria. We also develop measurement procedures and examine measurement characteristics. METHODS: Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. RESULTS: We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was 'above standard' (or 4 on a scale of 1-5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen's kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. CONCLUSIONS: Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score.

Observing sensitivity in slums in Yemen: the veiled challenge.

This study represents the first video observation of parenting practices conducted in Yemen, where women are generally fully veiled, showing only their eyes, in the presence of strangers. A total of 62 mothers and children (aged 2-6 years) were filmed in their homes for 15 minutes during free interaction. The mothers' veils did not hamper the coding of sensitivity. Consistent with the socioeconomically deprived context, average sensitivity levels were low, but over 25% of mothers were rated as (very) sensitive. Mothers with a higher educational level and those experiencing more social support were more sensitive. About half of the mothers had their child perform household chores, which was related to lower sensitivity. Observations revealed frequent looking at the camera. Almost half of the mothers verbally expressed insecurity about the videotaping, and a third expressed awareness of being filmed. Interestingly however, these behaviors were unrelated to Ainsworth ratings of maternal sensitivity.

Video observations of sensitivity in context: integrating insights from seven cultural communities.

This integrative discussion of the special issue on video observations of sensitive caregiving in different cultural communities provides a reflection on the seven empirical studies that comprise this special issue. The two main aims of this special issue are highlighted in terms of their overall conclusions: (1) video observations can be useful and reliable tools to assess sensitivity in non-Western cultural contexts; (2) caregiver sensitivity can be observed across very different cultural contexts and can be expressed in various culture-specific ways; (3) the Ainsworth sensitivity scale is particularly useful for capturing sensitivity regardless of modality. Further, the limitations of the set of studies as well as opportunities for future research are discussed.

Sensitive infant caregiving among the rural Gusii in Kenya.

The Gusii in rural Kenya represent a particularly interesting community for the study of sensitivity, as they have previously been described as not showing sensitive care. This study focuses on the observation of sensitivity in seven families with a 7-to 23-month-old infant, with extensive naturalistic video observations (ca. 2-4 hours per infant) described qualitatively and quantitatively. Sensitivity ratings showed substantial individual variation, ranging from low (2) to high (8). Sensitivity was mostly expressed non-verbally in the form of (subtle) physical responsiveness by a variety of caregivers, and seen to a high extent during infant feeding. Insensitivity was seen when caregivers were occupied with chores, and during infant bathing. Both warmth and harshness were observed, but infrequently. Results are discussed in terms of the nature of sensitive caregiving among the Gusii, and factors that might explain within-group differences.

Video observations of sensitive caregiving "off the beaten track": introduction to the special issue.

This introduction to the special issue on video observations of sensitive caregiving in different cultural communities provides a general theoretical and methodological framework for the seven empirical studies that are at the heart of this special issue. It highlights the cross-cultural potential of the sensitivity construct, the importance of research on sensitivity "off the beaten track," the advantages and potential challenges of the use of video in diverse cultural contexts, and the benefits of forming research teams that include local scholars. The paper concludes with an overview of the seven empirical studies of sensitivity in this special issue with video observations from Brazil, Indonesia, Iran, Kenya, Peru, South Africa, and Yemen.

Observing maternal sensitivity in a South African township: an exploratory study into behavioral features using different measures.

There is evidence that sensitive responsiveness is manifested differently in varying cultural contexts. This exploratory study examines a sample of 50 South African mothers in the context of a socioeconomically deprived Township, and investigates differences between the Ainsworth sensitivity scale (that does not specify particular manifestations of sensitivity) and the Maternal Behavior Q-sort (MBQ) mini, that assesses a more specified array of behaviors. Results showed a significant but modest association between the two measures, and maternal education was related to the MBQ-mini but not the Ainsworth scores. This pattern of results appears to be due to the higher salience of social games and verbal teaching in the MBQ-mini than in the Ainsworth scale. Such behaviors are less common in South African parenting, where more physical forms of responsiveness seem more typical. A local "South African" sort was developed to capture culture-specific manifestations of sensitivity.

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury.

BACKGROUND: Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world. METHODS: In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills. RESULTS: AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected. CONCLUSIONS: Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity. TRIAL REGISTRATION: The trial "Limitations of motor brain activity - use of virtual reality for simulation of therapeutic interventions" has been registered under reference number ISRCTN11757651 .

Social relations and presence of others predict bystander intervention: Evidence from violent incidents captured on CCTV.

Are individuals willing to intervene in public violence? Half a century of research on the "bystander effect" suggests that the more bystanders present at an emergency, the less likely each of them is to provide help. However, recent meta-analytical evidence questions whether this effect generalizes to violent emergencies. Besides the number of bystanders present, an alternative line of research suggests that pre-existing social relations between bystanders and conflict participants are important for explaining whether bystanders provide help. The current paper offers a rare comparison of both factors-social relations and the number of bystanders present-as predictors of bystander intervention in real-life violent emergencies. We systematically observed the behavior of 764 bystanders across 81 violent incidents recorded by surveillance cameras in Copenhagen, Denmark. Bystanders were sampled with a case-control design, their behavior was observed and coded, and the probability of intervention was estimated with multilevel regression analyses. The results confirm our predicted association between social relations and intervention. However, rather than the expected reversed bystander effect, we found a classical bystander effect, as bystanders were less likely to intervene with increasing bystander presence. The effect of social relations on intervention was larger in magnitude than the effect of the number of bystanders. We assess these findings in light of recent discussions about the influence of group size and social relations in human helping. Further, we discuss the utility of video data for the assessment of real-life bystander behavior.

Development of an interaction coding scheme (PaeD-TrICS) to record the triadic communication behaviours in preventive dental consultations with preschool child patients and families: a video-based observational study.

BACKGROUND: There is a paucity of research concerning paediatric dental consultations in primary care. This is potentially due to the difficulty of measuring the communication behaviours in the complex triadic consultations. The present study aims to describe the development and refinement of a coding scheme to record the triadic communication between dental professionals, child patients and parents. METHODS: The PaeD-TrICS was developed from video observation of triadic communications and refined through an iterative process. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. RESULTS: The PaeD-TrICS contains 45 codes. Forty-four dental professional-child-parent communications were successfully coded through administering the scheme on The Observer XT 10.5 system. Cohen's Kappa was 0.83 (inter-coder) and 0.90 (intra-coder). "Parental verbal facilitation" (mean = 1.68/min) was the most frequent behaviour. Dental professionals' "dentally engaging talk" (mean = 1.24/min), "praise" (mean = 1.10/min) and "instruction" (mean = 0.62/min) were frequently seen. Children's common behaviours included "speech other" (mean = 0.66/min) and non-verbal behaviour i.e. "non-verbal agreement" and verbal behaviour "speech yes" (mean = 0.26/min). CONCLUSIONS: The PaeD-TrICS is developed to capture the communication behaviour of the triadic consultations in a preventive dental setting. It demonstrates satisfactory intra- and inter-coder reliability and has been successfully used in paediatric dental consultations.

Measuring surgical safety during minimally invasive surgical procedures: a validation study.

BACKGROUND: During the implementation of new interventions (i.e., surgical devices and technologies) in the operating room, surgical safety might be compromised. Current safety measures are insufficient in detecting safety hazards during this process. The aim of the study was to observe whether surgical teams are capable of measuring surgical safety, especially with regard to the introduction of new interventions. METHODS: A Surgical Safety Questionnaire was developed that had to be filled out directly postoperative by three surgical team members. A potential safety concern was defined as at least one answer between (strongly) disagree and indifferent. The validity of the questionnaire was assessed by comparison with the results from video analysis. Two different observers annotated the presence and effect of surgical flow disturbances during 40 laparoscopic hysterectomies performed between November 2010 and April 2012. RESULTS: The surgeon reported a potential safety concern in 16% (85/520 questions). With respect to the scrub nurse and anesthesiologist, this was both 9% (46/520). With respect to the preparation, functioning, and ease of use of the devices in 37.5-47.5% (15-19/40 procedures) a potential safety concern was reported by one or more team members. During procedures after which a potential safety concern was reported, surgical flow disturbances lasted a higher percentage of the procedure duration [9.3 ± 6.2 vs. 2.9 ± 3.7% (mean ± SD), p < .001]. After procedures during which a new instrument or device was used, more potential safety concerns were reported (51.2 vs. 23.1%, p < .001). CONCLUSIONS: Potential safety concerns were especially reported during procedures in which a relatively high percentage of the duration consisted of surgical flow disturbances and during procedures in which a new instrument or device was used. The Surgical Safety Questionnaire can act as a validated tool to evaluate and maintain surgical safety during minimally invasive procedures, especially during the introduction of a new intervention.

Physical activity patterns across time-segmented youth sport flag football practice.

BACKGROUND: Youth sport (YS) reaches a large number of children world-wide and contributes substantially to children's daily physical activity (PA), yet less than half of YS time has been shown to be spent in moderate-to-vigorous physical activity (MVPA). Physical activity during practice is likely to vary depending on practice structure that changes across YS time, therefore the purpose of this study was 1) to describe the type and frequency of segments of time, defined by contextual characteristics of practice structure, during YS practices and 2) determine the influence of these segments on PA. METHODS: Research assistants video-recorded the full duration of 28 practices from 14 boys' flag football teams (2 practices/team) while children concurrently (N = 111, aged 5-11 years, mean 7.9 ± 1.2 years) wore ActiGraph GT1M accelerometers to measure PA. Observers divided videos of each practice into continuous context time segments (N = 204; mean-segments-per-practice = 7.3, SD = 2.5) using start/stop points defined by change in context characteristics, and assigned a value for task (e.g., management, gameplay, etc.), member arrangement (e.g., small group, whole group, etc.), and setting demand (i.e., fosters participation, fosters exclusion). Segments were then paired with accelerometer data. Data were analyzed using a multilevel model with segment as unit of analysis. RESULTS: Whole practices averaged 34 ± 2.4% of time spent in MVPA. Free-play (51.5 ± 5.5%), gameplay (53.6 ± 3.7%), and warm-up (53.9 ± 3.6%) segments had greater percentage of time (%time) in MVPA compared to fitness (36.8 ± 4.4%) segments (p ≤ .01). Greater %time was spent in MVPA during free-play segments compared to scrimmage (30.2 ± 4.6%), strategy (30.6 ± 3.2%), and sport-skill (31.6 ± 3.1%) segments (p ≤ .01), and in segments that fostered participation (36.1 ± 2.7%) than segments that fostered exclusion (29.1 ± 3.0%; p ≤ .01). Significantly greater %time was spent in low-energy stationary behavior in fitness (15.7 ± 3.4%) than gameplay (4.0 ± 2.9%) segments (p ≤ .01), and in sport-skill (17.6 ± 2.2%) than free-play (8.2 ± 4.2%), gameplay, and warm-up (10.6 ± 2.6%) segments (p < .05). CONCLUSIONS: The %time spent in low-energy stationary behavior and in MVPA differed by characteristics of task and setting demand of the segment. Restructuring the routine of YS practice to include segments conducive to MVPA could increase %time spent in MVPA during practice. As YS reaches a large number of children worldwide, increasing PA during YS has the potential to create a public health impact.

Tooth brushing motion patterns with manual and powered toothbrushes-a randomised video observation study.

INTRODUCTION: Systematic reviews have shown that powered toothbrushes (PTs) are more effective than manual toothbrushes (MTs), but with only minor effect sizes. Whether PTs are used adequately, however, has not been investigated so far. The aim of the present study was therefore to analyse motion habits with PT in comparison to MT toothbrushes by video observation. MATERIALS AND METHODS: One hundred subjects were enrolled in this observational trial and brushed their teeth in randomised order with a MT and PT while being video-filmed, resulting in 95 analysable sets of recordings. Parameters of interest were brushing duration (s; median (min;max)), type of brushing strokes, area of brushing, changes between areas (n; median (min;max)) and brushing sequence. RESULTS: Brushing duration was 145 s (60;354) and 135 s (48;271) for PT and MT, respectively (p ≤ 0.001). Subjects brushed vestibular surfaces completely, but reached oral surfaces to a much lesser extent, regardless of the toothbrush type. With both toothbrushes, subjects moved frequently between areas (MT 35 (14;79); PT 33 (14;85); n.s.) and brushed predominantly with circling and horizontal strokes; with the PT, 50.5% of the subjects spent only <10% of the brushing duration with passive brushing (positioning the brush head on the teeth with ≤2 movements/s). CONCLUSIONS: Intra-individual motion patterns were similar with both MT and PT, and most subjects persisted in their habitual motion patterns regardless of the toothbrush type. CLINICAL RELEVANCE: The use of PT and MT may need intensive training and supervision from oral hygiene educators in order to help subjects taking full advantage from these devices.

Video observations of sensitivity in context: integrating insights from seven cultural communities.

This integrative discussion of the special issue on video observations of sensitive caregiving in different cultural communities provides a reflection on the seven empirical studies that are at the heart of this special issue. The two main aims of this special issue are highlighted in terms of their overall conclusions: (1) video observations can be useful and reliable tools to assess sensitivity in non-Western cultural contexts; (2) caregiver sensitivity can be observed across very different cultural contexts and can be expressed in various culture-specific ways. Furthermore, the limitations of the set of studies as well as opportunities for future research are discussed.

Observing sensitivity in slums in Yemen: the veiled challenge.

This study represents the first video observation of parenting practices conducted in Yemen, where filming women is a taboo, and women are generally fully veiled, showing only their eyes, in the presence of strangers. A total of 62 mothers and children (aged 2-6 years) were filmed in their homes for 15 min during free interaction. The mothers' veils were not experienced as hampering the coding of sensitivity. Consistent with the socioeconomically deprived context, average sensitivity levels were low, but over 25% of mothers were rated as (very) sensitive. About half of the mothers elected to have their child do household chores, which in turn was related to lower levels of sensitivity. Observations revealed frequent looking at the camera. Almost half of the mothers verbally expressed insecurity about the videotaping, and a third expressed awareness of being filmed. Interestingly however, these behaviors were unrelated to Ainsworth ratings of maternal sensitivity.

Video observations of sensitive caregiving "off the beaten track": introduction to the special issue.

This introduction to the special issue on video observations of sensitive caregiving in different cultural communities provides a general theoretical and methodological framework for the seven empirical studies that are at the heart of this special issue. It highlights the cross-cultural potential of the sensitivity construct, the importance of research on sensitivity "off the beaten track," the advantages and potential challenges of the use of video in diverse cultural contexts, and the benefits of forming research teams that include local scholars. The paper concludes with an overview of the seven empirical studies of sensitivity in this special issue with video observations from Brazil, Indonesia, Iran, Kenya, Peru, South Africa, and Yemen.

Sensitive infant caregiving among the rural Gusii in Kenya.

The Gusii in rural Kenya represent a particularly interesting community for the study of sensitivity, as they have previously been described as not showing sensitive care. This study focuses on the observation of sensitivity in seven families with a 7-to 23-month-old infant, with extensive naturalistic video observations (ca. 2-4 h per infant) in a multiple caregiver setting, and potential co-existing harsh parenting practices. The average score for received sensitive caregiving was rather low at 5.3, but four out of seven infants were rated as receiving at least adequately sensitive care. Sensitivity was mostly expressed non-verbally in the form of (subtle) physical responsiveness by a variety of caregivers, and seen to a high extent during infant feeding. Insensitivity was seen when caregivers were occupied with chores, and during infant bathing. Results are discussed in terms of the nature of sensitive caregiving among the Gusii, and factors that might explain within-group differences.

Surgical flow disturbances in dedicated minimally invasive surgery suites: an observational study to assess its supposed superiority over conventional suites.

BACKGROUND: Minimally invasive surgery (MIS) is frequently compromised by surgical flow disturbances due to technology- and equipment-related failures. Compared with MIS in a conventional cart-based OR, performing MIS in a dedicated integrated operating room (OR) is supposed to be beneficial to patient safety. The aim of this study was to compare a conventional OR with an integrated OR with regard to the incidence and effect of equipment-related surgical flow disturbances during an advanced laparoscopic gynecological procedure [laparoscopic hysterectomy (LH)]. METHODS: Using video recording, 40 LHs performed between November 2010 and April 2012 (20 in a conventional cart-based OR and 20 in an integrated OR) were analyzed by two different observers. Outcome measures were the number, duration and effect (on a seven-point ordinal scale) of the surgical flow disturbances (e.g., malfunctioning, intraoperative repositioning, setup device). RESULTS: A total of 103 h and 45 min was observed. The interobserver agreement was high (kappa .85, p < .001). Procedure time was not significantly different (NS) [conventional OR vs. integrated OR, minutes ± standard deviation (SD), mean 161 ± 27 vs. 150 ± 34]. A total of 1651 surgical flow disturbances were observed (mean ± SD per procedure 40.8 ± 19.4 vs. 41.8 ± 15.9, NS). The mean number of surgical flow disturbances per procedure with regard to equipment was 6.3 ± 3.7 versus 8.5 ± 4.0, NS. No clinically relevant differences in the mean effect of these disturbances on the surgical flow between the two OR setups were observed. CONCLUSIONS: Performing LH in an integrated OR did not reduce the number of surgical flow disturbances nor the effect of these disturbances. Furthermore, in the integrated OR, repositioning of the monitors was a frequent and time-consuming source of disturbance. In order to maintain the high standard of surgical safety, the entire surgical team has to be aware that by performing surgery in an integrated OR different potential source for disruption arise.

Understanding discharge communication behaviours in a pediatric emergency care context: a mixed methods observation study protocol.

BACKGROUND: One of the most important transitions in the continuum of care for children is discharge to home. Optimal discharge communication between healthcare providers and caregivers (e.g., parents or other guardians) who present to the emergency department (ED) with their children is not well understood. The lack of policies and considerable variation in practice regarding discharge communication in pediatric EDs pose a quality and safety risk for children and their parents. METHODS: The aim of this mixed methods study is to better understand the process and structure of discharge communication in a pediatric ED context to contribute to the design and development of discharge communication interventions. We will use surveys, administrative data and real-time video observation to characterize discharge communication for six common illness presentations in a pediatric ED: (1) asthma, (2) bronchiolitis, (3) abdominal pain, (4) fever, (5) diarrhea and vomiting, and (6) minor head injury. Participants will be recruited from one of two urban pediatric EDs in Canada. Video recordings will be analyzed using Observer XT. We will use logistic regression to identify potential demographic and visit characteristic cofounders and multivariate logistic regression to examine association between verbal and non-verbal behaviours and parent recall and comprehension. DISCUSSION: Video recording of discharge communication will provide an opportunity to capture important data such as temporality, sequence and non-verbal behaviours that might influence the communication process. Given the importance of better characterizing discharge communication to identify potential barriers and enablers, we anticipate that the findings from this study will contribute to the development of more effective discharge communication policies and interventions.