Development, preliminary validation and reliability of the colourful 'My Feelings Form' self-report for young children.

BACKGROUND: Patient-reported outcome measures place the patient at the centre of his/her care. There are calls to introduce child-reported outcome measures to mental health services. We aimed to (a) develop an age-appropriate patient-reported outcome measure for children's mental health, and (b) validate this in a primary school and Child and Adolescent Mental Health Service (CAMHS). METHODS: A list of items to measure children's mental health was proposed (Draft 1) and revised to 14 items following focus group and user consultation (Draft 2). A colourful, cartoon and emoji version was created in consultation with children (Draft 3); a professional cartoon artist created the final 'My Feelings Form' (MFF), with usability feedback (Draft 4). The MFF was tested by 317 children aged 4-13 years from one mixed-gender primary school at two time points in 1 day, and 25 children aged 4-13 years from CAMHS. Results were analysed using test-retest reliability and exploratory factor analysis; a receiver operator characteristic curve was constructed. RESULTS: The CAMHS group scored significantly higher than the school group for the mean total score (23.5 ± 11.3 vs. 16.1 ± 6.2) and for 10 items. Test-retest reliability was acceptable (correlation = 0.74, p < .001). Exploratory factor analysis using 10 informative items identified two factors - emotional factor (Cronbach's alpha = 0.74) and function factor (Cronbach's alpha = 0.59). The revised 10-item form has a Cronbach's alpha of 0.77; a cut-off of 12 has a sensitivity of 80% and specificity of 60%, indicating that it correctly identified 80% of those who were attending CAMHS and gave 60% of the schoolchildren a negative result. CONCLUSIONS: The colourful MFF was co-produced with children, and preliminary data suggest that it is a useful patient-reported outcome measure for children's mental health.

Natural fertility, infertility and the role of medically assisted reproduction: The knowledge amongst women of reproductive age in North Queensland.

BACKGROUND: The demand for medically assisted reproduction continues to increase, with more women encountering challenges with fertility. Due to misconceptions and gaps in knowledge, women are often unaware of the risks related to delayed childbearing. Lack of understanding of natural fertility, infertility and the role of medically assisted reproduction can lead to emotional suffering and changes in family plans. AIMS: To assess the understanding and knowledge that women of reproductive age in North Queensland have regarding natural fertility, infertility and the role of medically assisted reproduction. MATERIALS AND METHODS: Data were collected from 120 women (30 nurses, 30 teachers, 30 university students and 30 Technical and Further Education students) via the distribution of a structured questionnaire. Participants were surveyed in person about their personal plans and opinions, knowledge about natural fertility, infertility and medically assisted reproduction, and their preferred source of information. RESULTS: Participants demonstrated suboptimal knowledge levels throughout all sections of the questionnaire, in particular when asked about medically assisted reproduction. When asked to identify their main source of information, 'friends and family' was the most popular choice. CONCLUSIONS: Results from this North Queensland study add to the existing international literature, highlighting the widespread nature of the problem. Without adequate understanding of natural fertility, the risks of infertility, and the role and limitations of medically assisted reproduction, women make uninformed decisions. Development of local reproductive health education programs need to be instigated in response.

Addition of shear-wave elastography during second-look MR imaging-directed breast US: effect on lesion detection and biopsy targeting.

PURPOSE: To determine if adding shear-wave elastography (SWE) to second-look ultrasonography (US) after breast dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging helps find or target lesions seen on DCE MR images for US-guided biopsy. MATERIALS AND METHODS: This HIPAA-compliant prospective study was approved by the institutional review board, and written informed consent was obtained from patients. From May 2011 to July 2012, 73 women with 96 Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 lesions after DCE MR imaging prospectively consented to undergo SWE during second-look US. If a lesion was not confidently seen with B-mode US, SWE during real-time scanning was performed to determine if SWE helped find or target lesions for US biopsy. A qualitative SWE six-point color scale was used to record the maximum elasticity in and around lesions. All lesions underwent US or DCE MR imaging-guided core biopsy. RESULTS: Median participant age was 52 years (range, 21-81 years). In 72 patients who underwent DCE MR imaging, 96 BI-RADS category 4 or 5 lesions were detected in 81 breasts. There were 29 (30%) malignancies (one malignancy was of nonbreast origin), 14 (15%) high-risk lesions, and 53 (55%) benign lesions. US revealed 22 cancers, and seven cancers were detected only with MR imaging. Real-time SWE helped find one lesion and target four lesions that were incompletely assessed with gray-scale US. These five lesions that were localized or targeted for biopsy were invasive cancers, representing 23% of the 22 malignancies detected with US. CONCLUSION: Real-time SWE added to second-look US after DCE MR imaging increased the detection rate of cancers and helped target cancers for US-guided biopsy.

Integrating parental leave into specialist training: experience of trainees and recently graduated RANZCOG Fellows.

OBJECTIVES: To ascertain the views of trainees and recently graduated Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on their experiences of taking parental leave during specialist training. DESIGN: An anonymous online survey, conducted over a 1-month period from 16 August 2012 to 14 September 2012, of participants' experiences of taking parental leave and of the effects of parental leave taken by trainee colleagues on participants' own training. SETTING AND PARTICIPANTS: All trainees undertaking training for the Fellowship of the College, and all Fellows who had graduated in the past 6 years were invited to take part. Of the total 1051 invitees, 261 responded to the survey. MAIN OUTCOME MEASURES: Ease with which parental leave was granted, ability to return to a training post after taking leave, and participants' experiences of views expressed about parental leave in the work environment. RESULTS: Most participants requesting parental leave were able to access it and return to a training post; however, a small proportion experienced difficulties. Among female respondents who had taken parental leave, 28 (26.2%) reported being asked about their intentions for future pregnancy during the training application process, and 45 (42.1%) reported receiving negative comments about this in the work environment. CONCLUSIONS: While in most instances parental leave is accessible automatically, a small but significant number of trainees reported encountering difficulties. These matters are being addressed within our own College, and our results are likely to be relevant to all bodies involved in postgraduate medical training, particularly given the increasing feminisation of the medical workforce.