Evaluation of a Virtual Tai Chi Program for Older Veterans at Risk of Loneliness or Physical Deconditioning: A Quality Improvement Project.

This Quality Improvement project evaluated the implementation of a virtual Tai Chi program for older Veterans (OVs) at risk of loneliness and/or physical deconditioning. A 12-week Tai Chi course was conducted virtually at three Veterans Affairs sites using VA Video Connect (VVC). Changes in physical function based on the 30-Second Chair Stand (30CST) and loneliness based on the De Jong Gierveld Loneliness Scale (DJGS) were measured, as were the OVs' satisfaction and adherence. Of 109 OVs who enrolled, 74 completed the program with a mean attendance rate of 84%. Completers demonstrated a statistically significant improvement in the 30CST, and those who were moderately or severely lonely at baseline saw a statistically significant improvement in the DJGS. Course evaluations were generally very positive. Results suggest that a virtual Tai Chi program is an effective and very satisfying intervention for OVs at risk of loneliness or physical deconditioning.

SARS-CoV-2 viral titer measurements in Ontario, Canada wastewaters throughout the COVID-19 pandemic.

During the COVID-19 pandemic, the Province of Ontario, Canada, launched a wastewater surveillance program to monitor SARS-CoV-2, inspired by the early work and successful forecasts of COVID-19 waves in the city of Ottawa, Ontario. This manuscript presents a dataset from January 1, 2021, to March 31, 2023, with RT-qPCR results for SARS-CoV-2 genes and PMMoV from 107 sites across all 34 public health units in Ontario, covering 72% of the province's and 26.2% of Canada's population. Sampling occurred 2-7 times weekly, including geographical coordinates, serviced populations, physico-chemical water characteristics, and flowrates. In doing so, this manuscript ensures data availability and metadata preservation to support future research and epidemic preparedness through detailed analyses and modeling. The dataset has been crucial for public health in tracking disease locally, especially with the rise of the Omicron variant and the decline in clinical testing, highlighting wastewater-based surveillance's role in estimating disease incidence in Ontario.

Case Illustration of the Natural History of Left Dominant Arrhythmogenic Cardiomyopathy.

Background: Arrhythmogenic left ventricular cardiomyopathy is an increasingly recognized cause of recurrent myocarditis, a mimicker of acute coronary syndrome, and an important cause of malignant ventricular arrythmias and heart failure. Desmoplakin is a protein that is critical to maintaining the structural integrity of the myocardium. Disruption of desmoplakin leads to fibrofatty infiltration of the myocardium which leads to congestive heart failure, cardiac arrhythmias, and sudden cardiac death. However, desmoplakin cardiomyopathy is often misdiagnosed, resulting in significant morbidity and mortality. We report 2 contrasting cases illustrating the natural history-hot and cold phases-of arrhythmogenic left ventricular cardiomyopathy. Case Series: The first case demonstrates a common phenotypic presentation of desmoplakin cardiomyopathy manifested as recurrent myocarditis and myocardial injury representing the hot phase. The second case is an undulating course of chronic systolic heart failure and ventricular arrhythmias representing the cold phase. Conclusion: Arrhythmogenic cardiomyopathy manifests as a spectrum of disease processes that involve the right, left, or both ventricles. Mutations in the desmoplakin gene are often associated with a left dominant ventricular cardiomyopathy. Diagnosis remains difficult as the condition has no signature clinical presentation, and imaging findings are variable.

Polyethylenimine mediated recovery of SARS-CoV-2 and total viral RNA: Impact of aqueous conditions on behaviour and recovery.

Wastewater-based epidemiology (WBE) is an emerging, practical surveillance tool for monitoring community levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, SC2). However, a paucity of data exists regarding SARS-CoV-2 and viral biomarker behaviour in aqueous and wastewater environments. Therefore, there is a pressing need to develop efficient and robust methods that both improve method sensitivity and reduce time and cost. We present a novel method for SARS-CoV-2, Human Coronavirus 229E (229E), and Pepper Mild Mottle Virus (PMMoV) recovery utilizing surface charge-based attraction via the branched cationic polymer, polyethylenimine (PEI). Initially, dose-optimization experiments demonstrated that low concentrations of PEI (0.001% w/v) proved most effective at flocculating suspended viruses and viral material, including additional unbound SC2 viral fragments and/or RNA from raw wastewater. A design-of-experiments (DOE) approach was used to optimize virus and/or viral material aggregation behaviour and recovery across varying aqueous conditions, revealing pH as a major influence on recoverability in this system, combinatorially due to both a reduction in viral material surface charge and increased protonation of PEI-bound amine groups. Overall, this method has shown great promise in significantly improving quantitative viral recovery, providing a straightforward and effective augmentation to standard centrifugation techniques.

CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity.

INTRODUCTION: The WHO Surgical Safety Checklist (SSC) is a communication tool that improves teamwork and patient outcomes. SSC effectiveness is dependent on implementation fidelity. Administrative audits fail to capture most aspects of SSC implementation fidelity (ie, team communication and engagement). Existing research tools assess behaviours during checklist performance, but were not designed for routine quality assurance and improvement. We aimed to create a simple tool to assess SSC implementation fidelity, and to test its reliability using video simulations, and usability in clinical practice. METHODS: The Checklist Performance Observation for Improvement (CheckPOINT) tool underwent two rounds of face validity testing with surgical safety experts, clinicians and quality improvement specialists. Four categories were developed: checklist adherence, communication effectiveness, attitude and engagement. We created a 90 min training programme, and four trained raters independently scored 37 video simulations using the tool. We calculated intraclass correlation coefficients (ICC) to assess inter-rater reliability (ICC>0.75 indicating excellent reliability). We then trained two observers, who tested the tool in the operating room. We interviewed the observers to determine tool usability. RESULTS: The CheckPOINT tool had excellent inter-rater reliability across SSC phases. The ICC was 0.83 (95% CI 0.67 to 0.98) for the sign-in, 0.77 (95% CI 0.63 to 0.92) for the time-out and 0.79 (95% CI 0.59 to 0.99) for the sign-out. During field testing, observers reported CheckPOINT was easy to use. In 98 operating room observations, the total median (IQR) score was 25 (23-28), checklist adherence was 7 (6-7), communication effectiveness was 6 (6-7), attitude was 6 (6-7) and engagement was 6 (5-7). CONCLUSIONS: CheckPOINT is a simple and reliable tool to assess SSC implementation fidelity and identify areas of focus for improvement efforts. Although CheckPOINT would benefit from further testing, it offers a low-resource alternative to existing research tools and captures elements of adherence and team behaviours.

Evaluation of the Online Component of a Blended Learning Electroconvulsive Therapy Curriculum for Psychiatry Residents to Treat Depression in Older Adults.

OBJECTIVE: The objective of this study was to evaluate the online component of a blended curriculum for psychiatry residents on the use of electroconvulsive therapy (ECT) to treat depression in older adults. METHODS: Second- and third-year general psychiatry residents completed a blended learning curriculum during their core geriatric psychiatry rotation. The curriculum consisted of didactic seminars, hands-on clinical management, and two online clinical cases focused on the management of late-life depression with ECT. Knowledge acquisition following module completion was measured using a nine-question multiple-choice test. The authors adapted the Medical E-Learning Evaluation Survey (MEES) to measure resident satisfaction, clinical relevance, and instructional design. RESULTS: A total of 37 residents completed both online modules. Of these, 35 residents completed the knowledge test and 23 completed the adapted MEES. Almost all participants (96%) agreed or strongly agreed that the modules were relevant to their clinical work, evidence-based, able to be completed in a reasonable amount of time, and a valuable learning experience. The average score on the knowledge test, after removing one outlier, was 83%. CONCLUSION: Psychiatry residents are very satisfied with the content and delivery of the online component of a blended curriculum for understanding the use of ECT for late-life depression. Future work should examine satisfaction with the remainder of the curricula as well as the impact on longer-term knowledge acquisition and patient care.

The two faces of Janus: Processes can be both exogenous forcings and endogenous feedbacks with wind as a case study.

Janus is the Roman god of transitions. In many environments, state transitions are an important part of our understanding of ecological change. These transitions are controlled by the interactions between exogenous forcing factors and stabilizing endogenous feedbacks. Forcing factors and feedbacks are typically considered to consist of different processes. We argue that during extreme events, a process that usually forms part of a stabilizing feedback can behave as a forcing factor. And thus, like Janus, a single process can have two faces. The case explored here pertains to state change in drylands where interactions between wind erosion and vegetation form an important feedback that encourages grass-to-shrub state transitions. Wind concentrates soil resources in shrub-centered fertile islands, removes resources through loss of fines to favor deep-rooted shrubs, and abrades grasses' photosynthetic tissue, thus further favoring the shrub state that, in turn, experiences greater aeolian transport. This feedback is well documented but the potential of wind to act also as a forcing has yet to be examined. Extreme wind events have the potential to act like other drivers of state change, such as drought and grazing, to directly reduce grass cover. This study examines the responses of a grass-shrub community after two extreme wind events in 2019 caused severe deflation. We measured grass cover and root exposure due to deflation, in addition to shrub height, grass patch size, and grass greenness along 50-m transects across a wide range of grass cover. Root exposure was concentrated in the direction of erosive winds during the storms and sites with low grass cover were associated with increased root exposure and reduced greenness. We argue that differences between extreme, rare wind events and frequent, small wind events are significant enough to be differences in kind rather than differences in degree allowing extreme winds to behave as endogenous forcings and common winds to participate in an endogenous stabilizing feedback. Several types of state change in other ecological systems in are contextualized within this framework.

Investigating electrochemical deposition of gold on commercial off-the-shelf 3-D printing materials towards developing sensing applications.

The COVID-19 pandemic highlighted the inaccessibility of quick and affordable clinical diagnostics. This led to increased interest in creating low-cost portable electrochemical (EC) devices for environmental monitoring and clinical diagnostics. One important perspective is to develop new fabrication methods for functional and low-cost electrode chips. Techniques, such as electron beam and photolithography, allow precise and high-resolution electrode fabrication; however, they are costly and can be time-consuming. More recently, fused deposition modeling three-dimensional (3-D) printing is being used as an alternative fabrication technique due to the low-cost of the printer and rapid prototyping capability. In this study, we explore enhancing the conductivity of 3-D printed working electrodes with EC gold deposition. Two commercial conductive filament brands were used and investigated to fabricate electrode chips. Furthermore, strategies to apply epoxy glue and conductive silver paint were investigated to control the electrode surface area and ensure good electrical connection. This device enables detection at drinking water concentration thresholds. The practical application of the fabricated electrodes is demonstrated by detecting Cu2+ using anodic stripping voltammetry.

An analysis of physician reviews in relation to quality and social media presence.

Press Ganey patient engagement survey scores are used among health care facilities throughout the US to evaluate patients' perception of the quality of care provided. The relation of Press Ganey score to primary quality metrics has not been reported before; thus, we studied it in a cohort of Baylor Scott and White Health primary care physicians. Using simple linear regression, we evaluated Press Ganey scores and compared them with primary care quality metrics associated with improved patient outcomes, including cancer screening, depression screening, blood pressure, and glucose control, in addition to well-child visits. We found that overall quality had a very low linear correlation with Press Ganey survey items, and high-quality performance and increased number of practice years had an overall positive correlation with high survey ratings. We also found that social media presence or total website activity was not an important feature in predicting the top 25 quality performers within the health care system.

Non-REM sleep with hypertonia in Parkinsonian Spectrum Disorders: A pilot investigation.

INTRODUCTION: From an ongoing multicenter effort toward differentiation of Parkinsonian spectrum disorders (PSD) from other types of neurodegenerative disorders, the sleep biomarker non-rapid-eye-movement sleep with hypertonia (NRH) emerged. METHODS: This study included in the PSD group patients with dementia with Lewy bodies/Parkinson disease dementia (DLB/PDD = 16), Parkinson disease (PD = 16), and progressive supranuclear palsy (PSP = 13). The non-PSD group included patients with Alzheimer disease dementia (AD = 24), mild cognitive impairment (MCI = 35), and a control group with normal cognition (CG = 61). In-home, multi-night Sleep Profiler studies were conducted in all participants. Automated algorithms detected NRH, characterized by elevated frontopolar electromyographic power. Between-group differences in NRH were evaluated using Logistic regression, Mann-Whitney U and Chi-squared tests. RESULTS: NRH was greater in the PSD group compared to non-PSD (13.9 ± 11.0% vs. 3.1 ± 4.7%, P < 0.0001). The threshold NRH≥5% provided the optimal between-group differentiation (AUC = 0.78, P < 0.001). NRH was independently associated with the PSD group after controlling for age, sex, and SSRI/SNRI use (P < 0.0001). The frequencies of abnormal NRH by subgroup were PSP = 92%, DLB/PDD = 81%, PD = 56%, MCI = 26%, AD = 17%, and CG = 16%. The odds of abnormal NRH in each PSD subgroup ranged from 3.7 to 61.2 compared to each non-PSD subgroup. The night-to-night and test-retest intraclass correlations were excellent (0.78 and 0.84, both P < 0.0001). CONCLUSIONS: In this pilot study, NRH appeared to be a novel candidate sleep biomarker for PSD-related neurodegeneration. Future studies in larger cohorts are needed to confirm these findings, understand the etiology of NRH magnitude/duration, and determine whether it is an independent prodromal marker for specific neurodegenerative pathologies.

Correlates of Conversion from Mild Cognitive Impairment to Dementia with Lewy Bodies: Data from the National Alzheimer's Coordinating Center.

BACKGROUND: Many patients with dementia with Lewy bodies (DLB) miss out on the best standards of care and psychosocial support due to diagnostic delays or inaccuracies following symptom onset. OBJECTIVE: This study seeks to identify baseline characteristics in individuals with mild cognitive impairment (MCI) that correlate with eventual conversion to DLB or Alzheimer's disease (AD). METHODS: Baseline neuropsychological and neuropsychiatric data were analyzed in National Alzheimer's Coordinating Center participants who completed the Uniform Data Set between 2006 and 2020 and subsequently converted from MCI to DLB or AD (n = 1632). RESULTS: Only 6% of participants with MCI converted to DLB. Among those who converted to DLB, multidomain amnestic MCI (aMCI) was the most common subtype at study entry. As part of logistic regression analyses, odds ratios (ORs) were estimated for conversion to DLB versus AD based on study-entry characteristics, adjusting for age, sex, education, and years to diagnosis. The strongest predictors of conversion to DLB (p≤0.0001) were nonamnestic MCI versus aMCI (OR 8.2, CI [5.0, 14]), multidomain MCI versus single-domain MCI (OR 2.7, CI [1.7. 4.2]), male sex (OR 4.2, CI [2.5, 7.1]), and presence of nighttime behaviors (OR 4.4 CI [2.8, 6.9]). CONCLUSION: A diagnosis of prodromal DLB should be considered in individuals with MCI who present with prominent executive/visuospatial deficits, neuropsychiatric symptoms, and less memory impairment. Early diagnosis of DLB may guide treatment planning, including the avoidance of antipsychotic medications in patients who develop psychotic symptoms, caregiver support, and initiation of early treatment(s) once medications become available.

'Modelling social exclusion in a diagnostically-mixed sample of people with severe mental illness'.

BACKGROUND: Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion. AIMS: (1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness. METHOD: Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations. RESULTS: About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age (p = .008), lack of higher education (p < .001), more previous admissions (p = .005), severity of current symptoms and greater experienced stigma (p = .006) and anticipated stigma (p = .035). Greater social inclusion was associated with better quality of life (p < .001) and less loneliness (p < .001). CONCLUSIONS: Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people's social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.

Leading from Behind: An Educational Intervention to Address Faculty and Learner Preparedness for Competence By Design in Psychiatry.

PURPOSE: Residency training programs across Canada are beginning to implement the Royal College of Physicians and Surgeons of Canada's new Competence By Design (CBD) framework in medical education. The objective of the current research was to assess faculty members' and learners' understanding of, and preparedness for, the national shift to CBD in psychiatry before and after an educational intervention. METHODS: The current research implemented a pre-test/post-test design to investigate faculty members' and learners' perceptions and attitudes towards competency-based medical education (CBME) and CBD before and after a one-hour educational session delivered by an expert on CBME. RESULTS: Of the 104 session attendees, 83 (79.8%) completed the pre-survey and 80 (76.9%) completed the post-survey. Both groups reported a moderate level of baseline knowledge of CBME and CBD. Knowledge of CBME improved significantly for both faculty members (p = 0.03) and learners (p < 0.01) after the education session; however, only learners showed a significant increase in knowledge of the CBD framework following the education session (p < 0.01). Further, only learners demonstrated a significant increase in perceived preparedness for CBD following the session (p = 0.02). CONCLUSION: Overall, a brief, one-hour education session was at least somewhat effective at improving knowledge and preparedness for psychiatry's transition to CBD. In order to facilitate the transition to CBD and to assist in the rollout of future policy changes, psychiatry departments should provide both faculty members and learners with educational sessions and resources prior to the policy implementation.

Social Innovation For Health Research: Development of the SIFHR Checklist.

BACKGROUND: Social innovations in health are inclusive solutions to address the healthcare delivery gap that meet the needs of end users through a multi-stakeholder, community-engaged process. While social innovations for health have shown promise in closing the healthcare delivery gap, more research is needed to evaluate, scale up, and sustain social innovation. Research checklists can standardize and improve reporting of research findings, promote transparency, and increase replicability of study results and findings. METHODS AND FINDINGS: The research checklist was developed through a 3-step community-engaged process, including a global open call for ideas, a scoping review, and a 3-round modified Delphi process. The call for entries solicited checklists and related items and was open between November 27, 2019 and February 1, 2020. In addition to the open call submissions and scoping review findings, a 17-item Social Innovation For Health Research (SIFHR) Checklist was developed based on the Template for Intervention Description and Replication (TIDieR) Checklist. The checklist was then refined during 3 rounds of Delphi surveys conducted between May and June 2020. The resulting checklist will facilitate more complete and transparent reporting, increase end-user engagement, and help assess social innovation projects. A limitation of the open call was requiring internet access, which likely discouraged participation of some subgroups. CONCLUSIONS: The SIFHR Checklist will strengthen the reporting of social innovation for health research studies. More research is needed on social innovation for health.

Systematic Literature Review of the Epidemiology of Advanced Prostate Cancer and Associated Homologous Recombination Repair Gene Alterations.

PURPOSE: To characterize the global epidemiology of metastatic castration-sensitive prostate cancer (mCSPC), nonmetastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC). Additionally, to assess the prevalence of homologous recombination repair gene alterations (HRRm) and their prognostic impact in advanced disease setting. MATERIALS AND METHODS: A systematic literature review of real-world evidence published from January 2009 through May 2019 was conducted to assess global epidemiology and clinical practice trends for mCSPC, nmCRPC, mCRPC and HRRm; 4,732 papers were systematically screened for inclusion. Ten conference proceedings from 2014 through 2019 were reviewed. RESULTS: Of the screened articles 22 relevant publications were identified for this paper. Six publications reported global epidemiology of advanced prostate cancer. The prevalence of nmCRPC was estimated as 1.1% to 12.3% of prostate cancer cases and for mCRPC 1.2% to 2.1% of prostate cancer cases. No mCSPC prevalence was captured. Sixteen publications investigated HRRm prevalence in advanced prostate cancer with the majority conducted in mCRPC assessed using next-generation sequencing of tissue and germline samples. In mCRPC, the highest prevalence HRRm in both germline (3.3%-6.0%) and somatic (5.0%-15.1%) was BRCA2. Five publications reported the prognostic impact of HRRm in advanced prostate cancer. CONCLUSIONS: Published real-world evidence quantifying the prevalence of advanced prostate cancer and HRRm beyond mCRPC is sparse. Published data on HRRm, specifically BRCA2, are consistent with published clinical trial data for poly (ADP-ribose) polymerase inhibitors in mCRPC. In mCRPC, real-world evidence suggests that patients with HRRm have different clinical outcomes to noncarriers. More data are needed to better understand real-world patient segmentation and clinical outcomes for biomarkers given increasing interest in profiling.

Social innovation research checklist: A crowdsourcing open call and digital hackathon to develop a checklist for research to advance social innovation in health.

While social innovations in health have shown promise in closing the healthcare delivery gap, especially in low- and middle-income countries (LMICs), more research is needed to evaluate, scale up, and sustain social innovations. Research checklists can standardize and improve reporting of research findings, promote transparency, and increase replicability of study results and findings. This article describes the development of a 17-item social innovation in health research checklist to assess and report social innovation projects and provides examples of good reporting. The checklist is adapted from the TIDieR checklist and will facilitate more complete and transparent reporting and increase end user engagement. SUMMARY POINTS: While many social innovations have been developed and shown promise in closing the healthcare delivery gap, more research is needed to evaluate social innovationThe Social Innovation in Health Research Checklist, the first of its kind, is a 17-item checklist to improve reporting completeness and promote transparency in the development, implementation, and evaluation of social innovations in healthThe research checklist was developed through a three-step process, including a global open call for ideas, a scoping review, and a three-round modified Delphi processUse of this research checklist will enable researchers, innovators and partners to learn more about the process and results of social innovation in health research.

I cannot live without air conditioning! The role of identity, values and situational factors on cooling consumption patterns in India.

As the world continues to deal with climate-induced heat events, sustainable energy behaviours, or lifestyles combined with non-behavioural interventions have been identified as crucial pathways to curb the demand for air conditioners. Typically, ecological communities serve as a reference point for sustainable lifestyles as they have strong environmental self-identity and values and are more likely to further engage in pro-environmental and energy-saving actions. Yet, it is unknown if individuals within these communities will act as expected, especially when confronted with extreme climatic challenges like heatwaves. It is also unclear which factors will define individual responses to these challenges. Utilising environmental self-identity and Value-Belief-Norm theories, this paper examines factors underlying cooling consumption behaviours of households living in a Universal Community with strong environmental world views in India. Twenty in-depth qualitative interviews with residents, thematically analysed, found that while people expressed strong environmental self-identity, preferences for air conditioner use was often mediated by hedonic factors such as comfort and sleep. Moral norms played a positive role in how people operated their air conditioners. Yet, when faced with the choice of using energy-efficient air conditioners, biospheric concern was of limited importance while situational factors like cost and functionality were more pivotal. The above results raise interesting questions around the difficulties that might emerge in changing preferences around air conditioning behaviours in non-environmental communities, especially, if environmentally conscious communities which are expected to be "the locus of change for energy efficiency actions" are significantly influenced by hedonic values.

Nature doesn't judge you - how urban nature supports young people's mental health and wellbeing in a diverse UK city.

Reviewed research reveals a lack of young people's voices articulating if and how urban nature supports their mental health and wellbeing. This paper presents qualitative research with young multi-ethnic urban residents living in a northern UK city and offers an important counter-narrative to the pervasive notion of childhood nature-deficit disorder. Using interviews and creative arts workshops, we explored the value of urban nature for the mental health and wellbeing of 24 young people aged 17-27 years, 9 of whom had lived experience of mental health difficulties. Trees, water, open spaces and views were frequently experienced nature typologies offering benefits. Deteriorating landscapes, young people's shifting identities and perceived time pressures disrupted support. Young people expressed how urban nature encounters were experienced as accepting and relational, offering a: stronger sense of self; feelings of escape; connection and care with the human and non-human world.

Validity, reliability, acceptability, and utility of the Social Inclusion Questionnaire User Experience (SInQUE): a clinical tool to facilitate social inclusion amongst people with severe mental health problems.

BACKGROUND: Individuals with severe mental health problems are at risk of social exclusion, which may complicate their recovery. Mental health and social care staff have, until now, had no valid or reliable way of assessing their clients' social inclusion. The Social Inclusion Questionnaire User Experience (SInQUE) was developed to address this. It assesses five domains: social integration; productivity; consumption; access to services; and political engagement, in the year prior to first psychiatric admission (T1) and the year prior to interview (T2) from which a total score at each time point can be calculated. AIMS: To establish the validity, reliability, and acceptability of the SInQUE in individuals with a broad range of psychiatric diagnoses receiving care from community mental health services and its utility for mental health staff. METHOD: Participants were 192 mental health service users with psychosis, personality disorder, or common mental disorder (e.g., depression, anxiety) who completed the SInQUE alongside other validated outcome measures. Test-retest reliability was assessed in a sub-sample of 30 participants and inter-rater reliability was assessed in 11 participants. SInQUE ratings of 28 participants were compared with those of a sibling with no experience of mental illness to account for shared socio-cultural factors. Acceptability and utility of the tool were assessed using completion rates and focus groups with staff. RESULTS: The SInQUE demonstrated acceptable convergent validity. The total score and the Social Integration domain score were strongly correlated with quality of life, both in the full sample and in the three diagnostic groups. Discriminant validity and test-retest reliability were established across all domains, although the test-retest reliability on scores for the Service Access and Political Engagement domains prior to first admission to hospital (T1) was lower than other domains. Inter-rater reliability was excellent for all domains at T1 and T2. CONCLUSIONS: The component of the SInQUE that assesses current social inclusion has good psychometric properties and can be recommended for use by mental health staff.