The reliability and validity of a child and adolescent participation in decision-making questionnaire.

BACKGROUND: There is a growing impetus across the research, policy and practice communities for children and young people to participate in decisions that affect their lives. Furthermore, there is a dearth of general instruments that measure children and young people's views on their participation in decision-making. This paper presents the reliability and validity of the Child and Adolescent Participation in Decision-Making Questionnaire (CAP-DMQ) and specifically looks at a population of looked-after children, where a lack of participation in decision-making is an acute issue. METHODS: The participants were 151 looked after children and adolescents between 10-23 years of age who completed the 10 item CAP-DMQ. Of the participants 113 were in receipt of an advocacy service that had an aim of increasing participation in decision-making with the remaining participants not having received this service. RESULTS: The results showed that the CAP-DMQ had good reliability (Cronbach's alpha = 0.94) and showed promising uni-dimensional construct validity through an exploratory factor analysis. The items in the CAP-DMQ also demonstrated good content validity by overlapping with prominent models of child and adolescent participation (Lundy 2007) and decision-making (Halpern 2014). A regression analysis showed that age and gender were not significant predictors of CAP-DMQ scores but receipt of advocacy was a significant predictor of scores (effect size d = 0.88), thus showing appropriate discriminant criterion validity. CONCLUSION: Overall, the CAP-DMQ showed good reliability and validity. Therefore, the measure has excellent promise for theoretical investigation in the area of child and adolescent participation in decision-making and equally shows empirical promise for use as a measure in evaluating services, which have increasing the participation of children and adolescents in decision-making as an intended outcome.

Finite element analysis of stress in the equine proximal phalanx.

REASONS FOR PERFORMING STUDY: To improve understanding of the internal structure of the proximal phalanx (P1), response of the bone to load and possible relation to the pathogenesis of fractures in P1. OBJECTIVES: To model the P1 and replicate the loads experienced by the bone in stance, walk, trot and gallop using finite element analysis. METHODS: The geometry of the P1 was captured using micro-computed tomography (µCT) and was reconstructed in 3 dimensions. Values for material properties and forces experienced at stance, walk, trot and gallop were taken from the literature and were applied to the reconstructed model. Using the same total load across the proximal articular surface, the model was solved with and without loading of the sagittal groove. Biomechanical performance was then simulated with finite element analysis and evaluated in terms of von Mises stress maps. RESULTS: Compared with the lowest force simulation equivalent to stance, the effects of the gallop force showed higher levels of stress along the sagittal groove and on the palmar surface just distal to the sagittal groove in both models, with and without the sagittal groove loaded. The results highlighted an area of bone on the dorsal aspect of P1 that experiences lower stress compared with the rest of the dorsal surface, an effect that was much more apparent when the sagittal groove was not loaded. Qualitative comparison of the models revealed minimal difference in the pattern of von Mises stress between the loaded and unloaded groove models. CONCLUSIONS: The study demonstrates a finite element model of P1 that produces results consistent with clinical observation. The simulated high stress levels associated with the sagittal groove correspond to the most common site for fractures in the equine P1. POTENTIAL RELEVANCE: With refinement of the model and further investigation, it may be possible to improve understanding of the behaviour of P1 under loading conditions that more closely simulate those experienced in the living animal, leading to a more solid understanding of fractures of P1.

Rheumatologists' judgements about the efficacy of anti-TNF therapy in two neighbouring regions.

OBJECTIVES: The requirement in Northern Ireland to prescribe biological agents according to National Institute for Clinical Excellence/British Society for Rheumatology (NICE/BSR) guidelines and within a fixed budget has created a waiting list for treatment that has no parallel in the Republic of Ireland. The study investigated the bearing this situation may have had on consultants' judgements in the respective areas. METHODS: Seventy-eight case vignettes created from the data on real patients with RA treated with biologicals in the north and south of Ireland were appraised by nine southern and eight northern consultants, who judged the clinical benefit and significance of the patients' condition after a trial of therapy. Quantitative (clinical judgement analysis) and qualitative (focus groups) techniques were used. RESULTS: Northern consultants perceived a slightly greater degree of clinical benefit after a trial of therapy than southern consultants. Judgement models of northern and southern consultants were broadly comparable. The latter tended to be more uniform in their judgements than the southern group. Focus group discussions with consultants largely validated the findings of the quantitative analysis but revealed how clinical judgement analysis might be misled by gaming strategies. CONCLUSIONS: Despite the absence of overt rationing in the south of Ireland, as far as the judgement of therapeutic benefit from biologicals was concerned, the clinical judgement policies of practitioners were very similar to those in the north. The adoption of NICE/BSR guidelines in the north may have improved the uniformity of clinical practice in Northern Ireland.

Elementary school-age children's developmental understanding of the causes of cancer.

This study examines children's conceptual understanding and factual knowledge of the causes of cancer. Using a standardized, developmentally based, semistructured interview (ASK [AIDS (acquired immunodeficiency syndrome) Survey for Kids]), 784 children (43% black, 38% white, and 18% Hispanic; 48% female) in kindergarten through sixth grade attending six public elementary/middle schools in New Haven, Connecticut, were asked open-ended questions about the causes of cancer and, for comparison, the causes of colds and AIDS. Responses were scored for level of conceptual understanding and coded for factual content and factual accuracy. The level of conceptual understanding for causality of cancer increased consistently as grade level increased. When comparisons were made among the illnesses, children's level of conceptual understanding was significantly lower for the causes of cancer than for the causes of colds (p < .0001), but not significantly different from that of AIDS. Although the single most frequent cause of cancer mentioned was cigarettes/smoking (24%), more than one in five students stated that casual contact or contagion was a cause of cancer. More children cited causal contact/contagion than cited the following factually accurate or logically contributory causes combined: poor diet, air/water pollution or overexposure to sun, alcohol, and old age. Slightly more than one half of students in kindergarten through sixth grade worried about getting cancer, and the vast majority (80%) knew that cancer could be fatal. Children have a less sophisticated conceptual understanding of cancer than of colds and a very limited factual knowledge base for cancer, and thus they have the capacity to increase both their understanding and knowledge. These results have implications for the creation of developmentally appropriate cancer prevention curricula for elementary school-age children.

Scholl compression hosiery in the management of venous disorders.

Graduated compression hosiery has an important role in the management of venous leg ulcers by counteracting chronic venous hypertension. The historically high rates of venous ulcer recurrence can be significantly reduced by optimizing compliance with the wearing of support hosiery. This is facilitated by providing information, practical support and opportunities for regular professional monitoring. Compliance is also aided by ensuring that the garment fits correctly and is comfortable and by offering the client a choice of products from those available.

Graduated Compression Hosiery.

Graduated compression hosiery is used for several clinical conditions related to venous insufficiency and lymphoedema. In the management of venous ulceration, graduated compression hosiery is regarded as an essential component of prevention of ulcer recurrence. Occasionally it is used for ulcer healing. It is also used prophylactically in the prevention of deep vein thrombosis1.

Children's understanding of the symptoms of AIDS.

Symptoms are the outward manifestations that allow children to identify and recognize illness; children's understanding of the symptoms of an illness may be directly related to their understanding of its cause or means of transmission. This study is the first empirical investigation of children's conceptual understanding and factual knowledge of the symptoms of AIDS. Children (N = 361; grades K to 6; 57% black, 24% Hispanic, 19% white; 52% female) attending four public schools in New Haven, Connecticut, were interviewed using a standardized semistructured interview (ASK, AIDS Survey for Kids) that included open-ended questions about the symptoms of AIDS and, for comparison, cancer and colds. Responses were scored for level of conceptual understanding and coded for factual content. For each illness, grade level was the variable most strongly correlated with symptomatology concept score (R = .42-.48, p < .0001) and contributed significantly (p < .0001) to the variance observed in concept score even after controlling for race, gender, verbal fluency, and socioeconomic status. The mean concept score was lower (p < .01) for symptomatology of AIDS (2.8 of possible 5) than for cancer (3.1) or colds (3.9). In addition, far more symptoms were named for colds than for either cancer or AIDS. Children who believed that HIV is spread via each of five potential means of transmission by casual contact were more likely (p < 01) to cite cold symptoms as symptoms of AIDS. We conclude that there exists a developmental progression in children's understanding of the symptomatology of AIDS. Children have a less sophisticated conceptual understanding and narrower factual knowledge base for AIDS than for colds and therefore have the capability to increase their understanding and knowledge about AIDS. Furthermore, improving children's understanding of the symptoms of AIDS may diminish misconceptions about transmission of HIV via casual contact.

Venous leg ulceration: treatment by high compression bandaging.

Venous leg ulceration is a major tissue viability problem that is becoming better recognized as clinical wound care practice changes from being anecdotal-based to research-based. The current prevalence of leg ulceration in the UK, Sweden and Australia is approximately 1 percent of the adult population, and approximately half a million in the United States. Between 70 and 90 percent of leg ulcers in the UK are venous in origin. Research has shown that graduated compression bandaging is an appropriate method of managing venous leg ulceration for many patients. Since Stemmer's work showing the usefulness of higher levels of external pressure (40 mmHg), the reliability and predictability of the four layer high compression bandaging system has been demonstrated. The purpose of this article is to introduce the extent of the venous leg ulceration problem, discuss risk factors and other aspects of venous leg ulceration, support the use of graduated compression, and describe the four layer high compression bandage system. The success of the four layer system is linked to the wider issues of using a research-based approach to the assessment and management of venous leg ulcers, and such an approach is integral to cost-effective, high quality patient care.

A randomized, controlled trial of a school-based, multi-faceted AIDS education program in the elementary grades: the impact on comprehension, knowledge and fears.

OBJECTIVE: Several educational theorists have suggested that young children are unlikely to benefit from detailed instruction regarding AIDS prevention because of inherent developmental cognitive limitations. This study aims to determine whether AIDS education in the elementary grades can advance young children's understanding of this illness. METHODS: A randomized, controlled trial was used to measure the impact of a 3-week, multifaceted AIDS education program on conceptual understanding, factual knowledge, and fears about AIDS in 189 students in grades kindergarten through 6th. The ASK (AIDS Survey for Kids), a standardized, semistructured interview that measures conceptual understanding, factual information, and fears about AIDS, was administered before and after the intervention. RESULTS: Children in the intervention group, as compared to those in the control group, showed significant (P < .0001) gains in their level of understanding of the concepts of causality and prevention of AIDS. These results were unaffected by controlling for grade, gender, race, socioeconomic status, and verbal fluency. The gains in children's understanding of causality of AIDS represented at least 2 years' growth in the level of conceptual sophistication and persisted at a follow-up evaluation several months later. After the intervention, more children (P < .001) in the intervention group than in the control group accurately identified causes of AIDS in response to open-ended questions: germ/germ theory (41% vs 13%), mother-to-infant transmission (54% vs 15%), blood transmission (83% vs 40%), and sexual transmission (56% vs 30%). Fewer than half as many children in the intervention group responded incorrectly to each of five direct questions about transmission of HIV through casual contact. The intervention did not increase children's fears about the illness. CONCLUSIONS: A short, developmentally based, multifaceted AIDS education program in the elementary grades can advance children's conceptual understanding and factual knowledge about AIDS and decrease their misconceptions about casual contact as a means of acquiring the illness, without increasing their fears. Significant advances in conceptual understanding about AIDS can be achieved through direct educational interventions.

Ankle pulses are not sufficient to detect impaired arterial circulation in patients with leg ulcers.

Much debate has taken place on the use of Doppler ultrasound in the community setting. A sequential study of patients attending a community ulcer clinic was undertaken to identify community nurses' ability to detect arterial disease by palpation of pedal pulses and to compare these figures with the recording of a resting pressure index. A total of 462 patients (553 limbs) were studied; 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with a reduced resting pressure index (< 0.9), 37% had detectable pulses. Of the 440 with a normal resting index (> or = 0.9), 25% had no detectable ankle pulses. A number of risk factors were identified. Palpation of pedal pulses alone by community nurses is a poor prediction of arterial disease and should be accompanied by the recording of a resting pressure index.

Implementing district-wide nurse-led venous leg ulcer clinics: a quality approach.

A review of the development of a specialist leg ulcer service.

Understanding of acquired immunodeficiency syndrome by elementary school children--a developmental survey.

OBJECTIVES: The developmental process by which young children acquire an understanding of the concepts of causality, treatment, and prevention of illness as related to acquired immunodeficiency syndrome (AIDS) is poorly understood. Previous studies have focused on adolescent populations and have measured the facts that children seem to know rather than their understanding of relevant concepts. Such approaches are likely to overestimate the child's true level of understanding and obscure significant misconceptions. The aims of this project are to measure directly the level of understanding of the concepts of causality, treatment, and prevention of AIDS in healthy, elementary school children and to assess the sociodemographic variables associated with their conceptual understanding. METHODS: Using a new, developmentally based, semistructured interview protocol (ASK, AIDS Survey for Kids), 361 children (57% black, 24% Hispanic, 19% white) in kindergarten through sixth grade at four public schools in New Haven, CT were interviewed. Responses to questions about causality, treatment, and prevention were scored for each of three illnesses (AIDS, and for comparison, colds and cancer) based on the level of conceptual sophistication of the response, irrespective of its factual accuracy. RESULTS: Scores for each of the concepts were highly intercorrelated and were correlated most strongly with grade level (R = .31 to .50, P < .0001 for each of these correlations, with the exception of the treatment of AIDS). Gender, race, and socioeconomic status did not contribute significantly to the variance observed for any of the concept scores in a linear regression model. Over-all, children's level of understanding of causality was significantly less sophisticated for AIDS than for colds (P < .0001); their level of conceptual understanding for the causality of AIDS was not significantly different from that of cancer (P = .9). CONCLUSIONS: Children's understanding of causality, treatment, and prevention of AIDS, as measured by the ASK, follows the same developmental sequence reported for children's understanding of general physical illness. Sociodemographic variables, such as race, gender, and socioeconomic status do not affect children's level of sophistication of these developmental concepts. These results have implications for the creation of developmentally appropriate and effective AIDS education curricula for primary and elementary grades. They also offer guidance to health care providers in their efforts to educate parents and young children about this important topic.