Psychometric properties and informant agreement of the WHODAS 2.0 in youth with mental disorder.

Objective: This study examined psychometric properties, parent-youth agreement, and factors associated with agreement on the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. Methods: Data come from a clinical sample of 56 youth, aged 14-17 years, receiving mental health care at a pediatric hospital. Correlations between the WHODAS 2.0, KIDSCREEN-27, and demographic variables were used to assess validity. Internal consistency was measured using ordinal alpha. The Bland-Altman method and intraclass correlation coefficients (ICC) were used to assess parent-youth agreement. Logistic regression examined factors associated with disagreement > 0.5 standard deviation. Results: For both parent and youth, correlations were low to moderate in exploring convergent (τ= -0.42 to 0.01) and divergent validity (τ/r = -0.12 to 0.32). Internal consistency was adequate (α > 0.7). Parent WHODAS 2.0 scores were significantly lower than youth scores and Bland-Altman plots revealed poor parent-youth agreement (ICC = -0.04 to 0.33). Lower household income was associated with lower odds of disagreement on the 35-item WHODAS 2.0 (OR= 0.28, 95% CI= 0.08-0.99), and older youth age was associated with lower odds of disagreement on the 12-item WHODAS 2.0 (OR= 0.40, 95% CI= 0.19-0.84). Conclusion: The psychometric properties of both WHODAS 2.0 versions were similar, so the abbreviated version may be sufficient to measure functional impairment in a clinical context. Additional research is needed to better understand the factors that influence discrepancies between informants and the implications for care. However, reports from both youth and parents appear valuable in understanding functional impairment.

Objectif: La présente étude a examiné les propriétés psychométriques, l'entente parent-jeune, et les facteurs associés à l'entente sur les versions en 12 items et en 36 items de la World Health Organization Disability Assessment Schedule (WHODAS) 2.0 (calendrier d'évaluation du handicap de l'OMS). Méthodes: Les données proviennent d'un échantillon clinique de 56 jeunes, de 14 à 17 ans, qui reçoivent des soins de santé mentale dans un hôpital pédiatrique. Les corrélations entre le WHODAS 2.0, KIDSCREEN-27, et les variables démographiques ont servi à évaluer la validité. La cohérence interne était mesurée à l'aide d'alpha ordinal. La méthode Bland-Altman et les coefficients de corrélation interclasse (CIC) ont servi à évaluer l'entente parent-jeune. La régression logistique a examiné les facteurs associés à la mésentente de > 0,5 déviation standard. Résultats: Pour les parents et les jeunes, les corrélations étaient de faibles à modérées en explorant la validité convergente (τ= −0,42 à 0,01) et divergente (τ/r = −0,12 à 0,32). La cohérence interne était adéquate (α > 0,7). Les scores des parents au WHODAS 2.0 étaient significativement plus faibles que les scores des jeunes et les tracés Bland-Altman révélaient une mauvaise entente parent-jeune (CIC = −0,04 à 0,33). Le revenu du ménage plus faible était associé avec des probabilités plus faibles de mésentente au WHODAS 2.0 de 35 items (RC = 0,28, IC à 95 % = 0,08 à 0,99), et l'âge avancé du jeune était associé à des probabilités plus faibles de mésentente au WHODAS 2.0 de 12 items (RC = 0,40, IC à 95 % = 0,19 à 0,84). Conclusion: Les propriétés psychométriques des deux versions du WHODAS 2.0 étaient semblables, donc la version abrégée peut suffire à mesurer la déficience fonctionnelle dans un contexte clinique. Il faut une recherche additionnelle pour mieux comprendre les facteurs qui influencent les divergences entre informateurs et les implications dans les soins. Cependant, les rapports tant des jeunes que des parents semblent valables pour comprendre la déficience fonctionnelle.

Examining the Association between Community-Level Marginalization and Emergency Room Wait Time in Ontario, Canada.

OBJECTIVE: This study examines the association between community-level marginalization and emergency room (ER) wait time in Ontario. METHODS: Data sources included ER wait time data and Ontario Marginalization Index scores. Linear regression models were used to quantify the association. RESULTS: A positive association between total marginalization and overall, high-acuity and low-acuity ER wait time was found. Considering specific marginalization dimensions, we found positive associations between residential instability and ER wait time and negative associations between dependency and ER wait time. CONCLUSIONS: Reductions in community-level marginalization may impact ER wait time. Future studies using individual-level data are necessary.

Do the American Society of Clinical Oncology Value Framework and the European Society of Medical Oncology Magnitude of Clinical Benefit Scale Measure the Same Construct of Clinical Benefit?

Purpose Whether the ASCO Value Framework and the European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS) measure similar constructs of clinical benefit is unclear. It is also unclear how they relate to quality-adjusted life-years (QALYs) and funding recommendations in the United Kingdom and Canada. Methods Randomized clinical trials of oncology drug approvals by the US Food and Drug Administration, European Medicines Agency, and Health Canada between 2006 and August 2015 were identified and scored using the ASCO version 1 (v1) framework, ASCO version 2 (v2) framework, and ESMO-MCBS by at least two independent reviewers. Spearman correlation coefficients were calculated to assess construct (between frameworks) and criterion validity (against QALYs from the National Institute for Health and Care Excellence [NICE] and the pan-Canadian Oncology Drug Review [pCODR]). Associations between scores and NICE/pCODR recommendations were examined. Inter-rater reliability was assessed using intraclass correlation coefficients. Results From 109 included randomized clinical trials, 108 ASCOv1, 111 ASCOv2, and 83 ESMO scores were determined. Correlation coefficients for ASCOv1 versus ESMO, ASCOv2 versus ESMO, and ASCOv1 versus ASCOv2 were 0.36 (95% CI, 0.15 to 0.54), 0.17 (95% CI, -0.06 to 0.37), and 0.50 (95% CI, 0.35 to 0.63), respectively. Compared with NICE QALYs, correlation coefficients were 0.45 (ASCOv1), 0.53 (ASCOv2), and 0.46 (ESMO); with pCODR QALYs, coefficients were 0.19 (ASCOv1), 0.20 (ASCOv2), and 0.36 (ESMO). None of the frameworks were significantly associated with NICE/pCODR recommendations. Inter-rater reliability was good for all frameworks. Conclusion The weak-to-moderate correlations of the ASCO frameworks with the ESMO-MCBS, as well as their correlations with QALYs and with NICE/pCODR funding recommendations, suggest different constructs of clinical benefit measured. Construct convergent validity with the ESMO-MCBS did not increase with the updated ASCO framework.