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PubMed2001

Screening for postnatal depression: are specific instruments mandatory?

BACKGROUND: Few studies have examined the utility of rating scales developed in non-puerperal context in detecting postnatal depression. This study evaluated the utility of the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) in screening for depression among recently delivered women in Hong Kong. METHODS: A prospective cohort of 145 Chinese women completed the GHQ, BDI and Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after delivery. They were then assessed using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP) to establish psychiatric diagnosis, against which the criterion validity of the GHQ and BDI was evaluated against this clinical diagnosis. The psychometric performance of the GHQ, BDI and EPDS in detecting postnatal depression was assessed using the receiver operating characteristic (ROC) curves. RESULTS: Both Chinese GHQ and BDI had satisfactory sensitivity and positive predictive value in detecting postnatal depression. Their receiver operating characteristic (ROC) curves were comparable to that of the EPDS. LIMITATION: The study was conducted in Chinese women using translated version of the rating scales. CONCLUSIONS: The GHQ and BDI are useful for detecting postnatal depression among recently delivered Chinese women. The results of this study suggest that rating scales developed in non-puerperal context may also be applicable for postnatal depression.

Adolescent↗
PubMed2006

The effects of an early developmental mother-child intervention program on neurodevelopment outcome in very low birth weight infants: a pilot study.

BACKGROUND: Several studies report increased minor neurodevelopment dysfunctions in children born very low birth weight (VLBW). Usefulness of preventive early intervention programs to improve neurodevelopment outcome of VLBW infants is still under investigation. AIMS: To evaluate the effects of an early post-discharge developmental mother-child intervention program on neurodevelopment outcome at 36 months in VLBW infants. STUDY DESIGN: Prospective study. SUBJECTS: 36 VLBW infants ([mean (S.D.)] birthweight=864 g (204 g); gestational age=27.9 weeks (2.4 weeks)), consecutively born January-August 2001, randomized in intervention and control groups. OUTCOME MEASURES: Neurodevelopment assessment at 36 months of chronological age with use of the Griffiths Mental Development Scale and related subscales. RESULTS: At 36 months of chronological age, as compared to controls, children in intervention group exhibited higher scores in personal-social subscales ([mean (S.D.)]=101.4 (9.3) vs. 92.9 (12.1), P=0.02), eye-hand coordination (92.7 (4.5) vs. 87.1 (9.9), P=0.041), practical reasoning (98.6 (8.2) vs. 89.4 (10.1), P=0.01). Development Scale were 97.6 (5.5) and 92.4 (9.9), respectively, in intervention and control groups (P=0.074). CONCLUSIONS: Early post-discharge developmental mother-child intervention program may have a positive effect on later neurodevelopment outcome of VLBW children.

Central Nervous System↗
PubMed1989

Psychomotor and mental development during infancy. Relation to psychosocial conditions and health. Part IV of a longitudinal study of children in a new Stockholm suburb.

This article presents the fourth substudy in a Swedish research project of a birth cohort of children in a newly-built Stockholm suburb. The aims are to follow and to describe their mental development by prospective methods. Here we present the results of the one-year follow-up. The children's mental development, measured with the Griffiths' Development Scales, and their behaviour in the test situation and during the home visit are described. These results are related to various psychosocial background factors (such as the parents' ages, number of siblings, form of custody), home environment factors (the parents' mental disease, addictions and criminality) and the children's physical health and development. Children with deviant behaviour during the home visits are described separately. Of 640 women who paid their first visit to the maternal welfare centers in a new Stockholm suburb during one prospective year, 532 (85%) were interviewed with regard to 41 stress factors forming a "Life stress score" (LSS). The interviews were supplemented with data from hospital, social welfare and police records concerning the expectant mother and the father. The 532 mothers were divided into three groups according to the degree of psychosocial stress (194 without psychosocial stress, 171 with severe psychosocial stress and 167 in an intermediate group). The pregnancies and deliveries of all mothers were evaluated. The physical health and development (using information from the child welfare clinics) and the mental health and development (using information from home visits and testings) were studied during infancy in 452 children (226 boys and 226 girls)--i.e. 77% of all children born in the suburb during the year. The children were tested with the Griffiths' Development Scales and their behaviour during the test was observed on home visits by the same psychologist (L.N.) at the age of 10 months (79 boys, 73 girls) or 14 months (92 boys, 107 girls), or about the age of 18 months (55 boys, 46 girls). The test results are mainly reported by descriptive methods. In summary, the results of the evaluation of the children's mental health during the first year of life, generally showed average developmental quotients. However, 20% of the children had values below the average. Thirty-two per cent of the children with low test results (less than -1 standard deviation on the total test) came from homes with serious psychosocial stress and 29% from homes with a mild degree of psychosocial stress. Of the nine children who had generally very low scores in the Griffiths' evaluation, seven came from homes with psychosocial stress.(ABSTRACT TRUNCATED AT 400 WORDS)

Child Behavior↗
PubMed2006

Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life.

OBJECTIVE: Reliable, valid, user-friendly measurement is necessary to successfully implement an outcomes evaluation program in clinical practice. Self-report questionnaires, which generally correlate highly with clinician ratings, are a cost-effective assessment option. However, even self-administered questionnaires can be burdensome to patients because many are lengthy. Consequently, we developed and determined the reliability and validity of ultra-brief, single-item assessments of 3 domains important to consider when treating depressed patients: symptom severity, psychosocial functioning, and quality of life. METHOD: In the first study (conducted June 1997 to March 2002), 1278 psychiatric outpatients with various DSM-IV diagnoses completed single-item assessments of psychosocial functioning and quality of life as well as more detailed measures of these constructs. In the second study (conducted August 2003 to July 2004), 562 psychiatric outpatients who were in ongoing treatment for a DSM-IV major depressive episode completed a depression symptom scale and a measure of global severity of depression. RESULTS: The test-retest reliability of the psychosocial functioning and quality-of-life items was high. The single-item measures of symptom severity, psychosocial functioning, and quality of life were significantly correlated with the total scores and individual item scores of longer measures of the same constructs (p < .001). The single-item measures significantly discriminated between depressed patients in full remission, in partial remission, and in a current depressive episode (p < .001). CONCLUSION: These studies provide evidence of the reliability and validity of single-item measures of symptom severity, psychosocial functioning, and quality of life. Very brief measures, such as the ones described in the present report, are not burdensome for patients to complete and can be easily incorporated into a busy clinical practice in order to collect data on treatment effectiveness.

Adaptation, Psychological↗
PubMed2004

The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective.

The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.

Consensus↗
PubMed1987

Epigenesis in developing avian scales. III. Stage-specific alterations of the developmental program caused by 5-bromodeoxyuridine.

As an approach to the study of a developmental program, 5-bromodeoxyuridine (BrdU) was administered to chick embryos in ovo at various stages of avian scale formation. This brought about stage-specific alterations in morphogenesis in the anterior tarsometatarsus such as feathered scales, from Day 6 through Day 6 1/2; feathers only, from Day 6 3/4 through Day 7 1/4; scalelessness and rudimentary scales, from Day 7 7/8 through Day 8 1/8; and partial ridge scales, from Day 8 1/8 through Day 10. The effects of BrdU were completely nullified by an excess dose of thymidine which instantly suppressed BrdU incorporation into nuclear DNA. Effects of BrdU causing scalelessness were further examined. The percentage of BrdU labeled cells was immunohistochemically detected. It increased linearly in both the epidermis and dermis, reaching nearly 100% 24 hr following its injection on Day 8. However, scale forming potency, as assayed by the area of scale epidermis on Day 11, decreased with the duration of BrdU incorporation into the cells and disproportionately dropped at 15 hr when about 50% of the cells had incorporated BrdU. Scalelessness was also produced when the period of the incorporation of BrdU exceeded 15 hr. Time sequence observations demonstrated epidermal cell shape, polarity, alignment, and packing density to be remarkably disordered so that the placode and interplacode failed to develop on Day 9 1/4. Epidermal-dermal recombinations were carried out by exchanging normal tissues with those treated with BrdU in the anterior tarsometatarsus. The results clearly showed defects in the dermis at the time of reassociation, giving rise to scalelessness.

Animals↗
PubMed2006

Revalidation of the postpartum stress scale.

AIMS AND OBJECTIVES: The purpose of this study was to test further and validate the postpartum stress scale developed for Taiwanese women. BACKGROUND: The postpartum stress scale was developed to measure postpartum stress in Taiwanese women. However, over the last decade, the social context in Taiwan has changed and several items in the scale needed to be re-examined. DESIGN: Non-experimental quantitative research with repeated measures at the first and fifth week of the postpartum period was conducted for this study. METHODS: A proportional stratified quota was used to sample from the 10 hospitals and six clinics with the highest birth rates in Kaohsiung, Taiwan. Participants were 505 and 518 postpartum women at each time point, respectively. RESULTS: Factor analysis at two points in time identified three attributes of postpartum stress: (a) maternal role attainment, (b) lack of social support, and (c) negative body changes. The Cronbach's alphas at each time point were 0.94 and 0.92, respectively. CONCLUSIONS: The results support the postpartum stress scale as a validated instrument that has been conceptualized, created, and tested with Taiwanese postpartum women. RELEVANCE TO CLINICAL PRACTICE: This study was done in the hope that women experiencing specific postpartum stressors would be detected and subsequently helped by supportive nursing intervention that provides stressor-specific coping resources.

Adult↗
PubMed1984

Instrument development for health belief model constructs.

Research was conducted to develop valid and reliable scales to test the Health Belief Model (HBM). The dependent variable chosen for scale development was frequency of breast self-examination. Independent variables were constructs related to the HBM: susceptibility, seriousness, benefits, barriers, and health motivation. Analyses for construct validity and theory testing included factor analysis and multiple regression. Chronbach Alpha and Pearson r were used to compute reliabilities. Scales that were judged valid and reliable were susceptibility, seriousness, benefits, barriers, and health motivation.

Adolescent↗
PubMed2004

Capturing the true burden of dystonia on patients: the Cervical Dystonia Impact Profile (CDIP-58).

OBJECTIVES: To develop a new rating scale for measuring the health impact of cervical dystonia (CD) that includes patients' perceptions and complements existing observer dependent clinician rating scales. METHODS: Scale development was in three stages. In Stage 1, a large pool of items was generated from patient interviews (n = 25), expert opinion, and literature review. In Stage 2, these items were administered by postal survey to people with CD. The resulting data were analyzed using Rasch item analysis to construct, from the item pool, a rating scale that satisfied criteria for rigorous measurement. In Stage 3, the measurement properties of this rating scale were examined in an independent sample of people with CD. RESULTS: In Stage 1, 150 items concerning the health impact of CD were generated. In Stage 2, 556 people completed questionnaires (87% response rate) and a 58-item rating scale measuring the health impact of CD in eight areas was constructed (CD Impact Profile, CDIP-58). In Stage 3, CDIP-58 data from 391 people (87% response rate) were received. Analyses supported the measurement of eight unidimensional constructs (infit mean square range 0.62 to 1.50), item calibration (33.37 to 67.56), and patient separation statistics (2.59 to 3.38). Items demonstrated stable calibrations in subgroups of people with CD supporting the stability of the CDIP-58. CONCLUSIONS: The CDIP-58 is a reliable and valid patient-based rating scale measuring the health impact of CD in eight health dimensions.

Adult↗
PubMedDate not supplied

Complications of adapting pressure ulcer risk assessment scales.

This article challenges recommendations to adapt a pressure ulcer risk assessment scale (RAS) according to the clinical context. The transformation of the Cubbin and Jackson (1991) RAS is used to illustrate problems in scale development. When new factors are added to an existing scale, this can lead to unnecessary complexity. When words are changed by a person developing a scale this illustrates their differing beliefs and value judgements. Arbitrary scores for factors are misleading and in some cases mystifying, yet appear to be objective. This article suggests that the relationship between sub-scales and the whole scale have not been adequately accounted for -- they can't simply be added up arithmetically. The paradox of risk is debated, namely, that the more something is thought to be a risk, the less risky it becomes. RASs should be replaced by risk reduction scales linking a risk factor with its outcome following intervention.

Activities of Daily Living↗
PubMedDate not supplied

Psychometric properties of the Japanese version of the Mental Adjustment to Cancer (MAC) scale.

This paper describes a study of the psychometric properties of the Japanese version of the mental adjustment to cancer (MAC) scale developed in England. The scale was completed by 455 Japanese cancer patients. The internal consistency was similar to that of the original version (Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.78) and the Japanese version had moderate to moderately high stability (correlation coefficients were above 0.64). Correlations between the MAC scale score and emotional states measured by the Profile of Mood States (POMS) indicated the concurrent validity. The results suggest that the Japanese version, like the original MAC scale, is a reliable and valid clinical research tool in Japan.

Adaptation, Psychological↗
PubMed2006

Expanded bed adsorption as a primary recovery step for the isolation of the insulin precursor MI3 process development and scale up.

Expanded bed adsorption (EBA) was evaluated for the isolation of the human insulin precursor MI3, expressed and secreted by the yeast Saccharomyces cerevisiae. The isoelectric point of the insulin precursor (pH 5.3) makes cation exchange a prime candidate for direct adsorption. In order to find a suitable window of operation for the process the adsorption equilibrium was analysed in a wide range of operating conditions (pH and conductivity) and for three different stationary phases. The same array of operating conditions was examined with regard to stable fluidisation of the adsorbents in S. cerevisiae suspensions. Interactions of the yeast with the fluidised stationary phase were investigated by a pulse response technique and the hydrodynamics of the fluidised bed under process conditions by residence time distribution analysis. The case study demonstrates that by parallel examination of product binding and fluidisation quality a window of operation can be found. Analysis of the binding kinetics by breakthrough experiments and modelling led to the definition of a set of operating conditions, which yield a compromise between optimal use of the equilibrium capacity provided by the adsorbent and high throughput required for an industrial separation. After initial experiments on the bench scale the protocol was transferred successfully to pilot scale demonstrating the design of a reliable operation.

Adsorption↗
PubMed2006

Scale-up development of high-performance polymer matrix for DNA sequencing analysis.

Linear polyacrylamide (LPA) has been widely used as a replaceable separation matrix in CE. An increase in the molecular weight of the separation medium favors the separation of larger DNA fragments. In order to obtain ultrahigh-molecular-weight (UHMW) LPA, a "frozen" method was developed to synthesize the LPA homopolymer. This approach has three major advantages when compared with other existing routes of LPA synthesis: (i) long LPA chains could be obtained easily, with their average molecular weight (MW) being in the high 10 MDa range; (ii) the desired MW could be adjusted over a broad range by controlling the temperature and the concentration of initiators during synthesis; (iii) the product solution contains only a tiny amount of impurity besides the solvent and LPA. Both static and dynamic laser light scattering measurements were carried out to characterize the synthesized LPA in the buffer solution. The DNA sequencing matrix prepared from LPA using this method was studied and the results were compared with the newly developed commercial product POP7 from Applied Biosystems. It should be noted that this approach can be applied to synthesize other water-soluble polymers, resulting in UHMW products because the chain transfer constant is smaller at lower temperatures.

Acrylic Resins↗
PubMed1982

Changes in morphology and cell proliferation during vitamin A-induced mucous metaplasia of developing chick scale cultured in vitro.

Throughout the process of vitamin A (V-A)-induced mucous metaplasia of the scale epidermis of a 12-day chick embryo, changes in the activities of cell proliferation were investigated in reference to morphological changes. In both the control and V-A cultures after 5 days, a dynamic steady state was established among the stratified layers which differentiated into keratinizing epidermis during the first 7 days. In the control, cell proliferates within only the basal layer and the cell cycle time, except Tg2, increased during 30 days of culture. In the V-A culture, this tendency was reversed in each parameter between day 10 and day 13, when symptoms of mucous metaplasia became morphologically prominent. On day 13 in the V-A culture, superficial cornified cell layers were sloughed off as whole sheets and concurrently DNA synthesis was reactivated throughout the entire cell layers of the epithelium. The correlation between two of five cell cycle times (Tgc, Tg1, Ts, Tg2, Tm) was statistically treated as linear regression lines and gave highly significant coefficients in every case. The regression coefficients between Ts and Tgc and Ts and Tg1 in V-A culture are significantly (P less than 0.01) smaller than those in the control. It was found that V-A induced sequential alterations in mucous metaplasia with respect both to morphology and proliferation in the epidermis of the chick embryo.

Animals↗
PubMed2004

Early development of scaling ability.

The map is a small-scaled version of the space it represents. It has been argued that children have difficulty interpreting maps because they do not understand scale relations. Recent research has shown that even preschoolers can solve problems that involve scaling in one dimension. This study examined whether early scaling ability extends to tasks involving two-dimensional maps and referent spaces of different sizes. Results showed that about 60% of the 4-year-olds and 90% of the 5-year-olds tested used distance information presented on a map to locate an object in a two-dimensional spatial layout. Children had more difficulties in solving mapping tasks with a larger referent space. This decrease in accuracy as a function of space size on the mapping task was greater than would have been expected on the basis of performance on a parallel nonmapping task. The results are discussed in terms of their implications for the mechanisms underlying early scaling ability.

Aptitude↗
PubMed2001

A parent-completed developmental questionnaire: follow up of ex-premature infants.

OBJECTIVE: Premature infants are at increased risk of developmental disability. Early identification of problems allows intervention to ameliorate or attenuate problems. A reliable screening tool allows triage of children in this high-risk population by identifying those unlikely to need full developmental assessment. To explore the test characteristics of an established parent-completed developmental assessment questionnaire 'Ages and Stages Questionnaire' (ASQ) in follow up of an Australian population of premature infants. METHODOLOGY: One hundred and sixty-seven children born prematurely with corrected ages 12- to 48-months attending the Growth and Development Clinic at the Mater Children's Hospital in Brisbane, Queensland, Australia; 136 questionnaires 'ASQ' were returned completed (81%) and were compared to formal psychometric assessment (Griffith Mental Development Scales for 12- and 24-months, Bayley Mental Development Intelligence Scale for 18-months, McCarthy General Cognitive Intelligence Scale for 48-months). Developmental delay was considered to be present if any of the above psychometric assessments fell below 1.0 standard deviations (SD). The ASQ cut-off used was 2.0 SD (US data derived means and SD). RESULTS: Aggregate results for all age groups comparing ASQ to psychometric assessments as 'gold standards' found the ASQ to have the following test characteristics: sensitivity (90%); specificity (77%); positive predictive value (40%); negative predictive value (98%); % over-referred (20%); % under-referred (1%); % agreement (79%). Likelihood ratio for children failing the ASQ was 3.8 and for passing the ASQ was 0.13. Twenty-one children with known disabilities were included in the study and in 14 of these, the ASQ overall score agreed with the psychometric assessment (67%). CONCLUSION: The high negative predictive value of the ASQ supports its use as a screening tool for cognitive and motor delays in the follow up of ex-premature infants. This would need to be combined with other strategies as part of a comprehensive follow up program for ex-premature infants.

Child, Preschool↗