Individual Scale Items Research Articles

Objective assessment of acute pain in foals using a facial expression-based pain scale.

Pain assessment based on facial expressions has been described in foals. To extend previous pilot findings of the Equine Utrecht University Scale for Facial Assessment of Pain in Foals (EQUUS-FAP FOAL). Prospective blinded case-control study (known groups analysis). Video recordings (30-60 s) of n = 100 foals (38 patients and 62 controls) were collected. Videos were randomised and scored by two observers, blinded for the condition of the animals. Inter- and intra-observer agreement was tested by Intra Class Correlation (ICC) analysis. Differences between patients and controls were tested using Mann-Whitney U test, differences before and after analgesic treatment were tested with Wilcoxon signed rank test. Multilevel binomial logistic regression was performed for statistical weighting of each pain scale item. Receiver operating characteristic (ROC) analysis was performed to determine sensitivity, specificity and cut-off values. EQUUS-FAP FOAL showed good inter- and intra-observer reliability (ICC coefficient of 0.85 and 0.90 respectively, p < 0.001). Patients had significantly higher pain scores (median score 7, IQR 5.3-7.5) compared with controls (median score 2.5, IQR 1-3, p < 0.001) and the patient pain scores decreased after analgesic treatment (median score 6.5, IQR 5-8 vs. median score 4.5, IQR 3.5-6.5, p < 0.05). Multilevel binomial logistic regression showed the relative importance of the individual scale items. Using the original scale, sensitivity and specificity were 88.2% (95% CI 76%-96%) and 87.9% (81%-98%) respectively, with an area under the ROC curve of 94.9% (92%-98%), based on a cut-off value of ≥4. These values remained similar with the weighted scale based on logistic regression output. Videos of included patients were short and acquired by a person in front of the stable. The current study shows that EQUUS-FAP FOAL can be effectively used to assess acute pain in young foals.

Development and validation of the Health Activation Scale for Children (HAS-C): an important intermediate outcome measure for health promotion initiatives

BackgroundValid and reliable measures for assessing health activation in school-aged children are currently lacking. This study aimed to develop a scale to measure health activation and evaluate its psychometric properties among English-speaking primary school children in Singapore.MethodsThe development of the Health Activation Scale for Children (HAS-C) involved an extensive literature review, expert consultations, cognitive interviews with primary school children, and thorough discussions for dimension and item refinement. A cross-sectional study was conducted with 597 children aged 8 to 12 years, recruited from four mainstream primary schools, comprising 50.1% boys and 64.8% Chinese students. The potential scale, along with other measures, was independently completed by the children. Descriptive statistics were provided for individual scale items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess factorial validity. Convergent validity was examined by correlating the scale scores with scores of health confidence and self-efficacy measures. Hypothesis-testing validity was evaluated by assessing the scale’s correlation with self-reported health behaviours, including daily consumption of vegetables and fruits, time spent on sedentary activities and physical activities. Internal consistency reliability was measured using Cronbach’s alpha.ResultsEFA suggested a three-factor structure for the 12-item HAS-C, which was subsequently confirmed by CFA with a good model fit. All three HAS-C dimension scores demonstrated moderate correlations (rho = 0.34–0.52) with health confidence and self-efficacy measures, indicating good convergent validity. They were positively correlated with more vegetable and fruit intakes, more time spent on exercises, and negatively correlated with time spent on sedentary activities, supporting hypothesis-testing validity. Internal consistency reliability for individual HAS-C dimensions was generally acceptable, with Cronbach’s alpha values of 0.70 or above.ConclusionThe 12-item multi-dimensional HAS-C exhibited good validity and reliability, making it a valuable tool for assessing health activation in primary school-aged children.

Functional and Structural Changes in Patients with Spinal Muscular Atrophy Treated in Poland during 12-Month Follow-Up: A Prospective Cohort Study.

Background: In recent years, rapid advances in diagnosis and treatment have been observed in spinal muscular atrophy (SMA) patients. The introduction of modern therapies and screening tests has significantly changed the clinical picture of the disease. The previous classification has, therefore, been replaced by new phenotypes: non-sitters, sitters, and walkers, defined by the patient's functional level. However, despite the change in the clinical picture of the disease, patients still suffer from accompanying structural disorders such as scoliosis or joint contractures. Their presence also significantly affects the acquisition of subsequent motor skills. Due to this, monitoring structural changes and ensuring therapists are aware of improvements or declines in patient functionality are essential components of clinical practice. This study aims to compare the assessment of structural and functional changes after a 12-month follow-up in SMA patients who have already experienced the effects of the disease and are now receiving modern therapy. Methods: We present a study of 34 SMA patients being treated with modern therapies and tested twice 12 months apart. The participants were tested using structural measurements and validated scales such as The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and Hammersmith Functional Motor Scale-Expanded (HFMSE). Results: During the 12-month follow-up, patients showed deteriorating, non-statistically significant structural changes. We also proved that patients showed a trend toward functional improvement. Analyzing the individual scale items, we distinguished which participants obtained the maximum score for a given parameter and no longer had an opportunity to improve during the second examination. Conclusions: Our study proved that most patients improved overall motor function. The examination of structural measurements should become a standard in the evaluation of SMA patients.

Consumer financial well-being: Does scale choice alter the measure?

AbstractA crucial first step in helping consumers improve their financial lives is understanding their financial circumstances and well-being. The Financial Well-Being (FWB) scale measures a consumer’s subjective well-being related to aspects of their financial circumstances. It is available in standard-length (10-item) and abbreviated (5-item) versions, but no research has compared how completing either version may alter consumers’ responses. Notably, the 5-item scale includes a higher share of reverse-coded (i.e., negatively framed) items. We hypothesize that the difference in item framing between scale versions influences participants’ feelings about their financial situation, predicting that completing the 5-item FWB scale will result in more negative responses compared to completing the 10-item FWB scale. To test this hypothesis, we implement a randomized survey experiment using the Understanding America Study. In our experiment with nearly 6,000 participants, we find that completing the 5-item versus the 10-item FWB scale reduces FWB scores (average decline in the 5-item FWB score of 0.9 points, 95% CI [–1.552, –0.249]), and increases the share with a “low” 5-item FWB score by 5.0 percentage points, 95% CI [0.028, 0.071]), responses to individual scale items, and self-rated FWB. This pattern is strongest among lower-income respondents (average decline in FWB score of 2.3 points, 95% CI [–3.385, –1.171] and increases the share with a “low” 5-item FWB score by 8.1 percentage points, 95% CI [0.041, 0.121]). These findings highlight that FWB scale choice can have unexpected consequences. We discuss the implications for research on FWB and on the measurement of well-being more broadly.

Abstract LB372: Examining medical mistrust and access to cancer preventive care in a diverse sample

Abstract Background: Medical mistrust has been linked to lower health care utilization, satisfaction and preventive actions among underserved populations. Further exploration of medical mistrust within these groups is needed to inform research and clinical approaches to improve trust and health equity. This study examined the relationship between medical mistrust and access to cancer preventive care among Black, American Indian (AI) and White participants in Virginia. Methods: A convenience sample (N=1,288) designed to oversample underrepresented communities in Virginia completed surveys assessing medical mistrust, access to medical care and colorectal cancer screening. Measures included the medical mistrust index, visiting a doctor in the last year (yes/no), ever having a colonoscopy (yes/no), perceived health status, race, age, sex, education, marital status, insurance coverage and rurality. Bivariate tests evaluated significant (p&amp;lt;.05) associations between outcomes of having a doctor visit in the last year and colonoscopy screening with medical mistrust, health status, and sociodemographics; significant findings were included in logistic regression models. Differences among endorsements of individual mistrust scale items by race was also assessed. Results: Sample was μ age=45 (SD=18), 47% female, 40% Black, 36% White, 14% AI, 45% had ≤ high school diploma/GED, 63% married, majority resided in metro areas (91%) and were medically insured (85%). Among the sample 80% had visited doctor in the last year and 63% of those eligible had a colonoscopy. Medical mistrust was significantly higher among Black and AI participants compared to White. In overall and stratified logistic regression models medical mistrust was not associated with visiting a doctor in the last year or obtaining a colonoscopy. 5 of 7 items of the medical mistrust index were endorsed more often among Black and AI participants compared to White. These included feeling that medical institutions deceive people (Black: r=0.07, p&amp;lt;0.01; AI: r=0.07, p=0.01; White: r=-0.11, p&amp;lt;0.01), cover-up mistakes (Black: r=0.11, p&amp;lt;0.01; AI: r=0.96, p=0.04; White: r=-0.13, p&amp;lt;0.01), conduct harmful experiments (Black: r=0.07, p&amp;lt;0.02; White: r=-0.10, p&amp;lt;0.01), lack competency (AI: r=0.07, p=0.01; White: r=-0.08, p&amp;lt;0.01), and make mistakes often (AI: r=0.10, p&amp;lt;0.01; White: r=-0.09, p&amp;lt;0.01). Conclusions: Medical mistrust was significantly higher among Black and AI participants compared to White but this was not associated with accessing medical care. Given differential endorsement of items dealing with medical errors and their concealment, these results suggest a need to investigate patient experiences after care is initiated to understand what factors may contribute to medical mistrust and care outcomes long term. Citation Format: Jackie Knigh Wilt, Maria D. Thomson. Examining medical mistrust and access to cancer preventive care in a diverse sample [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB372.

Women’s Mental Health During COVID-19 in South Africa

Women’s mental health vulnerability, already a concern before the COVID-19 pandemic, has been exacerbated due to social isolation and restrictions on daily activities. This paper aims to follow a cohort of women from pre - to during the pandemic to determine the change in their mental health using the PHQ-2 scale (a mental health screening tool). Additionally, we investigate whether women with depressive symptoms before the pandemic suffered similarly to those without while controlling for pandemic-related factors. Primarily, we use the Coronavirus Rapid Mobile Survey dataset and apply pooled ordered logit and fixed effects ordered logit models. We find that the value of the PHQ-2 scale significantly increased during the first period of the pandemic and then eased over time. Interestingly, the behaviour of the individual scale items differed over time. This result questions the internal reliability of the scale during the pandemic and the importance of analysing the scale items individually. Furthermore, being depressed before the pandemic increases the probability of ‘depressive feelings’ and does not matter for ‘anhedonia’. Other factors increasing the probability of mental health disorders are taking care of children for 13–24 h a day and living with a person who has gone hungry. In contrast, wearing a mask and living in a grant-receiving household decreases the probability. These findings inform future researchers of the unexpected behaviour of scales and policymakers of the vulnerability of women’s mental health during unprecedented times, given their vital role in increasing the well-being of future generations.

Additional Validation of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Eating Concerns Scale.

Maladaptive eating behaviors are typically associated with significant impairment in psychological functioning more broadly. The Minnesota Multiphasic Personality Inventory (MMPI) family of instruments has traditionally been the most frequently used psychological assessment of psychopathology by clinical psychologists. The most recent version, the MMPI-3, features a new Eating Concerns (EAT) scale that screens for the presence of problematic eating behaviors. The goals of the current study were (a) to independently replicate validity correlations reported from the college sample during EAT scale development, (b) to evaluate the utility of EAT scale item-level correlations with other substantive MMPI-3 scales, and (c) to evaluate the ability of the EAT items to predict specific frequency counts of dysfunctional eating behaviors. The current study examined the MMPI-3 assessment of dysfunctional eating behaviors among 188 undergraduate participants. Results indicated that the EAT scale is meaningfully associated with core symptom dimensions of maladaptive eating, including binging, vomiting, restricting, and concerns about weight and shape. In addition, this study identified meaningfully distinct patterns of correlations with personality and psychopathology constructs, and specific behavioral frequencies, across the five individual EAT scale items. These results contribute to the enhanced utility of this important screening scale in clinical settings.

Alpha wave asymmetry is associated with only one component of melancholia, and in different directions across brain regions.

Alpha wave asymmetry inconsistently correlates with Major Depressive Disorder (MDD). One possible reason for this inconsistency is the heterogeneity of MDD, leading to study of depressive 'subtypes', one of which is Melancholia. To investigate the correlation between Melancholia and alpha-wave asymmetry, 100 community participants (44 males, 56 females; aged at least 18yr) completed the Zung self-rated Depression Scale, and underwent 3min of eyes closed EEG recording from 24 scalp sites. There was no significant correlation between EEG data and Melancholia total score for the entire sample, but there was for those participants who had clinically significant depression (n=33). When examined at the level of individual Melancholia scale items, significant EEG data correlations were found for some of the items but not for others. Factor analysis revealed a two-factor structure for the Melancholia scale, only one of which exhibited significant correlations with EEG AA data. Further exploration of those data identified two subcomponents of that Melancholia factor, one which was inversely correlated with frontal alpha asymmetry, and another which was directly correlated with parietal-occipital alpha wave asymmetry. These findings suggest that Melancholia may itself be heterogeneous, similarly to MDD, and rely upon different aspects of cognitive function.

An unexplored equity factor: differential beliefs and attitudes toward contingency management by providers’ ethnicity

BackgroundAlthough considered one of the most effective interventions for substance use disorders (SUD), the widespread implementation of contingency management (CM) has remained limited. In more recent years there has been surge in the implementation of CM to address increasing rates of substance use. Prior studies at the provider-level have explored beliefs about CM among SUD treatment providers and have tailored implementation strategies based on identified barriers and training needs, to promote implementation of CM. However, there have been no implementation strategies that have actively sought to identify or address potential differences in the beliefs about CM that could be influenced by the cultural background (e.g., ethnicity) of treatment providers. To address this knowledge gap, we examined beliefs about CM among a sample of inpatient and outpatient SUD treatment providers.MethodsA cross-sectional survey of SUD treatment providers was completed by 143 respondents. The survey asked respondents about their attitudes toward CM using the Contingency Management Beliefs Questionnaire (CMBQ). Linear mixed models examined the effect of ethnicity (non-Hispanic White and Hispanic) on CMBQ subscale (general barriers, training-related barriers, CM positive-statements) scores.ResultsFifty-nine percent of respondents to the CMBQ self-identified as non-Hispanic White and 41% as Hispanic. Findings revealed that treatment providers who identified as Hispanic had significantly higher scores on the general barriers (p < .001) and training-related barriers (p = .020) subscales compared to the non-Hispanic White treatment providers. Post-hoc analyses identified differences in the endorsement of specific individual scale items on the general barriers (e.g., CM interventions create extra work for me) and training-related (e.g., I want more training before implementing CM) subscales.ConclusionsDissemination and implementation strategies for CM need to consider equity-related factors at the provider-level that may be associated with the adoption and uptake of CM.

Factors impacting quality of life in multiple system atrophy.

Multiple system atrophy (MSA) is an atypical parkinsonian disorder marked by autonomic dysfunction, parkinsonism, cerebellar dysfunction, and poor response to dopaminergic medications such as levodopa. Patient-reported quality of life is an important benchmark for clinicians and clinical trials. The Unified Multiple System Atrophy Rating Scale (UMSARS) allows healthcare providers to rate and assess MSA progression. The MSA-QoL questionnaire is a health-related quality of life scale intended to provide patient-reported outcome measures. In this article, we investigated inter-scale correlations between the MSA-QoL and UMSARS to determine factors impacting the quality of life of patients with MSA. Twenty patients at the Johns Hopkins Atypical Parkinsonism Center's Multidisciplinary Clinic with a diagnosis of clinically probable MSA and who filled out the MSA-QoL and UMSARS questionnaires within 2 weeks of each other were included. Inter-scale correlations between MSA-QoL and UMSARS responses were examined. Linear regressions were also performed to examine relationships between both scales. Significant inter-scale correlations were found between the MSA-QoL and UMSARS, both between MSA-QoL total score and UMSARS Part I subtotal scores and for individual scale items. There were no significant correlations between MSA-QoL life satisfaction rating and UMSARS subtotal scores or any specific UMSARS items. Linear regression analysis found significant associations between MSA-QoL total score and UMSARS Part I and total scores, and between MSA-QoL life satisfaction rating and UMSARS Part I, Part II, and total scores (after adjustment for age). Our study demonstrates significant inter-scale correlations between MSA-QoL and UMSARS, particularly relating to activities of daily living and hygiene. MSA-QoL total score and UMSARS Part I subtotal scores, which assess patients' functional status, were significantly correlated. The lack of significant associations between MSA-QoL life satisfaction rating and any UMSARS item suggests there may be aspects to quality of life that are not fully captured by this assessment. Larger cross-sectional and longitudinal analyses utilizing UMSARS and MSA-QoL are warranted and modification of the UMSARS should be considered.

Comparing Expert, Quasi-Expert, and Novice Evaluations of Award-Winning Design Products Using the Consensual Assessment Technique

ABSTRACT The consensus-based assessment has long been a prevalent methodology employed in “panel crit” settings in design education and professional design awards. Acknowledging the subjective nature of design evaluation and its importance to the design development process, we report two studies investigating the effect of three levels of design expertise (expert, quasi-expert, and novice) on the evaluation of award-winning lamp designs using the consensual assessment technique (CAT). The pilot study (N = 30) preliminarily examined expertise-related differences in evaluation outcome (i.e., ratings and rankings) and the use of the CAT instrument. In a follow-up study (N = 135), we tested four hypotheses using the refined CAT instrument. Results showed a significant interaction effect between expertise group and design on evaluation. Correlations between groups showed that quasi-experts were more similar to novices than experts. This finding contributes to the discussion on whether quasi-experts should be considered proper substitutes for experts. Furthermore, the reliability of ratings on individual CAT scale items varied among groups, suggesting that the degree to which raters were consistent within a group depends upon which aspect of design quality they were assessing. Taken together, the findings provide valuable insights into the influence of design education and experience on judging design quality.

An Evaluation of a Mobile App for Chronic Low Back Pain Management: Prospective Pilot Study.

BackgroundChronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group–based pain program—Pain Rehabilitation Outpatient-Camp.ObjectiveThis was a prospective pilot clinical trial that evaluated the PainNavigator platform’s utility in low back pain management to inform future trial development.MethodsA total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items—Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention.ResultsThe analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36% reduction in PEG-3 total scores, a 40% reduction in pain intensity, and a 40% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes.ConclusionsThese findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials.

Reliability of the PEDro scale: comparison between trials published in predatory and non-predatory journals

BackgroundLack of effective peer-review process of predatory journals, resulting in more ambiguity in reporting, language and incomplete descriptions of processes might have an impact on the reliability of PEDro scale. The aim of this investigation was to compare the reliability of the PEDro scale when evaluating the methodological quality of RCTs published in predatory (PJs) and non-predatory (NPJs) journals, to more confidently select interventions appropriate for application to practice.MethodsA selected sample of RCTs was independently rated by two raters randomly selected among 11 physical therapists. Reliability of each item of the PEDro scale and the total PEDro score were assessed by Cohen’s kappa statistic and percent of agreement and by Intraclass Correlation Coefficients (ICC) and the Standard Error of Measurement (SEM), respectively. The Chi-square test was used to compare the rate of agreement between PJs and NPJs.ResultsA total number of 298 RCTs were assessed (119 published in NPJs). Cronbach’s alphas were .704 and .845 for trials published in PJs and NPJs, respectively. Kappa values for individual scale items ranged from .14 to .73 for PJs and from .09 to .70 for NPJs. The ICC was .537 (95% CI .425—.634) and .729 (95% CI .632-.803), and SEM was 1.055 and 0.957 for PJs and NPJs, respectively. Inter-rater reliability in discriminating between studies of moderate to high and low quality was higher for NPJs (k = .57) than for PJs (k = .28).ConclusionsInterrater reliability of PEDro score of RCTs published in PJs is lower than that of trials published in NPJs, likely also due to ambiguous language and incomplete reporting. This might make the detection of risk of bias more difficult when selecting interventions appropriate for application to practice or producing secondary literature.

Development and validation of a new scale to measure chronic suicidal ideation: The Chronic Suicidal Ideation Inventory-5 (CSI-5)

ObjectiveLittle is known about characteristics that differentiate acute from chronic suicidal ideation. Studies have been hampered by the lack of a formal operational definition or measurement tool for chronic suicidal ideation (CSI). We sought to adapt a standardized measure of obsessive-compulsive thinking to rate chronic suicidal ideation in a mood disorder inpatient cohort. MethodWe devised a novel self-report instrument, based on constructs related to obsessive-compulsive thinking and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), as applied to preoccupations with suicidal thoughts and their persistence over 24 months in a previously described cohort of 97 inpatients with mood disorder. Exploratory factor analysis and principal components analysis were used to establish the factor structure of the instrument, and Cronbach's alpha and McDonald's omega were calculated to determine internal consistency of the scale. ResultsSignificant Pearson correlations with individual scale items and total CSI-5 scores were evident in relation to the 2-, 6-, 12- and 24-month periods preceding the index hospitalization. A one-factor solution explained 75% of the variance in total CSI-5 scores. Cronbach's alpha was 0.914, and McDonalds's omega was 0.916. CSI-5 scores were not significantly associated with current depression severity scores or actual past suicide attempts. ConclusionsThis 5-item adaptation of Y-BOCS-type questions provides an internally consistent and reliable assessment of chronic suicidal ideation in patients with mood disorder. The integrated assessment of time occupied by suicidal thoughts, activity interference, associated distress, efforts to resist suicidal thoughts, and degree of control over suicidal thinking provides a cohesive framework for understanding chronic suicidal ideation.

Evaluating the Impact of a Novel Peer-to-Peer Educational Modality on Knowledge and Attitudes About Perinatal Mood and Anxiety Disorders.

This study assessed whether the use of a peer-to-peer educational book, written and illustrated by women who experienced common mental disorders (CMDs) in the perinatal period, can positively impact women's knowledge and attitudes about these conditions. This one-group pretest/posttest survey assessed participants' knowledge and attitudes regarding CMDs immediately before and after reading INSPIRE: Stories of Motherhood. The book is composed of women's stories and artwork about their own experiences with parenthood, with an emphasis on the challenges of parenthood and depictions of CMDs, depression and anxiety, during the peripartum period. Study participants were recruited at the Robert Wood Johnson Medical School Obstetrics and Gynecology ambulatory care office in New Brunswick, NJ and participated while waiting for their appointments. Our voluntary study population included English-speaking females over age 18. Primary outcomes measured were knowledge and attitudes about CMDs. Measures included individual Likert scale items and composite "stigma scores." 325 adult women were approached and 251 agreed to participate (response rate 77%). 181 of the participants completed all of the items in the pre- and posttest surveys. Results suggested increased knowledge and more positive attitudes after the intervention, corresponding to a decrease in stigma between the pre- and posttest surveys. The mean difference in stigma score on the 5pt Likert scale was 1.5 (95%CI .9 to 2.1, p < .0001), and on the 3pt Likert scale was 0.9 (95%CI .3 to 1.5, p = .0028). The study suggests that resources that highlight lived experiences with peripartum CMDs as told by women themselves may be a useful educational tool. In this study, the book INSPIRE: Stories of Motherhood, told and illustrated by women who have experienced CMDs, increased participants' knowledge and resulted in more positive attitudes about these disorders.

Trends in Adolescent Asthma Responsibility Over a 12-Month Study Period

PurposeThe aim of this study is to assess factors that influence adolescent asthma responsibility and how patient- and parent-reported asthma responsibility changes over a 12-month period. MethodsOne hundred sixty-four adolescents and their parents completed questionnaires at baseline and 12 months, including the asthma responsibility questionnaire, in which higher scores indicate greater adolescent responsibility. Multiple linear regression was used to assess how baseline asthma responsibility, self-efficacy, outcome expectations, and demographic characteristics were associated with 12-month asthma responsibility. ResultsAsthma responsibility as reported by both adolescents and parents shifted significantly toward the adolescent over the study period (p < .001). Most individual scale items (e.g., noticing signs and symptoms of asthma, starting treatment when symptoms occur) also showed significant shifts toward greater adolescent responsibility. In the regression models, higher baseline asthma responsibility and older age were significant predictors of both higher adolescent- and parent-reported 12-month asthma responsibility, while female gender and mild asthma severity also predicted higher parent-reported asthma responsibility. ConclusionsAsthma responsibility shifted toward adolescents over a 12-month period. Regardless of age and gender, all types of adolescents were able to improve their responsibility level based on adolescent-reported results. Older females, according to parent-reported results, were more likely to improve their responsibility. Providers need to make sure adolescents are learning all the necessary skills to manage asthma independently before they reach adulthood.

Lamotrigine for acute bipolar depression: An exploratory item-level analysis.

ObjectivesLamotrigine is used to treat bipolar depression despite inconsistent evidence. Here we present the results of an exploratory item‐level analysis of pooled data from five randomized placebo‐controlled trials of lamotrigine for acute bipolar depression. The goal was to determine if certain depression scale items were more responsive to lamotrigine treatment.MethodsThe pooled sample contained 1072 adult outpatients treated for up to 7–10 weeks. Depressive symptoms were measured with the Hamilton Depression Rating Scale and the Montgomery–Åsberg Depression Rating Scale. Change scores on individual scale items were compared between treatment groups.ResultsThere were statistically significant effects on items assessing depressed mood/sadness, lack of interest/anhedonia, pessimism/guilt, and anergia/fatigue, on both scales. However, there was marked variation in the baseline symptom prevalence, and items with higher scores at baseline tended to have larger and statistically significant treatment effects.ConclusionsThe results suggested a significant treatment effect on core symptoms of depression. A floor effect appeared to limit the sensitivity of other scale items. Given the exploratory nature of the analysis, firm conclusions cannot be drawn, although the results were consistent with past research. Relying on total depression scale sum scores over targeted assessments of core depressive symptoms may have impeded signal detection in the original trials.

Correlation of dsm-5-based and hads self-reported depression phenotypes: Preliminary results of on-line survey in russian population cohort

IntroductionTo reduce the heterogeneity of depressive GWAS samples it seems relevant to evaluate and compare current instruments for depression phenotyping.ObjectivesThe aim is to evaluate the agreement of DSM criteria and HADS scores in depression phenotyping for population studies.MethodsThe self-report data was obtained from 5116 clients (females 50,63%; mean age 36,92±9,82 years, Ме=42; Q1=35, Q3=76) of genetic testing company Genotek Ltd.. The respondents completed an on-line questionnaire with items on social status and biometrics. Depression phenotyping was based on DSM-5 criteria (life-time and current for major and bipolar depression) and HADS (current).ResultsMean HADS scores were: HADS-A – 6,43±2,9, Ме=8; Q1=6, Q3=18; HADS-D – 4,5±2,83, Ме=6; Q1=4, Q3=17. Abnormal anxiety and depression (≥11 for each subscale) were present in 9% (N–456) and 3,4% (N–174) of respondents, respectively; borderline (8-10) – in 23% (N–1172) and 11,9% (N–592), respectively. The life-time report of major depression according to DSM-5 criteria was 17,6% (N–261) and of bipolar disorder – 8,3% (N–139). Moderate correlations were present for borderline HADS anxiety scores and DSM major depression (0.19, p&lt;.01). Similar correlations of HADS anxiety scores were registered for DSM bipolar depression (0.20, p&lt;.01). Moreover, HADS depression scores did not correlate with any DSM depressive phenotype.ConclusionsOur study shows significant correlations only for DSM depression criteria and HADS anxiety, but not depression scores. It could indicate the different significance of individual scale items in depression phenotyping and the need for their separate further evaluation.Conflict of interestThe research is supported by the Russian Scientific Fund grant #20-15-00132.

Characterization of Depressive and Anxiety Symptoms in Idiopathic REM Sleep Behavior Disorder.

Depression and anxiety are common in synucleinopathies and often present during prodromal stages, including idiopathic/isolated REM sleep behavior disorder (iRBD). However, the specific profiles of depression/anxiety and their predictive values for phenoconversion remain unclear. To assess the predominant manifestations, predictive value, and changes over time in depressive and anxiety symptoms in iRBD. Patients with polysomnography-confirmed iRBD (n = 114) and healthy controls (n = 44) were recruited. The Beck Depression Inventory and Beck Anxiety Inventory were administered at baseline, which was repeated prospectively over follow-up. Factor solutions were generated to delineate symptom clusters within the scales, and to help disentangle primary mood symptoms from other neurodegenerative confounds. Total scores, individual scale items, and factors were evaluated to 1) compare patients and controls, 2) assess progression of symptoms over time, and 3) assess predictive value for phenoconversion. At baseline, iRBD patients had more severe depressive (9.0 = 6.7 vs 5.8 = 4.8) and anxiety (7.0 = 7.9 vs 4.5 = 6.0) symptoms than controls. Increased scores were seen in numerous individual scale items and most scales' factors. For depressive symptoms, there was no progression of total scores or factors over time. However, anxiety scores worsened slightly over prospective follow-up (annual slope = 0.58 points, p < 0.05). Over an average 2.4 = 3.1-year follow-up, 37 patients phenoconverted and 72 remained disease-free. Neither baseline depressive nor anxiety symptoms predicted phenoconversion to clinical neurodegenerative disease. Depressive and anxiety symptoms are common in iRBD. However, they do not predict phenoconversion and show only modest progression over time, solely for anxiety.

Closing the gap: Raising medical professionals' transgender awareness and medical proficiency through pharmacist-led education.

IntroductionPatients who are transgender have unique population-specific needs and risk factors. Nationwide surveys of health profession school administrators indicate a gap in coverage of lesbian, gay, bisexual, and transgender health content in their curricula. To address this gap, a pharmacist-developed transgender–health care focused seminar was presented to medical professionals, trainees, and students accompanied by a novel education assessment scale.MethodsThe seminar was presented by a psychiatric pharmacy resident to health care professionals and trainees in various settings. Subjects covered during the seminar included terminology, diagnostic criteria and prevalence of gender dysphoria, nonhormonal treatment, gender-affirming hormone therapy, and other considerations. The Trans* Health Education Evaluation Scale (THEES) was developed to assess participants' self-perceived proficiency regarding care of patients who are transgender immediately before and after attending a seminar. Total scale scores were compared preseminar and postseminar using a repeated-measures t-test, and sign tests with Bonferroni correction were used for individual scale items. Psychometric properties of this scale were examined.ResultsFive seminars were given, and a total of 100 scales were completed by health care–associated workers and students. The majority of participants were in the pharmacy or medical professions. Attending 1 seminar significantly improved THEES total and individual item scores (P < .001). Additionally, 90% of participants felt the seminar was directly applicable to their practice, and 84% felt more confident in providing care to patients who are transgender.DiscussionA single, pharmacist-led, trans health–focused education session significantly improved the confidence level and self-perceived proficiency of health care–associated personnel as measured by THEES.