Item Sheet Research Articles

WHO Support tool to strengthen health information systems

Abstract In the first presentation, a representative of the WHO Europe team who took part to the development of the “Support tool to strengthen health information systems: guidance for health information system assessment and strategy development” as part of the European Health Information Initiative (EHII), will introduce the tool and the relevance of performing health information system assessments to support Member States in strengthening their HIS. The 4 main guiding steps of the HIS tool (1. Perform an HIS assessment; 2. Develop an HIS vision; 3. Develop an HIS improvement plan; 4. Monitor progress and perform regular evaluations) will be outlined as well as the HIS assessment item sheet that guides the performing of an assessment, which consists of a core module and several add-on modules. The aim of the core module is to provide an overview of the functioning of the entire national HIS. The aim of the add-on modules is to shed more light on specific parts or functions of the national HIS. As the tool is in continuous development, the plans for the future will be outlined, including a short introduction to the new add-on modules that will be included in the tool.

Analysis of validity, reliability, discrimination, difficulty and distraction effectiveness in learning assessment

Assessment is not only to measure learning progress, but also allows educators use information of student condition to improve learning. Result of students final exam eight grade in science subjects at SMPN 2 Lembah Gumanti are low. Items of question that are not qualified can be a factor that makes the results of the assessment low. Quality of items is not yet known because the teacher has not carried out the analysis. Therefore, need to analyze the quality of items in several aspects. This type of research is descriptive research. Sample are items on biology topics. Data are item sheet, answer key and answer sheets which is taken through documentation. Analysis is carried out with a program was name Anates version 4.0.9. The results of data analysis were obtained: 1) validity, 65.38 % invalid, 2) reliability of 0.67 classified as sufficient, 3) level of difficulty, 11.53 % very easy, 7.69 % easy, 50% medium, 19.23% difficult, and 11.53 % very difficult, 4) discrimination, 15% very bad, 15 % bad, 30% enough, and 40% good, 5) distraction effectiveness, 24.36 % does not work. It can be concluded that the item does not match the criteria either.

Developing teaching kit on the use of micro-hydro generator in remote area

The study aimed at: (1) identifying the criteria of teaching kit feasibility for the advantages of micro-hydro generator in remote area; and (2) identifying the effectiveness of teaching kit implementation on the use of micro-hydro generator in remote area in order to improve the students’ concept mastery on SMP Negeri 1 Rampi South Sulawesi. The study was a research and development that adapted the 4D model, which consisted of define, design, develop, and disseminate. The teaching kit that had been developed was a syllabus, lesson plans, student’s worksheet, and assessment instrument. For the data gathering, the researcher implemented the non-test technique, in the form of product validation sheet, student’s worksheet readability questionnaire sheet, teaching implementation sheet, and test technique, in the form of concept mastery test item sheet. The results of the study show that: (1) the teaching kit on the use of micro-hydro generator in remote area that has been developed falls into the “Very Good” category for syllabus, lesson plan, and student’s worksheet; and (2) the implementation of the teaching kit on the use of micro-hydro generator in remote area has been effective to improve the students’ concept mastery in SMP Negeri 1 Rampi South Sulawesi.

Aggressive behaviour and psychosis in a clinically referred child and adolescent sample

Despite evidence of an increased risk of violence among adults suffering from psychosis, very little is currently known about the relationship between early onset psychosis and aggressive behaviour. We aimed to identify and examine overlaps between aggressive behaviour and psychosis in a referred child and adolescent sample to assess whether potential risk factors and other associated features of this co-occurring pattern can be identified at a young age. Standardised item sheet data on young people referred to the Child and Adolescent Department of the Maudsley Hospital between 1973 and 2004 were used to contrast three groups: (1) aggressive-only (n = 1,346), (2) psychosis-only (n = 173), and (3) co-occurring aggression and psychosis (n = 39) on a range of comorbid symptoms and potential risk factors. Co-occurring cases presented with elevated rates of depersonalisation/derealisation, intrusive thoughts and restlessness, and were more likely to have received past treatment compared with both psychosis-only and aggressive-only cases. Although co-occurring cases resembled the psychosis-only group in many domains, including socio-demographic background and rates of emotional symptoms, they differed from 'pure' psychosis cases in having high levels of special educational needs, irritability, non-aggressive antisocial behaviours, as well as being more likely to be from a low social class and have increased contact with police and child care authorities. Our findings suggest that it is possible to identify early risk factors for aggression in individuals with psychosis.

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Social impairment in Hyperkinetic Disorder - relationship to psychopathology and environmental stressors.

There is paucity of information concerning social impairment in children and adolescents referred to mental health services. The aim of this study was to assess the association of social impairment, psychopathology and environmental stressors in Hyperkinetic Disorder (HKD) and to determine the frequency of pervasive developmental disorder (PDD) symptoms in HKD. 'Item sheets' about children and adolescents seen in child and adolescent mental health between 1992 and 2001 (n = 3644) were used to extract nine psychopathology domains, two social impairment subtypes and nine environmental stressors. The two social impairment subtypes were relationship difficulty (RD) and social communication difficulty (SCD) (i. e. autistic-like social impairment). The association of SCD/RD, psychopathology domains and environmental stressors was investigated in HKD cases and compared to a psychiatric control group. In children and adolescents with HKD, SCD was associated with speech and language difficulties, repetitive behaviour, developmental difficulties (all symptoms of PDD), affective symptoms, conduct problems and ADHD symptoms. Relationship difficulty was linked to conduct problems, affective symptoms and environmental stressors. Unlike SCD, RD was associated with all of the environmental stressors studied. There were significantly more children with PDD symptoms in the HKD group than in the control group. This study highlights the importance of subtyping social impairment in HKD and its association with psychopathology and environmental stressors. In HKD, SCD reflecting autistic social impairment is associated with other autistic symptoms, such as speech and language problems and repetitive behaviour. A small subgroup of HKD cases may have a milder form of autistic spectrum disorder.

Personality disorders in prisoners and their motivation for dangerous and disruptive behaviour.

To examine the associations between DSM-III, axis II, personality disorder, motivation and disruptive behaviour in prisoners. Interviews were carried out with 81 prisoners in prison special units in England using research diagnostic instruments and an item sheet measuring disruptive behaviours and their motivations. Independent associations were established using logistic regression. Specific associations were established between psychopathy and axis II disorders with violent and disruptive behaviour and motivations for these behaviours. The study supported a cognitive model explaining the functional association between personality disorder and antisocial behaviour. Personality disorders act as predisposing factors influencing the development of motivations and subsequently facilitate the enactment of disordered behaviour, in a linear progression. Assessment of personality disorder should be routine in disruptive and dangerous prisoners.

The forgotten children: children admitted to a county asylum between 1854 and 1900

Aims and MethodTo assess the part that the 19th century asylums played in the development of the discipline of child psychiatry. Admissions to the Worcester County Asylum between the years 1854 and 1900 were screened to identify children aged 16 and under. An item sheet was used to record details of the admission.ResultsOne-hundred and ninety-five children were admitted. Risk of suicide and dangerousness were routinely recorded, family history rarely. It was not possible to make retrospective diagnoses. The death rate was high and contact with the family was minimal post admission.Clinical ImplicationsChildren were treated exactly like the adult patients, and therefore asylums did not contribute significantly to the development of the discipline of child psychiatry.

Predictors of later schizophrenia and affective psychosis among attendees at a child psychiatry department.

Schizophrenia has been linked with psychological problems in childhood but there is little information on precursors of affective psychosis. To compare childhood psychological antecedents of adult schizophrenia and affective psychosis. Childhood item sheets, which give standardised information on signs and symptoms of mental illness in the year preceding assessment are completed for all attendees at the children's department of the Maudsley and Bethlem Royal Hospital. We examined item sheet data on individuals with an adult diagnosis of schizophrenia (n=59) or affective psychosis (n=27) and a comparison group with no adult mental illness (n=86) (all had attended the department). Abnormal suspiciousness or sensitivity and relationship difficulties with peers are associated with later schizophrenia. In contrast, affective psychosis is associated with childhood hysterical symptoms and disturbances in eating. Childhood psychological precursors for schizophrenia and affective psychosis differ and do not simply reflect non-specific psychiatric disturbance in adolescence.

Depressive conduct disorder: symptom patterns and correlates in referred children and adolescents

Background: In order to examine the validity of the ICD-10 diagnostic category of depressive conduct disorder (DCD), a sample of 58 patients (mean age 11.6) with this diagnosis consecutively referred to a teaching hospital was compared with 151 patients with conduct disorder (CD) (mean age 12.3) and with 128 patients with depressive disorder (DD) (mean age 14.2). Method: Data on symptom profile, sociodemographic characteristics, duration of disorder, family history and psychosocial background were collected using the Maudsley item sheet. Comparison of the three groups was performed using SPSS. Results: Controlling for age and gender differences, the DCD group had fewer biological depressive symptoms, fewer anxiety symptoms, less guilt and lower severity of overall depression compared to the DD group. They also displayed more self-injurious behaviour and had more adverse psychosocial circumstances than the DD subjects. Compared to the CD group, the DCD patients were less overtly aggressive and violent than the CD subjects, in addition to having significant depressive symptoms and a more frequent history of abuse. Limitations: The study was based on case-control and diagnosis had been reached after the discussion of clinicians involved in assessment. Conclusions: Overall, the results tentatively support the validity of this diagnostic subgrouping.

Maudsley Community Item Sheet

The Bethlem Royal and Maudsley Hospitals Item Sheet system for registering clinical data generated by psychiatric assessments is long established, with a proven track record as an instrument of scientific research. However, its use has not spread beyond the originating institution, despite being available in the public domain for many years. To address this problem we have designed a modified version of the Item Sheet. The new system has been simplified and improved to facilitate the use of this research aid in child guidance clinics and similar settings.

Depression, Family Environment, and Adolescent Suicidal Behavior

To assess the specific influence of family relationship difficulties, over and above the effect of depression, on the risk of adolescent suicidal behavior. The study was based on the clinical data summaries, "item sheets," of children and adolescents who attended the Maudsley Hospital during the 1970s and 1980s. Two hundred eighty-four cases of suicidal behavior, defined as suicidal ideas, attempts, or threats (mean age 13.9 years, SD 2.6), were compared with 3,054 nonsuicidal controls, using stepwise logistic regression controlling for age and sex. The following variables were each independently associated with suicidal behavior: an operationally defined depressive syndrome, odds ratio (OR) = 4.4 (95% CI 3.1 to 6.3); family discord, OR = 1.5 (95% CI 1.1 to 2.0); disturbed mother-child relationship, OR = 1.5 (95% CI 1.1 to 2.0); and familial lack of warmth, OR = 1.6 (95% CI 1.1 to 2.3). Twenty-seven percent of the suicidal cases met operational criteria for depression. In a separate analysis of nondepressed cases (n = 198), female gender, OR = 2.4 (95% CI 1.7 to 3.2), and conduct symptoms, OR = 1.4 (95% CI 1.02 to 1.95), were independent risk factors for suicidal behavior. Among the depressed cases (n = 73), gender and conduct symptoms did not affect the risk of suicidal behavior. Although depression is the largest single risk factor for teenage suicidal behavior, family relationship difficulties make a significant independent contribution to this risk. Depression also interacts with gender, so that the excess risk of suicidal behavior in females is confined to nondepressed cases.

Elective Mutism: An Analysis of 100 Cases

An extended series of 100 children with elective mutism (EM) was clinically analyzed. The total sample included two subgroups of clinically referred children at different locations and a subgroup of nonreferred children with EM. The study was based on comprehensive item sheets and, in the nonreferred sample only, the Child Behavior Checklist. EM is a rare disorder in the referred child psychiatric samples. It typically starts at preschool age, is more common in girls, and is seen in all social strata. A background of migration and early developmental risk factors is also quite common. Premorbid speech and language disorders play a role in one third of the clientele, and three quarters of children with EM had behavioral abnormalities during infancy and preschool age. School and unfamiliar people create the social context in which children with EM most frequently do not speak. Shyness and internalizing behavior problems are the most common personality features in EM, and comorbid diagnoses are quite frequent. This large series of affected children has identified the most typical features of EM and thereby extends the limited knowledge of this rare disorder of childhood.

A comparison of twins and singletons with child psychiatric disorders: an Item Sheet study.

An important assumption underlying the twin method of comparing MZ and DZ twins is that results from twin samples can be generalized to the larger singleton population. This study uses Item Sheet data on child psychiatric patients to compare twins and singletons on demographic, diagnostic and symptomatic variables. Although little difference was found between the two groups, conduct disorders were significantly over-represented in the twin population. The significance of this finding is discussed. This study lends overall support for the use of the twin method in child psychiatric samples.

Adult Outcomes of Childhood and Adolescent Depression

The present study was based on the clinical data summaries ("item sheets") of children who attended the Maudsley Hospital, London, England, during the late 1960s and early 1970s. These summaries were used to identify a group of 80 child and adolescent psychiatric patients with an operationally defined depressive syndrome. The depressed children were individually matched with 80 nondepressed psychiatric controls on demographic variables and nondepressive childhood symptoms by a computer algorithm. At follow-up, on average 18 years after the initial contact, information was obtained on the adult psychiatric status of 82% of the total sample. Adult assessments were made "blind" to case/control status. The depressed group was at an increased risk for affective disorder in adult life and had elevated risks of psychiatric hospitalization and psychiatric treatment. They were no more likely than the control group to have nondepressive adult psychiatric disorders. These findings suggested that there is substantial specificity in the continuity of affective disturbances between childhood and adult life.

The Bethlem and Maudsley Hospital item sheets (B-MIS)

The Bethlem and Maudsley Hospital item sheets (B-MIS) are summaries in coded form which are completed for every patient admitted or readmitted to the joint hospitals. The Part 1 item sheet contains information which is included in the Part 1 case summary, as described inNotes on Eliciting and Recording Clinical Information, and is completed at the same time as the summary is prepared; that is, usually within a fortnight of the patient entering hospital. Similarly, the Part 2 item sheet contains information normally found in the discharge summary, and is completed at the same time that this summary is prepared; shortly after the patient has left hospital. The item sheets are restricted to pieces of information which can be readily coded by the registrar. Thus, of necessity, they concentrate on relatively ‘hard’ data.

The subclassification of child firesetters.

The possibility that child firesetters are a heterogeneous group was investigated in a cross-sectional case note and item sheet study of all children referred to an Inner London clinic between 1973 and 1981. Firesetters were most usefully subdivided by age, and secondarily by reason for referral. There were no links between enuresis and dangerousness or cruelty to animals. Methodological issues and the implications of the findings are discussed, with particular reference both to the development of the disorder and to the subclassifications drawn for conduct disturbance.

Child firesetters: a clinical investigation.

The demographic, symptomatic, psychosocial and diagnostic profile of 104 child firesetters was investigated in a controlled case note and item sheet study of all children referred to an Inner London clinic between 1973 and 1981. Firesetters form a subgroup of severe conduct disorders, and are distinguished by a younger peak age of 8, higher boy/girl ratio and more marked psychosocial disturbance. The paper focuses on the relationships between background factors and firesetting, and also examines the relevance of enuresis and situational antecedents as specific determinants.

Season of birth in high and low genetic risk schizophrenics.

Hypotheses which have been proposed to account for the unusual seasonal birth pattern observed in schizophrenic populations are discussed. These competing hypotheses were tested by retrospectively studying season of birth in 975 schizophrenics divided according to family history of psychiatric illness. Information was obtained from case notes, item sheets, and questionnaires sent to general practitioners. The results were inconclusive, but there was a trend for high genetic risk cases to be born less often in the first quarter of the year. Although no clear support could be provided for one or other season of birth hypothesis, it is tentatively suggested that a seasonal constitutional damage factor may be responsible for the excess of births described in schizophrenic populations in the early months of the year.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression were investigated by means of a retrospective study of case notes and item sheets. One hundred and sixty-eight cases of depression, aged 20 to 29 years, were rated for obsessional personality as defined by Ingram (1961). The presence of previous obsessions, of obsessions in depression and of eight symptoms of depression was assessed from the item sheets. Obsessional personality was found to be significantly associated only with a decreased frequency of objective apathy, although it seemed to act to reduce the anxiety experienced by those with obsessions, in depression. Obsessions in depression were associated with rapid changes of mood, anxiety, agitation and overactivity and with a relative absence of retardation.