Lower Competence Scores Research Articles

Mapeamento de competências essenciais: conhecimentos, habilidades e atitudes para gestão em saúde pública

ABSTRACT This is a cross-sectional study, with a quantitative exploratory descriptive approach that aimed to mapp essential competencies in public health among professionals working in the management of a state health department. Data collection was conducted online through a questionnaire. Data were analyzed descriptively, and the competencies were assessed according to six domains of the Regional Framework for Essential Competencies in Public Health and the Degree of Competency Expression at Work. A total of 119 professionals participated in the study, with a predominance of females (70.6%) and an average age of 46.7 years. Domain 1 - Health Situation Analysis showed the highest Degree of Competency Expression at Work; while Domain 6 - International and Global Health obtained the lowest value. There was a significant relationship between the variables studied and education, highlighting that lower levels of education are associated with lower competence scores across the six analyzed domains. It is concluded that developing competencies is a challenge in public management due to its specificities. In this context, competency mapping plays a fundamental role in planning and implementing effective actions for Continuing Health Education.

The Knowledge Profile, Competence and Pending Problems of Chinese Anesthesiologists in Dealing with Malignant Hyperthermia: A Cross-Sectional Survey.

The National Remote Emergency System for Malignant Hyperthermia (MH-NRES) is an applet in China, designed to help anesthesiologists manage MH crisis. However, there is limited information about encountered difficulties in dealing with MH among Chinese anesthesiologists. The purpose of the study was to explore the current competency and encountered difficulties in the management of MH, as a key first step for assessing the potential user needs to develop the MH-NRES. The hospitals of different levels in different provinces across China were invited to participate in an online survey from November to December 2021. Anesthesiologists completed the online questionnaire containing four sections including demographic information, knowledge, competency, and continuing education about MH. A total of 1357 valid questionnaires were completed from anesthesiologists, most respondents (66.7%, n = 905) correctly answered the MH trigger drugs included volatile anesthetics and succinylcholine. However, most respondents (77.0%, n = 1045) did not know that the recommended initial dose of domestic dantrolene. Up to 83.9% (n = 1138) stated that their hospitals did not store dantrolene for MH emergency. More than half of respondents thought that it would take more than one hour to obtain dantrolene in emergency. Less work experiences, lower levels of hospital and educations and professional titles were associated with lower competency scores in managing MH. Only 31.0% (n = 936) reported that their hospital had ever conducted MH continuing education curricula. Scenario simulation is the training method that most interests the participants (79.0%, n = 1072) but a whopping 46.9% (n = 637) never received simulation. The study indicated that difficulty in obtaining dantrolene, lack of competency in management of MH, difficulty in obtaining professional help, and poor teamwork were the main problems of most anesthesiologists in face of MH.

A survey on critical health competences among diabetes educators using the Critical Health Competence Test (CHC Test)

BackgroundDiabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM). Diabetes educators are important healthcare professionals for implementing the concept of informed SDM in diabetes care. They need critical health competences (CHC) in order to provide evidence-based information and to support patients in understanding the risks of the disease and also the possible benefits or harm of the healthcare options. Therefore, we surveyed the CHC of diabetes educators.MethodsWe performed a cross-sectional survey using the validated Critical Health Competences (CHC) Test to measure CHC of certified diabetes educators and trainees in Germany. Diabetes educators were approached via newsletter, mailing lists or in person during the conference of the German Diabetes Association. Trainees were approached during their training sessions. We applied scenario 1 of the CHC test, which comprises 17 items with open-ended and multiple-choice questions. Mean person parameters with a range from 0 to 1000 were calculated to assess the levels of critical health competences and a multiple linear regression analysis was conducted to determine correlations between sociodemographic variables and levels of CHC.ResultsA total of 325 participants, mean age 38.6 (±11.1) years, completed the CHC test; n = 174 (55.5%) were certified diabetes educators and n = 151 (46.5%) were trainees. The participants achieved a mean score of 409.84 person parameters (±88.10) (scale from 0 to 1000). A statistically significant association was found only between the level of education and the level of CHC (b = 0.221; p-value 0.002). Participants with grammar school education achieved higher mean scores compared to participants with secondary school education (432.88 ± 77.72 vs. 396.45 ± 85.95; mean difference 36.42 ± 9.29; 95%CI 18.15 to 54.71; p < 0.0001).ConclusionDiabetes educators achieved low competence scores and it can be assumed that they do not have sufficient CHC to conduct consultations based on the SDM principles. Poor CHC among healthcare providers are a major barrier for the implementation of SDM. Core concepts of evidence-based medicine should be implemented into the curricula for diabetes educators in order to increase their levels of CHC.

Providers’ Implicit and Explicit Stereotypes About Mental Illnesses and Clinical Competencies in Recovery

We examined community providers’ stereotypes about mental illnesses and their association with clinical competencies among mental health professionals in Washington State’s community mental health system (N = 584). Mental Health Competence and Recovery Implicit Association Tests were developed. The Competency Assessment Instrument (CAI) measured provider competencies in rehabilitation. Bivariate and multivariate analyses were used to examine the associations between stereotypes and clinical competencies. On average, providers did not differentially associate the concepts of competence or recovery with physical illnesses versus mental illnesses. However, providers that implicitly associated recovery more with physical illnesses had lower clinical competency scores (p = .03). Explicit stereotypes were associated with lower competency scores. Providers’ stereotypes about mental illnesses are predictors of clinical competencies.

Vision specific quality of life in children with optic pathway gliomas

Children with optic pathway gliomas (OPGs) frequently experience vision loss from their tumors. Most pediatric OPG research has focused on radiographic and visual outcomes, yet the impact of vision loss on quality of life (QOL) in children with OPGs has not been studied. The present study prospectively recruited children ≤ 10 years of age with sporadic or neurofibromatosis type 1 (NF1)-related OPGs. Vision specific QOL was assessed by parent proxy using the Children's Visual Function Questionnaire (CVFQ), and scores were analyzed according to magnitude of visual acuity (VA) loss and presence of visual field (VF) loss. Thirty-six subjects completed the study (53 % female) with median age of 4.6 years. Children with mild, moderate and severe vision loss have lower CVFQ subscale scores, indicating a lower vision specific QOL, compared to those with normal vision. Lower Competence scores were noted in participants with more profound vision loss (p < 0.05), reflecting a decreased ability to complete activities of daily living (e.g., feeding, grooming). Children with two visually impaired eyes were rated as having greater difficulty with social interactions and pleasurable activities (Personality subscale, p = 0.039) compared to those with only one impaired eye. In summary, our findings demonstrate that children with vision loss secondary to their OPG have a decreased vision specific QOL compared to those with normal vision. Measuring vision specific QOL may be considered a meaningful secondary outcome measure for pediatric OPG clinical trials.

Early Emergence of Behavior and Social-Emotional Problems in Very Preterm Infants

ObjectiveChildren born very preterm are reported to have an increased frequency of social, emotional, and behavioral problems at school age compared with their peers born at term. The primary aim of this study was to compare social-emotional difficulties and competencies of very preterm and full-term children at 2 years' corrected age. In addition, the relation between perinatal variables and early behavior problems was also examined to help identify those very preterm children most at risk. MethodAt 2 years' corrected age, the parents of 188 very preterm (gestational age <30 weeks or birth weight <1,250 g) and 70 full-term (gestational age ≥37 weeks) children completed the Infant Toddler Social and Emotional Assessment to determine externalizing, internalizing, and dysregulation problems and social-emotional competencies. For the very preterm sample, extensive perinatal data were collected including sex, birth weight, gestational age, chronic lung disease, and postnatal steroids, as well as neonatal cerebral white matter abnormalities detected by magnetic resonance imaging. ResultsThe very preterm children at 2 years demonstrated significantly higher internalizing and dysregulation scores and lower competence scores than peers born at term. There was no significant difference in externalizing scores between groups. Female sex, lower birth weight z score, white matter abnormalities, and postnatal corticosteroids were significantly associated with lower competence scores in the very preterm group. ConclusionsVery preterm children exhibit higher rates of behavior problems early in development, in particular internalizing and dysregulation problems and poorer competence.

Social-Emotional Screening Status in Early Childhood Predicts Elementary School Outcomes

The goal was to examine whether children who screen positive for social-emotional/behavioral problems at 12 to 36 months of age are at elevated risk for social-emotional/behavioral problems in early elementary school. The sample studied (N = 1004) comprised an ethnically (33.3% minority) and socioeconomically (17.8% living in poverty and 11.3% living in borderline poverty) diverse, healthy, birth cohort from a metropolitan region of the northeastern United States. When children were 12 to 36 months of age (mean age: 23.8 months; SD: 7.1 months), parents completed the Brief Infant-Toddler Social and Emotional Assessment and questions concerning their level of worry about their child's behavior, emotions, and social development. When children were in early elementary school (mean age: 6.0 years; SD: 0.4 years), parents completed the Child Behavior Checklist and teachers completed the Teacher Report Form regarding behavioral problems. In a subsample (n = 389), parents reported child psychiatric status. Brief Infant-Toddler Social and Emotional Assessment screen status and parental worry were associated significantly with school-age symptoms and psychiatric disorders. In multivariate analyses that included Brief Infant-Toddler Social and Emotional Assessment status and parental worry, Brief Infant-Toddler Social and Emotional Assessment scores significantly predicted all school-age problems, whereas worry predicted only parent reports with the Child Behavior Checklist. Children with of-concern scores on the problem scale of the Brief Infant-Toddler Social and Emotional Assessment were at increased risk for parent-reported subclinical/clinical levels of problems and for psychiatric disorders. Low competence scores predicted later teacher-reported subclinical/clinical problems and parent-reported disorders. Worry predicted parent-reported subclinical/clinical problems. Moreover, the Brief Infant-Toddler Social and Emotional Assessment identified 49.0% of children who exhibited subclinical/clinical symptoms according to teachers and 67.9% of children who later met the criteria for a psychiatric disorder. Screening with a standardized tool in early childhood has the potential to identify the majority of children who exhibit significant emotional/behavioral problems in early elementary school.

Rural versus Urban African-American Adolescents

The purpose of this pilot study was to determine the differences between rural versus urban African-American adolescents on several scores of perceived competence in important areas of an adolescent's development. The sample included only African-American adolescents either living in urban public housing developments or a rural area approximately 40 miles away in the mid-south region. The Harter scale was utilized and the areas of competence included: scholastic competence, physical appearance, athletic competence, behavioral conduct, close friendships, social acceptance, and global self-worth. All scores were analyzed between environments and within gender. The urban sample scored significantly higher on several normed mean scores of self-competence with the exception of athletic ability, and social acceptance. In addition, the sample was contrasted with the original population norms developed by the authors of Harter's Self-Perception Profile for Children (SPPC) scale and participants scored lower on several competencies including: scholastic abilities, athletic ability, social acceptance, close friendships, and behavioral conduct. The differences found may be influenced by parenting skills, environment, or the interaction between them. Implications for practice would suggest these youth have lower competency scores in important developmental areas, and should benefit from interventions designed to increase mastery in critical competency areas.

Behavioral Problems and Competencies Reported by Parents of Normal and Disturbed Children Aged Four Through Sixteen

The study was designed (a) to provide prevalence data on behavioral problems and competencies, (b) to identify differences related to demographic variables, and (c) to compare clinically referred and demographically similar nonreferred children. Data were obtained with the Child Behavior Checklist (CBCL), consisting of 20 social competence items and 118 behavior problems. Parents of 1,300 referred children completed the CBCL at intake into outpatient mental health services, while parents of 1,300 randomly selected nonreferred children completed the CBCL in a home interview survey. Intraclass correlations were in the .90s for interparent agreement, 1-week test-retest reliability, and inter-interviewer reliability. Indices of the reported prevalence of each item are graphically portrayed for children grouped by age, gender, and clinical status. Multiple regressions and ANCOVAs showed minimal racial differences but significant tendencies for lower SES children to have higher behavior problem and lower competence scores than upper SES children. There were numerous gender differences on specific items but no significant gender difference in total behavior problem or competence score. Age showed more and larger differences than the other demographic variables, but these differences were dwarfed by differences related to referral status. Across all demographic groups, referal status accounted for more variance in total behavior problem and social competence scores than in the scores for any single item. However, some behavior problems that have traditionally received little attention were much more strongly associated with referral status than problems that have received much attention. Cutoff points on the distributions of total behavior problem and social competence scores yield good separation between referred and nonreferred samples.