Observation Scale For Evaluation Research Articles

A mixed methods study into the effectiveness of sensory rooms in reducing agitation levels in a psychiatric intensive care unit

Background:Reducing incidences of violence, and the use of restrictive interventions within psychiatric intensive care units (PICUs), is a priority nationally. One method for reducing violence and aggression from escalating in PICUs is sensory rooms. This study aimed to explore the effectiveness of sensory rooms as an alternative strategy to manage agitation levels in a PICU and understand the patient and staff experiences of using sensory rooms as an alternative intervention to standard approaches for agitation reduction. Method:A mixed methods approach collected data over six months using an observational rating scale pre and post-sensory room, and conducting nine semi-structured interviews with patients and staff. Results:71 patient contacts recorded, there was a statistically significant difference in pre and post-sensory room agitation ratings (p<0.001), with 66% (n = 47) experiencing a reduction in agitation rating post-usage. The sensory room was used as both a proactive and reactive strategy to manage agitation. Five themes emerged from the interviews: the sensory room supports emotional regulation, improves the patient's experience, develops therapeutic relationships, and offers an alternative agitation management strategy; however, it can be an underused resource due to access limitations. Conclusion:Staff and patients had positive experiences using a sensory room to manage agitation; it offers a safe space away from the busy ward environment. Several different factors impact staff using the intervention. Findings provide considerations for services when developing sensory rooms in PICUs, to ensure they are established as a reliable alternative for the management of agitation.

Behavioral Problems and Self-Feeding Independence Among Patients With Acute Stroke: A Single-Center Study.

Self-feeding independence is often the first goal in acute stroke rehabilitation. Attention deficits appear frequently after stroke, but neuropsychological tests may be difficult to perform in the acute phase, and the effect on self-feeding activities may be difficult to detect. Therefore, we aimed to clarify behavioral problems with self-feeding using the Moss Attention Rating Scale (MARS), a behavioral observational rating scale of attentional function, for a better understanding of the effects of self-feeding. To identify behavioral problems caused by attention deficits among patients with acute stroke who need assistance in self-feeding, using the MARS. Cross-sectional single-center study. St. Marianna University Yokohama Seibu Hospital, Kanagawa, Japan. A total of 96 patients (42 women and 54 men) were admitted to the hospital for stroke treatment. Patients' median age was 75.0 yr. The date of evaluation was a median of 3.0 days from admission. The primary outcome was the FIM® eating subscore. The secondary outcome was the MARS score. Significant differences were noted in the total raw MARS, logit, and three-factor scores for self-feeding independence (p < .01). The effect size of the consistent or sustained factor on independence was large (r = .83). Behavioral problems related to self-feeding dependence include the inability for sustained attention. Our results suggest that sustained concentration during self-feeding is necessary for eating independence. Rehabilitation focused on sustained attention is important for independent self-feeding. Plain-Language Summary: A patient's self-feeding independence is often the first goal in acute stroke rehabilitation. Patients frequently experience attention deficits after a stroke, but neuropsychological tests may be difficult to perform in the acute phase of rehabilitation, and the effect of attention deficits on self-feeding may be difficult to identify. To have a better understanding of the effects on self-feeding, this study aimed to identify behavioral problems using the Moss Attention Rating Scale (MARS). The study found that the MARS can be used to identify behavioral problems related to self-feeding independence, which can help occupational therapists to develop rehabilitation programs for their clients who have experienced a stroke.

Individualized homeopathic medicines in the treatment of premenstrual syndrome: A double-blind, randomized, placebo-controlled trial

IntroductionBackground: Premenstrual syndrome (PMS) is a common disorder among female population that adversely affects their physical and emotional well-being. Conventional treatments for PMS may have limitations and side effects, prompting a need for complementary therapeutic approaches. This double-blind, randomized, placebo-controlled trial aimed to investigate the efficacy of individualized Homeopathic medicines (IH) in treating PMS symptoms in comparison to placebo (PL). MethodsThis study recruited female participants of reproductive age who had been experiencing premenstrual syndrome (PMS) for >3 months, from the Outpatient Department. The participants were randomly assigned to receive either IH or PL. The measured outcomes included the Shortened Premenstrual Assessment Form (SPAF) questionnaire as the primary outcome, and the Premenstrual Tension Syndrome Visual Analogue Scale (PMTS-VAS) and the Premenstrual Tension Syndrome Observer Rating Scale – Revised (PMTS-OR) as secondary outcomes. These measures were assessed at baseline and every month for 3 months. ResultsThe results showed a statistically significant reduction in total SPAF scores for the IH group compared to the placebo group (F = 11.340; P < 0.001) at month 2 (-5.5 ± 1.8, P = 0.003), and month 3 (-6.6 ± 2.0, P = 0.002). Additionally, there were significant reductions in PMTS-VAS and PMTS-OR scores in the IH compared to placebo group. Natrum muriaticum (n = 4/30, 13.3 %) was the most frequently indicated medicines in the study. Four adverse events (13.33 %) occurred in the IH group, and six adverse events (16.67 %) in the Placebo group, with no serious events reported, and no additional medicinal treatment was required for participants during the study period. ConclusionsIndividualized Homeopathic medicines were found to be significantly effective, compared to placebo in reducing PMS symptoms. Further independent replication is warranted to validate and corroborate these findings, as well as to identify the most effective Homeopathic medicines for treating PMS symptoms. Until then, clinicians may consider these findings when exploring personalized and holistic therapeutic strategies for managing PMS. Trial RegistrationCTRI/2020/11/028,796, dt. 02/11/2020

Multichannel tDCS with advanced targeting for major depressive disorder: a tele-supervised at-home pilot study.

Proof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) may improve depression severity. This open-label multicenter study tested remotely supervised multichannel tDCS delivered at home in patients (N=35) with major depressive disorder (MDD). The primary aim was to assess the feasibility and safety of our protocol. As an exploratory aim, we evaluated therapeutic efficacy: the primary efficacy measure was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS). Participants received 37 at-home stimulation sessions (30 minutes each) of specifically designed multichannel tDCS targeting the left DLPFC administered over eight weeks (4 weeks of daily treatments plus 4 weeks of taper), with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models of the electric field generated by multichannel tDCS using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits. 34 patients (85.3% women) with a mean age of 59 years, a diagnosis of MDD according to DSM-5 criteria, and a MADRS score ≥20 at the time of study enrolment completed all study visits. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Concerning compliance, 85% of the participants (n=29) completed the complete course of 37 stimulation sessions at home, while 97% completed at least 36 sessions. No detrimental effects were observed, including suicidal ideation and/or behavior. The study observed a median MADRS score reduction of 64.5% (48.6, 72.4) 4 weeks post-treatment (Hedge's g = -3.1). We observed a response rate (≥ 50% improvement in MADRS scores) of 72.7% (n=24) from baseline to the last visit 4 weeks post-treatment. Secondary measures reflected similar improvements. These results suggest that remotely supervised and supported multichannel home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies. https://clinicaltrials.gov/study/NCT05205915?tab=results, identifier NCT05205915.

Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)

BackgroundAbout one third of patients with depression are in a condition that can be termed as “difficult-to-treat”. Some evidence suggests that difficult-to-treat depression is associated with a higher frequency of childhood trauma and comorbid personality disorders or accentuated features. However, the condition is understudied, and the effects of psychotherapy for difficult-to-treat depression are currently uncertain. The aim of this trial is to investigate the beneficial and harmful effects of 30 sessions of individual schema therapy versus treatment as usual for difficult-to-treat depression in the Danish secondary, public mental health sector.MethodsIn this randomized, multi-centre, parallel-group, superiority clinical trial, 129 outpatients with difficult-to-treat depression will be randomized (1:1) to 30 sessions of individual schema therapy or treatment as usual; in this context mainly group-based, short-term cognitive behaviour or psychodynamic therapy. The primary outcome is the change from baseline in depressive symptoms 12 months after randomization, measured on the observer-rated 6-item Hamilton Rating Scale for Depression. The secondary outcomes are health-related quality of life assessed with the European Quality of Life 5 Dimensions 5 Level Version, functional impairment assessed with the Work and Social Adjustment Scale, psychological wellbeing assessed with the WHO-5 Well-being Index, and negative effects of treatment assessed with the Negative Effects Questionnaire. Exploratory outcomes are improvement on patient self-defined outcomes, personal recovery, anxiety symptoms, anger reactions, metacognitive beliefs about anger, and perseverative negative thinking. Outcomes will be assessed at 6, 12, and 24 months after randomization; the 12-month time-point being the primary time-point of interest. Outcome assessors performing the depression-rating, data managers, statisticians, the data safety and monitoring committee, and conclusion makers for the outcome article will be blinded to treatment allocation and results. To assess cost-effectiveness of the intervention, a health economic analysis will be performed.DiscussionThis trial will provide evidence on the beneficial and harmful effects, as well as the cost-effectiveness of schema therapy versus treatment as usual for outpatients with difficult-to-treat depression. The results can potentially improve treatment for a large and understudied patient group.Trial registrationClinicalTrials.gov NCT05833087. Registered on 15th April 2023 (approved without prompts for revision on 27th April 2023).

Predominant negative symptoms: views of patients vs. doctors in a 1-year observational study

IntroductionNegative symptoms are a key aspect of schizophrenia, significantly impacting a patient’s functioning and quality of life. These symptoms are deemed predominant when they dominate the clinical picture and positive symptoms are only minimally present. As articulated in the most recent guidance by the European Psychiatric Association, including self-report measures is encouraged in negative symptom studies as they can further complement the observer-rated scales when assessing negative symptoms of schizophrenia.ObjectivesThe objective of the poster is to compare the views of patients vs. doctors regarding predominant negative symptoms during a 1-year observational study.MethodsThis was a 1-year-long, prospective, multicentric cohort study with three visits after baseline at 3, 6 and 12 months. Adult outpatients with a schizophrenia diagnosis according to the International Classification of Diseases 10th edition who exhibited predominant negative symptoms according to clinical judgement were included. Patients received pharmacological and some non-pharmacological treatment as usual.The primary outcome measure was the modified Short Assessment of Negative Domains (m-SAND), an anamnesis-based scale that is composed of 7 items: two positive items (delusions and hallucinations) which make the m-SAND Positive sub-scale (m-SAND-P) and five negative items (anhedonia, alogia, avolition, asociality and affective flattening) which make the m-SAND Negative sub-scale (m-SAND-N) Each item is rated from 0 to 5 (not observed; mild; moderate; moderately severe; severe; and extreme). Other measurements included the Self-evaluation of Negative Symptoms (SNS), a validated scale that provides meaningful information regarding the patients’ own perception of their negative symptoms.Least squares (LS) means were calculated for the change from baseline to final visit using a mixed model for repeated measures (MMRM).Results188 patients were included in the study. The mean age was 39.8 years and 65% of patients were men. The mean duration of illness was 12 years. At baseline, patients rated alogia and apathy (mean SNS score: 5.7) to be the most severe and then asociality (5.5). In contrast, doctors found affective blunting (mean m-SAND total score: 4.3), apathy (4.2) and anhedonia (4.0) to be the most severe.After the end of the observational period all negative symptom sub-domains improved significantly according to both the patients’ and doctors’ views. The latter group reported -1.9 LS mean change from baseline in apathy, -1.8 in anhedonia, and -1.7 in asociality (all p-value &lt;0.0001). Patients felt most change in alogia and asociality (-2.7), and apathy and anhedonia (-2.4).ConclusionsIn summary, both patients and doctors reported significant improvement in predominant negative symptoms. Nonetheless, there were some differences how they perceived severity and change in the specific domains.Disclosure of InterestJ. Dragasek: None Declared, Z. Dombi Employee of: Gedeon Richter Plc., K. Acsai: None Declared, V. Dzurilla Employee of: Gedeon Richter Plc., Á. Barabássy Employee of: Gedeon Richter Plc.

UJI KELAYAKAN MEDIA PEMBELAJARAN E-STORYBOOK DALAM PENGENALAN LITERASI BUDAYA UNTUK ANAK USIA DINI

This research aims to determine the feasibility level of the e-storybook learning media "culinary tourism typical snacks of Kudus" in introducing local cultural literacy to early childhood. This research uses a quantitative method. The testing procedures used are Alpha Testing and Beta Testing. The subjects of this study were kindergarten students in the Kaliwungu district, Kudus Regency. Data collection techniques were done through questionnaires and observation rating scales. Data analysis technique used quantitative data analysis. The research results obtained are that the e-storybook learning media "culinary tourism typical snacks of Kudus" is declared very feasible to be used in introducing local cultural literacy to early childhood in the kindergarten of the Kaliwungu district by media experts with an average percentage score of 98.5% with a category of very feasible and material experts with an average percentage score of 99% with a category of very feasible. Meanwhile, the feasibility test results by students as users show a percentage of 86.08% with a very feasible criteria.

Chemistry teachers’ utilization of three different constructivist-based teaching strategies in senior secondary schools in Dekina local government area of Kogi state

The study investigated chemistry teachers’ utilization of three different constructivist-based teaching strategies in senior secondary schools in the Dekina local government area of Kogi state. The study adopted a descriptive survey research design. Three research questions and two hypotheses guided the study. The population of the study comprised 33 chemistry teachers in all the public secondary schools in the Dekina local government area. Purposive sampling was used for the study. The instrument for data collection was an observational rating scale on chemistry teachers’ utilization of constructivist-based teaching strategies developed by the researcher. The reliability of the instrument was obtained. Cronbach alpha reliability estimate was used to determine the internal consistency of the instrument which gave a reliability index of 0.71. Kendell’s coefficient of concordance was used to determine the inter-raters’ reliability, which was obtained as 0.75. Data collected were analyzed using mean and standard deviation to answer the research questions, while the z-test was used in testing the hypothesis formulated at 0.05 level of significance. The findings of the study revealed the following: it was revealed that chemistry teachers’ qualifications and experience influence the utilization of constructivist-based teaching strategies. Based on the findings and conclusions, it was recommended among others that the government and Ministry of Education should employ qualified and experienced teachers to handle chemistry courses in senior secondary schools.

P70: Development and validation study of the suicide screening questionnaire-observer rating (SSQ-OR)

Background:Observer rating scales are necessary to evaluate the risk of suicide because individuals at risk for suicide are often unwilling to seek help on their own. Reliability and validity were evaluated for the newly developed Suicide Screening Questionnaire-Observer Rating (SSQ-OR).Methods:Preliminary items were assessed by 251 experts online and 25 questions were selected. 328 individuals at high-risk and 661 controls from 12 Crisis Response Centers and 5 university counseling centers were recruited to complete SSQ-OR, Beck Scale for Suicide Ideation (BSSI) and Patient Health Questionnaire-9 (PHQ-9). In a 6 months follow-up, we reached out to 176 participants to ask whether they had experienced a suicidal thought, plan, or attempt since the baseline assessment. Cronbach's 慣, Mann-Whitney U test, Spearman's correlation, factor analyses, Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to verify the SSQ-OR.Results:Structural validity was supported by a two-factor solution using exploratory and confirmatory factor analyses. Excellent model fit indices for the two-factor structure using exploratory factor analysis were confirmed (RMSEA = 0.033, TLI = 0.980, CFI = 0.983). The SSQ-OR demonstrated strong internal consistency. The concurrent validity based on the correlations with other self-reported indicators of suicidal potential-BSSI and PHQ-9- revealed substantial relationships. The high-risk group was effectively characterized by a cut-off point of 4, with a sensitivity of 0.73 and a specificity of 0.79. The SSQ-OR scores were significant predictors of suicidal thoughts and behaviors within 6 months.Conclusions:The SSQ-OR exhibits sound psychometric properties, and could be used as a complement to a self-report or clinical-administered scale to screen suicide risk comprehensively.

P167: Informal activities may explain improved depressive symptoms and resilience in nursing home residents: A cross-sectional study in Dutch and Flemish nursing homes

Objective:Pleasant, meaningful, recreational or other activities are often used in depression treatment in nursing home (NH) residents. Residents may also undertake such activities alongside or without a treatment (informal activities). It is not clear if such informal activities can partially explain treatment effects. Our aim was to explore associations of depressive symptoms and resilience with informal activities in residents.Methods:We calculated product scores of frequency and pleasantness for activities from 18 activity clusters in NH residents (AIM, Activities to Improve Mood inventory, Knippenberg et al., in prep). The Geriatric Depression Scale, 8 items (GDS-8, Jongenelis et al., 2007) and the Brief Resilience Scale (BRSnl, Dutch translation, Leontjevas et al., 2014) were administered when interviewing residents. Professional caregivers filled out the Nijmegen Observer Rated Depression scale (NORD, Leontjevas et al., 2011). Spearman’s rho’s of 0.20 to 0.39 and of 0.40 to 0.60 were regarded as weak and moderate, respectively.Results:277 Dutch speaking NH residents (male, N=104, 38%), from Flanders Belgium (male, N=137, 49.5%) and the Netherlands participated in the study. We found positive weak associations between the self-reported and observer-rated depression scales (GDS-8 and NORD), and between the AIM total score and resilience (BRSnl). Negative weak associations were found for both depression scales and resilience, and for the depression scales and AIM. Individual AIM clusters showed positive weak to moderate associations between resilience and activities stimulating cognition (e.g. reading, puzzling), activities related to nature (e.g. walking in a park, activities with animals), or doing something meaningful for others (e.g. helping with daily routines or volunteering). Regarding depression, next to the three mentioned clusters, negative weak to moderate associations were also found for craft activities, social activities, and showing a positive mindset (e.g. humour, giving compliments).Conclusion:The results underscore the value of activities that residents may undertake on their own alongside or without a treatment. More research is needed to understand whether informal activities alongside or without a treatment may explain intervention effects (e.g. placebo effects) on depression or resilience, and how these activities may be used to improve treatment protocols.

P76: Agreement between nursing-home caregivers’ observations of residents’ depression, wellbeing, and quality of life

Objective:In nursing home residents, outcomes are often assessed using proxies, especially in residents with severe cognitive problems. Although caregivers are commonly involved as proxies, studies assessing their agreement for proxy measures are scarce. Therefore, secondary analysis was performed on a dataset with proxy-reported scores of several scales in Dutch and Flemish nursing home residents with and without dementia.Methods:To assess the agreement between the observations of 81 pairs of caregivers, we calculated Cohen’s Kappa, Weighted Kappa, and Prevalence- and Bias-Adjusted Kappa (PABAK and PABAK- OS for ordinal data) coefficients for the items on the Nijmegen observer-rated depression scale for detection of depression in nursing home residents (NORD), the social wellbeing of nursing-home residents scale (SWON-3), and two subscales (i.e., “social relations” and “having something to do”) of the QUALIDEM. In addition, coefficients were calculated for the item concerning subjective judgment of the residents’ depressive symptoms (“no,” “yes, mild or light,” or “yes, severe”) and for the item concerning whether the caregivers believed a depression diagnosis had been established (“yes,” “no”).Results:In general, PABAK and PABAK-OS coefficients were higher than the Cohen’s and Weighted Kappa coefficients, suggesting a considerable amount of prevalence or bias. For the total sample, most items were above .40, indicating acceptable agreement. The results showed higher levels of agreement for proxy scores of residents with lower levels of dementia, compared to residents with more severe dementia.Conclusion:The general finding of different levels of agreement between coefficients with and without correction for prevalence and bias, suggest the importance of exploring both values to enable adequate interpretation of the reliability of these items. The result of limited levels of agreement between caregivers concerning residents with more severe dementia underscores challenges for measurements in this population. We believe that practitioners and researchers should be aware of these challenges when using and interpreting scores derived from proxies. Moreover, understanding why different raters reach different conclusions regarding the same residents is important for interpreting the meaning of proxy-reported scores.

A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression

Clinical outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder (MDD) vary widely, and no single mood rating scale is standard for assessing rTMS outcomes. This study of 708 subjects undergoing clinical rTMS compared the performance of four scales in measuring symptom change during rTMS treatment. Self-report and observer ratings were examined weekly with the Inventory of Depressive Symptomatology 30-item (IDS), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item (POMS), and Hamilton Depression Rating Scale 17-item (HDRS). While all scales were correlated and detected significant improvement, the degree of improvement over time as well as response (33–50%) and remission (20–24%) rates varied significantly. Higher baseline severity was associated with lower likelihood of remission, and greater improvement by sessions 5 and 10 predicted response across all scales. Use of only a single scale to assess outcome conferred 14–36% risk of failing to detect response/remission indicated by another scale. The PHQ was most likely to indicate improvement and least likely to miss response or remission. These findings indicate that assessment of symptom burden during rTMS treatment may be most accurately assessed through use of multiple instruments.

The effect of zolpidem-CR on the suicide item of the Hamilton Rating Scale for Depression in outpatients with depression, insomnia and suicidal ideation: Lessons learned

The REST-IT study found the addition of zolpidem-controlled release (CR) provided a significant reduction in observer-rated measurement of suicidal ideation (the Columbia Suicide Severity Rating Scale) in 103 depressed outpatients with insomnia and suicidal ideation, but without significant change in a self-report measure of suicidal ideation (the Scale for Suicide Ideation). This secondary analysis of the REST-IT data examined the suicide item of another observer-rated scale, the Hamilton Rating Scale for Depression (HRSD), further clarifying the impact of insomnia-focused treatment on suicidal ideation. This analysis established a significant advantage for zolpidem-CR compared with placebo on the HRSD suicide item.

Divide and conquer: Coparenting and parent involvement in families with young children

AbstractBackgroundDespite average‐sized U.S. families having more than one child, coparenting in families with two children is understudied.ObjectiveThe main aim of this exploratory study was to provide the first steps toward investigating the construct of divide‐and‐conquer coparenting, a coparenting strategy that emerges in families consisting of two parents and two children in which each parent focuses their attention on one child at a time. Specifically, the aim of the study was to provide preliminary evidence for the validity of a new observational rating scale to assess divide‐and‐conquer coparenting and to examine its relation to coparenting quality.MethodObservations of whole‐family interactions (N = 52 families) were coded for overall use of divide‐and‐conquer coparenting, each parents' involvement with each child, and quality of coparenting (i.e., cooperative and competitive). Parents were also asked to write responses to an open‐ended question concerning how their coparenting had changed since having a second child.ResultsDivide‐and‐conquer coparenting was positively associated with parent involvement patterns in which each parent mainly focuses on one child at a time, with parents' endorsement of use of divide‐and‐conquer coparenting in the open‐ended question, and with cooperative coparenting. It was negatively associated with competitive coparenting.ConclusionsResults provide support for the existence of a divide‐and‐conquer coparenting strategy in families with two young children and preliminary validation of our divide‐and‐conquer coparenting rating scale, as well as suggesting that this strategy is related to high‐quality coparenting.ImplicationsImplications for family intervention and future empirical work in this area are discussed.

A scoping review examining the association of housing quality and psychosocial well-being following homelessness: an ecological systems perspective

ABSTRACT Housing quality (HQ) has been previously associated with health and quality of life. Although HQ is an important factor in preventing homelessness, little is known about the range and breadth of this body of literature. To identify existing studies, we conducted a scoping review guided by the question: “in what ways has housing quality been associated with psychosocial well-being following homelessness in existing peer-reviewed literature?” using the framework proposed by Arksey & O'Malley and PRISMA-ScR guidelines. Our search was deployed in eight databases. A total of 713 titles and abstracts were screened following the removal of duplicates, and 32 articles were included in narrative synthesis. Six themes emerged from our data analysis of included articles: 1) quality of housing affecting well-being; 2) feeling forced to live in unsafe and poor-quality housing due to no other options; 3) HQ mediated by housing first; 4) determinants of HQ; 5) standardized measures of HQ; and 6) HQ is de-emphasized in research and practice following homelessness. Our findings demonstrate that HQ is associated with psychosocial well-being at micro, meso, exo, and macro systems levels for persons experiencing homelessness. We argue addressing HQ following homelessness is a key homelessness prevention strategy.

The External Validation of the Nursing Homes Short Depression Inventory in Older Adults with Major Neurocognitive Disorders in Long-Term Care Centers

Introduction: Depression is often difficult to detect in long-term care (LTC) patients with major neurocognitive disorders (MNCD), and an observer-rated screening scale could facilitate assessments. This study aimed to establish the external validity and reliability of the Nursing Homes Short Depression Inventory (NH-SDI) in LTC patients with MNCD and to compare its estimates to the Cornell Scale for Depression in Dementia (CSDD), the most used scale for depression in MNCD. Methods: A focus discussion group of experts assessed the content validity of the NH-SDI. Then, a convenience sample of 93 LTC patients with MNCD was observer-rated by trained nurses with the NH-SDI and CSDD. For 57 patients, a medical assessment of depression was obtained, and screening accuracy estimates were generated. Results: The prevalence of depression was 8.8% as per reference standard. NH-SDI’s content validity was judged acceptable with minor item wording modifications and specifications. The NH-SDI (cut-off ≥3) achieved 100% (95% confidence interval [CI]: 46–100%) sensitivity, 83% (95% CI: 69–91%) specificity, and 36% (95% CI: 14–64%) positive predictive value (PPV). The CSDD (cut-off ≥3) achieved 100% (95% CI: 46–100%) sensitivity, 75% (95% CI: 61–86%) specificity, and 28% (95% CI: 11–54%) PPV. No significant differences in areas under the receiver operating characteristic curve were found between scales. The NH-SDI and CSDD were highly correlated (r_s = 0.913; p < 0.001) and reliable (ICC = 0.77; p < 0.001). Conclusion: The NH-SDI appears valid and reliable in LTC patients with MNCD and quicker than the CSDD to rule out depression in a busy or short-staffed setting.

Development and validation of the interpersonal communication assessment tool for assessing the interpersonal communication skills of public health midwives

BackgroundInterpersonal Communication Skills (IPCS) are one of the core clinical skills that should be developed by the Public Health Midwives (PHMs), who are grass-root level public healthcare providers in primary healthcare settings in Sri Lanka. This study aimed to develop and validate the Interpersonal Communication Assessment Tool (IPCAT), an observational rating scale, to assess the IPCS of PHMs.MethodsItem generation, item reduction, instrument drafting, and development of the tool’s rating guide were made by an expert panel. A cross-sectional study was conducted in five randomly selected Medical Officer of Health (MOH) areas, the smallest public health administrative division in the district of Colombo, Sri Lanka, to identify the factor structure, which is the correlational relationship between a number of variables in the tool. A sample of 164 PHMs was recruited. The data on IPCS were collected by video-recording the provider-client interaction using simulated clients. All recorded videos were rated by a rater using the drafted IPCAT, which included a Likert scale of 1(poor) to 5 (excellent). Exploratory factor analysis was conducted using the Principal Axis Factoring extraction method and the Varimax rotation technique to explore the factors. Three independent raters were used to rate ten randomly selected videos to assess the tool’s internal consistency and inter-rater reliability.ResultsThe IPCAT obtained a five-factor model with 22 items, and all five factors explained 65% of the total variance. The resulting factors were “Engaging” (six items on making rapport), “Delivering” (four items on paying respect), “Questioning” (four items on asking questions), “Responding” (four items on empathy), and “Ending” (four items to assess the skills of ending a conversation productively). The internal consistency, Cronbach’s Alpha value, for all five factors was above 0.8, and the inter-rater reliability (ICC) was excellent (0.95).ConclusionsThe Interpersonal Communication Assessment Tool is a valid and reliable tool for assessing the interpersonal communication skills of Public Health Midwives.Trial registrationClinical Trial Registry, Sri Lanka. Ref No, SLCTR/2020/006(February 4th,2020)

Effects of behavior inhibition on stuttering severity and adverse consequences of stuttering in 3–6-year-old children who stutter

PurposeThe purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI. MethodForty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009). ResultsWe found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering. ConclusionsThis study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.

Evaluation of expressed self-contempt in psychotherapy: an exploratory study

ABSTRACT Self-contempt may be a frequent but overlooked clinical phenomenon, associated with a number of psychological problems such as increased sadness and shame. It was shown that self-contempt interferes with productive emotional processing and the quality of therapeutic alliance. This study aims to develop a reliable measure of expressed self-contempt given that a previous three-point assessment may be too restrictive in range, resulting in non-significant results. Thus, the present study applied an extended observer-rated scale to different participant groups in different contexts. This explorative phase focuses on a sample of N = 61 participants divided into three groups, including n = 20 controls, n = 21 patients with a diagnosis of borderline personality disorderand n = 20 patients with a diagnosis of major depressive disorder. Levels of self-contempt are compared between the groups and are associated with symptom indicators. Reliability of the instrument is analysed using inter-rater reliability and internal consistency, which are sufficient. The level of expressed self-contempt is not related to symptom intensity. Patients with borderline personality disorder do not express more self-contempt than the other groups. While further research should establish full validity of the scale, reliability is satisfactory and the use of the scale can be recommended.

A Study to Assess the Effectiveness of Perineal Massage on Labour Outcome among Primi mothers at selected Hospital, Erode

Background: Child birth is a painful and stressful event in a woman's life. Pregnant women commonly worry about pain during labour and birth. Labour pain is considered as one of the most intense forms of pain. Psychological challenge such as anxiety can contribute towards women’s perception of pain and may also affect their labor and birth experience. There are modern many non-invasive methods to relieve pain during childbirth. Among these methods is aromatherapy which is the most popular complementary therapy during child birth. Therefore, this study aimed to assess the effect of aromatherapy massage using lavender oil on the level of pain and anxiety during labor among primi gravida women. Objective: To determine the effectiveness of perineal massage on labour outcome among primigravida mothers in both the groups. Design: The research design selected for the present study was true experimental design where posttests only with control group design. Setting: The study was conducted in private maternity hospital, Erode district. Sample: The sample consisted of 30 (15 control and 15 experimental group) primi mothers attending antenatal OPD in private maternity Hospital, Erode District, were selected by simple random technique. Data collection procedure: The data were collected for 4 weeks in the month of June 2021.From both group the personal data were collected and to the experimental group external perineal massage was taught to the primi mother by demonstration. Post test was conducted for both control and experimental group with maternal outcomes observational rating scale while mother was admitted in labour ward with pain and assessed labour outcome. Results: The findings revealed that after the perineal massage the ongoing assessment tool to evaluate maternal outcome was fair and more effective during labour among the primi mothers in experimental group. In both control and experimental group there was no significant association between maternal outcome and demographic variables such as age, education, occupation, income per month, type of family, living area and previous source of information. Conclusion: The perineal massage was more effective in improving maternal outcome during labour among the primi mothers in experimental group.