Pictorial Tool Research Articles

Design and development of a new pictorial tool to facilitate communication around advance care planning.

Advance care planning (ACP) aims to ensure that people with chronic or advanced disease receive medical care that is consistent with their values and preferences. However, professionals may find it challenging to engage these patients in conversations about the end of life. We sought to develop a pictorial tool to facilitate communication around ACP. This was a three-phase study. In phase 1, we used the nominal group and Delphi techniques to achieve expert consensus regarding the conceptual content of the tool. In phase 2, a professional cartoonist was commissioned to create a series of cartoons representing each of the content areas resulting from the Delphi process. The pictorial tool was then administered (phase 3) with a sample of individuals with advanced/chronic disease to explore whether the cartoons were easy to understand and conveyed the intended message. Following a three-round Delphi process, consensus was reached regarding a set of 12 key content areas that should be considered in the context of an ACP interview. The cartoons created to represent each of the 12 areas were then reviewed and ordered so as to reflect the typical stages of an end-of-life care interview. After administering the pictorial tool with 24 frail older adults with advanced/chronic disease, changes were made to 9 of the 12 cartoons. The new pictorial tool comprises a set of 12 cartoons that can guide professionals as they seek to engage frail older adults with advanced/chronic disease in conversations about the end of life and ACP.

First-nation Australian children’s interpretation of a pictorial questionnaire designed to assess physical literacy

ABSTRACT Background The Physical Literacy in Children Questionnaire (PL-C Quest) is a pictorial tool designed to measure children’s self-reported physical literacy. It measures 30 elements within the four domains (physical, psychological, cognitive, and social) of the Australian Physical Literacy Framework (APLF). The development study of the PL-C Quest only included children from non-Indigenous backgrounds living in a metropolitan city. Hence, little is known about how Indigenous children living in regional and rural areas understand and engage with the items. Purpose The study aims to determine if Indigenous children living in regional and rural areas in Australia understand the items in the PL-C Quest (test content) and if they cognitively engaged with the items (response processes) as intended by the APLF definitions. Methods The study followed a qualitative descriptive approach. The PL-C Quest includes an orange cartoon bunny carrying out 30 scenarios with accompanying statements. Each scenario has one bunny rabbit doing the activity well and the other bunny not so well. Cognitive interviews were conducted based on verbal probing using Tourangeau’s four-stage cognitive model (comprehension, retrieval, judgment, and response). In the regional town, nine Indigenous children were interviewed one on one in after-school sessions. In the rural town, 12 Indigenous children enrolled in the school programme of a sports provider were interviewed in pairs or small groups. All individual and group interviews were audio recorded and transcribed verbatim. All transcripts were coded using the NVivo12 software. Each cognitive action of Tourangeau’s model, comprehension, retrieval, judgment, and response, became a coding category. Responses coded into each category were further categorised into sub-categories. For instance, ‘Understood as intended’, ‘Partially understood’, and ‘Misunderstood’ were subcategories for comprehension; ‘skills’ and ‘past events and experiences’ were for retrieval; ‘confident and unconfident’ were for judgement; and ‘justify’ and ‘unable to justify’ were subcategories for response category. Once the first author completed the analysis of the children’s responses to items, the other two authors’ part of the data collection confirmed the accuracy of the coding. Findings Overall, children in both sites understood most of the content of the items as intended. In addition, they could retrieve relevant information when responding to the items. For example, a few children reflected on their ability to play a ball-throwing Indigenous game and carry younger siblings when responding to the items, ‘Object Manipulation’ and ‘Strength’, respectively. Also, most children confidently selected the bunny that represented them more in all 30 items and were able to justify their responses. Conclusion The study is the first to generate validity evidence for the PL-C Quest when used with Indigenous children in regional and rural Australia. The findings demonstrate that this pictorial scale may be a suitable tool to collect data about the physical literacy of Indigenous children living in regional and rural areas – subject to further testing with a larger population. Future research may provide evidence on other sources of validity. For instance, whether these domains uphold the measured construct, physical literacy (internal structure), with Indigenous children.

Image-Based Communication for Strengthening Patient Health Education in Rural and Underserved Settings.

Effective communication is the cornerstone of efficient patient care. It is vital to obtain a thorough history, build the patient's trust, and ensure compliance to treatment. Image-based communication (IBC) using comic-like strips is better than the conventional verbal and written modes, as it is inexpensive, less human resource dependent, and diversity agnostic. Strips based on localand socioculturally relevant issues and characters grab readers' attention, are relatable and entertaining, and utilize a storyline that invigorates thinking. The medical advice delivered by an ideal IBC strip is easy to comprehend, has a better recall, and promotes patient adherence. With an idea that IBCstrips can serve as a vital supportive tool in underserved and overburdened clinics, we have described the nuances of adapting them into the existing physician-patient experience. We utilize a prototype IBC of an elderly woman helping a family whose child developed acute fever, possibly malaria. Various elements of an IBC strip, namely, panels, gutters, background, characters, bubbles, captions, and visual effects, are illustrated, and their variations are described later. Once designed, an IBC strip must be critically evaluated for the accuracy of the educational message, and errors, if any, must be corrected. The images are then subjected to a series oflocal field tests to ensure that they servetheir purpose and have the desired cultural competence. Once ready, IBC strips can be posted in public spaces and outside clinics or distributed to healthcare workers or patients. Here, they serve as educational and health literacy tools. The strips can significantly reduce caregiver-patient interaction time and improve the quality of communication, especially when patients are illiterate or understand a different language. It is easier to develop rapport and partnership with a patient when the communication is presented through a pictorial tool. An IBC strip can be used to train grassrootworkers, who subsequently train patients, thereby serving a dual purpose.To obtain tangible clinical and epidemiologic benefits from IBC strips, rigorous evidence building and standardization are a crucial long-term goal.

Content Validity of a Collaborative Goal-Setting Pictorial Tool for Children Who Wear Ankle-Foot Orthoses: A Modified Delphi Consensus Study

ABSTRACT Introduction To determine the optimum prescription and dosage for an ankle-foot orthosis and footwear, clinicians and families need to agree on goals for intervention. To facilitate family-centered collaborative goal setting, a table of potential goals and its pictorial representation had been developed previously. These tools incorporated the International Classification of Functioning, Disability, and Health (ICF) and International Organization for Standardization (ISO) clinical objectives for orthoses and were structured in an approach understandable to families. This study aimed to obtain consensus on the content validity of the Table and Pictorial Tools. Methods Seventeen experts from seven countries (orthotists, physical therapists, physicians, surgeons, and engineers) were invited. A modified Delphi technique was used to evaluate and refine the Table Tool (rounds 1 and 2) and Pictorial Tool (rounds 3 and 4). Participants rated their agreement with overall tool structure, content, and feasibility of use on a 4-point Likert scale, and provided open-ended feedback. Consensus was defined as a median score ≥3 (agree) with 75% of responses ≥3. Data were collected using REDCap. After each round, thematic analysis guided document revisions and anonymized feedback. Results Ten experts from four countries completed the study. Round 1 (Table Tool): median ratings were all 3; consensus was achieved for 3/5 questions. Round 2: full consensus was achieved. Round 3 (Pictorial Tool): median ratings were ≥3 for 10/11 questions; consensus was achieved for 4/11 questions. Round 4: full consensus was achieved. Conclusions The content validity for the Table and Pictorial Tools was established by modified Delphi consensus. These tools represent a comprehensive selection of goals across all ICF components. Clinical Relevance These novel tools have the potential to facilitate collaborative goal setting between families and clinicians and aid clinical education. A goal-setting framework specific to orthotic management may improve outcomes within the context of family-centered care.

Assessment of mother and child protection card utility in a rural block of Odisha

Background: Mother and Child Protection card was introduced for accelerating reduction in maternal, neonatal, and infant mortality and child under-nutrition & meant to be used by both beneficiaries and health care providers. It is a folding pictorial tool designed to assist mothers' understanding and monitor individual progress of maternal and child health and also enable the large networks of ASHAs, AWWs, and ANMs to converge their efforts and utilize the critical contact opportunities more effectively. Objective: To assess the completeness of information in MCP card filled by the AWW, ANM, and Beneficiary. Material and Methods: Twelve villages in mendhasal block of Khurdha district were selected for this study by multistage stratified random sampling method. MCP cards of Pregnant women from the second trimester onwards and Mothers of children 0-2 years of age were assessed for completeness using a Checklist. Results: A total of 34 and 46 items were checked for completeness in the MCP cards of Antenatal and post-natal women. The median entries found to be complete in Antenatal and Post-natal women were 34 and 26. Recording information on demographic details and antenatal care details was high but there was poor maintenance of other records like post-natal care, immunization, and growth chart. It was also found that beneficiaries are not marking the circles in the tablets consumption part. Conclusion: The study reported a gap in the maintenance of records in the Mother & Child Protection Card. Training for both the health care providers and mothers is needed for adequate use of the MCP card.

Face and Content Validity of the Pictorial Scale of Perceived Water Competence in Young Children.

An international group of experts have developed a pictorial tool to measure perceived water competence for children aged from 5 to 8 years old: the Pictorial Scale of Perceived Water Competence (PSPWC). The aim of the present study was to verify the validity of this tool. In the first part of the study, 120 children were interviewed to investigate face validity of the PSPWC to ensure that all pictorial items were understandable. In the second part of the study, 13 scientific and/or pedagogical international experts were invited to assess the tool's content validity via an online survey. Face validity results revealed that children were able to understand and sequence correctly the aquatic situations in 92% of the cases. The average Content Validity Index (CVI) of the PSPWC ranged from 0.88 to 0.95, showing acceptable content validity. Feedback from experts and children resulted in a major improvement of the "exit water" situation and minor improvements concerning some other items. Experts confirmed that the PSPWC was globally appropriate for different countries and cultures, except for the situation "water entry by slide" which was not considered usual practice in some countries. The PSPWC opens up to new fields of research; useful both for the prevention of drowning and for the support of children's aquatic education.

Body Mass Index, Physical Activity, and Body Image in Adolescents.

Body image dissatisfaction is a concern for adolescents’ mental and physical well-being, and the role of body mass index (BMI) and physical activity (PA) in it is still unclear. This study investigates the associations of BMI and PA with body image, separately for boys and girls, in a large sample of Finnish adolescents. We also examine the associations of BMI with body image in varying PA levels. A total of 10,496 adolescents (girls 52.6%) were included in the analyses. Body image was assessed using a pictorial tool, and categorized as wishing for a smaller body, being satisfied, and wishing for a bigger body. BMI (kg/m2) was categorized as thin, normal weight, and overweight/obese. Self-reported PA was divided into three similar-sized categories as low, moderate, and high PA levels. Adjusted ordinal regression analyses were conducted. Our results show that adolescents with thinness had higher odds of wishing for a bigger body compared to their normal-weight peers, while adolescents with overweight/obesity had smaller odds of wishing for a bigger body. Adolescents in low and middle PA levels had lower odds of wishing for a bigger body compared to adolescents in the high PA level. Yet, the PA level modified the associations between BMI and body image, especially in adolescents with thinness and more so in girls than in boys. These findings highlight the need to pay attention to healthy weight gain and PA in adolescents to support their body image satisfaction.

TaxonWorks: Character state matrices and identification tools

TaxonWorks is an integrated web-based application for practicing taxonomists and biodiversity specialists. It is focused on promoting collaboration between researchers and developers. TaxonWorks has a modular structure that enables various components of the application to target specific needs and requirements of different groups of users. Specific areas of interest may include nomenclature-related tasks (Yoder and Dmitriev 2021) designed to help assemble and validate scientific name checklists of a target group of organisms; and collection management tasks, including interfaces to create, filter, and edit collecting events, collection objects, and loans. This presentation focuses on matrix-related tools integrated into TaxonWorks. A matrix, which could either be used for phylogenetic analysis or to build an identification key, is structured as a table where columns represent numerous characters that could be used to describe a set of entities, taxa or specimens (presented as rows of the table). Each cell of the table may contain observations for specific character/entity combinations. TaxonWorks does not generate a table for each a particular matrix—all observations are stored as graphs. This structure allows building of a matrix of an unlimited size as well as reuse of individual observations in multiple matrices. For matrix columns, TaxonWorks supports a variety of different kinds of characters or descriptors: qualitative, presence/absence, quantitative, sample, gene, free text, and media. Each character may have specific properties, for example a qualitative descriptor may have numerous characters states, and a quantitative descriptor may have a measurement unit defined. For an entity in a matrix row, TaxonWorks supports either collection objects (specimens) or taxa as Operational Taxonomic Units (OTU). OTUs could either be linked to nomenclature or be stand alone entities (e.g., representing undescribed species). The matrix, once built, could serve several purposes. A matrix based on qualitative and quantitative characters could be used to build an interactive key (Fig. 1), construct standardized natural language descriptions for each entity, and determine a diagnosis (a minimal set of characters that separate one entity from all others). It could also be exported and used for phylogenetic analysis or to build an interactive key in an external application. TaxonWorks supports export files in several formats, including Nexus, TNT, NeXML. Application Programming Interfaces (API) are also available. A matrix based on media descriptors could be used as a pictorial identification tool (Fig. 2).

Differentiation of the Andean Ozadelpha ovata and O. rionegrella sp. nov. (Lepidoptera, Nepticulidae) based on characters of the male genitalia.

We describe a new species, Ozadelpha rionegrella Remeikis Dobrynina, sp. nov., a pygmy moth (Nepticulidae) from the southern Andes (Argentina). The new species is illustrated with photographs of the adult and male genitalia. We briefly discuss the issues of diagnostics of the new species and the related O. ovata (Puplesis Robinson, 2000) and provide an updated pictorial tool for diagnostics of all currently known Ozadelpha species.

Psychometric properties of a Silhouette Rating Scale assessing current and ideal body size and body dissatisfaction in adults

PurposeThe study aims at validating a new pictorial tool, the Silhouette Rating Scale (SRS). It consists of a series of nine female or male silhouettes. It was created to assess current and ideal body size evaluation, and body dissatisfaction. Our aims were to test the concurrent, convergent and discriminant validity of the scale, evaluating possible gender differences.MethodA first sample of 754 young adults (age M = 26.10 ± 8.50, males N = 218) and a second sample of 210 young adults (age M = 21.19 ± 3.22, males = 43) completed the SRS, and other self-report measures assessing body size evaluation, disordered eating, body satisfaction, depression, emotion regulation and insomnia.ResultsStatistical analyses performed on the first sample largely support the concurrent validity of the scale. Results obtained from the second sample confirm its convergent validity, showing strong correlations with the Contour Drawing Rating Scale. In addition, the correlations performed between the three responses of the SRS and other measures of eating disorders, depression, insomnia and emotion regulation indicated a good discriminant validity, though some of the variables measured seem to be significantly correlated.ConclusionsThe SRS is a reliable and valid tool for assessing current body size, body ideal and body dissatisfaction as compared to other widely used scales. It guarantees the universality of use thanks to the absence of details related to ethnicity or culture and at the same time, maintaining a right level of realism. Future studies will evaluate test–retest validity and its potential within clinical populations.Leve of evidenceV, descriptive cross sectional study

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The author of the article examines the lyrics of the poet and artist Harry Gordon through the category of intermediality, discovering the unique visual possibilities of his word when creating ekphrasises in the narrow sense of the word (�translations from the language of painting�) and works in the author`s artistic form � �daguerreotypes�. The use of the word as a pictorial tool to create artistic imagery by poet Harry Gordon is of scholarly interest. The study is based on the theory of intermediality. The category of �intermediality�, primarily known from the works of the German scholar Aage A. Hansen-Lowe, has been further developed by a number of scholars. Gordon�s landscapes appear as (framed) paintings; portraits are masterfully created; contour, colour, outline actively work along with the word. Literature does not belong to the expressive, but to the fine arts, which can display the contours of actual reality, but the share of representationalism in the poems and the optics of the artists of the word are undoubtedly different. Harry Gordon is a poet in poetry, a painter in painting. However, the intermediality and ekphrastic nature of his poetry is extremely interesting: the poet combines words, colours and outlines as a means of creating artistic imagery, he creates poems as �translations from the language of painting�, literary ekphrasis, works with a multiview lens. The art form, which Harry Gordon called the �daguerreotypes�, is often titled with visual motifs. Often these are images from the lyrical protagonist`s childhood, but a number of them belong to the present. They are mediators that take the protagonist back to the world of childhood, such as the alarm clock. Odessa and, more broadly, maritime motifs (�Dophinovka�, �Privoz�, �Bread Harbour�, �Liman�) are autobiographical. Gordon�s daguerreotypes are mostly images from his childhood, imprinted on the retina of the lyrical character. The lyrical protagonist is often an observer (sometimes the title even specifies the angle from which the observation is made: �At the window�), but often he is also the subject, sometimes observed by another lyrical character, or even an object mentioned but not in the picture. Often Gordon�s poetic pictures are filled with the gamut of experiences of the lyrical self, such as childhood fears, shame and embarrassment, lingering curiosity, excitement, a sense of freshness, longing, etc. With a clear predominance of visual motifs (and even endowing non-visible phenomena with the properties of the visual), Gordon�s �daguerreotype� depicts a picture with sound, smell, taste and tactile sensations. As a result of the study, it has been found that Gordon�s depiction is acquired by sound, olfactory, tactile, gustatory images, with the predominance of the visual, an exchange of signs is observed between the images generated by different senses.

The Perth Gender Picture (PGP): Young people’s feedback about acceptability and usefulness of a new pictorial and narrative approach to gender identity assessment and exploration

Background A number of psychological assessment tools have been developed to describe various dimensions of gender. Some of these tools are restricted to a binary gender concept and are inflexible in reflecting how a young person’s gender may change and develop over time. Most are text questionnaires which require a good level of literacy. Aims This study aimed to evaluate a newly developed pictorial tool that facilitates a conversation about gender between a child or adolescent (aged 11–18) and their clinician, enabling a diverse understanding and expression of gender identity. Methods The Perth Gender Picture (PGP) was co-created between clinicians and young clients between 2016 and 2018. In 2018, the measure was evaluated through a pilot study at the Gender Diversity Service at Perth Children’s Hospital in Western Australia. After use of the PGP during a clinical consultation, clients were invited to fill in a feedback questionnaire about their experience of its use. Clinicians participated in unstructured interviews to give their feedback. Results Most participants rated the PGP as easy to understand, acceptable and useful, and many stated that they found gender easier to describe with the picture rather than words. The results show positive uptake from clients, demonstrating feasible implementation with gender diverse young people. Discussion This evaluation positions the PGP as a useful tool to facilitate conversations about gender identity between gender diverse children and adolescents and their clinicians, in a nonjudgmental and playful manner. It is well-suited to young people who may have limited literacy or difficulty with complex language. The PGP has potential for use in other age groups and non-clinical contexts.

Blood Loss Estimation in Small Animals and Assessment of a Pictorial Tool to Improve Accuracy in a Global Population of Veterinary Anesthesia Staff.

Visual estimation of blood loss is the most common form of evaluating intraoperative hemorrhage, and is also the most inaccurate. This study investigated the visual estimation accuracy of a global population of anesthesia staff and students as an initial estimation and also with the assistance of a pictorial guide. A voluntary, two-part, online, anonymous survey was distributed to members of two email databases with an interest in anesthesia, including students, nurses, interns, residents, general practitioners, and specialists. The survey consisted of visual and brief descriptive depictions of blood loss scenarios involving small animals, principally including images of common surgical items and receptacles containing a blood-like substance. Each participant estimated the blood volume (in mL) for each scenario twice, initially (Pre-Guide [PGD]) and then with the aid of a pictorial guide (With-Guide [WGD]). The pictorial guide used similar images labeled with corresponding volumes. Data was analyzed for normality with the Shapiro-Wilks test, corrected to absolute error and compared for statistical significance using the Wilcoxon signed-ranks test or the Kruskal-Wallis test as appropriate. The overall raw PGD phase median estimation error was−27 mL (range −99 to 248 mL). The PGD raw median error increased with scenario complexity. There were no differences between role, gender, experience, or country of origin. The overall median raw estimation error for the WGD phase was 13 mL (range −80 ml to 143 mL) (p = 0.0128). Visual blood loss estimation is inaccurate amongst veterinary anesthetists and associated staff, showing decreasing accuracy with increasing complexity. A pictorial guide improves the accuracy generally, and specifically for more complex scenarios which are likely to reflect the clinical situation.

Validation of a Pictorial Survey Tool to Measure Time Use in an African Urban Setting

Background: Disease often depends on how a host interacts with his or her environment. This interaction is important for respiratory infectious diseases, where built environments may promote transmission. To learn about time use, or the amount of time people spend in a day doing various activities, in sub-Saharan Africa may be difficult because of low literacy and different cultural perceptions of time. We developed a culturally appropriate survey tool to measure time use called the mweso game. Method: Three cross-sectional studies were performed among adults in Kampala, Uganda, to evaluate criterion and construct validity and to assess reliability of the mweso game. The mweso game was compared to actual elapsed time, a detailed 24-hr recall survey, and between three different recall periods. In all analyses, the mean number of beads, or hours, was calculated; Pearson correlation coefficients and Cronbach’s α were estimated. Results: Criterion validity for the use of beads to measure time was fair; mean values tended to be accurate, but there was variability in estimates of time across participants. When comparing the mweso game to the 24-hr recall survey, construct validity was very good. For most of the settings, the difference between measurements was less than one hour; there was good to excellent correlation for most settings. Reliability and internal consistency were best for time use at home and work. Conclusions: We have developed the mweso game as an instrument to measure time use in the context of low literacy and different cultural perceptions of time. The mweso game was valid and reliable, especially for measuring time use at home and work. With further validation, it may prove useful in measuring time use and in studying its relation to transmission of respiratory infectious diseases.

Comparison of Parent and Child Ratings of Fruit and Vegetable Liking to Assess Parent Accuracy as Proxy Reporters

ABSTRACTThis study examined the accuracy of parent-report child fruit/vegetable (FV) liking. Child/parent dyads (n = 24) were recruited from six Head Start preschools in North Carolina. Liking for 10 FVs was assessed using a validated pictorial tool for children; a similar scale was used for parents. Negative relationships were observed between parent/child for one fruit (grapes) and one vegetable (broccoli). Positive relationships were observed among oranges, grapes, and overall fruit rankings. Parents tended to rank children’s liking of fruits higher than their children, while children ranked liking vegetables higher. Findings suggest parents may not be accurate respondents for preschool children’s FV liking.

Structural and Functional Features of Comparison Methods in the Yakut and Khakass Epics

In the article, an attempt of comparative analysis is made between the texts of two different Turkic epics (the Yakut Olonkho “Kyys Debiliye” and the Khakass alyptic nymakh “Ay Huuchin”) that were published in the academic series “Monuments of folklore of the peoples of Siberia and the Far East”. The choice of these texts is determined by the scientific nature of the publications, the belonging of these epics to one type of women-heroes tales, the presence of a Russian translation, and their relatively equal volume.The relevance of the study is determined by the growing interest for comparative study of the language and epic poetics, as well as their genesis. The purpose of this article is to establish the features in the methods of comparison formation in the Yakut and Khakass epics. The study of comparison is always in demand as an artistic and pictorial tool in linguistics and folklore studies. The subject of this study is the syntactic comparison structures, previously identified from the texts of the epics that were questioned by the method of continuous sampling. The methodology practiced by Yu.I. Vasiliev in the Yakut and E.V. Kyrzhinakova in the Khakass languages were used to study the comparisons and classifications.The study leads to conclusion that the comparison in the Yakut epic is expressed mainly by lexical means (the indicator of comparison are function and categorematic words), and in Khakass – lexical and morphological words (with the help of derivational and case affixes). The most common way of forming a comparison in the Yakut olonkho is the method with the help of the курдук index ‘alike, similar to, as’, and in Khakass alyptic nymakh – with the word чiли ‘like, akin to’. Words with a same etymology were not established among the lexical indicators of the two epics. The common ancient Turkic origin have two morphological indicators: the affix -ча and the affix of the ablative case. A relative analysis of comparative works revealed that there are no completely identical structures in epic texts, but comparisons with similar objects and images, decorated with the help of various indicator words and affixes, are noted. A number of comparable works have a commonality in the expression of the same features and functions. Further studying of the comparative formations with the involvement of a wider material, including other Turkic epics is for seen.

The Developmental Check-In: Development and initial testing of an autism screening tool targeting young children from underserved communities.

Children with autism spectrum disorder from low-income, minority families or those with limited English proficiency are diagnosed at a later age, or not at all, compared with their more advantaged peers. The Developmental Check-In is a new tool that could potentially be used to screen for autism that uses pictures to illustrate target behaviors. It was developed to enhance early identification of autism spectrum disorder in low literacy groups. The Developmental Check-In was tested in a sample of 376 children between the ages of 24 and 60 months, from underserved communities. It showed good ability to discriminate autism spectrum disorder from non-autism spectrum disorder (area-under-the-curve = 0.75) across the full age range represented in the sample. Twenty-six of the 28 Developmental Check-In items predicted the presence of autism spectrum disorder. Findings suggest that this pictorial tool may reduce linguistic and health literacy demands when screening for autism among vulnerable populations.

Usefulness of Assessment of Stool Form by the Modified Bristol Stool Form Scale in Primary Care Pediatrics

PurposeRome criteria are considered the gold standard for diagnosing functional constipation. The modified Bristol stool form scale (m-BSFS) was validated to measure stool form in children. However, neither the potential use of the m-BSFS as a tool to facilitate the diagnosis of potential constipation, nor the agreement between m-BSFS and stool consistency by Rome has been studied. Our objective is to determine if m-BSFS is a reliable tool to facilitat detection of constipation; and the agreement between stool form by m-BSFS and hard stool criteria in Rome.MethodsA survey tool with the Rome III criteria and the m-BSFS was developed. A Likert-scale addressed frequency of each stool form on the m-BSFS. Responses to Rome III and m-BSFS were compared.ResultsThe sensitivity and specificity of the m-BSFS was 79.2% and 66.0% respectively; and in children <4 years. improved to 81.2% and 75.0% respectively. There was poor agreement between hard stools by m-BSFS and the painful or hard bowel movement question of Rome Criteria.ConclusionThe potential utility of m-BSFS as a reasonably good tool to facilitate the diagnosis of potential constipation in children is shown. The poor agreement between painful or hard stool question in Rome III, and ratings for hard stool on the m-BSFS illustrates that one's perception may differ between a question and a picture. A useful pictorial tool to appraise stool form may, thus, be a favorable complement in the process of enquiry about bowel habits in well-child care.

Nurse-midwives\u2019 ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya

BackgroundObstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women.MethodsNurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated.ResultsTwenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations.ConclusionCounty nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.

What do prisoners eat? Nutrient intakes and food practices in a high-secure prison

There are limited studies on the adequacy of prisoner diet and food practices, yet understanding these are important to inform food provision and assure duty of care for this group. The aim of this study was to assess the dietary intakes of prisoners to inform food and nutrition policy in this setting. This research used a cross-sectional design with convenience sampling in a 945-bed male high-secure prison. Multiple methods were used to assess food available at the group level, including verification of food portion, quality and practices. A pictorial tool supported the diet history method. Of 276 eligible prisoners, 120 dietary interviews were conducted and verified against prison records, with 106 deemed plausible. The results showed the planned food to be nutritionally adequate, with the exception of vitamin D for older males and long-chain fatty acids, with Na above upper limits. The Australian dietary targets for chronic disease risk were not achieved. High energy intakes were reported with median 13·8 (se 0·3) MJ. Probability estimates of inadequate intake varied with age groups: Mg 8 % (>30 years), 2·9 % (70 years), 1·5 % (<70 years); folate 3·5 %; Zn and I 2·7 %; and vitamin A 2·3 %. Nutrient intakes were greatly impacted by self-funded snacks. Results suggest the intakes to be nutritionally favourable when compared with males in the community. This study highlights the complexity of food provision in the prison environment and also poses questions for population-level dietary guidance in delivering appropriate nutrients within energy limits.