Total Competence Scores Research Articles

Working together for patient health: Assessing interprofessional competencies among healthcare professionals in Lebanon

IntroductionInterprofessional collaboration (IPC) is the gold standard for safe, high-quality, and accessible patient-centered care. This study aims to assess IPC core competencies among Lebanese healthcare providers from different professions and explore the influence of several factors, including leadership, work ethics, and specialty, on healthcare IPC in Lebanon. MethodsThis cross-sectional online survey enrolled 245 healthcare workers in Lebanon between July and December 2021. The Interprofessional Education Collaborative (IPEC) Competency Self-Assessment Tool Version 3 was used to assess IPC. Bivariate and multivariate analyses were carried out to compare the total competency scale and subscales between the leadership group, work ethic, specialty, and education level, taking into account potential confounding variables, namely, age and gender. ResultsThe mean competency total scale was 4.22 ± 0.68. The bivariate analysis showed a significantly higher mean competency among participants who have a full-time job, higher administrative leadership (4.30 vs. 3.08, p = 0.001), interpersonal leadership (4.29 vs. 2.94, p = 0.006), conceptual leadership (4.28 vs. 3.15, p = 0.010) and higher work ethics (4.51 vs. 4.12, p < 0.001). Older age (r = 0.15, p = 0.017) was also significantly associated with higher competency. The multivariate analysis showed that having only high work ethics, as compared to low, remains significantly associated with higher total interprofessional competency, including the Interaction and Interprofessional Values subscales. No differences in IPEC scales between pharmacists and other healthcare providers were noted. ConclusionThe IPEC total competency score was higher among full-time healthcare providers and those who scored higher on leadership skills and work ethics. The study outcome shows the importance of education in interprofessional practice.

Effects of Problem-Based Learning Strategies on Undergraduate Nursing Students’ Self-Evaluation of Their Core Competencies: A Longitudinal Cohort Study

To respond to patients' increasing demands and strengthen nursing professionals' capabilities, nursing students are expected to develop problem-solving skills before they enter the workforce. Problem-based learning (PBL) is expected to provide effective simulation scenarios and realistic clinical conditions to help students achieve those learning goals. This article aims to explore the effects of PBL strategies on nursing students' self-evaluation of core competencies. This longitudinal cohort survey study evaluated 322 nursing students attending Chung Shan Medical University, Taiwan, in 2013 and 2014, where PBL teaching strategies are used in all four undergraduate years from freshman to senior. Based on their undergraduate academic levels, students were categorized into three groups- one-year PBL exposure, two-year PBL exposure, and three-year exposure. A core competency questionnaire was administered twice to ask participants to self-assess five professional competencies: learning attitude, problem identification, information analysis, execution, and life-long learning. The results showed that students with the longest exposure to PBL (Group 3) had higher self-evaluated scores for all core competencies than the other groups, except for the execution competency. The mean total competency score increased by 0.12 points between the pre-and-test. In addition, the mean score increased significantly more in Group 3 than in Groups 1 and 2. These trends were consistent for the information analysis, execution, and life-long learning competencies. In conclusion, the changes in the self-evaluated scores between groups indicate PBL strategies effectively improve nursing students' core competencies. The longest exposure group reported higher self-evaluated core competency scores than the other groups, especially for the information analysis, execution, and life-long learning competencies.

Effectiveness of Online Patient Safety Education on the Competency of Nurses in Intensive Care Units: A Quasi-experimental Study

Background &amp; Aims: Maintaining patient safety (PS) is one of professional and ethical duties of health care providers. Nurses, as the largest professional group in the health system, have a potential and significant power in influencing the health care quality. Their competency in PS is essential to ensure quality and safe care. Education plays a vital role in improving PS and providing high quality nursing care. Due to the prevalence of COVID-19 and the need to observe social distancing, it is not possible to hold face-to-face courses. Hence, e-learning is a valuable option during this pandemic. This study aims to evaluate the effectiveness of online PS education on the competence of nurses in intensive care units (ICUs). Materials &amp; Methods: This is a single-group quasi-experimental study with a pre-test/post-test design that was conducted in 2020 in Tehran, Iran. Participants were 50 nurses working in the ICUs of Hazrate Rasoole Akram Hospital and Firoozgar Hospital affiliated to Iran University of Medical Sciences, who were by a proportional stratified sampling method. The content of the educational program was prepared using clinical guidelines and the literature which included materials about (1) PS and its different aspects (medication error, hemovigilance, pressure ulcer, fall, nosocomial infections, hand hygiene, surface and equipment disinfection, and waste management), (2) PS culture, (3) the effects of human factors and teamwork on error incidence, (4) importance of communication with patients before and after the occurrence of errors and giving appropriate feedback on errors, (5) root cause analysis of errors, (6) activity analysis after an adverse event, and (7) risk management. The program was prepared using Storyline version 3 software. Educational content was provided to participants on Telegram application. Before and three months after the intervention, data were collected using the Patient Safety Competency Self-evaluation (PSCSE) questionnaire. Data were analyzed by descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (paired t-test) in SPSS software, version 22. Results: The mean scores of PS knowledge (21.75±3.28), attitude (61.52±4.19) and skill (84.66±53.7) after the intervention were significantly higher compared to their pretest scores (P&lt;0.001). The mean of total competency score (167.93±11.61) was also significantly higher after the intervention. Results showed that the educational program improved the nurses' competence by 17.86%. The education had the highest effect on PS knowledge, followed by PS skills and attitudes. Conclusion: Online education can increase PS knowledge, skills, and attitudes in ICU nurses and can ultimately promote their competence in PS. Nursing managers can use e-learning method to provide in-service training and retraining courses on familiarity with PS concepts, which can help manage medical errors caused by nurses. This learning method is recommended for nurses working in ICUs, especially during the COVID-19 pandemic.

Impact of a ‘Research in pharmacy’ course on students’ self-reported competence and confidence to conduct research: Findings from a Malaysian university

Objective: To evaluate the impact of a ‘Research in Pharmacy’ course on students’ self-reported competence and confidence to plan and conduct pharmacy practice research. Method: This is a pre- and post-intervention study conducted among third year pharmacy undergraduate students in a public university in Malaysia using an online questionnaire. A ‘Research in pharmacy’ course which encompassed lectures, tutorials, and practical sessions was delivered over a 14-week period. The students were divided into groups and assigned a project supervisor to guide them in planning and conducting a research project that was completed in one term. Result: Of the 109 students, 69 and 62 completed the questionnaire in the pre- and post-intervention periods, respectively. Students’ interest in conducting research and their interest in learning about research was similar in both periods. However, self-reported ability to conduct research increased significantly. Self-reported competence and confidence to conduct most components of research improved significantly (p&lt;0.05), although, extreme/very competent or confidence level was lower than 50% for most items. Overall, median total competence score (66.0 versus 74.0, p&lt;0.001) and median total confidence score (66.0 versus 71.5, p&lt;0.001) increased significantly after the course. Most students were very satisfied/satisfied with the online lectures (54.8%) and online project supervision (64.6%). Lack of time (61.3%) was the major challenge students encountered during the course. Conclusion: A ‘Research in pharmacy' course with both didactic and experiential components improved self-reported competence and confidence to plan and conduct research among pharmacy undergraduate students. Future studies should investigate the facilitators and barriers to students’ interest in pharmacy practice research.

Profiling Behavioral and Psychological Symptoms in Children Undergoing Treatment for Spondyloarthritis and Polyarthritis.

Few studies examine psychopathology in different juvenile idiopathic arthritis (JIA) subtypes and disease activity states. We aimed to (1) evaluate emotional and behavioral symptoms in children with juvenile spondyloarthritis (SpA) and polyarticular arthritis (PolyA) as compared to a national normative population using the Child Behavior Checklist (CBCL), and (2) evaluate the relationship between CBCL scores and disease activity. Patients with JIA aged 6-17 years with SpA or PolyA were recruited from our pediatric rheumatology clinic from April 2018 to April 2019 and the CBCL and clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10) were completed. Primary outcome measures were CBCL total competence, internalizing, externalizing, and total problems raw scores. We compared outcomes from each group to national CBCL normative data. To investigate the relationship between CBCL scores and disease activity, we ran a generalized linear regression model for all patients with arthritis with cJADAS10 as the main predictor. There were 111 patients and 1753 healthy controls (HCs). Compared to HCs, patients with SpA or PolyA had worse total competence and internalizing scores. Higher cJADAS10 scores were associated with worse total competence, worse internalizing, and higher total problems scores. Most of these differences reached statistical significance (P < 0.01). Self-harm/suicidality was almost 4-fold higher in patients with PolyA than HCs (OR 3.6, 95% CI 1.3-9.6, P = 0.011). Our study shows that patients with SpA and PolyA with more active disease have worse psychological functioning in activities, school, and social arenas, and more internalized emotional disturbances, suggesting the need for regular mental health screening by rheumatologists.

Construct validity for the self-reported competency and sub-construct associated characteristics of Romanian physicians in autism spectrum disorder

BackgroundLack of physicians’ knowledge regarding mental health, including Autism Spectrum Disorder (ASD) could have adverse effects on affected individuals’ health and quality of life. The purpose of this study was to provide construct validity for a modified questionnaire in order to determine the self-reported competency for underlying sub-constructs in ASD, make inferences on perceived competence in ASD based on a sample of Romanian physicians, and identify physicians’ characteristics associated with these sub-domains of competency.MethodsFor this survey, we modified a questionnaire that was used in Pakistan and Turkey, and administered it to a sample of 383 practicing physicians in Romania to assess their perceived competency regarding ASD. Exploratory factor analysis on 12 knowledge questions revealed five sub-domains: stigma, potential causes, children’s behavior, misconceptions, and educational needs associated with ASD knowledge. Using General Linear Models, we determined physicians’ characteristics that predict the total competency score and various competency sub-scores.ResultsSeventy-five percent of the responding physicians were female and 30% had over 30 years practicing medicine. The majority (73–94%) of physicians have correctly responded to some basic questions regarding knowledge about ASD. We also found that younger physicians were more knowledgeable about potential causes of ASD than older physicians (Adjusted Mean Score (AMS): 2.90 vs. 2.18, P < 0.01), while older physicians knew more about the behavior of children with ASD (AMS: 0.64 vs. 0.37, P = 0.02). We found a significant interaction (P < 0.01) between television as source of ASD knowledge and city where the clinic is located in relation to knowledge of the physicians regarding stigma related to ASD. However, the total score was not associated with the variables associated with sub-domains.ConclusionUsing factor analysis, we demonstrated construct validity of five sub-domains related to Romanian physicians’ knowledge about ASD that include stigma, potential causes, behavior in ASD children, special education needs, and misconceptions related to ASD. The lack of significant association of the knowledge of physicians on ASD neither with the Psychiatry nor the Pediatric ward rotations at medical school may support the need for improving the curriculum on ASD in Romanian medical schools.

Behavioral and Social Functioning of Children With and Without Positional Plagiocephaly: Late Infancy to School Age.

Positional plagiocephaly and/or brachycephaly (PPB) is associated with cognition, motor, and other developmental outcomes, but little is known about the social-behavioral adjustment of children with PPB. The primary aim of this study was to compare the social-behavioral development of preschool and school-age children with and without PPB and to examine the potential moderating effects of PPB severity on group differences. Two hundred twenty children with a history of PPB and 164 controls participated in at least one behavioral assessment at 4-11 months, 18 months, 36 months, and 7 years. The frequencies of observed problem behaviors and social competence were estimated using the Child Behavior Checklist Ages 1.5-5 (CBCL/1.5-5), Caregiver-Teacher Report Form(C-TRF), CBCL/6-18, and Teacher Report Form. Children with PPB were similar to controls on the internalizing, externalizing, or total problems composites. At 7 years, CBCL/6-18 total competence scores were significantly lower in children with histories of PPB than controls. In analyses stratified by PPB severity, we found that children with moderate/severe PPB had slightly higher scores on the C-TRF internalizing scale at 36 months and lower total competence scores at age 7 years. Children who had a history of mild PPB were similar to controls on all outcomes. This study is the first to examine social and behavioral outcomes in a large cohort of children with and without a history of PPB. We found limited evidence of an association between PPB and parent and teacher-reported social-emotional and behavioral adjustment through early school-age.

Effectiveness of a standard clinical training program in new graduate nurses' competencies in Vietnam: A quasi-experimental longitudinal study with a difference-in-differences design.

ObjectiveThis study aimed to estimate the effectiveness of a standard clinical training program for new graduate nurses in Vietnam.MethodsA quasi-experimental longitudinal study with a difference-in-differences design was conducted. A total of 280 new graduate nurses completed a self-administered questionnaire. The intervention group consisted of 206 respondents (those having participated in standard clinical training) and the control group (those that did not receive training) of 74. Differences in mean increases in competency scores between the intervention and control groups were estimated. The effect size of the intervention was estimated by calculating Cohen’s d. A generalized linear model was employed to identify the factors associated with mean increases.ResultsThe mean increase in total competency scores (range: 0–6 points) in the intervention group was 0.73 points greater than in the control group with an intermediate effect size (Cohen’s d = 0.53; 95% CI 0.26 to 0.80). A greater reduction in standard deviation of total competency scores in the intervention group was confirmed. Participation in standard clinical training produced a positive association with a mean increase in total competency score without significance (β = 0.04, P = 0.321). Provincial hospitals as clinical training venues had a significantly positive association (β = 0.11, P = 0.007) with the mean increase in total competency scores. Competency at pre-clinical training was negatively (β = -0.75, P < 0.001) associated with the mean increase.ConclusionFindings implied that the standard clinical training program could contribute to both increasing and standardizing new graduate nurses’ competencies in Vietnam. Further studies are needed to more precisely examine the attribution of standard clinical training to better increase new graduate nurses’ competencies.

The Competency Movement in Public Hospitals: Analysing the Competencies of Hospital Executive Managers

"Our primary aim was to provide a quantitative snapshot relying on a self-assessment tool developed for the local healthcare environment and formal tasks for top-level executive hospital managers of public healthcare organizations. We used a cross-sectional and descriptive mixed study design that targeted the nationwide population of 701 top-level managers in public hospitals in 2015 in Turkey. As the first step, position description content analysis was conducted based on document analysis to explore their legal tasks and statements, and the job requirements for an executive management position in public hospitals. Second, before designing the data-collection instrument, we conducted four meetings and group discussions with several hospital managers – with and without medical backgrounds – and five academics who were part of healthcare management and public administration departments. Lastly, we built upon past efforts and the literature, and constructed a questionnaire. The managers are fully responsible for the healthcare quality, medical, nursing, administrative issues and financial performance of the facility. The participants perceived that they were competent in most of the competencies. The participants’ mean total competency score was 81%, and the competency gap between the required and current competency levels differed from 13% to 22%. This research provides deep insight into the competencies perceived by hospital executive managers in a developing country context. Our results have several practical implications for both healthcare policymakers and new executive hospital managers. There is an urgent need for follow-up self-assessment for competencies and ongoing management training programs."

Self-assessment of clinical competence on sexual health by Iranian medical interns: a framework for curriculum revision

Background: The sexual medicine education in medical faculties has been a challenging issue worldwide in recent decades. Most of medical students are dissatisfied for their sexual health education which indicates an emergent need for curriculum revision. The nobility of the study was to reveal medical students' competency gaps on sexual medicine.Methods: This cross-sectional study was conducted at a large, public medical school, topped the national ranking for its excellence in education. The target population was medical interns in their 6th and 7th year of their course. With a census sampling approach, all eligible students were included. To develop the questionnaire, the framework of ESSM (European Society for Sexual Medicine) syllabus of sexual medicine 2012 was employed after being examined by an expert panel to meet the criteria of content coverage. Recruiting 10 participants, a pilot was conducted to assess the criterions of validity and reliability. Finally a 35 item questionnaire was developed including three domains; "male sexual problems", "female sexual problems" and "common to both sexes sexual problems” with 17, 9, and 9 items, respectively. Students were asked to answer each item in a five-level Likert scale. The total score was standardized to convert scores to a range of 0-100 making it easy to interpret. In addition, a single question on the general competency was asked. Analytical statistics were used appropriate to data type and distribution (t test, one-way ANOVA). Study protocol was approved by research executive and ethics board of the institution.Results: 152 of 260 eligible students participated, with mean age of 25.0 (SD=2.3), of whom 54% were females. The standardized total competency score was 22.3 (95% CI: 20.4-24.2). Regarding to not only total but also different domains scores, there was no significant difference in different grades (PV&gt;0.05). The female students' competency was significantly higher in the domain of "female sexual problems" and "common sexual problems, but not in the domain of "male sexual problems". None of the interns believed that they are competent enough to manage patients with sexual problems by themselves.Conclusions: We magnificently attained that medical students' clinical competency on sexual medicine is poor. Medical education system of Iran would not be able to deal with this challenge unless it provides with a comprehensive curriculum revision.

Psychopathological Aspects in Childhood Hematopoietic Stem Cell Transplantation (HSCT): The Perception of Parents and Adolescents.

Background: Data about psychosocial sequelae of childhood Hematopoietic Stem Cell Transplantation (HSCT) are limited and the association with a specific donor type or other medical factors is largely unknown (Chang et al., 2012). The aim of the present study was to compare the psychological aspects of pediatric HSCT survivors with healthy peers. A secondary aim was to detect whether parents and children differed in the perception of mental health status. The influence of medical factors on psychological status was also examined.Method: Thirty seven HSCT survivors (23 males) with a mean age of 14.4 years (SD = 3.03; range 8.16–18.33) were recruited. Twenty-six patients underwent an allogenic HSCT (matched unrelated donor, n = 20; matched sibling donor, n = 6) and 11 patients received an autologous HSCT. The children psychological aspects were assessed using the Youth Self Report (YSR) (Achenbach and Rescorla, 2001) and compared to a group of matched healthy peers. At the same time, parents were requested to complete the Child Behavior Checklist 6–18 (Achenbach and Rescorla, 2001). Medical and socio-demographic data were also collected.Results: HSCT survivors reported significantly higher levels of somatic complains (t27 = 3.14; p = 0.004; mean = 3.1) when compared to healthy peers (mean = 1.5). The parent CBCL scores on “child total competence” exceeded the normative clinical cutoff in 48.6% cases. Inter-rater agreement between parent and patient reports was present only in three scales: total competence score (K = 0.06, p = 0.002), somatic complaints (K = 0.21, p = 0.003) and attention problems (k = 0.13; p = 0.02). According to Ancova models, internalizing problems were more frequent in HSCT from family donors (F2 = 3.13; p = 0.06) or in the presence of acute complications (F1 = 11.95; p = 0.003).Conclusion: In contrast to the perception of parents, pediatric HSCT survivors reported good psychological health. However, they complained about more somatic problems as compared with healthy peers. Medical aspects such as donor source and the presence of acute complications should be taken into consideration for the psychological approach in order to improve pediatric HSCT survivor care.

Self-concept and psychiatric comorbidity in a sample of Egyptian adolescents with secondary nocturnal enuresis

Objective Enuresis is a common problem in children and adolescents that can be troubling for them and their families. The potential effect of enuresis on the synthesis of identity and self-concept in children and adolescents is still poorly understood. This study aimed to evaluate the probable impact of secondary nocturnal enuresis on the self-concept of Egyptian adolescents. Participants and methods Forty patients aged 10-18 years with a diagnosis of secondary enuresis and 40 control children of the same age range were recruited. A validated Arabic version of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in addition to the Child Behavior Check List (CBCL) and an Arabic-translated and validated version of the Piers-Harris Children's Self-Concept Scale were applied to evaluate the sample. Results After statistical adjustment for differences in intelligence quotient and socioeconomic status, youth with enuresis showed lower school, social, and total competence scores on CBCL but higher scores in all CBCL problem parameters. Adolescents with enuresis scored lower than control adolescents in all six subscales of the Piers-Harris Children's Self-Concept Scale in addition to the total score. Linear regression was used to adjust the results for significant differences between the two groups regarding intelligence quotient, socioeconomic status, CBCL school competence, CBCL total problems, and diagnosis of attention-deficit hyperactivity disorder and conduct disorder according to the MINI-KID interview. Differences in three subscales - behavior, intellect, and physical appearance - in addition to the total score were still significant after adjustment. Comparison between youth with nocturnal enuresis versus those with combined-type enuresis yielded no significant differences. Conclusion Older children and adolescents with enuresis suffer from high internalizing and externalizing problems, and low competence levels. They also suffer from low self-esteem that is most probably the result of enuresis itself and not due to low competence levels or behavioral problems. Further research is needed to determine the effect of treatment on the self-concept of these children.

Differences and Similarities of Mental Health Problems Reported by Adolescents: From Greece, Japan, Russia, and Sweden

The aims of the present study were to: 1) compare scores and scales of the Youth Self-Report (YSR) reported by healthy adolescents 15 - 17 years of age from Greece, Japan, Russia, and Sweden, 2) analyze gender and age effects of the YSR syndrome scores between and within countries, and 3) compare scores of competence scales and their associations to mental health problems. A comparison of problems (n = 812) yields a small effect size of 4.8% for cross-country in YSR total problems scores. There was a deviation above the overall mean for Greece and Russia, while Sweden and Japan had deviations below the mean. The effect sizes of country for narrowband and broadband scales were small or medium. Analysis within and between countries pointed out some problems that might be more/less common in some countries than others. In their total competence score, Greek adolescents scored higher than Swedish or Japanese. There were some negative associations between syndrome and competence scales across countries. Gender differences were shown across the countries with the exception of Japan. Age differences were less consistent due to the small range of age groups. Even though YSR is used in all four countries, translations and sampling procedure may influence (be one of) the variations.

Evaluation of a pilot Masterclass for dermatology nurses in psychosocial aspects of care

ObjectivesTo deliver a Masterclass to eight dermatology nurses focusing on the bio–psychosocial aspects of care for people living with skin disease; utilise psychosocial assessment tools available for Holistic Needs Assessment (HNA); increase participant nurses’ understanding of levels of psycho–social intervention; evaluate course impact on participants’confidencein HNA; evaluate course impact on participants’competencein HNA and record changes in practice following course completion.MethodA pragmatic action research approach was undertaken, utilising standardised pre– and postconfidence and competence questionnaires and reflection (free–text and verbal feedback). A two–day interactive learning programme was delivered with a half–day feedback debrief session at three months.Results: Overall confidence levels increased with mean total confidence scores increasing from 43.1 to 58.3 (range 0 to 90). Greatest percentage increase was demonstrated for: use of screening tools and discussing suicidal ideation. Overall competence levels increased with mean total competence scores increasing from 43.1 to 85.1 (range 0 to 130). Greatest percentage increases in competence were demonstrated for: use of the Distress Thermometer (386 per cent); use of screening tools for anxiety and depression (139 per cent); educating the patient about mechanisms of anxiety (129 per cent); structure and organisation of psychological practice (85 per cent) and assessing for suicidal ideation (85 per cent).ConclusionsThis Masterclass improved participants’ confidence and competence levels in assessing psychosocial aspects of care. It met participants’ expectations and course objectives. Development of an additional mentorship programme for participants following course completion is recommended to sustain change in practice.

Test-Retest Reliability of the Child Occupational Self-Assessment (COSA).

We examined the test-retest reliability of the Child Occupational Self-Assessment (COSA). Fifty-two children ages 6-12 yr completed the COSA on two separate occasions 7-14 days apart. Participant data were analyzed using intraclass correlation coefficients (ICCs). Test-retest reliability was good for total Competence and Value scores (ICC2,1=.72-.77) and poor to good across category scores (ICC2,1=.44-.78). These findings suggest that the children's perceptions of their abilities and the value they placed on their everyday activities as reflected in the test items were fairly consistent over a short period of time.

Innovative Educational Activities Using a Model to Improve Cultural Competency among Graduate Students

In the United States, there are inequalities in all aspects of healthcare. The Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Services was used to design, implement, and evaluate a nutrition counseling graduate class focusing on improving cultural competency. Each assignment and activity addressed one or more constructs of the model. Examples included participation in a simulation to stimulate self-awareness, assessing cultural competence of a health organization to improve knowledge, using respondent driven interview questions to develop skills, and conducting a nutrition assessment of an individual across cultures. Students significantly improved (P<0.001) each aspect of the cultural competency model after completion of the course. The total competence score improved from “culturally aware” (score of 68.7 at pre-) to “culturally competent” (score of 78.7 at post-).

EHMTI-0179. Emotive and behavior problems in adolescents with cronic headache (CDH) and medication overuse (MOH) using child behaviour checklist(CBCL) e youth self-report (YSR)

Fifty six patients ages 11.0-18.0 (39,3% male and 60,7% female), seen for headache in a third-level centre in Italy, and their 56 mothers were enrolled in this study. They were assessed using Parent Child Behaviour Checklist and Youth Self-report. A detailed history was taken to assess the presence of headache, using criteria defined by ICDHIII beta; in this way we have found: 7 patients with MOH and 24 patients with CDH. Results Patients with CDH at the YSR obtained higher T scores in Thought Problems: this result remained significant both in a three group comparison between patients with probable CDH, patients with confirmed CDH and patients with a non-chronic headache (p=0.04) and in a 2-groups comparison of patients with CDH (both probable or confirmed) or with non-chronic headache (p=0.01). Moreover, we observed a significant reduction of Total Competence score in patients with medication overuse (p=0.02). Conclusions This study confirmed that CDH could be related with a more severe psychopathology, and especially with Thoughts Problems at YSR. Moreover, patients with MOH are described by their mothers as having a reduction of functioning. No conflict of interest.

Empathy is related to clinical competence in medical care

Most medical schools focus upon aspects of interpersonal functioning such as empathy in the doctor-patient relationship with the aim of training clinically competent doctors. This study investigated the relationship between empathy and clinical competence among medical students. Fifty-seven medical students participated in the study. Clinical competence was assessed in an objective structured clinical examination (OSCE). Empathy was rated by an independent observer of the clinical interaction in OSCE stations. In addition, empathy was self-rated using the Jefferson Scale of Physician Empathy-Student Version. Observed behaviour indicative of empathy, as rated objectively by an independent observer, was strongly associated with clinical competence. The strong association between the behavioural manifestation of empathy and clinical competence was evident across a range of medical conditions and types of consultation. In addition, observable empathy was strongly associated with patients' ratings of the students' performances. Self-rated empathy, however, was not associated with clinical competence. Significant differences in mean total competence scores were noted between students low in observed empathy (mean±standard deviation [SD]: 165.86±12.92) and students high in observed empathy (mean±SD: 190.35±14.00) (t[55]=6.28, p=0.000, α≤0.01). In medical education, strategies that enhance the behavioural expression of empathy (or at least retard its decay) could help to make medical students appear to be more clinically competent to both examiners and patients. However, if medical students' internal emotions are found to be discrepant with their behaviour, these findings will raise difficult questions regarding the fundamental nature of genuine empathy and alert us to the possibility that medical students may learn that it pays to subscribe to the view that if a person does not feel empathy, he or she can fake it.

Psychosocial Functioning in Adolescents with Perinatal HIV Infection Receiving Highly Active Antiretroviral Therapy

With effective highly active antiretroviral therapy (HAART), perinatally HIV-infected children are living longer through adolescence. We conducted a cross-sectional study of perinatally HIV-infected adolescents, aged 11 to 18 years. Demographically matched controls were also enrolled. The adolescents completed the Youth Self-Report (YSR), while the caregivers filled out the Child Behavior Checklist (CBCL), to determine emotional and behavioral problems. The sample included 50 HIV-infected adolescents and 56 controls. The internalizing problem scores from the YSR were significantly higher in the HIV-infected group than those in the control group (13.76 versus 9.95, P = .02). The total competence scores, from both the self-report and the caregiver report in the HIV-infected group, were significantly lower than those of the control group (P = .005 and .001). Although HAART has prolonged the survival of HIV-infected children, they remain at increased risk of psychosocial problems as well as impaired social functioning.

Kişilerarası Sorun Çözme Eğitiminin Dikkat Eksikliği ve Hiperaktivite Bozukluğu olan Çocuklar Üzerindeki Etkisi

This study was designed to evaluate the effectiveness of the "I Can Problem Solve" (ICPS) program on behavioral and emotional problems in children with attention deficit hyperactivity disorder (ADHD). The subjects were 33 children with ADHD aged between 6 to 11 years. The study used a pre- and post-test quasi-experimental design with one group. The researchers taught 33 children with ADHD how to apply ICPS over a period of 14 weeks. The Child Behavior Checklist for Ages 6-18 (Teacher Report Form) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition Text Revision (DSM-IV-TR) Based Disruptive Behavior Disorders Screening and Rating Scale (parents' and teacher's forms) were used to evaluate the efficacy of the program. The scales were applied to parents and teachers of the children before and after the ICPS program. The findings indicated that the measured pre-training scores for behavioral and emotional problems (attention difficulties, problems, anxious/depressed, withdrawn/depressed, oppositional defiant problems, rule breaking behaviors, and aggressive behaviors) were significantly decreased in all children post-training. In addition, children's total competence scores increased (working, behaving, learning and happy) after the ICPS program. According to the results, it is likely that, ICPS would be a useful program to decrease certain behavioral and emotional problems associated with ADHD and to increase the competence level in children with ADHD. An additional benefit of the program might be to empower children to deal with problems associated with ADHD such as attention difficulties, hyperactivity-impulsivity, and oppositional defiant problems.