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PubMed2006

Mental health of children in foster and kinship care in New South Wales, Australia.

OBJECTIVES: To report baseline mental health measures from the Children in Care study, a prospective epidemiological study of children in court-ordered foster and kinship care in New South Wales, Australia. METHODS: Mental health, socialization and self-esteem were assessed in 347 children in a statewide mail survey, using two carer-report checklists, the Child Behavior Checklist (CBCL) and the Assessment Checklist for Children (ACC). RESULTS: Children in the study had exceptionally poor mental health and socialization, both in absolute terms, and relative to normative and in-care samples. Levels and rates of disturbance for children in foster care exceeded all prior estimates. Rates of disturbance for children in kinship care were high, but within the range of prior estimates. Boys presented with higher scope and severity of mental health problems than girls on the CBCL, while gender-specific patterns of disturbance were shown on the ACC. A moderate age effect was accounted for by children's age at entry into care. CONCLUSIONS: Children in care are at high risk of mental health problems. Psychological support for the children and their carers is an essential secondary prevention strategy. Implications for service delivery are discussed.

Age Factors↗
PubMed2005

Psychological evaluation of children with idiopathic constipation and their parents.

BACKGROUND: Constipation is one of the most common problems in childhood. In idiopathic constipation it is not possible to identify primary cause in every case. Child behavioral problems and disturbances in parent-child relationships have been cited as causes of constipation. Constipation is a source of anxiety to the child and to the family. The purpose of the present study was to evaluate psychological characteristics of constipated children and their parents. METHODS: Thirty-two otherwise healthy children with idiopathic constipation over 4 years old were prospectively evaluated between January 2002 and June 2003. The Child Behavior Checklist (CBCL) and Symptom Checklist-90 revised (SCL-90-R) were used to assess the psychological profiles of the children and the parents, respectively. Thirty children with inguinal hernia who had no constipation or other problems, and their parents were asked to complete the checklists as controls. The scores of the constipation group were compared statistically with those of the control group. RESULTS: In the constipation group there were 19 boys and 13 girls with a mean age of 7.3 years (4-14 years). All the patients responded to medical treatment. Constipated children and their parents were not found to have more behavior problems than the control group (P > 0.05). CONCLUSIONS: Children with idiopathic constipation and their parents do not show significant behavioral and emotional problems. Their psychological profiles are not different from the general population.

Case-Control Studies↗
PubMed1996

Nutritional risk in inner-city-dwelling older black Americans.

OBJECTIVE: To define the degree of nutritional risk in older inner-city black Americans and to identify important underlying factors associated with high nutritional risk. DESIGN: Cross-sectional descriptive study. SETTING AND PARTICIPANTS: A population-based sample of 400 noninstitutionalized persons older than 69 years of age in north St. Louis (NSL), Missouri, and a community-based sample of 115 residents aged 50 years and older living in public housing in East St. Louis (ESL), Illinois. Both study areas have high levels of poverty. MEASUREMENTS: Nutritional risk was measured using the Nutrition Screening Initiative Checklist. Demographic information, economic status, self-rated health, Geriatric Depression Scale score, and body mass index were assessed using established standardized instruments. MAIN RESULTS: Forty-eight percent of NSL and 66% of ESL subjects scored high on the Checklist. Compared with a mostly white (96%) comparison group from New England, both samples demonstrated particularly high prevalence for limited intake of fruits, vegetables, and milk; tooth and mouth problems; lack of money for food; eating alone; polypharmacy; and inability to shop, cook or feed on their own. High levels of depressive symptoms, fair or poor self-rated health, perceived inadequacy of income, and low income levels were associated with high risk, but even those subjects with no or few such predisposing factors were still high on the Checklist score compared with the New England sample. CONCLUSIONS: If confirmed, these results indicate that inner-city-dwelling older black Americans are at high nutritional risk. Attempts to reduce their nutritional risk should focus on improving nutritional content of their diet, oral health, polypharmacy, depressive symptoms, and poor general health; offering group meals; and providing assistance with shopping and cooking.

Black or African American↗
PubMed1992

Identifying hazards and risk opportunity in child farm injury.

Although children are overrepresented in farm injury, little is known about the environmental hazards and risk behaviours associated with injury, or about how to identify these factors at a local level. This study addresses the measurement of these hazards and hazardous behaviours. The study was conducted in 1990 at Gloucester, New South Wales, a small dairy, beef and hobby farm community. After some formative research and local consultation, a checklist survey was constructed and sent to 120 farm families with school-age children. Families were sent the checklist forms again two weeks later to assess test-retest reliability, which was found to be acceptable among the 38 per cent who responded on both occasions. The findings on the prevalence of environmental hazards and risk behaviours from the 84 per cent of respondents were useful to refine the existing injury information available from local hospital morbidity figures, which had identified injuries related to riding (horses, bicycles and motorcycles) and to machinery and drowning as major rural injury issues. In particular the importance of bicycle riding and horse-related injury were confirmed. The survey importantly identified some previously undetected issues, most notably the danger to children's hearing. The prevalence data were used to identify targets for the development of local health promotion initiatives, leading the local farm safety action group to select horses, helmets and hearing as issues for preventive action. Findings from the method indicated the importance of local information, involving farmers in constructing the checklist, and feeding back results to the community.

Agriculture↗
PubMed1997

The identification of children with developmental coordination disorder by class and physical education teachers.

BACKGROUND: Children diagnosed with developmental coordination disorder (DCD) have difficulty performing coordinated movements. In addition, these children have been found to have long-term social, emotional, behavioural and academic problems. Early identification is therefore important, and teachers may be very useful in this identification process. AIMS: In the present study, the ability of physical education and class teachers to identify children with coordination problems using the Movement Assessment Battery for Children checklist was assessed. SAMPLES: A total of 171 children was initially assessed. From this sample, 32 children found to have coordination problems were compared with 32 control children, matched on age, sex and Verbal IQ. METHODS: Motor coordination difficulty was identified in children aged between 9 and 11 years using the performance test of the Movement Assessment Battery for Children (MABC; Henderson & Sugden, 1992). These scores were then compared with the scores on the MABC checklist which was given to the child's class and physical education teachers. RESULTS: Class teachers were only able to identify 25 per cent of the children with DCD, whereas physical education teachers were able to identify 49 per cent of the DCD children. CONCLUSION: These differences were discussed in relation to the contextual settings in which the children were tested, based on the theory described by Sugden & Sugden (1991) in the development of their Motor Competence Checklist (MCC).

Analysis of Variance↗
PubMed2000

Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care.

OBJECTIVE: To test the effectiveness of two programmes to improve the treatment of acute depression in primary care. DESIGN: Randomised trial. SETTING: Primary care clinics in Seattle. PATIENTS: 613 patients starting antidepressant treatment. INTERVENTION: Patients were randomly assigned to continued usual care or one of two interventions: feedback only and feedback plus care management. Feedback only comprised feedback and algorithm based recommendations to doctors on the basis of data from computerised records of pharmacy and visits. Feedback plus care management included systematic follow up by telephone, sophisticated treatment recommendations, and practice support by a care manager. MAIN OUTCOME MEASURES: Blinded interviews by telephone 3 and 6 months after the initial prescription included a 20 item depression scale from the Hopkins symptom checklist and the structured clinical interview for the current DSM-IV depression module. Visits, antidepressant prescriptions, and overall use of health care were assessed from computerised records. RESULTS: Compared with usual care, feedback only had no significant effect on treatment received or patient outcomes. Patients receiving feedback plus care management had a higher probability of both receiving at least moderate doses of antidepressants (odds ratio 1.99, 95% confidence interval 1.23 to 3.22) and a 50% improvement in depression scores on the symptom checklist (2.22, 1.31 to 3.75), lower mean depression scores on the symptom checklist at follow up, and a lower probability of major depression at follow up (0.46, 0.24 to 0.86). The incremental cost of feedback plus care management was about $80 ( pound50) per patient. CONCLUSIONS: Monitoring and feedback to doctors yielded no significant benefits for patients in primary care starting antidepressant treatment. A programme of systematic follow up and care management by telephone, however, significantly improved outcomes at modest cost.

Acute Disease↗
PubMed2005

Quality of life and impairment in patients with multiple sclerosis.

OBJECTIVES: The aims of this study were to describe the quality of life in patients with multiple sclerosis (MS) given immunological treatment and in those not given immunological treatment and to investigate the relationship between impairment and quality of life. METHODS: Twenty nine patients given immunological treatment were matched with the same number of patients not given such treatment. Matching variables were sex, Kurtzke's Expanded Disability Status Scale (EDSS), years since diagnosis, and age (total n = 58). The patients were interviewed using the self-reported impairment checklist and they answered two questionnaires on quality of life, the 36-Item Short-Form Health Survey (SF-36) and the Subjective Estimation of Quality of Life (SQoL). RESULTS: The self-reported impairment checklist captured a more differentiated picture of the patients' symptoms of MS than the EDSS. Health related quality of life was markedly reduced, while the subjective quality of life was less affected. There was a stronger association between self-reported ratings of impairment and health related quality of life on the SF-36 than between impairment and global ratings of quality of life on the SQoL. Subjective quality of life on the SQoL was not directly dependent on impairment expressed in physical limitations. There were no statistically significant differences between the treated and untreated groups. A non-significant trend towards better health related quality of life was found in favour of the treated group with respect to emotional role, physical role, and social function on the SF-36. CONCLUSIONS: The self-reported impairment checklist and SF-36 proved to be valuable complements to the well established EDSS in describing the diverse symptoms of MS. Measuring both health related quality of life and subjective wellbeing provides valuable knowledge about the consequences of MS.

Activities of Daily Living↗
PubMed1995

Evaluation of the effectiveness of four different inhalers in patients with chronic obstructive pulmonary disease.

BACKGROUND: The percentage of patients inhaling their medication effectively varies widely, according to methods of assessment and inhalers used. This study was carried out to assess differences among four types of inhalers using inhaler-specific checklists. METHODS: Inhalation technique was evaluated in adult patients with chronic obstructive pulmonary disease (COPD). Inhalers investigated were either metered dose inhalers (MDIs) or the dry powder inhalers Turbohaler (Turbuhaler), Diskhaler, and Rotahaler. Errors were recorded against inhaler-specific checklists. From these, scores were derived by dividing the number of items correctly completed by the total number of items on the checklist and the result was expressed as a percentage. For every inhaler "essential actions" were identified and scores on these key manoeuvres were calculated. The percentage of patients performing all these essential actions correctly was also calculated. Scores were also compared with adjustment for differences in relevant patient characteristics. RESULTS: Important differences among inhalers were found. Of 152 patients with COPD (mean (SD) age 55.1 (8.7) years), those with MDIs performed worst, especially when only essential items were considered. Patients with a Diskhaler did best, although after correction for patient characteristics the differences tended to diminish. Only 60% of patients were able to perform all essential inhaler actions satisfactorily. Of those using the Diskhaler, 96% did so correctly, while the corresponding figure for those using the MDI was only 24%. CONCLUSIONS: Many patients with COPD use their inhaler ineffectively. After adjusting for patient characteristics, differences among inhalers, although less pronounced, persist. Patients using a Diskhaler made fewest errors, while most patients using MDIs made crucial mistakes.

Adult↗
PubMed1999

Ovarian cancer: comparison of observer performance for four methods of interpreting CT scans.

PURPOSE: To assess the effects of four interpretative methods on observers' mean sensitivity and specificity by using computed tomography (CT) of ovarian carcinoma as a model. MATERIALS AND METHODS: CT scans in 98 patients with ovarian carcinoma and 49 women who were disease free were retrospectively reviewed by four experienced blinded radiologists to compare single-observer reading, single-observer reading with an anatomic checklist, paired-observer reading (simultaneous double reading), and replicated reading (combination of two independent readings). Confidence level scoring was used to identify three possible disease forms in each patient: extranodal tumor, lymphadenopathy, and ascites. Patient conditions were then categorized as abnormal or normal. RESULTS: There were no significant improvements in sensitivity or specificity for classification of patient conditions as abnormal or normal when comparing single-observer interpretation with single-observer interpretation with a checklist or paired-observer interpretation. Although there was no significant improvement in the mean sensitivity (93% vs 94%) by using the replicated reading method, there was a statistically significant improvement in mean specificity (85% vs 79%) for the replicated readings compared with single-observer interpretations (P < .05). CONCLUSION: Diagnostic aids such as checklists and paired simultaneous readings did not lead to an improved mean observer performance for experienced readers. However, an increase in the mean specificity occurred with replicated readings.

Female↗
PubMed1999

Evaluation of some criteria used to select patients for brief psychodynamic therapy.

BACKGROUND AND OBJECTIVES: The effectiveness of brief psychotherapy is established, but criteria for the selection of patients remain elusive. This study examines the usefulness of some widely used criteria for the selection of patients for brief psychodynamic therapy (BPT). METHODS: A checklist of 39 criteria often used in a teaching hospital to screen patients for BPT was constructed. Scores derived from a principal components analysis of this checklist provided one set of predictor criteria. A second measure was derived from the consensual agreement of the independent ratings by 3 prominent advocates of BPT. A third predictor was derived from a similar analysis of items from the checklist on which consensual agreement for their relevance was obtained from the independent ratings of 23 BPT teachers in 16 university-affiliated hospitals. Reliable chart-based ratings of improvement in symptoms, increased insight, and improvement in general functioning of a convenience sample of 43 patients treated with BPT in the outpatient clinic of a teaching hospital served as outcome measures. RESULTS: No correlation between any of the derived predictors and any of the measures of outcome was significant after a Bonferroni correction. CONCLUSION: Teachers and clinicians still do not have good criteria for the selection of patients who will benefit from BPT. Exclusion of severe behavior disorders may, however, improve outcome rates by more than 15%.

Humans↗
PubMed1995

Psychopathology from adolescence into young adulthood: an 8-year follow-up study.

OBJECTIVE: This study investigated the stability of behavioral and emotional problems from adolescence into young adulthood. METHOD: Subjects from the general population (N = 459), aged 13-16 years, were evaluated initially with the Child Behavior Checklist (completed by parents) and 8 years later with the Young Adult Self-Report. The scoring format and factor structure of the two assessment instruments are similar; syndromes constructed from the two instruments are based on parents', teachers', and self-report information derived from large clinical samples. Signs of maladjustment also were assessed at follow-up through interviews. RESULTS: Of the individuals with total problem scores in the deviant range on the Child Behavior Checklist, 27.3% had total problem scores in the deviant range on the Young Adult Self-Report at follow-up. The probability of having a total problem score in the deviant range at follow-up was raised 7.4-fold by having deviant-range scores on the Child Behavior Checklist somatic complaints and anxious/depressed syndromes (simultaneously) at the initial assessment. Referral to mental health services was predicted by deviant-range scores on the anxious/depressed syndrome, while suicide attempts were predicted by deviance on the withdrawn syndrome. CONCLUSIONS: Adolescent problems tended to persist into young adulthood to a moderate degree. High rates of withdrawal from social contacts, anxiety or depression, somatic complaints without known medical origin, social problems, attention problems, delinquent behavior, and aggressive behavior during adolescence were risk factors for specific types of psychopathology and maladjustment at 8-year follow-up. The presence of psychopathology in adolescence should not be regarded as normative.

Adolescent↗
PubMed2004

Construct validity of an objective structured clinical examination (OSCE) in psychiatry: associations with the clinical skills examination and other indicators.

OBJECTIVE: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical Examiners (NBME) psychiatry subject examination. METHODS: Archival data from two successive classes of third-year medical students (1999-2000, N=142; 2000-2001, N=144) were aggregated and analyzed. RESULTS: The pattern and magnitude of convergence and discrimination were indicative of adequate construct validity for both the psychiatry checklist scores and the global process score. Clinical skills examination scores for history taking, interpersonal skills, and physical examination were related to psychiatry OSCE scores that reflected the same skill set. Construct validity was fairly higher for the global process rating. CONCLUSION: Evidence of construct validity of a psychiatry OSCE was obtained from multiple measures of performance, including the clinical skills examination. Findings lend support to the continued use of checklist and global process evaluations as part of OSCEs in psychiatry.

Adult↗
PubMed1994

A practical staff management package for use in a training program for persons with developmental disabilities.

A staff management package was investigated for increasing and maintaining behavioral training skills of direct-care staff. Behaviors of three direct-care staff members were monitored while they conducted a prevocational program with 27 adult clients with severe or profound mental retardation. The intervention was an easy-to-apply checklist used weekly by a supervisor to give feedback to direct-care staff. The management procedure did not require the supervisor to collect quantitative data to be graphed or charted. Use of the checklist during a weekly morning work session in a multiple-baseline design across subjects led to immediate improvement in staff performance during daily morning work sessions. Considerable generalization of improved staff performance to daily afternoon work sessions with a different client group occurred. Further increases in staff performance occurred when the management procedure was added to afternoon work sessions. Staff performance was maintained over 4 months after the management procedure was decreased from weekly to biweekly use. When performance of direct-care staff improved, on-task behavior of most clients also substantially increased. Direct-care staff preferred the staff management package compared to "traditional" methods of supervision, and the training unit adopted the checklist for continuous use at the conclusion of the study.

Adult↗
PubMed1980

The competent offspring of psychiatrically ill parents. Part II: A search for behavioural variables.

Behavioural questionnaires can be used to tease apart some of the variables involved in the psychosocial adjustment of the child. The findings and limitations of one such attempt are discussed. The study includes data collected on 90 psychiatric patients, their spouses and children. Data were collected from the patient's chart and through a structured interview with the spouse. A medical history, Rutter's parental questionnaire on children's behaviour and the Randall-McClure behaviour checklist were completed. A comparison between the 37 children scoring 13 or more and the 73 children scoring 6 or less on the Rutter's checklist was carried out. A major finding is that the characteristics of the parents do not differentiate between children exhibiting high scores versus low scores on the behavioural checklists. The group of emotionally disturbed children identified in this way is related more to the presence of an unsettling situation and poor school performance. These data do not, however allow for an assessment of the role of either temperament or marital discord in the production of emotional disturbance, nor do they designate who will eventually suffer from serious mental illness in adulthood.

Adolescent↗
PubMed2005

Behavioral characteristics of Prader-Willi syndrome in Korea: comparison with children with mental retardation and normal controls.

The purpose of this study was to examine the psychiatric characteristics of children with Prader-Willi syndrome in Korea, focusing particularly on their behavioral problems and obsessive-compulsive spectrum symptoms. Fourteen patients with Prader-Willi syndrome, together with their parents, underwent a psychiatric interview and parent questionnaire consisting of a Child Behavior Checklist. Twenty-four patients with mental retardation and 45 normal students were selected as control groups. Compared with the normal control group, the rates of inclusion in the clinical range and the mean scores with regard to social problems, thought problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems, and total problems profiles were significantly higher (P < .01) in the Prader-Willi syndrome group according to the results of the Child Behavior Checklist. Compared with the mental retardation group, there was a statistically significant (P < .05) difference in the delinquent behavior profile. Comparing selected Child Behavior Checklist items related to obsessive-compulsive spectrum symptoms, the Prader-Willi syndrome group showed significantly more (P < .05) compulsion, skin picking, and stealing than the mental retardation or normal control groups. These findings suggest that children with Prader-Willi syndrome in Korea have many behavioral problems, including obsessive-compulsive spectrum symptoms, needing proper psychiatric attention and treatment. This is the first study in Korea to evaluate the psychiatric and behavioral characteristics of children with Prader-Willi syndrome.

Adolescent↗
PubMed1998

Critical analysis of the pharmaceutical care research literature.

OBJECTIVE: To describe and evaluate published pharmaceutical care research and make recommendations to improve the quality of the literature. DATA SOURCES: MEDLINE and International Pharmaceutical Abstracts using the key word "pharmaceutical care," limited to research articles published January 1988-December 1996. STUDY SELECTION: Articles that evaluated the provision of pharmaceutical care in a defined population. DATA EXTRACTION: Citations (title and abstract) identified were reviewed. Articles potentially meeting the inclusion criteria were screened and scored according to the Pharmaceutical Care Research Checklist for the presence of criteria including pharmaceutical care process, methodology, and measures/outcomes. RESULTS: A total of 979 citations were identified. Of 57 abstracts identified as potentially meeting the inclusion criteria, 43 articles were eliminated, 2 were rejected, and 12 were accepted for analysis. Deficiencies identified included: a lack of research in community practice (n = 2), randomized controlled trials (n = 3), workload measurement (n = 6), and patient satisfaction (n = 1). Scoring according to the Pharmaceutical Care Research Checklist also identified the following deficiencies (maximum Composite Criterion Score [CCS] of 24): description of population sample (CCS 17), dropouts (CCS 13), informed consent (CCS 8), pharmacist training/qualifications (CCS 9), instrument validity (CCS 10), structure criteria (CCS 4), patient outcomes (CCS 11), and economic outcomes (CCS 12). The mean total checklist score was 37 of 50 (range 31-46). CONCLUSIONS: Few research studies have evaluated the provision of pharmaceutical care in a defined population. Deficiencies identified by low CCSs demonstrated the need for quality research design and a clear description of the pharmaceutical care process to evaluate the impact of pharmaceutical care. Recommendations for improvement in research design were made.

Humans↗
PubMed2001

Multimodal assessment of dissociation in adolescents: inpatients and juvenile sex offenders.

Two samples of adolescents were studied to assess the validity of several measures of dissociation. The first sample included 70 males from a residential treatment program for adolescent sex offenders (ASO). The second were 47 psychiatric inpatients. The measures included the DSM-IV field trial questionnaire for Dissociative Disorders of Childhood, Child Dissociative Checklist, Adolescent-Dissociative Experiences Schedule, Trauma Symptom Checklist for Children, and the Dissociation Research scale. Ten of the 70 adolescent sex offender subjects (14.3%) were identified as meeting DSM-IV criteria for a Dissociation-spectrum disorder diagnosis and two (4.2%) of the psychiatric patients. Between-groups analyses with the ASO revealed significant differences on the Child Dissociative Checklist and the Dissociation Research Scale. Cumulative trauma did not differ significantly between the dissociative and nondissociative groups of ASO, but physical abuse was related to a diagnosis of dissociation in this sample. The dissociation measures were highly intercorrelated for both groups, and suggest that they measure a similar construct.

Adolescent↗
PubMed2000

Psychosocial and traditional risk factors in early ischaemic heart disease: cross-sectional correlates.

BACKGROUND: Psychosocial/emotional distress has been repeatedly found to be a correlate of the onset/aggravation of ischaemic heart disease. METHODS: Eighty-three patients (63 men and 20 women) with known coronary artery disease who entered an aggressive lifestyle modification programme were administered a clinical/demographic history and the Symptom Checklist 90--Revised at baseline. Several measures of social isolation/alienation (shyness/self-consciousness, feeling lonely, feeling abused and overall) were derived from the the Symptom Checklist 90--Revised. RESULTS: Univariate tests of the association of known cardiovascular risk factors and the Symptom Checklist 90--Revised scales with age at initial diagnosis yielded several significant results for history of hypercholesterolaemia (P = 0.018), history of hypertension (P = 0.030), somatization (P = 0.007), obsessive-compulsive (P = 0.009), depression (P = 0.006), anxiety (P = 0.021), hostility (P = 0.003), paranoia (P = 0.050), psychoticism (P = 0.029), the Global Severity Index (P = 0.007), the Positive Symptom Distress Index (P = 0.005), the Positive Symptom Total Score (P = 0.003) and feeling abused (P = 0.037). Only history of hypertension, history of hypercholesterolaemia and the hostility scale (overall F = 6.08 and P = 0.0009) emerged as unique correlates of age at initial diagnosis in a multiple regression using only the significant univariate predictors. CONCLUSIONS: Psychosocial factors are sufficiently confounded with one another that they lose their predictive value once one is entered in the equation. High scores on the hostility scale were associated with a 5.7 year differential in age at initial diagnosis. The younger a patient is at initial diagnosis, the more likely he/she is to have high levels of emotional distress.

Coronary Disease↗