Methods of coping with social desirability bias: A review

Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study

Objective:

To explore whether goal-setting for rehabilitation with acute stroke survivors is patient-centred and identify factors which influence the adoption of patient-centredness in goal-setting practice.

Setting:

Acute stroke unit in a large teaching hospital in England.

Participants:

Patients with stroke who had no cognitive or significant communication problems and health care professionals who had a significant engagement with an individual patient were approached for participation.

Method:

Multiple qualitative methods were used. Perceptions and beliefs about patient-centredness, within the context of goal-setting, were collected from patients and corresponding professionals using qualitative semi-structured interviews. Adoption of patient-centred behaviour was triangulated using analysis of patient records and observation of team meetings related to participating patients.

Data analysis:

Interview transcripts and field notes were coded, clustered under categories and descriptively summarised. Additionally, data from patients’ documents were summarised. These summaries were then mapped on to an a-priori frame work of patient-centredness from which further interpretative themes were derived.

Results:

Seven patients and seven health-care professionals participated. Goal-setting was not consistently patient-centred as evidenced by a) incongruities between patients and professionals in setting, communicating and prioritising of goals and b) dysfunctional therapeutic relationships. The factors that influenced patient-centred goal-setting were both professional and patient beliefs and attributes, work-culture, practice model, limitations in knowledge and systems that disempowered both professionals and patients.

Conclusion:

It may be possible to infer that current local practice of goal-setting was inadequately patient-centred. Further research is required to identify strategies to overcome these challenges and to develop patient-centred goal-setting methods.

Dietary patterns associated with HbA1c and LDL cholesterol among individuals with type 1 diabetes in China

AIMS

To identify dietary patterns that influence cardiometabolic risk among individuals with type 1 diabetes (T1D) in China.

METHODS

Data are from a cross-sectional study of T1D in China (n=99). Dietary intake was assessed using three 24-hour recalls. Reduced rank regression was used to identify dietary patterns from a set of 20 food groups that maximized the explained variation in glycated hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) cholesterol.

RESULTS

Dietary pattern 1 was characterized by low intakes of wheat products and high-fat cakes, and high intakes of beans and pickled vegetables. Dietary pattern 2 was characterized by low intakes of high-fat cakes, nuts/seeds, fish/shellfish, and teas/coffee, and high intakes of rice and eggs. Participants in the highest tertile of dietary pattern 1 had significantly (p<0.05) higher HbA1c and LDL cholesterol compared to participants in the lowest tertile: mean difference in HbA1c was 1.0 percentage point (11 mmol/mol) and in LDL cholesterol was 0.36 mmol/L after adjustment for age and household income. Dietary pattern 2 was not associated with HbA1c or LDL cholesterol.

CONCLUSIONS

We identified a dietary pattern that is significantly related to HbA1c and LDL cholesterol. These findings provide support for behavioral strategies to prevent complications in individuals with T1D in China.

Music therapists' research activity and utilization barriers: a survey of the membership

BACKGROUND

Music therapists have access to a rapidly expanding body of research supporting the use of music-based interventions. What is not known is the extent to which music therapists access these resources and what factors may prevent them from incorporating research findings into clinical work.

OBJECTIVE

After constructing the Music Therapists' Research Activity and Utilization Barrier (MTRAUB) database, the purposes of this study involved: assessing the extent to which American Music Therapy Association (AMTA) members engage in certain research-related activities; and identifying respondents' perceived barriers to integrating research into clinical practice.

METHODS

This study employed a quantitative, non-experimental approach using an online survey. Respondents included professional, associate, student/graduate student, retired, inactive, and honorary life members of AMTA. Instrumentation involved a researcher-designed Background Questionnaire as well as the Barriers to Research Utilization Scale (BARRIERS; Funk, Champagne, Wiese, & Tornquist, 1991), a tool designed to assess perceived barriers to incorporating research into practice.

RESULTS

Of the 3,194 survey invitations distributed, 974 AMTA members replied (a response rate of 30%). Regarding research-related activities, descriptive findings indicate that journal reading is the most frequently reported research-related activity while conducting research is the least frequently reported activity. Results from the BARRIERS Scale indicated that Organizational and Communication factors are perceived as interfering most prominently with the ability to utilize research in clinical practice.

CONCLUSIONS

Findings suggest that research-related activity and perceived barriers vary as a function of educational attainment, work setting, and occupational role. The author discusses these differential findings in detail, suggests supportive mechanisms to encourage increased research activity and utilization, and offers recommendations for further analysis of the MTRAUB data.

Diabetes nutrition therapy and dietary intake among individuals with Type 1 diabetes in China

AIMS

To describe the contribution of diabetes nutrition therapy to disease self-management among individuals with Type 1 diabetes in China and to estimate the association of diabetes nutrition therapy with dietary intake.

METHODS

The 3C Study was an epidemiological study of the coverage, cost and care of Type 1 diabetes in China. The data reported in the present study are from the 3C Nutrition Ancillary Study, a follow-up study conducted a mean ± sd of 1.6 ± 0.2 years later. Diabetes nutrition therapy was assessed by an interviewer-administered questionnaire. Dietary intake was assessed using three 24-h recalls. The association of diabetes nutrition therapy with dietary intake was estimated using ancova.

RESULTS

Participants (n = 100; 54% male) had a mean ± sd age of 41.7 ± 16.3 years and a mean ± sd diabetes duration of 11.8 ± 9.7 years. Fewer than half of the participants reported that they had 'ever' met with a dietitian. While 64% of participants were taught carbohydrate counting, only 12% 'ever' use this tool. Participants on insulin pumps and those testing ≥ 1 time/day reported greater dietary flexibility and higher fruit intakes compared with participants on other insulin regimens and testing less frequently. After adjustment for confounding by age and occupation, there were no consistent differences in dietary intake across subgroups of diabetes nutrition therapy.

CONCLUSIONS

In this sample of individuals with Type 1 diabetes in China there is little dietitian involvement or carbohydrate counting. Increased frequency of nutrition education in conjunction with intensified self-monitoring of blood glucose is needed to improve care.

Sporadic salmonellosis in Lower Saxony, Germany, 2011-2013: raw ground pork consumption is associated with Salmonella Typhimurium infections and foreign travel with Salmonella Enteritidis infections

To investigate risk factors for sporadic salmonellosis, for each notified case four randomly selected population controls matched for age, sex and geographical region were interviewed via self-administered questionnaire. Conditional logistic regression analysis of 285 matched pairs revealed significant associations for raw ground pork consumption [odds ratio (OR) 6·0, 95% confidence interval (CI) 1·8-20·1], taking antacids (OR 5·8, 95% CI 1·4-24·5), eating meat outside the home (OR 5·7, 95% CI 2·2-14·6) and daily changing or cleaning of dishcloth (OR 2·1, 95% CI 1·2-3·9). Animal contact and ice cream consumption were negatively associated with salmonellosis (OR 0·5, 95% CI 0·2-1 and OR 0·3, 95% CI 0·1-0·6, respectively). S. Typhimurium infections were significantly associated with raw ground pork consumption (OR 16·7, 95% CI 1·4-194·4) and S. Enteritidis infections with having travelled abroad (OR 9·7, 95% CI 2·0-47·3). Raw egg consumption was not a risk factor, substantiating the success of recently implemented national control programmes in the poultry industry. Unexpectedly, hygienic behaviour was more frequently reported by cases, probably because they overestimated their hygiene precautions retrospectively. Although animal contact might enhance human immunocompetence, underreporting of salmonellosis by pet owners could have occurred. Eating raw pork products is the major risk factor for sporadic human S. Typhimurium infections in Lower Saxony.

Improving screening recall services for women with false-positive mammograms: a comparison of qualitative evidence with UK guidelines

OBJECTIVES

To gain an understanding of the views of women with false-positive screening mammograms of screening recall services, their ideas for service improvements and how these compare with current UK guidelines.

METHODS

Inductive qualitative content analysis of semistructured interviews of 21 women who had false-positive screening mammograms. These were then compared with UK National Health Service (NHS) guidelines.

RESULTS

Participants' concerns about mammography screening recall services focused on issues of communication and choice. Many of the issues raised indicated that the 1998 NHS Breast Screening Programme guidelines on improving the quality of written information sent to women who are recalled, had not been fully implemented. This included being told a clear reason for recall, who may attend with them, the length of appointment, who they will see and what tests will be carried out. Additionally women voiced a need for: reassurance that a swift appointment did not imply they had cancer; choice about invasive assessment or watchful waiting; the offer of a follow-up mammogram for those uncertain about the validity of their all-clear and an extension of the role of the clinical nurse specialist, outlined in the 2012 NHS Breast Screening Programme (NHSBSP) guidelines, to include availability at the clinic after the all-clear for women with false-positive mammograms.

CONCLUSIONS

It is time the NHSBSP 1998 recall information guidelines were fully implemented. Additionally, the further suggestions from this research, including extending the role of the clinical nurses from the 2012 NHSBSP guidelines, should be considered. These actions have the potential to reduce the anxiety of being recalled.

Exploring the social, emotional and behavioural development of preschool children: is Glasgow different?

BACKGROUND

Glasgow City has poorer adolescent and adult health outcomes in comparison to demographically similar cities in England and the rest of Scotland. Until now, little exploration of differences in child development between Glasgow and other areas has been made. The authors hypothesized that the poorer health outcomes and lifestyle behaviours of adults, coupled with relative economic deprivation, may impact on child social, emotional and behavioural development, compared with children from other parts of Scotland.

METHODS

Data from the Growing Up in Scotland national birth cohort study were used. Differences between Strengths and Difficulties Questionnaire (SDQ) scores and child and family characteristics of children living in the Greater Glasgow and Clyde (GGC) Health board vs. other health boards were examined. Logistic regression and linear regression models were fitted in order to explore independent associations between health board and SDQ raw and banded scores, respectively, whilst controlling for other contributing factors.

RESULTS

Children in GGC were demographically different from those in other areas of Scotland, being significantly more likely to live in the most deprived areas, yet no difference was found in relation to the mental health of preschool-aged children in GGC. Children in GGC had slightly better SDQ Conduct Problems scores once demographic factors were controlled for.

CONCLUSIONS

At 46 months, there does not appear to be any difference in Glasgow with regards to social, emotional and behavioural development. Glaswegian children appear to have slightly fewer conduct problems at this age, once demographics are taken into account. A range of theories are put forward as to why no differences were found, including the inclusion of areas adjacent to Glasgow City in the analysis, sleeper effects, and rater bias.

Impact of the Geriatric Medication Game® on nursing students' empathy and attitudes toward older adults

BACKGROUND

Nurses should be well-prepared to improve and address health-related needs of older adults, but students may have difficulty understanding and empathizing, as they may not yet have personally experienced aging-related challenges. Simulation games can be used to help students understand the experiences of others, but limited information is available on the impact of simulation experiences on student empathy.

OBJECTIVE

The objective of this study was to examine the impact of participation in an aging simulation game on nursing students' empathy and attitudes toward older adults as well as their understanding of patients' experiences in the healthcare system.

DESIGN

This study used a quasi-experimental, pretest-posttest design.

SETTING

A school of nursing in the Midwestern United States.

PARTICIPANTS

The convenience sample included 58 sophomore-level baccalaureate nursing students.

METHODS

Students played the role of an older adult during a 3-hour laboratory aging simulation game, the Geriatric Medication Game® (GMG). Students completed the (1) Kiersma-Chen Empathy Scale (KCES, 15 items, 7-point Likert-type), (2) Jefferson Scale of Empathy-Health Professions Students (JSE-HPS, 20 items, 7-point Likert-type), and (3) Aging Simulation Experience Survey (13 items, 7-point Likert-type) pre- and post-game to assess study objectives. Descriptive statistics and paired t-tests were performed in SPSS v.21.0, as the data were normally distributed.

RESULTS

Students' empathy (N=58) toward older adults significantly improved overall (KCES p=0.015, JSE-HPS p<0.001). Improvements also were seen on seven out of 13 questions related to attitudes and healthcare understanding (p<0.05). In the post-test, students agreed that they experienced frustration and impatience during the GMG.

CONCLUSIONS

Students may not be aware of older adults' feelings and experiences prior to experiencing aging-related changes themselves. Simulation activities, such as the GMG, can be a useful mechanism for addressing empathy and caring during student education.

Navigating Treacherous Waters—One Researcher's 40 Years of Experience with Controversial Scientific Research,

Science often must deal with issues that are politically controversial. However, there are dangers in dealing with controversial research and serious risks to the process of doing science and to the credibility of science, particularly social science. Here, I discuss lessons learned from engaging in and criticizing controversial research for nearly four decades. Social science research as a process is being damaged by questionable research practices, several of which are discussed. Social science results are being misrepresented through a variety of weak or incorrect methodologies, each of which is discussed. Discourse about social science results often shifts from academic discussion into attempts to discredit those with whom one may disagree. Science and the public are not being well served by these problems, so new researchers and policymakers need to be aware of them. For teaching purposes, examples are also presented of controversial research in which new analyses offer different results than previously reported.

A structured approach to a diagnostic of collective practices

“How social norms change” is not only a theoretical question but also an empirical one. Many organizations have implemented programs to abandon harmful social norms. These programs are standardly monitored and evaluated with a set of empirical tools. While monitoring and evaluation (M&E) of changes in objective outcomes and behaviors is well-developed, we will argue that M&E of changes in the wide range of beliefs and preferences important to social norms is still problematic. In this paper, we first present a theoretical framework and then show how it should guide social norms measurement. As a case study, we focus on the harmful practice of child marriage. We show how an operational theory of social norms can guide the design of surveys, experiments, and vignettes. We use examples from existing research to illustrate how to study social norms change.

Putting Life in Years (PLINY): a randomised controlled trial and mixed-methods process evaluation of a telephone friendship intervention to improve mental well-being in independently living older people

Background

Social isolation in older adults is associated with morbidity. Evaluating interventions to promote social engagement is a research priority.

Methods

A parallel-group randomised controlled trial was planned to evaluate whether telephone friendship (TF) improves the well-being of independently living older people. An internal pilot aimed to recruit 68 participants by 30 September 2012, with 80% retained at 6 months. Randomisation was web based and only analysts were blind to allocation. A service provider was contracted to train 10 volunteer facilitators by 1 April 2012 and 10 more by 1 September 2012. Participants were aged > 74 years with good cognitive function and living independently in an urban community. The intervention arm of the trial consisted of manualised TF with standardised training: (1) one-to-one befriending (10- to 20-minute calls once per week for up to 6 weeks made by volunteer facilitators) followed by (2) TF groups of six participants (1-hour teleconferences once per week for 12 weeks facilitated by the same volunteer). Friendship groups aimed to enhance social support and increase opportunities for social interaction to maintain well-being. This was compared with usual health and social care provision. The primary clinical outcome was the Short Form questionnaire-36 items (SF-36) mental health dimension score at 6 months post randomisation. Qualitative research assessing intervention acceptability (participants) and implementation issues (facilitators) and an intervention fidelity assessment were also carried out. Intervention implementation was documented through e-mails, meeting minutes and field notes. Acceptability was assessed through framework analysis of semistructured interviews. Two researchers coded audio recordings of telephone discussions for fidelity using a specially designed checklist.

Results

In total, 157 people were randomised to the TF group (n = 78) or the control group (n = 79). Pilot recruitment and retention targets were met. Ten volunteers were trained by 1 September 2012; after volunteer attrition, three out of the 10 volunteers delivered the group intervention. In total, 50 out of the 78 TF participants did not receive the intervention and the trial was closed early. A total of 56 people contributed primary outcome data from the TF (n = 26) and control (n = 30) arms. The mean difference in SF-36 mental health score was 9.5 (95% confidence interval 4.5 to 14.5) after adjusting for age, sex and baseline score. Participants who were interviewed (n = 19) generally declared that the intervention was acceptable. Participant dissatisfaction with closure of the groups was reported (n = 4). Dissatisfaction focused on lack of face-to-face contact and shared interests or attitudes. Larger groups experienced better cohesion. Interviewed volunteers (n = 3) expressed a lack of clarity about procedures, anxieties about managing group dynamics and a lack of confidence in the training and in their management and found scheduling calls challenging. Training was 91–95% adherent with the checklist (39 items; three groups). Intervention fidelity ranged from 30.2% to 52.1% (28–41 items; three groups, three time points), indicating that groups were not facilitated in line with training, namely with regard to the setting of ground rules, the maintenance of confidentiality and facilitating contact between participants.

Conclusions

Although the trial was unsuccessful for a range of logistical reasons, the experience gained is of value for the design and conduct of future trials. Participant recruitment and retention were feasible. Small voluntary sector organisations may be unable to recruit, train and retain adequate numbers of volunteers to implement new services at scale over a short time scale. Such risks might be mitigated by multicentre trials using multiple providers and specialists to recruit and manage volunteers.

Trial registration

Current Controlled Trials ISRCTN28645428.

Funding

This project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 2, No. 7. See the NIHR Journals Library website for further project information.

Patient preferences for change in symptoms associated with opioid-induced constipation

Introduction

While opioids have become a standard treatment option for those experiencing moderate to severe chronic pain, side effects of constipation and related symptoms have interfered with their usage in as many as 40–50% of treated patients. Prior research has elucidated the range of these symptoms, but no study has determined which of these symptoms patients most desire improving or whether improving constipation itself by as little as one more bowel movement per week is deemed an important change.

Methods

We conducted an online patient survey of 513 participants residing in one of six countries who reported having chronic pain, were taking opioids, and experiencing opioid-induced constipation (OIC) to address these questions.

Results

Respondents rank ordered their preferences and the following eight symptoms generated >80% endorsement as important to improve: improvement in having bowel movements without rectal pain, soft stools that are not loose or watery, regular bowel movements, a reduction in rectal straining, relief from feeling bloated, feeling less fear about having OIC when following their opioid medication regime, a desire to worry less overall about having a bowel movement, and with less ‘stomach’ area pain. When asked ‘how important is it you to have 1 more bowel movement per week”, over 90% endorsed it was ‘somewhat’, ‘very’, or ‘extremely important’ with nearly 70% (n = 354) endorsing the ‘extremely’ or ‘very important’ response options. In multivariate models, being in more overall pain or reporting fewer than 3 bowel movements per week were found to be independent predictors of the importance.

Conclusions

These results highlight the notable range of OIC symptoms most desired by patients to improve and demonstrate that bowel movements of only one more per week were important to register a meaningful improvement. The latter is particularly helpful for those assessing the minimal clinically important difference in treating this condition.

Electronic supplementary material

The online version of this article (doi:10.1007/s12325-014-0169-x) contains supplementary material, which is available to authorized users.

Criterion Validity is Maintained When Items Are Evaluatively Neutralized: Evidence from A Full–Scale Five–Factor Model Inventory

The original version and an evaluatively neutralized version (with items rephrased to reduce popularity) of a personality inventory were compared. The results revealed (i) similar criterion validity across three different sets of self–rated behaviours, (ii) stronger relations to the rated social desirability of criteria for the original version and (iii) less correlation between factors for the neutralized version. We take the results to indicate that evaluative neutralization is a viable technique for reducing social desirability in self–ratings. Implications for test construction are discussed. Copyright © 2014 European Association of Personality Psychology

A Superhumanization Bias in Whites’ Perceptions of Blacks

The present research provides the first systematic empirical investigation into superhumanization, the attribution of supernatural, extrasensory, and magical mental and physical qualities to humans. Five studies test and support the hypothesis that White Americans superhumanize Black people relative to White people. Studies 1–2b demonstrate this phenomenon at an implicit level, showing that Whites preferentially associate Blacks versus Whites with superhuman versus human words on an implicit association test and on a categorization task. Studies 3–4 demonstrate this phenomenon at an explicit level, showing that Whites preferentially attribute superhuman capacities to Blacks versus Whites, and Study 4 specifically shows that superhumanization of Blacks predicts denial of pain to Black versus White targets. Together, these studies demonstrate a novel and potentially detrimental process through which Whites perceive Blacks.

Is It A Small World After All?

The use of computer-mediated communication has led researchers to contradictory argumentations on information and communication technology (ICT) influences on users' engagement in their societal concern. The present study was focused on exploring the intercultural communication competence in terms of developmental model of intercultural sensitivity in netizens among Spanish college students. For this purpose, a pilot study was given to 64 volunteered respondents in order to assess comprehensiveness of a survey questionnaire dealing with popular conceptions of intercultural competence. After some minor adjustment and refinement, the improved questionnaire was used as instrument for research in which 398 university student participants were recruited to participate. Finding data were used to map the way the participants' intercultural competencies are positioned. Moreover, some significant regression coefficient outcomes were fitted into models in attempt to examine direct and indirect effect produced on internet ICT users' intercultural competence produced by the prediction and mediation variables considered for analysis in the present research.

Implementing sustainability on a corporate and a functional level

Purpose

– The purpose of this paper is to identify contingencies that are inherently linked to sustainability and that influence its implementation in companies. Further, to identify which coordination mechanisms (organic or mechanistic) are most effective for the implementation on the corporate and on the functional level.

Design/methodology/approach

– Inductive case-study based upon a cross-industry sample of five cases that applies a contingency approach. The case companies differ with respect to the degree of sustainability implementation, the underlying internal coordination and structural factors like ownership, size, and industry.

Findings

– The data revealed six contingency factors inherent to the implementation of sustainability that influence the effectiveness of organic or mechanistic coordination mechanisms according to the specific implementation context. Further, the implementation of corporate sustainability requires more internal coordination than implementing sustainability on the functional level.

Research limitations/implications

– The identified contingencies relevant for the internal coordination to implement sustainability and insights into the relevance of such coordination provide a sound basis for future research. Further, various research avenues are identified to advance the discipline's understanding of this so far under-researched field.

Practical implications

– This paper shows that a one-size-fits-all approach to sustainability implementation is not effective. Rather, companies need to consider specific contingencies and adapt their internal coordination efforts accordingly.

Originality/value

– This paper is the first to address internal coordination for implementing sustainability on the corporate and functional level. By providing insights on the context-specific effectiveness of different types of internal coordination for the implementation of corporate sustainability, sustainable sourcing, and sustainable marketing it provides a contribution to both academia and industry practice.

National Identification and Collective Emotions as Predictors of Pro-Social Attitudes Toward Islamic Minority Groups in Indonesia

The present study examined the role of Indonesian Moslem majority’s national identification, collective emotions of pride and guilt in predicting their support in helping members of Islamic minority and their perceived inclusion towards this group. Data from this study (N= 182) demonstrated that, in line with our prediction, support for minority helping significantly predicted perceived inclusion. We also hypothesized and found that collective pride and collective guilt directly predicted the minority helping. Finally, national identification had significant direct effects on both collective pride and collective guilt. These findings shed light on the importance of collective emotions and national identification in giving rise to pro-social attitudes of Indonesian Moslem majority towards members of Islamic minority. Implications of the research findings were discussed with reference to theories of group-based emotion and intergroup helping, and to practical strategies Indonesian government can apply to recognize Islamic minorities.

Screening primary-care patients forgoing health care for economic reasons

BACKGROUND

Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources.

OBJECTIVES

Identify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation.

DESIGN

Multicenter cross-sectional survey.

PARTICIPANTS

Forty-seven general practitioners working in the French-speaking part of Switzerland enrolled a random sample of patients attending their private practices.

MAIN MEASURES

Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels.

KEY RESULTS

Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R(2) = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times.

CONCLUSION

General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.

The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry

Background

Stroke is the leading cause of disability among adults in the United States. The association of patients’ pre-event socioeconomic status (SES) with post-stroke disability is not well understood. We examined the association of three indicators of SES—educational attainment, working status, and perceived adequacy of household income—with disability 3-months following an acute ischemic stroke.

Methods

We conducted retrospective analyses of a prospective cohort of 1965 ischemic stroke patients who survived to 3 months in the Adherence eValuation After Ischemic stroke – Longitudinal (AVAIL) study. Multivariable logistic regression was used to examine the relationship of level of education, pre-stroke work status, and perceived adequacy of household income with disability (defined as a modified Rankin Scale of 3–5 indicating activities of daily living limitations or constant care required).

Results

Overall, 58% of AVAIL stroke patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. After adjusting for demographic and clinical factors, stroke survivors who were unemployed or homemakers, disabled and not-working, retired, less educated, or reported to have inadequate income prior to their stroke had a significantly higher odds of post-stroke disability.

Conclusions

In this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke. The results may have implications for public health and health service interventions targeting stroke survivors at risk of poor outcomes.

Cardiovascular health literacy and treatment adherence in persons with serious mental illness

Persons with serious mental illnesses have shorter life spans than the general population, and their earlier death is often related to cardiovascular disease. This study examined health literacy and cardiovascular medication adherence in a sample of 98 participants with serious mental illness. Sixty-two percent of the participants had adequate health literacy as measured by the Test of Functional Health Literacy in Adults. The association between health literacy and medication adherence was not significant after controlling for education. There was a significant association between health literacy and education level, health literacy and site, and health literacy and the sodium intake subscale of the Hill-Bone adherence scale.

The Information-Related Time Loss on Construction Sites: A Case Study on Two Sites

Information management is essential in construction projects. Existing research has identified and discussed problems in communication and information transfer among different stakeholders, such as the loss of information caused by fragmentation and information islands. However, there are few statistics about the direct time waste caused by information loss arising from poor communication and information management. Existing surveys relying on self-reporting questionnaires and interviews often contain various biases. This paper presents a direct observation of two construction sites in China in relation to wasted time and the information flows in these time-wasting events. Analysis of the observation data provides objective and comprehensive statistics on time wasted due to inconsistent information, dislocation and ambiguity. This research also analyses the correlation between participants, information carriers, information loss and the amount of time wasted. Finally, the wasting of time is analysed from the perspective of information flows and problems that cannot be addressed by information technologies are discussed.

A latent profile analysis of schizotypy, temperament and character in a nonclinical population: association with neurocognition

Schizotypy is conceptualized as a latent personality construct that confers liability for schizophrenia, while it is also suggested that schizotypy can relate to certain favorable aspects. Investigating individual-level interactions between schizotypy and broader personality characteristics might give a clue to this question. We aimed to identify homogeneous classes of individuals based on schizotypy, temperament and character and to validate this classification using comprehensive neurocognitive data. We studied 455 nonclinical adults using the Schizotypal Personality Questionnaire, the Temperament and Character Inventory, and an array of neuropsychological tests. A latent profile analysis (LPA) of schizotypy, temperament and character was conducted, and cognitive performance was compared as a function of latent class membership. LPA provided a 3-class solution. Of the sample, 15% was classified into a "high-positive-schizotypy/adaptive" group characterized by high cognitive-perceptual but low interpersonal schizotypy, together with low harm avoidance and high self-directedness, cooperativeness and self-transcendence; 18% was classified into a "high-schizotypy/maladaptive" group characterized by overall high schizotypy, together with high harm avoidance and low self-directedness and cooperativeness; and 67% was classified into a "low-schizotypy/adaptive" group characterized by overall low schizotypy, together with intermediate-to-low harm avoidance, high self-directedness and intermediate-to-high cooperativeness. Overall cognitive performance of the high-positive-schizotypy/adaptive group was comparable to that of the low-schizotypy/adaptive group and superior to that of the high-schizotypy/maladaptive group. The present LPA clearly defines a group of individuals who have adaptive personality traits and intact neuropsychological functions despite high positive schizotypy, suggesting that there may be complex, nonlinear relationships between schizotypal traits and psychopathology.

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

Adherence to protocol among behavioral health providers working in co-located, collaborative care or Primary Care Behavioral Health settings has rarely been assessed due to limited measurement options. Development of psychometrically sound measures of provider fidelity may improve the translation of these service delivery models into every day practice. One hundred seventy-three integrated behavioral health providers in VA primary care clinics responded to an online questionnaire to assess the reliability and validity of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Psychometric assessment resulted in a reliable 48-item measure with two subscales that specified essential and prohibited provider behaviors. The PPAQ demonstrated strong convergent and divergent validity when compared to another measure of health care integration. Known-group comparisons provided partial support for criterion validity. The PPAQ is a reliable and valid self-report of behavioral health provider fidelity with implications for improving provider training, program monitoring, and clinical research.

Parents' satisfaction with repair of paediatric cleft lip/cleft palate in Honduras

BACKGROUND

Operation Smile is a non-profit organization that provides free cleft lip and cleft palate repair to impoverished children worldwide. To date, no longitudinal studies of satisfaction among these patients or their families have been published.

OBJECTIVES

In a cohort of parents of children receiving cleft lip/cleft palate repair, to assess parental satisfaction and fulfillment of expectations.

METHODS

A prospective cohort study with pre-operative and 6-month post-operative interviews of parents of 45 patients of the Operation Smile mission in Tegucigalpa, Honduras, 2007 was undertaken. Patients were recruited from a total of 96 who underwent surgery, with follow-up data available for 22 of them (49% of participants). Pre-operative interviews concerned expectations regarding surgery, and post-operative interviews addressed surgical outcomes and satisfaction.

RESULTS

Mean patient age was 4 years (range 3 months to 17 years); 51% underwent isolated cleft lip repair, and 49% cleft palate repair. This was the first surgery for 53%, the remainder having had previous surgery on one to six occasions. Pre-operatively, parents expressed expectations that speech (n = 26), appearance (n = 21) or feeding (n = 17) would improve. Among the 22 re-interviewed 6 months after surgery, two had experienced minor and one major post-operative complications. Only 14 of 22 had all their pre-operative expectations fulfilled. All except one parent reported satisfaction with the surgery.

CONCLUSION

Despite unmet expectations, parents of children who received medical mission surgery for cleft lip or cleft palate express satisfaction with outcomes. Other factors are likely to influence expressions of satisfaction in this setting.

Assessment of executive function in adolescence: a comparison of traditional and virtual reality tools

Paper-pencil type tests are traditionally used in the assessment of executive functions (EF); however, concerns have been raised as to whether these represent actual functioning in everyday life. Virtual reality (VR) environments offer a novel alternative for the assessment of cognitive function and therefore have the potential to enhance the evaluation of EF by presenting individuals with stimuli that come closer to reproducing everyday situations. The aims of this study were to (1) establish which traditional paper-pencil EF tests from the Delis-Kaplan Executive Function System (D-KEFS) are associated with performance on a VR-Stroop task and (2) compare D-KEFS tests and the VR-Stroop task in their ability to predict everyday EF and behavior, as measured by the Behavioral Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL). Thirty-eight typically developing adolescents aged between 13 and 17 years completed the ClinicaVR: Classroom-Stroop, and five D-KEFS subtests (Trail Making, Tower, Twenty Questions, Verbal Fluency and Color-Word Interference). Their parents completed the BRIEF and CBCL questionnaires. The results indicate that performance on the VR-Stroop task correlates with both traditional forms of EF assessment (D-KEFS, BRIEF). In particular, performance on the VR-Stroop task was closely associated with performance on a paper-pencil inhibition task. Furthermore, VR-Stroop performance more accurately reflected everyday behavioral EF than paper-pencil tasks. VR appears to offer an ecological perspective on everyday functioning and could be seen as complementary to traditional tests in the assessment of complex cognitive abilities.

Random and Systematic Error Effects of Insomnia on Survey Behavior

Insomnia is a prevalent experience among employees and survey respondents. Drawing from research on sleep and self-regulation, we examine both random (survey errors) and systematic (social desirability) effects of research participant insomnia on survey responses. With respect to random effects, we find that insomnia leads to increased survey errors, and that this effect is mediated by a lack of self-control and a lack of effort. However, insomnia also has a positive systematic effect, leading to lower levels of social desirability. This effect is also mediated by self-control depletion and a lack of effort. In supplemental analyses, we find that psychometric side effects of random and systematic error introduced by individuals high in insomnia negatively affect internal consistency estimates and measurement invariance on various organizational measures. Results were replicated across two studies, with alternative operationalizations of survey errors and social desirability and some alternative explanations examined. These findings suggest sleep may be a key methodological issue for conducting survey research. Recommendations from the sleep and self-regulation literature regarding potential strategies for counteracting the effect of insomnia on survey responses are discussed.

Text-based plagiarism in scientific writing: what Chinese supervisors think about copying and how to reduce it in students' writing

Text-based plagiarism, or textual copying, typically in the form of replicating or patchwriting sentences in a row from sources, seems to be an issue of growing concern among scientific journal editors. Editors have emphasized that senior authors (typically supervisors of science students) should take the responsibility for educating novices against text-based plagiarism. To address a research gap in the literature as to how scientist supervisors perceive the issue of textual copying and what they do in educating their students, this paper reports an interview study with 14 supervisors at a research-oriented Chinese university. The study throws light on the potentiality of senior authors mentoring novices in English as an Additional Language (EAL) contexts and has implications for the efforts that can be made in the wider scientific community to support scientists in writing against text-based plagiarism.

A cross sectional study examining social desirability bias in caregiver reporting of children's oral health behaviors

Background

Our previous research (Pediatrics 2010:126) found a strong association between caregiver oral health literacy (OHL) and children’s oral health status; however, we found a weak association with oral health behaviors (OHBs). We hypothesize that this may be due to social desirability bias (SDB). Our objectives were to compare caregivers’ responses to traditional OHB items and newer SDB-modulating items, and to examine the association of caregiver literacy with OHBs.

Methods

We performed a cross-sectional study of 102 caregiver-child dyads, collecting data for OHBs using both traditional and new SDB-modulating items. We measured OHL using REALD-30, a validated word recognition test. We relied upon percent agreement and Cohen’s kappa (k) to quantify the concordance in caregivers’ responses and multivariate log-binomial regression to estimate the impact of OHL on OHBs.

Results

Caregivers’ mean REALD-30 score was 20.7 (SD = 6.0), range 1-30. We found an association between OHL and 4 of 8 OHBs examined. A subset of behavior questions compared traditional versus SDB-modulating items: history of bottle-feeding: agreement = 95%, k = 0.83 (95% CL:0.68,0.99); daily tooth brushing: agreement = 78%, k = 0.25 (95% CL:0.04,0.46); fluoridated toothpaste use: agreement = 88%, k = 0.67 (95% CL:0.49,0.85). After controlling for caregivers’ race, marital status and study site, higher literacy scores remained associated with a decreased prevalence of parental report of “decided not brush the child’s teeth because it would be frustrating”.

Conclusions

Agreement between responses was high for 2 of 3 behavior items. Item 3 (tooth brushing frequency) revealed discordance, likely due to SDB. Use of the SDB-modulating items appears to yield a better estimate of OHB.

Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study

Unaccompanied asylum-seeking children (UASC) are considered at high risk for mental health problems, yet few studies focus on single ethnic populations. This study presents results from the largest Afghan UASC mental health survey in the U.K. Specifically, the study aims to estimate the prevalence of emotional and behavioural problems and to investigate the associations of these problems with demographic variables, cumulative traumatic events, and care and migration variables. A census sample of 222 Afghan UASC was interviewed using validated self-report screening measures. Emotional and behavioural problems were screened using the Hopkins Symptoms Checklist 37A (HSCL-37A). Pre-migration stressful life events were screened using the Stressful Life Events Questionnaire. Administrative data on care and asylum were provided by the local authority social services and the UK Border Agency. Approximately one-third (31.4%) scored above cut-offs for emotional and behavioural problems, 34.6% for anxiety and 23.4% for depression. Ordinary least squares regression indicated a significant dose-response relationship between total pre-migration traumatic events and distress as well as between increased time in the country and greater behavioural problems. Compound traumatic events in the pre-migration stages of forced migration have a deleterious association with UASC well-being. Increased time in country suggests a possible peer effect for these children. Consistent with other studies on refugee children, it should be stressed that the majority of UASC scored below suggested cut-offs, thus displaying a marked resilience despite the experience of adverse events.

Attitudes towards suicidal behaviour in outpatient clinics among mental health professionals in Oslo

BACKGROUND

To investigate attitudes of professionals working in mental health care outpatient clinics in Child and Adolescent Psychiatry (CAP) (for children and adolescents aged 0-18 years) and District Psychiatric Centres (DPC) (for adults aged 18-67 years).

METHODS

Professionals in four outpatient units in Oslo were enrolled (n = 229: 77%). The Understanding of Suicidal Patient scale (USP) (11 = positive to 55 = negative) and Attitudes Towards Suicide questionnaire (ATTS) (1 = totally disagree to 5 = totally agree) were used to assess professionals' attitudes. Questions explored competence, religion, experiences of and views on suicidal behaviour and its treatment.

RESULTS

All the professionals indicated positive attitudes (USP 18.7) and endorsed the view that suicide was preventable (ATTS 4.3). Professionals who had received supervision or were specialists had attitudes that were more positive. Professionals in CAP were less satisfied with available treatment. Psychiatric disorders were considered the most common cause of suicidal behaviour, and psychotherapy the most appropriate form of treatment. The professionals confirmed that patients with other disorders of comparable severity are followed up more systematically.

CONCLUSIONS

The professionals showed positive attitudes with minor differences between CAP and DPC.