Testing reliability and validity of practitioner-rated parental sensitivity: A novel tool for practice

Improving parental sensitivity is an important objective of interventions to support families. This study examined reliability and validity of parental sensitivity ratings using a novel package of an e-learning tool and an interactive decision tree provided through a mobile application, called the OK! package. Independent raters assessed parental sensitivity using the OK! package (N = 11 raters) and the NICHD Parental Sensitivity rating scales (N = 22 raters) on the basis of videotaped mother-child interactions at 10- or 12-months-old (N = 294) and at 24-months-old (N = 204) from the Dutch longitudinal cohort study Generation2 . Mothers reported on children's externalizing and internalizing problems and social competence when children were 4 and 7 years old. Results showed excellent single interrater reliability for raters using the OK! package (mean ICC = .79), and strong evidence for convergent validity at 10- or 12-month-old (r = .57) and 24-month-old (r = .65). Prospective associations of neither parental sensitivity rated using the OK! package or the NICHD Parental Sensitivity rating scales with child developmental outcomes were statistically significant (p > .05), with overlapping 95% confidence intervals for both measures. The OK! package provides a promising direction for testing alternatives to current training and instruction modalities.

A comparison of two strategies to assess sexual violence: general vs. specialised trauma screening strategies in two high-risk substance use health disparity samples

Background/Objective: Using two different high-risk samples, the present study compared and contrasted two different strategies/questionnaire types for assessing a history of sexual violence: a general trauma screening vs. specialised behaviourally-specific questionnaires.Methods: Sample 1 included 91 men and women seeking detoxification treatment services in a publicly funded, urban clinic who completed a trauma and substance use questionnaire battery during treatment. Sample 2 included 310 women at a rural college who completed a trauma and religious coping questionnaire battery for course credit. All participants completed both types of questionnaires: One general trauma screening questionnaire (i.e. the Life Events Checklist [LEC]) and two behaviourally-specific specialised questionnaires (i.e. the 2007 Sexual Experiences Survey [SES] and the Childhood Trauma Questionnaire [CTQ]).Results: There were large differences in the cases identified by the behaviourally-specific questionnaires (SES and CTQ) compared to the general trauma screening questionnaire (the LEC) in both samples but few differences in the prevalence rates of sexual violence detected by each questionnaire type. In the detoxification sample, the differences were especially notable for men. Follow-up analyses indicated that degree of traumatisation impacted results likely by increasing participant's willingness to endorse face-valid items on the LEC.Conclusions: For men, the behaviourally-specific questionnaires (SES/CTQ) were necessary to identify cases. For those with more severe trauma histories, the LEC was equivalent to the SES/CTQ in identifying a similar number of sexual violence cases. Thus, clinicians and researchers should consider the population when selecting assessments to identify sexual violence history.

Framing the work: A coparenting model for guiding infant mental health engagement with families

When working with families of infants and toddlers, intentionally looking beyond dyadic child-parent relationship functioning to conceptualize the child's socioemotional adaptation within their broader family collective can enhance the likelihood that clinical gains will be supported and sustained. However, there has been little expert guidance regarding how best to frame infant-family mental health therapeutic encounters for the adults responsible for the child's care and upbringing in a manner that elevates their mindfulness about and their resolve to strengthen the impact of their coparenting collective. This article describes a new collaborative initiative organized by family-oriented infant mental health professionals across several different countries, all of whom bring expansive expertise assessing and working with coparenting and triangular family dynamics. The Collaborative's aims are to identify a means for framing initial infant mental health encounters and intakes with families with the goal of assessing and raising family consciousness about the relevance of coparenting. Initial points of convergence and growing points identified by the Collaborative for subsequent field study are addressed.

Renal transplantation in pediatric recipients: Considerations and preoperative assessment strategies

INTRODUCTION AND OBJECTIVE

Renal transplantation in the pediatric population differs from adults in many aspects. This review will focus on the unique issues of the pediatric recipient.

MATERIAL AND METHODS

A narrative review on the scarce literature regarding preoperative evaluation before kidney transplantation of the paediatric recipient with an educational focus was conducted. The literature search allowed for identification of publications in English from January 2000 to October 2022. Published studies were identified by searching the following electronic databases: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar and Research Gate. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information (definitions, policies or guidelines).

RESULTS

Management of congenital urogenital anomalies and lower urinary tract dysfunction along with optimal pediatric urological preoperative assessment for renal transplantation in children is addressed in the light of the available literature. Furthermore, particular considerations including pre-emptive transplantation, transplantation of an adult-size kidney into an infant or small child is discussed.

CONCLUSIONS

Outcomes of RT in children have shown progressive improvement over the past 15 years. Transplantation with living related donor gives the best results and pre-emptive transplantation provides with benefits of avoiding dialysis. Surgical and medical considerations in both the pre-transplant and post-transplant management of the pediatric kidney recipient are extremely crucial in order to achieve better short and long-term results.

Effects of climate and land-cover change on the conservation status of gibbons

Species shift their distribution in response to climate and land-cover change, which may result in a spatial mismatch between currently protected areas (PAs) and priority conservation areas (PCAs). We examined the effects of climate and land-cover change on potential range of gibbons and sought to identify PCAs that would conserve them effectively. We collected global gibbon occurrence points and modeled (ecological niche model) their current and potential 2050s ranges under climate-change and different land-cover-change scenarios. We examined change in range and PA coverage between the current and future ranges of each gibbon species. We applied spatial conservation prioritization to identify the top 30% PCAs for each species. We then determined how much of the PCAs are conserved in each country within the global range of gibbons. On average, 31% (SD 22) of each species' current range was covered in PAs. PA coverage of the current range of 9 species was <30%. Nine species lost on average 46% (SD 29) of their potential range due to climate change. Under climate-change with an optimistic land-cover-change scenario (B1), 12 species lost 39% (SD 28) of their range. In a pessimistic land-cover-change scenario (A2), 15 species lost 36% (SD 28) of their range. Five species lost significantly more range under the A2 scenario than the B1 scenario (p = 0.01, SD 0.01), suggesting that gibbons will benefit from effective management of land cover. PA coverage of future range was <30% for 11 species. On average, 32% (SD 25) of PCAs were covered by PAs. Indonesia contained more species and PCAs and thus has the greatest responsibility for gibbon conservation. Indonesia, India, and Myanmar need to expand their PAs to fulfill their responsibility to gibbon conservation. Our results provide a baseline for global gibbon conservation, particularly for countries lacking gibbon research capacity.

Welcome, how are you doing? - towards a systematic mental health screening and crisis management for newly arriving refugees

Background: Compared to the general German population, refugees in Germany are a high-risk group for trauma spectrum disorders. Currently, many barriers exist for the implementation of a screen-and-treat approach for mental disorders as part of the routine health care provision during the early stage of the immigration process.Objective: The aim of the present study was to develop and test a systematic screening approach to identify individual refugees in need of mental health care during the initial immigration phase.Method: 167 newly arrived refugees underwent a screening interview with the Refugee Health Screener (RHS) carried out by Intercultural Therapy Assistants (ITAs). The ITAs were super-vised by psychologists at a reception centre in Bielefeld, Germany. A subsample of 48 persons partici-pated in clinical validation interviews.Results: Findings demonstrated the need for and feasibility of a systematic screening during the initial immigration phase. However, established cut-off values of the RHS had to be adapted and the screening procedure had to be adjusted due to the needs of a significant number of refugees in severe psychological crises.Conclusion: A systematic screening that is applied shortly after arrival facilitates the early identification of refugees at risk of developing mental disorders and may be helpful to prevent chronic symptom development and an aggravation of psychological crises.

Parent-Child Relationship Scale (P-CRS): A valid and clinically sensitive tool for assessing the parent-child relationship

The present study measured the efficacy of the Parent-Child Relationship Scale (P-CRS) in assessing the relationship between parents and children. The aims of the study were to explore how the scale scores change in relation to age and sex of the children, evaluate its ability to capture relational difficulties, and investigating its usefulness to assess the parent-child relationship in the context of certain psychopathological conditions. A total of 322 clinicians rated 542 mother-child dyads (92% Italian, 8% other nationality). The clinical group was comprised of 267 children with confirmed clinical conditions. The control group was comprised of 275 children with typical development, rated by clinicians in their private offices after four to five evaluative sessions. Descriptive statistics were captured and ANOVAs and linear regression analyses were performed to investigate in both groups the efficacy of the scale in assessing the parent-child relationship. Finally, to test P-CRS accuracy, optimal cutoff scores for each subscale were computed using the ROC method. The findings provide evidence for the P-CRS ability to capture relational difficulties in both groups, showing its utility as screening tool. Thus, the results support that P-CRS can be used for exploring how different relationship patterns can occur in different clinical conditions.

Reflexiones sobre la atención primaria del siglo xxi

La atención primaria debe de afrontar los nuevos desafíos del siglo xxi que ya han comenzado con la pandemia de la covid-19. Desafíos que tienen que ver con una nueva realidad sociosanitaria caracterizada por un aumento de la prevalencia de la comorbilidad y fragilidad ligada al envejecimiento y al impacto de los determinantes de la salud; cambios en la población con pacientes más informados y que reclaman participar en las decisiones que afectan a su salud en una sociedad cada vez más digitalizada. En ese contexto la atención primaria debe de resolver nuevos retos como cambiar su funcionamiento con equipos más cohesionados que puedan incorporar nuevos perfiles que aporten valor y donde exista un compromiso con la docencia y la investigación. La gestión de todos estos desafíos requiere que los profesionales que trabajan en atención primaria en el siglo xxi profundicen en sus competencias mirando más allá de las consultas de su centro de salud. Competencias como la selección y el uso del mejor conocimiento, el pensamiento crítico, el uso de la comunicación para acercarse a los valores y las preferencias de los pacientes, la toma de decisiones compartida y la conciencia social.

Para que todos estos cambios se puedan realizar hace falta un impulso institucional con múltiples medidas insistentemente reclamadas por los profesionales. Entre las que están, en primer lugar, una mayor inversión en personal y equipamiento, así como apostar por modelos organizativos avalados por la evidencia destinados a obtener una atención más coordinada e integrada entre la atención primaria, el hospital, la salud mental, la salud pública y los servicios sociales la utilización juiciosa de las soluciones de la e-salud o la incorporación de un área de conocimiento sobre atención primaria en la universidad.

Employment and child support outcomes among noncustodial fathers: An evaluation of the Fathers Advancing Community Together program

Prior research underscores the importance of fathers' involvement in their children's lives. However, there is mixed evidence about the degree to which fatherhood programs improve economic stability and child support outcomes among noncustodial fathers. We attempted to address some of these gaps in the literature by evaluating the Fathers Advancing Community Together (FACT) program. FACT was implemented by Rubicon Programs, a community-based nonprofit organization in the Bay Area, California known for providing services to help move people out of poverty. The program provided parents economic stability, responsible parenting, and healthy relationship workshops, as well as support services and intensive case management. We relied on data from the Department of Child Support Services to assess whether FACT increased the likelihood of employment, child support modifications, and child support payments among noncustodial fathers during a 6-month post-enrollment period. Using 3:1 coarsened exact matching procedures, the total sample resulted in 744 fathers (186 in the intervention group and 558 in the comparison group). Results from logistic regression models indicate that FACT participants were more likely to be employed and more likely to receive a child support modification during the post-enrollment period than their comparison counterparts, though we found no significant relationship between FACT participation and whether fathers made a child support payment.

Typifying conservation practitioners' views on the role of education

Education is an established tool to enhance human-environment relationships, despite the lack of empirical evidence to support its use. We used theories of change to unpack assumptions about the role of education in conservation. We interviewed practitioners from 15 conservation organizations in Madagascar to typify implicit pathways of change and assess whether emerging pathways echo theoretical advances. Five pathways were drivers of change: increasing knowledge, changing emotional connection and changing traditional cultural practices, fostering leaders, diversifying outcomes, and influencing community and society. These pathways reflect existing sociopsychological theories on learning and behavioral change. Most interviewees' organizations had a predominant pathway that was often combined with elements from other pathways. Most pathways lacked culturally grounded approaches. Our research reveals assumptions about the role of education in conservation and indicates that organizations had different ideas of how change happens. The diversity of practices reflects the complexity of factors that influence behavior. Whether this diversity is driven by local sociocultural context, interaction with other conservation approaches, or contingencies remains unclear. Yet, typifying the pathways of change and reflecting on them is the first step towards comprehensive evaluation of when and which pathways and interactions to promote.

The relative importance of COVID-19 pandemic impacts on biodiversity conservation globally

The COVID-19 pandemic has had an enormous impact on almost all aspects of human society and endeavor; the natural world and its conservation have not been spared. Through a process of expert consultation, we identified and categorized, into 19 themes and 70 subthemes, the ways in which biodiversity and its conservation have been or could be affected by the pandemic globally. Nearly 60% of the effects have been broadly negative. Subsequently, we created a compendium of all themes and subthemes, each with explanatory text, and in August 2020 a diverse group of experienced conservationists with expertise from across sectors and geographies assessed each subtheme for its likely impact on biodiversity conservation globally. The 9 subthemes ranked highest all have a negative impact. These were, in rank order, governments sidelining the environment during their economic recovery, reduced wildlife-based tourism income, increased habitat destruction, reduced government funding, increased plastic and other solid waste pollution, weakening of nature-friendly regulations and their enforcement, increased illegal harvest of wild animals, reduced philanthropy, and threats to survival of conservation organizations. In combination, these impacts present a worrying future of increased threats to biodiversity conservation but reduced capacity to counter them. The highest ranking positive impact, at 10, was the beneficial impact of wildlife-trade restrictions. More optimistically, among impacts ranked 11-20, 6 were positive and 4 were negative. We hope our assessment will draw attention to the impacts of the pandemic and, thus, improve the conservation community's ability to respond to such threats in the future.

The eightfold way of teaching psychological type

For Jung, the discovery of type differences represented the beginning of his individuation journey, and his experiential discovery can model the path of learning about psychological type. A course on psychological type can enable individuals to discover empirically Jung's revelations about the psyche if it is structured like the individuation journey itself: beginning with differentiation of the preferred functions, proceeding to the inferior function at the midpoint of the journey, and concluding with an exploration of the unconscious functions. Such a pedagogical method mandates a non-prescriptive approach that empowers students to lead their own learning, an approach expressed by the Taoist concept of wu wei. Psychological Types references wu wei as a means of balancing consciousness and the unconscious. Sometimes Jung's typology is thought to deal only with consciousness, but in fact it represented Jung's own eightfold way into the unconscious. To illustrate the dynamic interaction of conscious and unconscious functions, John Beebe's eight-function eight-archetype model is an indispensable tool, because it illuminates the unconscious opposites inherent in each type and connects them with archetypal complexes. With the aid of Beebe's model, students can plot a typological trajectory of development for their journey to the Self.

Using decision science to evaluate global biodiversity indices

Global biodiversity indices are used to measure environmental change and progress toward conservation goals, yet few indices have been evaluated comprehensively for their capacity to detect trends of interest, such as declines in threatened species or ecosystem function. Using a structured approach based on decision science, we qualitatively evaluated 9 indices commonly used to track biodiversity at global and regional scales against 5 criteria relating to objectives, design, behavior, incorporation of uncertainty, and constraints (e.g., costs and data availability). Evaluation was based on reference literature for indices available at the time of assessment. We identified 4 key gaps in indices assessed: pathways to achieving goals (means objectives) were not always clear or relevant to desired outcomes (fundamental objectives); index testing and understanding of expected behavior was often lacking; uncertainty was seldom acknowledged or accounted for; and costs of implementation were seldom considered. These gaps may render indices inadequate in certain decision-making contexts and are problematic for indices linked with biodiversity targets and sustainability goals. Ensuring that index objectives are clear and their design is underpinned by a model of relevant processes are crucial in addressing the gaps identified by our assessment. Uptake and productive use of indices will be improved if index performance is tested rigorously and assumptions and uncertainties are clearly communicated to end users. This will increase index accuracy and value in tracking biodiversity change and supporting national and global policy decisions, such as the post-2020 global biodiversity framework of the Convention on Biological Diversity.

Combined effects of life-history traits and human impact on extinction risk of freshwater megafauna

Megafauna species are intrinsically vulnerable to human impact. Freshwater megafauna (i.e., freshwater animals ≥30 kg, including fishes, mammals, reptiles, and amphibians) are subject to intensive and increasing threats. Thirty-four species are listed as critically endangered on the International Union for Conservation of Nature (IUCN). Red List of Threatened Species, the assessments for which are an important basis for conservation actions but remain incomplete for 49 (24%) freshwater megafauna species. Consequently, the window of opportunity for protecting these species could be missed. Identifying the factors that predispose freshwater megafauna to extinction can help predict their extinction risk and facilitate more effective and proactive conservation actions. Thus, we collated 8 life-history traits for 206 freshwater megafauna species. We used generalized linear mixed models to examine the relationships between extinction risk based on the IUCN Red List categories and the combined effect of multiple traits, as well as the effect of human impact on these relationships for 157 classified species. The most parsimonious model included human impact and traits related to species' recovery potential including life span, age at maturity, and fecundity. Applying the most parsimonious model to 49 unclassified species predicted that 17 of them are threatened. Accounting for model predictions together with IUCN Red List assessments, 50% of all freshwater megafauna species are considered threatened. The Amazon and Yangtze basins emerged as global diversity hotspots of threatened freshwater megafauna, in addition to existing hotspots, including the Ganges-Brahmaputra and Mekong basins and the Caspian Sea region. Assessment and monitoring of those species predicted to be threatened are needed, especially in the Amazon and Yangtze basins. Investigation of life-history traits and trends in population and distribution, regulation of overexploitation, maintaining river connectivity, implementing protected areas focusing on freshwater ecosystems, and integrated basin management are required to protect threatened freshwater megafauna in diversity hotspots.

Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5)

BACKGROUND

The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress.

OBJECTIVE

The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity.

METHOD

The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied.

RESULTS

The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5.

CONCLUSIONS

In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.

Realities of offering advice to governments on CITES

What happens when those who provide conservation advice are required to take policy and management action based on that advice? Conservation advocates and scientists often try to prompt regulatory change that has significant implications for government without facing the challenge of managing such change. Through a case study, we placed ourselves in the role of the government of Thailand, facing obligations to seahorses (Hippocampus spp.) under the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). These obligations include ensuring that its exports of seahorses do not damage wild populations. We applied a CITES-approved framework (which we developed) to evaluate the risks of such exports to 2 seahorse species. We used the framework to evaluate the pressures that put wild populations of the species at risk; whether current management mitigates the risk or offsets these pressures; and whether the species is responding as hoped to management policy. We based our analysis on information in published and grey literature, local knowledge, citizen science data, results of government research, and expert opinion. To meet CITES obligations, exports of both species would need to be prohibited until more precautionary adaptive management emerged. The risk of any exports of Hippocampus trimaculatus was above a tolerable level because of a lack of appropriate management to mitigate risks. In contrast, the risk of any exports of Hippocampus kuda could become tolerable if monitoring were put in place to assess the species' response to management. The process we developed for Authorities to determine risk in response to CITES guidelines was challenging to implement even without the need for government to consider social implications of conservation action. Despite the imperfections of our risk evaluation, however, it still served to support adaptive management. Conservationists need to keep implementation in mind when offering advice.

Fathers' Dosage in Community-based Programs for Low-income Fathers

Community-based programs for low-income fathers often struggle to get fathers to attend services and activities. This paper reviews the literature examining approaches to measuring dosage in fatherhood programs, rates of dosage, influences on dosage, and the associations between dosage and fathers' outcomes. Studies were limited to programs that conducted randomized control trials, quasi-experimental studies, and one-group pretest/post-test designs. Although most programs report low or moderate dosage levels, some programs achieve high levels of fathers' participation in parenting, coparenting, and economic security classes. Few studies examined dosage in relation to father outcomes. All but one of seven studies reporting effects showed that higher dose levels had positive associations with outcomes such as engagement with children, parenting satisfaction and self-efficacy, perception of coparenting quality, payment of child support, and earnings from work. This paper discusses future directions for studying father's dosage in fatherhood programs.

Achieving conservation impact by shifting focus from human attitudes to behaviors

Attitudes have been a commonly used psychological measure of program effectiveness in conservation social science research. The major limitation of this approach is that attitudes do not always translate into behavior and therefore may not provide an accurate assessment of program success. Given that achieving conservation goals generally relies on understanding and changing human behavior, we argue for the need to assess behavior rather than attitudes as an indicator of conservation outcomes. Psychological theory shows that attitudes and behavior are distinct, but related, concepts. Measuring conservation behaviors involves identifying the target behavior or behaviors and the optimal time to measure and then selecting the most appropriate method of measurement (i.e., direct observation, objective indicators, self-reported behavior, and behavioral intentions) that considers the strengths and weaknesses of each approach. We call for conservation programs to focus on influencing behavior rather than attitudes alone and encourage conservation practitioners and researchers to collect high-quality behavioral data to more effectively inform policy and programs.

Compliance with and ecosystem function of biodiversity offsets in North American and European freshwaters

Land-use change via human development is a major driver of biodiversity loss. To reduce these impacts, billions of dollars are spent on biodiversity offsets. However, studies evaluating offset project effectiveness that examine components such as the overall compliance and function of projects remain rare. We reviewed 577 offsetting projects in freshwater ecosystems that included the metrics project size, type of aquatic system (e.g., wetland and creek), offsetting measure (e.g., enhancement, restoration, and creation), and an assessment of the projects' compliance and functional success. Project information was obtained from scientific and government databases and gray literature. Despite considerable investment in offsetting projects, crucial problems persisted. Although compliance and function were related to each other, a high level of compliance did not guarantee a high degree of function. However, large projects relative to area had better function than small projects. Function improved when projects targeted productivity or specific ecosystem features and when multiple complementary management targets were in place. Restorative measures were more likely to achieve targets than creating entirely new ecosystems. Altogether the relationships we found highlight specific ecological processes that may help improve offsetting outcomes.

Wrestling with the complexity of evaluation for organizations at the boundary of science, policy, and practice

Boundary organizations are situated between science, policy, and practice and have a goal of supporting communication and collaboration among these sectors. They have been promoted as a way to improve the effectiveness of conservation efforts by building stronger relationships between scientists, policy makers, industry, and practitioners (Cook et al. 2013). Although their promise has been discussed in theory, the work of and expectations for boundary organizations are less defined in practice. Biodiversity conservation is characterized by complexity, uncertainty, dissent, and tight budgets, so boundary organizations face the challenging task of demonstrating their value to diverse stakeholders. We examined the challenges boundary organizations face when seeking to evaluate their work and thus aimed to encourage more productive conversations about evaluation of boundary organizations and their projects. Although no off-the-shelf solution is available for a given boundary organization, we identified 4 principles that will support effective evaluation for boundary organizations: engage diverse stakeholders, support learning and reflection, assess contribution to change, and align evaluation with assumption and values.

Progress and challenges in consolidating the management of Amazonian protected areas and indigenous territories

Effective management refers to the ability of a protected area or indigenous territory to meet its objectives, particularly as they relate to the protection of biodiversity and forest cover. Effective management is achieved through a process of consolidation, which among other things requires legally protecting sites, integrating sites into land-use planning, developing and implementing management and resource-use plans, and securing long-term funding to pay for recurrent costs. Effectively managing all protected areas and indigenous territories in the Amazon may be needed to avoid a deforestation tipping point beyond which regional climatic feedbacks and global climate change interact to catalyze irreversible drying and savannization of large areas. At present, protected areas and indigenous territories cover 45.5% (3.55 million km² ) of the Amazon, most of the 60-70% forest cover required to maintain hydrologic and climatic function. Three independent evaluations of a long-term large-scale philanthropic initiative in the Amazon yielded insights into the challenges and advances toward achieving effective management of protected areas and indigenous territories. Over the life of the initiative, management of sites has improved considerably, particularly with respect to management planning and capacity building, but few sites are effectively managed and many lack sufficient long-term financing, adequate governance, support of nongovernmental organizations, and the means to withstand economic pressures. The time and money required to complete consolidation is still poorly understood, but it is clear that philanthropic funding is critical so long as essential funding needs are not met by governments and other sources, which could be on the order of decades. Despite challenges, it is encouraging that legal protection has expanded greatly and management of sites is improving steadily. Management of protected areas in other developing countries could be informed by improvements that have occurred in Amazonian countries.

APPROACHES TO THE EVALUATION OF CULTURAL ADAPTATIONS OF HOME VISITING IN TRIBAL COMMUNITIES

The research that underlies evidence-based practices is often based on relatively homogenous study samples, thus limiting our ability to understand how the study findings apply in new situations as well as our understanding of what might need to be adapted. In a preliminary effort to address those gaps, the requirements for the Tribal Maternal Infant and Early Childhood Home Visiting Program (MIECHV) included the expectation that grantees design and implement rigorous evaluations to address local priorities and to help build the knowledge base regarding the use of evidence-based home-visiting programs in tribal communities. A priority that emerged across many Tribal MIECHV grantees was to determine the added benefit of the cultural adaptations that they were making to their home-visiting programs. While there is literature to describe recommended processes for making cultural adaptations to evidence-based programs themselves, there are very few guidelines for evaluating these adaptations. In this article, we review the varied evaluation approaches utilized by Tribal MIECHV grantees and provide three case examples of how evaluators and tribal communities worked together to articulate evaluation questions and choose appropriate and feasible evaluation designs. The lessons derived from these Tribal MIECHV evaluation experiences have implications for the role of the evaluator in diverse communities across the country evaluating home visiting and other evidence-based practices in settings characterized by unique cultural contexts.

BUILDING EVALUATION PARTNERSHIPS WITH TRIBAL COMMUNITIES FOR HOME VISITING

The goal of this current descriptive study was to examine the roles and relationships of evaluators with the tribal communities in which they work. First, we describe a participatory community research model with a strong capacity-building component as the standard for assessing successful working partnerships between evaluators, programs, tribes, and tribal organizations. This model serves as a yardstick against which we examine the success and challenges of program-evaluation partnerships. Second, we report on a survey of tribal Maternal, Infant, and Early Childhood Home Visiting program leaders and outline their impressions of successes and challenges related to program-evaluation partnerships. Survey participants discussed the importance of working with evaluators who have deep investment in and understanding of the tribal community; respect for cultural relevance and honor for cultural ways; collaboration that includes transparency, trust, and translation of research for community leaders and members; a focus on strength-based design without losing the need to consider challenges; and relationships of mutual trust that can weather addressing stressors when issues of conflict, limited resources, and/or mixed expectations arise.

Practitioner and scientist perceptions of successful amphibian conservation

Conservation requires successful outcomes. However, success is perceived in many different ways depending on the desired outcome. Through a questionnaire survey, we examined perceptions of success among 355 scientists and practitioners working on amphibian conservation from over 150 organizations in more than 50 countries. We also sought to identify how different types of conservation actions and respondent experience and background influenced perceptions. Respondents identified 4 types of success: species and habitat improvements (84% of respondents); effective program management (36%); outreach initiatives such as education and public engagement (25%); and the application of science-based conservation (15%). The most significant factor influencing overall perceived success was reducing threats. Capacity building was rated least important. Perceptions were influenced by experience, professional affiliation, involvement in conservation practice, and country of residence. More experienced practitioners associated success with improvements to species and habitats and less so with education and engagement initiatives. Although science-based conservation was rated as important, this factor declined in importance as the number of programs a respondent participated in increased, particularly among those from less economically developed countries. The ultimate measure of conservation success-population recovery-may be difficult to measure in many amphibians; difficult to relate to the conservation actions intended to drive it; and difficult to achieve within conventional funding time frames. The relaunched Amphibian Conservation Action Plan provides a framework for capturing lower level processes and outcomes, identifying gaps, and measuring progress.

Parental Cognitive Errors Mediate Parental Psychopathology and Ratings of Child Inattention

We investigate the Depression-Distortion Hypothesis in a sample of 199 school-aged children with ADHD-Predominantly Inattentive presentation (ADHD-I) by examining relations and cross-sectional mediational pathways between parental characteristics (i.e., levels of parental depressive and ADHD symptoms) and parental ratings of child problem behavior (inattention, sluggish cognitive tempo, and functional impairment) via parental cognitive errors. Results demonstrated a positive association between parental factors and parental ratings of inattention, as well as a mediational pathway between parental depressive and ADHD symptoms and parental ratings of inattention via parental cognitive errors. Specifically, higher levels of parental depressive and ADHD symptoms predicted higher levels of cognitive errors, which in turn predicted higher parental ratings of inattention. Findings provide evidence for core tenets of the Depression-Distortion Hypothesis, which state that parents with high rates of psychopathology hold negative schemas for their child's behavior and subsequently, report their child's behavior as more severe.

A comparative approach to assess drivers of success in mammalian conservation recovery programs

The outcomes of species recovery programs have been mixed; high-profile population recoveries contrast with species-level extinctions. Each conservation intervention has its own challenges, but to inform more effective management it is imperative to assess whether correlates of wider recovery program success or failure can be identified. To contribute to evidence-based improvement of future conservation strategies, we conducted a global quantitative analysis of 48 mammalian recovery programs. We reviewed available scientific literature and conducted semistructured interviews with conservation professionals involved in different recovery programs to investigate ecological, management, and political factors associated with population recoveries or declines. Identifying and removing threats was significantly associated with increasing population trend and decreasing conservation dependence, emphasizing that populations are likely to continue to be compromised in the absence of effective threat mitigation and supporting the need for threat monitoring and adaptive management in response to new and potential threats. Lack of habitat and small population size were cited as limiting factors in 56% and 42% of recovery programs, respectively, and both were statistically associated with increased longer term dependence on conservation intervention, demonstrating the importance of increasing population numbers quickly and restoring and protecting habitat. Poor stakeholder coordination and management were also regularly cited by respondents as key weaknesses in recovery programs, indicating the importance of effective leadership and shared goals and management plans. Project outcomes were not influenced by biological or ecological variables such as body mass or habitat, which suggests that these insights into correlates of conservation success and failure are likely to be generalizable across mammals.

Early warning epidemic surveillance in the Pacific island nations: an evaluation of the Pacific syndromic surveillance system

OBJECTIVE

The Pacific Syndromic Surveillance System (PSSS), launched in 2010, provides a simple mechanism by which 121 sentinel surveillance sites in 21 Pacific island countries and areas perform routine indicator- and event-based surveillance for the early detection of infectious disease outbreaks. This evaluation aims to assess whether the PSSS is meeting its objectives, what progress has been made since a formative evaluation of the system was conducted in 2011, and provides recommendations to enhance the PSSS's performance in the future.

METHODS

Twenty-one informant interviews were conducted with national operators of the system and regional public health agencies that use information generated by it. Historic PSSS data were analysed to assess timeliness and completeness of reporting.

RESULTS

The system is simple, acceptable and useful for public health decision-makers. The PSSS has greatly enhanced Pacific island countries' ability to undertake early warning surveillance and has contributed to efforts to meet national surveillance-related International Health Regulation (2005) capacity development obligations. Despite this, issues with timeliness and completeness of reporting, data quality and system stability persist.

CONCLUSION

A balance between maintaining the system's simplicity and technical advances will need to be found to ensure its long-term sustainability, given the low-resource context for which it is designed.

An agenda for assessing and improving conservation impacts of sustainability standards in tropical agriculture

Sustainability standards and certification serve to differentiate and provide market recognition to goods produced in accordance with social and environmental good practices, typically including practices to protect biodiversity. Such standards have seen rapid growth, including in tropical agricultural commodities such as cocoa, coffee, palm oil, soybeans, and tea. Given the role of sustainability standards in influencing land use in hotspots of biodiversity, deforestation, and agricultural intensification, much could be gained from efforts to evaluate and increase the conservation payoff of these schemes. To this end, we devised a systematic approach for monitoring and evaluating the conservation impacts of agricultural sustainability standards and for using the resulting evidence to improve the effectiveness of such standards over time. The approach is oriented around a set of hypotheses and corresponding research questions about how sustainability standards are predicted to deliver conservation benefits. These questions are addressed through data from multiple sources, including basic common information from certification audits; field monitoring of environmental outcomes at a sample of certified sites; and rigorous impact assessment research based on experimental or quasi-experimental methods. Integration of these sources can generate time-series data that are comparable across sites and regions and provide detailed portraits of the effects of sustainability standards. To implement this approach, we propose new collaborations between the conservation research community and the sustainability standards community to develop common indicators and monitoring protocols, foster data sharing and synthesis, and link research and practice more effectively. As the role of sustainability standards in tropical land-use governance continues to evolve, robust evidence on the factors contributing to effectiveness can help to ensure that such standards are designed and implemented to maximize benefits for biodiversity conservation.

The family assessment device: an update

The current study set out to describe family functioning scores of a contemporary community sample, using the Family Assessment Device (FAD), and to compare this to a currently help-seeking sample. The community sample consisted of 151 families who completed the FAD. The help-seeking sample consisted of 46 families who completed the FAD at their first family therapy appointment as part of their standard care at an outpatient family therapy clinic at an urban hospital. Findings suggest that FAD means from the contemporary community sample indicate satisfaction with family functioning, while FAD scores from the help-seeking sample indicate dissatisfaction with family functioning. In addition, the General Functioning scale of the FAD continues to correlate highly with all other FAD scales, except Behavior Control. The cut-off scores for the FAD indicating satisfaction or dissatisfaction by family members with their family functioning continue to be relevant and the FAD continues to be a useful tool to assess family functioning in both clinical and research contexts.

The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations

A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self-report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test-retest and concurrent reliability, and modest sensitivity to change after treatment. FAD-dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop-out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.

Child maltreatment in DSM-5 and ICD-11

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease-11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches.

Gay and lesbian couples in Italy: comparisons with heterosexual couples

Assessing couple relationships across diverse languages and cultures has important implications for both clinical intervention and prevention. This is especially true for nontraditional relationships potentially subject to various expressions of negative societal evaluation or bias. Few empirically validated measures of relationship functioning have been developed for cross-cultural applications, and none have been examined for their psychometric sufficiency for evaluating same-sex couples across different languages and cultures. The current study examined the psychometric properties of an Italian translation of the Marital Satisfaction Inventory - Revised (MSI-R), a 150-item 13-scale measure of couple relationship functioning, for its use in assessing the intimate relationships of gay and lesbian couples in Italy. Results for these couples were compared to data from heterosexual married and unmarried cohabiting couples from the same geographical region, as well as to previously published data for gay, lesbian, and unmarried heterosexual couples from the United States. Findings suggest that, despite unique societal pressures confronting Italian same-sex couples, these relationships appear resilient and fare well both overall and in specific domains of functioning compared to heterosexual couples both in Italy and the United States.

[Introduction to Exploratory Factor Analysis (EFA)]

INTRODUCTION

Exploratory Factor Analysis (EFA) has become one of the most frequently used statistical techniques, especially in the medical and social sciences. Given its popularity, it is essential to understand the basic concepts necessary for its proper application and to take into consideration the main strengths and weaknesses of this technique.

OBJECTIVE

To present in a clear and concise manner the main applications of this technique, to determine the basic requirements for its use providing a description step by step of its methodology, and to establish the elements that must be taken into account during its preparation in order to not incur in erroneous results and interpretations.

METHODOLOGY

Narrative review.

DEVELOPMENT

This review identifies the basic concepts and briefly describes the objectives, design, assumptions, and methodology to achieve factor derivation, global adjustment evaluation, and adequate interpretation of results.

Measuring progress of collaborative action in a community health effort

OBJECTIVE

To measure the progress made by the collaborative actions of multisectorial partners in a community health effort using a systematic method to document and evaluate community/system changes over time.

METHODS

This was a community-based participatory research project engaging community partners of the Latino Health for All Coalition, which based on the Health for All model, addresses health inequity in a low-income neighborhood in Kansas City, Kansas, United States of America. Guided by three research questions regarding the extent to which the Coalition catalyzed change, intensity of change, and how to visually display change, data were collected on community/system changes implemented by the community partners from 2009-2012. These changes were characterized and rated according to intensity (event duration, population reach, and strategy) and by other categories, such as social determinant of health mechanism and sector.

RESULTS

During the 4-year study period, the Coalition implemented 64 community/system changes. These changes were aligned with the Coalition's primary goals of healthy nutrition, physical activity, and access to health screenings. Community/system efforts improved over time, becoming longer in duration and reaching more of the population.

CONCLUSIONS

Although evidence of its predictive validity awaits further research, this method for documenting and characterizing community/system changes enables community partners to see progress made by their health initiatives.

[Training evaluation using the four courses portfolio in primary care residents of a Teaching Unit in Murcia]

OBJECTIVE

To evaluate the performance and quality of the 10 groups of training tasks envisaged in the portfolio training model undertaken by all residents of the Primary Care Teaching Unit in Murcia.

DESIGN

A cross-sectional study was conducted on the portfolios provided and completed by all residents in May 2011.

PARTICIPANTS

All residents who were in training at that time (131).

METHOD

Ten groups of training tasks were established from those recommended by the National Commission for the specialty. The performance of each one in each of the portfolios was evaluated, and the compliance for each training task was calculated. The quality of the performance of each of the tasks was given a score, 0 points (very poor) to 10 points (excellent).

RESULTS

As regards compliance, the tasks that were most performed were: filling in the Resident book correctly and using the resident skills guide, both with 99.24%, followed by reflection reports on the training visits. All tasks had a compliance rate higher than 67%. The mean percentage of compliance was 86.49%. All tasks obtained an average score greater than 7 (outstanding). The overall mean score was 7,8 points.

CONCLUSIONS

The level of perfomance of the tasks set out in the portfolio by the residents was very satisfying. It is necessary to continue working on improving the performance of the portfolio.

[Report of Internal Consistency of the Scales in Research Published in the Colombian Journal of Psychiatry]

OBJECT

Establishment of the frequency of reporting internal consistency of the scales in research published in the Colombian Journal of Psychiatry (CJP) between 2006 and 2010.

METHOD

A descriptive study was carried out which computes the report of internal consistency (Cronbach alpha) of scales in research published as original papers in the CJP. Validation studies were excluded.

RESULTS

A total of 114 articles were published and 30 of them were included in the analysis. Researchers applied 67 scales for measuring some variables and Cronbach alpha of 20 (29.8%) scales was reported in the participating population.

CONCLUSIONS

In the CJP, few published studies that apply measuring scales for variables report internal consistency in the analyzed sample. It is necessary for authors to report the internal consistency of used scales in the study population to guarantee the validity of conclusions.

[Impact of the Tobacco Law on the workplace: a follow up study of a cohort of workers in Spain 2005-2007]

OBJECTIVE

The aim of this study is to describe the changes caused by the Law on Tobacco and its consumption in workers who are active smokers.

DESIGN

A post-intervention follow up study of a cohort of users.

SETTING

Health Centres in Valencia and Majorca.

PARTICIPANTS

Users who attended health centres.

INTERVENTION

The field work consisted of each patient filling in a case report form with the requested information.

MAIN MEASUREMENTS

The variables collected were, sex, place of work, education level, number of workers in the company, number of cigarettes smoked. They were told that on the following day they had to count the cigarettes smoked throughout the day, noting whether they had been smoked during or outside working hours. If they smoked during working hours, they reported whether it was inside or outside the workplace. On the following day they were telephoned to let us know the number of cigarettes smoked. This telephone call was repeated at six months and eighteen months.

RESULTS

Smoking prevalence and the number of cigarettes smoked in the workplace has been reduced by 9% per month. The variables associated with compliance with the law were education level, the sex of the worker, and the size of the company.

CONCLUSIONS

The coming into force of the Tobacco Law has been effective.

[Self-audit and tutor accreditation]

OBJECTIVE

To describe the experience of using self-audit (SA) as a means of accrediting family and community medicine tutors, to analyse the knowledge that the tutors have on this self-assessment methodology, and to record their opinions on this method.

DESIGN

Retrospective descriptive study and analysis of an opinion questionnaire.

SETTING

Family and community medicine teaching units (TU) in Catalonia.

PARTICIPANTS

Tutors from family and community medicine TU in Catalonia (July 2001-July 2008).

METHODS

Training of the tutors in SA methodology, creation of a reference group and a correction cycle. Correction by peers of the SAs performed by the tutors according to previously determined criteria and subsequent issue of a report-feedback. Self-administered questionnaire by a group of TU tutors.

MEASUREMENTS AND MAIN OUTCOMES

A total of 673 SA were performed. The most frequent topic selected was diabetes mellitus in 27.9% of cases. The overall evaluation of the SA from a methodological point of view was correct in 44.5% of cases, improvable in 45.3%, and deficient in 10.2%. A total of 300 opinion questionnaires were issued. The response rate was 151/300 (50.03%). On the question about the usefulness of the SA in professional practice, 12% considered it very useful, 56% adequate, and 32% of little use or not useful. As regards whether it was a good means for the re-accreditation or accreditation of tutors, 66% considered that it was not.

CONCLUSIONS

A high percentage of the SAs analysed are not carried out correctly, which indicates that tutors do not know this self-assessment method very well. They consider that SAs are a useful tool for improving clinical practice, but not a good means for accreditation and re-accreditation.

[An instrument to evaluate primary health care from the population perspective]

OBJECTIVE

To reduce, translate, and adapt transculturally, the short version of the PCAT questionnaire for users (PCAT Customer client version), in order to achieve an abbreviated version of the original instrument in Catalan and Castilian that is conceptually similar to the English original, culturally adequate and viable for use among the Spanish population, and useful for inclusion in the health surveys.

DESIGN

Translation and adaptation of one questionnaire. Three steps were followed: a) question selection; b) transcultural adaptation of the selected questions, by means of direct translations to Castilian and Catalan with subsequent re-translation to English; c) clarity, acceptability, and familiarity with content of the 2 pretest questionnaire versions were evaluated through cognitive interviews of persons with different profiles in the targeted population.

RESULTS

Fifteen questions were selected for the adult version and 24 for the <15 year-old version. These facilitated the identification of a primary health care provider and the collection of information on the dimensions of first contact, continuity of care, comprehensiveness of care and coordination.

CONCLUSIONS

It is hoped that these instruments will be useful when included in the questionnaires of health surveys throughout Spain. The items selected facilitate evaluation of the degree to which primary health care succeeds as the first user contact with health services, maintains continuity of attention, coordinates and provides services, making them available when necessary. Furthermore, cultural competence will be evaluated.

[Evaluation of a community experience intervening to help with grief]

Objetivo

Evaluar la efectividad de un programa comunitario en duelo (tabla 1).

Diseño

Estudio observacional longitudinal (efectividad) y descriptivo cualitativo (grado de satisfacción).

Emplazamiento

Centro de Salud Olarizu de Vitoria-Gasteiz.

Participantes

Un total de 22 mujeres y 9 varones, con una edad media de 47 años, que han perdido a un ser querido entre los 3 meses y 2 años anteriores al inicio de la intervención, y que han acudido a nuestro centro entre los meses de enero a junio de 2004. Cuatro de ellos no completaron el estudio.

Intervenciones

Entrevistas individuales con seguimiento emocional pautado (REFINO, Neimeyer, Worden, Friedman y Roussel) y sesiones grupales psicoeducativas.

Mediciones principales

Inventario de experiencias en duelo (IED) de Sanders et al, al inicio y a los 6 meses, y encuesta de satisfacción global al finalizar las sesiones psicoeducativas.

Resultados

Al finalizar el programa se observa mejoría en las siguientes dimensiones del IED: desesperanza (p = 0,006), pérdida de control (p = 0,001), despersonalización (p = 0,001), somatización (p = 0,002), enfado/hostilidad (p = 0,048), ansiedad ante la muerte (p = 0,021), negación/ ocultamiento (p = 0,016), pérdida deenergía (p = 0,049), optimismo (p = 0,017) y dependencia (p = 0,030). Más del 80% de los participantes ha visto cumplidas sus expectativas sobre el programa y lo recomendarían a otros dolientes.

Discusión y conclusiones

La intervención es efectiva a medio plazo, por lo que podría considerarse su puesta en práctica ante situaciones de duelo. Se recomienda estudiar la evolución a más largo plazo y con grupo control de comparación.

[Do we agree on the technical quality of our chest X-rays? A radiologist, an expert in X-ray diagnosis, and a family doctor try to find out]

OBJECTIVE

To appraise the degree of concordance in the interpretation of the technical quality of chest x-rays at a health centre between an expert in x-ray diagnosis, a family doctor, and a radiologist.

DESIGN

Transversal study. Setting. Primary care. Cartuja Health Centre, Granada, Spain.

PARTICIPANTS

Patients at the Cartuja Health Centre who had a simple chest x-ray in 2002. 150 studies were chosen by simple randomised sampling. Two were rejected because they dealt with a repeat examination of the same patient and seven because they did not reach minimum quality. The final sample was 141 x-rays.

MAIN MEASUREMENTS

The observers filled in independently, for each examination, an 11-item protocol on the technical quality of the images. The kappa index between pairs of observers was calculated for each item, as was the overall kappa index.

RESULTS

96% of the examinations were conducted with large x-ray plates (3543). There was only acceptable or good concordance between the 3 observers in 2 questions (kappa, 0.559-0.858). In 5 questions concordance was homogeneously low (kappa, 0.034-0.375). In some questions there was a strong discrepancy between the appraisal of the expert and that of the 2 other observers.

CONCLUSIONS

General concordance can be considered low, although it is somewhat greater between the radiologist and the family doctor than between either of these and the expert. This poses the need to improve professional training in evaluation of the technical quality of images. In addition, there was unnecessary expense in large-size x-ray plates.

[Impact of medical counselling on giving up smoking during pregnancy]

OBJECTIVE

Women s tobacco consumption has increased in Spain in recent years, especially among women of reproductive age. This study aims to evaluate the impact of medical counselling integrated into pre-natal care on tobacco consumption during pregnancy and the period after delivery.

DESIGN

Quasi-experimental intervention study.Setting. Hospital del Mar, Barcelona.

PATIENTS

219 patients who attended the Hospital del Mar for delivery during 1996 (control group) and 169 patients seen during their pregnancies at the same hospital in 1997 (intervention group).

INTERVENTIONS

The control group patients had received normal care. The pregnant women in the intervention group received systematic structured counselling on giving up smoking, backed up by a special brochure composed for this purpose.

MEASUREMENTS AND RESULTS

The intervention and control groups showed no statistically significant differences either in their social or demographic variables or in their tobacco consumption. In both groups the evolution of their smoking during pregnancy was determined during their pre-natal visits and six months after delivery through a telephone interview. 44 of the women in the control group (20.1%) gave up smoking before their first pre-natal visit, and 11 (5%) gave up during pregnancy. In the intervention group 26 (17.7%) had given up spontaneously and 16 (10.9%) gave up during pregnancy. Of those who gave up completely during pregnancy, 36.4% of women in the control group and 64.3% in the intervention group remained abstinent at six months (P=.002).

CONCLUSIONS

Counselling at pre-natal check-ups to give up smoking lightly increases the number of women who give up and reduces significantly the number of post-delivery backsliders.

[Evaluation of clinical competence in the postgraduate family medicine course, by means of the Structured Objective Clinical Test]

OBJECTIVE

To evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas.

DESIGN

Observational and descriptive.

SETTING

Family medicine clinics in the metropolitan area of Mexico City.Participants. 89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM).

MAIN MEASUREMENTS

After prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics.

RESULTS

The overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section.

CONCLUSIONS

Academic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities.

[Economic evaluation of a new selective COX-2 NSAID, rofecoxib, in a real practice context]

OBJECTIVE

To evaluate the economic and health consequences of the use of a new COX-2 anti-inflammatory drug.

DESIGN

Cost-effectiveness analysis by modelling three options for prescribing non-steroidal anti-inflammatories (NSAIDs) in patients diagnosed with arthrosis and undergoing long-term NSAID treatment. Option 1: NSAID prescription without gastric protection for low-risk patients, and with gastric protection for patients running a medium or high risk of developing complications (current procedure). Option 2: exclusive prescription of rofecoxib (25 mg/day) for all patients (high and low risk). Option 3: single-therapy rofecoxib (25 mg/day) prescription for patients sensitive to combined treatment (NSAIDs and gastric protection) due to the risk of complications. In each case, resources and expected clinical benefits were accounted for by the calculation of the cost of avoidance of each moderate or high gastro-intestinal side-effect (GISE) (symptomatic ulcer or complication) avoided. The direct economic impact on the centre of passing from option 1 to any of the other two options was calculated.

SETTINGS AND PARTICIPANTS

The study, conducted in the Barceloneta Primary Care Centre, included in its modelling the 124 patients diagnosed with arthrosis who received NSAIDs continuously during the year 2000.

RESULTS

Option 2 supposed avoiding 1.5 cases of GISE (0.5 symptomatic ulcers and 0.9 serious complications), to an additional cost of 336 566.78 euros. Each case avoided would cost 24,641.50 euros; and each serious case avoided 38,464.79 euros. Option 3 avoided 0.25 cases of serious complication, at an additional cost of 9,015.18 euros. Avoiding one case would cost 37,262.75 euros.

CONCLUSIONS

The overall health benefits arising from the universal or partial introduction of a selective COX-2 inhibitor NSAID involve a unit cost of 24,040.48 or 36,060.73 euros, depending on the option. The impact on the Centre s pharmaceutical budget would increase by 1.3% under option 2, and by 0.35% under option 3.

[Medical record of primary care: quality and predisponding factors]

OBJECTIVE

To obtain a method which allows quantitative evaluation of the register of risk factors in the primary care medical records of the adult population and to analyze the effect that several factors, related to primary care centers, users and physicians in primary care, determine over it.

DESIGN

An observational cross-sectional study.

SETTING

Primary health care.

PARTICIPANTS

A total sample of 1473 medical records from eight health districts of Catalonia.

MEASUREMENTS

Information was collected using a structured questionnaire, with socio-demographic data related to the primary care center, the users and the primary care physician, which also collected criteria of the risk factors of the medical records defined a priori by a consensus group of professionals in primary health care.

RESULTS

Only 18.3% (95% CI: 16.3-20.3%) of the total medical records sample analyzed accomplished criteria of minimum data set register. Risk was higher due: a higher number of physicians in the Primary care centers (OR = 1.10; 95% CI: 1.01-1.20); female gender of the user (OR = 1.17; 95% CI: 1.01-1.36); older age of the user (OR = 1.02; 95% CI: 1.02-1.03); if there was one visit during last year at least (OR = 1.51; 95% CI: 1.23-1.85); and female gender of the physician who fulfilled the Medical Record (OR = 1.46; 95% CI: 1.24-1.71).

CONCLUSIONS

Average of minimum data set register of the medical record of the adult population is 18.3% (95% CI: 16.3-20.3). The following factors are related to minimum data set register: more number of physicians in the primary care center, female sex of the user, year of last register in medical record, and female sex of the physician.

[Evaluation of continuous education: from the satisfaction to the impact. With regard to a formative programme in minor surgery in a health area]

OBJECTIVE

To compare the evaluation of reaction of an activity of continuous education (CE) in minor surgery (MS), with the impact in the realization of MS in a health area.

DESIGN

Observational cross-sectional study. Setting. 27 centers in a health area that offer MS between their services.

MEASUREMENTS

The valuation was studied in a scale from 1 to 10, of 9 theoretical-practical activities of CE in MS and the consideration of its utility. The number of activities of MS (NMS) carried out in all the units, was picked up during one year, and a model of lineal regression was built. The independent variable was the NMS, and the explanatory ones the assistance pressure (AP), the postgraduate formation (PF), the staff of the unit, the equipment (E), and the carried out CE.

RESULTS

The valuation of the CE had a median of 8 (with interquartile range 1), 85.1% of the people who realized CE in MS said that this would be of utility. However in the explanatory regression model the PF was the only significant variable (beta = 6.7; 95% CI, 0.12-12.22). Neither the CE, nor the AP, nor the E, explained the variability among the NMS.

CONCLUSION

The CE in MS with conventional methodology has a very positive reaction evaluation, but its impact in the later realization of MS is not significant.