Measures of agreement between many raters for ordinal classifications

Screening and diagnostic procedures often require a physician's subjective interpretation of a patient's test result using an ordered categorical scale to define the patient's disease severity. Because of wide variability observed between physicians' ratings, many large‐scale studies have been conducted to quantify agreement between multiple experts' ordinal classifications in common diagnostic procedures such as mammography. However, very few statistical approaches are available to assess agreement in these large‐scale settings. Many existing summary measures of agreement rely on extensions of Cohen's kappa. These are prone to prevalence and marginal distribution issues, become increasingly complex for more than three experts, or are not easily implemented. Here we propose a model‐based approach to assess agreement in large‐scale studies based upon a framework of ordinal generalized linear mixed models. A summary measure of agreement is proposed for multiple experts assessing the same sample of patients' test results according to an ordered categorical scale. This measure avoids some of the key flaws associated with Cohen's kappa and its extensions. Simulation studies are conducted to demonstrate the validity of the approach with comparison with commonly used agreement measures. The proposed methods are easily implemented using the software package R and are applied to two large‐scale cancer agreement studies. Copyright © 2015 John Wiley & Sons, Ltd.     

Jordanian mothers' perceptions of their children's social competence: an examination of family factors and demographic variables

Children's social competence is an area of research that receives minimal attention from Jordanian researchers. It is important to investigate this area of development so as to provide parents with information about the nature of social competence and possible factors affecting its development. This research study examined Jordanian mothers' perceptions of their kindergarten children's social competence: individual and social attributes. Perceptions were investigated in relation to family size, child's gender, mothers' education level, and marital status. Social competence ratings were obtained from 726 mothers who responded to the study's two-part questionnaire developed by the researcher. The results revealed an average level of social competence ratings by mothers on the total scale with higher ratings for children's social attributes compared to individual attributes. Significant results were found between the study's variables and mothers' perceptions of children's competencies. Mothers who are married, with the least number of children, and with higher education levels rated competencies higher compared to their counterparts. Significant differences were also found for gender with mothers rating the social competence of girls higher than boys. Directions for future research include investigating social competence using multiple sources of data.     

A conceptual model of quality of life in schizophrenia: Description and preliminary clinical validation

The utility of quality of life (QOL) as an evaluative tool in clinical psychiatric research and drug trials could be enhanced by developing appropriate conceptual models of QOL, specific for psychiatric disorders. In our proposed model, QOL of individuals maintained on antipsychotic drug therapy for schizophrenia, is viewed as the subject's perception of the outcome of an interaction between severity of psychotic symptoms, side-effects including subjective responses to antipsychotic drugs, and the level of psychosocial performance. In order to test the validity of the model in clinical setting, we selected a sample of 62 schizophrenic patients clinically stabilized on antipsychotic drug therapy, and measured their subjective QOL and other potentially relevant clinical and psychosocial factors. Standardized scales including the positive and negative syndromes scale (PANSS), abnormal involuntary movements scale (AIMS), Hillside Akathisia scale (HAI), and the social performance schedule (SPS) were used for this purpose. Results of a multiple regression analysis using subjective quality of life as the outcome variable, indicated that severity of schizophrenic symptoms (partial R2=0.32, p < 0.0001) and subjective distress caused by akathisia (partial R2=0.11, p < 0.01) and neuroleptic dysphoria (partial R2=0.06, p < 0.05), accounted for nearly half of the variance, while the contribution from the psychosocial indicators was negligible. These results broadly endorse key aspects of the proposed model, and suggest further studies in this direction. These results suggest that improvement in patients' subjective experiences during antipsychotic therapy can enhance patients' QOL. This conceptual model has been developed with particular focus on the impact of antipsychotic medications on the QOL of persons with schizophrenia. As such, it is more applicable to clinical trials of new antipsychotic medications but may not be broad enough to be applicable for other social or vocational interventions.     

Using the person trade-off approach to examine differences between individual and social values

Health state valuations, elicited by methods such as the standard gamble and the time trade-off, give an indication of the value that an individual attaches to particular health states. As measures of individual values, it has been argued that such valuations serve as poor proxies for social preferences, which, it is suggested, are a function of other factors, such as the initial severity of the patient's health state. The person trade-off (PTO) method has been proposed as a technique which takes account of many of these other factors. This paper reports on a study using the PTO to investigate whether an individual's preferences over treatments for themselves differ from their preferences when they are asked to think about the treatment of other people. The results suggest that there is indeed a difference, although qualitative data suggests that health gain is an important determinant of social value. This latter finding runs counter to those of a number of other studies which suggest that concerns about pre-treatment severity are as, if not more, important. Possible explanations for the differences are put forward. © 1998 John Wiley & Sons, Ltd.     

Griffiths量表对孤独症谱系障碍儿童发育评估的意义

目的探讨Griffiths发育评估量表-中文版(G D S-C)在评估孤独症谱系障碍(A S D)儿童中的应用价值,为其临床应用及推广提供理论依据。方法本研究共纳入39例ASD儿童作为研究对象,均使用GDS-C和0~6岁儿童神经心理发育量表(简称儿心量表)在2周内进行评估,并使用儿童孤独症评定量表(CARS)评估ASD程度。将GDS-C各维度分别与儿心量表和CARS进行分析比较,观察其相关性。结果除A运动维度外,GDS-C测得的B个人-社会、C语言、D手眼协调、E表现维度智龄均高于儿心量表(t值分别为2.90、2.85、3.58、3.40,均P<0.01)。按照ASD儿童各维度迟缓分布,GDS-C测评中A维度发现迟缓人数比率明显高于儿心量表(χ~2=15.10,P <0.01),其他各维度比较无明显差异。GDS-C量表A、B、C、D、E维度与儿心量表运动、社会行为、语言、精细动作、适应能力维度相关系数高且显著(r值分别为0.95、0.84、0.78、0.83、0.92,均P <0.01),F实际推理与儿心量表适应能力相关性稍弱(r=0.50,P <0.01)。GDS-C量表B、C及F维度与CARS量表成负相关(r值分别为―0.37、―0.38、―0.39,均P <0.05)。结论 GDS-C量表与儿心量表在ASD儿童的发育评估中具有较高的一致性。因其测试项目更为细致,能更准确的得到被测儿童的实际智龄,值得临床推广。     

EDUCATION FOR SOCIAL WORK IN HEALTH CARE ORGANIZATIONS

The American health care delivery system stands on the brink of major change and reorganization. There are many opportunities for the social work profession to increase its influence and expand the scale of its actiuities within health care. These opportunities represent a challenge to the uision, creativity, and flexibility of social work educators. This article discusses educators' roles within the context of a system conceptualization of the inputs, throughputs, and outputs of education for social work in health care organizations.     

Optimal administrative scale for planning public services: a social cost model applied to Flemish hospital care

In choosing the scale of public services, such as hospitals, both economic and public administrative considerations play important roles. The scale and the corresponding spatial distribution of public institutions have consequences for social costs, defined as the institutions' operating costs and the users' travel costs (which include the money and time costs). Insight into the relationship between scale and spatial distribution and social costs provides a practical guide for the best possible administrative planning level. This article presents a purely economic model that is suitable for deriving the optimal scale for public services. The model also reveals the corresponding optimal administrative planning level from an economic perspective. We applied this model to hospital care in Flanders for three different types of care. For its application, we examined the social costs of hospital services at different levels of administrative planning. The outcomes show that the social costs of rehabilitation in Flanders with planning at the urban level (38 areas) are 11% higher than those at the provincial level (five provinces). At the regional level (18 areas), the social costs of rehabilitation are virtually equal to those at the provincial level. For radiotherapy, there is a difference of 88% in the social costs between the urban and the provincial level. For general care, there are hardly any cost differences between the three administrative levels. Thus, purely from the perspective of social costs, rehabilitation should preferably be planned at the regional level, general services at the urban level and radiotherapy at the provincial level. Copyright © 2014 John Wiley & Sons, Ltd.     

An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS

This study examined social networks and social isolation in older (50 years or more) and younger (ages 20 to 39) adults with HIV/AIDS. The author conducted interviews with 88 individuals living with HIV/AIDS in the Pacific Northwest. Both groups' social networks had similar patterns; however, older adults were more likely to live alone. More than 38 percent of older adults and 54 percent of older adults of color were at risk of social isolation compared with 25 percent of those 20 to 39 years of age. Older men and older adults of color had significantly lower scores on the social network scale than others. Having a confidant and receiving instrumental support were significantly correlated with reduced HIV stigma. Implications for social work practitioners are discussed.     

我国疟疾防治政策演变及趋势分析

建国以来,我国疟疾防治工作取得显著成效,目前已经基本建立较完备的疟疾防治政策体系。我国60多年疟疾防治工作主要分为四个阶段,政府针对各个阶段的疫情情况以及社会环境适时地制定和调整一系列防治疟疾的政策法规。本文回顾了我国疟疾防治政策的历史演变,从各阶段疟疾疫情规模、主要政策内容及其特点等方面进行系统梳理归纳。在此基础上分析在政策指导下我国疟疾防治工作所取得的成绩以及在今后的防治工作中面临的挑战,从而提出制定和完善我国消除疟疾政策的若干建议,为我国实现消除疟疾的目标提供参考依据。     

Development and field testing of a decision aid to facilitate shared decision making for adults newly diagnosed with attention‐deficit hyperactivity disorder

BackgroundThe number of individuals who are diagnosed with attention‐deficit hyperactivity disorder (ADHD) during adulthood has increased in recent years. However, there is still no decision aid (DA) to help adults newly diagnosed with ADHD make decisions regarding further treatments.ObjectiveThis study aimed to describe the development process of a DA for adults newly diagnosed with ADHD and its field testing during the shared decision‐making (SDM) process in a clinical setting.MethodsThe development process involved the creation of a DA prototype using the International Patient Decision Aid Standards criteria and revision of the prototype through the stakeholders'' reviews. The field testing of the DA compared scores before and after the SDM process on the service users'' knowledge scale, decisional conflict scale and the Conners Adult ADHD Rating Scales.ResultsThe developed DA contained options of watchful waiting with own coping skills and pharmacological treatment, which consisted of several kinds of drug options. Fifteen adults newly diagnosed with ADHD participated in the field testing. The participant decision‐making quality outcomes such as their knowledge and decisional conflict improved after the SDM process. ADHD severity did not change.ConclusionA DA for adults with ADHD was systematically developed following the international criteria. Field testing indicated that the DA could serve as a tool to facilitate the SDM process. Further research on this DA is necessary before its routine implementation.Patient or Public ContributionDuring the development process of the DA, the service users who had already been diagnosed with ADHD reviewed the DA prototype and provided feedback, which improved the final version of the DA.     

Investigating the Influence of Threat Appraisals and Social Support on Healthy Eating Behavior and Drive for Thinness

This study examined the relationship between perceived obesity threats, social support, and college students' eating attitudes and behaviors. Results showed that perceived vulnerability to obesity negatively predicted healthy eating behavior. In addition, the perceived severity of obesity-related health problems positively predicted women's drive for thinness. Social support played a significant role in explaining health behaviors. Specifically, appraisal by others indirectly predicted college students' healthy eating behavior through increased self-efficacy. Among women, informational support moderated the relationships between both vulnerability and severity on healthy eating behavior. At low levels of support, vulnerability and severity negatively predicted students' healthy eating behavior. Overall, results suggest that messages designed to increase perceived vulnerability and severity may be detrimental when trying to improve people's dietary habits; however, among women certain types of social support may buffer the defensive responses resulting from obesity threats.     

IN-HOME INTERVENTION FOR DEPRESSIVE SYMPTOMS WITH LOW-INCOME MOTHERS OF INFANTS AND TODDLERS IN THE UNITED STATES

Depressive symptoms in low-income mothers negatively affect infant–toddler development. This pilot study tested a short-term, home-based depressive symptom intervention with 16 African American and White, Non-Hispanic mothers in Early Head Start (EHS) programs who were randomly assigned to intervention and usual care/waiting list conditions. Mothers met in their homes with master's-prepared psychiatric mental health nurses who worked with them to improve their management of depressive symptoms and life issues, use of social support, and parenting. The intervention group showed a significantly greater decrease from baseline in depressive symptom severity at 8 and 16 weeks in contrast to the mothers receiving usual care. Observations of maternal interactions showed improvement in the intervention mothers. The results support testing on a larger scale.     

Quantifying social consequences of occupational injuries and illnesses: state of the art and research agenda

BACKGROUND: Quantitative methods for describing the social effects of occupational injury and illness are evaluated including surveys of prevalence and ratings of severity of social role disability. METHODS: The reliability and validity for the injured worker population of the most commonly used general and condition-specific role disability measures is reviewed and summarized. This review is used to support the development of a prototype strategy for quantifying the social consequences of occupational injuries and to identify areas of need for further research and development. CONCLUSIONS: Research is needed to: (a) determine which of existing measures is most precise in describing the severity of dysfunction due to a specific illness or injury, (b) expand the development of measures of specific role functioning (including paid work), and (c) develop item banks to support the construction of computer adaptive assessments of role functioning.     

Parent perceptions of autism severity: Exploring the social ecological context

BackgroundHealth professionals incorporate parent reports into the diagnosis and treatment of children with an autism spectrum disorder (ASD). Yet little is known about the contextual forces that may shape parents' perceptions of their child.ObjectivesThe current study seeks to: 1) compare the social ecological contexts of parents of children with ASD and parents of non-autistic children, and 2) explore the social ecological influences on parents' perception of their child's ASD severity.MethodsThis study employed a cross-sectional analysis of data from the 2007–2008 National Survey of Children's Health (NSCH) in the United States. Social ecological factors of interest included variables depicting family physical environment, family social environment, and individual parent characteristics.ResultsResults indicate that parents of children with ASD had increased odds of reporting poor neighborhood social capital, greater aggravation, more difficulty coping, and lower levels of relationship satisfaction and mental health. Parents' perceptions of their child's ASD severity were associated with several factors of their social ecological context. More severe parent-reported ASD was associated with aspects of the physical environment (rundown housing and garbage on the street), the social environment (parent relationship satisfaction) and individual parent characteristics (parent aggravation and mental health).ConclusionsResults suggest ways that professionals can contextualize parent reports to aid in the diagnosis and treatment of children with ASD. Findings also highlight a need for longitudinal research using well-characterized measures to determine the nature and direction of relationships between contextual factors and parents' perceptions.     

Financial Stress,Parental Depressive Symptoms,Parenting Practices,and Children's Externalizing Problem Behaviors: Underlying Processes

This study examined the relationships among financial stress encountered by families, parents' social support, parental depressive symptoms, parenting practices, and children's externalizing problem behaviors to advance our understanding of the processes by which family financial stress is associated with children's problem behaviors. We also tested moderated mediation to investigate if these relationships differed depending on children's characteristics. The data were drawn from 290 predominantly rural families with young children who were identified as at risk for the development of serious conduct problems. Using structural equation modeling, we found that the relationship between family income and children's externalizing problem behaviors was mediated by parents' social support, parental depressive symptoms, and parenting practices. The results also showed that the children's levels of aggression severity, academic functioning, and developmental strengths moderated the mediating relationships between family income and parental depressive symptoms and between family income and positive parenting.     

江苏省中小学生体育发展现状及影响因素

了解江苏省中小学生体育发展现状及影响因素,为制定干预对策提供参考.方法 采用分层整群抽样的方法,从江苏省8城市抽取30所中小学6 846名学生,对其体育发展情况进行问卷调查.结果 在学校因素中,场馆器材不能满足体育课、课外活动的报告率分别为11.96%,15.63%,体育课不足3节/周、被占用、完全能上满规定时间、缺乏兴趣的报告率分别为55.15%,51.57%,53.87%,42.25%,学校规定大课间活动的报告率为80.53%,不喜欢教师或教学方式的报告率为25.82%;个人因素中,每周参加课外活动≥3次、每天参加课外活动≥1h、掌握3项及以上运动技能、参加课余体育项目培训班的报告率分别为18.00%,12.66%,60.70%,15.50%;家庭因素中,家长支持并陪同学生参加体育活动的报告率为32.98%;社会因素中,体育成绩、《体质测试》成绩、体育活动影响在校评优和升学就业的报告率分别为35.92%,32.46%,24.04%.不同性别、不同地区中小学生体育发展差异有统计学意义,总体上男生体育发展好于女生,苏南中小学生好于苏北.结论 体育课程质量低、中小学生课外体育活动时间与频数少、家长不陪同和社会政策缺乏明确的考核评价机制是制约中小学生体育发展的主要因素.中小学生体育的持续发展需各因素兼容并济,和谐发展.     

Rudolf Virchow on the typhus epidemic in Upper Silesia: an introduction and translation

Rudolf Virchow's Report on the 1848 typhus epidemic is one of the neglected classics of ‘social medicine’— a term he did much to popularise. His analysis of the epidemic emphasised the economic, social and cultural factors involved in its aetiology and clearly identified the contradictory social forces that prevented any simple solution. Instead of recommending medical changes like more doctors or hospitals, he outlined a revolutionary programme of social reconstruction; including full employment, higher wages, the establishment of agricultural co-operatives, universal education and the disestablishment of the Catholic church. The present paper includes the first English translation of these long-term recommendations. It also locates Virchow's Report within the context of the Medical Reform Movement of 1848 and traces his influence on the subsequent development of social medicine. Parallels are drawn between Virchow's attempts to reform health care and current developments in the political economy of health.     

Hospital Length of Stay: Social Work Services as an Important Factor

In earlier studies it was found that the severity of patients' psychosocial problems was a significant predictor of length of stay (LOS). This current study compared predictors of LOS for samples of patients referred to social services in three large urban hospitals in June–October 2002 (n?=?176) and 2006 (n?=?147), and examined changes in patient characteristics and the nature of social work practice. A significant relationship between psychosocial severity and LOS was again found, confirming the important role that social services can potentially play in controlling hospital costs. Some significant changes were also found in the pattern of social work practice; this was generally in the direction of more community consultation and collaboration, suggesting a greater emphasis on multidisciplinary teamwork.     

肝硬化患者焦虑抑郁情绪及生活质量的调查与干预

目的调查肝硬化患者焦虑、抑郁水平及社会支持与生活质量状况,找到干预患者情绪状况、改善生活质量的有效途径。方法运用基本问卷、躯体状态、医用焦虑抑郁量表、社会支持量表、诺丁汉健康量表对175例肝硬化患者问卷调查。结果 HADS-A均值≥9分的170例(97.7%),HADS-D均值≥9分的155例(89.1%),患者普遍存在焦虑抑郁情绪。3组不同年龄段患者在主观支持(P=0.005)、疼痛(P=0.012)、社交(P=0.040)、活动(P=0.012)、诺丁汉健康量表总分(P=0.024)方面存在显著差异,抑郁、客观支持、并发症和、主观支持对预测诺丁汉健康量表总分作用显著。结论肝硬化患者年龄、抑郁情绪、病情严重情况、社会支持对患者的生活质量影响明显,在进行心理干预时,可从抑郁情绪、社会支持入手,对不同年龄阶段的患者给予有针对性的团体心理干预,提高患者的生活质量。