Assessing children's appraisals of security in the family system: the development of the Security in the Family System (SIFS) scales

BACKGROUND: Although delineating the processes by which children appraise the family as a source of security from their collective experiences in the family subsystem has assumed center stage in many conceptualizations of child development, the dearth of measures of child adaptation in the family system has hindered empirical advances. Therefore, this study introduced and tested the psychometric properties of the Security in the Family System (SIFS) scales, a new measure designed to assess children's appraisals of security in their family as a whole. METHODS: The SIFS was administered to 853 10-15-year-old schoolchildren and readministered to a smaller subsample two weeks later. Additional data was gathered from children, caregivers and teachers using a variety of instruments tapping family instability, cohesion, and conflict; parenting warmth and psychological control; child externalizing and internalizing symptoms; parent-child and interparental insecurity; and children's reactions to conflict simulations. RESULTS: Consistent with models of emotional security in the family, exploratory and confirmatory factor analyses yielded three reliable (i.e., good internal consistency, test-retest reliability) dimensions of family security: Preoccupation, Security, and Disengagement. Concurrent and prospective associations between the SIFS scales and measures of family functioning, children's psychological problems, and insecurity in specific family relationships supported the validity of the SIFS. Support for the discriminant validity of the SIFS was evidenced by its specific patterns of relations with children's psychological problems and ability to predict psychological problems after controlling for insecurity in specific family subsystems. CONCLUSIONS: Results indicate that the SIFS is a psychometrically sound tool capable of advancing family process models, and that family security is a viable construct whose factors parallel already-identified patterns of children's security in other family relationships.     

Characteristics of Mini-Mental State Examination 1 year after stroke

OBJECTIVES: The Mini-Mental State Examination (MMSE) is commonly used to evaluate cognition after stroke. The purpose of this study was to describe the properties of MMSE in relation to different stroke characteristics. MATERIALS AND METHODS: Subjects were survivors (n = 253) of a population-based cohort who had had a first-ever stroke 1 year earlier. At baseline, patients were evaluated with regard to stroke type, stroke severity, unilateral neglect, and prestroke dementia. The 1-year follow-up included an MMSE, a functional evaluation according to the modified Rankin Scale (MRS) and a question regarding subjective memory problems. RESULTS: The mean MMSE was 24.9. Patients with lacunar infarction scored 26.6. Impact of hemisphere localization was insignificant. Twenty-nine percent of the patients had cognitive impairment (cut-off <24). After adjustment for age and education, 16% had cognitive impairment; 41% of the patients had subjective memory problems. The kappa-value between subjective memory problems and dichotomized MMSE was 0.21. Patients with cognitive impairment scored at average 1.8 higher on the MRS. CONCLUSIONS: If cut-off is used, the MMSE should be adjusted for age and education; otherwise the prevalence of cognitive impairment may be overestimated. Cognitive impairment heavily influences functional outcome. Subjective memory problems correlate poorly with MMSE. The impact of hemisphere location may previously have been overestimated.     

Measurement Properties of Performance-Based Assessment of Functional Capacity

Performance-based functional assessments, including standardized functional capacity evaluation (FCE) batteries, are commonly used to determine the physical work abilities of individuals who have sustained musculoskeletal injury. The purpose of this paper is to critically examine research pertaining to the measurement properties of performance-based FCE, along with the theoretical bases for such measurement. While rater judgments of maximum performance during FCE appear reliable, FCEs do not appear to be purely tests of physical capacity as performance during assessment is influenced by multiple personal and environmental contextual factors. FCEs are more accurately considered behavioural tests influenced by multiple factors including physical ability, beliefs, and perceptions, and should be interpreted with in the subject's broader personal and environmental context.     

A double-blind, placebo-controlled investigation of the effects of two doses of a valerian preparation on the sleep, cognitive and psychomotor function of sleep-disturbed older adults

One of the most popular herbal remedies for the alleviation of sleep problems is valerian. However, research into valerian is sparse, and studies differ greatly with respect to design, measures, and preparations used. This clinical study used standardized sleep EEG and psychometric tests to evaluate the clinical efficacy of a valerian preparation (Li 156). A placebo-controlled three way crossover clinical trial was completed using 16 (5 male and 11 female) sleep-disturbed participants (aged 50 to 64 years, mean age 55.9, SD 4.68). Participants slept overnight in a sleep laboratory, following a 21:00 hours dose of valerian 300 mg, valerian 600 mg, or placebo (double-blind). EEG sleep was recorded for each participant at 23:00 hours until 07:00 hours, when a psychometric evaluation was performed the morning after dose. Test periods were separated by six days washout period. Results showed no significant effect between valerian 300 mg, valerian 600 mg or placebo on any EEG parameter or psychometric measure. This suggests valerian at these doses is ineffective as an acute dose for sleep problems. However, valerian is widely used, and is traditionally sedative. Therefore, more research is required into therapeutic dose, types of valerian preparation, and the optimum period of use for therapeutic effect.     

The Munich vulnerability study on affective disorders: premorbid psychometric profile of affected individuals

OBJECTIVE: We conducted a longitudinal high-risk study to identify psychometric vulnerability markers for affective disorders. METHOD: We examined 82 healthy subjects [high-risk probands (HRPs)] with at least one first-degree relative suffering from an affective disorder. The premorbid psychometric profile of 20 HRPs who developed a psychiatric disorder during follow-up was compared with the profile of control subjects without personal and family history of psychiatric disorders matched for age and gender. RESULTS: Somatization, complaints (vegetative lability), and perception of strain are increased in HRPs who developed a psychiatric disorder. These alterations were not influenced by the time interval until the onset of the disorder. CONCLUSION: The premorbid psychometric profile in subjects at high risk for affective disorders is characterized by somatization, complaints, and elevated perception of strain. Together with previous findings our results suggest that these alterations can be regarded as potential vulnerability markers for affective disorders.     

Assessing student reflection in medical practice. The development of an observer-rated instrument: reliability, validity and initial experiences

INTRODUCTION: This study describes the development of an instrument to measure the ability of medical students to reflect on their performance in medical practice. METHODS: A total of 195 Year 4 medical students attending a 9-hour clinical ethics course filled in a semi-structured questionnaire consisting of reflection-evoking case vignettes. Two independent raters scored their answers. Respondents were scored on a 10-point scale for overall reflection score and on a scale of 0-2 for the extent to which they mentioned a series of perspectives in their reflections. We analysed the distribution of scores, the internal validity and the effect of being pre-tested with an alternate form of the test on the scores. The relationships between overall reflection score and perspective score, and between overall reflection score and gender, career preference and work experience were also calculated. RESULTS: The interrater reliability was sufficient. The range of scores on overall reflection was large (1-10), with a mean reflection score of 4.5-4.7 for each case vignette. This means that only 1 or 2 perspectives were mentioned, and hardly any weighing of perspectives took place. The values over the 2 measurements were comparable and were strongly related. Women had slightly higher scores than men, as had students with work experience in health care, and students considering general practice as a career. CONCLUSIONS: Reflection in medical practice can be measured using this semistructured questionnaire built on case vignettes. The mean score allows for the measurement of improvement by future educational efforts. The wide range of individual differences allows for comparisons between groups. The differences found between groups of students were as expected and support the validity of the instrument.     

Psychometric properties of the SF-36 in the early post-stroke phase

BACKGROUND: Patients who have had a stroke are a large group in whom long-term disability is common and therefore impaired general health is likely. The Short Form 36 (SF-36) is a popular measure of general health that has been used with this patient group, but not all aspects of its psychometric properties have been established for use in this context, and its use in the early post-stroke phase has been neglected. AIMS: To examine the reliability, validity and sensitivity to change of the SF-36 (UK version I) in patients in the early post-stroke period. DESIGN: A prospective, observational study of stroke outcomes was carried out. RESEARCH METHODS: From May 1996 to April 1997, patients who had had a stroke were identified by 24 general practices in Scotland and were recruited within 1 month of their stroke, whether in hospital or at home. Outcome measures including the SF-36 were administered at one, 3 and 6 months after onset. RESULTS: The internal consistency of the eight subscales at all three time-points was good except for 1 month Vitality (alpha = 0.6824) and 3 month General Health (alpha = 0.6650), which were borderline in comparison with the criterion value of 0.7. Construct validity was adequate overall, although correlations between Role Physical and General Health and the Barthel Index and Canadian Neurological Scale were lower than hypothesized. Most SF-36 subscales were sensitive to change between 1 and 3 months post-stroke, but none detected change between 3 and 6 months. CONCLUSIONS: There were some practical problems in using the SF-36 in an acutely unwell stroke population. However, analysis of psychometric properties suggested that most of the subscales were adequately reliable and valid. Sensitivity to change was poorer in the later stages of the study.     

Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care

PTSD affects a substantial number of women in medical settings and is associated with significant distress and impairment. There are effective methods of treating trauma-related distress, but a minority seek such care. Thus, primary care is an important setting in which to identify individuals with PTSD. We sent questionnaires, including the PTSD Checklist—Civilian Version (PCL-C), to 419 female veterans who were seen in our primary care clinic in 1998; 56% (N = 221) returned the measures. A random subset (n = 49) was interviewed to establish psychiatric diagnoses. The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care.     

Reliability,validity and standardization of the Japanese version of the Social Adjustment Scale-Self Report

The purpose of the present paper was to examine the reliability and validity of the Japanese version of the Social Adjustment Scale-Self Report (SAS-SR) and to present its normative data. The SAS-SR was administered to a random sample of all the employees of a large general hospital, together with the General Health Questionnaire (n = 363). It was also administered to a representative subset of first-visit patients at 33 psychiatric hospitals and clinics from all over Japan, along with the semistructured psychiatric interview to ascertain the patients' diagnoses (n = 1581). For the internal consistency reliability of the subscales and the overall scale of the SAS-SR, Cronbach's alpha was between 0.61 and 0.73. The Pearson product-moment correlations between the subscale and overall scale scores with the GHQ score were mostly >0.3. The scores were statistically significantly and substantively different between the normal sample and the patient samples, and were also meaningful, differentiating between various diagnostic subgroups. The reference ranges of the SAS-SR scores for mentally healthy subjects were calculated as 95% prediction intervals; for example, 1.22-2.22 for the overall score. The Japanese version of the SAS-SR has good reliability and satisfactory validity. The present study provided reference ranges for its scores in order to increase their interpretability. With its ease of administration and its rich subscales, the scale promises to offer a psychometrically sound measure with which to assess social adjustment in people with various psychiatric disorders.     

护理学专业学生心理健康状况调查

[目的]了解护理学专业学生的心理健康状况,为学校开展健康教育工作提供参考资料.[方法]采用症状自评量表(SCL-90)对护理学专业1 049名在校生进行问卷式调查.[结果]不同年级学生在躯体化、强迫、人际敏感、抑郁、焦虑、恐怖、偏执及精神病性等9个因素得分及总分间均有显著性差异,而不同学历层次学生仅在人际关系的得分间有显著性差异.护理学专业学生轻度的心理问题检出率为48.2%,1、2、3、4年级学生分别为40.0%,55.6%,44.9%,50.5%,各年级组相比较均有显著性差异.不同学历层次学生轻度的心理问题检出率间差异不明显,中等水平的心理问题检出率为8.9%,各年级及不同学历层次学生间均无显著性差异.护理学专业学生的主要心理问题为强迫症状,其次为人际敏感、抑郁及敌对等.[结论]大学生心理问题不容忽视,尤其是2年级学生应引起关注.