Search

Key summary points Aim To evaluate the prognostic value of a shortened screening instrument based on the Dutch national Safety Management System [Veiligheidsmanagementsysteem (VMS)] guidelines for older emergency department patients. Findings A high VMS-score is associated with elevated risks of hospitalization and 90-day mortality. A prediction model for 90-day mortality, which incorporated the VMS-score, showed promising results. Message The shortened VMS-based screening tool can be a helpful instrument to identify frail older emergency department patients. Electronic supplementary material The online version of this article (10.1007/s41999-020-00385-0) contains supplementary material, which is available to authorized users., Purpose It is important to identify which older patients attending the emergency department are at risk of adverse outcomes to introduce preventive interventions. This study aimed to assess the prognostic value of a shortened screening instrument based on the Dutch national Safety Management System [Veiligheidsmanagementsysteem (VMS)] guidelines for adverse outcomes in older emergency department patients. Methods A cohort study was performed including patients aged 70 years or older who visited the emergency department. Adverse outcomes included hospital admission, return emergency department visits within 30 days, and 90-day mortality. The prognostic value of the VMS-score was assessed for these adverse events and, in addition, a prediction model was developed for 90-day mortality. Results A high VMS-score was independently associated with an increased risk of hospital admission [OR 2.26 (95% CI 1.32–3.86)] and 90-day mortality [HR 2.48 (95% CI 1.31–4.71)]. The individual VMS-questions regarding history of delirium and help in activities of daily living were associated with these outcomes as well. A prediction model for 90-day mortality was developed and showed satisfactory calibration and good discrimination [AUC 0.80 (95% CI 0.72–0.87)]. A cut-off point that selected 30% of patients at the highest risk yielded a sensitivity of 67.4%, a specificity of 75.3%, a positive predictive value of 28.5%, and a negative predictive value of 94.1%. Conclusion The shortened VMS-based screening instrument showed to be of good prognostic value for hospitalization and 90-day mortality. The prediction model for mortality showed promising results and will be further validated and optimized. Electronic supplementary material The online version of this article (10.1007/s41999-020-00385-0) contains supplementary material, which is available to authorized users.

The Strengths and Difficulties Questionnaire (SDQ) is a widely used mental health screening instrument developed in the United Kingdom that measures five proposed factors. U.S. research, however, historically supports a slightly different three-factor solution. The present study reports results using both principal factor analysis (PFA) and confirmatory factor analysis (CFA) on data from multiple waves of an ongoing mental health project in middle school aged children. PFA analyses suggested three, five and six-factor solutions with substantial cross-loadings from items. CFAs showed alternative five and six-factor solutions fit well when items guided by the initial PFA were allowed to cross-load. Neither the original five-factor nor popular three-factor models fit well without allowing cross-loading items. These data suggest that popular SDQ three and five-factor model may have variable fit in certain U.S. populations.

Due to demographic changes an increasing prevalence of hospitalized patients suffering from cognitive impairments must be assumed. To enable the best possible treatment a routine procedure is necessary to detect this group of patients early on admission.The current study assessed the prevalence rate of cognitive impairment in inpatients65 years who were tested by the mini mental state examination (MMSE) during admission. Based on the screening quota the willingness of nurses to use the MMSE as a routine instrument was tested. The quota was also compared to the number of diagnoses coded as F in the ICD-10-GM. This retrospective study was conducted from October 2018 to March 2019 at a university hospital.Of the 7311 inpatients65 years, 11.7% were screened. The prevalence of cognitive impairments was 20.7% and was higher than the prevalence rate of dementia and delirium on the basis of medical diagnoses (p 0.001). With only 11.7% the willingness of the nursing staff to use the MMSE to assess cognitive impairments during patient admission was low.The higher prevalence confirms the necessity to detect patients with cognitive disorders; however, the low willingness to use the MMSE suggests that a shorter instrument should be used and more information should be provided to nurses about patients with cognitive impairments.HINTERGRUND: Aufgrund des demografischen Wandels ist von einer zunehmenden Prävalenz stationärer Patienten mit kognitiven Beeinträchtigungen auszugehen. Für eine bestmögliche Versorgung gilt es, diese Patientengruppe mit einem routinemäßigen Verfahren frühzeitig zu erkennen.Die aktuelle Studie untersuchte die Prävalenzrate von kognitiven Beeinträchtigungen bei stationären Patienten65 Jahre, die mit dem Mini-Mental-Status-Test (MMST) während der pflegerischen Aufnahme untersucht wurden. Anhand der Screeningquote wurde die Bereitschaft von Pflegekräften, den MMST als Routineinstrument zu verwenden, überprüft. Die Quote wurde zudem mit der Anzahl der kodierten F‑Diagnosen der ICD-10-GM verglichen. Diese retrospektive Studie wurde vom Oktober 2018 bis März 2019 an einer Universitätsklinik durchgeführt.Von 7311 stationären Patienten65 Jahre wurden 11,7 % gescreent. Die Prävalenz kognitiver Beeinträchtigungen betrug 20,7 % und war höher als die Prävalenzrate von Demenz und Delir aufgrund medizinischer Diagnosen (p 0,001). Mit 11,7 % ist die Bereitschaft des Pflegepersonals, den MMST zur Einschätzung kognitiver Beeinträchtigungen während der Patientenaufnahmen einzusetzen, gering.Die höhere Prävalenz bestätigt die Notwendigkeit, Patienten mit kognitiven Störungen zu erkennen. Die geringe Bereitschaft, den MMST anzuwenden, legt jedoch nahe, dass zum einen ein kürzeres Instrument verwendet und zum anderen Pflegenden mehr Informationen zu kognitiv beeinträchtigten Patienten vermittelt werden sollten.

Zusammenfassung Hintergrund Die oropharyngeale Dysphagie ist bei geriatrischen Patienten weit verbreitet und fast immer multikausal bedingt. Sie führt zu schwerwiegenden Komplikationen und wird oft unzureichend detektiert. Alle bekannten und etablierten Screeningmaßnahmen fokussieren sich auf Patienten mit neurologischer Grunderkrankung, insbesondere nach Schlaganfall. Material und Methoden In der Arbeitsgruppe „Dysphagie“ der Deutschen Gesellschaft für Geriatrie (DGG), in der Ärzte, Logopäden und Schlucktherapeuten zusammengeschlossenen sind, erfolgte eine selektive Literaturrecherche zum Dysphagiescreening. Basierend auf Ergebnissen der Literaturrecherche und eigenen Erfahrungen wurde durch eine Konsensgruppe ein neues Screeninginstrument für geriatrische Patienten entwickelt und konsentiert. Ergebnisse Das Screeninginstrument zur Erfassung einer oropharyngealen Dysphagie bei geriatrischen Patienten gliedert sich in 3 Teile: 1. Vigilanz und Sitzposition, 2. Speichelschluck, Zungenbeweglichkeit und Hustenstoß sowie 3. Wasserschlucktest. Das Screeninginstrument kann durch geschultes medizinisches Personal angewendet werden und ist einfach in den Arbeitsalltag zu integrieren. Diskussion Das neu entwickelte Screeninginstrument ist speziell für die Anwendung bei geriatrischen Patienten vorgesehen. Es hat Vorteile gegenüber bisher empfohlenen Screeningtests. Bisherige Erfahrungen zeigen eine gute Praktikabilität und Akzeptanz im geriatrischen Team. Weitere Studien müssen die Validität des Instruments prüfen.

The Strengths and Difficulties Questionnaire (SDQ) is the most widely used mental health screening instrument for children and adolescents. It is a short questionnaire including 25 items that can be answered by parents, teachers or children. There are two studies which report norms for the German SDQ parent version. They do not include children younger than 6 years. Moreover, whether the German SDQ parent version is measurement invariant across age has not yet been investigated. The absence of measurement invariance across age would support the use of age-specific norms that are not yet available for the German SDQ parent version. We used data of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative survey including 14,835 children aged 3-17 years, to assess measurement invariance of the German SDQ parent version across the full age range. Multi-group confirmatory factor analysis revealed that the hyperactivity and emotional symptoms subscales are not comparable between children of different ages. This supports the use of age-specific norms for these two subscales and for the total SDQ. We used methods of centile estimation to smoothly model the centiles of the SDQ total score and the subscale scores in dependence on age. These age-specific centiles reflect the developmental course of SDQ problems in children (including preschoolers) and adolescents living in Germany. They can be used to identify children and adolescents with abnormal behaviour, while accounting for the developmental course of emotional and behaviour problems.

The present study examined the measurement properties of the Emotional and Behavioral Screener (EBS), a universal screening instrument which identifies students presenting with emotional and behavioral problems. The primary research questions sought to examine the degree to which the EBS item responses fit the Rasch model through evaluating fit of item responses to the Rasch model and item-measure correlations. The sample consisted of K-12 students with emotional disturbance (n = 1138) and with no identified disabilities (n = 1096). Students were rated by their teachers on the 10-item EBS. The findings suggested the EBS possesses favorable measurement properties such that most items had (1) overall good fit to the Rasch model, (2) a few items across age/gender that assess internalizing problems were found to be somewhat problematic, (3) the item hierarchy was found to align with logical and theoretical expectations, and (4) teachers endorsed the response options in a reliable and predictive manner with response categories mostly being distinguishable from one another. Overall, the results justify the interpretations and decisions made with the EBS scores.

Comprehensive violence risk assessment can require substantial time and resources, which may be challenging for an already strapped public mental health system. Herein, we describe a naturalistic study of the Fordham Risk Screening Tool (“FRST”), a violence risk screening instrument designed to quickly identify individuals for whom thorough violence risk assessment would be advisable. All patients admitted to one of three state hospitals during the study period received FRST screening and HCR-20V3 risk assessment. The FRST reliably and accurately identified individuals deemed high risk by the HCR-20V3. The implications of these findings, and the broader clinical policy choices are reviewed.

Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.

Background About one in five patients with depression experiences a chronic course. Despite the great burden associated with this disease, there is no current screening instrument for Persistent Depressive Disorder (PDD). In the present study, we examine a short screening test, the persistent depression screener (PDS), that we developed for DSM-5 PDD. The PDS is comprised of one question that is administered following an initial self-assessment for depression. Methods Ninety patients from an inpatient clinic/day clinic specialized in treating depression completed the PDS. They were also assessed using a structured clinical interview covering the DSM-5 criteria for PDD. Retest reliability was examined after two weeks (n = 69, 77%). Results In this sample, the prevalence of PDD was 64%. Sensitivity of the PDS was 85% with a positive predictive value of 80%. Specificity was 63%. Positive and negative likelihood ratios were 2.3 and .24, respectively. Agreement between the PDS results and the outcome of the clinical interview was moderate (Cohen’s Kappa κ = .48 ([95%-CI .28, .68], p

Background Obesity, with its rising prevalence among Canadians and its estimated cost of $2 billion annually in Canada, is no longer considered a cosmetic issue, but a major health issue that imposes a great burden on the healthcare system and economy. This cross sectional study aims to evaluate the feasibility of identifying the weight status of 6 to 11 year-old children in a university dental clinic using a simplified overweight screening instrument. Methods One hundred sixty eight healthy children were enrolled. Weight and height were measured and overweight/obesity status was assessed using two techniques: 1) the 2007 World Health Organization Body Mass Index (BMI)-for-age reference Tables, 2) simplified overweight screening instrument without BMI calculation. Measures of overall, positive, and negative percent agreement between the two approaches were computed. Results The children’s average weight, height, BMI and BMI z-score were respectively 32.6 ± 9.5 kg, 133.8 ± 10.7 cm, 17.8 ± 3.2, and 0.4 ± 1.0. The overall, positive, and negative percent agreement between the two screening approaches were respectively, 89%, 100%, and 83%. Conclusion This study demonstrated the feasibility and parental acceptance of weight, height and BMI measurement in a dental setting and evidence that supports the validity of a new simplified approach to assess children’s weight status without having to compute BMI. Trial registration NCT02637752. Registered 18 December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0808-x) contains supplementary material, which is available to authorized users.

Background There is a growing consensus about the importance of mental health screening of youths in welfare and juvenile justice institutions. The Massachusetts Youth Screening Instrument-second version (MAYSI-2) was specifically designed, normed and validated to assist juvenile justice facilities in the United States of America (USA), in identifying youths with potential emotional or behavioral problems. However, it is not known if the USA norm-based cut-off scores can be used in Switzerland. Therefore, the primary purpose of the current study was to estimate the diagnostic performance and optimal cut-off scores of the MAYSI-2 in a sample of Swiss youths in welfare and juvenile justice institutions. As the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample of the current study and consequently we could estimate the diagnostic performance and the optimal cut-off scores of the MAYSI-2 for the language regions separately. The other main purpose of the current study was to identify potential gender differences in the diagnostic performance and optimal cut-off scores. Methods Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions (drawn from the French-, German- and Italian-speaking parts of Switzerland). The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). The MAYSI-2 scores were submitted into Receiver-Operating Characteristic (ROC) analyses to estimate the diagnostic performance and optimal ‘caution’ cut-off scores of the MAYSI-2. Results The ROC analyses revealed that nearly all homotypic mappings of MAYSI-2 scales onto (cluster of) psychiatric disorders revealed above chance level accuracy. The optimal ‘caution’ cut-off scores derived from the ROC curve for predicting (cluster of) psychiatric disorders were, for several MAYSI-2 scales, comparable to the USA norm-based ‘caution’ cut-off scores. For some MAYSI-2 scales, however, higher optimal ‘caution’ cut-off scores were found. Conclusions With adjusted optimal ‘caution’ cut-off scores, the MAYSI-2 screens potential emotional or behavioral problems well in a sample of Swiss youths in welfare and juvenile justice institutions. However, as for choosing the optimal ‘caution’ cut off score for the MAYSI-2, both language as well as gender seems to be of importance. The results of this study point to a compelling need to test the diagnostic performance and optimal ‘caution’ cut-off scores of the MAYSI-2 more elaborately in larger differentiated language samples in Europe.

The differentiation of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) poses a clinical challenge. In children, overlap of psychopathological and cognitive findings has been found for both disorders. In addition, some children suffer from both disorders. The Social Communication Questionnaire (SCQ) is a screening instrument for ASD symptoms which indicates the presence of ASD in a rapid and economic way. However, validity to differentiate ASD and ADHD as differential or comorbid diagnoses has not been studied. Here, the differential validity was compared in groups of children with ASD, ADHD, ASD + ADHD, and typically developing (TD) children and IQ > 70. ROC analyses indicated an excellent differentiation between ASD and TD with ROC–AUC = .941 and between ASD + ADHD with ROC–AUC = .993. The optimal cutoff was below the originally recommended one of 15. The differentiation between children with ASD with (ROC–AUC = .982) or without ADHD (ROC–AUC = .864) and ADHD alone also showed acceptable differential validity, and here, the optimal cutoff corresponded to the recommended. Taken together, the SCQ can be recommended as a screening instrument for a first differentiation between children with ASD and typically developing children as well as children with ADHD.

Background: Sleep reduction, resulting from insufficient or poor sleep, is a common phenomenon in adolescents. Due to its severe negative psychological and behavioral daytime consequences, it is important to have a short reliable and valid measure to assess symptoms of sleep reduction.Objective: This study aims to validate the Sleep Reduction Screening Questionnaire (SRSQ) that can be used to screen for symptoms of sleep reduction in adolescents.Methods: Various samples from the general and clinical populations were included in the study. The SRSQ is a nine-item questionnaire that is based on the longer, four dimensional Chronic Sleep Reduction Questionnaire (Meijer in J Sleep Res 17:395-405, doi:10.1111/j.1365-2869.2008.00677.x, 2008). Items were selected on the basis of principal components analysis, item-total correlations, and substantive consideration. The SRSQ was validated by calculating correlations with self-reported and objective sleep and self-reported daytime functioning. Cut-off scores were determined so that the SRSQ can be used as a screening instrument.Results: Internal consistencies of the SRSQ were good (Cronbach’s alpha = .79 in the general population). Correlations with self-reported sleep, daytime functioning and objective sleep variables were satisfactory and in the expected directions. The SRSQ discriminates well between clinical and non-clinical cases. When accounting for prevalence of sleep reduction symptoms in the general population, the area under the curve was .91, sensitivity was .80 and specificity was .87.Conclusions: The SRSQ appears to be a short reliable and valid questionnaire. Due to the limited number of items and the availability of cut-off scores, it is a practical tool for clinical and research purposes.

Introduction: With an increasing proportion of patients in need of end-of-life (EOL) care presenting to the emergency department (ED), many of these patients may benefit from early palliative care (PC) referral. In fact, early PC referral is one of the Choosing Wisely ED recommendations in the USA. As such, there is a potential benefit to identifying patients with advanced or end-stage illness with PC needs. The objective of this systematic review is to identify and synthesize the available evidence regarding the existence and psychometric properties of screening tools to identify patients with advanced or end-stage illness and PC needs presenting to EDs. Methods: A comprehensive search of eight electronic databases and the grey literature was conducted. Studies assessing the ability of a screening instrument to identify ED patients with advanced or end-stage illness in need of PC were eligible for inclusion. Two independent reviewers completed study selection, quality assessment, and data extraction. Disagreements were resolved through third-party adjudication. Due to the significant heterogeneity, as well as inconsistent outcome reporting, a descriptive summary of the results was completed. Results: Once duplicates were removed, the title and abstracts of 3516 studies were screened, of which, 15 studies were included. Overall, 10 unique screening instruments were assessed across the studies. The most commonly assessed screening tool was the use of the modified surprise question (SQ), in which physicians were asked if they would be surprised if the patient died within a specified period of time. Only four of the included studies assessed the diagnostic or psychometric properties of the screening tools. One study reported that the modified SQ predicted PC consultation with 35% sensitivity, 89% specificity, and a negative predictive value of 97%. The proportion of patients identified with PC needs ranged from 12% to 73%, with studies utilizing the SQ reporting a range of 12% to 33%. Conclusion: A variety of screening tools are available to identify ED patients with advanced or end-stage illness who would benefit from a referral for PC. While the modified SQ was the most common instrument assessed and appears to be simple to implement, it is unclear if the diagnostic and psychometric properties of this tool are sufficiently robust to warrant widespread implementation.

The Parental Concerns Questionnaire (PCQ) was designed as a parent-interview screening instrument for young children with developmental concerns at risk for potentially severe behavior problems (SBDs). Parents of 262 young children (4 to 48 months) answered to the 15 dichotomous PCQ items interviewed by trained staff. Cluster analysis for items revealed three item clusters, which we labeled Developmental/Social (8 items), Biomedical (3 items), and Behavior Problems (3 items). This paper discussed primarily the Behavior Problems cluster, with items referring to self-injurious, aggressive, and destructive behaviors. Parents' concerns about behavior problems were high, with item-endorsements of the Behavior Problems cluster ranging from 41.8 % to 68.8 %. The Behavior Problems cluster was significantly correlated with all three subscales of the Behavior Problems Inventory (BPI-01), with select subscales of the Aberrant Behavior Checklist (ABC), and with the Repetitive Behavior Scale-Revised (RBS-R) providing some evidence for concurrent validity. Sensitivity and specificity data were computed for the three PCQ items as well as for the cluster score in comparison with the BPI-01, ABC, and RBS-R showing strong sensitivity. The PCQ Behavior Problems cluster is a useful screening checklist with high sensitivity for potential SBDs in young children at-risk for developmental delays.

Item does not contain fulltext While child self-reports of psychopathology are increasingly accepted, little standardized instruments are utilized for these practices. The Berkeley Puppet Interview (BPI) is an age-appropriate instrument for self-reports of problem behavior by young children. Psychometric properties of the Dutch version of the BPI will be reported, specifically, test-retest reliability, intra-class correlations, congruent and concurrent validity. In a sample of 300 children (M (age) = 7.04 years, SD = 1.15), the BPI was administered twice, with a 1-year interval. Parents and teachers filled out questionnaires about their children's problem behavior. Findings from the analyses indicate that the BPI subscales have sufficient test-retest reliability and can be reliably coded. Furthermore, findings suggest adequate congruent validity. More support for concurrent validity is found among externalizing problems in comparison to internalizing problems. With regard to the present study, the BPI seems to have adequate psychometric properties. As such, the BPI enables interviewing young children about their psychopathology-related symptoms in a standardized way. The BPI could be applied in clinical practice as a complement to the diagnostic cycle, allowing children's self-reports to play an increasingly important role. 14 p.

There is a need for brief screening instruments for autistic spectrum disorders (ASD) that can be used by frontline healthcare professionals to aid in the decision as to whether an individual should be referred for a full diagnostic assessment. In this study we evaluated the ability of a short form of the autism spectrum quotient (AQ) questionnaire, the 10 item AQ-10, to correctly classify individuals as having or not having ASD. In a sample of 149 individuals with ASD and 134 controls without an ASD diagnosis, we found that the full AQ (AQ-50) abridged AQ (AQ-S) and AQ-10 all performed well as a screen for ASD. ROC analysis indicated that sensitivity, specificity and area under the curve were very similar at suggested cut-off's for ASD across measures, with little difference in performance between the AQ-10 and full AQ-50. Results indicate the potential usefulness of the AQ-10 as a brief screen for ASD.

Background: Persistent postsurgical pain can have a significant effect on the quality of life of women being treated for breast cancer. The aim of this prospective study was to develop a screening tool to identify presurgical demographic, psychological and treatment-related factors that predict persistence of significant pain in the operated area after 6 months from surgery. Methods: Background and self-reported questionnaire data were collected the day before surgery and combined with treatment-related data. Pain in the operated area was assessed 6 months after surgery with a questionnaire. The Bayesian model was used for the development of a screening tool. Results: Report of preoperative chronic pain, more than four or more previous operations, preoperative pain in the area to be operated, high body mass index, previous smoking and older age were included in the six-factor model that best predicted significant pain at the follow-up in the 489 women studied. Conclusion: A six-factor risk index was developed to estimate the risk of developing significant pain after breast cancer surgery. Neither treatment- nor mood-related variables were included in the model. Identification of risk factors may lead to prevention of persistent postsurgery pain. This tool could be used for target prevention to those who are at the highest risk of developing persistent postsurgery pain.

Low-intensity laser therapy (LILT) has been considered as a treatment modality in diabetic distal symmetric polyneuropathy (DSP). The aim of this study is to determine the effectiveness of LILT on DSP. We examined 107 subjects with type 2 diabetes for detection of DSP using the Michigan Neuropathy Screening Instrument (MNSI). Seventeen subjects were eligible to be enrolled in the study. Nerve conduction studies (NCS) were performed in all eligible subjects as an objective method to confirm neuropathy. The participants received LILT three times a week for ten sessions. NCSs were reevaluated after completion of the treatment. The absolute changes in NCS parameters were considered to establish the effectiveness of the treatment. Baseline demographics were similar in all participants. The mean differences of NCV parameters were considered for comparison. At the end of the study, the subjects showed a significant increase in neural potential amplitudes (p < 0.05). This study clearly demonstrated a significant positive effect of LILT on improvement of nerve conduction velocity on diabetic distal symmetric polyneuropathy (DSP). This finding supports the therapeutic potential of LILT in DSP.

Youth delinquents and mental complaints: A study with the revised Massachusetts Youth Screening Instrument (MAYSI-2) with Flemish juvenile boys International research indicates that psychopathology is more common in juvenile delinquents compared to the general population. Research in Belgium is scarce. We screened for mental problems with the Massachusetts Youth Screening Instrument-Second Version (MAISY) in 67 juvenile male delinquents and 96 regular school going boys. The results showed that juvenile delinquents scored significantly higher than school going youth on all the MAYSI-2 scales with exception of the somatic complaints scale. In four of the six scales (Alcohol/Drug Use, Angry/Irritable, Depressed/Anxious and Suicide Ideation) the juvenile delinquents scored more often in the ‘caution zone’ that requires clinical attention. The results indicate that psychopathology prevalence is significantly elevated in Belgian juvenile delinquents compared to school going youth. Instruments such as the MAYSI-2 can be useful to screen for mental problems and timely initiation of treatment.

Contains fulltext : 71068.pdf (Publisher’s version ) (Closed access) BACKGROUND: The heterogeneity of patients regarding pain-related cognitive-behavioral mechanisms, such as pain-avoidance and pain-persistence patterns, has been proposed to underlie varying treatment outcomes in patients with fibromyalgia (FM). PURPOSE: To investigate the validity of a screening instrument to discriminate between pain-persistence and pain-avoidance patterns in FM. METHOD: In a three-part study, a self-reported screening instrument that assesses pain-avoidance behavior was used to distinguish patients with pain-persistence and pain-avoidance patterns. The resultant groups were compared with regard to several pain-related cognitive-behavioral factors, performance on a physical fitness test, and with regard to the judgments of trained therapists based on a semi-structured interview. RESULTS: The validity of the screening instrument to distinguish between pain-avoidance and pain-persistence patterns was supported by other validated self-report questionnaires for pain-related cognitive-behavioral factors, physical exercise tests, as well as by a high correspondence with blinded therapist judgment after intake assessments. CONCLUSION: These findings suggest that a short self-report screening instrument can be used to distinguish between pain-avoidance and pain-persistence patterns within the heterogeneous population of FM patients, which offers promising possibilities to improve treatment efficacy by tailoring treatment to specific patient patterns.

FRAGESTELLUNG: Die fruhe Diagnose entzundlich-rheumatischer Erkrankungen (entz.-rh. E.) ist entscheidend fur die Prognose. Zwischen Symptombeginn und rheumatologischer Erstvorstellung liegen in Deutschland ca. 1 bis 5 Jahre. Der Einsatz von Patientenfragebogen fur die Fruherkennung entz.-rh. E., deren Effizienz in anderen Landern bereits gezeigt wurde, konnte die Situation verbessern. Ziel unserer Arbeit war daher die Entwicklung eines patienten-bezogenen, deutschsprachigen Messinstrumentes mit hoher Sensitivitat und Spezifitat sowie hohem pradiktivem Wert fur entz.-rh. Erkrankungen. PATIENTEN UND METHODEN: Auf der Basis des FDA-anerkannten Connective Tissue Disease Screening Questionnaire (CSQ) Fragebogens entstand der Rheuma Check-Fragebogen. 1448 Patienten (195 ohne, 437 mit Verdacht auf und 816 mit gesicherter entz.-rh. E.) in rheumatologischen und allgemein-internistischen Kliniken und Praxen beantworteten den entwickelten Rheuma Check-Fragebogen, der auch Begleiterkrankungen und soziodemographische Daten erfasst. Ein Auswertungsalgorithmus wurde entwickelt. ERGEBNISSE: Das mittlere Alter des Gesamtkollektivs betrug 52,5 ± 15,1 Jahre, 73,1% waren Frauen. 53,1% hatten keine Begleiterkrankung. Der RheumaCheck zeigt eine hohe Sensitivitat (77,6%) und Spezifitat (79,9%), die Flache unter der ROC-Kurve betrug 0,85 (p < 0,001). FOLGERUNG: Trotz einer zu erwartenden hohen Zahl falsch positiver Ergebnisse bei der breiten Anwendung auf der Bevolkerungsebene konnen mit dem RheumaCheck, einem einfachen, kostengunstigen Messinstrument, Patienten, die eine facharztliche rheumatologische Abklarung benotigen, fruhzeitiger identifiziert und schneller als bislang zur Diagnose und Therapie gefuhrt werden. Auf www.rheuma-check.de steht er kostenfrei zur Verfugung.

One of the earliest instruments to screen for problem gambling, the Twenty Questions (20Q), was developed within Gamblers Anonymous. This instrument has not received serious research attention, however, and its psychometric properties are generally unknown. This study reports reliability and validity data for this instrument in 3 independent samples totaling 456 participants: two samples of problem gamblers in treatment and a non-treatment sample of problem gamblers. The Twenty Questions was shown to possess high reliability as measured by Cronbach’s alpha. Concurrent, convergent and predictive validity of the 20Q supported the use of this instrument as an acceptable screening instrument. Classification analyses indicated that the 20Q is comparable to the DSM-IV diagnostic criteria for pathological gambling in specificity, sensitivity and rates of false negatives and false positives. The 20Q appears to be a reliable and valid measure of problem gambling and warrants continued research attention.

This study empirically evaluates the value of the psychiatric section of the Addiction Severity Index (ASI) as a screening instrument for non-substance use Axis-I psychiatric disorders. Data were from a diverse sample of 672 recently admitted patients to inpatient, residential, and outpatient substance abuse treatment. ASI psychiatric summary scale scores and SCID-III-R results were subjected to Receiver Operating Characteristics analyses to determine how well the ASI identified participants with/out a co-occurring psychiatric disorder. Diagnostic detection using the ASI psychiatric scales was good: ASI Interviewer Severity Ratings (ISRs) yielded 81% sensitivity and 53% specificity (C = 0.73); ASI Clinical Factors (CFs), 85% sensitivity and 55% specificity (C = 0.78); ASI Composite Scores (CSs), 80% sensitivity and 60% specificity (C = 0.76); ASI Evaluation Indices (EIs), 80% sensitivity and 60% specificity (C = 0.75). Separate analyses by gender generated very similar results. Clinical implications and applications as well as further research directions are discussed.

Peripheral neuropathy is a common complication of diabetes mellitus. In the EURODIAB study, total cholesterol and triglycerides were associated to peripheral diabetic neuropathy (PDN). The study’s aim was to evaluate the influence of cholesterol, triglycerides and statin use on a clinical score of peripheral neuropathy in patients with diabetes mellitus. Ninety patients at a university hospital in Manaus, Brazil were included in this study. They were evaluated using Michigan Neuropathy Screening Instrument (MNSI) and the clinical component of the Michigan Diabetic Neuropathy Score (MDNS). According to MDNS clinical component, 20 (22.2%) patients had PDN and compared to those patients who did not have PDN, they had more time of diabetes diagnosis (16.2 ± 11.3 vs. 10.2 ± 8.6 years), more stroke (15 vs. 3%), more insulin use (75.0 vs. 48.6%) and also higher serum urea levels. When considering only the 65 (72.2%) patients with serum urea below 50 mg/dl, there was a positive correlation between total cholesterol and MDNS (r=0.2580, p

Background MNSI is widely used for evaluation of distal symmetric peripheral polyneuropathy (PPN) in individuals with diabetes. In the DCCT/EDIC study, the MNSI was validated for screening of signs and symptoms of PPN, presenting, for a cutoff of ≥2.5, sensitivity of 61%, specificity of 79%, positive predictive value (PPV) of 55% and negative (NPV) of 83%, when compared to neurological examination in combination with nerve conduction studies as gold standard. Objective To evaluate the sensitivity, specificity, PPV, NPV and accuracy of Neuropathy Diabetes Score (NDS) (≥3.0) compared to MNSI score, used as the gold standard.

Materials and methods This study was carried out in the Diamantina, Minas Gerais-Brazil. This is a prospective study conducted in 27 volunteers, 5 diagnosed as type 1 diabetes (DM1), 10 as type 2 diabetes (DM2). All volunteers underwent a protocol with detailed clinical examination, glycemic index, muscle strength, balance and dynamic mobility, and sensitivity of the feet using the Michigan Neuropathy Screening Instrument and Semmes-Weinstein Monofilaments. After collecting data, Results of both groups were compared with their controls.

Background Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment. Methods We applied two algorithms from machine learning and data mining ― the LASSO and the random forest ― to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada. Results Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not. Conclusions Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.

Background Current evidence suggests that screening and brief intervention (SBI) programs can be effective at reducing risky alcohol consumption. While validity and reliability have been demonstrated for existing screening instruments, little is known about how the diagnostic properties of an instrument influence the cost-effectiveness of SBI. We develop a decision theoretic framework to model this issue, and to measure the potential improvement in cost-effectiveness that could result from changes in screening instrument properties and other factors associated with SBI.

The aim of this study was to use the Eating Attitudes Test-26 (EAT-26) as a screening instrument on a specific population with a marked prevalence of binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). The EAT-26 questionnaire was used in order to identify the high-risk subjects for referral to clinical evaluation. EAT-26 was administered to 845 subjects who, for the first time, came to the Nutritional Medicine Service looking for a diet between January 1999 and December 2002. From this initial sample, subsequently, 250 subjects were randomly selected and administered a semistructured clinical interview for DSM-IV (SCID I, version 2.0). Discriminant analysis provided a cutoff value of EAT-26=11. Logistic regression analysis indicated high Dieting (D) or Bulimia (B) subscale scores as a risk factor of EDNOS or bulimia nervosa (BN) cases, respectively; on the other hand, a high Oral Control (O) subscale score represented a protecting factor for BED cases. Our study tried to assess the usefulness of EAT-26 as a screening instrument for obese patients attending a Medical Nutritional Service. Results from this study suggest that a cutoff score of 11, lower than that indicated in the literature, improves the diagnostic accuracy of the EAT-26 in a high-risk setting regarding sensibility level (68.1%) and leading to a reduction of the false negative rate (31.9%).

This study evaluated a brief screening instrument for predicting psychological distress in patients undertaking magnetic resonance imaging (MRI) scans. The scale is adapted from Wolpe and Lang’s (1964) Fear Survey Schedule (FSS; see Lukins, Davan, & Drummond, 1997). Noise and/or confinement were identified as the most unpleasant feature of the MRI by 48.3% of 118 outpatients. The MRI-FSS (Lukins et al., 1997; 9 items) significantly predicted the number of panic attack symptoms and state anxiety experienced during MRI scan better than a range of other measures. There was a significant increase in MRI-FSS scores from prescan to postscan among those who experienced high levels of anxiety during the scan. The MRI-FSS appears to be a useful indicator of likely adverse psychological reactions in the MRI scan that is sensitive to the sequelae of the MRI procedure.

Despite the prevalence of psychiatric disorders in medical settings, mental health problems often go undetected and patients do not receive appropriate treatment. The main goal of this study is to provide additional information about the Beck Anxiety Inventory – Primary Care (BAI–PC), a brief instrument that screens for patients with anxiety. This study provides information on the performance of the BAI–PC as a screening instrument for depression and PTSD in addition to its original purpose as a screening instrument for anxiety. This efficient tool can identify patients who can benefit from effective psychological treatments and facilitate referrals to psychologists working in medical settings.

The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments critically in relation to its construct validity and cutoff scores. Reference is made to the use of the SOGS in the Australian setting, where historically gambling has been a widely accepted part of the culture, corresponding to one of the highest rates of legalised gambling and gambling expenditure in the world. An alternative approach to the development of an instrument to detect people who have problems in relation to gambling is proposed.

The study was conducted on 957 school children using Rutter B scale which was to be completed by the class teachers in Ludhiana, India. One hundred and forty-one children (14.6%) scored more than 9 points and were included in the second part of the study. An equal number of sex matched children scoring less than 9 points served as controls. Both these groups were called for an interview with a child psychiatrist along with their parents. Only 117 and 124 children turned up and were included in the analysis. Based on the screening instrument results and parental interview, 45.6% of the children were estimated to have behavioural problems, of which 36.5% had significant problems. It was noticed that neither the screening instrument nor the interview was able to detect all the problems. Scholastic under-achievement was found to be associated with maximum problems. Scholastic under-achievement can be a useful starting point of identifying children with behavioural problems. Close cooperation between school teachers, parents, and health care providers is essential to ensure healthy development of children.

The Clubhouse Research and Evaluation Screening Survey (CRESS) is a brief instrument designed to predict clubhouse readiness for certification assessment and, hence, performance in regard to expected model outcomes. The development of CRESS provides a practical example of the methodological challenges involved in creating a brief and valid screening instrument. Developed over a period of 5 years, CRESS is grounded in a series of workgroups, surveys, and pilot studies conducted by Fountain House and the International Center for Clubhouse Development (ICCD) in New York City. CRESS is shown to have criterion-oriented validity for the measurement of ICCD clubhouse model-related performance, as well as demonstrated ease in administration to a national sample of mental health programs.

The present study provided psychometric data on the KID-SAVE, an empirically based measure of children's exposure to community violence. The KID-SAVE was administered to 470 inner-city children in the third through seventh grades and demonstrated excellent reliability. Factor analysis yielded three subscales: Traumatic Violence, Indirect Violence, and Physical/Verbal Abuse. Initial investigation of construct validity suggested that the KID-SAVE successfully discriminated between groups of children reporting high and low levels of traumatic symptoms. The KID-SAVE appears to be a promising assessment tool and allows for quantification of the severity of violence exposure.

The Parent Questionnaire (scale A2), the Teacher Questionnaire (scale B2) by Rutter, and the Children's Depression Inventory (CDI) were validated using ROC-analysis. The material was collected from an epidemiological study of a normal population of 5664 8-9 year-old children. The screening results were compared with the corresponding parent, teacher, and child (DISC) interviews. In addition to this traditional way of validating the combined interview, results from all three interviews were also used. We found that the Teacher Questionnaire scale B2 was the most valid, and had the best overall power to discriminate psychiatric disturbances. The Teacher Questionnaire (scale B2) may be recommended when screening child psychiatric disturbances. The Parent Questionnaire (scale A2) was also found to be a valid instrument. Our results do not support the use of CDI as a sole screening instrument of psychiatric disturbances in children.

Existing screening instruments address adolescent health from a pediatric / public health perspective. We developed a school based screening instrument (the JWHS-76) for high schools measuring multiple health related domains from a child psychiatric viewpoint. We studied 1769 students in two suburban high schools (48% girls, mean age 16, predominantly white). Factor analyses revealed five coherent factors: general risk taking, mental health problems, sex related risks, eating and dietary problems, and general health problems. Analyses by gender, age and coping style revealed significant and consistent associations. The JWHS-76 is supported by preliminary evidence as a valid screening instrument in high school.

The authors present a psychometric study of the questionnaire proposed by the Gamblers Anonymous organization for the self-assessment of problem gambling. The study was carried out in Spain with two samples: one of 127 problem gamblers (mean age: 41.67; sex: 78.7% men; mean duration of the problem: 5 years) and the other of 142 social gamblers (mean age: 38.46; sex: 60% men). The questionnaire was self-applied, in the presence of one of the investigators in case any doubts arose. The results indicate that it is a good screening instrument, with high reliability (Cronbach's alpha = 0.94), good covergent validity (the correlation with the SOGS questionnaire is high (r = 0.94; p < 0.001)), good factorial validity (the questionnaire's structure is unidimensional and coherent (just one factor explains more than 50% of the variance)), and its discriminative power is high (diagnostic efficacy = 98.88%). The study offers a comparative analysis of this instrument with other measures of problem gambling, emphasizing its extraordinary performance.

This article describes the process of evaluating the social competence of developmentally disabled (DD) adolescents who were referred for group therapy and which, in turn, led to the development of the GAF: The Group Assessment Form. The GAF allows for a more organized and in-depth understanding of a particular adolescent's social function. A description of a group treatment program servicing developmentally disabled adolescents and a definition of the term DD follows. Features and benefits of the GAF are discussed, including a symptom rating scale which involves frequency ratings on specific problem social behaviors as reported by the parent and the adolescent, thereby allowing for qualitative comparisons. The article concludes with an outline of additional clinical uses, such as its value as an instructional guide for beginning group leaders during their traineeship and as an aid in clarifying group treatment expectations and goals, thereby preventing possible premature termination.

Background The aim of this study is to investigate the psychometric properties and the perceived usefulness of the BARO (Dutch: BAsisRaadsOnderzoek; Protection Board Preliminary Examination of Juvenile Suspects). The BARO is a first-line screening instrument for the identification of psychiatric disorders, adverse environmental factors, and levels of (dys)function in adolescent offenders (age 12 to 18), to be used by social workers of the Child Protection Board (CPB) following a police arrest. Method CPB workers administered the BARO to 295 juvenile offenders (91% boys, 9% girls). A subgroup of 66 offenders (89% boys, 11% girls) underwent an elaborate diagnostic assessment by forensic psychologists and psychiatrists. Using these assessments the most relevant psychometric properties of the BARO were studied. The perceived usefulness was studied using questionnaires to be filled in by the CPB social workers. Results The internal consistency of the instrument was sufficient to good, the concurrent validity of the CPB social workers applying the BARO and the forensic experts carrying out the comprehensive diagnostic assessment was strong, the discriminatory value of the instrument was moderate to strong, and the perceived usefulness of the instrument was evaluated as good to very good by the majority of the CPB workers. Discussion The BARO has sufficient to good psychometric properties including moderate to strong discriminatory value and is considered a good screening instrument by the CPB social workers. In conclusion, the BARO seems to be a very promising first-line screening instrument to identify psychiatric and psychosocial problems in young offenders.

Background Cognitive tests have been used in population surveys as first stage screens for dementia but are biased by education. However functional ability scales are less biased by education than the cognitive scale and thus can be used in screening for dementia. Objective To validate Activities of Daily Living (ADL) scale appropriate for use in assessing the presence of dementia in an elderly population living in care homes in Sri Lanka. Method Sinhalese version of the modified Bristol and Blessed scale was administered to subjects aged 55 years and above residing in 14 randomly selected elders' homes. Receiver Operating Characteristic (ROC) was used to determine the cut-off scores of both the scales. Results Based on the ROC analysis, optimal cut off score of the modified Bristol scale was 20 with a sensitivity of 100%, specificity of 74.2% and the area under the curve 0.933(95% CI: 0.871-0.995) while the optimal cut off score of the modified Blessed scale was 10.5 with a sensitivity of 100%, specificity of 71% and the area under the curve 0.892 (95% CI: 0.816-0.967). Conclusion The findings confirm that both the scales can be used in screening for dementia in the elderly living in care homes in Sri Lanka.

Background We tested the validity of the SCOFF, a five-question screening instrument for eating disorders, in a general population sample. Methods A random sample of 1863 Finnish young adults was approached with a questionnaire that contained several screens for mental health interview, including the SCOFF. The questionnaire was returned by 1316 persons. All screen positives and a random sample of screen negatives were invited to SCID interview. Altogether 541 subjects participated in the SCID interview and had filled in the SCOFF questionnaire. We investigated the validity of the SCOFF in detecting current eating disorders by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for different cut-off scores. We also performed a ROC analysis based on these 541 persons, of whom nine had current eating disorder. Results The threshold of two positive answers presented the best ability to detect eating disorders, with a sensitivity of 77.8%, a specificity of 87.6%, a PPV of 9.7%, and a NPV of 99.6%. None of the subjects with current eating disorder scored zero points in the SCOFF. Conclusion Due to its low PPV, there are limitations in using the SCOFF as a screening instrument in unselected population samples. However, it might be used for ruling out the possibility of eating disorders.

Background A substance use screening instrument was used to determine factors predictive of drinking during pregnancy. Alcohol consumption during pregnancy can lead to negative birth outcomes. Methods The participants (n = 4,828) for the study were sampled from pregnant women attending prenatal clinics in Montana, South Dakota, and North Dakota. Clinic sites for the administration of the screening instrument were selected in each state, based on geographic and known population characteristics. Univariate and multivariate statistical procedures were used to determine factors predictive of drinking during pregnancy. Results Women who drank tended to: be single, be between 21–25 years old, have had fewer children, have had abortions, and be unemployed. Demographic factors that were protective of drinking when pregnant were married and full-time housewife status. Other variables associated with maternal alcohol use were: past sexual abuse, current or past physical abuse, tobacco use, other drug use, lived with substance users, and had mates who were substance users. Other contributing factors for alcohol use included: feeling sad, believing that drinking any amount of alcohol while pregnant was acceptable, had been in treatment, could use treatment now, and were able to hold four or more drinks. Conclusion Because drinking rates were high and factors correlated with drinking are known, alcohol screening for this population is essential.

Population-based alcohol screening is recommended in primary care, and increasingly incentivized by policies, yet is challenging to implement. The U.S. Veterans Health Administration (VA) achieved high rates of screening using a national performance measure and associated electronic clinical reminder to prompt and facilitate screening and document results. However, the sensitivity of alcohol screening for identifying unhealthy alcohol use is low in VA clinics.We aimed to understand factors that might contribute to low sensitivity of alcohol screening.This was an observational, qualitative study.Participants included clinical staff responsible for conducting alcohol screening and nine independently managed primary care clinics of a single VA medical center in the Northwestern U.S.Four researchers observed clinical staff as they conducted alcohol screening. Observers took handwritten notes, which were transcribed and coded iteratively. Template analysis identified a priori and emergent themes.We observed 72 instances of alcohol screening conducted by 31 participating staff. Observations confirmed known challenges to implementation of care using clinical reminders, including workflow and flexibility limitations. Three themes specific to alcohol screening emerged. First, most observed screening was conducted verbally, guided by the clinical reminder, although some variability in approaches to screening (e.g., paper-based or laminate-based screening) was observed. Second, specific verbal screening practices that might contribute to low sensitivity of clinical screening were identified, including conducting non-verbatim screening and making inferences, assumptions, and/or suggestions to input responses. Third, staff introduced and adapted screening questions to enhance patient comfort.This qualitative study in nine clinics found that implementation of alcohol screening facilitated by a clinical reminder resulted primarily in verbal screening in which questions were not asked vertbatim and were otherwise adapted. Non-verbal approaches to screening, or patient self-administration, may enhance validity and standardization of screening while simultaneously addressing limitations of the clinical reminder and issues related to perceived discomfort.

Multiple studies are reporting linkage to regions on chromosomes 2 and 4 for alcoholism phenotypes. The linkage appears to be robust to both sample ascertainment and phenotype measurement. In a recent paper, Wilhelmsen et al1 reported linkage to regions on chromosomes 2 and 4 for quantitative phenotypes related to alcoholism. Using families from a sample selected for heavy smoking, linkage analyses were conducted for the total score on a commonly used screening instrument for alcoholism (the CAGE questionnaire) as well as measures of the quantity and frequency of drinking. Three different measures all resulted in peaks on chromosome 2 at 43 cM, with the LOD scores ranging between 2.0 and 3.4. This region on chromosome 2 has been linked with alcohol dependence in a report by the Collaborative Study on the Genetics of Alcoholism (COGA) group2 and is near a linkage peak reported in an analysis of heavy drinkers from the Framingham Heart Study.3

Background: A previous Q-methodological study revealed four distinct preference profiles for health care delivery and self-management: ‘Conscious & Compliant’; ‘Backseat Patient’; ‘Self-confident & Autonomous’; and ‘Worried & Insecure’. Aim: Methods: Web-survey among all chronic patients (12-19 yrs) of a paediatric hospital and their parents. Adolescents' fit to the Abbreviated QCP descriptions was scored on a five-point Likert-scale. Results: 990 adolescents and 778 parents responded. Adolescents recognize themselves twice as often in the ‘Conscious & Compliant’ profile than in the other profiles. Fit to any of the profiles is associated with age, gender, quality of life, impact of disease, self-efficacy, independent behaviour and readiness for transition. While the ‘Backseat Patient’ and the ‘Worried & Insecure’ type feel less self-efficacious, the ‘Self-confident & Autonomous’ type is at risk for non-adherence. Parents & children's assessments correspond fairly well, but there are significant differences. Conclusions: The Q-care profiles are recognizable to adolescents and parents, and they discriminate fairly well. The QCP seem potentially suitable to stimulate communication with adolescents. A practical manual for use of QCP during consultations was developed, including tips for interventions to be used by healthcare providers to address typical problems associated with each profile. Further research into the applicability of this new tool and the possibility to use the Q-care profiles as a screening instrument for self-management failure is now underway.

Objective To compare the utility of two brief cognitive screening instruments in patients with HD. Background The most commonly used brief screening instrument for cognitive impairment is the MMSE; however, the Montreal Cognitive Assessment (MoCA) contains the same number of total points as the MMSE, requires about 10 minutes to administer, and may be more sensitive to cognitive changes in patients with HD. Correlation between these brief screening instruments and other cognitive and functional measures in HD is largely unknown. Methods The MMSE and MoCA were administered on the same day in counterbalanced order to 73 subjects with HD. Associations between MoCA and MMSE with motor, functional, and other cognitive variables were evaluated by Spearman rank correlations. Results Scores on the MoCA (mean = 19.2 ± 5.4, range 2-29) were consistently lower, with greater range, than those on the MMSE (mean = 23.5 ± 4.3, range 8-30) for the HD subjects whose mean age and education were 50.7 and 13.9 years, respectively. Mean motor UHDRS = 38.2 ± 16.4; mean Independence Scale (IS) = 68.4 ± 10.1; and mean Total Functional Capacity (TFC) = 6.4 ± 2.0. MoCA score correlated with UHDRS (r = −0.47), IS (r = 0.58), and TFC (r = 0.52) (all p Conclusions Our results suggest that the MoCA may show increased sensitivity to cognitive deficits and better correlation with other cognitive and functional measures than the MMSE in patients with HD. Larger studies will be needed to confirm and extend these findings.

Differentiating autism from other handicapping conditions, especially mental retardation, has been a constant problem for public schools. This study investigated the effectiveness of three instruments to discriminate autistic from trainable mentally retarded children. The Autism Screening Instrument for Educational Planning, the Childhood Autism Rating Scale, and the Diagnostic Checklist for Behavior Disturbed Children, Form E-2 were administered to 20 autistic and 20 TMR students. Discriminant analysis was used to determine the best linear combination of scores that would separate the two groups of children. All three instruments were found to separate the two samples of children. However, the CARS and the ASIEP provided for a greater separation of groups.