For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to (...) review outcome measures for use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

Patient-reported outcome measures (PROMs) are increasingly used to assess multiple facets of healthcare, including effectiveness, side effects of treatment, symptoms, health care needs, quality of care, and the evaluation of health care options. There are thousands of these measures and yet there is very little discussion of their theoretical underpinnings. In her 2008 Presidential address to the Society for Quality of Life Research (ISOQoL), Professor Donna Lamping challenged researchers to grapple with the theoretical issues that arise from (...) these measures. In this paper, I attempt to do so by arguing for an analogy between PROMs and Hans-Georg Gadamer’s logic of question and answer. While researchers readily admit that the constructs involved in PROMs are imperfectly understood and lack a gold standard, they often ignore the consequences of this fact. Gadamer’s work on questions and their importance to philosophical hermeneutics helps to show that the questions researchers ask about such constructs are also imperfectly understood. I argue that these questions should not be standardized, and I instead propose a theoretical framework that understands PROMs as posing genuine questions to respondents—questions that are open to reinterpretation. (shrink)

If we cross-classify the absolutist-consequentialist distinction with an intuitive-analytical one we can see that economists probably attract the hostility of those in the other three cells as a result of being analytical consequentialists, as much as because of their concern with “costs”. Suggesting that some sources of utility are to be regarded as rights cannot, says the analytical consequentialist, overcome the fact that fulfilling and respecting rights is a resource-consuming activity, one that will inevitably have consequences, in resource-constrained situations, for (...) the fulfilment of the rights of others. Within the analytical consequentialist framework QALY-type measures of health outcome have the unique advantage of allowing technical and allocative efficiency to be addressed simultaneously, while differential weighting of QALYs accruing to different groups means that efficiency and equity can be merged into the necessary single maximand. But what if such key concepts of the analytical consequentialist are not part of the discursive equipment of others? Are they to be disqualified from using them on this ground? Is it ethical for intuition to be privileged in ethical discourse, or is the analyst entitled to “equal opportunities” in the face of “analysisism”, the cognitive equivalent of “racism” and “sexism”? (shrink)

This paper considers the use of outcome measures in the British National Health Service (NHS). Measuring outcomes is a major conceptual and practical problem. Many different measures are currently available yet no consensus has been reached on which should be preferred over others, or about which should take priority when they conflict. Some currently used measures are described, the relationship between these measures and the measured activities are discussed, and fundamental problems with both the measures and their use (...) are revealed. It is shown that however assiduous the search, the ‘perfect’ outcome measure will always remain elusive. (shrink)

Introduction: Moral injury involves the adverse psychological, biological, spiritual, behavioural, and social consequences of actions that violate moral values. It can lead to anxiety, depression, burnout, and post-traumatic stress disorder. Nurses, who often face ethical dilemmas, are particularly vulnerable. Despite its significance, the relationship between moral injury and mental health outcomes in nurses remains underexplored. Aim: This systematic review aimed to describe the associations among moral injury, anxiety, depression, and quality of life in nurses. Methods: The review was registered (...) in PROSPERO (CRD42023438731) and was conducted following the PRISMA guidelines. A literature search was performed in December 2023 across PubMed, CINAHL, Scopus, and Web of Science. Peer-reviewed primary research involving nurses, published in English or Italian, without time restrictions, was considered eligible. The risk of bias and the quality of evidence were assessed using the Joanna Briggs Institute checklist and the GRADE approach. Results: Out of 4730 articles identified, eight met the inclusion criteria. The analysis revealed significant positive associations between moral injury, anxiety, and depression, along with a significant negative association with quality of life. Conclusion: These findings highlight the need for healthcare systems to implement strategies that mitigate moral injury among nurses. Future research should prioritize longitudinal studies to explore causal relationships and develop targeted interventions. Additionally, standardizing the concept and measurements of moral injury is crucial for enhancing the comparability and understanding of this phenomenon. (shrink)

Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions (PPIs) to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on (...) positive emotion outcomes. We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes. (shrink)

Infections and deaths associated with COVID-19 show a high degree of heterogeneity across different populations. A thorough understanding of population-level predictors of such outcomes is crucial for devising better-targeted and more appropriate public health preparedness measures. While demographic, economic, and health-system capacity have featured prominently in recent work, cultural, and behavioral characteristics have largely been overlooked. However, cultural differences shape both the public policy response and individuals' behavioral responses to the crisis in ways that can impact infection dynamics (...) and key health outcomes. To address this gap, we used meta-analytic methods to explore the global variability of three public health outcomes during the first wave of the pandemic. This set of analyses identified several cultural/behavioral attributes as independent predictors of public health outcomes after adjusting for key demographic, political, economic, and health-system-related predictors; which were robust in sensitivity analyses. In conclusion, this study clearly demonstrates that cultural attributes do in fact account for some of the global disparities in COVID-19-attributed health outcomes. As a consequence, policymakers should more explicitly consider a society's cultural attributes alongside other important parameters such as demographic characteristics and health system constraints in order to develop better tailored and more effective policy responses. (shrink)

The coronavirus disease 2019 pandemic had a negative psychological impact on the population at scale, yet it is possible that vulnerable patient populations may experience a heavier burden with increased feelings of anxiety and distress. Cancer patients have to trade-off between the fear of exposing themselves to the virus and the need to continue life-saving medical procedures. The present study investigated the prevalence of generalized anxiety and post-traumatic stress symptoms in a population of Italian cancer patients and healthy participants in (...) the months following the COVID-19 outbreak. Using standardized measures of PTSS and generalized anxiety, we found that patients experienced higher levels of adverse mental health outcomes. Several variables were found to negatively affect PTSS and anxiety in this population, including the younger age of respondents, having children, and the impossibility to attend regular medical check-ups. These findings stress the importance of maintaining a clear and regular communication with patients throughout future waves of the pandemic and ensure continuity of care in this vulnerable population. Furthermore, this study indicates the need to establish psychological interventions aimed at patients with cancer, targeting especially younger generations who are more likely to experience adverse psychological outcomes. (shrink)

In recent decades, social and behavioral scientists have begun to explore how and why human beings thrive or flourish and to consider whether traits indicative of thriving or flourishing may themselves influence physical well-being. This stands in contrast to the historical tendency in these fields to focus on pathology: mental illness, psychological dysfunction, deviant behavior, social problems, and so on. In epidemiology, too, the influence of pathology is seen in a tacit emphasis on risk factors for disease outcomes and for (...) rates of morbidity and mortality, as opposed to, say, protective factors promotive of good health. Methodologically, there is nothing substantial that would prohibit looking at the world... (shrink)

ObjectivesThe purpose of the current study was to examine whether a self-report measure identifies prenatal substance use and predicts resulting adverse birth outcomes in a large cohort using electronic medical records.MethodsPregnant patients who were admitted between 2014 and 2015 at Christiana Care Health System and delivered singleton birth were included in the analyses. Participant demographic information, pregnancy comorbidities, self-reported substance use, and birth outcomes were retrieved from electronic medical records. Detailed descriptive analyses of prenatal substance use were conducted, and (...) logistic models were evaluated for the associations between substance use and each birth outcome.ResultsThe average maternal age was 30 years, 37% receiving Medicaid. Over 58% were White, 26% were Black, and 13% were Hispanic. Cigarette smoking only showed the highest prevalence among substance u... (shrink)

Patient-reported outcome measures are now common endpoints in clinical trials. In 2009 in an effort to standardize and streamline their use in medical product labeling, the FDA published FDA Guidance for Industry Patient-Reported Outcomes Measures: Use in Medical Product Development to Support Labeling Claims. This publication drew attention to the need to ensure that PROMs are methodologically sound. Nonetheless, in this paper I discuss how many of these measures continue to fall short in terms of validity, interpretability, and responsiveness. (...) As a reaction to these shortcomings, researchers increasingly call for the development of more scientific measures. I argue that although improving PROMs’ measurement properties is a worthy endeavor, we should not be uncritical of these attempts. Calling for improved measures in the name of science should not blind us to the way that even our best measures employ values in their development—values that may further the marketing needs of industry. When values are needed to further our scientific ends, it behooves us to examine them in terms of their social consequences. Thus I argue that we ought to consider not only the scientific advances that new PROMs may bring but also the values that are used to develop them. (shrink)

The first 1000 days of life, from conception to 2 years, are a critical window for the influence of environmental exposures on the assembly of the oral microbiome, which is the precursor to dental caries (decay), one of the most prevalent microbially induced disorders worldwide. While it is known that the human microbiome is susceptible to environmental exposures, there is limited understanding of the impact of prenatal and early childhood exposures on the oral microbiome trajectory and oral health. A (...) barrier has been the lack of technology to directly measure the foetal "exposome", which includes nutritional and toxic exposures crossing the placenta. Another barrier has been the lack of statistical methods to account for the high dimensional data generated by‐omic assays. Through identifying which early life exposures influence the oral microbiome and modify oral health, these findings can be translated into interventions to reduce dental decay prevalence. (shrink)

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health (...) care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of “listening” to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome. (shrink)

The current manner of practicing chaplaincy in health care is one which prizes the multi-faith chaplain. When one asks multi-faith chaplain, “To whom are you beholden?” they will respond, “The patient.” This is evident in the way that chaplaincy is currently practiced and taught, which prizes the use of psychology over recourse to theology. Chaplaincy’s recourse to practices whose aims are directed toward the efficient rather than the eternal challenges its original telos. This paper looks at this question by (...) blending a Catholic and Engelhardtian approach to conclude that chaplains should recognize that they are beholden to God, rather than to patients’ autonomy. (shrink)

This study explored calibrating a large item bank for use in multidimensional health measurement with computerized adaptive testing, using both item responses and response time (RT) information. The Activity Measure for Post-Acute Care is a patient-reported outcomes measure comprised of three correlated scales (Applied Cognition, Daily Activities, and Mobility). All items from each scale are Likert type, so that a respondent chooses a response from an ordered set of four response options. The most appropriate item response theory model (...) for analyzing and scoring these items is the multidimensional graded response model (MGRM). During the field testing of the items, an interviewer read each item to a patient and recorded, on a tablet computer, the patient’s responses and the software recorded RTs. Due to the large item bank with over 300 items, data collection was conducted in four batches with a common set of anchor items to link the scale. Van der Linden’s (2007) hierarchical modeling framework was adopted. Several models, with or without interviewer as a covariate and with or without interaction between interviewer and items, were compared for each batch of data. It was found that the model with the interaction between interviewer and item, when the interaction effect was constrained to be proportional, fit the data best. Therefore, the final hierarchical model with lognormal model for RT and the MGRM for response data was fitted to all batches of data via a concurrent calibration. Evaluation of parameter estimates revealed that (1) adding response time information did not affect the item parameter estimates and their standard errors significantly; (2) adding response time information helped reduce the standard error of patients’ multidimensional latent trait estimates, but adding interviewer as a covariate did not result in further improvement. Implications of the findings for follow up adaptive test delivery design are discussed. (shrink)

Employee health is not only positively related to the employee well-being and family happiness, but also impacts organizations, and society as a whole. We searched the health-promoting leadership literature in the following databases: Web of Science, ProQuest, EBSCO, and a Chinese local database. Based on this research, we clarify the concept of health-promoting leadership, propose a definition of health-promoting leadership, and examine measurement scales for this type of leadership. We also suggest a research framework for (...) health-promoting leadership, demonstrating its potential outcomes at both the individual level and the organizational level ; the mechanisms for its development based on conservation of resources theory, the job demands–resources model, social learning theory, and social exchange theory; and antecedents. Finally, we identify six potential research areas: Research level, performance, the impacts of health-promoting leaders on themselves, moderators, research methods, and intervention effects on health-promoting leadership. (shrink)

The importance of graduating ethical health professionals is indisputable. Yet evaluating the quality of ethics education programs remains problematic for educators. A divide between learning and integrating ethics in everyday professional practice lies at the heart of this issue. The Ethics in Professional Practice (EPP) project addresses health professions' students’ self-efficacy for ethical practice. Students are cast as central characters in authentic vignettes and complete guided learning activities to facilitate their ethical reasoning skills. A design-based research approach was (...) utilised to create EPP resources and this study focuses on the analysis phase of the design process. The aim was to investigate EPP learning outcomes by developing innovative measures based upon Kirkpatrick’s ( 2006 ) evaluation model: namely, reaction, learning, behaviour and effects. Health professions students from Exercise and Sports Science, Rehabilitation Counselling and Speech Pathology (n = 58) participated in the EPP. Qualitative content analysis of reflective statements demonstrated their ethical sensitivity in four categories: Expectations and Empathy in Quality Care; Managing Overwhelming Demands; Informed, Engaged and Empowered; Access to Flexible Models of Service Delivery. Findings from the Rehabilitation Counselling cohort (n = 16) were explored in-depth using Semantic Differential Scales and demonstrated positive ethical reasoning outcomes. Participants also developed individual, ethical practice goals for professional practica. Qualitative content analysis of these goals demonstrated clear ethical reasoning learning effects. Participants integrated concepts of becoming an ethical professional with effective communication, collaboration, empowerment and quality care. Study outcome measures are critiqued and findings may inform redesign of future ethics education resources. (shrink)

Measures are designed to evaluate the processes and outcomes of care associated with the delivery of clinical (and non-clinical) services. They allow for intra- and interorganizational comparison to be used continuously to improve patient health outcomes. The use of performance measures always means to abstract the complex reality (medical scenarios and procedures) in order to provide an understandable and comparable output. Measures can focus on global performance. The more detailed data are available the more specific judgements with respect to (...) the appropriateness of clinical decision-making and implementation of evidence are feasible. Externally reported measures are intended both to inform and lead to action. By providing this information, deficiencies in patient care and unnecessary variations in the care process can be uncovered. Such variations have contributed to disparities in morbidity and mortality. The developments in information technology, especially world-wide interconnectivity, standards for electronic data exchange and facilities to store and manage large amounts of data, offer the opportunity to analyse health-relevant information in order to make the delivery of healthcare services more transparent for consumers and providers. Global performance measures, such as the overall life expectancy (mortality) in a country, can give a rough orientation of how well health systems perform but they do not offer general solutions nor spe-cific insights into care processes that have to be improved. In contrast to population-based measures, case-based performance measures use a defined group of patients depending on specific patient characteristics and features of disease. By means of these measures we are able to compare the number of patients that receive a necessary medical procedure against those patients who do not. The use of case-based measures is a bottom-up approach to improve the overall performance in the long run. They are not only a tool for global orientation but can offer a straightforward link to the areas of deficient care and the underlying procedures. Performance measures are relevant to providers as well as consumers, from their own individual perspective. Cased-based measures focus on the management of individual patient. This approach to performance measurement can inform physicians in a meaningful and constructive way by monitoring their individual performance and by pointing out possible areas of improvement. (shrink)

Resilience is the process and outcome of healthy adaptation despite significant adversity. Proliferation of research on the resilience construct has led to scientific concerns about the operationalization and measurement of resilience for assessment science and practice. Various studies that have investigated the psychometric properties and construct validity of the Resilience Scale for Adolescents have yielded inconsistent findings, which could partly be due to variations in the methodological approaches. This study investigated the factor structure and construct validity of the (...) READ in four European regions participating in the Universal Preventive Resilience Intervention Globally Implemented in Schools to Improve and Promote Mental Health for Teenagers project. Participants included adolescents aged 10–15 years from Spain, Iceland, Italy, and Poland. The five-factor model of the READ was similar across gender and participating regions. Construct validity of the READ was supported. After establishing construct separability, incremental validity was supported. The READ is a valid and reliable measure of protective factors involved in resilience and demonstrates promise for cross-cultural applicability. Recommendations for measuring resilience and validating the READ in future investigations are provided. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation (...) instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

Background: Screen time among adults represents a continuing and growing problem in relation to health behaviors and health outcomes. However, no instrument currently exists in the literature that quantifies the use of modern screen-based devices. The primary purpose of this study was to develop and assess the reliability of a new screen time questionnaire, an instrument designed to quantify use of multiple popular screen-based devices among the US population. -/- Methods: An 18-item screen-time questionnaire was created to quantify (...) use of commonly used screen devices (e.g. television, smartphone, tablet) across different time points during the week (e.g. weekday, weeknight, weekend). Test-retest reliability was assessed through intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). The questionnaire was delivered online using Qualtrics and administered through Amazon Mechanical Turk (MTurk). -/- Results: Eighty MTurk workers completed full study participation and were included in the final analyses. All items in the screen time questionnaire showed fair to excellent relative reliability (ICCs = 0.50–0.90; all < 0.000), except for the item inquiring about the use of smartphone during an average weekend day (ICC = 0.16, p = 0.069). The SEM values were large for all screen types across the different periods under study. -/- Conclusions: Results from this study suggest this self-administered questionnaire may be used to successfully classify individuals into different categories of screen time use (e.g. high vs. low); however, it is likely that objective measures are needed to increase precision of screen time assessment. (shrink)

Increased use of scales in data-driven consumer digital platforms and the management of organisations has led to greater interest in understanding social and psychological measurement expertise and techniques as historically constituted ‘technologies of power’ in the making of what Stark has labelled the ‘scalable subject’. Taking a genealogical approach, and drawing on published and archival data, this article focuses on self-rated health, a scale widely used in population censuses, national health surveys, patient-reported outcome measurement tools, (...) and a variety of digital apps. The article suggests that the first methodological articulation of self-rated health by the investigators of the Cornell Study of Occupational Retirement (1951–58) provides a window into the key epistemic, institutional, and cultural uncertainties about psychological and social measurement, processes of adjustment to ‘old age’, and the capacity of individuals to value their own health. I propose that these uncertainties have become incorporated into extant and operational measurements of health. (shrink)

Measurement outcomes are frequently used as evidence in favor of or against medical and surgical interventions, health policies, and system designs. Indeed, in the medical and health services research literature, outcomes are the currency of policy debate and decision making. Yet in the philosophy of science and philosophy of medicine, the measures used in evidence-based medicine (EBM) are rarely discussed. Rather, the focus here is almost exclusively on study design and hierarchies of evidence. This concentration on the (...) methodology of study design has meant that for practical purposes the measures used in randomized controlled trials, observational studies, audits, and so forth, appear as a “black box.” Yet as I argue in the first part of this article, an engagement with measurement can improve our understanding of EBM and the quality of our evidence. In the second part of the article, I develop such an engagement with one aspect of measurement, namely, the validity of patient-reported outcome measures. Here, I illustrate some of the complexity that is required to improve the validity of these measures and hence the validity of our study outcomes, that is, evidence. The concentration in philosophy of science on study design over measurement methodology perhaps reveals the interest that many philosophers of medicine have in causation, but there is more to the production of high-quality scientific evidence than securing the causal inference. (shrink)

Research on the predictors of outcome for early, community-based, and time-limited interventions targeted for clinical depression in adolescents is still scarce. We examined the role of demographic, psychosocial, and clinical variables as predictors of outcome in a trial conducted in Finnish school health and welfare services to identify factors associating to symptom reduction and remission after a brief depression treatment. A total of 55 12–16-year-olds with mild to moderate depression received six sessions of either interpersonal counseling for (...) adolescents or brief psychosocial support. Both interventions resulted in clinical improvement at end of treatment and 3- and 6-month follow-ups. Main outcome measures were self-rated BDI-21 and clinician-rated Adolescent Depression Rating Scale. Latent change score models were used to identify predictors of change in depressive symptom scores and clinical remission at end of treatment and 3- and 6-month follow-ups over the combined brief intervention group. Symptom improvement was predicted by younger age and having a close relationship with parents. Both symptom improvement and clinical remission were predicted by male gender, not having comorbid anxiety disorder, and not having sleep difficulties. Our results add to knowledge on factors associating with good treatment outcome after a brief community intervention for adolescent depression. Brief depression interventions may be useful and feasible especially for treatment of mild and moderate depression among younger adolescents and boys, on the other hand clinicians may need to cautiously examine sleep problems and anxiety comorbidity as markers of the need for longer treatment. (shrink)

Since the 1970’s epidemiological measures focusing on “health-related quality of life” or simply “quality of life” have figured increasingly as endpoints in clinical trials. Before the 1970’s these measures were known, generically, as performance measures or health status measures. Relabeled as “quality of life measures” they were first used in cancer trials. In the early 2000’s they were relabeled again as “patient-reported outcome measures” or PROMs, in their service to the FDA to support drug labeling claims. To (...) the limited degree that the philosophical literature addresses these measures, it tends to associate them with two major theories of well-being: subjective well-being and the capabilities approach. In this paper, I argue that philosophers ought to treat quality of life measures/proms as a distinct from these theories. I argue that quality of life/proms serve healthcare as vehicles for patient-centered care and this has important consequences for how we theorize these measures. To this end, two requirements set them apart from measures of subjective well-being and the capabilities approach: quality of life/proms need to be patient-directed and inclusive. (shrink)

Does law matter regarding public health outcomes? Regardless of what one may think about the answer to this age-old question, in recent years the public health community has increasingly demonstrated and recognized the roles that public health laws and policies play in effectuating long-lasting and broad-based population-wide changes. Public health laws and policies have been instrumental in the following ways: reducing smoking prevalence; reducing underage alcohol-related drinking, driving, crashes, and fatalities; reducing exposure to second-hand smoke; eliminating (...) vaccine–associated paralytic poliomyelitis ; increasing seat-belt use and reducing traffic fatalities; reducing dental carries; and reducing access to and consumption of unhealthy foods and beverages sold in schools and to reductions in caloric intake and overweight. In fact, in a review of the ten greatest public health achievements in the 20th century, all were influenced by policy change. (shrink)

This paper explores the legality and ethics of an individual securing insurance (life, disability or other forms of income protection insurance for which there is individual risk assessment) in anticipation of undergoing genetic testing. It also seeks to examine the situation from the perspective of genetic counsellors and the extent of their obligations in providing information and advice to individuals contemplating genetic testing. These are matters of importance for health care professionals, human research ethics committees as well, of course, (...) as individuals who may be contemplating undertaking genetic testing. (shrink)

Reflective function is defined as an individual’s ability to understand human behavior in terms of underlying mental states including thoughts, feelings, desires, beliefs, and intentions. More specifically, the capacity of parents to keep their child’s mental states in mind is referred to as parental RF. RF has been linked to adult mental health and parental RF to children’s mental health and development. The gold standard measure of RF is the interview-based Reflective Functioning Scale applied to the Parent Development (...) Interview or Adult Attachment Interview, which while well validated, is time-and labor-intensive to administer. Given the increasing need for reliable, valid, and rapid RF assessment in wide-ranging settings, two alternative measures were considered including the Reflective Function Questionnaire and Parental Reflective Function Questionnaire. We determined the convergent validity of these measures in comparison with the PDI-rated RFS. A sample of mothers and fathers was drawn from a sub-study of the ongoing Alberta Pregnancy Outcomes and Nutrition longitudinal cohort when their children were 42–60 months of age. Pearson correlations and multiple linear regression was conducted, followed by splitting the sample to compute Cohen’s kappas measures of agreement. Two subscales of the PRFQ correlated significantly with the gold standard PDI-rated RFS, providing evidence for convergent validity. As a brief multidimensional measure of parental RF, the PRFQ offers an alternative for measurement of RF in large-scale studies of parental development and child health. (shrink)

The novelty of the coronavirus disease 2019 (COVID-19) pandemic is that it is occurring in a globalized society enhanced by digital capabilities. Our aim was to analyze the psychological and emotional states of participants in different pandemic-related contexts, with a focus on their digital and physical distancing behaviors. The online survey was applied during the ascending phase of the pandemic in March 2020 in two neighboring EU countries: Italy and Croatia. The study subjects involved four groups, two directly affected by (...) epidemiological measures and two serving as controls—(1) participants from Italy who were in lockdown (Italy group), (2) participants from Croatia who were not in lockdown but who were in direct contact with an infected person and underwent epidemiological measures (CRO-contact group), (3) participants from Croatia who were in an analogous situation but not near the same infected person (CRO-no contact group), and (4) participants from Croatia who were not aware of any infected person (CRO-unrelated group). The survey consisted of validated scales of psychological and emotional states, and custom-made questionnaires on the digital (online) and physical (off-line) behavior of the participants. The Italy group in lockdown had higher self-perceived scores for depression, stress, post-traumatic intrusion, and avoidance, as well as the highest digital activity and physical distancing than the not-in-lockdown Croatian groups. The insight into the extent of online activities and off-line isolation allowed for the introduction of Digital Activity and Physical Distancing Scores. Self-perceived post-traumatic avoidance was higher in both the Italy and CRO-contact groups than the control CRO-no contact and CRO-unrelated groups, and higher avoidance correlated with higher Digital Activity and Physical Distancing Scores. Being in direct contact with the infected person, the CRO-contact group had no other alterations than unexpectedly lower post-traumatic hyperarousal when compared with the Italy group. The Italy group in lockdown demonstrated higher self-perceived psychological toll together with higher digital activity and physical distancing than Croatian groups not in lockdown, even when compared with the affected CRO-contact group. The study outcomes suggest that the general emergency measures influenced citizens in lockdown more than exposure to the virus through direct contact with an infected person. (shrink)

In recent years, the principle of equivalence has been accepted in many countries as the standard against which healthcare provision for prisoners should be measured. There are several ways in which this principle can be interpreted, but current policy in the UK and elsewhere seems to focus on the measurement and achievement of equivalence in the process of healthcare provision. We argue that it is not appropriate to apply this interpretation to all aspects of prisoner healthcare, as it does (...) not necessarily address the challenges inherent to the prisoner population and prison setting. Consequently equivalence of health outcomes should also be considered alongside processes in the interests of providing healthcare in prison that is equivalent to that outside prison. (shrink)

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators’ ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also (...) being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one’s clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education. (shrink)

Engagement with the historical and theoretical underpinnings of measuring quality of life (QoL) and patient‐reported outcomes (PROs) in healthcare is important. Ideas and values that shape such practices—and in the endgame, people's lives—might otherwise remain unexamined, be taken for granted or even essentialized. Our aim is to explicate and theoretically discuss the philosophical tenets underlying the practices of QoL assessment and PRO measurement in relation to the notion of person‐centredness. First, we engage with the late‐modern history of the concept (...) of QoL and the act of assessing and measuring it. Working with the historical method of genealogy, we describe the development of both QoL assessments and PRO measures (PROMs) within healthcare by accounting for the contextual conditions for their possibility. In this way, the historical and philosophical underpinnings of these measurement practices are highlighted. We move on to analyse theoretical and philosophical underpinnings regarding the use of PROMs and QoL assessments in clinical practice, as demonstrated in review studies thereof. Finally, we offer a critical analysis regarding the state of theory in the literature and conclude that, although improved person‐centredness is an implied driver of QoL assessments and PROMs in clinical practice, enhanced theoretical underpinning of the development of QoL assessments is called for. (shrink)

In their contribution, Kok et al raise a relevant, though often underestimated, issue: clinical ethics support services are often assumed to lead to an improvement of quality of care at the organisational level, but evidence in support of this claim is weak, if not completely lacking.1 Therefore, the authors propose a complex theoretical model connecting a specific kind of CESS, moral case deliberation, with mechanisms for quality of care improvement at the individual and the organisational level. The proposal is original, (...) and the topic discussed of great interest not only to practitioners and researchers dealing with CESS, but also to health policy-makers and managers of healthcare system, for all of whom it is indeed crucial to understand whether and how ethics support can positively impact quality of care. However, despite its undoubtful merits, we feel that some claims and model’s underlying assumptions might require in-depth scrutiny and more solid justification. i. First, the authors discuss two different approaches to understanding quality of care: the first approach, which they define as reductionist, interprets quality as an outcome-oriented, quantitative, and therefore, measurable function. The second approach defines quality …. (shrink)

Emotional regularity is the degree to which a person maintains and returns to a set of emotional states over time. The present investigation examined associations between emotional regularity and extant emotion measures as well as psychologically relevant dimensions of personality, health, and real-world occupational outcomes. Participants included 598 U.S. adults who provided daily experience sampling reports on their emotional states for approximately two months. Results suggest that emotional regularity was related to, but distinct from, well-established measures of emotion including (...) emotional intensity, variability, covariation, inertia, granularity, and emodiversity. Furthermore, emotional regularity significantly predicted measures of personality, psychological health, and occupational outcomes even when accounting for extant emotion measures and sociodemographic covariates. Finally, it explained modest (7.5%) improvement (in terms of cross-validated RSq.) over baseline models containing emotional intensity, variability, and sociodemographic covariates. These findings suggest that emotional regularity may provide an important indicator of healthy emotional functioning and may be a promising area for further scientific discovery. (shrink)

Mindfulness-based interventions have proved effective in reducing various clinical symptoms and in improving general mental health and well-being. The investigation of the mechanisms of therapeutic change needs methods for assessment of mindfulness. Existing self-report measures have, however, been strongly criticized on various grounds, including distortion of the original concept, response bias, and other. We propose a psychophysiological method for the assessment of the mindfulness learned through time-limited mindfulness-based therapy by people who undergo meditation training for the first time. We (...) use the individual pre-post-therapy changes (dERPi) in the event-related brain potentials (ERPs) recorded in a passive meditation task as a measure of increased mindfulness. dERPi is computed through multivariate assessment of individual participant's ERPs. We tested the proposed method in a group of about 70 recurrently depressed participants, randomly assigned in 1.7:1 ratio to mindfulness-based cognitive therapy (MBCT) or cognitive therapy (CT). The therapy outcome was measured by the long-term change (dDS) relative to baseline in the depression symptoms (DS) assessed weekly, for 60 weeks, by an online self-report questionnaire. We found a strong, highly significant, negative correlation (r = -0.55) between dERPi (mean = 0.4) and dDS (mean = -0.7) in the MBCT group. Compared to this result, the relationship between dDS and the other (self-report) measures of mindfulness we used was substantially weaker and not significant. So was also the relationship between dERPi and dDS in the CT group. The interpretation of dERPi as a measure of increased mindfulness was further supported by positive correlations between dERPi and the other measures of mindfulness. In this study, we also replicated a previous result, namely, the increase (dLCNV) of the late contingent negative variation (LCNV) of the ERP in the MBCT group, but not in the control group (in this case, CT). We interpreted dLCNV as a measure of increased meditative concentration. The relationship between dLCNV and dDS was, however, very week, which suggests that concentration might be relatively unimportant for the therapeutic effect of mindfulness. The proposed psychophysiological method could become an important component of a "mindfulness test battery" together with self-report questionnaires and other newly developed instruments. (shrink)

IntroductionAdolescent connectedness, a key component of positive youth development, is associated with various positive health outcomes. Several measures have been developed to assess this construct. However, no study has summarized data on the existing measures of adolescent connectedness. We conducted this scoping review to fill this gap. We specifically aimed to: identify the existing measures of adolescent connectedness, determine the most frequently used measures among the identified measures, and summarize the psychometric properties of these measures with a keen interest (...) in highlighting their cross-cultural utility and validity.MethodsWe searched CINAHL, Embase, PsycInfo, PubMed, and Web of Science databases for relevant articles published since database inception to 7th February 2021. Our search structure contained the key words “Adolescents”, “Connectedness”, and “Measures”. We also searched Open Gray for potentially relevant gray literature.ResultsWe identified 335 measures from 960 eligible studies assessing various domains of adolescent connectedness, including school, family, community, peer, ethnic, racial, cultural, religious/spiritual, and self-connectedness. Most of the included studies were from North America and Europe. Most of the measures were measures of school connectedness among adolescents. Of the identified measures, 60 of them met our criteria of frequently used measures. These frequently used measures were used across 481 of the included studies with 400 of them reporting their psychometric properties. The reported reliability of these measures was adequate in 89.8% of these studies. These measures also appeared to be valid in terms of their face, content, construct, criterion, convergent, discriminant, concurrent, predictive, measurement invariance, and cross-cultural validity.ConclusionsThere exists a wide array of measures of adolescent connectedness. Sixty of these measures have been frequently used across studies and appear to be reliable and/or valid. However, this evidence is mostly from North America and Europe. This is a reflection of the limitation of this review where only studies published in English were considered. It might also reflect the paucity of research in other regions of the world. More research is needed for clearer insights. (shrink)

BackgroundOver the last decades there has been a change in the way schooling is perceived recognizing that children’s learning is closely linked to children’s health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children’s emerging needs and have a positive impact on their wellbeing.MethodsA pilot cross-over randomized controlled design was (...) employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life, wellbeing and life functioning, emotional and behavioral difficulties, as well as duration of sleep. Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties.ResultsImprovements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep and SDQ. Minimal clinically important differences as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL.DiscussionFindings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used. (shrink)