Existem evidências de que as manifestações psicóticas não são vivenciadas apenas por pessoas diagnosticadas com transtornos mentais, mas também por pessoas saudáveis da população geral, as denominadas experiências tipo-psicóticas. A Escala de Avaliação das Experiências Psíquicas na Comunidade (CAPE) é um instrumento usado em pesquisas epidemiológicas e foi desenvolvido especificamente para a detecção e avaliação da frequência de experiências tipo-psicóticas na população geral. A CAPE, em sua apresentação original é composta por 42 itens, distribuídos em três dimensões: positiva, negativa e depressiva. O objetivo deste estudo foi verificar as evidências de fidedignidade e validade da CAPE em uma amostra brasileira e investigar a associação de traumas na infância e uso de cannabis com a ocorrência de experiências tipo-psicóticas em indivíduos da população geral. A amostra foi composta por 217 pacientes em primeiro episódio psicótico, 104 irmãos de pacientes psicóticos e 319 controles de base populacional, todos residentes na área de cobertura do Departamento Regional de Saúde do Estado de São Paulo (DRS XIII). Os participantes responderam a instrumentos de avaliação e diagnósticos, incluindo a Entrevista Clínica Estruturada para o DSM IV (SCID), o Questionário sobre Traumas na Infância (CTQ), Questionário de Experiências com Maconha (CEQ), além da CAPE. Os dados clínicos foram analisados por meio do pacote estatístico SPSS e as evidências psicométricas por meio do software AMOS. Após a retirada de nove itens, a CAPE, com 33 itens, mostrou bons índices de ajustamento [CFI = 0,895; GFI = 0,822; PGFI = 0,761; RMSEA = 0,055 p (rmsea <= 0,05) = 0,04] e boa consistência interna (> 0,70) em todos as suas dimensões. Nas análises realizadas apenas com a amostra de base populacional, não foram encontradas diferenças significativas entre as pontuações totais da CAPE-33 e das suas três dimensões quanto a intervalos de idade, estado civil e escolaridade. Mulheres apresentaram pontuações significativamente mais elevadas do que os homens no escore total (p<0,001) e nas dimensões negativa (p < 0,001) e depressiva (p < 0,001). A vivência de traumas na infância (abuso emocional, abuso físico, abuso sexual, negligência emocional, negligência física) associou-se com pontuações mais elevadas no escore total da CAPE (p <0,001) e nas suas três dimensões (positiva p = 0.001, negativa p = 0,004, depressiva p < 0,001). Indivíduos que relataram uso de cannabis alguma vez na vida apresentaram maiores pontuações na dimensão positiva da CAPE-33, em comparação às pessoas que nunca usaram a substância (p = 0,016). A CAPE adaptada para o Brasil (CAPE-33) mostrou bons índices de ajustamento e consistência interna, como encontrado em outras culturas. Presença de trauma precoce e uso de cannabis associaram-se à ocorrência de experiências tipo-psicóticas, à semelhança do que os estudos epidemiológicos mostram para a esquizofrenia. Nossos dados corroboram a abordagem dimensional das psicoses, com frequência e gravidade das manifestações se distribuindo num continnum na população geral. / There is evidence that psychotic manifestation is not experienced only by people diagnosed with mental disorders but also by healthy people in the general population, known as psychotic-like experiences. The Community Assessment Psychic Experiences (CAPE) is an instrument used in epidemiological research and was developed specifically for the detection and evaluation of the frequency of psychotic-like experiences in the general population. The CAPE, in its original submission, is composed of 42 items, distributed in three dimensions: positive, negative and depressive. The objective of this study was to verify the evidence of reliability and validity the CAPE in a brazilian sample and to investigate the association of childhood traumas and cannabis use with the occurrence of psychotic-like experiences in individuals of the general population. The sample consisted of 217 patients in the first psychotic episode, 104 siblings of psychotic patients and 319 population-based controls, all residents in the coverage area of the São Paulo Regional Health Department (DRS XIII). Participants responded to assessment and diagnostic tools, including the Structured Clinical Interview for DSM IV (SCID), the Childhood Trauma Questionnaire (CTQ), the Cannabis Experience Questionnaire (CEQ), and CAPE. Clinical data were analyzed using SPSS statistical package and the psychometric evidence using AMOS software. After the removal of nine items, CAPE, with 33 items, showed good adjustment indices [CFI = 0.895; GFI = 0.822; PGFI = 0.761; RMSEA = 0.055 p (rmsea <= 0.05) = 0.04] and good internal consistency (> 0.70) in all its dimensions. In the analyzes performed only with the population-based sample, no significant differences were found between the CAPE-33 total scores and its three dimensions regarding age, marital status and schooling intervals. Women presented scores significantly higher than men in the total score (p <0.001) and in the negative (p <0.001) and depressive (p <0.001) dimensions. The experience of childhood traumas (emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect) was associated with higher scores in the CAPE total score (p <0.001) and its three dimensions (positive p = 0.001, negative p = 0.004, depressive p <0.001). Individuals who reported cannabis use in their lifetime had higher scores in the positive dimension of the CAPE-33 compared to people who had never used the substance (p = 0.016). The CAPE adapted to Brazil (CAPE-33) showed good adjustment indices and internal consistency, as found in other cultures. Presence of early trauma and use of cannabis were associated with the occurrence of psychotic-like experiences, in accordance with what epidemiological studies show for schizophrenia. Our data corroborate the dimensional approach of the psychoses, with frequency and severity of the manifestations being distributed in a continnum in the general population.

Speech audiometry is the aspect of audiology that provides critical information on how individuals hear one of the most important sounds of daily life: speech. The speech recognition threshold (SRT) is a measure of speech audiometry that is widely used to provide information on an individual's capacity to hear speech. Over time, researchers and clinicians have worked to improve the SRT by developing and modifying a variety of word lists to be used during testing. Eventually, spondaic words were selected as the best stimuli for the SRT. The spondaic words had to meet four criteria: familiarity, phonetic dissimilarity, normal sampling of English sounds, and homogeneity with respect to audibility. This study examined the aspect of homogeneity with regard to slope of the psychometric function. Specifically, whether slope of the psychometric function had an effect on the number of words used to obtain the SRT, and thus reduce test time, as well as whether slope had an effect on the relationship between the SRT and the pure-tone average (PTA). It was hypothesized that words with a steep slope would significantly reduce test time and yield a close SRT-PTA agreement. Three word lists (steep, medium, and shallow sloping words), all recorded by a male talker, were used to obtain the SRT on 40 participants (ages 18-30 years). Statistical analysis showed significant differences in the number of words to obtain the SRT and the SRT-PTA agreement. However, when the differences were examined from a clinical perspective, the results were negligible. When compared with words with medium and steep slopes, words with shallow slope required an average of four extra words to obtain the SRT, which does not result in a meaningful reduction in test time. For clinical purposes, it appears that the slope of the psychometric function does not need to be taken into consideration for the SRT. Clinicians may use a variety of words as long as they meet the original four criteria for selection of spondees.

Speech audiometry has long been a component of a thorough audiological examination. The speech recognition threshold (SRT) measurement is perhaps the most widely used measurement in speech audiometry. For decades, researchers and clinicians have worked to create and fine-tune word lists that for use in SRT testing; their aim being to improve the accuracy for classifying a client's ability to hear and comprehend speech. Experts in the field have agreed to follow four tenets of speech audiometry when selecting word sets. This study examined whether improvement to stimulus lists for SRT measurement could be made in regards to the tenet of homogeneity with respect to audibility if the slope of the psychometric function were a selection consideration. The study was performed with the hypothesis that steeply sloping words would significantly reduce the number of words needed to obtain the SRT. Three word lists, all recorded by a female talker, comprising of steeply sloping words, medium sloping words, and shallow sloping words, were used in the study. Participants with normal hearing between the ages of 18 and 30 years provided data that was used to calculate SRT measurements for all three lists from each ear. The results showed a significant difference in the number of words needed to obtain the SRT when comparing the steep and shallow word sets and the shallow and medium word sets. Steeply sloping words required fewer words to obtain the SRT, M = 17.02. Shallow sloping words required the most words, M = 18.88, amounting to a difference of 1.86 words. While statistically different, a reduction by fewer than 2 words during the course of SRT testing will not equate to a substantial saving of time for the clinician. For clinical application, the slope of the psychometric function of the words used in SRT measurement need not be a primary consideration when developing stimulus lists.

No description available.

Patient adherence to in-clinic rehabilitation is between 30-70% and even lower for home exercise programs (HEPs). Barriers to patient adherence have been identified and include but are not limited to anxiety, depression, lack of positive feedback, lack of social support, lack of time, low levels of physical activity at baseline, pain during exercise, and low self-efficacy. As clinicians prescribing rehabilitation may not be able to influence all of the identified barriers, they may positively influence others. Self-efficacy, or an individual’s belief in his/her ability to successfully complete a task, is a patient barrier that may be addressed by a clinician when aware of low self-efficacy and have tools to improve this barrier. Interventions to overcome this specific barrier have demonstrated an increase in not only self-efficacy but patient adherence as well. Although interventions have proven to be successful, patient adherence has yet to increase according to the literature. At this time, there is no evidence to suggest that clinicians are assessing an individual’s level of self-efficacy prior to prescribing HEPs. In addition, there is no known metric to measure self-efficacy for HEPs in patients rehabilitating musculoskeletal conditions. Assessment of patient barriers, specifically self-efficacy, needs to be a standard of care in order to increase adherence, in turn, improve patient outcomes and to reduce the cost to our healthcare system. The first purpose of this dissertation was to determine in patients with musculoskeletal conditions what scales have been developed and evaluated for assessing self-efficacy in conjunction with adherence. In addition, to determine if a tool exists specifically to assess self-efficacy for HEPs. Due to the task and situation-specific nature of self-efficacy, it is important that this construct is reflected in the assessments utilized by clinicians. The second purpose was to determine the importance and utilization of patients’ self-efficacy to physical therapists when addressing patient barriers. This included determining how physical therapists assess patient self-efficacy and barriers to assessment. The third purpose was to develop the Self-Efficacy for Home Exercise Programs Scale and determine the psychometric properties of the instrument. This also allowed for the examination of how self-efficacy relates to patient adherence in a musculoskeletal patient population. The results of the first study suggest that within the musculoskeletal literature, a number of scales are being used to assess patient self-efficacy. These scales are either task, situation, or condition specific. No scale was found to assess self-efficacy for HEPs. This finding indicates the need to develop a scale to assess self-efficacy for HEPs. In the second study, 71% (n = 329/464) of physical therapists, disclosed assessing self-efficacy prior to prescribing HEPs and rated self-efficacy as very to extremely important when it comes to their patients’ adherence. Verbal discussion is the most common method of self-efficacy assessment (50%), followed by observation of the patient (38%), then patient self-report questionnaires (10%). Commonly, physical therapists report using verbal discussion and observation in combination. Of the 29% of the physical therapists that do not assess self-efficacy, 40% report not knowing how to assess self-efficacy, 19% are not sure what to do with the information once self-efficacy is assessed, 16% claim there are other barriers to assessment, 15% claim that assessing self-efficacy will not change their practice, another 9% claim assessing self-efficacy takes too much time, and the last 1% do not know what self-efficacy is. These results further suggest the need for a scale to assess self-efficacy for HEPs. The purpose of the final study was to developed a Self-Efficacy for Home Exercise Programs Scale. The scale was found to have high internal consistency (α = 0.96), acceptable test-retest reliability (ICC = 0.8, SEM = 5, MDC = 7), and strong convergent validity with the Self-Efficacy for Exercise scale (rho(ρ) = 0.83, p < 0.01). Unique to this scale, a cutoff score was determined to be 59 points with a positive likelihood ratio of 2.0 (95% CI 1.1 – 2.5) indicating those who score below 59 points on the SEHEPS would be 2 times more likely to be non-adherent than adherent to their HEP. A weak to moderate, positive relationship was detected between the patients’ initial level of self-efficacy for their HEP and adherence (rho(ρ) = 0.38, p = 0.03). These results suggest that the Self-Efficacy for Home Exercise Programs Scale may be utilized by rehabilitation clinicians to assess self-efficacy for HEPs. Clinically, this scale may provide clinicians the ability to decipher patients who are not likely to adhere to their prescribed HEP, allowing clinicians to intervene immediately. Early intervention to improve self-efficacy may increase adherence to HEPs and eventually patient outcomes.

Depression is a mental illness that requires prompt identification and treatment due to grave consequences if untreated. Depression can affect a person's level of functioning, lead to worsening health conditions, comorbid substance abuse, and suicide. Despite these facts, the current state of nursing practice includes an inadequate diagnosis of patients with depression, lack of guidelines for the use of assessment tools and diagnostic tests to identify depression, and insufficient information concerning the accuracy of depression assessment tools. This systematic literature review examined 6 depression assessment tools in regard to their accuracy as identified by specificity, sensitivity, reliability, and validity. This project also examined the pros and cons, demographics, and healthcare settings that use these depression inventory tools. This project used the Orlando nursing process theory as a theoretical framework. Based on the review of 10 articles selected, evidence showed that the Hamilton depression rating scale has the highest sensitivity (93%) and specificity (97%) rates. The implications for positive social change include the opportunity for clinicians to use the findings of this project in their selection of depression assessment tools in healthcare settings. Other researchers can use this project as a valuable resource for management of major depressive disorders.

Introdução - O estudo do conhecimento nutricional, das motivações para as escolhas alimentares e da qualidade da dieta traz informações importantes para o controle das crescentes prevalências de excesso de peso e doenças crônicas. Apesar da eficiência das estratégias de controle depender de uma escala de boa qualidade, se desconhece a precisão das escalas existentes ou estas não estão em acordo com recomendações vigentes. Objetivo - Desenvolver escalas para avaliar o conhecimento nutricional, a motivação de saúde para escolhas alimentares e a qualidade da dieta com aplicação da Teoria de Resposta ao Item (TRI). Métodos - Para desenvolver as escalas de conhecimento nutricional (NKTS) e motivação de saúde para as escolhas alimentares (SOFIE) foram utilizados questionários já existentes e utilizados no estudo HELENA, uma investigação multicêntrica da União Europeia: Nutritional Knowledge Test (NKT) e Food Choices and Preferences (FCP). Para desenvolver a escala de qualidade da dieta (ESQUADA) foi desenvolvido um questionário, baseado no Guia Alimentar para a População Brasileira e cuja relevância e compreensão foram estudadas a partir das sugestões de nutricionistas, em grupos focais, e adolescentes e jovens adultos brasileiros, em um questionário online. Para cada escala, a dimensionalidade dos itens foi estudada separadamente pela análise fatorial exploratória. A TRI foi aplicada para identificar os itens com melhor discriminação da informação de interesse, bem como localizá-los nos diferentes níveis do continuum e calcular os escores dos indivíduos. Foi verificada a associação entre os escores de NKTS e SOFIE com consumo de alimentos e biomarcadores nutricionais, avaliados no estudo HELENA. Para construir as escalas foram utilizados BILOG-MG versão 3, GGUM 2004 e o R. As sugestões dos nutricionistas foram analisadas no MAXQDA versão 12. As sugestões dos adolescentes e jovens adultos e a caracterização das escalas foram realizadas no Microsoft Office Excel versão 2013. O estudo das associações foi realizado no Stata versão 14. Resultados - A análise fatorial e a TRI indicaram que onze itens do NKT e dezesseis itens do FCP avaliam adequadamente o conhecimento nutricional e a motivação de saúde para as escolhas alimentares, compondo, respectivamente, NKTS e SOFIE. NKTS identifica indivíduos com conhecimento nutricional básico, adequado e avançado. SOFIE classifica indivíduos com baixa, indiferente e alta motivação de saúde para as escolhas alimentares. Os escores de NKTS e SOFIE associaram positivamente com marcadores de alimentação saudável. Em relação à ESQUADA, os nutricionistas consideraram os itens relevantes para avaliar a qualidade da dieta, mas indicaram a necessidade de alterar a escrita de alguns, bem como de suas alternativas de resposta. Todos os itens foram facilmente compreendidos por adolescentes e adultos jovens. A análise fatorial e a TRI reteram 25 itens para a ESQUADA, possibilitando identificar cinco níveis de qualidade da dieta. Conclusão - NKTS, SOFIE e ESQUADA, respectivamente, apresentaram medidas acuradas do conhecimento nutricional, das motivações de saúde para as escolhas alimentares e da qualidade da dieta, permitindo caracterizar seus diferentes níveis. Outros estudos podem analisar a relação entre ESQUADA e marcadores de consumo alimentar, bem como selecionar as escalas desenvolvidas para avaliação em outras populações. / Introduction - The study of the nutritional knowledge, the motivations to food choices, and the diet quality provides important information to control the increasing prevalences of overweight and chronic diseases. Although the effectiveness of the control strategies depends on a good quality scale, the accuracy of existing scales is unknown or these scales are not in line with current recommendations. Objective - This thesis aimed to develop scales to evaluate the nutritional knowledge, health motivation influencing food choices, and diet quality using the IRT analysis. Methods - Due to develop the scales of the nutritional knowledge (NKTS) and health motivation to food choices (SOFIE), questionnaires already used in the HELENA study, a European multicenter research, were used: Nutritional Knowlwdge Test (NKT) and Food Choices and Preferences (FCP). Due to develop the scale of diet quality (ESQUADA), a questionnaire, based on the Food Guide for the Brazilian Population, was created. The relevance and laypersons\' comprehension of this questionnaire were studied based on the suggestions from: nutritionists using focus groups\' discussions and Brazilian adolescents and young adults using an online questionnaire. The dimensionality of the items was analysed separately using the exploratory factor analysis for each scale. The IRT analysis was applied to identify the items with the best discrimination of the information of interest, as well as to locate them at the different levels of the continuum and to calculate the IRT scores. The association between IRT scores, food consumption and nutritional biomarkers was analyzed around NKTS and SOFIE. The softwares BILOG-MG version 3, GGUM 2004, and R were used to construct the scales. The nutritionists\' suggestions were analyzed in MAXQDA version 12. The laypersons\' suggestions and the characterization of each scale level were performed in Microsoft Office Excel version 2013. The study of association was performed in Stata version 14. Results - Factor analysis and IRT analysis indicated that eleven items from NKT and sixteen items from FCP adequately evaluate the nutritional knowledge and health motivation influencing food choices and compose NKTS and SOFIE, respectively. NKTS identifies individuals with basic, adequate, and advanced nutritional knowledge. SOFIE classifies individuals with low, indifferent, and high health motivation influencing food choices. The scores from NKTS and SOFIE were positively associated with healthy food markers. Regarding the ESQUADA, the nutritionists considered the items relevant to assess the quality of diet. However, they indicated the need to change the writing of some items as well as their response options. Adolescents and young adults easily understood all items. The factor analysis and IRT analysis retained 25 items in ESQUADA, possibiting to identify five levels of diet quality. Conclusion - NKTS, SOFIE, and ESQUADA, respectively, presented accurate measures of nutritional knowledge, health motivation to food choices, and quality of diet, allowing the characterization of their different levels. Other studies may analyze the relationship between ESQUADA and food consumption, as well as select the developed scales to evaluate these latent traits in other populations.

Modes of information processing were examined for 91 subjects aged between 5 years 7 months and 6 years 3 months, using A.R. Luria's model of brain function as the theoretical basis of the study. A factor analysis of the results of six psychometric tests administered to all subjects indicated the presence of two distinct factors. These were hypothesised to represent the separate contributions of simultaneous and successive synthesis. Further separate factor analyses, of the six psychometric tests and tests of M-Space (derived from the work of R. Case) and tests of standard school assessment tasks (that were also administered to the subjects), were performed. The results indicated that although both modes of synthesis are available to children of this age, simultaneous synthesis is not a potent factor in school learning. A further exploratory study was carried out using the same 91 subjects. Subjects were given a series of verbal subtraction problems requiring understanding of mathematical relationships, and randomly assigned to two presentation groups. One group received pictorial information in addition to the verbal presentation. The other group received concrete materials. A multiple regression analysis was performed on the whole group using factor scores for simultaneous and successive syntheses (derived from the factor analysis of the six psychometric tests) as independent variables and criterion test scores for the verbal subtraction problems as the dependent variable. The analysis indicated that although neither aptitude for successive synthesis nor aptitude for simultaneous synthesis had predictive value for this kind of probelm solving, simultaneous synthesis was possibly the predominant mode of information processing. Further multiple regression analyses performed on each of the presentation groups indicated an interaction between successive synthesis and the modes of presentation of information. Due to the small numbers of subjects in each presentation group this result was inconclusive.

<p>It has been suggested that persons with intellectual disabilities (ID) manifest the full range of mental health problems. The main purpose of this thesis is to adapt and evaluate two clinical assessment instruments and to investigate the occurrence of mental health problems as well as psychiatric care utilisation in persons with ID. </p><p>The psychometric properties of a Swedish version of the two instruments [Reiss Screen for Maladaptive Behaviour (RSMB) and the Psychopathology Inventory for Mentally Retarded Adults (PIMRA)] were investigated in a random, institutional and clinical sample of administratively defined (ADDEF) adults with ID (n = 199). The analyses suggest that the RSMB could be used as intended by staff as a primary screening device for the identification of mental health problems in persons with ID, and that the PIMRA had a potential to identify individuals with a specific mental disorder. The psychometric evaluation reveals that the Swedish versions of the RSMB and PIMRA measure a construct related to the diagnostic categories in the DSM-III-R and DSM-IV. This construct could be conceptualised as mental health problems.</p><p>The RSMB and PIMRA results show that the overall occurrence of mental health problems in ADDEF samples of persons with ID (175 men and 148 women) ranged from 34 to 64%.</p><p>The preliminary level of ID was mild (23%), moderate (39%) and severe (38%). The most common mental health problems were aggressive and self-injurious behaviours, depression, anxiety and adjustment disorders. In registered patients receiving out- or in-patient psychiatric care the occurrence of adults with an ICD-10 diagnosis of ID was approximately 1% (70 to 90% had a mild level of ID). </p><p>In contrast to the high frequency of mental health problems reported, psychiatric care was used infrequently. This tendency is particularly evident in persons with moderate and severe ID.</p>

Thesis (M.A. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2007.