Bullying is a common problem among children and adolescents in which the consequences can be severe. Bullying is associated with a variety of negative outcomes and can lead to a variety of mental and physical health problems. The purpose of this study was to examine forms of bullying behaviors that were most predictive of student-reported bullying and the frequency of student-reported bullying in response to a variety of bullying behaviors. In this study, an archival dataset was utilized. Data collected in the fall of 2012 came from 8387 6th through 12th grade students who attended 124 public middle and high schools in Anne Arundel County Public Schools, Maryland. The web-based bullying survey, designed as a component of a district-wide bullying prevention initiative, was intended to assess the prevalence, type, and social norms associated with bullying and school violence.<br>For the first research question, logistic regression analyses indicated that teasing and name-calling were the most frequent forms of bullying and were the two primary predictors of student-reported bullying. Social and/or relational forms of bullying were overall the most frequently reported forms of bullying. In contrast, physical or direct forms of bullying and cyberbullying were the least frequent forms of bullying reported.<br>For the second research question, a series of chi-square analyses indicated significant differences for all types of bullying behavior and whether or not student reported being bullied. Specifically, compared to student who did not report being bullied in the past month, those students who did report being bullied within the last month were more likely to report (a) being called names, (b) being threatened, (c) being teased or picked on, (d) being pushed or shoved, (e) having emails or messages sent to others about them, (f) having rumors or lied spread about them, (g) being ignored or left on purpose, (h) having sexual comments or gestures made toward them; and (i) having their property stolen. Based on the results of this current study, several different proposals for future research can be proposed, including (a) examination of the changes in bullying behaviors and reporting of bullying longitudinally, from elementary to high school and (b) comparisons between schools with and without bullying prevention programs in regard to type and frequency of student bullying behaviors and student reporting of bullying. / School of Education; / School Psychology / PhD; / Dissertation;

Background: Commonly used response scales in patient-reported outcome (PRO) measures include the visual analogue scale, 11-point numeric rating scale, 5-point numeric rating scale, 5-point verbal rating scale, and 5-point verbal-numeric rating scale. Although prior studies have explored the interpretation of response scale labels and compared scores resulting from the response scale, many questions remain. Purpose: To identify sets of verbal descriptors interpreted with the least variation and to explore whether the response scales provide interval level data and whether the scales are interchangeable. Methods: Subject recruitment and screening was through an online drug-drug interaction service (MediGuard.org). Via an online survey platform, subjects used a scale (0 = lowest possible and 10=highest possible) to assign interpretation scores to verbal descriptors. Repeated measures analysis of variance informed the test interval data between scores. Subjects also completed repeated administrations of four symptom-specific item stems with different response scales. Ordinal regression informed the analysis of scores assigned to verbal descriptors, comparison of probabilities of responding in given categories across scales, and prediction of response category on one scale conditional on observed response on another scale. Cut-points informed tests for interval level data. Results: The sample (n=350) comprised 223 females and 127 males with a mean (SD) age of 56.9 (12.1) years. Number of health conditions per subject ranged from 1 to 12 (median = 5). Age, sex, level of education, and number of health conditions were associated with the interpretation of verbal descriptors. Scores assigned to "poor," "fair," "good," "very good," "excellent," "somewhat," "sometimes," and "quite a bit," had the largest variation. The probability of responding in the same categories on the different response scales was significantly different across scales before and after collapsing categories. No scale yielded interval level data. The 11-NRS data tended more towards interval level than the data from other scales. Conclusions: Using different response scales with verbal descriptors in non-randomized studies may introduce bias. Differential item functioning and subgroup analyses should be investigated in the development and use of these response scales. The scales are not interchangeable. Compared with other scales the 11-NRS produced data approaching interval level. Collapsing categories entails significant probabilities of misclassification.

Electronic data capture technologies, such as interactive voice response (IVR) systems, are emerging as important alternatives for collecting self-reported data. The purpose of this research was to assess the measurement equivalence between the original paper-based versions and the adapted interactive voice response (IVR) versions of the EQ-5D and the QLQ-C30. Furthermore, we examined the test-retest reliability of two consecutive administrations of the IVR versions of the EQ-5D and the QLQ-C30. The comparison of the paper and IVR versions of the EQ-5D was conducted utilizing a crossover design with subjects randomly assigned to one of two assessment orders: 1) paper then IVR or 2) IVR then paper. A convenience sample of in-treatment outpatient cancer clinic patients (n=139) were asked to complete each assessment two days apart. For the test-retest component, outpatient cancer clinic patients (n=127) were asked to complete the IVR-based EQ-5D twice, two days apart. The analyses tested for mean differences (paired t-test) and test-retest reliability (ICC).In the crossover analysis, ten of the fifteen mean differences analyzed for the scales and items of the QLQ-C30 were within the equivalence interval set a priori. The ICCs for the scales and items of the QLQ-C30 ranged from 0.698 to 0.899. Two of the items, insomnia and appetite loss, did not meet our threshold of being statistically different from an ICC of 0.70. The EQ-5D index score means were equivalent between paper and IVR, however the EQ VAS score differences were not wholly contained in the equivalence interval. The ICCs were above 0.890 for the index and the EQ VAS. In the test-retest analysis, the ICCs for the nine multi-item scales for the QLQ-C30 were all above 0.69, ranging from 0.698 to 0.891. Ten of the fifteen mean differences analyzed were within the equivalence interval set a priori. For the EQ-5D, the mean differences were wholly contained within the equivalence intervals for both the index and the EQ VAS and the ICCs were significantly different from 0.70. Overall, the IVR version of the questionnaires provided psychometrically equivalent results to those obtained on the original paper version and showed good stability over time.

Patient reported outcomes (PROs) are becoming increasingly important in cancer studies, particularly with the emphasis on patient centered outcome research. However, multiple PROs, using different scales, with different directions of favorability are often used within a trial, making interpretation difficult. To enhance interpretability, we propose the use of a standardized effect size graph, which shows all PROs from a study on the same figure, on the same scale. Plotting standardized effects with their 95% confidence intervals (CIs) on a single graph clearly showing the null value conveys a comprehensive picture of trial results. We demonstrate how to create such a graph using data from a randomized controlled trial that measured 12 PROs at two time points. The 24 effect sizes and CIs are shown on one graph and clearly indicate that the intervention is effective and sustained.

Les données rapportées par les patients sont maintenant fréquemment utilisées en recherche biomédicale. Ces instruments permettent la mesure de concepts subjectifs tels que la qualité de vie, les niveaux d’anxiété, de douleur, de fatigue. L’interprétation d’une différence de score au cours du temps était basée sur l’hypothèse que le sens des concepts et échelles restai stable au cours du temps dans l’esprit des individus. Cette hypothèse semble aujourd’hui dépassée. L’auto-évaluation d’un concept est maintenant comprise comme contingente de la représentation subjective qu’à un sujet du dit concept, cette représentation pouvant changer au cours du temps, surtout après avoir vécu un évènement de santé : ce phénomène est connu comme le « response shift ». Depuis la fin des années 1990s, l’investigation de ce phénomène est devenue un sujet d’intérêt majeur en psychométrie. Si des développements ont vu le jour, ce sujet reste récent et donc accompagné de débats variés que ce soit sur le plan théorique ou méthodologique. Aussi, l’objectif général de cette thèse est d’investiguer certaines problématiques méthodologiques et statistiques liées au response shift. Ce manuscrit est composé de trois travaux principaux : un état de l’art et une synthèse des travaux conduits à un niveau international depuis que le response shift est étudié, une étude pilote des performances de la procédure d’Oort (une méthode populaire de détection de response shift) par simulations et un travail théorique sur les liens entre response shift et complexité sémantique des concepts mesurés et items utilisés. / Patient-Reported Outcomes are increasingly used in health-related research. These instruments allow the assessment of subjective concepts such as Health-Related Quality of Life, anxiety level, pain or fatigue. Initially, the interpretation of a difference in score over time was based on the assumption that the meaning of concepts and measurement scales remains stable in individuals’ minds over time. This assumption has been challenged. Indeed, the self-assessment of a concept is now understood as a contingency of the subjective meaning a subject has of this concept, which can change over time especially as a result of a salient medical event: the “response shift” phenomenon. Since the end of the 1990s, researches on response shift phenomenon has become of prime interest in the field of health-related research. If developments have been made, it is still a young field with various scientific debates on a theoretical, methodological and statistical level. Thus, the broad objective of this thesis is to investigate some methodological and statistical issues regarding response shift concept, detection and integration into PRO data analyses. The manuscript is composed of three main works: a state of the art and synthesis of the works conducted at an international level since response shift phenomenon is investigated, a pilot study investigating the statistical performances of the Oort’s Procedure (a popular method of response shift detection using Structural Equation Modeling) by simulations and a theoretical work about the links between response shift occurrence and semantic complexity of concepts measured and items used.

Class of 2015 Abstract / Objectives: To compare the self-reported medication knowledge and attitudes of patients with psychiatric disorders who attended a patient medication education group (PMEG) versus those who did not. Methods: A convenience sample of 288 patients being discharged from an adult inpatient psychiatric unit was used. Just prior to discharge, patients were offered the opportunity to complete a questionnaire to assess their medication knowledge and attitudes. Patients who consented and attended the PMEG were assigned to the treatment group (n=81), while those who did not attend the PMEG were assigned to the control group (n= 207). The survey included nine statements for which the patients selected either agree or disagree. A Rasch analysis was used to analyze scaled questions. Chi-squared tests and Mann-Whitney U were used to analyze nominal and ordinal data, respectively. Demographic data was also collected. An alpha priori of 0.05 was applied. A Bonferroni correction was applied for multiple tests. Results: Patients who attended the PMEG were found to have a higher level of education compared to those who did not attend (p=0.037). There were no significant differences in knowledge and/or attitudes between those who attended PMEG during this admission versus those who did not attend (p=0.065). However, those who attended a PMEG during a previous hospital admission had a more positive attitude toward taking their medications (p=0.025). Conclusions: Results suggest that attitudes toward taking medications may gradually improve over time after patients attend a PMEG during an acute inpatient psychiatric admission.

INTRODUCTION: Immune checkpoint inhibitors are a new form of immunotherapy that has transformed the treatment landscape for an ever-increasing number of malignancies. While these medications utilize and enhance the immune system to treat malignancies, they can also have significant side effects, termed immune related adverse events, that in many ways resemble autoimmune disease states. One such example is inflammatory arthritis, which has been found to resemble a number of different presentations, including rheumatoid arthritis and seronegative spondyloarthropathies. In addition to these traditional inflammatory arthritis phenotypes, worsening of pre-existing arthritis is another subgroup of inflammatory arthritis that has previously not been considered in this population. Furthermore, while the effects of these autoimmune arthropathies on functionality is well-documented, it is not known whether there is a significant effect on functionality in patients that experience immune checkpoint inhibitor-induced arthritis. Given that patient reported outcomes are a validated and routinely utilized measure of functionality and quality of life, the Health Assessment Questionnaire, pain visual analogue scale and Patient Global Assessment were used to measure these outcomes following diagnosis. Our aim here is to explore the subtypes of inflammatory arthritis that result from this type of treatment and its overall effect on functionality and quality of life. METHODS: This study was a retrospective review of patients at one academic center who experienced an inflammatory arthritis resulting from immune checkpoint inhibition and required a referral to a rheumatologist for further work-up. Patients were evaluated in clinic at which time they also completed a Health Assessment Questionnaire as part of standard of care. Once patients were evaluated, their inflammatory arthritis was classified based on which clinical arthritis that it matched most closely, including polymyalgia rheumatica, rheumatoid arthritis, seronegative spondyloarthritis, or an exacerbation or osteoarthritis. Other demographic information such as gender, age, and race were also collected. Patient questionnaires were scored and compared to the type of inflammatory arthritis to assess for any correlations. RESULTS: We found 30 patients that had an inflammatory arthritis resulting from immune checkpoint inhibition, with 12 having a polyarthritis similar to rheumatoid arthritis, 11 patients having osteoarthritis exacerbation, 4 patients with a polymyalgia rheumatica arthritis phenotype and 3 patients with a spondyloarthopathy. In terms of the patient reported outcomes, the overall score was 0.57 ± 0.47, indicating that there was little effect of these arthropathies on overall functionality. The pain visual analogue scale had an average score of 41.8 ± 31.4 mm and the Patient Global Assessment had an overall score of 25.6 ± 26.7 mm. DISCUSSION: The overall results suggest that the inflammatory arthritis phenotypes do not significantly impact the functionality or quality of life of most patients who experience this side effect. Given that the use of immune checkpoint inhibitors will continue to grow, the overall need to better understand the resulting arthritis presentations is key. This is perhaps most true for those with pre-existing osteoarthritis, given the widespread nature of the disease in the general population and the prominence of the exacerbation as seen in our cohort.

Background: To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18-65. Methods: By applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions-education, occupation, and skin colour-using ten health measures: Self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions. Results: Once controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: Middle-level education = 3.535 [1.329, 5.741], p < 0.01; high-level education = 5.249 [3.050, 7.448], p < 0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p < 0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables,-0.066 [-0.098,-0.033], p < 0.01). Conclusions: In terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country's universal healthcare system-which offers full coverage and access and affordable medications- A nd its highly developed education system.

Objectives: Patient-reported outcomes (PROs; self-report assessments) are increasingly important in evaluating medical care and treatment efficacy. Electronic administration of PROs via computer is becoming widespread. This article reviews the literature addressing whether computer-administered tests are equivalent to their paper-and-pencil forms. Methods: Meta-analysis was used to synthesize 65 studies that directly assessed the equivalence of computer versus paper versions of PROs used in clinical trials. A total of 46 unique studies, evaluating 278 scales, provided sufficient detail to allow quantitative analysis. Results: Among 233 direct comparisons, the average mean difference between modes averaged 0.2% of the scale range (e.g., 0.02 points on a 10-point scale), and 93% were within ±5% of the scale range. Among 207 correlation coefficients between paper and computer instruments (typically intraclass correlation coefficients), the average weighted correlation was 0.90; 94% of correlations were at least 0.75. Because the cross-mode correlation (paper vs. computer) is also a test-retest correlation, with potential variation because of retest, we compared it to the within-mode (paper vs. paper) test-retest correlation. In four comparisons that evaluated both, the average cross-mode paper-to-computer correlation was almost identical to the within-mode correlation for readministration of a paper measure (0.88 vs. 0.91). Conclusions: Extensive evidence indicates that paper- and computer-administered PROs are equivalent.

Patient-reported outcomes (PROs) produce meaningful information about patient-perceived health status reported directly by patients. Routine collection of PROs data is particularly important in chronic conditions, such as heart failure (HF). Major cardiovascular societies and regulatory agencies encouraged PRO inclusion in randomized controlled trials (RCTs), but PROs remain underutilized as a key outcome in these studies. In this systematic review, we aimed to evaluate temporal trends and explore trial characteristics associated with PRO inclusion in HF RCTs published in high-impact medical journals. We also assessed the quality of PRO reporting against the Consolidated Standards of Reporting Trials PRO extension. We found that over half of HF RCTs included a PRO. The proportion of RCTs with PROs increased significantly since 2000. A number of RCT characteristics such as multicentre; medium-sized (n = 51-250 participants); trials coordinated in Central and South America; and that tested health services, devices or surgery, exercise and rehabilitation interventions were independently associated with higher odds of PRO inclusion. The quality of PRO reporting was modest, with better reporting in RCTs with PROs a primary or co-primary endpoint. Consistent PRO inclusion and high-quality reporting are necessary to increase the utility of these findings by patients, clinicians, and health care policy makers. / Thesis / Master of Science (MSc)