29 research outputs found
Psychometric Qualities of the Dimensional Assessment of Personality Pathology â Short Form for Adolescents
A growing body of research recognizes the occurrence and validity of personality pathology during adolescence as well as its relevance as a developmental precursor of adult personality pathology.The present study recognizes the need for a comprehensive and concise instrument to assess the dimensions of personality pathology in adolescents. Therefore, the psychometric qualities of an abbreviated version of the Dimensional Assessment of Personality Pathology - Basic Questionnaire for Adolescents (DAPP-BQ-A), which has been denoted as the DAPP - Short Form for Adolescents (DAPP-SF-A), were examined.The factorial structure, internal consistency, test-retest reliability, discriminative validity, and classification accuracy of the DAPP-SF-A scales were examined in three samples: 1596 non-referred adolescents; 166 adolescents referred to inpatient and outpatient mental health services; and 58 referred and general population adolescents.Despite a reduction in the number of items by 50% (from 290 to 144 items), the promising psychometric qualities established for the DAPP-BQ-A were replicated for the DAPP-SF-A.The results of this study are promising regarding the qualities of the DAPP-SF-A and its utility in both clinical and research settings. In addition, the equivalence of the instruments for adolescents and (young) adults enables the investigation of developmental trajectories across different life stages
The EVIDEM framework and its usefulness for priority setting across a broad range of health interventions
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Associations of specific and multiple types of childhood abuse and neglect with personality pathology among adolescents referred for mental health services
The present study investigated the unique association between five types of childhood abuse and neglect and 18 lower-order dimensions of personality pathology, and using latent classes analysis (LCA) explored patterns of childhood abuse or neglect experiences. Further differences across latent classes on personality pathology traits, personality disorder symptom count and a diagnosis of personality disorder were examined. Participants were 178 adolescents and young adults (12â22 years; MâŻ=âŻ16.02, 65.7% girls; 83% Axis I/II disorder) from the Netherlands referred for mental health services. Emotional abuse was uniquely associated with 11 personality pathology traits; sexual and physical were associated with three and four traits, respectively. LCA yielded three classes, namely, severe maltreatment (class 1), low-moderate emotional maltreatment and sexual abuse (class 2), and least maltreatment (class 3). After controlling for age, gender, presence of any Axis I disorder, multivariate analysis of covariance indicated that classes with more types of maltreatment experiences and higher severity (classes 1 and 2) endorsed more personality pathology traits, personality disorder symptom counts and a diagnosis of a personality disorder than the least maltreatment class. Findings have theoretical and clinical implications entailing the identification of patterns of maltreatment types and related personality pathology traits among youth
Associations of specific and multiple types of childhood abuse and neglect with personality pathology among adolescents referred for mental health services
The present study investigated the unique association between five types of childhood abuse and neglect and 18 lower-order dimensions of personality pathology, and using latent classes analysis (LCA) explored patterns of childhood abuse or neglect experiences. Further differences across latent classes on personality pathology traits, personality disorder symptom count and a diagnosis of personality disorder were examined. Participants were 178 adolescents and young adults (12â22 years; M = 16.02, 65.7% girls; 83% Axis I/II disorder) from the Netherlands referred for mental health services. Emotional abuse was uniquely associated with 11 personality pathology traits; sexual and physical were associated with three and four traits, respectively. LCA yielded three classes, namely, severe maltreatment (class 1), low-moderate emotional maltreatment and sexual abuse (class 2), and least maltreatment (class 3). After controlling for age, gender, presence of any Axis I disorder, multivariate analysis of covariance indicated that classes with more types of maltreatment experiences and higher severity (classes 1 and 2) endorsed more personality pathology traits, personality disorder symptom counts and a diagnosis of a personality disorder than the least maltreatment class. Findings have theoretical and clinical implications entailing the identification of patterns of maltreatment types and related personality pathology traits among youth
Are patients' judgments of health status really different from the general population?
Background: Many studies have found discrepancies in valuations for health states between the general population (healthy people) and people who actually experience illness (patients). Such differences may be explained by referring to various cognitive mechanisms. However, more likely most of these observed differences may be attributable to the methods used to measure these health states. We explored in an experimental setting whether such discrepancies in values for health states exist. It was hypothesized that the more the measurement strategy was incorporated in measurement theory, the more similar the responses of patients and healthy people would be. Methods: A sample of the general population and two patient groups (cancer, rheumatoid arthritis) were included. All three study groups judged the same 17 hypothetical EQ-5D health states, each state comprising the same five health domains. The patients did not know that apart from these 17 states their own health status was also included in the set of states they were assessing. Three different measurement strategies were applied: 1) ranking of the health states; 2) placing all the health states simultaneously on a visual analogue scale (VAS); 3) separately assessing the health states with the time trade-off (TTO) technique. Regression analyses were performed to determine whether differences in the VAS and TTO can be ascribed to specific health domains. In addition, effect of being member of one of the two patient groups and the effect of the assessment of the patients' own health status was analyzed. Results: Except for some moderate divergence, no differences were found between patients and healthy people for the ranking task or for the VAS. For the time trade-off technique, however, large differences were observed between patients and healthy people. The regression analyses for the effect of belonging to one of the patient groups and the effect of the value assigned to the patients' own health state showed that only for the TTO these patient-specific parameters did offer some additional information in explaining the 17 hypothetical EQ-5D states. Conclusions: Patients' assessment of health states is similar to that of the general population when the judgments are made under conditions that are defended by modern measurement theory
Comparative Cost Analysis of Four Interventions to Prevent HIV Transmission in Bandung, Indonesia
Background: the costs of HIV/AIDS interventions in Indonesia are largely unknown. Knowing these costs is an important input for policy makers in the decision-making of setting priorities among HIV/AIDS interventions. The aim of this analysis is to determine the costs of four HIV/AIDS interventions in Bandung, Indonesia in 2015, to inform the local AIDS commission. Methods: data on utilization and costs of the different interventions were collected in a sexual transmitted infections (STI)-clinic and the KPA, the local HIV/AIDS commission, for the period of January 2015-December 2015. The costs were estimated from a societal perspective, using a micro-costing approach. Results: the total annualized costs for condom distribution, mobile voluntary counselling and testing (VCT), religious based information, communication, and education (IEC) and STI services equalled US2,985, US5,865, respectively. Conclusion: this analysis has provided cost estimates of four different HIV/AIDS interventions in Bandung, Indonesia. Additionally, it has estimated the costs of scaling up these interventions. Together, this provides important information for policy makers vis-Ă -vis the implementation of these interventions. However, an evaluation of the effectiveness of these interventions is needed to estimate the cost-effectiveness
Evidence-Informed Deliberative Processes â Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries
Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness
Priority setting of health interventions is generally considered as a valuable approach to support low- and
middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present
initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information,
and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority
setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are
important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we
propose the use of âevidence-informed deliberative processesâ as an approach that does explicitly recognise
priority setting as a political process and an intrinsically complex task. In these processes, deliberation between
stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by
evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be
seen as the product of both international learning (âcoreâ criteria, which include eg, cost-effectiveness, priority
to the worse off, and financial protection) and learning among local stakeholders (âcontextualâ criteria). We
believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more
meaningful contribution to achieving UHC
Equity in utilization of antiretroviral therapy for HIV-infected people in South Africa: a systematic review
INTRODUCTION: About half a million people in South Africa are deprived of antiretroviral therapy (ART), and there is little systematic knowledge on who they are â e.g. by severity of disease, sex, or socio-economic status (SES). We performed a systematic review to determine the current quantitative evidence-base on equity in utilization of ART among HIV-infected people in South Africa. METHOD: We conducted a literature search based on the Cochrane guidelines. A study was included if it compared for different groups of HIV infected people (by sex, age, severity of disease, area of living, SES, marital status, ethnicity, religion and/or sexual orientation (i.e. equity criteria)) the number initiating/adhering to ART with the number who did not. We considered ART utilization inequitable for a certain criterion (e.g. sex) if between groups (e.g. men versus women) significant differences were reported in ART initiation/adherence. RESULTS: Twelve studies met the inclusion criteria. For sex, 2 out of 10 studies that investigated this criterion found that men are less likely than women to utilize ART, while the other 8 found no differences. For age, 4 out of 8 studies found inequities and reported less utilization for younger people. For area of living, 3 out of 4 studies showed that those living in rural areas or certain provinces have less access and 2 out of 6 studies looking at SES found that people with lower SES have less access. One study which looked at the marital status found that those who are married are less likely to utilize ART. For severity of disease, 5 out of 6 studies used more than one outcome measure for disease stage and reported within their study contradicting results. One of the studies reported inconclusive findings for ethnicity and no study had looked at religion and sexual orientation. CONCLUSION: It seems that men, young people, those living in certain provinces or rural areas, people who are unemployed or with a low educational level, and those being unmarried have less access to ART. As studies stem from different contexts and use different methods conclusions should be taken with caution