The development and initial validation of the Perinatal Mental Health Awareness scale in student midwives

Background & aim: Perinatal mental health problems have been demonstrated to impact upon maternal, and fetal/child outcomes. Despite the global evidence and a policy-driven responsibility for identification of these problems, research demonstrates that student midwives/midwives lack knowledge and confidence to assess, identify, and manage them. A similar context is evident for learning disabilities, despite the holistic care philosophy of midwifery. A brief assessment tool to identify knowledge and confidence defecits and strengths within a holistic care framework could support curriculum development. This study sought to develop a Perinatal Mental Health Awareness scale and evaluate its psychometric properties in student midwives.Methods: We employed a cross-sectional and exploratory instrument development and evaluation design to determine the measurement veracity of the new scale.Results: The scale demonstrated good psychometric properties, revealing three subscales mapping onto (i) mental health symptoms, (ii) physical/medical issues and (iii) learning disability. Results indicated a clear differentiation in scores across the subscales, indicating comparative deficits in mental health domains.Conclusion: Our findings facilitate confidence in the psychometric robustness of the measure. The scale enables student midwives to assess and compare different domains of midwifery practice, in line with a holistic model of midwifery care. A focus on physical health in midwifery education appears to disadvantage knowledge and confidence for managing mental health problems in a midwifery context. This valuable finding highlights the potential need for curriculum rebalancing. The measure offers the opportunity to assess and develop curriculum/training provision and monitor the effectiveness of subsequent curricular developments

Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

© 2016 Jefford et al. Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. Conclusion: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous

The genetic architecture underlying the evolution of a rare piscivorous life history form in brown trout after secondary contact and strong introgression

Identifying the genetic basis underlying phenotypic divergence and reproductive isolation is a longstanding problem in evolutionary biology. Genetic signals of adaptation and reproductive isolation are often confounded by a wide range of factors, such as variation in demographic history or genomic features. Brown trout ( ) in the Loch Maree catchment, Scotland, exhibit reproductively isolated divergent life history morphs, including a rare piscivorous (ferox) life history form displaying larger body size, greater longevity and delayed maturation compared to sympatric benthivorous brown trout. Using a dataset of 16,066 SNPs, we analyzed the evolutionary history and genetic architecture underlying this divergence. We found that ferox trout and benthivorous brown trout most likely evolved after recent secondary contact of two distinct glacial lineages, and identified 33 genomic outlier windows across the genome, of which several have most likely formed through selection. We further identified twelve candidate genes and biological pathways related to growth, development and immune response potentially underpinning the observed phenotypic differences. The identification of clear genomic signals divergent between life history phenotypes and potentially linked to reproductive isolation, through size assortative mating, as well as the identification of the underlying demographic history, highlights the power of genomic studies of young species pairs for understanding the factors shaping genetic differentiation

Evidence for the continuum-severity model of psychosis through scrutiny of the architecture of symptoms associated with schizophrenia

The psychosis continuum provides a framework to develop a compelling insight into the architecture of psychotic experiences in non-clinical samples. Using schizophrenia specific measures within non-clinical samples offers further opportunity to investigate psychotic experiences and compare to those reported in clinical samples. A cross sectional survey method was used to collect data from a non-clinical sample (n=510) using the Schizophrenia Quality of Life Scale-Revision 4 (SQLS-R4) and the Hospital Anxiety and Depression Scale (HADS). Conducting confirmatory factor analysis and bi-factor modelling found that a bi-factor model offered a better model fit to the data than the established two factor model. A general factor explained most item variance whilst seven domain specific factors explained a further small amount of item variance. Participants with higher anxiety reported comparatively poorer QOL to those with lower anxiety. Comparison with data taken from a clinical sample found similarities in both the internal consistency and correlation coefficients between SQLS-R4 totals and sub-scales and HADS total scores and sub-scales. These results show the presence of a robust general psychosis QOL factor within a non-clinical sample. The use of schizophrenia specific measures and bi-factor modelling can provide suitable methods for investigating the nature of the psychosis continuum

Commentary on Phillipou et al., Anorexia Nervosa: Eating Disorder or Body Image Disorder?

Phillipou et al. (2018) assert that anorexia nervosa (AN) should be thought of as a body image disorder (BID), and not as it is currently categorized as an eating disorder (ED, American Psychiatric Association, 2013). They propose that the change in description may serve as a more valuable and accurate portrayal of the illness, and suggest that conceptualizing AN as an ED is too simplistic and thus misleading. Phillipou et al. (2018) examine the view that AN is somehow different from other eating disorders such as pica, rumination disorder, avoidance/restricted food intake disorder, binge eating disorder and bulimia nervosa, because at its core AN is fundamentally an illness of ‘body image’. A parallel objective of Phillipou et al. (2018) is to alter the general public’s perception of AN, from one in which the public believe the AN patient is principally driven by disordered eating behaviour in order to reduce body fat, to one in which the patients’ overriding stimulus is actually body image

Measurement properties of the Illness Perception Questionnaire in practitioners working with patients with co-morbid schizophrenia and learning disability

Rationale, aims and objectives: The widely-used Illness Perception Questionnaire (IPQ) adapted for use in patients with major mental health problems and those who care and work with them, was originally developed for evaluating the illness perceptions of patients with physical pathology. There have been concerns expressed regarding the appropriateness of the IPQ and derivative measures of it in axis I disorders such as schizophrenia. The current investigation examined the measurement characteristics of a modified version of the IPQ in mental health practitioners working with patients with schizophrenia co-morbid with learning disability. Method: Two hundred and ten mental health practitioners working with patients with schizophrenia co-morbid with learning disability participated in the study. Contemporary models of the measurement structure of the IPQ were evaluated using confirmatory factor analysis. The internal reliability of the IPQ was also evaluated. Results: Single factor, 5-factor and 6-factor models were evaluated against data. All models were found to offer a poor fit to the data. The internal reliability of the measure was also found to be unsatisfactory overall. Conclusions: Consistent with one previous study that has found poor measurement characteristics of the IPQ when used in the context of schizophrenia, the current study found the measure to be a poorly performing index of illness perceptions. Echoing previous observations of the use of this tool in axis I disorder, it is recommended that a new measure of illness perceptions be developed using contemporary research methodology sensitive to the context of psychotic illness in order to provide a more effective tool for the provision of person-centered psychiatry and healthcare

Incorporating Test Data for Small UAS at the Conceptual Design Level

Increasing demand for improved capabilities of small unmanned aircraft systems (sUAS) has generated interest in improving the design techniques for these vehicles. sUAS have typically been designed using iterative methods with multiple prototypes, but advancements in aircraft design software will make it possible to generate conceptual designs of very small VTOL aircraft with reduced hardware prototyping. This paper describes a research effort to generate a conceptual design of an approximately 6-lb quadcopter using the NASA rotorcraft design software NDARC. Wind tunnel and hover test data are used to validate and refine the conceptual design results. The effects of parametric design variations on vehicle scale are shown. The design study described herein shows that the NDARC software, which was designed for full-scale rotorcraft, can be used to design and evaluate sUAS vehicles

Resilience: paradoxical insight or conceptual poverty?

Purpose: This paper looks at some of the evidence that supports the construct of resilience and the operationalisation of the ‘phenomena’ of resilience within contemporary society. The concept of resilience has become an influential and society-wide construct, embraced by the positive psychology movement and impacting on educational, health and social policy significantly and demonstrably. Importantly, the concept of resilience has a substantial historical heritage and legacy and the permeation of the construct within the collective social consciousness is rarely considered or queried, but generally accepted and embraced. Moreover, the construct of resilience within itself is invariably couched within contemporary discourse as a universal good and highly desirable attribute and further still, considered by many as a fundamental component contributing to the fabric of an individuals’ character. Approach: A short review of selective evidence of key conceptual issues. Findings: Resilience as a concept, is defuse, generally ill-defined and highly subjective. The concept of resilience, though popular and intrinsic to a number of aspects of public and educational policy remains controversial, provides an explanatory account of differential outcomes which may not always be positive and importantly, may potentially disenfranchise the individual. Originality: The synthesis of the brief and selective appraisal of evidence in this area suggests that the concept of resilience, if it exists at all, is highly mercurial, ambiguous in definition and despite its omnipresence as a representation of a positive and internalised attribution to the individual, has a significant negative side which is seldom considered. Querying the concept of resilience against the overwhelming backdrop of positive belief and opinion regarding the concept may represent a social heresy, however, the balance of evidence would suggest a debate about the concept is long overdue and moreover, the concept itself provides a useful fulcrum to consider where beliefs, attitudes and opinions about abstract concepts stop and science, evidence and fact-based reflection begin