Validity Aspects of the Strengths and Difficulties Questionnaire (SDQ) Adolescent Self-Report and Parent-Report Versions Among Dutch Adolescents

In this study, validity aspects of the Strengths and Difficulties Questionnaire (SDQ) self-report and parent-report versions were assessed among Dutch adolescents aged 12 to 17 years (community sample: n = 962, clinical sample: n = 4,053). The findings mostly support the continued use of both SDQ versions in screening for psychosocial problems as (a) exploratory structural equation analyses partially supported the grouping of items into five scales; (b) investigation of associations between scales of the SDQ and the Child Behavior Checklist, Youth Self-Report, and Intelligence Development Scales-2 provided evidence for the SDQ versions' convergent and divergent validity; and (c) receiver operating characteristics curves yielded evidence for both SDQ versions' criterion validity by showing that these questionnaires can be used to screen for psychosocial problems, except for the adolescent-reported version for males. Regardless of the adolescent's gender, the receiver operating characteristics curves showed both SDQ versions to be useful for screening for three specific types of problems: anxiety/mood disorder, conduct/oppositional deviant disorder, and attention-deficit/hyperactivity disorder. Additionally, parent-rated SDQ scores were found to be useful for screening for autism spectrum disorder.

Is the Strengths and Difficulties Questionnaire applicable to lower educated adolescents?

Background

The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a widely used instrument to identify emotional and behavioral problems by Preventive Child Healthcare (PCH). It is a valid instrument in more highly educated adolescents, however evidence regarding lower educated adolescents (vocational school) is lacking. The aim of this study was to compare the psychometric properties of the SDQ-SR when used with less well and more highly educated ('higher') adolescents, and to explore opinions of adolescents and PCH professionals regarding its suitability.

Methods

We included 426 adolescents (130 lower and 296 higher educated), who completed the SDQ-SR. We compared how the psychometric properties (i.e. internal consistency) applied to lower and higher educated adolescents. We assessed whether the five-factor structure of the SDQ is invariant across different educational levels. Moreover, we interviewed 24 adolescents from pre-vocational secondary education schools, and performed online focus group interviews with 17 PCH professionals.

Results

The internal consistencies (Cronbach's alphas) per SDQ scale were comparable for lower and higher educated adolescents. On most subscales the lower educated adolescents had higher mean scores than the higher educated adolescents. Findings on differences by educational level for the other psychometric properties, i.e. multi-group invariance and single group (CFA) analyses, were inconsistent, with some measures showing unequal factor loadings but others not. Although professionals and lower educated adolescents reported that the SDQ includes many outdated and difficult words, professionals nevertheless perceived the SDQ-SR as a valid instrument.

Conclusions

The psychometric properties of the SDQ-SR are sufficient for use among lower educated adolescents. However, for optimal implementation in PCH there is a need for improvement in the wording of the SDQ, as expressed by both professionals and adolescents.

Key messages

The psychometric properties of the SDQ are sufficient for use among lower educated adolescents. For optimal implementation the SDQ needs to be updated in more understandable language.

Triage in Preventive Child Healthcare: A novel triage protocol to identify health problems

Background

A triage approach to routine health assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. Each PCH service use their own protocol (with health themes such as visuals disorders, sleeping- and psychosocial problems) to determine whether a follow-up assessment is needed. In this study a novel standardized triage protocol was developed. The aim was to improve the quality of detection of health problems in primary school children by PCH by investigating the quality of detection of health problems and satisfaction of this novel triage protocol.

Methods

We included 459 primary school children undergoing routine health assessments in 2 PCH services across the Netherlands. We used parent-reported child problems and PCH registry data. After each assessment PCH professionals reported whether they had identified any problems and carried out any additional actions (e.g., additional assessments, referral). The validity of the protocol is assessed, with problems identified by PCH professionals and performing additional actions as criteria.

Results

Results showed that the psychometric properties of the novel triage protocol were moderate to good. Sensitivity (true positives) and specificity (true negatives) for the novel triage protocol were 0.73 and 0.62, respectively for the identification of any problems, and were 0.91 and 0.41, respectively, for additional PCH actions.

Conclusions

The novel triage protocol is a valid tool for the detection of health problem in primary school children by PCH. Few children with health problems were missed. Professionals and parents were very satisfied with the novel protocol. Professionals made specific recommendations about adaptations of the protocol to improve efficiency and facilitate implementation in daily PCH practice.

Key messages

The novel triage protocol is a valid tool for the detection of health problem in primary school children. For optimal implementation in preventive child healthcare the novel triage protocol needs some minor adaptations.

A prototype small-bore ventilation catheter with a cuff: cuff inflation optimizes ventilation with the Ventrain

Background

Ventilation through small‐diameter tubes typically precludes use of a cuff as this will impede the necessary passive outflow of gas alongside the tube's outer surface. Ventrain assists expiration and enables oxygenation and normoventilation through small‐bore cannulas or catheters, particularly in obstructed airways. A small‐bore ventilation catheter (SBVC; 40 cm long, 2.2 mm inner diameter) with a separate pressure monitoring lumen and a cuff was developed. Efficacy of oxygenation and ventilation with Ventrain through this catheter was investigated in sealed and open airways in a porcine cross‐over study.

Methods

Six pigs were ventilated with Ventrain (15 l/min oxygen, frequency 30 breaths per min, I : E‐ratio 1 : 1) through the SBVC, both with the cuff inflated and deflated. Prior to each test they were ventilated conventionally until steady state was achieved.

Results

With an inflated cuff, PaO₂ rose instantly and remained elevated (median [range] PaO₂ 61 [52–69] kPa after 30 min; P = 0.027 compared to baseline). PaCO₂ remained stable at 4.9 [4.2–6.2] kPa. After cuff deflation, PaO₂ was significantly lower (9 [5–28] kPa at 10 min, P = 0.028) and interventional ventilation had to be stopped prematurely in five pigs as PaCO₂ exceeded 10.6 kPa. Pulmonary artery pressures increased markedly in these pigs. Intratracheal pressures were kept between 5 and 20 cmH₂O with the cuff inflated, but never exceeded 2 cmH₂O after cuff deflation.

Conclusion

The SBVC combines the benefits of a small diameter airway and a cuff. Cuff inflation optimizes oxygenation and ventilation with Ventrain.

A Novel Triage Approach to Identifying Health Concerns

BACKGROUND

We investigated the detection of health problems in preventive child health care (PCH) by a novel triage approach for routine health assessments. In the triage approach, all children were preassessed by a physician's assistant, and only those in need of follow-up were assessed by a PCH physician or nurse. In the traditional approach, all children were assessed by a PCH physician or nurse.

METHODS

A prospective cohort design was used with data on routine assessments of 1897 children aged 5 to 6 and 10 to 11 years. Primary outcomes were the detection of overweight, visual disorders, and psychosocial problems, with type of approach (traditional vs triage) as independent variable. To assess the severity of health problems, BMI, Snellen, Strengths and Difficulties Questionnaire, and Child Behavior Checklist, scores were compared for both approaches in subgroups of children with overweight, visual disorders, or psychosocial problems.

RESULTS

No significant differences were found between the approaches in terms of the detection of incident cases of overweight, visual disorders, and psychosocial problems. Significantly higher Strengths and Difficulties Questionnaire scores were found in the subgroup with psychosocial problems when the triage approach was used. Marginal differences between the approaches were found for severity of overweight in the subgroup of overweight children.

CONCLUSIONS

A novel triage approach to PCH resulting in less involvement of physicians and nurses in routine assessments appears to detect health problems as effectively as the traditional approach in place. More research is needed to determine the long-term outcomes of the 2 approaches.

A novel triage approach of child preventive health assessment: an observational study of routine registry-data

BACKGROUND

The coverage of preventive health assessments for children is pivotal to the system of preventive health screening. A novel method of triage was introduced in the Preventive Youth Health Care (PYHC) system in the Netherlands with an associated shift of tasks of professionals. Doctor's assistants carried out pre-assessments to identify children in need of follow-up assessment, whereas in the traditional approach all children would have been screened by a doctor or nurse. The accessibility and care delivery of this new PYHC system was studied.

METHODS

The new triage approach was compared to the traditional approach in 780 children undergoing PYHC assessment with the use of an observational retrospective study design. Outcomes were attendance of assessment appointments (accessibility of care) and referral of children to either extra PYHC assessment or external specialised care (delivery of preventive care). PYHC registry data were analysed. In two regions of the Netherlands, 390 children five to six years of age were randomly selected from the PYHC registries according to the socio-economic strata of the schools they attended.

RESULTS

When the triage and traditional approaches to PYHC were compared, we found similar attendance rates for assessment appointments, namely about 90%. As expected, 100% of the children in the traditional group were assessed by a PYHC doctor compared to 46% of the children in the triage group. Significantly fewer children were referred for extra PYHC assessment or for treatment by an external specialised care giver when a triage as opposed to the traditional assessment approach was used (19.6% vs. 45.9%).

CONCLUSIONS

The novel triage approach for preventive health assessment shows equal accessibility, but a different delivery of preventive care. A beneficial effect of the adoption of the triage approach is the opportunity to provide more attention from doctors and nurses to children at risk of health problems. However, lower referral rates of the triage approach may be explained by an under-identification of children with health problems. Further research is needed to document the health outcomes and the possible reduction of health care costs with a triage approach compared to traditional PYHC care.

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

The hypothesis was tested whether retrograde autologous priming (RAP) of the cardiopulmonary bypass system, compared to a standard primed system (NON-RAP group), results in less haemodilution and less transfusion of packed red blood cells. Retrospectively, data was collected from the medical charts of one hundred patients undergoing elective coronary artery bypass grafting using cardiopulmonary bypass. Fifty patients where RAP was used have been compared to fifty patients using NON-RAP. The prime volume in the NON-RAP group was 1,627±108 mL versus 782±96 mL in the RAP group (p<0.001). The lowest haematocrit during perfusion was 22% in the NON-RAP group versus 26% when the RAP technique was used (p<0.001). In the NON-RAP group, 26% of the patients received packed red cells in contrast to 6% in the RAP group (p<0.012). A positive association was found between RAP and less transfusion of packed red blood cells (p<0.012). In conclusion, retrograde autologous priming, reducing the prime volume of the cardiopulmonary bypass system, causes less haemodilution and reduces intraoperative transfusion of packed red blood cells.

Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia!

Although epidural anesthesia is considered safe, several complications may occur during puncture and insertion of a catheter. Incidences of paresthesia vary between 0.2 and 56%. A prospective, open, cohort-controlled pilot study was conducted in 188 patients, ASA I-III, age 19-87 years, scheduled for elective surgery and epidural anesthesia. We evaluated a 20 G polyamide (standard) catheter and a 20 G combined polyurethane-polyamide (new) catheter. Spontaneous reactions upon catheter-insertion, paresthesia on questioning, inadvertent dural or intravascular puncture, and reasons for early catheter removal were recorded. The incidence of paresthesia reported spontaneously was 21.3% with the standard catheter and 16.7% with the new catheter. Systematically asking for paresthesia almost doubled the paraesthesia rate. Intravascular cannulation occurred in 5%. No accidental dural punctures occurred. An overall incidence of 13.3% of technical problems led to early catheter removal. The new catheter was at least equivalent to the standard regarding epidural success rate and safety : rate of paresthesia, intravascular and dural cannulation.

Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability

A screening of hearing and visual function was performed using clinical assessment methods in a Dutch institutionalized population of 672 people with mild to profound intellectual disability (ID). Because the studied population was not comparable to the total Dutch population with ID, subgroups were distinguished according to level of ID, age younger and older than 50 years, and the presence or absence of Down's syndrome (DS). The prevalences of both hearing and visual impairment were considerably increased in all subgroups, as compared with the general population. In the least affected group, i.e. those < 50 years with a mild or moderate ID by other causes than DS, the prevalences of hearing and visual impairment were 21% and 4%, respectively (as opposed to 2-7% and 0.2-1.9% in the general Dutch population <50 years, respectively). The prevalence of hearing impairment showed a sharp and highly significant increase in individuals with DS and subjects > or = 50 years. To a lesser extent, young adults with severe or profound ID had an increased risk of hearing impairment. Visual impairment and blindness were specifically highly prevalent in people with severe or profound ID (51% < 50 years of age). Down's syndrome and an age > or = 50 years were also significant risk factors for visual impairment. There was an alarmingly high prevalence of combined sensory impairment, especially in those with severe or profound ID (20%). Although hearing impairment had been diagnosed prior to this screen in 138 people and visual impairment in 65 individuals, a first diagnosis of hearing impairment was made in 128 subjects and of visual impairment in 90 cases. This highlights the tendency for sensory impairments to go unnoticed in people with ID, which is not restricted to those with severe or profound ID. Therefore, the present authors stress the importance of regular screening as outlined in the existing IASSID international consensus statement.

Umbilical artery blood velocimetry: a prospective longitudinal study in search of the intrauterine growth-retarded fetus

In a longitudinal prospective study involving 125 patients, blood velocity waveforms in the umbilical artery were recorded and analyzed from the 15th week of gestation until term to evaluate the predictive value of blood velocity parameters with regard to fetal growth retardation. Measurements were performed with a combined real-time linear array and 2-MHz pulsed Doppler technique. The mean values (+/- 2 S.D.) of the A/B ratio, resistance index (RI) and pulsatility index (PI) were calculated from the 15th to the 40th week of gestation. The degree of intrauterine growth retardation was related to postnatal catch-up growth. Three groups of patients were compared with regard to blood velocity waveform indices. Group NL-I/II: waveform indices (WI) within 2 S.D. of the population mean. Group EL-II: consistently WIs above 2 S.D. of the population mean. Significant differences with regard to neonatal growth variables were found between these groups. In spite of the fact that these differences in growth variables were statistically significant, no clear relationship was found between the velocity waveform indices and true intrauterine growth retardation, defined by a non-birthweight criterion. It seems that umbilical artery velocimetry cannot predict true intrauterine growth retardation.