Marco J. Mariotto

MEASUREMENT OF QUALITY OF WELL BEING IN A CHILD AND ADOLESCENT CYSTIC FIBROSIS POPULATION

Substantial interest in the Quality of WellBeing Scale (QWB) has been shown recently, especially in chronic illness populations.1,2 Designed as a single metric to apply to general populations, the QWB combines physical symptoms and functionality in the areas of mobility, physical activity, and social activity. Although the QWB has been used for policy analysis, its application in clinical populations has been more limited.3

Self-management of cystic fibrosis : a structural model for educational and behavioral variables

One hundred and ninety-nine patients and their primary caregivers at two metropolitan cystic fibrosis centers participated in a clinical trial to evaluate the effectiveness of a health education program designed to help improve self-management skills for the care of CF. The baseline data from the study was used to test a structural model that hypothesized the relationship between educational, behavioral, and health status variables. Controlling for the effects of all other variables, including demographic, self-efficacy (confidence in being able to perform a behavior) was the most important educational factor predicting self-management behavior for monitoring and treating respiratory problems. Knowledge about the management of CF was only related to the ability of caretakers to apply coping skills to problems associated with CF. The more caretakers reported performing monitoring behaviors the more likely they were to report performing self-management treatment behaviors. The findings suggest that educational interventions that focus on increased knowledge alone are not likely to be effective in improving self-management behavior for CF. Based on the structural model analyses, it is recommended that educational programs for CF patients and families address increased self-efficacy and improved monitoring skills to influence the improvement of self-management treatment for CF.

Comparability of selection instruments in studies of heterosexual-social problem behaviors

To evaluate the comparability of the selection methods used in analogue studies on heterosexual-social problem behaviors, 67 undergraduate males were administered four commonly used paper-and-pencil self-report instruments designed to assess both “dating experience” and “social anxiety”. Major findings from the analyses were (a) the majority of the intercorrelations were statistically significant, although most were relatively low in magnitude, (b) based on a principal component analysis, the battery of instruments appeared multidimensional in nature with considerable content and method variance present among instruments, and (c) using traditional selection criteria, all instruments produced relatively independent subject samples, and little was gained from knowing classification on one instrument in predicting classification on another. Implications for past and future research in this analogue research area and the current clinical research on social skills training were discussed, along with the lack of convergence of these instruments.

Effects of weight cycling in female rats

Recent reports indicate that weight cycling (repeated periods of weight gain and loss) cause an organism to become an energy conserver, meaning that the organism gains weight more quickly and loses weight more slowly during subsequent weight cycles. The effects of weight cycling on rates of weight gain and loss, caloric efficiency, and ad lib wheel running were investigated with three groups of adult female rats: 1) cycling (cycled twice); 2) maturity control (cycled once); and 3) chow control (not cycled). The cycled group evidenced weight-gain periods of 36 and 21 days, respectively, and showed a significant increase in food efficiency during the second weight-gain period, relative to the first. There was no evidence that maturation was responsible for this phenomenon. Time required to lose weight and ad lib wheel running were not influenced by weight cycling. These findings suggest that weight cycling may make maintenance of normal weight more difficult and have implications for human weight-control programs.

Observational assessment systems use for basic and applied research

Three observational assessment systems, the Time-Sample Behavioral Checklist, the Staff-Resident Interaction Chronograph, and the Clinical Frequencies Recording System, are shown to have remarkable utility for a wide range of basic and applied research questions. The assessment systems have already been employed to measure independent and dependent variables in a number of treatment outcome and staff training studies and as measures in more basic studies of environmental history effects for chronic mental patients. Current and planned investigations employing the observational measures are outlined. These include psychometric studies of the instruments themselves, investigations of various parameters of ongoing treatment programs, and empirical validations of proposed nosological diagnostic schemas. Finally, several metamethodological issues germaine to observational assessment, in general, are noted, including the observation vs. interpretation debate and the role of precise observational measurement in applied research contexts.

Criteria for the Assessment of Organism-Environment Correlation in Human Developmental Studies.

A review of the literature indicates that the analysis of genotype-behavior relationships in humans becomes quite problematic in the presence of organism (gene)-environment correlation. Up to the present time all attempts to deal with this problem have been statistical in nature. Little attention has been paid to the data-gathering strategies which precede statistical analysis. Based on previous research the present paper offers methodological and statistical criteria necessary for adequate measurement of organism-environment correlation. A path analysis model which meets the specified criteria is offered as an approach to the study of organism-environment correlation.

The Utility of Assessment for Different Purposes

Although formal assessment is a hallmark of scientific research, it is equally important to rational decision-making in management and clinical activities. The operation of mental health services systems for the chronically mentally ill requires a multitude of decisions at administrative and clinical levels, and each decision involves a choice among alternative courses of action. A facility director deciding, for example, on the level of funding for a treatment program chooses among at least three alternatives: increase funding, decrease funding, or maintain the status quo. Likewise, an individual clinician’s decision to administer a neuroleptic drug to a particular patient involves a choice among drugs, dosage levels, and methods of administration. Even the tacit decision to continue activities “as usual” involves a choice not to change to alternative courses of action. All rational decision-making requires that choices among courses of action be based upon the probable gains and losses each alternative offers. The operation of mental health services for the chronically mentally ill involves choices that assume some level of assessment because they imply comparisons and predictions. Thus, formal assessment is as important to good services as it is to good research.

Familiar/interactive raters are not always best: The influence of sampling schedules and class of behavior

Retrospective rating scales are widely used for formal assessment of typical performance. Raters who are the most familiar/interactive with ratees are routinely recommended to maximize the quality of ratings. This caveat to use the most familiar/interactive raters fails to distinguish sampling parameters of the observations on which ratings are based that may be important to assessing different classes of behavior. We hypothesized that systematic observational schedules would be of greater importance to ratings of public events than familiarity/interaction, per se, while the caveat would hold for ratings of private events. We used the Psychotic Inpatient Profile (PIP), which provides separate factor scores for ratings of public and private events, to examine these hypotheses in a quasi-experimental study with adult inpatients of mental hospitals. A large multiinstitutional data set provided retrospective PIP ratings by two types of raters. The most familiar/interactive local clinical staff for each client completed the PIP after observing on an ad lib schedule, along with ongoing job duties. Unfamiliar, noninteractive raters completed the PIP for each client after observing on a systematic time-sampling schedule for purposes of coding an entirely different instrument. Data were selected so that each of 189 clients received PIP scores from four raters, reflecting functioning during the same time period based on day-shift observations by one rater of each type and evening-shift observations by one rater of each type. Analyses of variance, consistency/discriminability of ratings, and prediction of social-action outcomes all supported the hypotheses. We discuss alternative strategies that are better for assessing typical performance in most circumstances. We also provide recommendations for improving the adequacy of observations for those circumstances in which the standardized retrospective rating scale could be a cost-effective assessment strategy.