Marios Constantinou

An international road map to improve pain assessment in people with impaired cognition: the development of the Pain Assessment in Impaired Cognition (PAIC) meta-tool

BackgroundPain is common in people with dementia, yet identification is challenging. A number of pain assessment tools exist, utilizing observation of pain-related behaviours, vocalizations and facial expressions. Whilst they have been developed robustly, these often lack sufficient evidence of psychometric properties, like reliability, face and construct validity, responsiveness and usability, and are not internationally implemented. The EU-COST initiative “Pain in impaired cognition, especially dementia” aims to combine the expertise of clinicians and researchers to address this important issue by building on previous research in the area, identifying existing pain assessment tools for dementia, and developing consensus for items for a new universal meta-tool for use in research and clinical settings. This paper reports on the initial phase of this collaboration task.MethodsAll existing observational pain behaviour tools were identified and elements categorised using a three-step reduction process. Selection and refinement of items for the draft Pain Assessment in Impaired Cognition (PAIC) meta-tool was achieved through scrutiny of the evidence, consensus of expert opinion, frequency of use and alignment with the American Geriatric Society guidelines. The main aim of this process was to identify key items with potential empirical, rather than theoretical value to take forward for testing.Results12 eligible assessment tools were identified, and pain items categorised according to behaviour, facial expression and vocalisation according to the AGS guidelines (Domains 1 – 3). This has been refined to create the PAIC meta-tool for validation and further refinement. A decision was made to create a supporting comprehensive toolkit to support the core assessment tool to provide additional resources for the assessment of overlapping symptoms in dementia, including AGS domains four to six, identification of specific types of pain and assessment of duration and location of pain.ConclusionsThis multidisciplinary, cross-cultural initiative has created a draft meta-tool for capturing pain behaviour to be used across languages and culture, based on the most promising items used in existing tools. The draft PAIC meta-tool will now be taken forward for evaluation according to COSMIN guidelines and the EU-COST protocol in order to exclude invalid items, refine included items and optimise the meta-tool.

Smoking prevalence and tobacco exposure among adolescents in Cyprus

BACKGROUND Smoking has been internationally recognized as an epidemic contributing to major health problems. Smoking contributes to most of the preventable deaths worldwide. Although Cyprus is considered among developed countries with high smoking prevalence (estimates of 25-35% of the population), not much has been done for the systematic scientific study of this problem, especially in adolescence. The present study aimed to investigate smoking prevalence and related factors among Cypriot adolescents. METHODS Participants were selected through stratified random sampling. The final sample included two subpopulations: middle (n = 1085) and high (n = 767) school students. RESULTS Six percent of middle school students reported being regular smokers. This climbed to 24% among high school students. Smoking prevalence increases with age, and appears higher in boys than in girls. Smoking is quite common in the participants families, particularly among fathers. Cigarette and smoke exposure in the home was high, as only a fifth of the students reported smoking never being allowed in the home. Exposure to actors smoking on television was the norm (62-67%) with low reported exposure to anti-smoking messages. Having friends who smoke, exposure to others smoking and low educational aspirations were significant predictors of smoking for both groups. Additional predictors, which were different for middle and high school students, were identified. CONCLUSION Further research to investigate the nature of these effects is required and to provide further insight into the psychosocial parameters affecting smoking. These results can guide possible prevention and intervention programs for adolescents, and suggest the importance of following a systemic approach.

Training models and status of clinical neuropsychologists in Europe: results of a survey on 30 countries

Abstract Objective: The aims of the study were to analyze the current European situation of specialist education and training within clinical neuropsychology, and the legal and professional status of clinical neuropsychologists in different European countries. Method: An online survey was prepared in 2016 by a Task Force established by the European Federation of Psychological Associations, and representatives of 30 countries gave their responses. Response rate was 76%. Results: Only three countries were reported to regulate the title of clinical neuropsychologist as well as the education and practice of clinical neuropsychologists by law. The most common university degree required to practice clinical neuropsychology was the master’s degree; a doctoral degree was required in two countries. The length of the specialist education after the master’s degree varied between 12 and 60 months. In one third of the countries, no commonly agreed upon model for specialist education existed. A more systematic training model and a longer duration of training were associated with independence in the work of clinical neuropsychologists. Conclusions: As legal regulation is mostly absent and training models differ, those actively practicing clinical neuropsychology in Europe have a very heterogeneous educational background and skill level. There is a need for a European standardization of specialist training in clinical neuropsychology. Guiding principles for establishing the common core requirements are presented.