Pei Shan Tsai

Diagnostic Accuracy of Rating Scales for Attention- Deficit/Hyperactivity Disorder: A Meta-analysis

CONTEXT: The Child Behavior Checklist–Attention Problem (CBCL-AP) scale and Conners Rating Scale–Revised (CRS-R) are commonly used behavioral rating scales for diagnosing attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. OBJECTIVE: To evaluate and compare the diagnostic performance of CBCL-AP and CRS-R in diagnosing ADHD in children and adolescents. DATA SOURCES: PubMed, Ovid Medline, and other relevant electronic databases were searched for articles published up to May 2015. STUDY SELECTION: We included studies evaluating the diagnostic performance of either CBCL-AP scale or CRS-R for diagnosing ADHD in pediatric populations in comparison with a defined reference standard. DATA EXTRACTION: Bivariate random effects models were used for pooling and comparing diagnostic performance. RESULTS: We identified and evaluated 14 and 11 articles on CBCL-AP and CRS-R, respectively. The results revealed pooled sensitivities of 0.77, 0.75, 0.72, and 0.83 and pooled specificities of 0.73, 0.75, 0.84, and 0.84 for CBCL-AP, Conners Parent Rating Scale–Revised, Conners Teacher Rating Scale–Revised, and Conners Abbreviated Symptom Questionnaire (ASQ), respectively. No difference was observed in the diagnostic performance of the various scales. Study location, age of participants, and percentage of female participants explained the heterogeneity in the specificity of the CBCL-AP. CONCLUSIONS: CBCL-AP and CRS-R both yielded moderate sensitivity and specificity in diagnosing ADHD. According to the comparable diagnostic performance of all examined scales, ASQ may be the most effective diagnostic tool in assessing ADHD because of its brevity and high diagnostic accuracy. CBCL is recommended for more comprehensive assessments.

Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: A cross-sectional observational study

OBJECTIVE The aim of the study was to investigate the association between dialysis shift and subjective sleep quality in chronic haemodialyzed patients. DESIGN A cross-sectional observational study. PARTICIPANTS AND METHODS A total of 206 haemodialyzed patients aged from 22 to 71 participated in this study. Participants were grouped into the morning-shift and other-shifts groups. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). All participants also completed the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS Dialysis shift significantly predicted the PSQI score with patients receiving morning-shift haemodialysis having better sleep quality (β=0.15, p=0.01). Other independent predictors of the PSQI score included depression (β=0.42, p<0.001), anxiety (β=0.38, p<0.001), and tea drinking (β=0.20, p0.001). Together these factors explained 48.2% of the variance in the PSQI score. CONCLUSION Morning dialysis shift was significantly associated with better subjective sleep quality in chronic haemodialyzed patients after adjusting for other confounders.

Resilience mediates the relationship between depression and psychological health status in patients with heart failure: A cross-sectional study

BACKGROUND Depressive symptoms are linked to increased morbidity and mortality, and impaired health status in patients with heart failure. Elevating resilience may mitigate the negative consequences associated with depressive symptoms. However, the role of resilience in the relationship between depressive symptoms and health status in patients with heart failure remains unknown. OBJECTIVES To examine the relationships among depressive symptoms, resilience, and physical and psychological health status in patients with heart failure and to determine whether resilience plays a mediating or moderating role in the relationship between depressive symptoms and physical and psychological health status. DESIGN Cross-sectional study design. SETTING Cardiac outpatient clinics in hospitals in Northern Taiwan. PARTICIPANTS The sample comprised 128 community-dwelling and medically stable patients with echocardiographically documented heart failure. METHODS Hierarchical multiple regressions were conducted to determine whether depressive symptoms and resilience are associated with physical and psychological health status. The moderating role of resilience was examined by testing the significance of the interaction between depressive symptoms and resilience. The mediating role of resilience was analyzed using the PROCESS procedure in SPSS. RESULTS Depressive symptoms were significantly associated with both physical and psychological health status (both p<.01) in patients with heart failure after adjustment for sociodemographic variables, comorbidities, and the New York Heart Association functional class. Furthermore, resilience mediated the relationship between depressive symptoms and psychological health status (b=-0.05; confidence interval: -0.01, -0.001) but not that between depressive symptoms and physical health status (b=-0.004; confidence interval: -0.003, 0.003). CONCLUSIONS Depressive symptoms are risk factors for poor health status in patients with heart failure. However, enhancing resilience may facilitate improving psychological health status in patients with depression and heart failure. Future studies should investigate further the design and feasibility of resilience-focused interventions for patients with depression and heart failure.

Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: A systematic review and metaanalysis

OBJECTIVES This systematic review and metaanalysis compared the effects of biofeedback-assisted pelvic floor muscle training with those of pelvic floor muscle training alone in patients with urinary incontinence after radical prostetactomy. DESIGN A review and metaanalysis study design. DATA SOURCES The metaanalysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A systematic search of PubMed/Medline OVID, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, BioMed Central, Web of Science, Chinese Electronic Periodical Services, Chinese Journal and Thesis Database, and China National Knowledge Infrastructure was performed for retrieving records. REVIEW METHODS For determining the effects of training type on urinary incontinence, randomized controlled trials on biofeedback-assisted pelvic floor muscle training with or without electrical stimulation were compared with those on pelvic floor muscle training with or without electrical stimulation, respectively, in the metaanalysis. The Cochrane Collaboration tool in the Cochrane Handbook for Systematic Review of Interventions 5.1.0 was used to assess the methodological quality of the included trials. Subjective and objective measurement of urinary incontinence improvement and the quality of life were the primary and secondary outcome measures, respectively. Data were analyzed using Comprehensive Meta-Analysis software 2.0. In addition, subgroup analyses and metaregression were performed to explore the possible sources of heterogeneity. RESULTS Thirteen randomized controlled trials involving 1108 patients with prostatectomy incontinence were included. The immediate-, intermediate-, and long-term effects of objectively measured biofeedback-assisted pelvic floor muscle training on urinary incontinence were significant (mean effect size=-0.316, -0.335, and -0.294; 95% CI: -0.589 to -0.043, -0.552 to -0.118 and -0.535 to -0.053; p=0.023, 0.002, and 0.017, respectively) when compared with those of pelvic floor muscle training alone. However, when urinary incontinence was measured subjectively, only the intermediate and long-term effects of biofeedback were found (p=0.034 and 0.005, respectively). Small-to-moderate immediate- and intermediate-term effects on the quality of life were observed when biofeedback-assisted pelvic floor muscle training was compared with pelvic floor muscle training alone. No publication bias was observed among studies. CONCLUSIONS Biofeedback can be an adjunct treatment to pelvic floor muscle training for reducing urinary incontinence in patients who have undergone radical prostatectomy.

CE: original research: The efficacy of a nurse-led breathing training program in reducing depressive symptoms in patients on hemodialysis: a randomized controlled trial.

BackgroundDepression is common in patients with chronic kidney disease who are on hemodialysis. Available behavioral modalities for treating depression may not be feasible for patients who receive hemodialysis two or three times per week. ObjectivesThe purpose of this randomized controlled trial was to examine the efficacy of a nurse-led, in-center breathing training program in reducing depressive symptoms and improving sleep quality and health-related quality of life in patients on maintenance hemodialysis. Participants and methodsFifty-seven patients on hemodialysis were randomly assigned either to an eight-session breathing training group or to a control group. The Beck Depression Inventory II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Medical Outcome Studies 36-Item Short Form Health Survey (SF-36) were used to assess self-reported depressive symptoms, sleep quality, and health-related quality of life, respectively. ResultsThe intervention group exhibited significantly greater decreases in BDI-II scores than the control group. No significant differences in PSQI change scores were observed between the groups. SF-36 change scores for both the domain of role limitation due to emotional problems and the mental component summary were significantly higher in the breathing training group than in the control group. ConclusionThis intervention significantly alleviated depressive symptoms, reduced perceived role limitation due to emotional problems, and improved the overall mental health component of quality of life in patients on maintenance hemodialysis.

Neighborhood disadvantage and physical aggression in children and adolescents: a systematic review and meta-analysis of multilevel studies

Child and adolescent physical aggression are influenced by multiple contexts, such as peers, family, school, and neighborhood. However, the effect of neighborhoods on youth physical aggression remains unclear. The objective of this study was to quantitatively synthesize studies that have examined the effect of neighborhood disadvantage on physical aggression in children and adolescents and to identify potential moderators. We searched seven databases for articles published before April 25, 2015. Studies were considered eligible if they were published in peer-reviewed journals, used multilevel data, controlled for neighborhood clustering, used physical aggression as the study outcome, and considered children or adolescents as the study population. Of the 152 eligible studies, we included 43 in the meta-analysis. The results from the random-effects model revealed that neighborhood disadvantage was positively and significantly associated with physical aggression (P < .001). Metaregression and moderator analyses further indicated a stronger association between neighborhood disadvantage and physical aggression among studies with younger participants, a higher percentage of female participants, and a longer follow-up period (P < .05). Current findings, however, may not be generalized to other types of aggression. The observed neighborhood effects may also be limited because of the omission of studies that did not provide sufficient information for calculating the pooled effect. In summary, the results provide supporting evidence for the adverse effect of living in disadvantaged neighborhoods on physical aggression after adjusting for the individual-level characteristics of children and adolescents. Interventions targeting structural contexts in neighborhoods are required to assist in reducing physical aggression in young people. Aggr. Behav. 42:441-454, 2016.

Psychometric testing of a Mandarin Chinese Version of the Clinically Useful Depression Outcome Scale for patients diagnosed with type 2 diabetes mellitus

BACKGROUND The Clinically Useful Depression Outcome Scale (CUDOS) is a self-report instrument that assesses symptoms and the severity of depression, but its psychometric properties in patients with type 2 diabetes mellitus in Chinese-Speaking populations are unknown. OBJECTIVES To examine the psychometric properties of the Mandarin Chinese version of the CUDOS (CUDOS-Chinese). DESIGN A methodological research design. SETTING Endocrinology and metabolism outpatient clinics at 2 university-affiliated hospitals in northern Taiwan. PARTICIPANTS Two-hundred and fourteen type 2 diabetic patients with the mean age of 62.6 years were enrolled, and two-hundred and twelve of them completed the study. METHODS Internal consistency, test-retest reliability, concurrent, and contrasted-groups validity were assessed. A receiver operating characteristic curve analysis was performed to assess sensitivity and specificity. Construct validity by means of confirmatory factor analysis was conducted. RESULTS Internal consistency (Cronbach α of total scale and four subscales=0.93, 0.80, 0.66, 0.80, and 0.83, respectively), test-retest reliability (intra-class correlation coefficients of total scale and four subscales=0.92, 0.89, 0.94, 0.89, and 0.91, respectively), and strong correlations with the Beck Depression Inventory-II (r=0.87) suggested good reliability and validity. The confirmatory factor analysis supported a four-factor model. A cut-off score of 19/20 yielded 77.8% sensitivity and 75.6% specificity. CONCLUSIONS The CUDOS-Chinese demonstrated satisfactory validity and reliability for detecting depression in type 2 diabetic patients in Taiwan.

Development and preliminary validation of the Chinese version of the Sleep-Associated Monitoring Index

OBJECTIVE To examine the psychometric properties of the Chinese version of the Sleep-Associated Monitoring Index (SAMI) in Taiwanese haemodialysis patients. DESIGN An instrument translation and validation study. SETTING A haemodialysis (HD) unit in a university-affiliated medical centre in northern Taiwan. PARTICIPANTS 206 patients who were 18 or above, diagnosed with end-stage renal disease and under maintenance HD twice or thrice a week, 3 h or more per session for more than 3 months. METHODS A principal component analysis was used to examine the construct validity of the SAMI. The participants were classified into poor (n=160) and good sleepers (n=46) using a cut-off value of 5 on the Pittsburgh Sleep Quality Index (PSQI). All participants filled out the Beck Depression Inventory (BDI) and Back Anxiety Inventory (BAI) along with the SAMI. Internal consistency was examined by the Cronbachs α. To assess test-retest reliability, the participants were asked to fill out the SAMI on a second occasion at a 2-week interval. RESULTS Eight subscales emerged from the principal component analysis. Individual with insomnia had significantly higher total SAMI scores (p<0.001). The SAMI total score significantly correlated to the PSQI, BDI, and BAI (r=0.65, 0.67, 0.67; all p<0.001). Cronbachs α was 0.95 for the entire scale. The intra-class correlation coefficient between the initial and retest SAMI total score was 0.72 (p<0.001). The SAMI-Chinese demonstrated an area under the receiver operation characteristic curve of 0.771 (SE=0.044; 95% CI: 0.685-0.857; p<0.001) in detecting individuals with poor sleep. A cut-off value of 51 indicated a sensitivity of 0.86 and a specificity of 0.63 in distinguishing between poor and good sleepers. CONCLUSIONS The SAMI-Chinese demonstrated excellent construct validity, contrast group validity, external validity, internal consistency, and satisfactory test-retest reliability. It also demonstrated satisfactory diagnostic ability for insomnia.

Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience:

Background: Despite the recognition of the negative effects of depressive symptoms on self-care confidence and self-care maintenance in patients with heart failure, little is known about the moderating role of resilience underlying these relations. Aims: To explore whether depressive symptoms affect self-care maintenance through self-care confidence and whether this mediating process was moderated by resilience. Methods: The sample comprised 201 community-dwelling and medically stable patients with echocardiographically documented heart failure. A moderated mediation model was conducted to test whether self-care confidence mediated the association between depressive symptoms and self-care maintenance, and whether resilience moderated the direct and indirect effects of depressive symptoms after adjustment for covariates. Results: Depressive symptoms reduced self-care maintenance indirectly by decreasing self-care confidence (indirect effect: −0.22, 95% confidence interval: −0.36, −0.11), and this pathway was only significant for patients with moderate and high levels and not with low levels of resilience. Resilience also moderated the direct effects of depressive symptoms on self-care maintenance such that the negative association between depressive symptoms and self-care maintenance was reversed by the existence of high resilience. Conclusions: Resilience moderated the direct and indirect effects of depressive symptoms through self-care confidence on self-care maintenance in heart failure patients. Efforts to improve self-care maintenance by targeting depressive symptoms may be more effective when considering self-care confidence in patients with moderate to high levels of resilience.