Tom Backer Johnsen

Risk factors for PTSD, anxiety, and depression among adolescents in Gaza.

The present study examined among adolescents in Gaza the relationship between exposure to war stressors and psychological distress as well as the effects of age, gender, and socioeconomic status. Data were collected from a sample of 139 adolescents 12 to 17 years old. Results showed that adolescents reported elevated levels of intrusion, avoidance, and depression compared to levels in communities not affected by war in the recent past. The proportion scoring within the clinical range of posttraumatic stress disorder (PTSD) was 56.8% compared to 6.3% in peacetime populations, reflecting a Hedgess g of 1.29 (p < .001). Significant risk factors for PTSD were exposure (β = .377, p < .001), female gender (β = -.257, p < .001), older age (β = .280, p < .01), and an unemployed father (β = -.280, p < .01). Risk factors for anxiety were exposure (β = .304, p < .001), female gender (β = -.125, p < .01), and older age (β = 272, p < .01), whereas female gender (β = <.238, p < .001) was the only significant risk factor for depression. The present study suggests large individual differences in how adolescents are affected by war stressors.

A modified version of the non-communicating children pain checklist-revised, adapted to adults with intellectual and developmental disabilities: sensitivity to pain and internal consistency.

UNLABELLED Despite enhanced interest in manifestations of pain in adults with intellectual and developmental disabilities (IDD), the characteristics of pain behavior in this group have seldom been examined. The aim of the present study was to provide a sensitive pain behavior scale for adults with IDD. The participants, 228 adults (mean age, 38.7 years) with different levels of IDD, were videotaped before and during an influenza vaccination and scored using the Non-Communicating Childrens Pain Checklist-Revised (NCCPC-R). Observed pain behaviors not captured by the NCCPC-R, was also registered. Sensitivity to pain of all 27 items was examined by Signed Rank test, internal consistency by Cronbachs alpha, and sensitivity to change of the total scale by Standardized Response Mean (SRM). Thirteen items were excluded from the original NCCPC-R scale; 4 new items were added, making a modified scale of 18 items. This scale, named the Non-Communicating Adults Pain Checklist-Revised (NCAPC), was rescored and examined for psychometric properties in a random sample (N = 89). Sensitivity to pain of all items (P < .05) and high internal consistency (alpha = 0.773) were demonstrated. Large sensitivity to pain at all levels of IDD was shown (SRM, 1.20 to 2.07). Better psychometric properties were demonstrated for NCAPC than NCCPC-R in the target population. PERSPECTIVE This article presents initial psychometric properties of a new measure, the NCAPC, evaluating pain behavior in adults with IDD. This measure could help clinicians to better capture pain expressions in this population and contribute to better pain management for this group of patients.

Beliefs about professional ethics, dentist-patient communication, control and trust among fearful dental patients: the factor structure of the revised Dental Beliefs Survey.

The revised version of the Dental Beliefs Survey (DBS‐R), intended to measure three dimensions of the patient–dentist relationship as perceived by the patient, namely Ethics, Communication and Control, was tested in a confirmatory factor analysis. Five different models for the internal structure of the questionnaire were tested. The final model, a 5‐factor solution, basically including the 3 assumed dimensions as well as the re‐introduced dimension Trust covered in the first version of the DBS plus a global factor including all items, yielded an acceptable fit. This model also omits 4 items from DBS‐R, i.e. items 3, 11, 18, and 28. The reduced DBS‐R is recommended for clinical use when assessing the patients perception of the relationship to the dentist, including both trust and ethical behavior.

Short-Term Effects of a Writing Intervention Among Adolescents in Gaza

This study evaluates the effect of a short-term group intervention titled Writing for Recovery in Gaza. Adolescents (N = 139) aged 12–17 were randomly assigned to an intervention or to a waiting list group. Levels of distress were assessed at baseline and at posttest. A follow-up assessment was conducted 5 months after both groups had received the intervention. Results at posttest showed a reduction in posttraumatic stress symptoms in both groups, an increase in depression in the intervention group, and no change in anxiety symptoms. At follow-up, a significant decline in depression scores was evident. Overall, no evidence for improvements due to the intervention was found.

Palpation of Muscle and Skin. Is this a Reliable and Valid Procedure in Assessment of Patients with Long-lasting Musculoskeletal Pain?

The aims of this study were to investigate reliability and aspects of validity of a previously developed method called the Global Physiotherapeutic Muscle Examination (GPM), which comprises items related to palpation of Muscle (18 items) and Skin (12 items). Inter-tester reliability was examined by three physiotherapists examining 19 persons. Construct and discriminative validity was studied by data from 247 patients with long-lasting musculoskeletal pain and 104 healthy subjects. For the patients, concurrent validity was examined by correlating psychological functioning, measured with the revised version of the Minnesota Multiphasic Personality Inventory (MMPI-2), as well as information about pain, with the domains of Muscle and Skin. Reliability was acceptable, with overall intra-class correlation coefficients ranging from 0.54 to 0.84, but with low measurement error. Construct evaluation was done by means of Structural Equation Modeling (SEM), resulting in a modified and improved model with fewer tests: 12 within Muscle and eight within Skin. Composite scores of palpation differed significantly between healthy subjects and patients, and between sub-groups of patients. A relationship was found between Muscle and Skin and psychological characteristics, but differently for females and males. Pain showed a low but significant correlation only to the Muscle domain. The items included in a modified model of palpation can be used in a reliable and valid way when screening patients with long-lasting pain.

Examination of Respiration in Patients with Long-lasting Musculoskeletal Pain: Reliability and Validity

Clinical examination of respiration may be an important aspect of musculoskeletal problems, but has scarcely been reported. The aims of this study were to evaluate the reliability and validity of the domain Respiration, containing 12 items oriented towards the inspection of respiratory movement and rhythm. Inter-tester reliability was examined by three physiotherapists examining 19 persons. Construct and discriminative validity of the Respiration method was studied by data from 247 patients with long-lasting muscu loskeletal pain and 104 healthy subjects. Concurrent validity to psychological variables and pain was also examined. Responsiveness was studied by comparing change in Respiration in patients who returned fully to work vs. those still on sick leave 6 months after rehabilitation. The results indicated fair but acceptable reliability. A modified Respiration scale consisting of eight items was obtained by means of Structural Equation Modeling (SEM). Respiration scores differed significantly between healthy subjects and patients. A relationship was found between Respiration and psychological characterisin tics, and between Respiration and pain, particularly in patients with widespread pain. Responsiveness of the Respiration method to clinically important change was demonstrated. Respiration can be reliably and validly assessed, and the method seems useful in the evaluation of patients with musculoskeletal problems and used as an outcome measure in rehabilitation.

Development of the Norwegian Short-Form McGill Pain Questionnaire (NSF-MPQ)

The Short-Form McGill Pain Questionnaire (SF-MPQ) contains 15 pain descriptors (11 Sensory, four Affective). The aim was to develop a valid Norwegian SF-MPQ (NSF-MPQ). Descriptors were selected among 333 previously collected Norwegian pain adjectives, selection criteria being conceptual equivalence to the SF-MPQ and adjectives used by > 33%. Pain intensity scoring systems of the SF-MPQ were modelled. The NSF-MPQ, a pain drawing and the Disability Rating Index were presented to 277 patients from five different clinical settings. All pain descriptors were used by ≥ 33% in at least one of the five clinical groups, patients with persistent pain using most descriptors. Cronbachs α was adequately high (0.74–0.87). Spearman rank (ρ) correlations were moderate to very high between groups of pain descriptors (0.68–0.97). Pain descriptor scores showed low to moderate correlations with the two pain intensity variables (VAS and Present Pain Intensity) (0.27–0.52). All scores showed low correlations with pain area extension (0.20–0.45) and disability (0.05–0.30), indicating construct validity of the NSF-MPQ. The NSF-MPQ discriminated between two or more patient groups on item level, but discriminative ability on total score and subscore levels was mediocre. The NSF-MPQ seems to express a different construct than pain distribution and disability, and allows registration of distinctions of pain qualities.

Patient motives and fulfillment of motives in renewal of complete dentures.

Seventy-four edentulous patients were interviewed concerning their opinion of their old dentures, motives for renewing them, and requirements for new ones. After an initial period of adaptation they were asked questions relating to their experience with the new dentures. More than 80% of the patients claimed to have functional motives for renewing their old dentures. A similar proportion had functional requirements with regard to the new ones. Less than 30% claimed to have any esthetic motives. Examination of the data, however, suggests that the esthetic factor may be underrecorded. The patient motives, as recorded, were only weakly correlated to the overall acceptance of new dentures. More than 90% found their new dentures as expected or better than expected.

Factor structure of the revised Jalowiec Coping Scale in patients admitted for elective coronary angiography.

OBJECTIVES The way patients cope with their illness may influence their well-being, and for the assessment of coping relevant and valid instruments are required. The objective of the present study was to investigate the psychometric properties of the frequently used Jalowiec Coping Scale (JCS) in patients admitted for elective coronary angiography. We examined the original eight-factor model of the 60-item revised JCS and two three-factor models later proposed in the literature. METHODS Using a cross-sectional design the JCS was completed by outpatients with suspected coronary artery disease 1-4 days prior to angiography. Item analyses and confirmatory factor analysis (CFA) for each model were performed, for those among the 647 participating patients that completed at least half the questions in the JCS. Exploratory post hoc analyses based on modification indices were performed in the case of unsatisfactory model fit. RESULTS Neither of the proposed structures had satisfactory fit without modifications allowing some items to load on more than one factor. However, one of the two three-factor models performed well in item analysis and the CFA performed mostly satisfactory after some modifications. CONCLUSION As for most coping scales reported in the literature, the CFA in the present study showed problems with all three proposed models of the JCS. Despite these problems one of the models may be used with caution. Further improvement of the quality of coping instruments, including CFA based on large samples is recommended.