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To determine the acceptability, internal consistency and test–retest reliability of self-efficacy, motivation and knowledge scales relating to pre-school children’s nutrition, oral health and physical activity.
An online questionnaire was completed twice with an interval of 7–11d.
Online questionnaires were sent to participants via email from nursery managers. The parent questionnaire was also available on the parenting website www.netmums.com.
Eighty-two parents and sixty-nine nursery staff from Bristol, UK who had and worked with 2–4-year-olds, respectively.
Response rates were 86·3 and 86·0 % and missing data 15·9 and 14·5 % for the second administration of the parent and nursery staff questionnaires, respectively. Weighted κ coefficients for individual items mostly fell under the ‘moderate’ agreement category for the parental (75·0 %) and nursery staff (55·8 %) items. All self-efficacy and motivation scales had acceptable levels of internal consistency (Cronbach’s α coefficients>0·7). The intraclass correlation coefficients for the self-efficacy, motivation and knowledge scales ranged between 0·48 and 0·82. Paired t tests found an increase between test and retest knowledge scores for the Nutrition Motivation (t=−2·91, df=81, P=0·00) and Knowledge (t=−3·22, df=81, P=0·00) scales in the parent questionnaire.
Our findings demonstrate that the items and scales show good acceptability, internal consistency and test–retest reliability.
Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.
To evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.
A multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.
In total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0–5) for the SAD PERSONS scale, to 97% (95% CI 93–99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2–47) for the Modified SAD PERSONS Scale to 47% (95% CI 41–53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50–0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69–0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P < 0.001).
Risk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.
Risk of self-harm and suicide is greatly increased in the period after
discharge from psychiatric in-patient care.
To investigate the impact on suicide of a series of policy initiatives to
enhance care in the immediate post-discharge period.
A time series analysis was based on 1997–2007 data from the National
Confidential Inquiry into Suicide and from Hospital Episode Statistics
There was no evidence of a reduced risk of suicide in the first 12 weeks
following discharge in 2003–2007 compared with 1997–2002. In contrast,
the relative risk of non-fatal self-harm in the 12 weeks after discharge
declined. The risk ratio for self-harm (2003–2007 v.
1997–2002) at 0–1 week post-discharge was 0.86 (95% CI 0.80–0.92) and at
2–4 weeks it was 0.89 (95% CI 0.85–0.94).
These findings provide some support for the impact of recent policy
changes on the risk of non-fatal self-harm in the immediate period after
discharge from psychiatric in-patient care.
There is no evidence to support current advice not to use benzodiazepines after bereavement.
To determine the role of benzodiazepines in the management of bereavement.
We conducted a randomised, double-blind, placebo-controlled evaluation of the use of diazepam after recent bereavement. Participants were randomised to either 2 mg diazepam or identically packaged placebo up to three times daily. The primary outcome measure was the Bereavement Phenomenology Questionnaire.
Thirty subjects were randomised. No evidence was found of an effect of benzodiazepines on the course of the first 6 months of bereavement (estimated mean difference of combined follow-up assessments=0.3 in favour of placebo; 95% CI –6.2 to +6.7).
We found no evidence of a positive or negative effect of benzodiazepines on the course of bereavement.
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