A validity-driven approach to the understanding of the personal and societal burden of low back pain : development of a conceptual and measurement model

Introduction: While the importance and magnitude of the burden of low back pain upon the individual is well recognized, a systematic understanding of the impact of the condition on individuals is currently hampered by the lack of an organized understanding of what aspects of a person’s life are affected and the lack of comprehensive measures for these effects. The aim of the present study was to develop a conceptual and measurement model of the overall burden of low back pain from the individual’s perspective using a validity-driven approach.
Methods: To define the breadth of low back pain burden we conducted three concept-mapping workshops to generate an item pool. Two face-to-face workshops (Australia) were conducted with people with low back pain and clinicians and policy-makers, respectively. A third workshop (USA) was held with international multidisciplinary experts. Multidimensional scaling, cluster analysis, participant input and thematic analyses organized participants’ ideas into clusters of ideas that then informed the conceptual model.
Results: One hundred and ninety-nine statements were generated. Considerable overlap was observed between groups, and four major clusters were observed - Psychosocial, Physical, Treatment and Employment - each with between two and six subclusters. Content analysis revealed that elements of the Psychosocial cluster were sufficiently distinct to be split into Psychological and Social, and a further cluster of elements termed Positive Effects also emerged. Finally, a hypothesized structure was proposed with six domains and 16 subdomains. New domains not previously considered in the back pain field emerged for psychometric verification: loss of independence, worry about the future, and negative or discriminatory actions by others.
Conclusions: Using a grounded approach, an explicit a priori and testable model of the overall burden of low back pain has been proposed that captures the full breadth of the burden experienced by patients and observed by experts.

A systematic review of the extent and measurement of healthcare provider racism

Background
Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

Objectives
This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

Methods
The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

Results
The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

Conclusion
Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

Methods and technologies to promote information-centered knowledge construction

This alternative event for the 2013 iConference is a combination of lightning talks, a demonstration of an assessment technology for knowledge construction in complex domains, and a hands-on exercise in using the tools discussed. The unifying logic for this presentation is that meaningful learning often involves solving challenging and complex problems that allow for multiple solution approaches and a variety of acceptable solutions. While it is important to prepare students to solve such problems, it is difficult to determine the extent to which various interventions and programs are contributing to the development of appropriate problem-solving strategies and attitudes. Simply testing domain knowledge or the ability to solve simple, single-solution problems may not provide support for improving individual student ability or relevant programs and activities. A reliable and robust methodology for assessing the relevant knowledge constructions of students engaged in solving challenging problems is needed, and that is our focus.

Detection and measurement of Plasmodiophora brassicae

Clubroot, caused by Plasmodiophora brassicae, is one of the most important diseases of brassicas. Management of clubroot is difficult, and the best means of avoiding the disease include planting in areas where P. brassicae is not present and using plants and growing media free from pathogen inoculum. As P. brassicae is not culturable, its detection has traditionally relied on plant bioassays, which are time-consuming and require large amounts of glasshouse space. More recently, fluorescence microscopy, serology, and DNA-based methods have all been used to test soil, water, or plant samples for clubroot. The use of fluorescence microscopy to detect and count pathogen spores in the soil requires significant operator skill and is unlikely to serve as the basis for a routine diagnostic test. By contrast, serologic assays are inexpensive and amenable to high-throughput screening but need to be based on monoclonal antibodies because polyclonal antisera cannot be reproduced and are therefore of limited quantity. Several polymerase chain reaction (PCR)-based assays have also been developed; these are highly specific for P. brassicae and have been well-correlated with disease severity. As such, PCR-based diagnostic tests have been adopted to varying extents in Canada and Australia, but wide implementation has been restricted by sample processing costs. Efforts are underway to develop inexpensive serologic on-farm diagnostic kits and to improve quantification of pathogen inoculum levels through real-time PCR. Proper detection and quantification of P. brassicae will likely play an increasingly important role in the development of effective clubroot management strategies.

Factor structure and measurement invariance of the Health Education Impact Questionnaire: does the subjectivity of the response perspective threaten the contextual validity of inferences?

Objective:
On-going evidence is required to support the validity of inferences about change and group differences in the
evaluation of health programs, particularly when self-report scales requiring substantial subjectivity in response generation are used as outcome measures. Following this reasoning, the aim of this study was to replicate the factor structure and investigate the measurement invariance of the latest version of the Health Education Impact Questionnaire, a widely used health program evaluation measure.
Methods:
An archived dataset of responses to the most recent version of the English-language Health Education Impact
Questionnaire that uses four rather than six response options (N=3221) was analysed using exploratory structural equation
modelling and confirmatory factor analysis appropriate for ordered categorical data. Metric and scalar invariance were
studied following recent recommendations in the literature to apply fully invariant unconditional models with minimum
constraints necessary for model identification.
Results:
The original eight-factor structure was replicated and all but one of the scales (Self Monitoring and Insight) was
found to consist of unifactorial items with reliability of ⩾0.8 and satisfactory discriminant validity. Configural, metric and scalar
invariance were established across pre-test to post-test and population sub-groups (sex, age, education, ethnic background).
Conclusion:
The results support the high level of interest in the Health Education Impact Questionnaire, particularly for use as a pre-test/post-test measure in experimental studies, other pre–post evaluation designs and system-level monitoring and evaluation.

Clients who stalk psychologists: prevalence, methods, and motives

There is emerging recognition that psychologists are susceptible to various forms of intrusiveness by clients, including stalking. Information regarding the contexts in which stalking emerges and the behaviors to which clinicians are subjected is limited. A random sample of Australian psychologists (N = 1,750) was surveyed to ascertain the prevalence, nature, and occupational impact of stalking by clients. Of the 830 respondents, 19.5% had been stalked for 2 weeks or more. Psychologists typically perceived the stalking to be motivated by resentment (42%) or infatuation (19%). Most practitioners altered their professional practice as a consequence of the harassment and 29% considered leaving the profession. Stalking by clients is a salient professional issue that requires greater attention to better manage conduct that is potentially damaging to both therapists and clients.

Gait termination : a review of experimental methods and the effects of aging and gait pathologies

The study of human gait has expanded and diversified to the extent that it is now possible to identify a substantive literature concerning a variety of gait tasks, such as gait initiation [Halliday SE, Winter DA, Frank JS, Patla AE, Prince F. The initiation of gait in young, elderly, and Parkinson's disease subjects. Gait Posture 1998;8:8–14; Mickelborough J, van der Linden ML, Tallis RC, Ennos AR. Muscle activity during gait initiation in normal elderly people. Gait Posture 2004;19:50–57], stepping over and across obstacles [Patla AE, Prentice SD, Robinson C, Newfold J. Visual control of locomotion: strategies for changing direction and for going over obstacles. J Exp Psych 1991;17:603–34; Chen, HC, Ashton-Miller JA, Alexander NB, Schultz AB. Effect of age and available response time on ability to step over an obstacle. J Gerontol 1994;49:227–33; Sparrow WA, Shinkfield AJ, Chow S, Begg RK. Gait characteristics in stepping over obstacles. Hum Mov Sci 1996;15:605–22; Begg RK, Sparrow WA, Lythgo ND. Time-domain analysis of foot–ground reaction forces in negotiating obstacles. Gait Posture 1998;7:99–109; Patla AE, Rietdyk S. Visual control of limb trajectory over obstacles during locomotion: effect of obstacle height and width. Gait Posture 1993;1:45–60] negotiating raised surfaces such as curbs and stairs [Begg RK, Sparrow WA. Gait characteristics of young and older individuals negotiating a raised surface: implications for the prevention of falls. J Gerontol Med Sci 2000;55A:147–54; Mcfayden BJ, Winter DA. An integrated biomechanical analysis of normal stair ascent and descent. J Biomech 1988;21:733–44]. In addition, increasing research interest in age-related declines in gait that might predispose individuals to falls has engendered a very extensive literature concerning ageing effects on gait. While rapid locomotor adjustments are common in the course of daily activities there has been no previous review of the findings concerning gait adaptations when walking is terminated both rapidly and unexpectedly. The aims of this review were first, to summarise the key research findings and methodological considerations from studies of termination. The second aim was to demonstrate the effects of ageing and gait pathologies on termination with respect to the regulation of step characteristics, lower-limb muscle activation patterns and foot–ground reaction forces.

Sustainability: meaning and measurement with application to agriculture

Sustainability refers to having the ability to meet present needs without impacting on future generations to meet their needs. It incorporates social, economic and environmental aspects, and as a measure of sustainability, a range of sustainability indicators at the economy, regional, and individual level, have been suggested. However, given the complex and multidisciplinary nature of the concept, an interdisciplinary approach is necessary. Sustainability is not something that is easily measurable, and the aim of this paper is to present a conceptual framework for quantifying sustainability on the basis of social economic efficiency. According to neoclassical economic theory, economic activity will only be sustained by the private sector as long as it is profitable. However, private economic decisions do not always ensure long-term sustainability of environmental resources or production. The approach suggested here is to derive a measure of social economic efficiency as a measure of sustainability. For dairy farmers, increased productivity has been emphasized, while recognizing the need to reduce greenhouse emissions, pests and disease, nutrient run-off into the environment and degradation of the soil structure. By incorporating environmental and economic impacts, a fuller measure of efficiency, social economic efficiency, and sustainability of the farming practice can be developed.

Can Australain general practitioners tackle chidhood overweight/obesity? Methods and processes from the LEAP (live, eat, and play) randomized controlled trial

Background: General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

Objectives: To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children.

Methods: A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks.

Results: General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

Conclusions: Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Environmental efficiency : meaning and measurement and application to Australian dairy farms

Technical efficiency has been widely studied in the literature, but in its pursuit, many of the inputs used can impact on the environment. Environmental effects can be modelled as undesirable output or, as has been the case in more recent studies, as conventional inputs. This paper examines the concept of environmental efficiency and how it can be used to evaluate the performance of Australian dairy farming, using nitrogen surplus, arising from excessive applications of fertilizer, as a detrimental input. Farming promotes the image of clean and green production and if this image is to be maintained, there is a need to ensure activities are environmentally friendly.