Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial

BackgroundA pregnant woman''s psychological health is a significant predictor of postpartum outcomes. The Antenatal Psychosocial Health Assessment (ALPHA) form incorporates 15 risk factors associated with poor postpartum outcomes of woman abuse, child abuse, postpartum depression and couple dysfunction. We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among pregnant women than providers practising usual prenatal care.MethodsA randomized controlled trial was conducted in 4 communities in Ontario. Family physicians, obstetricians and midwives who see at least 10 prenatal patients a year enrolled 5 eligible women each. Providers in the intervention group attended an educational workshop on using the ALPHA form and completed the form with enrolled women. The control group provided usual care. After the women delivered, both groups of providers identified concerns related to the 15 risk factors on the ALPHA form for each patient and rated the level of concern. The primary outcome was the number of psychosocial concerns identified. Results were controlled for clustering.ResultsThere were 21 (44%) providers randomly assigned to the ALPHA group and 27 (56%) to the control group. A total of 227 patients participated: 98 (43%) in the ALPHA group and 129 (57%) in the control group. ALPHA group providers were more likely than control group providers to identify psychosocial concerns (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–3.0; p = 0.02) and to rate the level of concern as “high” (OR 4.8, 95% CI 1.1–20.2; p = 0.03). ALPHA group providers were also more likely to detect concerns related to family violence (OR 4.8, 95% CI 1.9–12.3; p = 0.001).InterpretationUsing the ALPHA form helped health care providers detect more psychosocial risk factors for poor postpartum outcomes, especially those related to family violence. It is a useful prenatal tool, identifying women who would benefit from additional support and interventions.The psychosocial health of a pregnant woman and her family is a significant predictor of intrapartum, newborn and postpartum outcomes.^1,2,3,4 A critical review of the literature has identified an association between antenatal psychosocial risk factors and the poor postpartum outcomes of woman abuse, child abuse, postpartum depression and couple dysfunction.⁵Clinicians have indicated that a practical tool to help them systematically collect and record prenatal psychosocial information would be helpful.⁶Although specific and often well-validated tools are available to predict or detect child abuse, woman abuse or depression,^7,8,9,10 clinicians are unlikely to use them because of time constraints.¹ Other forms aid in collecting more comprehensive antenatal psychosocial data,^11,12,13,14 but they are not evidence-based, and were developed to predict obstetric or newborn rather than psychosocial outcomes.In contrast, the Antenatal Psychosocial Health Assessment (ALPHA) form (Appendix 1) was designed to identify antenatal psychosocial risk factors for poor postnatal psychosocial outcomes. It incorporates 15 risk factors found through critical literature review⁵ to be associated with woman abuse, child abuse, postpartum depression and couple dysfunction.¹⁵ These risk factors are grouped intuitively by topic, with suggested questions, into 4 categories: family factors, maternal factors, substance use and family violence. The ALPHA form has been field-tested by obstetricians, family physicians, midwives and nurses,^15,16 who have found using it to be feasible and useful.¹⁵ Pregnant women appreciate and feel comfortable with the psychosocial enquiry.¹⁵ The ALPHA form was developed as a screening tool to help providers systematically identify areas of psychosocial concern. Once feasibility was established,¹⁵ the next step was to determine whether using it in regular practice would increase the number of concerns identified.We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns in their pregnant patients than clinicians practising usual prenatal care. A secondary objective was to determine women''s and providers'' satisfaction with the ALPHA form.     

Listening to local voices: adapting rapid appraisal to assess health and social needs in general practice.

OBJECTIVES--To explore the use of rapid appraisal in defining the health and social needs of a community and to formulate joint action plans between the residents and service providers. DESIGN--Collection of data by an extended primary care team from three sources: existing documents about the neighbourhood, interviews with a range of informants, and direct observations to build a profile of the community. SETTING--Council estate of 670 homes in Edinburgh. MAIN OUTCOME MEASURES--Perceived problems of the community and suggestions for change. RESULTS--The interviews and focus groups identified six priorities for change, many of which were not health related. These changes have been or are being implemented. CONCLUSIONS--An expanded primary care team can use rapid appraisal as a first step in identifying and meeting local health needs. It facilitates a multidisciplinary approach and complements quantitative methods of assessing need.     

Using deterministic models to assess risk in sediment-impacted estuaries

Terrestrial sediments transported off disturbed watersheds can threaten downstream estuarine and coastal environments. Practitioners in the field of environmental management need to be able to assess how activities that disturb the land are likely to impact on downstream estuarine and coastal receiving waters. Such assessments usually take the form of estimating risk, which has two components: the extent of undesirable consequences and the probability of occurrence of those consequences. The consequence in this case is primarily the ecological damage. In order to estimate risk, a methodology was developed around the use of a deterministic computational model of watershed/estuarine sediment transport. Model simulations are run which cover the physically realistic range of the controlling variables (e.g., wind speed, wind direction, sediment runoff). The model results are related to estuary damage and combined with the probability of occurrence for each scenario, providing a means of quantifying risk. In addition, answers to `long-term average', `most likely' and `worse case' type questions can be made. The procedure has the advantages of being easily implemented, transparent and repeatable. It is also more efficient than a standard Monte-Carlo procedure. The risk associated with changes in landuse can be examined without repeating model simulations. The example used to illustrate the method is that of a developing watershed in which proposed building activities are expected to alter the sediment yield to the downstream estuary during floods, which in turn is expected to smother shellfish beds. By elucidating risk associated with each development scenario, the management debate can be focused on choice of an acceptable risk level.     

Using the satellite-derived NDVI to assess ecological responses to environmental change

Assessing how environmental changes affect the distribution and dynamics of vegetation and animal populations is becoming increasingly important for terrestrial ecologists to enable better predictions of the effects of global warming, biodiversity reduction or habitat degradation. The ability to predict ecological responses has often been hampered by our rather limited understanding of trophic interactions. Indeed, it has proven difficult to discern direct and indirect effects of environmental change on animal populations owing to limited information about vegetation at large temporal and spatial scales. The rapidly increasing use of the Normalized Difference Vegetation Index (NDVI) in ecological studies has recently changed this situation. Here, we review the use of the NDVI in recent ecological studies and outline its possible key role in future research of environmental change in an ecosystem context.     

Using indicator species to assess the state of macrobenthic communities

Environmental impact assessments are often followed by the continuous monitoring needed to determine community change. This long-term monitoring can be time-consuming and expensive. The concept of indicator species attempts to use their presence in a sample or area to characterise a certain degree of community change or pollution effects. This approach has been widely applied to benthic monitoring studies. However, many studies develop their own list of `indicators' in cases without having a prior knowledge of the area or any long-term data. This can result in the production of circular arguments. We carry out a meta-analysis on data sets from 5 of the 20 designated United Kingdom's sewage sludge dumping grounds and the data set from the classic study of Pearson & Rosenberg (1978). We construct a number of indices to examine this robustness across studies. Having refined our criteria for an `indicator taxa' we examine the spatial and temporal changes in macrobenthic communities occurring at the Tyne sewage sludge dumpsite to examine the utility of this approach. Of the total pool of 123 taxa, 81 taxa responded in one study only. While Spio filicornis(O. F. Müller), Spiophanes bombyx(Claparède), Lagis koreni (Malmgren) and Nephtys cirrosa (Ehlers) showed directly contradictory patterns in different locations. The Spearman's rank correlation test showed a significant negative relationship between the density of macro-litter per station found at the Tyne dumping ground and the abundance of Abra alba(Wood) (r _s=0.462, n= 6, P=0.1) and Amphiura filiformis(O. F. Müller)(r _s=0.493, n= 6, P=0.1). These were the only indicator taxa, which showed a strong relationship to sewage contamination. We therefore conclude that while the concept of indicators may be widely applicable, the actual indicator taxa are not. This demonstrate that the used of indicators must be continually developed providing prior information of the study area.     

Using historical data to assess the biogeography of population recovery

Historical ecology research is valuable for assessing long‐term baselines, and is increasingly applicable to conservation and management. In this study, we describe how historical range data can inform key aspects of protected species management, including evaluating conservation status and recovery, and determining practical management units. We examine contemporary (1973–2012) and historical (1250–1950) data on nesting beach distributions for green sea turtles Chelonia mydas in the Hawaiian Islands. Green turtle populations in Hawai‘i declined until federal and international protections began in the 1970s, but over the past four decades one index population has shown encouraging increases and broader recovery has been inferred. We find that 80% of historically major nesting populations are extirpated, or have heavily reduced nesting abundances in comparison with current estimates. Furthermore, historical nesting areas were not geographically isolated, but distributed across the archipelago. In comparison, today more than 90% of green turtle nesting in Hawai‘i occurs at a single site that is vulnerable to sea level rise. This research suggests that assessing recovery without historical data on spatial patterns may overlook important ecological dynamics at the popu lation or ecosystem level, which can result in improper or inadequate conservation assessments and recovery targets.     

Using jackknife to assess the quality of gene order phylogenies

Background  

In recent years, gene order data has attracted increasing attention from both biologists and computer scientists as a new type of data for phylogenetic analysis. If gene orders are viewed as one character with a large number of states, traditional bootstrap procedures cannot be applied. Researchers began to use a jackknife resampling method to assess the quality of gene order phylogenies.     

Using different methods to assess the discomfort during car driving

This study investigated the discomfort caused by car driving. Discomfort estimates were achieved by self-administered questionnaire, measured by different testing methods, and through the goniometry of principal angles. Data from a total of 200 non-professional drivers who fulfilled the questionnaire was analysed. 118 subjects were analysed by goniometry and 30 drivers were assessed using the OWAS (Ovaco orking Posture Analysis), RULA (Rapid Upper Limb Assessment), and CORLETT tests. The aim of this paper was to assess the appearance of the discomfort and to find some correlations between drivers' postures. Results suggest that different levels of discomfort are perceived in different body regions when driving cars. Differences appear mostly between the genders concerning the discomfort. With the questionnaire and the different estimation techniques, it is possible to identify 'at risk' drivers and ensure urgent attention when necessary. It can be concluded that the questionnare and the CORLETT test are good in predicting location of discomfort. TheB org CRI10scale is good indicator of the level of the discomfort, while OWAS and RULA can appraise the body posture to predict discomfort appearance. According to the goniometry data, the drivers posture could be one of the contributing factors in appearing of discomfort.     

Using the rat forced swim test to assess antidepressant-like activity in rodents

The forced swim test (FST) is one of the most commonly used animal models for assessing antidepressant-like behavior. This protocol details using the FST in rats, which takes place over 48 h and is followed by the video analysis of the behavior. The swim test involves the scoring of active (swimming and climbing) or passive (immobility) behavior when rodents are forced to swim in a cylinder from which there is no escape. There are two versions that are used, namely the traditional and modified FSTs, which differ in their experimental setup. For both versions, a pretest of 15 min (although a number of laboratories have used a 10-min pretest with success) is included, as this accentuates the different behaviors in the 5-min swim test following drug treatment. Reduction in passive behavior is interpreted as an antidepressant-like effect of the manipulation, provided it does not increase general locomotor activity, which could provide a false positive result in the FST.     

Using grizzly bears to assess harvest-ecosystem tradeoffs in salmon fisheries

Implementation of ecosystem-based fisheries management (EBFM) requires a clear conceptual and quantitative framework for assessing how different harvest options can modify benefits to ecosystem and human beneficiaries. We address this social-ecological need for Pacific salmon fisheries, which are economically valuable but intercept much of the annual pulse of nutrient subsidies that salmon provide to terrestrial and aquatic food webs. We used grizzly bears, vectors of salmon nutrients and animals with densities strongly coupled to salmon abundance, as surrogates for "salmon ecosystem" function. Combining salmon biomass and stock-recruitment data with stable isotope analysis, we assess potential tradeoffs between fishery yields and bear population densities for six sockeye salmon stocks in Bristol Bay, Alaska, and British Columbia (BC), Canada. For the coastal stocks, we find that both bear densities and fishery yields would increase substantially if ecosystem allocations of salmon increase from currently applied lower to upper goals and beyond. This aligning of benefits comes at a potential cost, however, with the possibility of forgoing harvests in low productivity years. In contrast, we detect acute tradeoffs between bear densities and fishery yields in interior stocks within the Fraser River, BC, where biomass from other salmon species is low. There, increasing salmon allocations to ecosystems would benefit threatened bear populations at the cost of reduced long-term yields. To resolve this conflict, we propose an EBFM goal that values fisheries and bears (and by extension, the ecosystem) equally. At such targets, ecosystem benefits are unexpectedly large compared with losses in fishery yields. To explore other management options, we generate tradeoff curves that provide stock-specific accounting of the expected loss to fishers and gain to bears as more salmon escape the fishery. Our approach, modified to suit multiple scenarios, provides a generalizable method to resolve conflicts over shared resources in other systems.     

New programme of antenatal care in general practice.

The conclusions from recent analyses of the clinical worth of routine antenatal attendances have been used in the setting of a modern primary health care team. As a result the number of times a low risk nulliparous woman is seen by her general practitioner has been reduced from 15 to eight and a low risk multiparous woman from 15 to six. The number of consultations with a midwife has also been considerably reduced. The time saved is used in longer, more structured consultations and for more intensive care of high risk, usually socially deprived, women. Despite these reductions in consultations organised, well recorded care of this type renders antenatal attendances at a hospital virtually unnecessary for low risk women.     

Survey of health visiting in antenatal care.

The range of the health visitor''s work is expanding. To find out what antenatal work health visitors actually carry out and what their attitudes towards such work are we surveyed general practitioners, midwives, and health visitors in three district health authorities. The results indicate that health visitors are qualified and willing to work with women in the antenatal period.     

Using information theory to assess the communicative capacity of circulating microRNA

The discovery of extracellular microRNAs (miRNAs) and their transport modalities (i.e., microparticles, exosomes, proteins and lipoproteins) has sparked theories regarding their role in intercellular communication. Here, we assessed the information transfer capacity of different miRNA transport modalities in human serum by utilizing basic principles of information theory. Zipf Statistics were calculated for each of the miRNA transport modalities identified in human serum. Our analyses revealed that miRNA-mediated information transfer is redundant, as evidenced by negative Zipf’s Statistics with magnitudes greater than one. In healthy subjects, the potential communicative capacity of miRNA in complex with circulating proteins was significantly lower than that of miRNA encapsulated in circulating microparticles and exosomes. Moreover, the presence of coronary heart disease significantly lowered the communicative capacity of all circulating miRNA transport modalities. To assess the internal organization of circulating miRNA signals, Shannon’s zero- and first-order entropies were calculated. Microparticles (MPs) exhibited the lowest Shannon entropic slope, indicating a relatively high capacity for information transfer. Furthermore, compared to the other miRNA transport modalities, MPs appeared to be the most efficient at transferring miRNA to cultured endothelial cells. Taken together, these findings suggest that although all transport modalities have the capacity for miRNA-based information transfer, MPs may be the simplest and most robust way to achieve miRNA-based signal transduction in sera. This study presents a novel method for analyzing the quantitative capacity of miRNA-mediated information transfer while providing insight into the communicative characteristics of distinct circulating miRNA transport modalities.     

Using aerial photographs to remotely assess tree hollow availability

Tree hollows provide critical habitat for many species worldwide. The conservation of hollow-bearing trees presents a particular challenge for forest managers, partly due to difficulties in predicting their occurrence across a landscape. We trialled a novel approach for assessing relative hollow availability, by remotely estimating mature crown cover and senescence from aerial photographs in Tasmania, Australia. These estimates were tested against plot-based field assessments of actual occurrence of hollow-bearing trees. In dry forest we conducted ground-based surveys of hollows for all mature trees (>50 cm dbh) in 37 half-hectare plots. In wet forest, we conducted helicopter-based surveys of hollows for all mature trees in 45 oldgrowth plots (0.29–4.63 ha). Aerial photographs (1:10,000–1:25,000) were used to classify the senescence and cover of mature crowns in each plot. Regression analysis showed that, in dry forest, hollow-bearing tree densities were strongly related to the remote assessment of mature crown cover, with an 8% increase in variability explained if senescence was also included (R ² = 0.50). In wet forest, mature crown cover alone was the best model (R ² = 0.53 when outliers were removed). Assessing senescence was less important in dense wet forests than dry forest because trees take longer to form mature-shaped crowns and so mature-shaped crowns are more likely to have hollows. These results suggest that, with skilled photo-interpretation, aerial photographs can be useful for remotely assessing the relative density of hollow-bearing trees. This approach has the potential to greatly improve conservation planning for hollows and hollow-dependent fauna.     

Using Learning Outcome Measures to assess Doctoral Nursing Education

Education programs at all levels must be able to demonstrate successful program outcomes. Grades alone do not represent a comprehensive measurement methodology for assessing student learning outcomes at either the course or program level. The development and application of assessment rubrics provides an unequivocal measurement methodology to ensure a quality learning experience by providing a foundation for improvement based on qualitative and quantitatively measurable, aggregate course and program outcomes. Learning outcomes are the embodiment of the total learning experience and should incorporate assessment of both qualitative and quantitative program outcomes. The assessment of qualitative measures represents a challenge for educators in any level of a learning program. Nursing provides a unique challenge and opportunity as it is the application of science through the art of caring. Quantification of desired student learning outcomes may be enhanced through the development of assessment rubrics designed to measure quantitative and qualitative aspects of the nursing education and learning process. They provide a mechanism for uniform assessment by nursing faculty of concepts and constructs that are otherwise difficult to describe and measure. A protocol is presented and applied to a doctoral nursing education program with recommendations for application and transformation of the assessment rubric to other education programs. Through application of these specially designed rubrics, all aspects of an education program can be adequately assessed to provide information for program assessment that facilitates the closure of the gap between desired and actual student learning outcomes for any desired educational competency.     

Using indicators of fish health at multiple levels of biological organization to assess effects of stream pollution in southwest Germany

The health of fish populations and assemblagesin two degraded streams in south-westernGermany were investigated in order to validatethe use of biomarkers for the assessment ofsmall streams as part of the Valimar project.In the more severely polluted stream,recruitment was impaired and populationabundances were low. Extinction ofsite-specific species and appearance of nonsite-specific species has resulted in a shiftin the species composition from thatcharacteristic of unpolluted reference streams.In the less severely degraded stream, abundantrecruitment and relatively high densities ofadults indicated healthy, self sustaining fishpopulations. Missing species, however,indicated some effects of human influenceswithin the reference stream. The reproductivestatus of adult stone loach, Barbatulabarbatula, was not affected in any stream asreflected by normal production of eggs andreproductive behavior. Indices of energystorage differed between the investigated sitesbut could not be related to pollution. Theevaluation of biological integrity based onfish assemblages revealed that both sites inthe more severely impacted stream were in poorcondition. The two reference sites wereclassified in moderate and good condition,respectively. By excluding effects of migrationbarriers on the fish assemblage there was astronger correlation between chemical waterquality and biomarker responses. The resultsindicate the importance of assessing theeffects of pollution within the content oflongitudinal gradients in streams and theusefulness of measuring health effects overseveral levels of biological organization.