Psychometric properties and factor structure of the early development instrument in a sample of Jordanian children.

BACKGROUND: Investing in children's early years can have a lasting positive effect, such as better academic outcomes throughout their school careers. In Jordan, investments have been made in early childhood development and early childhood care and education to improve children's school readiness. School readiness comprises a range of abilities needed to succeed in school, including physical, emotional, social, and cognitive skills. To measure the impact of these investments on children's school readiness, Jordan has been implementing the Early Development Instrument (EDI), a population-level, teacher-completed checklist of children's school readiness, assessing children's development in five main areas, referred to as domains. METHODS: The goal of the current study was to examine the psychometric properties of the Arabic version of the EDI, using data collected in 2018 on a sample of 5952 children in Jordan. The EDI was translated from the original English version to Arabic and adapted for use in Jordan. We conducted a categorical confirmatory factor analysis (CFA) for each of the five domains of the EDI and examined the reliability of the domains and subdomains using Cronbach's alpha reliability coefficient. RESULTS: With few exceptions, the study results are in line with those of the analysis of the psychometric properties found with the original, Canadian English version of the EDI in a population of Canadian children. Results of CFAs demonstrated, for the most part, good model fits. Internal consistency indices of the domains ranged from 0.60 for physical health and well-being to 0.96 for social competence. For the subdomains, they ranged from 0.26 to 0.94. CONCLUSIONS: Our results provide empirical support for the adaptation of the EDI for population monitoring of school readiness in Jordan. Validation of the Arabic adaptation opens up the possibility of assessing school readiness of young children in Jordan in comparison to the many other countries that have successfully adapted and applied the EDI.

Randomized controlled trial comparing health-related quality of life in patients undergoing vertical scar versus inverted T-shaped reduction mammaplasty.

BACKGROUND: There is controversy regarding the superiority of the vertical scar reduction technique versus the inverted T-shaped reduction technique for breast reduction surgery. METHODS: Two hundred fifty-five patients were randomized to either the vertical scar reduction or inverted T-shaped reduction technique immediately before surgery over a 5-year period. Patients completed the Health Utilities Index Mark 3, Short Form-36, Breast-Related Symptoms Questionnaire, and Multidimensional Body-Self Relations Questionnaire at 1 week preoperatively and 1, 6, and 12 months postoperatively. Data were treated according to intention-to-treat principles. The primary outcome was the difference in the change in Health Utilities Index Mark 3 score from baseline to 12 months postoperatively between the two techniques. RESULTS: Patients undergoing either technique gained a statistically significant and clinically important improvement from baseline to 1 year postoperatively in the Health Utilities Index Mark 3 (vertical scar reduction, 0.81, 0.16 to 0.87, 0.19; inverted T-shaped reduction, 0.79, 0.20 to 0.89, 0.15) and the Breast-Related Symptoms Questionnaire (vertical scar reduction, 50.26, 12.98 to 95.59, 9.36; inverted T-shaped reduction, 50.06, 12.50 to 94.09, 9.86). No difference in mean change in scores from baseline to 12 months postoperatively was seen in any of the quality of life questionnaires between the techniques. CONCLUSIONS: There was a clinically important improvement between baseline and 1 year postoperatively in both groups in the Health Utilities Index Mark 3 and the Breast-Related Symptoms Questionnaire. The authors conclude that the techniques are similar when quality of life is the outcome of interest. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Cortisol response to stress in female youths exposed to childhood maltreatment: results of the youth mood project.

BACKGROUND: Few studies have examined stress reactivity and its relationship to major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) among maltreated youth. We examined differences between maltreated and control participants in heart rate and cortisol resting and reactivity levels in response to a psychosocial stressor. METHODS: We recruited 67 female youths aged 12 to 16 with no prior history of depression from child protection agencies and a control group of 25 youths matched on age and postal code. Child maltreatment was measured with two self-report instruments. Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. RESULTS: Piecewise multilevel growth curve analysis was used to model group differences in resting and reactivity cortisol levels and heart rate in response to the Trier Social Stress Test (TSST). During the resting period, both the maltreated and control groups showed a similar decline in levels of cortisol. During the reactivity phase, youth in the control group showed an increase in cortisol levels following the TSST and a gradual flattening over time; maltreated youth exhibited an attenuated response. This blunted reactivity was not associated with current symptoms of MDD or PTSD. There were no group differences in resting and reactivity levels of heart rate. CONCLUSIONS: These findings provide further support for hypothalamic-pituitary-adrenal axis dysregulation among maltreated youth. Since the ability to respond to acute stressors by raising cortisol is important for health, these findings may assist in understanding the vulnerability of maltreated youth to experience physical and mental health problems.