Intake Assessment and Diagnostic Accuracy of Attention Deficit Hyperactivity Disorder diagnostic Scale Being Developed for Children in Nepal.

BACKGROUND: Establishment of accurate diagnosis of participants is vital before starting the development of diagnostic scale. The aim of this study was to develop psychometrically sound Attention Deficit Hyperactivity Disorder diagnostic scale for children. METHODS: Informed consent was taken. Initial diagnosis of Attention Deficit Hyperactivity Disorder was made by using Diagnostic and Statistical Manual-5. Socio-demographic data were obtained. Behavior observation, parental information and teacher's report were also analyzed. Then, Kiddie-Schedule for Affective disorders and Schizophrenia, Child and Adolescent Symptoms Inventory, Stroop Color and word test were done to obtain confirmatory data. Verbatim collection was done to develop the culture specific items. Likewise, standardization was done Results: Accurate diagnosis was established with the help of various tools and techniques. Comorbid conditions were excluded. Diagnostic accuracy was assessed where reliability of each item was ? 0.90; whereas, sensitivity and specificity were 97.0% and 96.6%, respectively with cut off score of 38.5. All items are highly co-related with Attention Deficit Hyperactivity Disorder items of Child and Adolescent Symptoms Inventory-5. CONCLUSIONS: Results clearly indicated that diagnostic accuracy values of this scale is high.

Validation of Attention Deficit Hyperactivity Disorder Diagnostic Scale for Children.

BACKGROUND: There is no valid Attention Deficit Hyperactivity Disorder diagnostic tool to fit Nepalese culture and language till date. Current study is intended to develop and validate the Attention Deficit Hyperactivity Disorder scale for children in Nepal. METHODS: Mixed method study was conducted with 840 samples (i.e. children with Attention Deficit Hyperactivity Disorder =356, Anxiety =128 and General Population=356).Items generation, scale development and scale evaluation were the three consecutive steps followed to develop and validate the scale.Children with Attention Deficit Hyperactivity Disorder (already met the Diagnostic and statistical Manual-5 criteria) were further assessed by Kiddie-Schedule for Affective disorders and Schizophrenia (K-SADS-PL), Child and Adolescent Symptoms Inventory (CASI-5) to confirm the diagnosis and psychometric validation. Pilot studies were done for items clarity. Each data obtained from three comparison groups (Attention Deficit Hyperactivity Disorder , Anxiety and General Population) were included for standardization process where tests of dimensionality, reliability, validity,calculating norms (cut off) were doneas scale evaluation process. RESULTS: The final version of the scale had 21 items. Three sub-scales (Inattention, Impulsivity and Hyperactivity) were identified by using Principal Axis Factor Analysis.All factors showed strong statistically significant convergent validity and Discriminant validity Cronbach's alpha of each item is ? 0.91.As total score criteria, 38.5 is considered as the best cut-off point for this scale. CONCLUSIONS: By using systematic process, a valid and reliable Attention Deficit Hyperactivity Disorder diagnostic scale is being developed in Nepalese culture and language.

Psycho-social impact of visual impairment on health-related quality of life among nursing home residents.

BACKGROUND: Visual impairment (VI) affects physical, psychological, and emotional well-being, and social life as well. The purpose of this exploratory study was to assess the psycho-social impact of VI on health-related quality of life (HRQoL) among nursing home residents. METHODS: This cross-sectional study involved 272 residents of 60 years or older residing in seven nursing homes of the Kathmandu Valley, Nepal. Comprehensive ocular examinations, including near and distance vision assessment and refractions were carried out. VI was defined as visual acuity (VA) less than 6/18 in the better eye. Residents were divided into two groups: one group did not have VI (in whom VA was greater than or equal to 6/18 in the better eye), and the other had VI (in whom VA was worse than 6/18 in the better eye).Face-to-face interviews were conducted filling out a 36-item The Medical Outcomes Study Short-Form (SF-36) questionnaire. The SF-36 questionnaire was scored according to the scoring algorithm SF-36 subscales. RESULTS: The mean age of residents was 74.68 ± 8.19 years (range, 60-99 years) and the majority were female (78.68%). The mean composite score of SF-36 was 46.98 ± 13.08. VI detrimentally affected scores of both the physical and the mental components, but the impact of VI was slightly greater for the physical component than that for the mental component. There was a trend towards a lower composite score as well as each subscale score of the SF-36 in participants with VI than in those without VI. CONCLUSION: VI has a negative effect on HRQoL. HRQoL is reduced among nursing home residents and the reduction in the HRQoL bears a positive association with VI.

Impact of visual impairment on vision-specific quality of life among older adults living in nursing home.

BACKGROUND: Visual impairment (VI) has a significant negative impact on quality of life (QoL) amongst older people living in nursing homes. The purpose of this study was to determine the prevalence of VI and blindness and to explore the association between severity of VI and vision-specific QoL among older people living in nursing homes of Kathmandu, Nepal. METHODS: This cross-sectional study involved 158 residents aged 60 years or older residing in seven nursing homes of Kathmandu Valley, Nepal. Near acuity, presenting and the best corrected distance visual acuity (VA) were assessed in each eye and considered in the better eye after adequate refraction. A complete anterior and posterior segment examination was carried out. Face-to-face interviews were conducted using a 57-item Nursing Home Vision-Targeted Health-Related Quality of Life (NHVQoL) questionnaire. RESULTS: The mean age of residents was 75.60 ± 7.12 years and the majority were female (66.46%). The prevalence of VI and blindness was 45.57% and its leading cause was cataract, which was followed by age-related macular degeneration, corneal opacity, glaucoma and macular scar. The mean composite score of NHVQoL questionnaire was 52.22 ± 12.49. There was a consistent overall deterioration in the mean composite score as well as each subscale score of NHVQoL questionnaire with a worsening of VA. CONCLUSION: VI and blindness are highly prevalent among older people living in nursing homes. VI has a significant negative impact on vision-specific QoL. Vision-specific QoL is reduced, and the reduction in the QoL bears a positive association with severity of VI among older people living in nursing homes.