Measuring Perceptions of the Therapeutic Alliance in Individual, Family, and Group Therapy from a Systemic Perspective: Structural Validity of the SOFTA-s.

This study examined the multidimensional structure of the client and therapist versions of the self-report measure, System for Observing Family Therapy Alliances (SOFTA-s; Friedlander, Escudero, & Heatherington, Therapeutic alliances in couple and family therapy: An empirically informed guide to practice. Washington, DC: American Psychological Association, 2006) across three distinct therapeutic modalities (individual, family, group). Specifically, we investigated whether the originally theorized model of four first-order factors (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family) would be reflected in a second-order factor (Therapeutic Alliance). The sample included 105 therapists who worked with 858 clients (165 individuals, 233 families, and 43 groups) in several Spanish community agencies. To control for dependent data, we used multilevel modeling. Results of the multilevel confirmatory factor analyses showed adequate reliabilities, fit indices, and factor loadings across the three therapy contexts for both versions of the measure (client and therapist). Adequate measurement invariance was also found across respondents and therapy modalities. Taken together, these results support the structural validity of the SOFTA-s, a brief and flexible self-report alliance measure that can be used reliably in clinical practice as well as in studies of individual, family, and group therapy.

Este estudio examinó la estructura multidimensional de las versiones del paciente y del terapeuta de la herramienta de medición por autoinforme, "Sistema de Observación de Alianza Terapéutica en Intervención Familiar" (System for Observing Family Therapy Alliances, SOFTA-s; Friedlander, Escudero, & Heatherington, 2006) entre tres modalidades terapéuticas diferentes (individual, familiar, grupal). Específicamente, investigamos si el modelo teorizado originalmente de cuatro factores de primer orden (participación en el proceso terapéutico, conexión emocional con el terapeuta, seguridad dentro del sistema terapéutico y un objetivo en común dentro de la familia) se reflejaría en un factor de segundo orden (alianza terapéutica). La muestra consistió en 105 terapeutas que trabajaron con 858 pacientes (165 individuos, 233 familias y 43 grupos) en varios organismos de comunidades españolas. Para evaluar los datos dependientes, utilizamos el modelo multinivel. Los resultados de los análisis factoriales confirmatorios multinivel demostraron fiabilidades, índices de ajuste y cargas factoriales adecuadas entre los tres contextos de terapia para ambas versiones de la herramienta de medición (paciente y terapeuta). También se halló una invariancia de medición adecuada entre los encuestados y las modalidades de terapia. En conjunto, estos resultados respaldan la validez estructural del SOFTA-s, una herramienta de medición de la alianza breve y flexible por autoinforme que puede utilizarse de manera fiable en la práctica clínica, así como en estudios de la terapia individual, familiar y grupal. Este estudio examinó la estructura multidimensional de las versiones del paciente y del terapeuta de la herramienta de medición por autoinforme, "Sistema de Observación de Alianza Terapéutica en Intervención Familiar" (System for Observing Family Therapy Alliances, SOFTA-s; Friedlander, Escudero, & Heatherington, 2006) entre tres modalidades terapéuticas diferentes (individual, familiar, grupal). Específicamente, investigamos si el modelo teorizado originalmente de cuatro factores de primer orden (participación en el proceso terapéutico, conexión emocional con el terapeuta, seguridad dentro del sistema terapéutico y un objetivo en común dentro de la familia) se reflejaría en un factor de segundo orden (alianza terapéutica). La muestra consistió en 105 terapeutas que trabajaron con 858 pacientes (165 individuos, 233 familias y 43 grupos) en varios organismos de comunidades españolas. Para evaluar los datos dependientes, utilizamos el modelo multinivel. Los resultados de los análisis factoriales confirmatorios multinivel demostraron fiabilidades, índices de ajuste y cargas factoriales adecuadas entre los tres contextos de terapia para ambas versiones de la herramienta de medición (paciente y terapeuta). También se halló una invariancia de medición adecuada entre los encuestados y las modalidades de terapia. En conjunto, estos resultados respaldan la validez estructural del SOFTA-s, una herramienta de medición de la alianza breve y flexible por autoinforme que puede utilizarse de manera fiable en la práctica clínica, así como en estudios de la terapia individual, familiar y grupal.

Validity and reliability of the health-related questionnaire IBDQ-32 in Mexican patients with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease comprises two conditions: ulcerative colitis and Crohn's disease. Inflammatory Bowel Disease Questionnaire 32 (IBDQ-32) is a specific questionnaire which has been translated from English into Spanish and validated. In the Spanish-speaking countries of America it has not been validated. The aim was to determine the psychometric properties, validity and reliability of the Mexican version of the IBDQ-32 questionnaire. METHODS: A total of 316 patients with inflammatory bowel disease and 100 healthy controls participated in the study. The questionnaires IBDQ-32 and SF-36 were issued on two occasions (separated by 15 days). The psychometric properties of the Mexican version of the IBDQ-32 questionnaire were determined. RESULTS: Patients with inflammatory bowel disease had an impaired quality of life compared to healthy controls. There were no differences between ulcerative colitis and Crohn's disease in the total scores of IBDQ-32 and its domains. The internal consistency reliability was good. The intraclass coefficient showed good reliability (repeated measurement) for total scale and all four subscales. Factor analysis explained variance is higher than 50% therefore is considered adequate/acceptable. The correlation between IBDQ-32 and SF-36 showed a satisfactory association. The social domain is the only one that presented a ceiling effect. CONCLUSIONS: The Mexican version of the IBDQ-32 quality of life questionnaire is valid and reliable. This sample included the entire spectrum of inflammatory disease (remission and activity) and was comparable when assessing quality of life with the SF-36 generic questionnaire.

Symptom clusters and nutritional status in primary liver cancer patients receiving transcatheter arterial chemoembolization.

Introduction: Introduction: symptom clusters (SCs) are highly prevalent among patients diagnosed with primary liver cancer. Malnutrition poses a heightened risk for a more pronounced total symptom cluster score. Objective: this study aimed to identify SCs and assess the nutritional status of patients undergoing transcatheter arterial chemoembolization (TACE). Furthermore, it aimed to investigate the association between nutritional status and symptom clusters. Methods: primary liver cancer patients who were scheduled to receive TACE were recruited. Symptoms data were collected using the MD Anderson Symptom Inventory (MDASI-C) and the Symptom Module specific to Primary Cancer (TSM-PLC). Nutritional assessment relied on the Nutritional Risk Screening-2002 (NRS-2002) and blood biochemistry. The SCs were extracted using exploratory factor analysis, while the relationship between SCs and nutritional status was evaluated using Spearman correlation analysis. Results: the study included 226 patients, four distinct symptom clusters emerged: emotional-psychological symptom cluster, upper gastrointestinal symptom cluster, post-embolization-related symptom cluster, and liver function impairment symptom cluster. 68.14 % of patients were found to be at high risk of malnutrition. Our study revealed significant differences in Scs scores between patients at risk of malnutrition and those without such risk (p < 0.050). Notably, we observed a positive correlation between NRS-2002 scores and the scores of all symptom clusters (r = 0.205 to 0.419, p < 0.001), while a negative correlation was observed between prealbumin levels and the scores of all symptom clusters (r = -0.183 to -0.454, p < 0.001). Conclusion: the study highlights the high risk of malnutrition among liver cancer patients receiving TACE and the positive correlation between high malnutrition risk and Scs scores.

Introducción: Introducción: los grupos de síntomas (SC, por sus siglas en inglés) son altamente prevalentes entre los pacientes diagnosticados de cáncer primario de hígado. La desnutrición aumenta el riesgo de que la puntuación total de los grupos de síntomas sea más pronunciada. Objetivo: este estudio estaba dirigido a identificar los SC y a evaluar el estado nutricional de los pacientes sometidos a quimioembolización arterial transcatéter (TACE, por sus siglas en inglés). Adicionalmente, estaba dirigido a investigar la asociación entre el estado nutricional y los grupos de síntomas. Métodos: se reclutaron pacientes con cáncer primario de hígado que tenían programado recibir TACE. Los datos de los síntomas se recolectaron mediante el Inventario de síntomas del MD Anderson (MDASI-C) y el Módulo de síntomas específicos del cáncer primario (TSM-PLC). La evaluación nutricional se basó en el cribado de riesgo nutricional 2002 (NRS-2002) y la bioquímica sanguínea. Los SC se extrajeron mediante un análisis factorial exploratorio, mientras que la relación entre los SC y el estado nutricional se evaluó mediante un análisis de correlación de Spearman. Resultados: el estudio incluyó 226 pacientes, de los cuales surgieron cuatro grupos de síntomas distintos: grupo de síntomas emocionales-psicológicos, grupo de síntomas gastrointestinales superiores, grupo de síntomas relacionados con la postembolización y grupo de síntomas de deterioro de la función hepática. El 68,14 % de los pacientes presentaban un alto riesgo de desnutrición. Nuestro estudio reveló diferencias significativas en las puntuaciones de los SC entre los pacientes con riesgo de desnutrición y aquellos sin dicho riesgo (p < 0,050). En particular, observamos una correlación positiva entre las puntuaciones del NRS-2002 y las puntuaciones de todos los grupos de síntomas (r = 0,205 a 0,419, p < 0,001), mientras que se observó una correlación negativa entre los niveles de prealbúmina y las puntuaciones de todos los grupos de síntomas (r = -0,183 a -0,454, p < 0,001). Conclusión: el estudio destaca el alto riesgo de desnutrición entre los pacientes con cáncer de hígado que reciben TACE y la correlación positiva entre el alto riesgo de desnutrición y las puntuaciones de los SC.

Construct validity and reliability of the BARRIERS scale in the Spanish context.

OBJECTIVE: To establish the construct validity of the Spanish version of the BARRIERS scale. METHOD: Methodological study of validation of a measurement instrument based on data from previously published studies. The study population consisted of nurses from the Basque Health Service and the Canary Health Service. The following variables were extracted and unified: Years of professional experience, possession of a specialist nursing degree, possession of a doctorate, type of activity performed by the professional and field of work. For construct validation, a confirmatory factor analysis (CFA) was performed based on the initial model proposed for the scale and RASCH analysis. A polychoric correlation matrix, factor extraction by unweighted least squares and PROMIN oblique rotation were used. For the RASCH analysis, the Joint Maximun Likelihood estimation (JMLE) method was used; the fit of the items and persons were estimated by means of outfit - Unweighted Mean Square fit statistic (UMS) and infit -Weighted Mean Square Fit Statistic (WMS), as well as the reliability and separation of items and persons. RESULTS: A total of 1200 nurses and midwives made up the final validation sample (n = 1200), with a mean professional experience of 21.22 ± 9.26 years. The CFA presented a good fit to the data (KMO = 0.935 [95% CI: 0.921-0.945]), changing the factorial assignment in 6 items, while 5 items received factorial scores in more than one factor. The fit values for the 4-factor solution were RMSEA = 0.026 [95% CI: 0.026-0.027] and GFI = 0.991 [95% CI: 0.986-0.991]. In the RASCH analysis most items presented infit-WMS and outfit-UMS values with a good fit. CONCLUSIONS: The Spanish version of the BARRIERS scale has adequate construct validity although there are changes in the assignment of items to the dimensions compared to the original model. The RASCH analysis indicates adequate fit for both persons and items.

Scale of concern about COVID-19 infection in Peruvian Health Care Workers.

INTRODUCTION: The global SARS-CoV-2 pandemic has generated concern about contagion, especially among healthcare workers who are on the front line. OBJECTIVE: To design and analyse the evidence of content validity, internal structure and reliability of a measure of concern about the spread of COVID-19 among Peruvian healthcare workers. MATERIAL AND METHODS: Quantitative study and instrumental design. The scale was administered to 321 health science professionals (78 males and 243 females), whose ages ranged from 22 to 64 years (38.12 ±â€¯9.61). RESULTS: Aiken's V-coefficient values were statistically significant. An exploratory factor analysis was performed which indicated the existence of a single factor, and confirmatory factor analysis (CFA) confirmed a satisfactory six-factor model. The CFA solution obtained adequate fit indices (RMSEA = 0.079; P = .05; TLI = 0.967; IFC = 0.980; GFI = 0.971, and AGFI = 0.931), and showed good internal consistency based on Cronbach's alpha coefficient (α = 0.865; CI 95%, 0.83-0.89). CONCLUSIONS: The scale of concern for COVID-19 infection is a valid and reliable brief measure that can be used for research and professional purposes.

[Health-related quality of life in Chileans from vulnerable communes]. / Calidad de vida relacionada con la salud en chilenos de comunas vulnerables.

OBJECTIVE: The COVID-19 pandemic and the resulting social and health crisis impacted the well-being of the population. Health-related quality of life (HRQoL) could be affected, mainly in conditions of social vulnerability. The objective was to analyze the HRQoL and the psychometric properties of the EQ-5D instrument in adult Chilean population from vulnerable communes of the Metropolitan Region. METHOD: Cross-sectional study carried out during quarantine period April to June 2021. Five hundred adults residing in Chilean communes were selected and completed a structured questionnaire by video-call, including the EQ-5D instrument. Descriptive analyzes and confirmatory factor analyzes of the traditional reflective model were performed. RESULTS: The age of the sample was 36.36±12.41 years, the majority reported having a secondary education level and being employed. Regarding the EQ-5D instrument, the most affected dimensions were pain/discomfort and anxiety/depression. The global health status was 73.0±19.71 points. The model showed an adequate fit: χ2=6.992, p=0.221, CFI=0.996, TLI=0.993, RMSEA=0.028 (90% CI: 0.000-0.073) and SRMR=0.067. In addition, the items of the scale were good indicators of the construct of interest. CONCLUSIONS: In a pandemic context, the population was mostly affected by pain/discomfort and anxiety/depression. The EQ-5D instrument is a useful tool to estimate CRSV in the Chilean population in the context of pandemic. In addition, the psychometric evidence supports the dimensionality of the construct and the potential utility of decomposing its analysis.

Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample.

Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria.Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples.Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models.Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples.Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.

The distinction between PTSD and DSO as related but separate constructs was validated using the ITQ in a Hungarian clinical and non-clinical sample.CPTSD was more frequent than PTSD among general help-seeking clinical clients, while in the non-clinical sample PTSD had a higher prevalence rate.Interpersonal trauma in childhood and adulthood was associated with more PTSD and DSO symptoms.

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting.

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

The Italian validation of the MIES adapted to the healthcare setting yielded a three-factor structure: (a) 'perceived transgressions by self'; (b) 'perceived transgressions by others'; (c) 'perceived betrayals by others'.Findings suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency.Future research should consider the role of individualising and social binding moral principles in shaping moral injury experiences among healthcare professionals across different socio-cultural settings.

Structural analysis and reliability of the Perceived Stress Scale in nursing professionals from Peru.

OBJECTIVE: The objective was to provide psychometric evidence of the 14-item and 10-item version of the Perceived Stress Scale in nursing professionals from Peru. METHOD: Data on 2848 professionals (92.275% women) between 23 and 69 years old (M = 21.876; SD = 10.763) was extracted from ENSUSALUD 2015. An exploratory structural equation modelling (ESEM) was applied with Mplus 7.0 software to analyse several measurement models in the PSS: unidimensional, bidimensional, models with method factor, and bifactor. Finally, the reliability was analysed. RESULTS: The two-factor structure obtained adequate fit indices, and acceptable factorial loadings (>.50), while the unidimensional model has poor statistical support. The construct and score reliability was also adequate. CONCLUSION: The two-factor model of the PSS-10 and PSS-14 presents adequate psychometric properties to expand its use to empirical research.

[Validation of the Spanish version of the Golombok Rust Inventory of Sexual Satisfaction]. / Validación de la versión española del Golombok Rust Inventory of Sexual Satisfaction.

INTRODUCTION: Self-reports are one of the most used techniques in the evaluation of human sexuality. For this reason, valid and reliable evaluation instruments are necessary for high quality studies. OBJECTIVE: The main purpose of this study was to translate and validate the Golombok Rust Inventory of Sexual Satisfaction for use in Spanish. METHOD: A sample of 1,265 subjects (1,007 men, 258 women) completed the Golombok Rust Inventory of Sexual Satisfaction questionnaire. Two independent translators performed the translation and a group of experts unified the versions. RESULTS: The items showed adequate correlation, both in the men's version (0.306-0.440), and in the women's version (0.355-0.652). Reliability is high in both versions (men: 0.864; women: 0.924). Factor analysis adjusts to the theoretical dimensions proposed by the authors of the questionnaire, explaining 57.75% of the variance in men, and 66.67% in women. CONCLUSIONS: The Spanish version of the Golombok Rust Inventory of Sexual Satisfaction has the necessary psychometric properties to be used both in the clinic and in research.

Transcultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in intensive care. / Adaptación transcultural y validez de un pictograma para evaluar necesidades de comunicación en adultos con vía aérea artificial en cuidados intensivos.

OBJECTIVE: To perform the cross-cultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in ICU in Cartagena, Colombia. METHOD: Scale validation study, population comprising all the patients who were hospitalized in six ICU of Cartagena-Colombia. The sample was made up of 181 adult patients with artificial airway, the adaptation to Spanish was determined (translation, backtranslation, expert review, pre-final version, pilot test, final version), facial validity by expert agreement, content validity with the Lawshe index modified by Tristan (cut-off point 0.58), exploratory factor analysis (AFE) with the Bartlett's test of sphericity and Cattell's graph; internal consistency measured through the Cronbach alpha statistic. RESULTS: Patients between the ages of 19 and 88years participated (mean: 54±17); 91.71% expressed frequent needs for accompaniment, knowing date and time; 61% of the experts agreed with the cross-culturally adapted items, the overall Content Validity Index (CVI) was 0.86 with agreement in understanding eleven items. The AFE suggested retaining 13 items and 3 factors (perception/cognition, elimination and exchange, comfort), which explain the construct. The internal alpha Cronbach consistency was 0.64. CONCLUSIONS: The pictographic material, Spanish version, was shown to be a multidimensional instrument composed of 18 items grouped in 3 factors. Therefore, it is recommended it be applied to the patient with artificial airway and to establish communication as a preliminary point of care in nursing.

Scale of Concern about COVID-19 Infection in Peruvian Health Care Workers. / Escala de preocupación por el contagio de la COVID-19 en personal de la salud peruano.

INTRODUCTION: The global SARS-CoV-2 pandemic has generated concern about contagion, especially among healthcare workers who are on the front line. OBJECTIVE: To design and analyse the evidence of content validity, internal structure and reliability of a measure of concern about the spread of COVID-19 among Peruvian healthcare workers. MATERIAL AND METHODS: Quantitative study and instrumental design. The scale was administered to 321 health science professionals (78 males and 243 females), whose ages ranged from 22 to 64 years (38.12±9.61). RESULTS: Aiken's V-coefficient values were statistically significant. An exploratory factor analysis was performed which indicated the existence of a single factor, and confirmatory factor analysis (CFA) confirmed a satisfactory six-factor model. The CFA solution obtained adequate fit indices (RMSEA=0.079; p=0.05; TLI=0.967; IFC=0.980; GFI=0.971, and AGFI=0.931), and showed good internal consistency based on Cronbach's alpha coefficient (α=0.865; CI 95%, 0.83-0.89). CONCLUSIONS: The scale of concern for COVID-19 infection is a valid and reliable brief measure that can be used for research and professional purposes.

Transcultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in intensive care.

OBJECTIVE: To perform the cross-cultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in ICU in Cartagena, Colombia. METHOD: Scale validation study, population comprising all the patients who were hospitalized in six ICU of Cartagena-Colombia. The sample was made up of 181 adult patients with artificial airway, the adaptation to Spanish was determined (translation, backtranslation, expert review, pre-final version, pilot test, final version), facial validity by expert agreement, content validity with the Lawshe index modified by Tristan (cut-off point 0.58), exploratory factor analysis (AFE) with the Bartlett's test of sphericity and Cattell's graph; internal consistency measured through the Cronbach alpha statistic. RESULTS: Patients between the ages of 19 and 88 years participated (mean = 54 ±â€¯17), 91.71% expressed frequent needs for accompaniment, knowing date and time; 61% of the experts agreed with the cross-culturally adapted items, the overall Content Validity Index (CVI) was 0.86 with agreement in understanding eleven items. The AFE suggested retaining 13 items and 3 factors (perception/cognition, elimination and exchange, comfort), which explain the construct. The internal alpha Cronbach consistency was 0.64. CONCLUSIONS: The pictographic material, Spanish version, was shown to be a multidimensional instrument composed of 18 items grouped in 3 factors. Therefore, it is recommended it be applied to the patient with artificial airway and to establish communication as a preliminary point of care in nursing.

Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis.

INTRODUCTION: Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS: In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS: We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS: The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.

Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5).

Background: The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress. Objective: The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity. Method: The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied. Results: The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5. Conclusions: In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.

Antecedentes: La disponibilidad de instrumentos psicométricamente sólidos para la evaluación del trastorno de estrés postraumático (TEPT) es indispensable para el trabajo clínico y científico con personas que sufren angustia relacionada con el trauma.Objetivo: El objetivo del presente estudio fue traducir la Escala de Diagnóstico Postraumático del DSM-5 (PDS-5) al alemán y evaluar sus propiedades psicométricas, así como su validez convergente, discriminante y factorial.Método: La traducción al alemán autorizada del PDS-5 fue completada por 270 pacientes ingresados en clínicas de trauma ambulatorias especializadas. De estos, el 57,8% completó la PDS por segunda vez (el tiempo medio entre evaluaciones fue de 12,0 días). Con el fin de examinar la validez convergente y discriminante del PDS-5, la lista de verificación del trastorno de estrés postraumático para el DSM-5, así como las subescalas de depresión del Cuestionario de salud del paciente (PHQ-9), de somatización (PHQ-15) y de trastorno de ansiedad generalizada (GAD-7) fueron aplicadas.Resultados: La puntuación total del PDS-5 mostró una excelente consistencia interna (α = .91) y confiabilidad al reaplicar (rho = .84). La validez convergente fue apoyada por una fuerte correlación con la puntuación total de la lista de verificación de trastorno de estrés postraumático para el DSM-5 (PCL-5; rho = .91). Las correlaciones con las subescalas del Cuestionario de Salud del Paciente de depresión (rho = .81), ansiedad (rho = .72) y somatización (rho = .65) fueron significativamente más bajas (todas p <.001) lindicando validez discriminante del PDS-5. El Análisis Factorial Confirmativo no resultó en una preferencia clara por uno de los modelos probados. La definición de un valour de corte de diagnóstico de ≥36 basado en el análisis ROC resultó en una alta sensibilidad (.92) y especificidad (.96) en comparación con un diagnóstico de TEPT probable según el PCL-5.Conclusiones: En resumen, nuestros resultados indican que la traducción al alemán PDS-5 proporciona información válida y confiable sobre la severidad y diagnóstico del TEPT.

Use of structural equation models to evaluate the relationship between eating patterns and obesity for elderly people.

INTRODUCTION: Introduction: in the Brazilian population it is noted that obesity is increasing in all ages, particularly in the elderly, due to changes in habits and the consumption of foods with high energy density. The objective of this study was to reanalyze the data from a Food Frequency Questionnaire (FFQ) in order to obtain new food patterns from the elderly population. Methods: sociodemographic data, morbidities, and Food Frequency Questionnaire (FFQ) results were collected from a representative sample of 355 elderly in the city of Botucatu, São Paulo, Brazil, and stratified by Basic Health Unit in the municipality. The data from the FFQ were transformed into daily consumption, and only foods with an intake of at least 40 % were included in the analysis. Eating patterns were obtained by means of an exploratory and confirmatory factor analysis using the principal component method, associating them with obesity and demographic variables obtained via structural equation models (SEMs). Results: with the data from the FFQ, four eating patterns were obtained using the exploratory and confirmatory factor analysis: healthy, traditional, snacks and weekend meals, and mild diet. Using SEMs and considering general obesity as measured by the body mass index (BMI), being female, younger, hypertensive, diabetic, and having lower adherence to the traditional pattern increases BMI. Additionally, using SEMs and considering central obesity as measured by waist circumference (WC), being hypertensive or diabetic, and having a lower adherence to the traditional pattern increases WC. Conclusion: removing excess zeroes from FFQ data it was possible to obtain well-defined eating patterns using the exploratory and confirmatory analysis, and to associate them with obesity through SEMs.

INTRODUCCIÓN: Introducción: en la población brasileña se observa que la obesidad ha aumentado en todas las edades, incluidas las personas mayores, debido a los cambios en los hábitos y el consumo de alimentos con alta densidad energética. El objetivo de este estudio fue volver a analizar los datos de un cuestionario de frecuencia alimentaria (FFQ) con el fin de obtener los nuevos patrones dietéticos de la población de edad avanzada. Métodos: se recogieron datos sociodemográficos y de morbilidad, y los resultados de un cuestionario de frecuencia alimentaria (FFQ) de una muestra representativa de 355 personas mayores de la ciudad de Botucatu, São Paulo, Brasil, y se estratificaron por Unidad Básica de Salud del municipio. Los datos del FFQ se transformaron en consumo diario y solo se incluyeron en el análisis alimentos con al menos un 40 % de consumo. Los patrones dietéticos se obtuvieron mediante el análisis factorial exploratorio y confirmatório con el método del componente principal, asociándolos con la obesidad y las variables demográficas mediante modelos de ecuaciones estructurales (SEM). Resultados: con los datos del FFQ se obtuvieron cuatro patrones dietéticos mediante el análisis exploratorio y confirmatorio: saludable, tradicional, tapas y comidas de fin de semana, y dieta ligera. Con los SEM y considerando la obesidad general medida por el índice de masa corporal (IMC), ser mujer, más joven, hipertensa, diabética y con menos adherencia al patrón tradicional aumenta el IMC. Además, con los SEM y considerando la obesidad central medida por la circunferencia de la cintura (WC), ser hipertenso, diabético y tener una menor adherencia al patrón tradicional aumenta los valores de WC. Conclusiones: el análisis factorial exploratorio y confirmatorio reveló los patrones dietéticos y los modelos de ecuaciones estructurales resultaron útiles para obtener las relaciones existentes entre los resultados de interés.

[Properties of a scale of concern for COVID-19: Exploratory analysis in a Peruvian sample]. / Propiedades de una escala de preocupación por la COVID-19: análisis exploratorio en una muestra peruana.

OBJECTIVE: Concern about getting sick could help prevent disease. The aim of this study was to analyze the psychometric properties of a COVID-19 concern scale (EPCov-19). MATERIALS AND METHODS: This is an instrument-based study and information was collected from 224 people of Peruvian nationality in the context of social isolation. The items of the Cancer Concern Scale were adapted for this study. RESULTS: A scale with satisfactory psychometric properties was obtained. With a matrix of polychoric correlations, values higher than the standard were obtained in all 6 items (r >0.3) and the reliability was acceptable (α=0.866; 95% CI=0.83 - 0.89). Parallel analysis suggested unidimensionality of the EPCov-19, the variance explained was 79.7% and saturations were higher than 0.4. Goodness-of-fit índices were satisfactory (CFI=0.995; GFI=0.997; TLI=0.991; and RMSEA=0.059, 95% CI=0.012 - 0.077). CONCLUSIONS: This is a valid and reliable instrument for measuring concern about the spread of COVID-19 and can be used in future studies.

Results of mapping patients expectation using SERVQUAL.

BACKGROUND: Understanding expectations of the patients towards the quality of services that hospitals providing is very important in quality in healthcare. With every health care organization claiming its services to be the best, benchmarking and comparing them to ascertain the real best is very difficult but much required in this competitive world. Patients have a varied need depending upon the resources and criticality of disease. The aim of the study was to identify the factors linked with patient's expectations contributing to the quality of the service delivered by the hospital. MATERIALS AND METHODS: Multi-speciality hospitals were visited to survey indoor and outdoor patients of different age groups. Omega coefficient and Cronbach α test were used to test the questionnaire's validity and reliability. The factor analysis technique was used to identify factors determining patient expectations. The SERVQUAL framework was used to categorize evaluation criteria. RESULTS: The resultant factors show variations in prioritizing service demands by the patients. Such a system would enable the patients to select a hospital capable of delivering best quality services. CONCLUSION: This study identifies the factors that contribute in delivering high quality service by the hospital. It gives a futuristic view to design a framework for evaluating the quality of the service delivered by a hospital.

Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis.

INTRODUCTION: Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS: In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS: We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS: The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.

Estudio factorial exploratorio de empatía en docentes de una facultad de odontología / Exploratory Factorial Study of Empathy in Teachers of a Faculty of Dentistry

Resumen Objetivo: Explorar las dimensiones latentes presentes en los 20 ítems del constructo empatía, medido en docentes de una facultad de Odontología. Metodología: Docentes de odontología, pertenecientes a la Facultad de Odontología de la Universidad Andrés Bello, sede Santiago, constituida por 145 profesores de ambos sexos, en los cuales participaron el 88,27%. El instrumento aplicado es la Escala de Empatía de Jefferson para Profesionales de la Salud. La conformación del modelo de medida de la empatía se realizó mediante el análisis factorial exploratorio. El nivel de significación empleado fue de α<0,005. Resultados: Los resultados generales indican que los niveles de empatía son adecuados. Es posible establecer un modelo de tres factores. Dentro de la dimensión Cuidado Compasivo, perteneciente a la Empatía Emocional, se encuentra un ítem (14), el cual presentó una carga factorial significativa con Toma de Perspectiva con el paciente que pertenece a la Empatía Cognitiva. Conclusiones: Se establece un modelo tridimensional de la empatía en docentes de pregrado con el paciente. Los ítems de cada una de las dimensiones se correlacionaron entre sí, en concordancia con el modelo original de la empatía. Estos hallazgos deben ser corroborados por un análisis factorial confirmatorio.

Abstract Objective: To explore the latent dimensions, present in the 20 items of the empathy construct, measured in teachers of a dental school. Methodology: Dental teachers belonging to the Faculty of Dentistry of the Andrés Bello University, Santiago, consisting of 145 teachers of both sexes, in which 88.27% participated. The instrument applied was the Jefferson Empathy Scale for Health Professionals. Compliance with the model and the measurement of empathy levels was verified by means of exploratory factor analysis. The empathy measurement model was built using exploratory factor analysis. The level of significance used was α<0.005. Results: The overall results indicate that empathy levels are adequate. A three-factor model can be established. Within the Compassionate Care dimension, belonging to Emotional Empathy there is one item (14), which presented a significant correlation with Perspective Taking with the patient belonging to Cognitive Empathy. Conclusions: A three-dimensional model of empathy in undergraduate teachers with the patient is established. The items of each of the dimensions correlated with each other in agreement with the original model of empathy. These findings should be corroborated by a confirmatory factor analysis.