Cross-cultural adaptation and psychometric properties of the MMSE and MoCA questionnaires in Tanzanian Swahili for a traumatic brain injury population.

BACKGROUND: Traumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania's TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania. METHODS: A cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated. RESULTS: MoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001). CONCLUSIONS: With the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania's adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.

Cross-cultural adaptation and psychometric properties of the Kessler Scale of Psychological Distress to a traumatic brain injury population in Swahili and the Tanzanian Setting.

BACKGROUND: To evaluate the psychometric properties of a Swahili version of the Kessler Psychological Distress scale in an injury population in Tanzania. METHODS: Swahili version of the Kessler Psychological Distress scale was developed by translation and back-translation by a panel of native speakers of both English and Swahili. The translated instruments were administered to a sample of Tanzanian adults from a traumatic brain injury registry. The content validity, construct validity, reliability, internal structure, and external reliability were analyzed using standard statistical methods. RESULTS: Both translated versions of the Kessler Psychological Distress scale were found to be reliable (>0.85) for all tested versions. Confirmatory factor analysis of one and two factor solution showed adequate results. Kessler Psychological Distress scale scores were strongly correlated to depression and quality of life (R>0.50). CONCLUSIONS: This paper presents the first Swahili adaptations of the Kessler Psychological Distress scale as well as the first validation of these questionnaires in Tanzania. The instrument was found to have acceptable psychometric properties, resulting in a new useful tool for medical and social research in this setting.

Clinical evaluation of the alcohol use disorders identification test (AUDIT) in Moshi, Tanzania.

BACKGROUND: Alcohol use disorder is a major cause of morbidity and mortality in low- and middle-income countries. Alcohol screening using a validated tool is a useful way to capture high-risk patients and engage them in early harm reduction interventions. Our objectives were to 1) evaluate the psychometric evidence the Alcohol Use Disorders Identification Test (AUDIT) and its subscales in the general population of Moshi, Tanzania, and 2) evaluate the usefulness of the tool at predicting alcohol-related harms. METHODS: Two hundred and fifty-nine adults living in Moshi, Tanzania were included in the study. We used the AUDIT and its subscales to determine the classification of harmful and hazardous drinking. To analyze the internal structure of AUDIT and the model adequacy we used Confirmatory Factor Analysis (CFA). The reliability of AUDIT was analyzed for Cronbach's alpha, Omega 6 and Composite Reliability. The optimal cut off point for the AUDIT was determined by the receiver operating characteristic (ROC) curve, using the Youden approach to maximize sensitivity and specificity. RESULTS: The median score of the AUDIT was 1 (inter-quartile range: 0-7). The internal structure of the AUDIT showed factor loadings ranging from 0.420 to 0.873. Cronbach's alpha, Omega and Composite Reliability produced values above 0.70. The Average Variance Extracted was 0.530. For the AUDIT, a score of 8 was identified as the ideal cut-off value in our population. CONCLUSIONS: This study validates AUDIT in the general population of Moshi and is one of the only studies in Africa to include measures of the internal structure of the AUDIT and its subscales.

Sports and Functional Training Improve a Subset of Obesity-Related Health Parameters in Adolescents: A Randomized Controlled Trial.

To investigate the effects of two different modes of physical activity on body composition, physical fitness, cardiometabolic risk, and psychological responses in female adolescents participating in a multi-disciplinary program. The 12-week randomized intervention included 25-adolescents with overweight divided into two groups: sports practice-SPG and functional training-FTG. The SPG intervention was divided into three sports: basketball, handball, and futsal. SPG participants performed one sport 3-times/week, over the course of 1 month. The FTG performed concurrent exercises 3-times/week. This study was registered in Clinical Trials Registry Platform under number: RBR-45ywtg and registered in Local Ethics Committee number: 2,505.200/2018. The intensity of physical exercises-PE was matched between groups by the rating of perceived exertion. The primary outcome was body composition, and secondary outcomes were physical fitness, cardiometabolic risk, and psychological responses. There was a significant time-effect for body mass, body mass index, and low-density lipoprotein (LDL-c), all being reduced. There were increases over time for musculoskeletal mass, aerobic fitness, and high-density lipoprotein (HDL-c) (p < 0.05). There was a group time interaction with body fat percentage being lower post-intervention in the SPG (p < 0.05). No significant differences were observed for the other variables. Both physical activity models were effective in improving a subset of obesity-related health parameters. The findings should be extended by further investigation using more sophisticated measures of energy expenditure. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-45ywtg.

Effects of the Order of Physical Exercises on Body Composition, Physical Fitness, and Cardiometabolic Risk in Adolescents Participating in an Interdisciplinary Program Focusing on the Treatment of Obesity.

The main objective of this study was to investigate the effects of the order of physical exercises on body composition, physical fitness, and cardiometabolic risk in adolescents participating in an interdisciplinary program focusing on the treatment of obesity. The final 12-week analyses involved 33 female adolescents who were split into two groups of concurrent training (CT): resistance plus aerobic training and aerobic plus resistance training, with equalization performed in all physical exercises. The only difference between the two groups was the order in which the exercises were performed. The results showed reductions in fat mass, body fat, and waist circumference, as well as increases in musculoskeletal mass and resting metabolic rate (p < 0.05) following the multiprofessional intervention period. However, no significant differences were observed in regard to body mass, body mass index, neck circumference, or arm circumference (p > 0.05). Maximal isometric strength and maximal oxygen consumption showed significant increases after the intervention period (p < 0.05). There were reductions in insulin, HOMA-IR, total cholesterol, triglycerides, and low-density lipoproteins (p < 0.05), and an interaction within the resistance plus aerobic training group showed lower values for triglycerides when compared to itself (p = 0.002). No difference was found in fasting glycemia for either group (p > 0.05). It is worth noting that the equalization training variables presented no differences between the two groups (p > 0.05). Based on these results, both CT methods were found to be effective in promoting health parameters in overweight and obese female adolescents, and triglyceride values decreased more in the resistance plus aerobic group. Future studies with larger samples and feeding control should be conducted to confirm or refute our findings.

Motivação, paixão e mindfulness: um estudo correlacional sobre engajamento no esporte / Motivation, passion and mindfulness: a correlational study on engagement in sport / Motivación, pasión y mindfulness: un estudio correlacional sobre la participación en el deporte

O objetivo do presente estudo foi verificar o efeito preditor da motivação sobre estado de mindfulness durante a prática esportiva e o papel mediador da paixão pelo esporte nessa relação. Participaram 176 atletas (M= 27,05±9,06 anos) que responderam às escalas de Motivação no Esporte, de Paixão e de Estado de Mindfulness para Atividade Física. A modelagem de equações estruturais mostrou que a motivação intrínseca afetava positivamente a experiência de mindfulness no esporte. Essa relação foi mediada pela paixão harmoniosa. Observou-se dois processos de engajamento com prática esportiva, um associado a comportamento autodeterminado moderado pela paixão harmoniosa, resultando na experiência de mindfulness, e outro proveniente da motivação extrínseca, resultando na paixão obsessiva pela atividade.

This study aimed to verify the predictive effect of motivation over the mindfulness state in sports practice and the mediating role of passion in this relation. A hundred and seventy-six athletes (M= 27,05±9,06 years old) responded to the Motivation in Sport, Passion, and State of Mindfulness scales. Structural equation modeling showed that intrinsic motivation positively affected the experience of mindfulness in sport, and this relationship was moderated by harmonious passion. The results suggest two processes of engagement in sports practice, one emanating from self-determined behavior, mediated by harmonious passion and resulting in mindfulness experience, and another coming from extrinsic motivation, resulting in an obsessive passion for the activity.

Este estudio verificó el efecto predictivo de la motivación sobre el estado de mindfulness en la práctica deportiva y el papel me-diador de la pasión en esta relación. Ciento setenta y seis atletas (M= 27,05±9,06) respondieron a las escalas de Motivación en el Deporte, Pasión y Mindfulness. Los modelos de ecuaciones estructurales mostraronque la motivación intrínseca afectaba positivamente la experiencia de la atención plena en el deporte y que esta relación estaba mediada por una pasión armoniosa. Se observó un proceso de compromiso con las activi-dades deportivas asociado con el comportamiento autodeterminado moderado por la pasión armoniosa y que resulta en la experiencia del mindfulness, y otro que emana de la motivación extrínseca, que resulta en una pasión obsesiva por la actividad.