Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness.

OBJECTIVES: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). METHODS: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. RESULTS: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. CONCLUSIONS: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.

Development and Validation of the EspaiJove.net Mental Health Literacy (EMHL) Test for Spanish Adolescents.

There is evidence of the effectiveness of implementing mental health literacy (MHL) programs. However, there are substantial limitations in the instruments available for measuring MHL. This study aimed to develop and validate the EspaiJove.net MHL test (EMHL) for Spanish adolescents by assessing its psychometric properties. The development of the EMHL test was conducted using item pool generation and a pilot study. A convenience sample of students aged 13-15 years (n = 355) participated in the validity study. Reliability was assessed for internal consistency and via test-retest. Convergent validity was evaluated by comparing the effect sizes among known groups with different levels of mental health knowledge, the correlation with mental health-related instruments, and the item discrimination index. A final version of a 35-item EMHL test was obtained with two parts: (i) a binary choice format (yes/no) for the identification of mental disorders; (ii) a multiple choice question with four possible answer options. Internal consistency was acceptable in the first part (Cronbach's alpha = 0.744; Guttman's lambda 2 = 0.773) and almost acceptable in the second part (Cronbach's alpha = 0.615; Guttman's lambda 2 = 0.643). The test-retest evaluation supported the stability of the test (first part, ICC = 0.578; second part, ICC = 0.422). No ceiling and floor effects were found. The EMHL test scores discriminated between known groups with different levels of mental health knowledge and it is associated with several-related constructs of MHL. Conclusions: The EMHL test is a relevant measure for assessing MHL in adolescents into Spanish context with acceptable validity and stability.

Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments.

PURPOSE: The objective was to obtain a standardized evaluation of available prostate cancer-specific quality of life instruments used in patients with early-stage disease. METHODS: We carried out systematic literature reviews in the PubMed database to identify manuscripts which contained information regarding either the development process or metric properties of prostate cancer-specific quality of life instruments. Each instrument was evaluated by two experts, independently, using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0-100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden and alternative forms. RESULTS: Eight instruments and 57 manuscripts (2-15 per instrument) were identified. The Expanded Prostate Cancer Index Composite (EPIC) was the best rated (overall EMPRO score 83.1 points). Good results were also obtained by University of California Los Angeles-Prostate Cancer Index (UCLA-PCI), Patient-Oriented Prostate Utility Scale (PORPUS) and Prostate Cancer Quality of Life Instrument (PC-QoL) with 77.3, 70.5 and 64.8 points, respectively. These four instruments passed with distinction the validity and responsiveness evaluation. Insufficient reliability results were observed for UCLA-PCI and PORPUS. CONCLUSIONS: Current evidence supports the choice of EPIC, PORPUS or PC-QoL. Attribute-specific EMPRO results facilitate selecting the adequate instrument for every purpose. For longitudinal studies or clinical trials, where responsiveness is the priority, EPIC or PC-QoL should be considered. We recommend the PORPUS for economic evaluations because it allows cost-utility analysis, and EPIC short versions to minimize administration burden.

Adaptation into Spanish of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and preliminary validation in a student sample.

PURPOSE: There is growing interest in the assessment of positive mental health as a global indicator of societal wealth. We aimed to adapt the Warwick-Edinburgh Mental Well-being scale (WEMWBS) into Spanish and to perform a preliminary evaluation of its metric properties. METHODS: Forward and back-translations and cognitive debriefing were carried out. University students (n = 148) were recruited to evaluate the final Spanish version, following the UK original study. Distribution of WEMWBS responses, internal consistency, test-retest reliability, construct validity, and factor structure were assessed. RESULTS: Only 4 (out of 14) items of the initial Spanish version were not rated as conceptually and linguistically equivalent to the original and were modified. The final version was clear and comprehensible. Global score's Cronbach's alpha (0.90), item-total score correlations (0.44-0.76), and test-retest ICC (0.84) were all satisfactory. Moderate to high correlations (r = 0.45-0.70) were observed between the WEMWBS and validity scales. Preliminary confirmatory factor analyses did not support the hypothesis of a single factor. CONCLUSIONS: A conceptually equivalent Spanish version of the WEMWBS was obtained with high internal consistency, good test-retest reliability, and similar construct validity as the original instrument. Further validity and factorial studies are necessary in larger and more heterogeneous samples.

Hypothesis testing for coefficient alpha: an SEM approach.

We show how to test hypotheses for coefficient alpha in three different situations: (1) hypothesis tests of whether coefficient alpha equals a prespecified value, (2) hypothesis tests involving two statistically independent sample alphas as may arise when testing the equality of coefficient alpha across groups, and (3) hypothesis tests involving two statistically dependent sample alphas as may arise when testing the equality of alpha across time or when testing the equality of alpha for two test scores within the same sample. We illustrate how these hypotheses may be tested in a structural equation-modeling framework under the assumption of normally distributed responses and also under asymptotically distribution free assumptions. The formulas for the hypothesis tests and computer code are given for four different applied examples. Supplemental materials for this article may be downloaded from http://brm.psychonomic-journals.org/content/supplemental.

Disentangling impulsiveness, aggressiveness and impulsive aggression: an empirical approach using self-report measures.

There is confusion in the literature concerning the concept of impulsive aggression. Based on previous research, we hypothesize that impulsivity and aggression may be related, though not as closely as to consider them the same construct. So, our aim was to provide empirical evidence of the relationship between the impulsivity and aggressiveness constructs when considered as traits. Two widely used questionnaires [Barratt's Impulsiveness Scale (BIS) and Aggression Questionnaire-Refined (AQ-R)] were administered to 768 healthy respondents. Product-moment and canonical correlations were then calculated. In addition, a principal components analysis was conducted to explore whether impulsive aggression can be defined phenotypically as the expression of a single trait. The common variance between impulsivity and aggressiveness was never higher than 42%. The principal components analysis reveals that one component is not enough to represent all the variables. In conclusion, our results show that impulsivity and aggressiveness are two separate, although related constructs. This is particularly important in view of the misconceptions in the literature.

The effect of varying the number of response alternatives in rating scales: experimental evidence from intra-individual effects.

Despite a hundred years of questionnaire testing, no consensus has been reached on the optimal number of response alternatives in rating scales. Differences in prior research may have been due to the use of various psychometric models (classical test theory, item factor analysis, and item response theory) and different performance criteria (reliability, convergent/discriminant validity, and internal structure of the questionnaire). Furthermore, previous empirical studies on this issue have tackled the experimental design from a between-subjects perspective, thus ignoring intra-individual effects. In contrast with this approach, we propose a within-subjects experimental design and a comprehensive statistical methodology using structural equation models for studying all of these aspects simultaneously, therefore increasing statistical power. To illustrate the method, two personality questionnaires were examined using a repeated measures design. Results indicated that as the number of response alternatives increased, (1) internal consistency increased, (2) there was no effect on convergent validity, and (3) goodness of fit worsened. Finally, the article assesses the practical consequences of this research for the design of future personality questionnaires.

[Study of empathy in a Spanish sex offender sample]. / Empatía en una muestra española de delincuentes sexuales.

International research has emphasised that empathy is a relevant factor of sex offending. The main goal of this study is to explore, in a Spanish sex offender sample, the relationship between empathy deficits and sex crime for various types of victims. This study also analyses the positive effect that psychological treatment could have on empathy. For this purpose, 118 non-sex offenders were compared on an adapted version of Rape Empathy Measure to 39 treated rapists and 34 untreated rapists. Results show that the untreated rapists have lower empathy levels than non-sex offenders. Nevertheless, the treated rapists scored higher on empathy than the other two groups assessed, untreated rapists and non-sex offenders. Lastly, some suggestions are provided for future research in terms of the assessment of empathy and other factors related to sexual aggression.

[Recidivism risk assessment in sex offenders]. / Predicción de riesgo de reincidencia en agresores sexuales.

Violent behaviour risk assessment is one of the most relevant research areas in current Psychology of Crime. Various scales for violence risk assessment have recently been developed from research about crime careers and risk factors. One of these instruments is the Sexual Violence Risk Assessment-20 (SVR-20), translated and adapted to Spanish by the Group of Advanced Studies in Violence of the University of Barcelona. The goal of this study is to verify the predictive capacity of the SVR-20 to predict sexual violence recidivism in a Spanish sample of sexual offender inmates. The method used was a retrospective study based in 163 sexual offender files and a 4-year time lag. The data were analysed with the logistic regression technique. Of the sample, 79.9% non-recidivist individuals were correctly classified, and 70.8% recidivist individuals. The ROC curve obtained for the model shows a very good discriminant capacity for the SVR-20, with a 0.83 AUC value. The main conclusion of this study is that the Spanish adaptation of SVR-20 is a good instrument to predict the risk of sexual violence.

IQ heritability estimation: analyzing genetically-informative data with structural equation models.

When analyzing genetic data, Structural Equations Modeling (SEM) provides a straightforward methodology to decompose phenotypic variance using a model-based approach. Furthermore, several models can be easily implemented, tested, and compared using SEM, allowing the researcher to obtain valuable information about the sources of variability. This methodology is briefly described and applied to re-analyze a Spanish set of IQ data using the biometric ACE model. In summary, we report heritability estimates that are consistent with those of previous studies and support substantial genetic contribution to phenotypic IQ; around 40% of the variance can be attributable to it. With regard to the environmental contribution, shared environment accounts for 50% of the variance, and non-shared environment accounts for the remaining 10%. These results are discussed in the text.

Assessing aggressiveness quickly and efficiently: the Spanish adaptation of Aggression Questionnaire-refined version.

The assessment of aggressiveness and the prediction of aggression has become a relevant research and applied topic in Psychiatry and Psychology. There have been many attempts in order to get a fast and reliable tool to measure aggression. Buss and Durkee started the pathway, and recently Bryant and Smith developed a tool with an enormous potential, a fast-applicable, reliable and valid test. We herein report a Spanish adaptation of this test and we show that aggressiveness can be measured rapidly, and in a simple, valid and reliable way across different populations. We focus on the discriminant capacity of this test to detect aggressive individuals.