Sound psychometric properties of the Swedish version of the Spinal Cord Independence Measure Self-Report.

OBJECTIVE: To describe data completeness, targeting and reliability of the Swedish version of the Spinal Cord Independence Measure Self-Report (s-SCIM-SR). DESIGN: Translation and reliability study. SUBJECTS: Programme participants (n = 48) and peer mentors (n = 42) with spinal cord injury enrolled in the INTERnational Project for the Evaluation of "activE Rehabilitation" (inter-PEER). METHODS: The translation process was based on guidelines/recommendations, and involved expert competence, including consumers. The s-SCIM-SR was distributed online, once for programme participants and twice for peer mentors. RESULTS: Sixty-nine individuals (77%) obtained a total score. Most missing data were found in the items Respiration and Using the toilet. Cronbach's alpha for the full scale was 0.89, for Self-care 0.92, for Respiration and sphincter management 0.37 and for Mobility 0.86. The intraclass correlation coefficient was excellent for all subscales and the full scale. Measures of variability showed high sensitivity to changes and Bland Altman analyses revealed no systematic changes between evaluation points. CONCLUSION: These results support the data completeness, targeting and reliability of the Swedish version of the SCIM-SR. However, some problems were found in the subscale Respiration and sphincter management. The s-SCIM-SR can be considered psychometrically sound and suitable to assess physical independence among persons with spinal cord injury in Swedish community settings.

Association between somatic symptoms and modern health worries.

OBJECTIVE: Modern health worries (MHWs) refer to perceived risk to personal health from technological changes and features of modern life, and is associated with health outcomes. The present objective was to test the hypotheses of (i) associations between MHWs and a global measure of typical somatization symptoms, referred to as somatic symptom distress, and (ii) associations between MHWs and a broad range of specific typical somatization symptoms and eye/skin and airway symptoms. METHODS: Cross-sectional population-based data were used. Validated instruments were used to assess MHWs (Modern Health Worries Scale), typical somatization symptoms (Patient Health Questionnaire 15-item Somatic Symptom Severity Scale, PHQ-15), eye/skin and airway symptoms (Environmental Hypersensitivity Symptom Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Multivariate linear regression analyses were conducted with MHWs as dependent variable, symptoms as independent variables, and background variables, anxiety and depression as confounding variables. RESULTS: When controlled for background variables, MHWs were statistically significantly, but only very weakly, associated with global PHQ-15 score, most of the specific typical somatization symptoms, and eye/skin and airway symptoms. When controlled also for depression and anxiety, the associations were statistically significant, but even more weakly associated with global PHQ-15 score and most of the specific symptoms. CONCLUSIONS: The results suggest a very small increased risk of somatic symptom distress and related specific symptoms in MHW, and that depression and anxiety are confounding variables in these associations.

Translation and validation of two International Spinal Cord Injury (SCI) Data Sets-a modified process.

Study design: A descriptive design was used of a reflective process of problem solving among individuals working together to improve the process of translating. Setting: Sweden. Objectives: The aim of this study was to describe a modified process for translation and validation of the International Spinal Cord Injury (SCI) Quality of Life (QoL) and Activity and Participation (A&P) Basic Data Sets from English into Swedish. Methods: The process of translation followed the Executive Committee for the International SCI Standards and Data Sets (ECSCI) recommendations. The initial translation was performed by translators. Experts in SCI were then assembled to scrutinize the translations and to reach a consensus for defining a final version. Results: The whole process was time consuming. To save time in future translations, the start-up planning is of great importance. To identify appropriate participants with knowledge and interest to be part of the project is crucial. In addition, the consensus meetings, when scrutinizing the translated International SCI Data Sets, should be well prepared and structured. We identified a few steps that could make the process more efficient. Conclusions: By adding a few steps as well as defining the role of a project coordinator, we believe that future translations of the International SCI Data Sets for non-English-speaking countries could be facilitated.

Commonly rare and rarely common: comparing population abundance of invasive and native aquatic species.

Invasive species are leading drivers of environmental change. Their impacts are often linked to their population size, but surprisingly little is known about how frequently they achieve high abundances. A nearly universal pattern in ecology is that species are rare in most locations and abundant in a few, generating right-skewed abundance distributions. Here, we use abundance data from over 24,000 populations of 17 invasive and 104 native aquatic species to test whether invasive species differ from native counterparts in statistical patterns of abundance across multiple sites. Invasive species on average reached significantly higher densities than native species and exhibited significantly higher variance. However, invasive and native species did not differ in terms of coefficient of variation, skewness, or kurtosis. Abundance distributions of all species were highly right skewed (skewness>0), meaning both invasive and native species occurred at low densities in most locations where they were present. The average abundance of invasive and native species was 6% and 2%, respectively, of the maximum abundance observed within a taxonomic group. The biological significance of the differences between invasive and native species depends on species-specific relationships between abundance and impact. Recognition of cross-site heterogeneity in population densities brings a new dimension to invasive species management, and may help to refine optimal prevention, containment, control, and eradication strategies.

A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials.

The objective of this study was to investigate the preventive effect of oral hygiene on pneumonia and respiratory tract infection, focusing on elderly people in hospitals and nursing homes, by systematically reviewing effect estimates and methodological quality of randomized controlled trials (RCTs) and to provide an overview of additional clinical studies in this area. Literature searches were conducted in the Medline database, the Cochrane library databases, and by hand-searching reference lists. Included publications were analyzed for intervention (or topic) studied, main conclusions, strength of evidence, and study design. RCTs were further analyzed for effect magnitudes and methodological details. Absolute risk reductions (ARRs) and numbers needed to treat (NNTs) were calculated. Fifteen publications fulfilled the inclusion criteria. There was a wide variation in the design and quality of the studies included. The RCTs revealed positive preventive effects of oral hygiene on pneumonia and respiratory tract infection in hospitalized elderly people and elderly nursing home residents, with ARRs from 6.6% to 11.7% and NNTs from 8.6 to 15.3 individuals. The non-RCT studies contributed to inconclusive evidence on the association and correlation between oral hygiene and pneumonia or respiratory tract infection in elderly people. Mechanical oral hygiene has a preventive effect on mortality from pneumonia, and non-fatal pneumonia in hospitalized elderly people and elderly nursing home residents. Approximately one in 10 cases of death from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene. Future research in this area should be focused on high-quality RCTs with appropriate sample size calculations.

Effects of stream predator richness on the prey community and ecosystem attributes.

It is important to understand the role that different predators can have to be able to predict how changes in the predator assemblage may affect the prey community and ecosystem attributes. We tested the effects of different stream predators on macroinvertebrates and ecosystem attributes, in terms of benthic algal biomass and accumulation of detritus, in artificial stream channels. Predator richness was manipulated from zero to three predators, using two fish and one crayfish species, while density was kept equal (n = 6) in all treatments with predators. Predators differed in their foraging strategies (benthic vs. drift feeding fish and omnivorous crayfish) but had overlapping food preferences. We found effects of both predator species richness and identity, but the direction of effects differed depending on the response variable. While there was no effect on macroinvertebrate biomass, diversity of predatory macroinvertebrates decreased with increasing predator species richness, which suggests complementarity between predators for this functional feeding group. Moreover, the accumulation of detritus was affected by both predator species richness and predator identity. Increasing predator species richness decreased detritus accumulation and presence of the benthic fish resulted in the lowest amounts of detritus. Predator identity (the benthic fish), but not predator species richness had a positive effect on benthic algal biomass. Furthermore, the results indicate indirect negative effects between the two ecosystem attributes, with a negative correlation between the amount of detritus and algal biomass. Hence, interactions between different predators directly affected stream community structure, while predator identity had the strongest impact on ecosystem attributes.

[Consultation skills training is necessary in medical education. Evaluation by student questionnaire and focus group interviews]. / Undervisning i konsultationsmetodik behövs i läkarutbildningen.

At Lund University Medical School communication skills are taught during both the preclinical and clinical part of the medical programme. As part of the training during the 5th year the students are required to videotape at least one patient consultation at a local primary health care centre. The students then meet in groups of 6-7 participants and a group leader to watch the recorded consultations and discuss them. To evaluate the quality of the consultation skills training and to identify potential weaknesses, we used both a quantitative and a qualitative method. A written questionnaire was distributed to all students and three focus group interviews, two with students and one with group leaders, were performed. The focus groups consisted of 5-6 participants each. The students were overall pleased with the training, and the majority thought that their consultation skills had improved. More commitment from the tutors at the health care centres was needed in order for the students to successfully record a complete consultation. Nearly all students found that the participants cooperated well in the groups, and that the group leader helped to create a positive atmosphere and gave constructive advice.