Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth.

OBJECTIVE: Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents. METHOD: We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability. RESULTS: Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized. CONCLUSIONS: Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.

Home-based video assessment of children's autism-related behaviours: Psychometric analysis and linkages with parental responsiveness and context.

OBJECTIVES: Assessment of autism-related behaviours (ARBs) in children has generally been limited to direct observations in clinical settings or informant-based reports. The widespread availability of video-streaming devices has made home observations of children's ARBs feasible. This approach could enable assessment of the generalization and durability of interventions and may be able to overcome methodological limitations of predominant current assessment approaches (response biases, limited sensitivity to treatment). DESIGN AND METHODS: Forty-four autistic children and their families participated in a repeated-measures study with a correlational design. Approximately 10 hr of unprompted behaviour at home were videorecorded over the course of a week (2 hr per day) for each participant. Gold standard measures of ARBs were also administered (ADOS-2 and ADI-R). Two home-based observational measures of ARBs utilizing streaming video were developed and evaluated: the ARCHER and the CHEERS. Trained independent evaluators made ratings on the ARCHER, CHEERS and an observational measure of parental responsiveness. RESULTS: Correlations with the ADOS-2 and ADI-R were .47 and .34 for ARCHER scores and .51 and .48 for CHEERS scores, respectively. In linear mixed models, more responsive parenting was associated with fewer ARBs on a daily basis. Children spent their afternoons engaged in many typical activities including electronics, homework and games with family members, and ARBs were more prominent in some of these contexts (e.g., electronics) than others (e.g., family games). CONCLUSIONS: Home-based observational assessment of ARBs may be useful for clinical and descriptive research.

Assessment of the validity and reliability of the Indonesian version of Short Form 12 (SF-12).

INTRODUCTION: Psychometric evaluation of the 12-item Short-Form Health Survey (SF-12), a well-used scale for measuring health-related quality of life (HrQoL), has not been done in general populations in Indonesia. This study assessed the validity and reliability of the SF-12 in middle-aged and older adults. METHODS: Participants self-completed the SF-12 and SF-36. Scaling assumptions, internal consistency reliability, and 1-week test-retest reliability were assessed for the SF-12. Confirmatory factor analysis was conducted to assess its construct validity. Correlations between SF-12 and SF-36 component scores were computed to assess convergent and divergent validity. Effect size differences were calculated between SF-12 and SF-36 component scores for assessing criterion validity. RESULTS: In total, 161 adults aged 46-81 years (70% female) participated in this study. Scaling assumptions were satisfactory. Internal consistency for the SF-12 Physical Component Summary (PCS-12) and the Mental Component Summary (MCS-12) were acceptable (a = 0.72 and 0.73, respectively) and test-retest reliability was excellent (ICC = 0.88 and 0.75, respectively). A moderate fit of the original two-latent structure to the data was found (root mean square error of approximation [RMSEA] = 0.08). Allowing a correlation between physical and emotional role limitation subscales improved fit (RMSEA = 0.04). Correlations between SF-12 and SF-36 component summary scores support convergent and divergent validity although a medium effect size difference between PCS-12 and PCS-36 (Cohen's d = 0.61) was found. CONCLUSIONS: This study provides the first evidence that SF-12 is a reliable and valid measure of HrQoL in Indonesian middle-aged and older adults. The algorithm for computing SF-12 and its association with SF-36 in the Indonesian population warrant further investigation.

Development and Psychometric Testing of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale.

OBJECTIVES: Caregiver self-efficacy-a caregiver's belief in his/her ability to contribute to patient self-care-is associated with better patient and caregiver outcomes in single chronic conditions. It is, however, unknown if caregiver self-efficacy improves patient and caregiver outcomes in multiple chronic conditions (MCCs) because there is no instrument to measure this variable. We developed the 10-item Caregiver Self-Efficacy in Contributing to patient Self-Care (CSE-CSC) scale for that purpose, and we tested its psychometric characteristics in caregivers of patients with MCCs. METHODS: In this cross-sectional multisite study, we tested the structural validity of the CSE-CSC scale with exploratory and confirmatory factor analysis, and we tested construct validity by correlating CSE-CSC scores with those of the Caregiver Contributions to Self-Care of Chronic Illness Inventory. We also tested reliability, and precision of the CSE-CSC scale. RESULTS: The 358 enrolled caregivers (mean age 54.6 years; 71.5% female) cared for patients with an average of 3.2 chronic conditions. Structural validity was good, and it showed 2 factors within the scale. Construct validity showed significant correlations between scores of the CSE-CSC scale and the Caregiver Contributions to Self-Care of Chronic Illness Inventory. Reliability coefficients were between 0.90 and 0.97. Measurement error yielded satisfactory results. CONCLUSIONS: The CSE-CSC scale is valid, reliable, and precise in measuring caregiver self-efficacy in contributing to patient self-care in MCCs. Because caregiver self-efficacy is a modifiable variable, the CSE-CSC scale can be used in clinical practice and research to improve patient and caregiver outcomes.

Deriving a Preference-Based Measure for People With Duchenne Muscular Dystrophy From the DMD-QoL.

OBJECTIVES: This study generates a preference-based measure for capturing the quality of life of people with Duchenne muscular dystrophy (DMD) from a new measure of quality of life, DMD-QoL. METHODS: A health state classification system was derived from the DMD-QoL based on psychometric performance of items, factor analysis, and item response theory analysis. Preferences for health states described by the classification system were elicited using an online discrete choice experiment survey with life years as an additional attribute, from members of the UK general population (n = 1043). Discrete choice experiment data was modeled using a conditional fixed-effects logit model and utility estimates were directly anchored on the 1 to 0 full health-dead scale. RESULTS: The health state classification system has 8 dimensions: mobility, difficulty using hands, difficulty breathing, pain, tiredness, worry, participation, and feeling good about yourself. The standard model had mostly statistically significant coefficients and reflected the instrument's monotonic structure. However, 2 dimensions had inconsistent coefficients (where utility increased as health worsened) and a consistent model was estimated that merged adjacent inconsistent severity levels. The best state defined by the classification system has a value of 1 and the worst state has a value of -0.559. CONCLUSION: The modeled results enable DMD-QoL-8D utility values to be generated using DMD-QoL or DMD-QoL-8D data to generate QALYs for people with DMD. QALYs can then be used to inform economic models of the cost-effectiveness of interventions in DMD. Future research comparing the psychometric performance of DMD-QoL-8D to existing generic preference-based measures, including EQ-5D-5L, is recommended.

Rasch Analysis of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales Administered to Patients With Duchenne Muscular Dystrophy.

OBJECTIVES: The objective of this study was to examine the psychometric properties of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL 4.0 GCS) in Duchenne muscular dystrophy (DMD), a rare, severely debilitating, and ultimately fatal neuromuscular disease. METHODS: Patients with DMD were recruited from 20 centers across 9 countries as part of the Cooperative International Neuromuscular Research Group Duchenne Natural History Study (NCT00468832). The psychometric properties of the PedsQL 4.0 GCS were examined using Rasch analysis. RESULTS: In total, 329 patients with DMD (mean age 9 years, range 3-18 years, 75% ambulatory) completed the PedsQL 4.0 GCS. The most difficult instrument items, expressing the greatest loss in health-related quality of life, were those associated with emotional well-being (eg, being teased by other children, feeling sad, and not making friends), as opposed to somatic disability (eg, lifting heavy objects, participating in sports, and running). The mean item and person fit residuals were estimated at 0.301 (SD: 1.385) and -0.255 (1.504), respectively. In total, 87% (20 of 23) of items displayed disordered thresholds, and many exhibited nontrivial dependency. The overall item-trait interaction χ2 value was 178 (115 degrees of freedom, P<.001). Our analysis also revealed significant issues with differential item functioning, and by investigating residual principal component loadings, the PedsQL 4.0 GCS total score was found to be multidimensional. CONCLUSIONS: The PedsQL 4.0 GCS records information clinically relevant to patients with DMD, but the total scale score may not be fit for purpose as a measure health-related quality of life in this disease population.

Psychometric properties testing of a Cantonese version of the Life-Space Assessment in people with stroke.

The Life-Space Assessment (LSA) advances measurements of mobility by determining the extent of the spatial area in which a person moves in real life. Yet there is no Cantonese version of the LSA. This study aimed to translate and culturally adapt the LSA into Cantonese (C-LSA) and examine its psychometric properties in people with stroke. Psychometric properties were examined in 112 people with stroke. The life-space of stroke survivors was compared with that of healthy older people with and without depressive symptoms. The content validity of the C-LSA was good. The Cronbach's α was 0.73. The test-retest reliability was 0.95. The standard error of measurement was 4.21 and the minimal detectable change was 11.66, without any ceiling or floor effects in the C-LSA composite score. The composite score correlated significantly with the Fugl-Meyer Assessment of lower extremities score (rs = 0.31), the Five Times Sit-To-Stand time (rs = - 0.43), and the Frenchay Activities Index score (rs = 0.48). People with stroke had significantly lower C-LSA composite scores than healthy older people. Depressive symptoms worsened the composite and assisted life-space scores only of people with stroke. The C-LSA is a reliable and valid tool for measuring life-space in stroke populations.

Psychometric evaluation of patient assessment of chronic illness care among Korean cancer survivors.

BACKGROUND: The Patient Assessment of Chronic Illness Care (PACIC) was developed in the United States to assess the implementation of the Chronic Care Model (CCM)-based intervention from the patient's perspective. Although the psychometric properties of the PACIC have been reported in other chronically ill patients, it has not been reported in cancer survivors. Our aim was to evaluate the acceptability, validity, and reliability of a Korean version of the PACIC among cancer survivors (K-PACIC-CS). METHODS: Among 204 cancer survivors at a university-based hospital in South Korea, we performed psychometric evaluation of the K-PACIC-CS according to acceptability (descriptive statistics, missing values, and floor and ceiling effects), validity (confirmative factor analysis [CFA] and convergent validity), and reliability (internal consistency, i.e., Cronbach's alpha). RESULTS: The item response was high (missing rate = 0.5%). The floor effect was 3.9%- 43.6% and the ceiling effect was 6.9%- 41.2%. The CFA revealed good indices of fit and confirmed the five structures predetermined in the original version of PACIC. The K-PACIC-CS scores had significant positive relationships with cancer survivors' self-efficacy and health-related quality of life. The total K-PACIC-CS showed excellent internal consistency (Cronbach's alpha = .94) and those of the subscales were acceptable (Cronbach's alpha = .76 -.86). CONCLUSIONS: This study suggests that the K-PACIC-CS is a valid and reliable instrument for measuring implementation of CCM-based chronic care from the survivor's perspective.

Assessment of the responsiveness of four scales in geriatric patients with chronic neck pain.

The purpose of this study was to evaluate the responsiveness of Copenhagen Neck Functional Disability Scale (CNFDS), Neck Disability Index (NDI), Neck Bournemouth Questionnaire (NBQ), Neck Pain and Disability Scale (NPDS) in geriatric patients with non-specific chronic neck pain. A total of 52 geriatric patients with non-specific chronic neck pain were included in the present study. All participants were included in a physical therapy and rehabilitation program for five sessions per week that lasted 3 weeks. All participants were evaluated before and after the treatment. Pain and disability were assessed with the Visual Analog Scale-pain (VAS-pain), VAS-disability, muscle spasm, CNFDS, NDI, NBQ, NPDS scales. Additionally, patient satisfaction scores were questioned both before and after the treatment. Following the 3-week physical therapy and rehabilitation program, significant improvements were detected in the VAS-pain, VAS-disability, muscle spasm, CNFDS, NDI, NBQ, and NPDS scores (p < 0.05). Responsiveness values were found to be as follows: CNFDS [effect size (ES) = 0.78; standardized response mean (SRM) = 0.90], NDI (ES = 0.66; SRM = 1.18), NBQ (ES = 0.82; SRM = 0.97) and NPDS (ES = 0.87; SRM = 0.98). Our study demonstrated that CNFDS, NDI, NBQ, and NPDS are responsive scales in determining treatment-related changes in geriatric patients with non-specific neck pain. These results also suggest that all of these four scales can be used in the assessment of treatment induced changes in geriatric patients with chronic neck pain.

Psychometric utility of the international HIV dementia scale and Montreal Cognitive Assessment in HIV-associated asymptomatic neurocognitive impairment.

There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive Assessment [MoCA] and the International HIV Dementia Scale [IHDS]) in their ability to identify asymptomatic HAND (i.e., asymptomatic neurocognitive impairment [ANI]). Participants included 74 Thai PLWH: 38 met Frascati criteria for ANI and 36 were cognitively normal (CN). Participants completed Thai language versions of the MoCA (MoCA-T) and IHDS, and a validated neurocognitive battery. We examined between-group differences for MoCA-T and IHDS total scores, and scale subcomponents. We also conducted receiver operating characteristic (ROC) analyses to determine the ability of the MoCA-T and IHDS to discriminate between CN and ANI groups, and compared their area under the curve (AUC) values. Results revealed lower MoCA-T total score, as well as the Visuospatial/Executive and Delayed Recall subtask scores, in the ANI relative to CN group. Groups did not differ on the IHDS. For ROC analyses, the MoCA-T, but not the IHDS, significantly differentiated the ANI from CN group, and there was a significant difference in AUC values between the MoCA-T (AUC = .71) and IHDS (AUC = .56). Sensitivity and specificity statistics were poor for both screening measures. These data indicate while the MoCA-T functions better than the IHDS in detecting Thai PLWH with ANI, the mildest form of HAND, neither cognitive screener, showed strong utility. Our findings reflect the limited efficacy of common screening measures in detecting subtler cognitive deficits among Thai PLWH, and highlight the need for better screening tools.

Use of Food to Cope With Culturally Relevant Stressful Life Events Is Associated With Body Mass Index in African American Women.

BACKGROUND: Although stress is an established contributor to obesity (in general population studies), mechanisms to explain this association in African American women that incorporate culturally relevant frameworks have received little attention. OBJECTIVE: To investigate how stress is associated with body mass index (BMI) in this population, we examined multivariate models of BMI predicted by race-related, gender-related, and generic stressful life events and by use of food to cope with stress. We hypothesized that the three types of stressful life events would be indirectly associated with BMI through using food to cope with stress. METHODS: Psychometrically robust measures were included in surveys administered to a socioeconomically diverse sample of 189 African American women aged 21-78 years. Hypotheses were tested using structural equation modeling. We examined race-related, gender-related, and generic stressful life events as latent constructs indicated by exposure to and appraisal of potential stressors predicting a mediator, using food to cope, which predicted BMI; this model also included direct paths from the three latent stressful life event constructs to BMI. RESULTS: Almost every participant reported using food in some way to cope with stress; 33% and 42% met established criteria for overweight and obesity, respectively. The race-related stressful life event construct was the only latent construct predicting using food to cope with stress, and using food to cope with stress predicted BMI. A significance test of indirect effects demonstrated that the race-related stressful life event construct was indirectly associated with BMI through the mediator, using food to cope. DISCUSSION: Culturally relevant stress exposures and stress-related eating are important areas of foci for tackling overweight, obesity, and related health inequities in African American women. Findings highlight the importance of developing more complex models to understand the stress-related factors that elevate risk for overweight and obesity in this population.

Maternal Experiences of Racial Discrimination, Child Indicators of Toxic Stress, and the Minding the Baby Early Home Visiting Intervention.

BACKGROUND: Racism is a significant source of toxic stress and a root cause of health inequities. Emerging evidence suggests that exposure to vicarious racism (i.e., racism experienced by a caregiver) is associated with poor child health and development, but associations with biological indicators of toxic stress have not been well studied. It is also unknown whether two-generation interventions, such as early home visiting programs, may help to mitigate the harmful effects of vicarious racism. OBJECTIVE: The purpose of this study was to examine associations between maternal experiences of racial discrimination and child indicators of toxic stress and to test whether relationships are moderated by prior participation in Minding the Baby (MTB), an attachment-based early home visiting intervention. METHODS: Ninety-seven maternal-child dyads (n = 43 intervention dyads, n = 54 control dyads) enrolled in the MTB Early School Age follow-up study. Mothers reported on racial discrimination using the Experiences of Discrimination Scale. Child indicators of toxic stress included salivary biomarkers of inflammation (e.g., C-reactive protein, panel of pro-inflammatory cytokines), body mass index, and maternally reported child behavioral problems. We used linear regression to examine associations between maternal experiences of racial discrimination and child indicators of toxic stress and included an interaction term between experiences of discrimination and MTB group assignment (intervention vs. control) to test moderating effects of the MTB intervention. RESULTS: Mothers identified as Black/African American (33%) and Hispanic/Latina (64%). In adjusted models, maternal experiences of racial discrimination were associated with elevated salivary interleukin-6 and tumor necrosis factor-α levels in children, but not child body mass index or behavior. Prior participation in the MTB intervention moderated the relationship between maternal experiences of discrimination and child interleukin-6 levels. DISCUSSION: Results of this study suggest that racism may contribute to the biological embedding of early adversity through influences on inflammation, but additional research with serum markers is needed to better understand this relationship. Improved understanding of the relationships among vicarious racism, protective factors, and childhood toxic stress is necessary to inform family and systemic-level intervention.

EQ-5D Brazilian population norms.

BACKGROUND: The EQ-5D-3L is a widely used generic health-related quality of life measure commonly applied to describe health outcomes and to measure disease burden. The aim of this study was to generate Brazilian population norms, stratified by age and gender, based on Brazilian preference weights for EQ-5D-3L. METHODS: A multicenter cross-sectional study was conducted in three Brazilian urban areas. The final sample consisted of 5774 respondents, aged from 18 to 64 years. Amongst other information, respondents were asked to self-report their health status using the EQ-5D-3L descriptive system and visual analog scale (EQ-VAS). Data on socio-demographic characteristics was obtained through specific questionnaires. The Brazilian TTO scoring algorithm was used to derive the utility values. Multivariate logistic regression models were fitted to analyze the influence of age, sex, education status and sample site on the presence of any problem for each dimension of EQ5D. RESULTS: Mean values were computed for both weighted index scores and self-rated health status (EQ-VAS), and stratified by gender and age groups. Health status declines with age, ranging between 0.87 for the youngest group 18-29 year-olds and 0.76 for 60-64-year-old. Men reported higher scores (0.85) than the woman (0.79). Lower education levels were associated with lower EQ-5D index score in most age groups. CONCLUSION: This study provides EQ-5D reference values for the Brazilian population. These values can be used by local decision-makers and researchers in economic evaluations and population health studies.

Mixed Methods Study of Nurse Assessment of Patient Preferences for Engagement During Hospitalization.

BACKGROUND: Global healthcare initiatives emphasize the importance of engaging patients in their healthcare to improve patients' experience and outcomes. Assessing patient preferences for engagement is critical, as there are many ways patients can engage in their care and preferences vary across individuals. OBJECTIVE: The primary purpose of this study was to evaluate the effect of implementation of the Patient Preferences for Engagement Tool 13-Item Short Form (PPET13) during hospitalization on patient and nurse experience of engagement. Readmissions and emergency department (ED) usage within 30 days postdischarge were also examined. METHODS: The mixed methods study was conducted within two medical units in the United States between December 2018 and May 2019. Preimplementation group patients completed a demographic survey and the Patient Experience of Engagement Survey (PEES) on discharge. Implementation group patients completed the PPET13 within 24 hours of admission with their nurse and the demographic survey and PEES on discharge. A focus group with nurses who implemented the PPET13 was conducted following the implementation period. Data analysis included confirmatory factor analysis, multiple and logistic regression, and qualitative content analysis. RESULTS: There was significant improvement in PEES scores during the implementation phase. The PEES score was a significant predictor of ED visits, but not 30-day readmissions. Nurses were not always certain how to best integrate patient preferences for engagement into their care delivery and suggested integrating the PPET13 into the electronic health record to assist with streamlining the assessment and communicating preferences across the care team. DISCUSSION: Assessing patients' preferences for engagement using the PPET13 was associated with an improved experience of engagement, which was found to mediate the relationship between utilization of PPET13 and ED usage within 30 days postdischarge. Use of a patient engagement preference tool, such as the PPET13, can help inform the delivery of individualized engagement strategies to improve patient and family engagement and outcomes; however, nurses need formalized education on how to tailor their care to meet the individual engagement preferences of their patients.

Assessment of the severity of infant crying and its impact on parents: Development and validation of the ColiQ Questionnaire in France.

OBJECTIVES: The purpose of this study was to develop and validate a questionnaire that comprehensively assesses symptoms and severity of crying, symptoms suggesting infant functional gastrointestinal discomfort, and its impact on parents' quality of life: the Infant Colic Questionnaire (ColiQ©). For the first time, parents had access to a web application to follow their infants' evolving symptoms with a daily questionnaire. METHODS: The ColiQ was developed with a board of clinical experts (physicians and psychologists) based on extensive parent input. A longitudinal, observational study was conducted in France for 3 months. ColiQ assessments were collected online at six different time points. Psychometric testing demonstrated that ColiQ has acceptable psychometric properties (reliability, internal consistency, construct validity, and responsiveness). RESULTS: The ColiQ is a 16-question instrument developed in French including ten questions describing symptoms (Infant score) and six questions describing impacts (Parent score). The ColiQ demonstrated good test-retest reliability (ICC >0.70), internal consistency for both the Symptom and Impact subscale scores (Cronbach's α >0.70), and construct validity. Responsiveness was good; the ColiQ was able to detect significant improvement in the target population as early as 1 month (p<0.05). The global ColiQ score discriminated between severity levels (mild, medium, severe). CONCLUSIONS: The ColiQ was developed with input from parents and healthcare professionals and has shown validity, reliably, and responsiveness to change. Parents can use the web application to follow how their infants' symptoms evolve. The ColiQ can help parents quantify and verbalize their concerns during consultations, and provides an opportunity to facilitate conversations between the physician and parents.

Translation and validation of the Japanese version of the measure of moral distress for healthcare professionals.

OBJECTIVES: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). METHODS: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was conducted. RESULTS: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0-432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach's alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055-0.067]) and reliability (0.91 [95%CI, 0.89-0.92]) of the instrument. CONCLUSIONS: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.

Determinants of worry using the SARS-CoV-19 worry (CoV-Wo) scale among United States residents.

We sought to develop a brief Severe Acute Respiratory Syndrome Coronavirus 2-related worry (CoV-Wo) scale to understand COVID-19-related worry among adults in the United States. We also aimed to model key determinants of worry in the early stage of the COVID-19 pandemic in the United States. A total of 806 participants completed an online survey in late March 2020. Exploratory and confirmatory factor analyses assessed scale structure. Factor analysis stratified by depression was used to assess measurement invariance. Linear regression models examined COVID-19-related worry determinants. The CoV-Wo scale exhibited good reliability (α = 0.80) and a two-factor structure: health (α = 0.83) and resources (α = 0.71). The full scale and both subscales were higher among participants who stopped working due to COVID-19 and those with depression. Perception of quality medical care if infected with COVID-19 was associated with reduced worry. The CoV-Wo scale is a low burden assessment of COVID-19-related worry, that captures common worries in domains affected by COVID-19 and can be used to develop psychosocial resources.

Catering to the patient - development, validation and psychometric properties of an innovative assessment instrument.

Introduction: It has been shown that communication skills acquired during undergraduate medical education are of great importance. Hence, many countries require teaching communication as part of their medical curricula. To assess students' learning progress, "Catering to the Patient", as an aspect of showing empathy, should be evaluated. Since there was no description of a validated instrument fitting for this purpose, one had to be developed. To describe its process of development and its psychometric properties were the aims of this study. Methods: Based on the Calgary-Cambridge Observation Guide (CCOG), items describing catering to the patient were selected and modified. Cognitive pretest interviews were conducted to check understandability. Therefore, 7 raters assessed 1 video each (R=7, V=1). In a following pilot study (R=3, V=10) first psychometric properties were evaluated and necessary corrections in the preliminary evaluation form were carried out before the final evaluation form was used to assess students' ability to cater to the patient and psychometric properties were described in detail (R=2, V=35). Results: The final assessment instrument, "catering to the patient - Marburg evaluation form", contains 11 checklist items and two global ratings (items 12 and 13). In the final evaluation the inter-rater reliability (IRR) ranged from 0 to 0.562, the median was r=0.305. Concerning item 13 (a global rating), 88.6% of the videos were scored with the maximum difference of one point. The internal consistency was very high (Cronbach's α: α=0.937 and α=0.962), and the correlation between the checklist items and the global rating was high (Pearson's r: r=0.856 and r=0.898). Discussion: The assessment instrument "catering to the patient" is suitable for giving feedback and for using it in formative examinations. Its use for summative examinations can be considered. Further examinations should evaluate if a three-point Likert scale could reach higher values and if item 13 can be used as a stand-alone item.

MOVEMENT ASSESSMENT BATTERY FOR CHILDREN-SECOND EDITION: THEORETICAL ADEQUACY OF A MOTOR ASSESSMENT INSTRUMENT.

OBJECTIVE: To investigate the adequacy of the theoretical model of the Movement Assessment Battery for Children-Second Edition (MABC-2) instrument. METHODS: 582 children, of both sexes, aged between 3 and 5 years and residents in the city of Maringá (state of Paraná, Southern Brazil) participated in the study. Data were collected from May/2014 to June/2015 and analyzed using descriptive and inferential statistics. RESULTS: The evidence obtained from exploratory factor analysis indicated the presence of two factors, which was the option that best fitted the explanatory model. Hence, it was necessary to regroup the motor tasks of the dimensions "Aiming & catching" and "Balance" into only one dimension. It is noteworthy that the "Bicycle trail" motor task did not fit the model, as it presented a low and negative factor load in the analyzed dimensions. In the confirmatory factor analysis, adequate adjustment indices were observed for the tested model, which confirmed the non-classification of the "Bicycle trail" motor task in the original dimension. CONCLUSIONS: After removing the "Bicycle trail" motor task, the adjusted two-factor model seems to be the most appropriate to assess the motor performance of children participating in the study.

Theoretical conceptualisations of problematic exercise in psychometric assessment instruments: A systematic review.

BACKGROUND AND AIMS: The aim of the present systematic review was to identify psychometric tools developed to assess problematic exercise in order to identify and compare their theoretical conceptualisations on which they are based. METHODS: A systematic literature search was conducted in the electronic databases Web of Science, Scielo, PsychINFO, PsycTEST and SCOPUS from their inception to January 2020. RESULTS: Seventeen assessment instruments met the eligibility criteria to be included in the present review. The instruments were classified according to their conceptualisation into five groups: (i) problematic exercise as an end of an exercise continuum, (ii) problematic exercise as a means of regulating body size and weight, (iii) problematic exercise as dependence, (iv) problematic exercise as a behavioural addiction and (v) no clear conceptualisation. DISCUSSION: The results suggest that the conceptualisations of the assessment instruments have resulted in a strong dichotomy in relation to the primary or secondary character of the problematic exercise that might be limiting the capacity of the instruments to adequately capture the multidimensionality of this construct. CONCLUSIONS: Given the interest in understanding the complexity surrounding the problematic exercise, future research should develop more comprehensive definitions of this construct. This would allow a greater conceptual consensus to be reached that would allow progress to be made in the study of the problematic exercise.