Psychometric validation of the modified Naranjo algorithm used in homeopathy for chronic cases.

OBJECTIVES: The modified Naranjo algorithm assesses the physician assigned cause-effect relationship for homeopathic medicines. It is being adopted in homeopathy researches, but not yet validated systematically. We intended to validate the modified Naranjo algorithm by examining its psychometric properties. METHODS: An online survey sought agreement of 25 experts on the 10 items of the tool on 5-point agreement scale. Next, 285 responses from collected prospectively from chronic cases enrolled under the clinical verification program of the council in 2018 were subjected to testing of construct validity using exploratory principal component analysis (PCA). Confirmatory factor analysis (CFA; n=150) was performed to verify the goodness-of-fit of the model. Reliability was tested using internal consistency, test-retest reliability, and inter-rater reliability by kappa statistics. RESULTS: Experts' responses mean values were 4 or higher (i.e. responses were relevant) and standard deviations were less than 1 (i.e. less heterogeneous). In PCA using varimax, all the items loaded above the pre-specified value of 0.4 and identified 4 components explaining 64.1% of variation. The goodness-of -fit of the 4-component CFA model was acceptable (chi-square 89.253, p<0.001). Internal consistency (Cronbach's alpha 0.7) was borderline; test-retest reliability was acceptable. Kappa statistics was moderate to fair, but poor for few of the items. CONCLUSIONS: Statistical evaluations indicate that the modified Naranjo algorithm is useful, but needs improvement.

Measurement invariance of the moral vitalism scale across 28 cultural groups.

Moral vitalism refers to a tendency to view good and evil as actual forces that can influence people and events. The Moral Vitalism Scale had been designed to assess moral vitalism in a brief survey form. Previous studies established the reliability and validity of the scale in US-American and Australian samples. In this study, the cross-cultural comparability of the scale was tested across 28 different cultural groups worldwide through measurement invariance tests. A series of exact invariance tests marginally supported partial metric invariance, however, an approximate invariance approach provided evidence of partial scalar invariance for a 5-item measure. The established level of measurement invariance allows for comparisons of latent means across cultures. We conclude that the brief measure of moral vitalism is invariant across 28 cultures and can be used to estimate levels of moral vitalism with the same precision across very different cultural settings.

Quality of life in opium-addicted patients with coronary artery disease as measured with WHOQOL-BREF.

OBJECTIVE: Several factors can influence the quality of life in patients with coronary artery disease (CAD). The goal of this research was to measure quality of life in opium-addicted patients with CAD in order to assess the effect of CAD risk factors on their quality of life. METHOD: The WHOQOL-BREF questionnaire was completed through interviews with 275 patients who underwent isolated coronary artery bypass surgery in Tehran Heart Centre between May and September 2006. RESULTS: No significant differences were found in the mean scores of the four domains of quality of life between the addicted and non-addicted patients. Furthermore, the evaluation of QOL in the groups with CAD risk factors showed that the mean QOL domains were statistically similar between opium addicted and non-opium addicted patients. In the addicted group, men had a higher psychological health score than women. A previous history of myocardial infarction reduced the psychological score in this group. Also, in the addicted patients with a history of diabetes mellitus, social functioning was better than that of the non-diabetics. CONCLUSIONS: The different domains of quality of life in our opium-addicted and non-addicted patients with CAD were similar; and among all the major risk factors for coronary artery disease, only female gender and a previous history of myocardial infarction could influence quality of life in the opium-addicted patients.

Internalized stigma and its correlates among treatment seeking opium users in India: A cross-sectional observational study.

Opium has been used in India since ancient times for social, recreational, religious and medicinal purposes. Opium users seem to constitute a distinct sub-population among opioid users, who have minimal complications, better functioning and socio-cultural acceptance. Prominent levels of stigma have been reported against people who use opioid drugs, but the same cannot be extrapolated to opium users. There is a vast number of opium users in India, and it is prudent to understand the stigma faced by them to better address their problems. Hence, in the current study we aimed to assess the internalized stigma and its correlates among opium users who seek treatment at a tertiary care drug treatment centre in North India. 117 adult male participants having opioid dependence (opium being the most common opioid in last 3 months) were assessed using Internalized Stigma of Mental Illness (ISMI) scale - Hindi version. The stigma scores were in the mild to moderate range, which was less than that found in previous studies among heroin and alcohol users in similar setting. Moreover, higher stigma scores were associated with lower educational status and higher proportions of income spent on substances. This is the first study to document stigma among opium users. Further research needs to be conducted to understand the determinants of stigma in this population.

Do existing psychologic scales measure the nonspecific benefit associated with CAM treatment?

OBJECTIVE: To determine whether existing psychologic well-being scales are sensitive to change after complementary and alternative medicine (CAM) treatment, and whether changes in those scales of well-being correlate with symptom change. This may limit the need for the development of new CAM-specific outcomes. DESIGN: A study investigating change on several outcome measures over a 4-month period during CAM treatment. Patients attending the Centre for Complementary and Integrated Medicine (CCIM, Southampton, UK) for their first appointment were recruited and completed their baseline forms (T1) at the first consultation. Three (3) further sets of questionnaires (T2, T3 and T4) were mailed to them with a stamped addressed envelope at monthly intervals and were returned to CCIM. PATIENTS AND LOCATIONS: People visiting the CCIM were treated by 1 of 3 practitioners with an individualized combination of homeopathy, dietary advice, and nutritional supplements for treatment of their chronic benign illness. OUTCOME: The previously validated outcome measures were as follows: (1) symptoms (Measure Yourself Medical Outcome Profile: MYMOP); (2) mood (Positive and Negative Affect Scale; PANAS); and (3) Brief Assessment of Sense of Coherence (BASOC). RESULTS: Forty-five (45) patients were recruited and 40 completed the study; MYMOP (p=0.001), PANAS negative (p=0.025), and BASOC (p=0.019) all showed similar patterns of significant improvement over time; PANAS positive showed a nonsignificant trend for improvement (p=0.074). Change on one scale was correlated with change on other scales. CONCLUSIONS: Existing psychology scales of well-being are sensitive to change after CAM treatment and consistent with symptom improvement. Existing measures of positive affect provide an alternative to the negative, symptom-driven approach of conventional medicine.

O inventário de envolvimento paterno revisado: inclusão de pais com filhos pré-escolares / The inventory of father involvement revised: inclusion of fathers with preschool children / El inventario de envolvimiento paterno revisado: inclusión de padres de preescolares

Apesar da importância do envolvimento paterno, sua avaliação persiste desafiadora. No Brasil, o Inventário de Envolvimento Paterno (IFI-BR) vem se mostrando adequado para uso com pais de crianças de 5 a 10 anos. Entretanto, do ponto de vista do desenvolvimento infantil e de intervenções preventivas, seria importante avaliar o envolvimento paterno quando as crianças são mais novas. Assim, este trabalho teve como objetivos: identificar limitações do IFI-BR, quando usado com pais de crianças entre 2 e 10 anos, e avaliar itens para o IFI-BR-revisado. No Estudo 1, 434 pais com filhos no Ensino Infantil ou Fundamental 1 responderam a um questionário sociodemográfico e ao IFI-BR. Com base em análises de dados omissos, estrutura interna e precisão, modificações foram sugeridas, visando à manutenção da estrutura interna original do instrumento. No Estudo 2, 572 pais com filhos na mesma faixa etária responderam a um questionário sociodemográfico e à versão modificada do IFI-BR. Foram comparadas as frequências de dados omissos e estimativas de precisão para os itens originais e modificados, selecionando aqueles que melhor representavam essa amostra de pais para compor a versão revisada do IFI-BR. Esses resultados indicaram evidências adequadas de validade, com base no conteúdo da versão revisada do IFI-BR, quando utilizada para avaliar a qualidade do envolvimento paterno de pais brasileiros com filhos do Ensino Infantil ao Fundamental 1. Após verificadas evidências de validade adicionais, essa versão revisada do IFI-BR poderá ser utilizada, por exemplo, em estudos longitudinais e na avaliação de intervenções precoces com pais.(AU)

Despite the importance assigned to father involvement, evaluating this construct remains a challenge. In Brazil, the Inventário de Envolvimento Paterno (IFI-BR) has showed satisfactory evidence of validity for fathers of children between 5 and 10 years old. From the perspective of child development and preventive interventions, however, evaluating father involvement with younger children is essential. Hence, this study sought to: identify limitations of the IFI-BR for fathers of children between 2 and 10 years old, and evaluate items for a revised IFI-BR. In Study 1, 434 fathers of children in early childhood and primary school settings answered a sociodemographic questionnaire and the IFI-BR. Based on analyses of missing data, internal structure, and reliability, modifications were suggested to maintain the original internal structure. In Study 2, 572 fathers of children in the same age range answered a sociodemographic questionnaire and the modified IFI-BR. After comparison between values for missing data and reliability of the original and modified items, the items that best represented the broader sample of fathers were selected to compose the revised IFI-BR. Results indicated adequate evidence of content validity for the revised IFI-BR when used to assess the involvement of Brazilian fathers with children in early childhood education and primary school settings. After additional evidence has been verified, this revised IFI-BR can be used, for example, in longitudinal studies and to evaluate early interventions with fathers.(AU)

La participación paterna es importante, pero su evaluación sigue siendo desafiadora. En Brasil, el Inventário de Envolvimento Paterno (IFI-BR) demuestra ser adecuado para aplicar a padres de niños de 5 a 10 años de edad. No obstante, desde la perspectiva del desarrollo infantil y de las intervenciones preventivas, sería importante evaluar la participación de los padres de niños más jóvenes. Este estudio tuvo como objetivos: identificar limitaciones del IFI-BR cuando se aplica a padres de niños entre los 2 y 10 años y evaluar ítems para el IFI-BR-revisado. En Estudio 1, 434 padres con hijos en el jardín de infantes o escuela primaria respondieron un cuestionario sociodemográfico y el IFI-BR. Con base en el análisis de datos faltantes, estructura interna y exactitud, se sugirieron modificaciones para mantener la estructura interna original del instrumento. En Estudio 2, 572 padres respondieron un cuestionario sociodemográfico y la versión modificada del IFI-BR. Se compararon las frecuencias de datos faltantes y estimaciones de exactitud para los ítems originales y modificados, seleccionando aquellos que representaban mejor a esta muestra de padres para la versión revisada del IFI-BR. Estos resultados indicaron evidencia adecuada de validez, basada en el contenido de la versión revisada del IFI-BR, cuando se utilizó para evaluar la calidad de la participación de padres brasileños con niños en el jardín de infantes y en la escuela primaria. Después de verificada la evidencia adicional de validez, la versión revisada del IFI-BR se puede utilizar, por ejemplo, en estudios longitudinales y en la evaluación de intervenciones precoz con los padres.(AU)

Outcome related to impact on daily living: preliminary validation of the ORIDL instrument.

BACKGROUND: The challenge of finding practical, patient-rated outcome measures is a key issue in the evaluation of health care systems and interventions. The ORIDL (Outcome in Relation to Impact on Daily Living) instrument (formerly referred to as the Glasgow Homoeopathic Hospital Outcomes Scale or GHHOS) has been developed to measure patient's views of the outcome of their care by asking about change, and relating this to impact on daily life. The aim of the present paper is to describe the background and potential uses of the ORIDL, and to report on its preliminary validation in a series of three studies in secondary and primary care. METHODS: In the first study, 105 patients attending the Glasgow Homoeopathic Hospital (GHH) were followed-up at 12 months and changes in health status were measured by the EuroQol (EQOL) and the ORIDL. In the second study, 187 new patients at the GHH were followed-up at 3, 12, and 33 months, using the ORIDL, the Short Form 12 (SF-12), and the Measure Yourself Medical Outcome Profile (MYMOP). In study three, 323 patients in primary care were followed for 1 month post-consultation using the ORIDL and MYMOP. In all 3 studies the Patient Enablement Instrument (PEI) was also used as an outcome measure. RESULTS: Study 1 showed substantial improvements in main complaint and well-being over 12 months using the ORIDL, with two-thirds of patients reporting improvements in daily living. These improvements were not significantly correlated with changes in serial measures of the EQOL between baseline and 12 months, but were correlated with the EQOL transitions measure. Study 2 showed step-wise improvements in ORIDL scores between 3 and 33 months, which were only weakly associated with similar changes in SF-12 scores. However, MYMOP change scores correlated well with ORIDL scores at all time points. Study 3 showed similar high correlations between ORIDL scores and MYMOP scores. In all 3 studies, ORIDL scores were also significantly correlated with PEI-outcome scores. CONCLUSION: There is significant agreement between patient outcomes assessed by the ORIDL and the EQOL transition scale, the MYMOP, and the PEI-outcome instrument, suggesting that the ORIDL may be a valid and sensitive tool for measuring change in relation to impact on life.

Quality of life, social desirability and their relationship in opium addicted persons in southeast of Iran.

BACKGROUND & AIM: Addiction leads to many problems which may adversely affect addicted people, their families and impose health care agencies with many challenges. This study aimed to examined quality of life (QoL), social desirability and their relationship among opium addicted persons in southeast of Iran. MATERIAL & METHODS: In a cross-sectional study conducted from September 2012 to January 2013, 123 addicted people were studied. Date collection tools were; checklist of demographic data, Iranian version of the 36-item short form QoL (SF-36) and Marlowe-Crowne Social Desirability Scale (MC-SDS). RESULTS: While mean score of QoL was 60.4±29.5, mean score of social desirability were 14.2±3.7. Low, moderate and high levels of social desirability were observed in 4.9%, 90.2% and 4.9% of participants, respectively. Pearson's correlation were not significant between mean score of social desirability and mean score of QoL (p=0.969, r=0.004). CONCLUSION: Addicted participants of present study showed a moderate level of QoL and social desirability, without any significant relationship between QoL and social desirability. Further research is suggested in addicts with social and cultural differences.

Impact of complementary and alternative medicine on the quality of life in inflammatory bowel disease: results from a French national survey.

BACKGROUND: Complementary and alternative medicines (CAM) are widely used by patients with inflammatory bowel disease (IBD). Few data have been published on the impact of CAM on the quality of life (QOL). AIMS: The aim of the study was to describe CAM use in French patients with IBD, identify characteristics associated with CAM use, and assess the impact of CAM on the QOL. METHODS: We conducted an internet survey on CAM through the French IBD patient's association website. Patients had to answer a questionnaire (LimeSurvey application) about sociodemography, IBD treatment, CAM type, socioeconomic data, and QOL using the Short IBD Questionnaire (SIBDQ). Patients noted the impact of CAM on their symptoms and on their QOL on a scale of 0-100. CAM users and nonusers were compared by univariate and multivariate analyses. RESULTS: A total of 936 IBD patients responded and 767 (82.4%) filled up the whole questionnaire: 503 reported CAM use and 172 had never used. The types of CAM reported were diet-based (30.7%), body-based (25.1%), homeopathic or traditional medicine (19.6%), naturopathy (15.2%), and mind-body medicine (9.1%). The gastroenterologist was aware of CAM use in only 46% of patients. CAM users were more likely to have ulcerative colitis [odds ratio (OR)=1.78, P=0.018], clinical remission (OR=1.42, P=0.06), high level of education (OR=1.51, P=0.02), poor observance (OR=1.81, P=0.017), or to have terminated conventional treatment (OR=2.03, P=0.003). CAM users tend to have higher rates of SIBDQ scores, greater than 50 (OR=1.57, P=0.06). Improvement in symptoms and QOL was reported with all CAM types except mind medicine. CONCLUSION: CAM use is widespread among IBD patients. CAM users report improvement in symptoms and QOL, but they tend to stop their conventional treatment. Better information about CAM might improve adherence to conventional treatment.

Patient activation measures in a government homeopathic hospital in India.

The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.

[The psychological characteristics of patients with drug addictions]. / Psikhologicheskie osobennosti bol'nykh narkomaniiami.

The paper presents results of the examination of 70 patients with different forms of drug addiction (opium, heroin, pervitin addictions, including patients with polynarcomania). Psychologic tests were used to evaluate personal traits of the patients (MMPI variation), peculiarities of the emotional sphere (test of Lusher) and the intellectual level (Progressive Matrices of Raven). It was revealed that chronic drug dependence resulted in considerable disorders of personality--psychopathization and schizoidization. Intellectual abilities of the patients were on the low normal level.

Neonatal abstinence syndrome: assessment and management.

A scoring system for the neonatal abstinence syndrome has been devised and implemented as both a clinical and investigative tool. The score monitors the passively addicted infant in a more comprehensive and objective fashion, and facilitates a more precise evaluation of the clinical status of the infant undergoing withdrawal. In addition, the scoring system has been applied in research designed to test the comparative usefulness of various pharmacologic agents currently recommended for the neonatal abstinence syndrome, and has been found useful in following the progression and diminution of withdrawal symptomatology before, during, and after therapy. Furthermore, the scoring system provides a basis ofr developing uniform criteria for the assessment and treatment of the neonate born to the addicted mother.

Deserción de pacientes de psicoterapia: exploración de factores pronósticos en base a la evaluación psicométrica de ingreso / Patient drop out from psychotherapy: exploration of prognostic factors based on psychometric assessment at admission

Este trabajo forma parte del proyecto de investigación que la Unidad de Psicoterapia Breve ha desarrollado en el Instituto Psiquiátrico Dr. J. Horwitz B. acerca del impacto que tiene la utilización de manuales en el entrenamiento de terapeutas noveles y su efecto en los resultados terapéuticos. De 27 pacientes que se sometieron a la evaluación inicial, sólo 9 terminaron sus psicoterapias. Aquí se pretende describir y sistematizar las variables del paciente que pueden estar asociadas a la deserción del tratamiento. Se utilizaron para medir estas variables los instrumentos de K. Howard y D. Orlinsky, las escalas de depresividad de Beck y sintomatológica de Goldberg, que se aplicaron en 27 pacientes. Los resultados obtenidos en este estudio muestran que los pacientes que abandonan el tratamiento presentan mayor cantidad de consultas y tratamientos previos, más sintomatología depresiva, obsesiva y angustiosa y un nivel de funcionamiento global más deficitario que los pacientes que terminaron su tratamiento. Se discute el aporte de estos resultados a la comprensión de las causas que determinan la deserción de pacientes en los servicios públicos de salud mental