Expressed emotion measure adaptation into a foreign language.

Expressed emotion (EE) measures have been created in English; adaptation into a foreign language is difficult. The aim of this study was to adapt the five minutes speech sample (FMSS), with a designed procedure ensuring optimum quality of the adaptation, and thus better trans-cultural validity. A strategy for improving inter-rater agreement comprised three phases: (1) phase of initial ratings (70 French samples), (2) experimental phase in two steps: ratings of 40 other samples in French, followed by analysis of differences between the French-language ratings and English-language ratings and (3) final rating phase of the initial 70 samples. For each phase, the κ coefficients measuring inter-rater agreement were calculated and compared using a bootstrap procedure. The improvements between these scorings were significant at p < 0.05 (phase 2 initial versus phase 2 final and phases 1 versus 3). The French inter-rater agreement significantly improved after this procedure.

Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis.

OBJECTIVE: To assess the impact of digital ulcers (DUs) on disability and health-related quality of life (HRQoL) in systemic sclerosis (SSc). METHODS: Two hundred and thirteen patients with SSc were evaluated at four annual meetings of a patient society between 2004 and 2007 (n = 177) or during hospital stay (n = 36). HRQoL was assessed by the SF-36, global disability by the health assessment questionnaire (HAQ), hand disability by the Cochin Hand Function Scale (CHFS) and global hand and wrist mobility by the Kapandji index. RESULTS: Sixty-seven patients (31.4%) had at least one DU at the time of evaluation. Patients with DUs showed significantly more pitting scars (p<0.001) and calcinosis (p<0.0001) than others. Patients with DU had significantly greater HAQ (mean (SD) 1.218 (0.723) vs 0.930 (0.717), p = 0.008), CHFS (mean (SD) 27.38 (20.68) vs 16.73 (18.19), p<0.0001) and aesthetic prejudice (mean (SD) 6.1 (2.2) vs 3.9 (2.5), p<0.0001) scores than others. Hand and wrist mobility were significantly diminished in patients with DU (mean (SD) Kapandji score 75.3 (22.8) vs 81.7 (19.2), p<0.0001). The presence of a DU did not significantly alter the physical component but influenced the mental component (mean (SD) 43.38 (12.53) vs 39.58 (9.54), p = 0.026) of the SF36. CONCLUSION: Patients with SSc with DUs have reduced wrist and hand mobility, increased global and hand disabilities and decreased mental component of HRQoL.

[Construct validation study of the Relationship Scales Questionnaire (RSQ) on an adult sample]. / La version française du Relationship Scales Questionnaire de Bartholomew (RSQ, Questionnaire des échelles de relation): étude de validation du construit.

INTRODUCTION: The authors present the construct validity of the French version of the Relationship Scales Questionnaire (RSQ) designed by Griffin and Bartholomew (1994), which is the most widely-used self-report concerning adult attachment. OBJECTIVES: To improve knowledge on the psychometric properties of the RSQ by studying the construct validity on a sample of adults. METHOD: Subjects were recruited in a primary social care setting in Paris, France, and asked to fill in the RSQ twice: the first time just before meeting the social worker in charge, the second time, at home, with a prestamped form, two days later. A questionnaire on sociodemographic and economic variables was also filled in during the first time. Statistical analyses were conducted using Exploratory Factor Analysis with orthogonal rotation. The reliability was studied using Cronbach's coefficient for each new scale from the factor analysis. The test-retest reliability was studied for the prototypic scales and for the scales from the factor analysis, using the intra-class correlation method. RESULTS: One hundred and twenty-six subjects were recruited and completed the two forms (mean interval: 2.16 days). The factor analysis gives a three-factor structure explaining 48% of the total variance. The three factors were: factor 1 "Avoidance" with seven items explaining 21% of the total variance; factor 2 "Anxiety in the relationships" (five items) explaining 14% of total variance and factor 3 "Security" (five items) explaining 11% of the total variance. Cronbach's coefficient was low for the prototypical scales (0.41 for "secure", 0.54 for "fearful", 0.22 for "preoccupied", and moderate for "dismissive" (0.64). It was moderate for the scales designed from the factor analysis (0.66 for F1, 0.69 for F2 and 0 .60 for F3). The Intraclass Coefficients (ICC) were modest for the four prototypical scales (ICC<0.70) and were good for the scales designed from the factor analysis (F1: ICC=0.80; F2: ICC=0.85 and F3: ICC=0.78). DISCUSSION: The construct validity studied on an adult sample confirms the good psychometric properties of the RSQ considering the factor analysis, the test-retest short time reliability and the internal consistency. The factor analysis with three factors provides a different structure of classical descriptions with only two factors, but confirms the most recent results on Attachment Self-Reports that find a factor concerning security and two factors concerning management of insecurity (avoidance and anxiety in relationships). To be confirmed, the results require further research (confirmatory factor analysis, larger sample, other type of population).

The Bermond-Vorst Alexithymia Questionnaire cutoff scores: a study in eating-disordered and control subjects.

BACKGROUND: The evaluation of alexithymic deficits has become increasingly desirable in health and psychopathology research. The purpose of this study was to calculate alexithymia cutoff scores for a recently developed self-report alexithymia questionnaire: the Bermond-Vorst Alexithymia Questionnaire Form B (BVAQ-B). SAMPLING: Three hundred subjects (47 eating-disordered patients and 253 healthy individuals) completed the BVAQ-B and the 20-item Toronto Alexithymia Scale (TAS-20). METHODS: The TAS-20 was used as a gold standard for this research, with its previously established cutoff scores serving as diagnostic criteria for determining the presence or absence of alexithymia. The BVAQ-B cutoff score selection was based on the examination of psychometric data (i.e., the sensitivity and specificity of the BVAQ-B scores and receiver operating characteristic curve analyses) and of clinical data (i.e., BVAQ-B mean score of the control subjects, who were mostly nonalexithymic, and BVAQ-B mean score of a group of patients with eating disorders, the majority of whom were alexithymic). RESULTS: This research found that the most appropriate BVAQ-B cutoff scores for determining the absence and presence of alexithymia were 43 and 53, respectively. CONCLUSION: In light of these findings, we believe that the BVAQ-B may also lend itself to a categorical evaluation of alexithymia, with these cutoff scores determining its absence or presence.

Development and validation of a scale for mouth handicap in systemic sclerosis: the Mouth Handicap in Systemic Sclerosis scale.

OBJECTIVE: To develop and assess the reliability and construct validity of a scale assessing disability involving the mouth in systemic sclerosis (SSc). METHODS: We generated a 34-item provisional scale from mailed responses of patients (n = 74), expert consensus (n = 10) and literature analysis. A total of 71 other SSc patients were recruited. The test-retest reliability was assessed using the intraclass coefficient correlation and divergent validity using the Spearman correlation coefficient. Factor analysis followed by varimax rotation was performed to assess the factorial structure of the scale. RESULTS: The item reduction process retained 12 items with 5 levels of answers (total score range 0-48). The mean total score of the scale was 20.3 (SD 9.7). The test-retest reliability was 0.96. Divergent validity was confirmed for global disability (Health Assessment Questionnaire (HAQ), r = 0.33), hand function (Cochin Hand Function Scale, r = 0.37), inter-incisor distance (r = -0.34), handicap (McMaster-Toronto Arthritis questionnaire (MACTAR), r = 0.24), depression (Hospital Anxiety and Depression (HAD); HADd, r = 0.26) and anxiety (HADa, r = 0.17). Factor analysis extracted 3 factors with eigenvalues of 4.26, 1.76 and 1.47, explaining 63% of the variance. These 3 factors could be clinically characterised. The first factor (5 items) represents handicap induced by the reduction in mouth opening, the second (5 items) handicap induced by sicca syndrome and the third (2 items) aesthetic concerns. CONCLUSION: We propose a new scale, the Mouth Handicap in Systemic Sclerosis (MHISS) scale, which has excellent reliability and good construct validity, and assesses specifically disability involving the mouth in patients with SSc.

A double-blind sham controlled study of right prefrontal repetitive transcranial magnetic stimulation (rTMS): therapeutic and cognitive effect in medication free unipolar depression during 4 weeks.

BACKGROUND: Transcranial magnetic stimulation (TMS) has become a therapeutic tool in psychiatric diseases. METHODOLOGY: The objective was to evaluate the efficacy of TMS in unipolar depression: the percentage of responders (>50% HDRS reduction) and remission (HDRS score < or =8, after four weeks of active TMS treatment in depressed patients free of any antidepressive agent versus placebo-TMS. RESULTS: 27 patients were randomized in two groups: rTMS (N=11) versus sham TMS (N=16). Statistical differences were detected between sham and TMS treated groups on remission (0/16 versus 4/11 p=0.032, 1/16 versus 6/11 0.028 and 1/16 versus 7/11 p=0.011 at day 14, day 21 and day 28, respectively) and on response (2/16 versus 5/11 at day 14 (NS), 2/16 versus 7/11 p=0.0115 at day 21 and 1/16 versus 7/11 (p=0.025) day 28, respectively, using the exact Fisher test). Significant differences were observed between day 1 versus day 8 (p<0.01), day 15, day 21 and day 28 (p<0.001) in TMS group and only versus day 21 (p<0.01) and day 28 (p<0.05) for the sham group. ANOVA comparison between TMS and sham groups was significant at day 14 and day 28 (p<0.05). LIMITATIONS: The few number of patients. CONCLUSION: Our study has shown an efficacy of right rTMS in free medication unipolar depression over a month. Nevertheless, number of patients included is limited and multicentric studies will be necessary to specify the antidepressive action of TMS.

Psychometric properties of the bath ankylosing spondylitis disease activity index (BASDAI): comparison of the different versions available in English.

OBJECTIVE: International ASAS consensus statement proposed the use of the BASDAI to evaluate active disease in ankylosing spondylitis patients before the use of anti-TNF agents. To analyze the psychometric properties of the different versions of the BASDAI. METHODS: All versions available in English were analyzed according to the methods developed by the American Psychological Association. Except for the initial version, the procedure of translation was accepted if a translation followed by a back translation was carried out. The psychometric properties analyzed were: face validity, content validity, construct validity (factorial analysis, convergent and divergent validity), reliability (test retest, Cronbach's coefficient alpha), and responsiveness. RESULTS: Except for the German version which was not available in English, the following versions were analyzed: English (En), French (Fr), Swedish (Sw), Spanish (Sp), and Turkish (Tu). The procedure translation was correct in all the versions without taking into account the initial En version. Face validity was validated in all versions. No version initially defined the dimensions for the content validity. Construct validity was partially studied and validated in En, Fr and Sp. Reliability was validated in En, Fr, Tu, and partially in other versions. In all versions, except for the Fr, responsiveness was demonstrated. CONCLUSION: The English version of the BASDAI is the most validated tool. Some efforts had to be made to continue the validation procedure of all versions of the BASDAI. This is an important step for further international comparison.

[A motor function measurement scale for neuromuscular diseases - description and validation study]. / La mesure de fonction motrice, outil d'évaluation clinique des maladies neuromusculaires. Etude de validation.

A new scale for motor function measurement has been developed for neuromuscular diseases. After the study of a preliminary and a first version, the validation study included 303 patients, aged 6 to 62 years. Seventy-two patients had Duchenne muscular dystrophy, 32 Becker muscular dystrophy, 30 limb-girdle muscular dystrophy, 39 facio-scapulo-humeral dystrophy, 29 myotonic dystrophy, 21 congenital myopathy, 10 congenital muscular dystrophy, 35 spinal muscular atrophy and 35 hereditary neuropathy. The sensitivity for change was evaluated with 152 patients one year after. The scale comprised 32 items, in three dimensions: standing position and transfers, axial and proximal motor function, distal motor function. High correlations (>0.80) were found between the total score and other scores: Vignos and Brooke grades, Functional Independence Measure, the global severity of disability evaluated with visual analog scales by physicians and physiotherapists. This scale is reliable, does not require any special equipment and is well accepted by patients. It takes an average of 36 min (range 8-75) to complete the scale. Preliminary results of the second evaluation showed good sensitivity to change since last visit, considering rating by patient, investigator or physiotherapist. Also, significant differences in scores are obtained with the greatest deterioration observed in Duchenne patients.

Resolving a disagreement in a clinical team: overcoming conflicting views about the role of family therapy in an outpatient treatment programme for anorexia nervosa.

In the Adolescent Psychiatry Department at the Institut Mutualiste Montsouris, Paris, as is also observed in the literature, the outcome for anorexic patients can sometimes be catastrophic, regardless of treatments proposed. This disturbing finding led us to reassess our therapeutic treatment strategies, in an effort to improve patient outcome. The multidimensional treatment program implemented in the Department includes parent counselling, but not the whole family in a family therapy procedure. It has been demonstrated better outcome for patients who underwent family therapy in comparison to patients who underwent individual therapy. This raised the question of whether family therapy could improve our outpatient programme. This paper describes here how a research programme was developed to resolve a disagreement in our clinical team as to whether family therapy should be added to the existing care programme. The paper describes the difficulties encountered by our team, and the experimental design chosen to resolve the debate. Data will not be set out here.

Increased risk of secondary acute nonlymphocytic leukemia after extended-field radiation therapy combined with MOPP chemotherapy for Hodgkin's disease.

The purpose of this study was to evaluate the influence of the number of mechlorethamine, vincristine, procarbazine, and prednisolone (MOPP) cycles and the extent of irradiation on the risk of secondary acute nonlymphocytic leukemia (SANLL) after a single combined treatment for Hodgkin's disease (HD). Between April 1972 and May 1980, 462 patients with HD clinical stage (CS) I, II, and III were prospectively treated with three or six cycles of MOPP and supra- and/or infradiaphragmatic irradiation (40 Gy). Four hundred forty-one patients achieved complete remission (CR). By January 1988, 237 patients had been followed-up in first CR for at least 10 years. Ten patients developed SANLL between the 34th and 123rd month of CR. The 15-year SANLL risk is 3.5% +/- 2.7%. Cox's stepwise regression analysis performed with all initial and treatment covariates (sex, age, histology, splenectomy, MOPP chemotherapy, and irradiation extent) showed that the only significant explanatory variable of SANLL risk was the irradiation extent (P less than .002). Using the log-rank test, SANLL risk ranged from 2.2% for supradiaphragmatic irradiation alone to 9.1% for subtotal (STNI) or total nodal irradiation (TNI) (P less than .001). These results strongly suggest that extended high-dose irradiation and MOPP chemotherapy should not be combined for the treatment of HD.

Standard and long-acting depot neuroleptics in chronic schizophrenics: an 18-month open multicentric study.

The overall objective of this 18-month open study was to compare standard neuroleptics and long-acting depot neuroleptics following the current psychiatric practice in order to determine the best therapy. Thirty French psychiatrists from 15 different wards participated in this experiment. One hundred eighty-one chronic schizophrenic patients were randomly assigned to receive one of the following three treatments: standard neuroleptics, pipotiazine palmitate, or fluphenazine decanoate. Criteria used for evaluation were an overall clinical evaluation by a psychiatrist, a Brief Psychiatric Rating Scale, and a Nurse's Observation Scale for Inpatient Evaluation. No significant difference (P greater than .05) was observed between the three groups in drug effectiveness or tolerance.

[Validation of assessment scales in physical medicine and rehabilitation: how are psychometric properties determined?]. / Validation des échelles d'évaluation en médecine physique et de réadaptation: comment apprécier correctement leurs qualités psychométriques.

The psychometric properties of a rating scale are, unfortunately, badly assessed in practice. Each property is thoroughly studied. Validity has different facets: content, criterion, construct, face validity. Each facet is accurately defined and the experimental and statistical methods used are explained in detail. Reliability is assessed with use of the intraclass correlation coefficient and the Bland and Altman method. Guidelines are given for choosing, in a specific experimental situation, the appropriate coefficient. Responsiveness is evaluated with use of effect size and standardized response mean. Finally practical recommendations are given.

[The Oswestry index for low back pain translated into Arabic and validated in a Arab population]. / Traduction en arabe et validation de l'indice d'Oswestry dans une population de lombalgiques Nord-Africains.

OBJECTIVE: To translate into Arabic and validate the Oswestry index for low back pain in an Arab population. BACKGROUND: No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available. DESIGN: Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient. RESULTS: Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2. CONCLUSION: We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.

In vivo effects of progestins on prolactin secretion.

To assess a possible inhibitory effect of progestins on PRL secretion, serum PRL and estradiol levels were determined in 13 women with hyperprolactinemia due to a pituitary microadenoma before and after 3 months of treatment with a potent progestin, lynestrenol. PRL levels also were assessed during a TRH challenge test before and after treatment. Results were compared to those obtained in 10 normal women studied during the early follicular phase of their menstrual cycle and at the end of 3 months of treatment. The PRL response to TRH was blunted in patients before lynestrenol therapy. After therapy, basal serum PRL levels were significantly decreased, and the response to TRH was almost abolished. No change occurred in the normal women. The estradiol level was 80.5 +/- 7.5 (+/- SEM) pg/ml in patients before treatment and decreased to 29.2 +/- 5.0 pg/ml after therapy. Therefore, lynestrenol, a potent 19-nortestosterone derivative, exhibits in vivo an anti-PRL effect that could be related to its antiestrogenic and/or androgenic activities.

Methodological approaches to shortening composite measurement scales.

Composite measurement scales (CMSs) have contributed to improving the measurement of complex medical phenomena such as physical and psychological functioning or health-related quality of life. However, their use in patient care and research is often limited by their length and excessive respondent burden. In such situations, short instruments should be made available. Efforts to develop short instruments have largely focused on shortening existing instruments. To investigate the methodology currently used in the shortening of CMS, we assessed 42 studies reported in medical, psychological, and educational journals between 1984 and 1994. A number of methodological and statistical considerations important in the CMS shortening procedure were found to have been ignored or neglected by authors developing short forms from existing CMS. Serious flaws appear mainly to result from inadequate conceptualization of the shortening process, and inappropriate use and excess credit given to statistical techniques used to select items to be retained in short forms. When performed, the assessment of measurement properties of the short form was often inappropriate, and cross validation studies were seldom conducted. We propose recommendations for shortening existing CMS, to help authors and investigators develop and choose, respectively, shortened measurement instruments. These recommendations address the preliminary choice of the original CMS to be shortened, and the two successive phases to be considered in the development of short forms: the shortening process itself, where items are selected, and the validation of the shortened CMS, which should be conducted independently using independent subject samples.

Diflunisal versus placebo for treatment of pain in general practice.

The efficacy and safety of diflunisal versus placebo in the treatment of pain were compared in a multicenter, double-blind study of 1,037 patients treated for seven days by general practitioners. A statistically significant (P less than 0.001) difference in favor of diflunisal was seen using four evaLuation criteria. The incidence of side effects was generally low with both treatments; nevertheless, the number of patients suffering at least one side effect was greater after diflunisal than after placebo (P less than 0.05). A comparison of the profile of responders to diflunisal and to placebo showed no particular pattern.

The ability of the Cochin rheumatoid arthritis hand functional scale to detect change during the course of disease.

OBJECTIVE: To assess changes measured with the Cochin rheumatoid arthritis (RA) hand functional disability scale during the course of the disease. METHODS: A cohort study evaluating outcome measure responsiveness in RA was conducted in a referral center. Ambulatory or hospitalized patients with RA according to the 1987 American College of Rheumatology (formerly the American Rheumatism Association) criteria were evaluated twice. Clinical measures included Cochin's scale, Revel's functional index, hand functional index, visual analog scale of patient-perceived handicap, visual analog scale of pain in hands and wrists, total score of swelling, total score of tenderness, and morning stiffness duration. Responsiveness was assessed by the effect size (ES) and the standardized response mean (SRM). The nonparametric Spearman rank correlation coefficient (r) was used to assess the correlation between two quantitative variable changes. RESULTS: Fifty-five patients (44 women) were evaluated twice at an interval of 15.4 +/- 1.4 months (mean +/- SD) (range 13-18 months). The Cochin scale total score had worsened at the second visit (95% confidence interval for mean differences -5.16, 0.73). Its SRM and ES values were -0.20 and -0.15, respectively. Changes in the score had the highest correlation (r = 0.58) with changes in the patient-perceived handicap, while it had only fair or little correlation with changes in the disease activity measures. The factor 2 scale subscore significantly worsened and had the highest values of SRM and ES (SRM = -0.40 and ES = -0.31). CONCLUSION: The Cochin scale can detect small but meaningful changes in RA hand disability.

Improvement of the isolation-induced social behavioural deficit involves activation of the 5-HT1B receptors.

1. Mice were isolated for 7-9 days. An isolated mouse and a mouse reared in group showed a difference in their behaviour when observed together under an inverted beaker. The isolated mouse makes one half escape attempts in regard to the grouped mouse. This is considered as a social behavioural deficit. 2. 1- 3-(trifluoromethyl)phenyl piperazine (TFMPP), 1-(3-chlorophenyl)piperazine (m-CPP) and 5-methoxy-3 (1,2,3,6-tetrahydropyridin-4-yl) 1-H indole (RU-24969) activating preferentially the 5-HT1B receptors increased the number of escape attempts of the isolated mice up to the level of grouped mice. 3. Penbutolol, a beta-blocking drug acting also at 5-HT1 receptors, devoid of effect when given alone, antagonized significantly and dose-dependently the effects of TFMPP, m-CPP and RU-24969. 4. The interaction between TFMPP and five various serotonin antagonists was examined. Neither the 5-HT2 receptor antagonist ritanserine, the 5-HT3 receptor antagonist ICS 205-930, the 5-HT1C receptor antagonists mianserin and cyproheptadine antagonized the effect of TFMPP. The neuroleptic spiperone decreased by itself the number of escape attempts and opposed the TFMPP effect. 5. Taken together, these results suggest that the isolation-induced social behavioural deficit may be considered as a behavioural model responsive to 5-HT1B agonists.

Effect of tricyclic antidepressant drugs in the isolation-induced social behavioural deficit test.

1. Mice were isolated for 7-9 days. An isolated mouse and a mouse reared in group show a difference in their behaviour when observed together under an inverted beaker. The isolated mouse makes one half escape attempts in regard to the grouped mouse. This is considered as a social behavioural deficit. 2. The effect of four tricyclic antidepressant drugs was tested on this social behavioural deficit. None of the following drugs acutely given: imipramine, desipramine, amitriptyline impaired the social behavioural deficit. Clomipramine reduced the deficit at the only dose of 2 mg/kg. The four antidepressants tended to increase the deficit at the high dose of 32 mg/kg but this may reflect a sedative effect. Chronic amitriptyline did not impair the social behavioural deficit. 3. It is concluded that acute and probably also chronic antidepressant treatments are without effect on the isolation induced social behavioural deficit test.

Analysis of the terms used by general practitioners to characterize patients considered by them as depressed. A prospective study on 682 patients.

The aim of the study was to investigate the terms used by general practitioners (GPs) to describe the patients considered by them to be depressed. 682 patients were diagnosed as depressed by 79 GPs selected at random in four regions of France. The frequency of the diagnosis of depression made by GPs in the total patient population was 3.6-5%. The GPs were asked to describe the main symptoms of these patients on a plain chart. The percentage of use of each term was calculated in each region. In all the regions, the most frequent symptoms were insomnia (31.8%), fatigue (29.9%) and anxiety (24.6%). The results suggest that the three main terms used by GPs to describe depression differ from those used by psychiatrists.