New insights into the behavioral structure of Pikler educators: An application of T-pattern detection and analysis with THEME.

Introduction: The recent generalization of early childhood schooling has given rise to a need for the development of rigorous, specific training programs aimed at early education professionals (0-3 years of age). This work emanates from the unique nature of Pikler-Lóczy education as a reference for early childhood education centers, and its expertise in providing quality care in an everyday classroom situation. The aim of the study is to use T-pattern detection and analysis, within the framework of observational methodology, to identify relevant aspects of the choreography followed by Pikler educators during breakfast, and thus provide substantial material with a view to creating a training plan. Methods: Two expert educators in Pikler-Lóczy education were directly and systematically observed in their own classrooms, following a nomothetic, follow-up and multidimensional design. The observation instrument underwent a molarization process so that the detected elements would be more significant and understandable for novice educators. Results: Using THEME, the invariant aspects of the educators' behavior were analyzed. The significance level for the critical interval was the THEME default (α = 0.005). The results show: on the one hand, changes expected in T-patterns in accordance with the observation instrument molarity; and on the other hand, stability in terms of the comparison between the two educators. Discussion: These results help us to identify the complex structure of the breakfast choreography, and how educators establish interaction with children. In addition to specific issues pertaining to Pikler-Lóczy education, the conclusions highlight the advantages of using T-pattern analysis within the framework of observational methodology, in order to dissect a mealtime routine in its natural context, and explain components of early childhood education intervention that satisfy basic childhood needs. This constitutes a starting point from which to generate instructive material for the training of professionals working in early education.

T-pattern detection in the scientific literature of this century: A systematic review.

Introduction: Scientific literature contains mainly systematic reviews focused on substantial aspects, but there are also approaches that have combined both substantial and methodological aspects, which is our preferred option since it undeniably adds value. The aims of this study were: (1) to carry out a systematic review of the literatura on T-Pattern analysis (TPA), and (2) to explore the possible contribution of mixed methods research to the integration of qualitative and quantitative elements on a synthesis level. Methods: Based on PRISMA guidelines, searches were carried out in the Scopus, PsycINFO, and Web of Science databases. The general search syntax was: "THEME" AND ("T-Patterns" OR "T Patterns") carried out in title, keywords and abstract. In addition, we included empirical articles on THEME and T-Patterns collected in other sources based on citations in several empirical works and consultations with different authors. This selection process resulted in 125 primary documents making up this systematic review. Results: The results showed that the detection of structures in behavior patterns forms a nexus between studies carried out in very diverse fields and contexts. Most studies are observational, whilst the applicability and power of T-Pattern detection are extraordinary. It allows the researcher to go deeper in a robust analysis that responds to the integration of qualitative and quantitative elements which constitutes the leit motive of mixed methods; and also to discover the deep, hidden structure that underlies the respective databases, regardless of the methodology used in each study. The possibilities in assigning parameters notably increase the options for obtaining results and their interpretation. Discussion: It is relevant the extraordinary strength and applicability of T-pattern detection. There is a high presence of T-pattern detection and analysis in studies using observational methodology. It is necessary commit to consolidating the methodological analysis of selected works, as taking individual and collective responsibility for improving methodological quality of TPA studies, taking advantage of the resources provided by the THEME program.

Cross-cultural adaptation and validation of the Spanish version of the Client-Centred Rehabilitation Questionnaire (CCRQ).

PURPOSE: The aim of the study is to present the process of translation, adaptation and validation of the Client-Centred Rehabilitation Questionnaire (CCRQ) in the Spanish context. METHODS: The process integrates two sequential phases. Phase 1 consists of a questionnaire translation and back-translation process conducted by a panel of experts, and a pilot study. In phase 2, CCRQ-e (Spanish version) was administered to 305 rehabilitation inpatients to collect evidence on the reliability and validity of the instrument. RESULTS: The exploratory and confirmatory analysis confirmed seven original domains, eliminating four items from the original scale. CCRQ-e has a good internal consistency. Discriminative construct validity distinguished significant differences based on age, educational level, and severity of diagnosis. Criterion validity of the CCRQ and EQ-5D showed negative significant correlations between CCRQ-e and the general perception of health EQ-VAS, and a positive correlation between CCRQ-e and EQ pain and EQ anxiety (higher scores in CCRQ-e mean lower client-centered practice perceived). CONCLUSIONS: The Spanish version of the CCRQ is suitable for evaluating person-centered rehabilitation from the person's perspective. It includes aspects related to the comfort, decision-making, and participation of the client, as well as questions about the provision of service and the environment.Implications for rehabilitationThe original seven domains of the CCRQ could be replicated in the sample of patients from Spanish rehabilitation services.By eliminating four items from the original scale, the validated scale, known as the CCRQ-e (Spanish version), was obtained.The CCRQ-e allows a reliable and valid evaluation of the perception of the person-centeredness of the Spanish rehabilitation services.The CCRQ-e is the first self-reported measure in Spanish of an individual's experience during the rehabilitation service.

Structural analyses in the study of behavior: From rodents to non-human primates.

The term "structure" indicates a set of components that, in relation to each other, shape an organic complex. Such a complex takes on essential connotations of functionally unitary entity resulting from the mutual relationships of its constituent elements. In a broader sense, we can use the word "structure" to define the set of relationships among the elements of an emergent system that is not determined by the mere algebraic sum of these elements, but by the interdependence relationships of these components from which the function of the entire structure itself derives. The behavior of an integrated living being can be described in structural terms via an ethogram, defined as an itemized list of behavioral units. Akin to an architectural structure, a behavioral structure arises from the reciprocal relationships that the individual units of behavior establish. Like an architectural structure, the function of the resulting behaving complex emerges from the relationships of the parts. Hence, studying behavior in its wholeness necessitates not only the identification of its constitutive units in their autarchic individuality, but also, and importantly, some understanding of their relationships. This paper aimed to critically review different methods to study behavior in structural terms. First, we emphasized the utilization of T-pattern analysis, i.e., one of the most effective and reliable tools to provide structural information on behavior. Second, we discussed the application of other methodological approaches that are based on the analysis of transition matrices, such as hierarchical clustering, stochastic analyses, and adjusted residuals. Unlike T-pattern analysis, these methods allow researchers to explore behavioral structure beyond its temporal characteristics and through other relational constraints. After an overview of how these methods are used in the study of animal behavior, from rodents to non-human primates, we discussed the specificities, advantages and challenges of each approach. This paper could represent a useful background for all scientists who intend to study behavior both quantitatively and structurally, that is in terms of the reciprocal relationships that the various units of a given behavioral repertoire normally weave together.

Presentación de la traducción, adaptación y validación del Client-Centred Rehabilitation Questionnaire - versión Española (CCRQ-E) / Presentation of the translation, adaptation and validation of the Client-Centred Rehabilitation Questionnaire - Spanish version (CCRQ-E)

El creciente interés de aplicar una práctica centrada en la persona en los servicios de terapia ocupacional y rehabilitación, implican disponer de herramientas para que la persona del servicio pueda evaluar las diferentes dimensiones que engloba el concepto. Después de un proceso de traducción, adaptación cultural y validación el Client-Centred Rehabilitation Questionaire o Cuestionario de Rehabilitación Centrado en el Cliente versión española (CCRQ-e) es una medida de autoevaluación diseñada para evaluar la experiencia centrada en la persona en los servicios de rehabilitación. Engloba tanto aspectos relacionados con el confort, decisión o participación del cliente, como aspectos relacionados con la provisión de servicio o el entorno. El instrumento consta de 29 ítems específicamente desarrollados para representar las características de rehabilitación en 7 subescalas: Toma de decisiones, educación, evaluación de resultados, implicación de la familia, soporte emocional, confort físico y continuidad/coordinación. Las 7 subescalas muestran una buena consistencia interna. Asimismo, la validez de constructo del instrumento mostró una buena capacidad discriminante entre programas y centros, en las diferentes subescalas, resultando un instrumento adecuado para evaluar la atención centrada en la persona en los servicios de rehabilitación. (AU)

The growing interest in applying a person-centered practice in occupational therapy and rehabilitation services, implies having tools so that the person in the service can evaluate the different dimensions that the concept encompasses. After a process of translation, cultural adaptation and validation, the Client-Centred Rehabilitation Questionnaire or Cuestionario de Rehabilitación Centrado en el Cliente in its Spanish version (CCRQ-e), is a self-assessment measure designed to assess the person-centered experience in rehabilitation services. It encompasses both aspects related to customer comfort, decision or participation, as well as aspects related to the provision of service or the environment. The instrument consists of 29 items, specifically developed to represent rehabilitation characteristics, in 7 subscales: decision making, education, outcome evaluation, family involvement, emotional support, physical comfort, and continuity/coordination. The 7 subscales show good internal consistency. Likewise, the construct validity of the instrument showed a good discriminating capacity between programs and centers, in the different subscales, resulting in an adequate instrument to evaluate person- centered care in rehabilitation services. (AU)

Transformative learning experience among nursing students with patients acting as teachers: Mixed methods, non-randomized, single-arm study.

AIM: To examine the effects of expert HIV patients acting as teachers to Spanish nursing students both on their HIV-related knowledge, attitudes and practices and on their approach to the care model as well as to explore their learning experience. DESIGN: Non-randomized, single-arm study with quantitative before and after measurements and qualitative data. METHODS: The intervention consisted of five 90-min workshops led by two women living with HIV. Thirty-four nursing students participated, and quantitative and qualitative data were gathered from February to June 2018. We used the Patient-Practitioner Orientation Scale (PPOS) and the KAP questionnaire on HIV/AIDS to collect quantitative data. RESULTS: Statistically significant differences were found in the global score for care orientation and its two dimensions, caring and sharing. About the changes resulting from the workshops, the quantitative results-more patient-centred care perception and better attitudes towards people living with HIV-match the qualitative findings in all the aspects studied, except in sharing. CONCLUSION: Incorporating expert patients as teachers in the nursing bachelor's degree resulted in more patient-centred care and improved knowledge, attitudes and practices. The workshops conducted by qualified expert patients showed transformative learning power, as the participants improved professional and personal aspects.

From randomized control trial to mixed methods: a practical framework for program evaluation based on methodological quality / Del ensayo controlado aleatorizado a los métodos mixtos: un marco práctico para la evaluación de programas basado en la calidad metodológica

The evidence used when making decisions about the design, implementation and evaluation in intervention programs should be methodologically sound. Depending on the context of the intervention, different methodologies may apply. Nonetheless, the intervention context is often unstable and, to adapt to changing circumstances, it sometimes becomes necessary to modify the original plan. The framework proposed herein draws on approaches that can be considered two extremes of a continuum (experimental/quasi-experimental designs and studies based on observational methodology). In unstable intervention context conditions, this enables decisions from a methodological quality approach regarding design, measurement, and analysis. Structural dimensions, i.e., units (participants, users), treatment (program activities), outcomes (results, including decisions about the instruments to use and data gathering), setting (implementation context) and time will be detailed as part of the practical framework. The present study aims to specify the degree of correspondence/complementarity between components in these structural dimensions of a program evaluation from a practical complementarity perspective based on methodological quality.(AU)

La evidencia utilizada al tomar decisiones sobre el diseño, implementación y evaluación en los programas de intervención debe ser metodológicamente sólida. Dependiendo del contexto de la intervención, se pueden aplicar diferentes metodologías. Sin embargo, el contexto de la intervención es a menudo inestable y, para adaptarse a las circunstancias cambiantes, en algunas ocasiones se hace necesario modificar el plan original. El marco propuesto en este documento se basa en enfoques que pueden considerarse dos extremos de un continuo (diseños experimentales / cuasiexperimentales y estudios basados ​​en metodología observacional). En condiciones de contexto de intervención inestable, esto permite tomar decisiones desde un enfoque de calidad metodológica en cuanto a diseño, medición y análisis. Las dimensiones estructurales, i.e., las unidades (participantes, usuarios), el tratamiento (actividades del programa), los resultados (incluidas las decisiones sobre los instrumentos a utilizar y la recopilación de datos), el entorno (contexto de implementación) y el tiempo se detallarán como parte del marco práctico. El presente estudio tiene como objetivo especificar el grado de correspondencia / complementariedad entre componentes en estas dimensiones estructurales de la evaluación de un programa desde una perspectiva de complementariedad práctica basada en la calidad metodológica.(AU)

Feeling Informed Versus Being Informed: Mixed-Methods Analysis of Family Perceptions and Behavior Following a Pediatric Emergency Department Visit.

PURPOSE: To examine perceptions of family-centered care, satisfaction, and quality of communication with health professionals during a pediatric emergency department visit, and to evaluate the perceived usefulness of the information received and whether provider treatment recommendations were followed after discharge. DESIGN: Embedded mixed methods design with two concurrent phases. Participants in phase 1 were 385 adult relatives of children (age 6 days-17 years, mean 5.0 years, SD 4.5) seen in a pediatric emergency department. On the day of the visit, relatives completed questionnaires exploring perceptions of family-centered care, satisfaction (CSQ-8), and quality of communication with professionals (ad hoc instrument). For phase 2, we conducted daily structured telephone interviews with 37 of these parents over the six consecutive days following the emergency visit. RESULTS: Satisfaction with the visit was significantly related to the perception of family-centered care (B = 0.25; 95% CI [0.20, 0.29]; p < .001). Follow-up interviews revealed that 45.9% (n = 17) of families did not follow the prescribed treatment and 32.4% (n = 12) made a further appointment with their primary care pediatrician. Qualitative analysis suggested that families lacked certain information from care providers. CONCLUSIONS: Elements of a family-centered approach were rated positively and families believed that the information they received was useful. Importantly, more than half of the families who were followed up by telephone had doubts about provider treatment recommendations. PRACTICE IMPLICATIONS: Family-centered care in the pediatric emergency department could enhance communication and help to ensure that treatment recommendations are followed at home.

Manual Material Handling Training: The Effect of Self-Observation, Hetero-Observational and Intrinsic Feedback on Workers' Knowledge and Behaviour.

This study aimed to assess the effect of systematic self-observation, hetero-observational feedback, and feedforward and intrinsic feedback (SsObserWork components) on workers' knowledge and behaviour of a manual material handling (MMH) technique in the industrial sector. Blue-collar workers recruited from a food processing company in Catalonia (Spain) were randomized into SsObserWork (N = 31) and control (N = 30) groups. SsObserWork group members participated individually in two sessions and a three-week follow-up between sessions where they received the SsObserWork components. The control group participated individually in two sessions where they received a standard MMH training. An ad hoc instrumentcalled the MMH-SsObserWork instrument was used to assess the MMH behaviour, and an adaption of the instrument was done to assess the workers' knowledge. Significant differences were found between groups for the identification of recommended back positions in the first session and also on comparing both sessions. However, no differences were found for the rest of the criteria. There also were significant differences between groups in the score changes of the back, knee joints, elbow joints, and interaction criterion, indicating that the SsObserWork group improved the MMH performance in these criteria (behaviour). SsObserWork intervention showed a positive effect on improving the knowledge and behaviour of the MMH technique, specifically on back posture.

Psychosocial characteristics and affective symptomatology associated with patient self-initiated consultations in Spanish general practice.

We aimed to determine the sociodemographic and psychosocial profile, and the associated subclinical affective symptomatology of users above the 95th percentile in the distribution of patient self-initiated, face-to-face consultations. Additionally, we sought to determine the contribution of subclinical symptomatology in differentiating between the groups above or below this cut-off point. A total of 16,803 users who self-initiated at least one face-to-face consultation with a GP at any of 13 PHC practices over 1 year, were eligible. After discarding those fulfilling exclusion criteria, 129 cases and 109 controls, matched by gender and age, answered the Family APGAR, the Duke-UNC and the Goldberg Anxiety-Depression scale. Both groups did not differ significantly on any of the sociodemographic and psychosocial variables recorded showing a similar percentage distribution. However, users with high self-initiated consultation rates obtained lower scores on the affective social support subscale from the Duke-UNC. Regarding Goldberg scale, the two groups differed significantly on the likelihood of displaying depression and/or anxiety symptoms. Users with a high probability of suffering from depression and/or anxiety were more prevalent among users on the top 5% in the distribution. Altogether, results indicate that these users report a lack of affective social support and have a higher probability of suffering from subclinical depression and/or anxiety. Early detection and treatment of affective symptomatology would temperate this excess in consultation. General practitioners, social workers and psychologists could act as gatekeepers, preventing this overuse of medical services and in turn lowering economical costs, professional burnout and patients' suffering and discontent.

T-patterns integration strategy in a longitudinal study: a multiple case analysis.

This work analyzes stability and change of T-patterns related with on-task persistence and social interaction of preschool-age children. Stability and change are considered as natural setting indicators of time allocation processes and social dynamics with teachers and peers, within the fields of educational neuroscience and developmental science. In contrast with descriptive observations, developmental scales or ratings, T-pattern analysis clarifies and allows predictions on otherwise hidden behavioral patterns and their stability and change processes in natural settings. Here, T-pattern analyses were applied on observational behavior profiles of three preschool children, their teacher and their interacting peers in classroom and playground natural settings, to identify the structure and dynamics of daily activities in a multiple case study strategy about persistence and social interaction processes, considering teachers' and peers influence on children's behavior. Behavioral data were obtained with the Observational System of Social Interaction in a nomothetic, following and multidimensional observational design. Main results include the identification and description of patterns, their stability and change over time, and their subsumed structure regarding setting, child, and diachronic information. Two main behavioral patterns identified were: (1) teacher's attempts at redirecting child behavior to on-task were followed by on-task and off-task alternation loops, and (2) peers or teacher not responding to child social emissions, predict the kid going off-task. This constitutes a methodological contribution to Educational Neuroscience's efforts to describe real-world group contexts and predict the use of time in preschool contexts by children, their subsumed behavioral patterns and the influence of peers and teachers.

Clinical Utility of the Canadian Occupational Performance Measure in Older Adult Rehabilitation and Nursing Homes: Perceptions among Occupational Therapists and Physiotherapists in Spain.

INTRODUCTION: Scientific evidence that supports the psychometric properties of the COPM as a tool to enable personalized care has been repeatedly shown. However, there is a lack of studies about its utility within the Spanish research community. AIM: This qualitative study seeks to ascertain the perceptions of professionals from social health centers, nursing homes, and Spanish rehabilitation services about the clinical utility of the COPM as a standardized instrument. METHODS: Thirty occupational therapists and physiotherapists in four focus groups discussed the experience of applying the COPM. The interpretative phenomenological analysis (IPA) incorporated a multidimensional model of clinical utility based on the components of acceptable, appropriate, accessible, and practicable by the clients, professionals, and institutions. Results and Discussion. The results of the utility study showed that the COPM helped professionals and clients to gain significant involvement in the treatment process. The COPM contributed to the process of further goal setting, occupation-based, and client-centered, thus achieving considerable satisfaction from the clients that had treatment. The professional training and adaptation to the geriatric population were vital to this process. CONCLUSION: The COPM is a useful and viable tool for the institutions that are supportive of a client-centered approach in the Spanish context.

Central sensitization in knee osteoarthritis and fibromyalgia: Beyond depression and anxiety.

OBJECTIVES: To determine the psychopathological profile of patients with central sensitization (CS) in a sample of knee osteoarthritis, with and without CS, and fibromyalgia, and to compare their psychopathological profiles. METHODS: The final sample consists of 19 patients with osteoarthritis and CS (mean 66.37 years ± 8.77), 41 osteoarthritis patients without CS (mean 66.8 ± 7.39 years), 47 fibromyalgia patients (mean 46.47 years ± 7.92) and 26 control subjects (mean 51.56 years ± 11.41). The psychopathological profile was evaluated with the Millon Multiaxial Clinical Inventory. RESULTS: The average score of MCMI-III reflect higher scores in the fibromyalgia and osteoarthritis-CS groups. Patients with osteoarthritis-CS are more likely to report larger scores in Borderline and Major Depression scales. Fibromyalgia patients are more likely to report more increased scores in Somatoform and Major Depression, versus osteoarthritis-CS group. Fibromyalgia patients versus osteoarthritis without CS are more likely to report higher scores in Schizoid, Depression, Histrionic, Sadistic, Borderline, Somatoform, Posttraumatic Stress Disorder and Major Depression scales. DISCUSSION: Patients with CS have less differences in their psychopathological profiles as well as in both osteoarthritis groups and greatest differences are obtained between the fibromyalgia and osteoarthritis without CS, so perhaps presence of CS is the key to differentiate those groups and not chronic pain. An exhaustive assessment brings more accurate psychopathological profiles, thus better psychological treatment could be applied.

Methodological quality checklist for studies based on observational methodology (mqcom) / Checklist de calidad metodológica para estudios basados en metodología observacional

BACKGROUND: No existing instrument addresses the minimum number of items that guarantee methodological quality in studies based on observational methodology. Consequently, professionals who are not experts in observational methodology do not have a basic framework to guide their practice in this type of study. This study developed a checklist to measure the minimum number of items for methodological quality that studies based on observational methodology should consider and provided evidence of their validity based on test content and intercoder reliability. METHOD: Fifty-four judges with at least 1 year of experience in observational methodology and research based on this methodology evaluated the items of the developed checklist in terms of relevance, usefulness, and feasibility. Items were selected if they obtained at least .5 in the Osterlind indexes of the three aspects evaluated. Two coders applied the selected items to a random selection of articles that used observational methodology to investigate soccer, and intercoder reliability was examined using Cohen's kappa (k) coefficients. RESULTS: The final checklist included 16 items grouped into 11 criteria/dimensions, with adequate reliability coefficients. CONCLUSIONS: This study developed a useful instrument for non-expert professionals to enhance the methodological quality of studies based on observational methodology

ANTECEDENTES: no existen instrumentos referidos a los ítems mínimos que garanticen la calidad metodológica en estudios basados en metodología observacional. En consecuencia, los profesionales no expertos en metodología observacional no disponen de una guía básica que oriente su práctica en este tipo de estudios. Se desarrolló una escala para medir los ítems mínimos de calidad metodológica que deben considerar los estudios basados en metodología observacional aportando evidencias de su validez basada en el contenido de la prueba y fiabilidad intercodificadores. MÉTODO: cincuenta y cuatro jueces con al menos un año de experiencia en metodología observacional y su aplicación evaluaron los ítems del checklist elaborado respecto a su relevancia, utilidad y viabilidad. Se seleccionaron aquellos ítems que obtuvieron al menos ,5 en los índices de Osterlind en los tres aspectos evaluados. Dos codificadores los aplicaron a una selección aleatoria de artículos que utilizaron metodología observacional en fútbol y se estudió la fiabilidad intercodificadores mediante coeficientes kappa (k) de Cohen. RESULTADOS: la escala resultante constó de 16 ítems agrupados en 11 criterios/dimensiones, con coeficientes de fiabilidad adecuados. CONCLUSIONES: se desarrolló un instrumento útil dirigido a profesionales no expertos para potenciar la calidad metodológica de estudios basados en metodología observacional

Methodological quality checklist for studies based on observational methodology (MQCOM).

BACKGROUND: No existing instrument addresses the minimum number of items that guarantee methodological quality in studies based on observational methodology. Consequently, professionals who are not experts in observational methodology do not have a basic framework to guide their practice in this type of study. This study developed a checklist to measure the minimum number of items for methodological quality that studies based on observational methodology should consider and provided evidence of their validity based on test content and intercoder reliability. METHOD: Fifty-four judges with at least 1 year of experience in observational methodology and research based on this methodology evaluated the items of the developed checklist in terms of relevance, usefulness, and feasibility. Items were selected if they obtained at least .5 in the Osterlind indexes of the three aspects evaluated. Two coders applied the selected items to a random selection of articles that used observational methodology to investigate soccer, and intercoder reliability was examined using Cohen's kappa (k) coefficients. RESULTS: The final checklist included 16 items grouped into 11 criteria/dimensions, with adequate reliability coefficients. CONCLUSIONS: This study developed a useful instrument for non-expert professionals to enhance the methodological quality of studies based on observational methodology.

Support System for the Assessment and Intervention During the Manual Material Handling Training at the Workplace: Contributions From the Systematic Observation.

Efficacy of classical manual material handling (MMH) training interventions on back pain prevention at the workplace has been called into question. The way that observation (self-observation or hetero-observation) is used in other areas to create feedback addressed to modify motor activities can justify innovative components for these interventions. However, their implementation and evaluation cannot be done without tackling the methodological challenge of developing a reliable observational instrument to measure manual handling practice during the training process. The aims of this study were: (1) justify and develop an hetero-observation (H-O) instrument to assess changes in the worker behavioral patterns with a level of analysis convenient to derive a parallel version for the systematic self-observation (S-O) during training on MMH; (2) provide evidence on the inter-rater reliability of the H-O instrument; (3) provide evidence on the usability of the S-O instrument and its perceived usefulness; and (4) provide evidence on the benefits that can be derived with the use of the H-O instrument to create feedback based on T-pattern and polar coordinate analysis. A mixed method approach mainly grounded on systematic observation was used. A convenience sample composed by blue-collar workers participated in the study. Based on literature review and expert opinion, the H-O instrument proposed was composed by six dimensions (feet, knee joints, back, elbow joints, load position, and interaction between back tilt and displacement) plus a structural dimension which defined MMH phases. The inter-rater reliability of this instrument was almost perfect for all dimensions using a tolerance level of 2 s (the range of time-unit kappa was from 0.93 to 0.97 and the range of event-based kappa was from 0.82 to 0.9). The usability and usefulness of the S-O instrument was highly valued by workers. Regarding the way to use hetero-observations to create feedback, the paper shows the great potential of T-pattern and polar coordinate analysis. The observational instruments developed combined with these techniques make it possible to characterize the body positions adopted during manual handling performance, and this is crucial to create feedback on performance instead of only feedback on results.

Personality and psychopathology as predictors of patient-initiated overuse in general practice.

OBJECTIVE: We aimed to characterize, by means of the MCMI, the psychopathological profile of users above the 95th percentile in the distribution of patient-initiated, face-to-face consultations. Additionally, we sought to determine the specific contribution of the patterns assessed by the Millon inventory in differentiating between the groups above or below this cut-off point. METHODS: A total of 16803 users who initiated at least one face-to-face consultation with a GP at any of 13 PHC practices over one year, were eligible. After discarding those meeting our exclusion criteria, 129 cases and 109 controls matched by gender and age completed the MCMI-III. RESULTS: The profile of users above the 95th percentile showed elevated scores for compulsivity and narcissism, reflecting rigidity and perfectionism with anxious symptomatology but with no physical or psychosomatic complaints. Regarding differentiation between the two groups, the results showed elevated scores for dependency to increase the probability of belonging to the group above the 95th percentile; conversely, elevated scores for compulsivity appeared to be protective, decreasing the probability of belonging to this same group. Furthermore, elevated scores for anxiety and major depression also increased the probability of belonging to this group. The results for clinical syndromes present a profile of overusers reporting anxiety and somatic complaints associated with low self-esteem. CONCLUSIONS: Excessive patient-initiated consultations can be an easily detectable marker for underlying psychological problems. The results suggest that overusers of patient-initiated consultations above the 95th percentile show an MCMI profile associated with dependency, compulsivity, anxiety, and major depression.