Instruments to assess the role of the clinical pharmacist: a systematic review.

BACKGROUND: The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary. METHODS: A literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the "pharmaceutical services," "validity studies," and "professional performance" domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute's standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected. RESULTS: A total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments. CONCLUSIONS: Without standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD 42018099912.

Validation Assessment of a Pain Interference Questionnaire among Student Pharmacists.

Validation studies of pain interference instruments used among student pharmacists are rare yet essential for understanding their appropriate use and interpretation in pharmacy education and practice. This study conducted validation and reliability assessments of a five-item Pain Interference Scale previously administered to student pharmacists. Construct validity was assessed using Rasch analysis. Unidimensionality was measured using: point-biserial measure correlations; percent of raw variance explained by items; difference between expected; variance modeled by items; and Rasch model fit. To assess scale functioning, response frequency distribution, observed average and sample expected logit distribution, Andrich logit distribution, item separation, and item reliability were assessed. Visual examination of the Item-Person Map determined content validity. Items explained 64.2% of data raw variance. The difference between raw variance modeled and observed was 0.6. Point-biserial measure correlations were >0.77. Item mean-square infits were 0.7-1.3 while outfit measures were 0.72-1.16. There were >10 responses per response category, response frequency and Andrich thresholds progressively advanced, and observed average and sample expected logits advanced monotonically, Andrich logits = -2.33-1.69, item separation = 2.61, and item reliability = 0.87. Item probability curves indicated response categories were minimally yet adequately distinct. Cronbach's alpha = 0.93. The Item-Person Map had a ceiling effect indicating content gaps. In conclusion, the pain interference instrument has acceptable construct validity yet contains content gaps. Additional difficult items should be added to the instrument to better capture pain interference among student pharmacists.

Teste Informatizado e Dinâmico de Escrita: evidências de validade baseadas na TRI / Computerized and Dynamic Writing Test: evidence of validity based on IRT / Test Informatizado y Dinámico de Escritura: evidencias de validez con base en la TRI

Este estudo objetiva buscar evidências de precisão e de validade com base na estrutura interna do Teste Informatizado e Dinâmico de Escrita, utilizando a Teoria de Resposta ao Item. Foram incluídos 304 participantes de Porto Alegre, entre 10 e 17 anos. Utilizou-se o TIDE, cujo objetivo é avaliar o potencial de aprendizagem em escrita narrativa de adolescentes. Verificou-se a dimensionalidade dos módulos em análise por meio de análise fatorial, satisfazendo critério para a realização das análises por meio da TRI. O módulo pré-teste foi ajustado para o modelo Logístico de dois parâmetros, com alfa de Cronbach de 0,82. Todos os itens apresentaram valores adequados de discriminação, entre 1,88 e 3,49. A dificuldade dos itens variou de -0,01 a 1,27. O módulo instrucional foi ajustado pelo modelo de resposta gradual de Samejima, apresentando alfa de Cronbach foi de 0,91. Observou-se, portanto, evidências de validade com base na estrutura interna do TIDE. (AU)

This study aimed to investigate evidence of accuracy and validity based on the internal structure of the Computerized and Dynamic Writing Test, using the Item Response Theory. A total of 304 participants from Porto Alegre, aged between 10 and 17 years, were included. The aim of this study was to evaluate the adolescents' potential for learning in narrative writing. The dimensionality of the modules under analysis was verified by means of factorial analysis, satisfying criterion for the accomplishment of the analyses through IRT. The pre-test module was adjusted for the two-parameter logistic model, with Cronbach's Alpha of .82. All items presented adequate discrimination values ​​between 1.88 and 3.49. The difficulty of the items ranged from -0.01 to 1.27. The instructional module was adjusted using Samejima's graded response model, presenting a Cronbach's alpha of .91. Accordingly, evidence of validity based on the internal structure of the CDWT was observed. (AU)

Este estudio objetiva buscar evidencias de precisión y de validez con base en la estructura interna del Test Informatizado y Dinámico de Escritura, utilizando la Teoría de Respuesta al Ítem. Participaron 304 participantes de Porto Alegre, entre 10 y 17 años. El TIDE fue utilizado con el objetivo de evaluar el potencial de aprendizaje en la escritura narrativa de adolescentes. La dimensionalidad de los módulos en análisis se averiguó por medio de análisis factorial, satisfaciendo los criterios para la realización de los análisis por medio de la TRI. El módulo pre-test se ajustó al modelo Logístico de dos parámetros, con Alpha de Cronbach de 0,82. Todos los ítems presentaron valores adecuados de discriminación, entre 1,88 y 3,49. La dificultad de los ítems sufrió variación de -0,01 a 1,27. El módulo instruccional fue ajustado por el modelo de respuesta gradual de Samejima, presentando Alpha de Cronbach de 0,91. Por lo tanto, se observaron evidencias de validez con base en la estructura interna del TIDE. (AU)

Desenvolvimento e validação de um instrumento para avaliar intervenções em relação aos princípios da Promoção da Saúde / Desarrollo y validación de un instrumento para evaluar intervenciones con relación a los principios de la Promoción de la Salud / Development and validation of an instrument to evaluate interventions in relation to Health Promotion principles

Objetivo: Desenvolver e validar um instrumento destinado a avaliar a proximidade de intervenções que buscam promover saúde, em relação aos princípios da Política Nacional de Promoção da Saúde do Brasil. Métodos: Estudo transversal de desenvolvimento e validação de um instrumento, a partir de consulta a 20 trabalhadores, na análise da primeira versão, 19 na versão final, e mais 31 trabalhadores na análise da fidedignidade e da avaliação de conteúdo, realizada por dez especialistas na versão inicial e 12 na versão final. Foram utilizados o índice de validade de conteúdo, o alpha de Cronbach (α) e o coeficiente de correlação intraclasse. Resultados: A adequação dos indicadores foi de 89,8%; a clareza de 82,5%; a consistência interna de α=0,80, e a correlação teste-reteste, de 0,93. Conclusão:O instrumento apresentou validade e fidedignidade aceitáveis, podendo ser utilizado na avaliação de intervenções que tenham o objetivo de promover a saúde.

Objetivo: Desarrollar y validar un instrumento para evaluar la proximidad de intervenciones que buscan promover la salud con los principios de la Política Nacional de Promoción de la Salud de Brasil. Métodos: Se realizó estudio transversal del desarrollo y validación de un instrumento, a partir del análisis de 20 trabajadores en el análisis de la primera versión, 19 en la versión final, 31 para el análisis de confiabilidad y la evaluación de contenido por 10 especialistas en la versión inicial y 12 en la versión final. En el análisis se utilizaron el índice de validez de contenido, el alfa de Cronbach (α) y el coeficiente de correlación intraclase. Resultados: La adecuación de los indicadores fue del 89,8%, la claridad del 82,5%, la consistencia interna de α=0,80 y la correlación test-retest 0,93. Conclusión: El instrumento mostró validez y confiabilidad aceptables y se puede utilizar para evaluar intervenciones que buscan promover la salud.

Objective: To develop and validate of an instrument to evaluate interventions in relation to Health Promotion principles in Brazil. Methods: A cross-sectional study of the development and validation of an instrument was carried out, based on the assessment of the first version by 20 health workers, the final version by 19, analysis of reliability by 31, and content evaluation of the first version by ten experts and of the final version by 12 experts. The content validity index, Cronbach's alpha (α) and intraclass correlation coefficient were used. Results: The indicators achieved 89.9% adequacy, 82.5% clarity, internal consistency was α=0,80, and the test-retest correlation was 0.93. Conclusion: The instrument showed acceptable validity and reliability and can be used for the evaluation of Health Promotion interventions.

Emotional Dysregulation Scale - Adults (EDEA): validity evidence / Escala de Desregulação Emocional - Adultos (EDEA): evidências de validade / Escala de Desregulación Emocional - Adultos (EDEA): evidencias de validez

Emotional self-regulation is necessary at various times in life; however, studies have indicated differences in the way men and women tend to express, contain, or change their emotions. These events are essential to be investigated in psychological instruments, since, when assessing this construct, an item could be endorsed by either sex, resulting in a biased conclusion. With this in mind, this study aimed to analyze the differential item functioning (DIF) of the Emotional Self-Regulation Scale - Adult (EARE-AD) for sadness, concerning the gender variable and the instrument's distribution's response categories. Due to the existence of DIF, neutralized items were prioritized, thus favoring less biased results. Based on this, in a second study, a reduced version of the scale (Emotional Dysregulation Scale - Adults - EDEA) with 15 items was proposed. We searched for validity evidence based on the internal structure for this new version.

A autorregulação emocional é necessária em diversas ocasiões da vida, porém estudos têm indicado diferenças na forma como homens e mulheres tendem a expressar, conter ou mudar suas emoções. É importante investigar essas considerações em instrumentos psicológicos, uma vez que, quando se avalia esse construto, sobretudo no caso de um item ter maior probabilidade de endosso por um ou outro sexo, os resultados podem ser enviesados. Com base nisso, o objetivo deste estudo foi analisar o funcionamento diferencial do item (DIF) da Escala de Autorregulação Emocional - Adulto (EARE-AD) para tristeza, em relação à variável sexo. Além disso, analisaram-se as distribuições das categorias de respostas do instrumento. Mediante a existência de DIF, itens neutralizados foram priorizados, favorecendo assim resultados menos tendenciosos. A partir disso, em um segundo estudo, foi proposta uma versão reduzida da escala (Escala de Desregulação Emocional - Adultos - EDEA) com 15 itens, com vistas a buscar evidências de validade baseadas na estrutura interna para essa nova versão.

La autorregulación emocional es necesaria en varios momentos de la vida, sin embargo, los estudios han indicado diferencias en la forma en que hombres y mujeres tienden a expresar, contener o cambiar sus emociones. Estas informaciones son importantes para ser investigadas en los instrumentos psicológicos, pues al evaluar estos aspectos, cuando es más probable que un ítem sea respaldado en ambos sexos, los resultados pueden estar sesgados. Así, el objetivo de este estudio fue analizar el funcionamiento diferencial del ítem (DIF) de la Escala de Autorregulación Emocional - Adulto (EARE-AD) para la tristeza, en relación con la variable de sexo, además de la distribución de las categorías de respuesta del instrumento. Debido a la existencia de DIF, se priorizaron los ítems neutralizados, lo que favoreció resultados menos sesgados. En base a esto, en un segundo estudio, se propuso una versión reducida de la escala (Escala de Desregulación Emocional - Adultos - EDEA) con 15 ítems, en que se buscó por la evidencia de validez basada en la estructura interna de esta nueva versión.

The Brazilian Portuguese version of the Exercise Adherence Rating Scale (EARS-Br) showed acceptable reliability, validity and responsiveness in chronic low back pain.

BACKGROUND: This study aimed to adapt the Exercise Adherence Rating Scale (EARS) into Brazilian Portuguese and evaluate its measurement properties, given as reliability, validity, and responsiveness in patients with non-specific Chronic Low Back Pain (CLBP). METHODS: A total of 108 patients with a mean age of 46.62 years (SD = 9.98) and CLBP participated in this longitudinal study. Participants were oriented on undertaking the prescribed exercises in the first session, and adherence behavior was assessed after 1 week, and finally reassessed after 2 weeks (test-retest reliability). Three weeks after the first assessment, they were invited again to full fill the EARS (responsiveness). The intraclass correlation coefficient (ICC2,1) and Cronbach's α were used to assess test-retest reliability and internal consistency, respectively. Spearman's correlation and confirmatory factor analysis (CFA) were used to assess construct validity, and the Receiver operating characteristic curve and area under the curve (AUC) were used to analyze responsiveness. RESULTS: The one-factor EARS-Br (adherence behavior) structure with 6 items showed acceptable fit indexes (comparative fit index and goodness of fit index> 0.90 and root-mean-square error of approximation< 0.08). The EARS-Br scale showed acceptable internal consistency (α = 0.88) and excellent reliability (ICC = 0.91 [95% CI 0.86-0.94]). Mild to moderate correlations were observed between EARS-Br total score vs. disability, pain catastrophizing, depression/anxiety, fear-avoidance and pain intensity. A Minimally Important Change (MIC) of 5.5 in the EARS-Br total score was considered as a meaningful change in the adherence behavior (AUC = 0.82). Moderate accuracy (AUC = 0.89) was obtained for a 17/24 total EARS cutoff score after home exercise was prescribed. The sensitivity and specificity were also acceptable (greater than 80%). CONCLUSION: Our results demonstrated acceptable EARS-Br reliability, validity, and responsiveness for patients with CLBP. A final score of 17/24 on EARS after the prescription of home-exercise could be used as a cut-off for an acceptable adherence behavior associated with improvement in patient outcomes.

Professional competence of nurses in emergency services: evidence of content validity / Competencia profesional del enfermero en urgencias: las evidencias de la validez del contenido / Competência profissional do enfermeiro em emergências: evidências de validade do conteúdo

ABSTRACT Objective: To verify the evidence of content validity of the Identifying Issues (Identification questions) elaborated from the theoretical-logical model of the Matrix and the Profile of Professional Competence of the emergency nurse. Method: Descriptive and methodological study of a quantitative approach with a psychometric reference as a precursor in the elaboration of a measurement instrument for the evaluation of competencies. The study was conducted in 2013 in Brazil, with a national sample of nurses specialized in emergency services and/or with professional competence in the area. Three stages were considered: questionnaire development; data collection with Delphi, appropriate statistics for Likert; and interpretative analysis of the comments/suggestions of the analyzed issues. Results: Delphi was used in four stages. There were minor adjustments to the content and inclusion of a new Competence. They obtained 90% of Score Percentage and 98.61 of Content Validity Index. Conclusion: There was consensus among the experts and the research demonstrated evidence of content validity, suggesting pertinence and adequacy to represent the constructs of competencies.

RESUMEN Objetivo: Certificar las evidencias de la validez con base en el contenido de las Cuestiones Identificadoras elaboradas desde el modelo teórico-lógico de la Matriz y del Perfil de Competencia Profesional del enfermero de urgencias. Método: Estudio descriptivo y metodológico de abordaje cuantitativo con referencial psicométrico como precursor en la elaboración de instrumento de medida de la evaluación de las competencias. Realizado en 2013 en Brasil, con muestra nacional de enfermeros expertos en urgencias y/o competencia profesional. Se consideraron tres etapas: la construcción de cuestionario; la recogida de los datos con Delphi, la estadística apropiada para Likert; y el análisis interpretativo de los comentarios/las sugerencias de las cuestiones juzgadas. Resultados: Delphi ocurrió en cuatro etapas. Hubo pequeños arreglos en el contenido y en la inclusión de una nueva Competencia. Obtuvieron el 90% de Porcentual de la Puntuación y 98,61 de Índice de Validez de Contenido. Conclusión: Hubo consenso entre los expertos y la investigación demostró evidencias de validez del contenido, sugiriendo pertinencia y adecuación para representar los constructos de competencias.

RESUMO Objetivo: Verificar as evidências de validade com base no conteúdo das Questões Identificadoras elaboradas a partir do modelo teórico-lógico da Matriz e do Perfil de Competência Profissional do enfermeiro de emergências. Método: Estudo descritivo e metodológico de abordagem quantitativa com referencial psicométrico como precursor na elaboração de instrumento de medida da avaliação das competências. Realizado em 2013 no Brasil, com amostra nacional de enfermeiros experts em emergências e/ou competência profissional. Consideraram-se três etapas: construção de questionário; coleta dos dados com Delphi, estatística apropriada para Likert; e análise interpretativa dos comentários/sugestões das questões julgadas. Resultados: Delphi ocorreu em quatro etapas. Houve pequenos ajustes no conteúdo e na inclusão de uma nova Competência. Obtiveram 90% de Percentual do Escore e 98,61 de Índice de Validade de Conteúdo. Conclusão: Houve consenso entre os experts e a pesquisa demonstrou evidências de validade do conteúdo, sugerindo pertinência e adequação para representar os construtos de competências.

Comparing methods of misclassification correction for studies of adolescent alcohol use.

BACKGROUND: Despite concerns over measurement error, self-report continues to be the most common measure of adolescent alcohol use used by researchers. Objective measures of adolescent alcohol use continue to advance; however, they tend to be cost prohibitive for larger studies. By combining appropriate statistical techniques and validation subsamples, the benefits of objective alcohol measures can be made more accessible to a greater number of researchers. OBJECTIVES: To compare three easily implemented methods to correct for measurement error when objective measures of alcohol use are available for a subsample of participants, regression calibration, multiple imputation for measurement error (MIME), and probabilistic sensitivity analysis (PSA), and provide guidance regarding the use of each method in scenarios likely to occur in practice. METHODS: This simulation experiment compared the performance of each method across different sample sizes, both differential and non-differential error, and differing levels of sensitivity and specificity of the exposure measure. RESULTS: Failure to adjust for measurement error led to substantial bias across all simulated scenarios ranging from a 35% to 208% change in the log-odds. For non-differential misclassification, regression calibration reduced this bias to between a 1% and 23% change in the log-odds regardless of sample size. At higher sample sizes, MIME produced approximately unbiased (between a 0% and 9% change in the log-odds) and relatively efficient corrections for both non-differential and differential misclassification. PSA provided little utility for correcting misclassification due to the inefficiency of its estimates. CONCLUSION: Concern over measurement error resulting from self-reported adolescent alcohol use persists in research. Where appropriate, methods involving validity subsamples provide an efficient avenue for addressing these concerns.

Validation of the self-assessment of communication skills and professionalism for nurses / Certificación de la autoevaluación de las habilidades de comunicación y profesionalismo para enfermeros / Validação do self-assessment of communication skills and professionalism para enfermeiros

ABSTRACT Objectives: to translate, adapt cross-culturally and validate into Brazilian Portuguese the following instrument: "Self-assessment of communication skills and professionalism in residents" for the nursing professional, and to determine if personal characteristics and performance of the nurse interfere in the self-assessment about professionalism and interpersonal communication. Method: quantitative study. Results: the sample consisted of 110 nurses with mean age of 32 years old (± 7.3), most of them were women (n = 80; 72.7%). The internal consistency of the scale "Autoavaliação sobre profissionalismo e comunicação interpessoal entre enfermeiro e paciente" presented moderate and satisfactory reliability (α=0,712). Factorial analysis identified four factors: Interpersonal Skills, Exchange of Information, Honesty in the Relationship and Professionalism. Conclusion: the instrument is valid and reliable in Portuguese and for Brazilian culture. Interpersonal Skills changed with gender and marital status. Ability to exchange information was influenced by gender and working sector. Self-assessment of professionalism changed with marital status.

RESUMEN Objetivos: traducir, adaptar culturalmente y certificar para la lengua portuguesa el instrumento de Autoevaluación de las Habilidades de Comunicación y Profesionalismo de residentes para el enfermero profesional y evaluar si las características personales y de actuación del enfermero interfieren en la autoevaluación del profesionalismo y de la comunicación interpersonal. Método: trata-se de un estudio metodológico cuantitativo. Resultados: La muestra estaba formada por 110 enfermeros con edad promedio de 32 años (±7,3) y la mayoría eran mujeres (n=80; 72,7%). La consistencia interna da la escala "Autoevaluación sobre profesionalismo y comunicación interpersonal entre enfermero y paciente" demostró confiabilidad moderada y satisfactoria (α=0,712). El análisis factorial identificó cuatro factores: Habilidad Interpersonal, Intercambio de Información, Sinceridad en las Relaciones y Profesionalismo. Conclusión: el instrumento es válido y confiable en la lengua portuguesa y para la cultura brasileña. La habilidad interpersonal osciló en relación con el sexo y el estado civil. El intercambio de informaciones fue influenciado por el sexo y el sector de actuación. La autoevaluación del profesionalismo sufrió variaciones según el estado civil.

RESUMO Objetivos: traduzir, adaptar culturalmente e validar para o português o instrumento Self-assessment of communication skills and professionalism in residents para o profissional enfermeiro e avaliar se características pessoais e de atuação do enfermeiro interferem na autoavaliação sobre o profissionalismo e comunicação interpessoal. Método: estudo metodológico quantitativo. Resultados: A amostra foi de 110 enfermeiros com média de idade de 32 anos (±7,3) e a maioria mulheres (n=80; 72,7%). A consistência interna da escala "Autoavaliação sobre profissionalismo e comunicação interpessoal entre enfermeiro e paciente" apresentou confiabilidade moderada e satisfatória (α=0,712). A análise fatorial identificou quatro fatores: Habilidade Interpessoal, Troca de Informação, Sinceridade na Relação e Profissionalismo. Conclusão: o instrumento é válido e confiável na língua portuguesa e para a cultura brasileira. A habilidade interpessoal modificou-se com sexo e estado civil. A troca de informações foi influenciada pelo sexo e setor de atuação. A autoavaliação do profissionalismo modificou-se com estado civil.

Evaluación de la técnica modificada de Dennis para el diagnóstico de fasciolosis bovina / Evaluation of modified Dennis parasitological technique for diagnosis of bovine fascioliasis

Introducción. La fasciolosis bovina genera cuantiosas pérdidas económicas, que en Colombia se estiman en COP$12.483 millones anuales, y tiene una prevalencia de 25 % en vacunos lecheros. La enfermedad se diagnostica mediante pruebas parasitológicas. En el país se utiliza la técnica de Dennis modificada en el 2002, pero su sensibilidad, especificidad y validez se desconocen. Objetivo. Evaluar la validez y el desempeño de la técnica modificada de Dennis para el diagnóstico de fasciolosis bovina, usando como prueba de referencia la observación de parásitos en el hígado. Materiales y métodos. Se hizo un estudio de evaluación diagnóstica. Se seleccionaron por conveniencia bóvidos de descarte sacrificados entre marzo y junio de 2013 en Frigocolanta; de cada ejemplar se recolectaron 25 g de heces y se examinaron los conductos biliares y el hígado en busca de Fasciola hepatica . Se estimaron los valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo e índice de validez, con intervalos de confianza de 95 %. Como prueba de referencia se usó la evaluación post mortem. Resultados. Se analizaron 180 bóvidos. La sensibilidad y la especificidad de la técnica modificada de Dennis fueron de 73,2 % (IC 95% 58,4-87,9) y 84,2 % (IC 95% 77,7-90,6), respectivamente. El valor predictivo positivo fue de 57,7 % (IC 95% 43,3-72,1) y el negativo fue de 91,4 % (IC 95% 86,2-96,6). La prevalencia de fasciolosis bovina fue de 22,8 % (IC 95% 16,4-29,2). Conclusión. La validez y el desempeño de la técnica modificada de Dennis fueron superiores a los de la técnica tradicional, por lo que constituye una buena heramienta de tamización para el diagnóstico de la fasciolosis en estudios poblacionales y de prevalencia, así como en jornadas de salud animal.

Introduction: Bovine fascioliasis causes important economic losses, estimated at COP$ 12,483 billion per year; its prevalence is 25% in dairy cattle. Parasitological techniques are required for it diagnosis. The Dennis technique, modified in 2002, is the one used in Colombia, but its sensitivity, specificity and validity are not known. Objective: To evaluate the validity and performance of the modified Dennis technique for diagnosis of bovine fascioliasis using as reference test the observation of parasites in the liver. Materials and methods: We conducted a diagnostic evaluation study. We selected a convenience sample of discarded bovines sacrificed between March and June, 2013, in Frigocolanta for the study. We collected 25 g of feces from each animal and their liver and bile ducts were examined for Fasciola hepatica . The sensitivity, specificity, predictive positive value, predictive negative value, and validity index were calculated with 95% confidence intervals. The post-mortem evaluation was used as the gold standard. Results: We analyzed 180 bovines. The sensitivity and specificity of the modified Dennis technique were 73.2% (95% CI=58.4% - 87.9%) and 84.2% (95% CI= 77.7% - 90.6%), respectively. The positive predictive value was 57.7% (95% CI= 43.3% - 72.1%) and the negative one 91.4% (95% CI= 86.2% - 96.6%). The prevalence of bovine fascioliasis was 22.8% (95% CI= 16.4% - 29.2%). Conclusion: The validity and the performance of the modified Dennis technique were higher than those of the traditional one, which makes it a good screening test for diagnosing fascioliasis for population and prevalence studies and during animal health campaigns.

Evaluation of modified Dennis parasitological technique for diagnosis of bovine fascioliasis.

INTRODUCTION: Bovine fascioliasis causes important economic losses, estimated at COP$ 12,483 billion per year; its prevalence is 25% in dairy cattle. Parasitological techniques are required for it diagnosis. The Dennis technique, modified in 2002, is the one used in Colombia, but its sensitivity, specificity and validity are not known.  OBJECTIVE: To evaluate the validity and performance of the modified Dennis technique for diagnosis of bovine fascioliasis using as reference test the observation of parasites in the liver.  MATERIALS AND METHODS: We conducted a diagnostic evaluation study. We selected a convenience sample of discarded bovines sacrificed between March and June, 2013, in Frigocolanta for the study. We collected 25 g of feces from each animal and their liver and bile ducts were examined for Fasciola hepatica. The sensitivity, specificity, predictive positive value, predictive negative value, and validity index were calculated with 95% confidence intervals. The post-mortem evaluation was used as the gold standard.  RESULTS: We analyzed 180 bovines. The sensitivity and specificity of the modified Dennis technique were 73.2% (95% CI=58.4% - 87.9%) and 84.2% (95% CI= 77.7% - 90.6%), respectively. The positive predictive value was 57.7% (95% CI= 43.3% - 72.1%) and the negative one 91.4% (95% CI= 86.2% - 96.6%). The prevalence of bovine fascioliasis was 22.8% (95% CI= 16.4% - 29.2%).  CONCLUSION: The validity and the performance of the modified Dennis technique were higher than those of the traditional one, which makes it a good screening test for diagnosing fascioliasis for population and prevalence studies and during animal health campaigns.

Evaluation of a screener to assess diet quality in the Netherlands.

Generally, there is a need for short questionnaires to estimate diet quality in the Netherlands. We developed a thirty-four-item FFQ--the Dutch Healthy Diet FFQ (DHD-FFQ)--to estimate adherence to the most recent Dutch guidelines for a healthy diet of 2006 using the DHD-index. The objectives of the present study were to evaluate the DHD-index derived from the DHD-FFQ by comparing it with the index based on a reference method and to examine associations with participant characteristics, nutrient intakes and levels of cardiometabolic risk factors. Data of 1235 Dutch men and women, aged between 20 and 70 years, participating in the Nutrition Questionnaires plus study were used. The DHD-index was calculated from the DHD-FFQ and from a reference method consisting of a 180-item FFQ combined with a 24-h urinary Na excretion value. Ranking was studied using Spearman's correlations, and absolute agreement was studied using a Bland-Altman plot. Nutrient intakes derived from the 180-item FFQ were studied according to quintiles of the DHD-index using DHD-FFQ data. The correlation between the DHD-index derived from the DHD-FFQ and the reference method was 0·56 (95% CI 0·52, 0·60). The Bland-Altman plot showed a small mean overestimation of the DHD-index derived from the DHD-FFQ compared with the reference method. The DHD-index score was in the favourable direction associated with most macronutrient and micronutrient intakes when adjusted for energy intake. No associations between the DHD-index score and cardiometabolic risk factors were observed. In conclusion, the DHD-index derived from the DHD-FFQ was considered acceptable in ranking but relatively poor in individual assessment of diet quality.

Validity assessment of the nutrition screening initiative checklist in older adults.

OBJECTIVE: To ascertain whether the NSI (Nutrition Screening Initiative Checklist) is a valid screening instrument for diagnosing nutritional risk in an older population from a medium-size city in the south of Brazil. METHODS: The study population comprised individuals aged 60 years or older selected from a population-based cross-sectional survey. Data collection was carried out at two different timepoints: first, the NSI (instrument under test) was applied and later a dietary recall (gold standard) based on the previous day. Validity analyses were performed based on sensitivity and specificity as well as the Receiver Operating Characteristic Curve. RESULTS: A total of 183 older adults were studied. Agreement between the dietary recall and the NSI for positive and negative results was 54.6%.The sensitivity and specificity values were low for all cut-off points of the instrument. The area under the curve was 0.52 (95%CI: 0.44-0.62) for the cut-off point ≥6. CONCLUSION: Based on sensitivity and specificity values, the NSI proved ineffective for application in the population studied.

Validación del Cuestionario de lugar de control del dolor en estudiantes argentinos con cefaleas recurrentes / Validation of the Pain Locus of Control Questionnaire in Argentinean University Students with Headaches / Validação do Questionário de lugar de controle da dor em estudantes argentinos com dores de cabeça recorrentes

Objetivo. Validar el Cuestionario de lugar de control del dolor (CLCD) en una muestra de estudiantes universitarios argentinos con cefaleas recurrentes. Método. Se empleó un muestreo no probabilístico intencional de 382 estudiantes universitarios de la ciudad de Córdoba (Argentina), que en los últimos seis meses habían sufrido de cefaleas. El 77.7% de la muestra fueron mujeres y el 22.3% varones, con una media de edad de 22.4 años (DE=4.2). Se realizaron estudios para evaluar la estructura interna, consistencia interna y la validez externa del cuestionario. Resultados. El análisis factorial exploratorio mostró tres factores que explicaban un 39.79% de la varianza: (1) locus de control externo por profesionales de la salud, (2) locus de control externo por azar y (3) locus de control interno. Asimismo, los valores alfa de Cronbach para evaluar la consistencia interna de los factores resultaron óptimos (valores α comprendidos entre 0.80 y 0.86).Los análisis realizados para evaluar la validez externa del cuestionario, mediante el coeficiente de correlación de Pearson, revelaron que los factores locus de control externo por profesionales de la salud y los factores locus de control externo por azar correlacionaron positivamente con la intensidad del dolor (r= 0.15, p<0.01; r=0.23, p<0.01, respectivamente), no obstante los valores obtenidos fueron bajos. Conclusión. Aunque presenta limitaciones en su validez externa, los estudios psicométricos realizados permiten concluir que el CLCD es un instrumento confiable y válido para evaluar locus de control en población universitaria argentina con dolor crónico ocasionado por cefaleas.

Objective. This study aims to validate the Pain Locus of Control Questionnaire (PLCQ) in Argentinean university students with recurrent headaches. Method. 382 university students were intentionally selected, 77.7% were females and the 22.3% males, with an average age of 22.4 years old (SD= 4.2). Psychometric studies were developed to evaluate internal structure, internal consistency and external validity. Results. Exploratory factor analysis revealed a factor structure of three dimensions that explained the 39.79% of variance: (1) health professional's external locus of control, (2) hazardous locus of control and (3) internal locus of control. Additionally, Cronbach's α values were observed to be optimal for the three factors of the scale (among 0.80 and 0.86). Although, Pearson's coefficients calculated to evaluate external validity revealed that the factors "health professionals' external locus of control" and "random external locus of control" were significantly and positively correlated to pain intensity (r=0.15/ p<0.01; r= 0.23, p<0.01, respectively), they turned out to be low. Conclusion. The psychometric studies developed in this study suggest that the PLCQ is reliable and valid to be used with Argentinean university students with recurrent headaches. However this study is preliminary, therefore more studies are needed to supplement these findings and to improve its lack of external validity.

Escopo. Validar o Questionário de lugar de controle de dor (QLCD) numa amostra de estudantes universitários argentinos com dores de cabeça recorrentes. Metodologia. Foi empregada uma amostragem não probabilística intencional de 382 estudantes universitários da cidade de Córdoba (Argentina) que nos últimos seis meses têm sofrido dores de cabeça. O 77.7% da amostra foram mulheres e 22.3% homens, com uma média de idade de 22.4 anos de idade (DE= 4.2). Foram realizados estudos para avaliar a estrutura interna, consistência interna e a validez externa do questionário. Resultados. A análise fatorial exploratório mostrou três fatores que explicavam um 39.79% da variação: 1) locus de controle externo por profissionais da saúde, 2) locus de controle externo aleatório e 3) locus de controle interno. Do mesmo jeito os valores alfa de Cronbach para avaliar a consistência interna dos fatores resultaram ótimos (valores α compreendidos entre 0.80 e 0.86). As análises feitas para avaliar a validez externa do questionário, a través do coeficiente de correlação de Pearson, revelaram que os fatores locus de controle externo por profissionais da saúde e os fatores locus de controle externo aleatório correlacionaram positivamente com a intensidade da dor (r= 0.15, p<0.01; r=0.23, p<0.01 respetivamente), contudo, os valores obtidos foram baixos. Conclusão. Embora apresente limitações na sua validez externa, os estudos psicométricos feitos permitem concluir que o QLCD é um instrumento confiável e válido para avaliar locus de controle em população universitária argentina com dor crónica ocasionada por dores de cabeça.

[Detection of an intrapulmonary shunt in patients with liver cirrhosis through contrast-enhanced transcranial Doppler. A study of prevalence, pattern characterization, and diagnostic validity]. / Detección del shunt intrapulmonar en pacientes con cirrosis hepática mediante doppler transcraneal con contraste. Estudio de prevalencia, caracterización del patrón y validez diagnóstica.

INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n=43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n=37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n=37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95%CI: 0.666-0.959; P=.001), sensitivity was 76.2% (95%CI: 54.9-89.4) and specificity was 90% (95%CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison.

Avaliação da equivalência semântica e consistência interna de uma versão em português do Internet Addiction Test (IAT) / Evaluation of semantic equivalence and internal consistency of a Portuguese version of the Internet Addiction Test (IAT)

OBJETIVO: Este estudo teve por objetivo a adaptação transcultural do Internet Addiction Test (IAT) para o idioma português. MÉTODOS: O trabalho consistiu em cinco etapas: (1) tradução; (2) retradução; (3) revisão técnica e avaliação da equivalência semântica por profissionais da área; (4) avaliação do instrumento por uma amostra de estudantes, avaliando-se o seu grau de compreensão; e (5) análise da consistência interna por meio do coeficiente alfa de Cronbach. RESULTADOS: O instrumento foi traduzido e adaptado para o idioma português, demonstrando ser facilmente compreendido e apresentando valor de consistência interna de 0,85. CONCLUSÃO: O instrumento encontra-se traduzido e adaptado para o português e apresenta consistência interna satisfatória. São necessárias análises de equivalência de mensuração e reprodutibilidade.

OBJECTIVE: The aim of this study was to cross-culturally adapt the Internet Addiction Test (IAT) to the Portuguese language. METHODS: The translation and evaluation process consisted of five steps: (1) translation; (2) back-translation; (3) peer review and evaluation of semantic equivalency by experts; (4) instrument evaluation through a sample of students, by evaluating their understanding level; and (5) analysis of the instrument's internal consistency (Cronbach's alpha-coefficient). RESULTS: The instrument was translated and adapted to Portuguese. As shown, the Portuguese version of the IAT was easily understood and the internal consistency value was 0.85. DISCUSSION: The translated and adapted IAT displays a satisfactory internal consistency. In a further step, measurement and reproducibility analyses have to be conducted.

Adaptação transcultural da Massachusetts General Hospital (MGH) Hairpulling Scale para o idioma português (Brasil) / Brazilian Portuguese cross-cultural adaptation of the Massachusetts General Hospital (MGH) Hairpulling Scale

CONTEXTO: A tricotilomania (TTM) caracteriza-se pelo ato de arrancar, de forma recorrente, os próprios cabelos por prazer, gratificação ou alívio de tensão, acarretando perda capilar perceptível. A Massachusetts General Hospital (MGH) Hairpulling Scale é um instrumento utilizado recentemente em muitos estudos para avaliar sintomas de TTM. OBJETIVO: O presente trabalho teve como objetivo adaptar essa escala para o idioma português. MÉTODOS: Envolveu cinco etapas: (1) tradução; (2) retradução; (3) revisão técnica e avaliação das equivalências semântica e conceitual por especialistas em saúde mental; (4) avaliação do instrumento por estudantes, por meio da avaliação do grau de compreensão e (5) análise da consistência interna do instrumento pelo coeficiente alfa de Cronbach. RESULTADOS: O instrumento foi traduzido e adaptado para o idioma português. Demonstrou ser de fácil compreensão e o valor da consistência interna correspondeu a 0,96. CONCLUSÃO: O instrumento encontra-se traduzido e adaptado para o idioma português. São necessárias análises de equivalência de mensuração e reprodutibilidade.

BACKGROUND: Trichotillomania (TTM) is characterized by the act of pulling out, in a recurrent way, your own hair for pleasure, gratification or tension release, leading to a perceptible hair loss, and it is included in the Impulse Control Disorders Unclassified Elsewhere of the DSM-IV-TR (APA, 1994) section. The Massachusetts General Hospital (MGH) Hairpulling Scale is an instrument used recently in many studies to assess trichotillomania symptoms. OBJECTIVE: The present paper aims to adapt this scale into the Portuguese language. To cross-culturally adapt the Massachusetts General Hospital (MGH) Hairpulling Scale to Portuguese and evaluate its internal consistency. This instrument aims to evaluate Trichotillomania. METHODS: The work consisted of five steps: (1) translation; (2) back-translation; (3) peer review and evaluation of semantic and conceptual equivalences using experts; (4) instrument evaluation through a sample of students, by evaluating their level of understanding; and (5) analysis of the instrument's internal consistency through Cronbach's a-coefficient. RESULTS: The instrument was translated and adapted to Portuguese, and shown to be easily understood, with an internal consistency value of 0.96. DISCUSSION: The instrument is now translated and adapted to Portuguese. Measurement and reproducibility analyses are needed.

Tradução para o português e validação do instrumento Diabetes Quality of Life Measure (DQOL-Brasil) / Translation to portuguese and validation of the Diabetes Quality Of Life Measure (DQOL-Brazil)

OBJETIVO: Avaliar as propriedades psicométricas da versão brasileira do questionário de medida da qualidade de vida em diabetes (DQOL). MÉTODOS: O DQOL foi traduzido ao português segundo protocolo e aplicado em 121 indivíduos (56,2 por cento mulheres), com tempo diagnóstico médio de diabetes melito tipo 2 de 8,1 ± 7,13 anos e na faixa etária de 32 a 89 anos. RESULTADOS: O instrumento apresentou consistência interna total (alfa de Cronbach = 0,92). Todas as questões apresentaram correlação positiva (p < 0,01) com seus domínios e com o escore geral do questionário, exceto as questões 18 e 35, que requereram exclusão da versão traduzida. O instrumento foi capaz de diferenciar pacientes com HbA1c acima e abaixo de 9 por cento (p = 0,01). CONCLUSÃO: O DQOL-Brasil apresenta aspectos de confiabilidade e validade adequados para sua utilização em pacientes adultos com diabetes tipo 2.

OBJECTIVE: To evaluate the psychometric properties of Brazilian version of Diabetes Quality of Life measure (DQoL-Brazil). METHODS: The DQOL was translate to Portuguese, following a recommended protocol, and applied to 121 subjects (56.2 percent females) with average diagnostic to type 2 diabetes of 8.1 (SD=7.13) years, (range 32-89 years old). RESULTS: The translated measure showed high internal consistency (Cronbach’s alpha = 0.92). A positive correlation (p < 0.01) was found between all the items and their scales and the total score of instrument, except in the items 18 and 35. These items were excluded from the translated version of DQoL. In concurrent validity analysis, patients with HbA1C higher than 9 percent presented a significantly higher (p = 0.01) total score for DQoL. CONCLUSION: DQoL-Brazil presents reliability and validity to be used in type 2 diabetes adult patients.