A High Activity Level Is Required for Augmented Muscle Capillarization in Older Women.

PURPOSE: This study aimed to evaluate the influence of lifelong regular physical activity on skeletal muscle capillarization in women. METHODS: Postmenopausal women, 61±4 yr old, were divided according to self-reported physical activity level over the past 20 yrs: sedentary (SED; n = 14), moderately active (MOD; n = 12), and very active (VERY; n = 15). Leg blood flow (LBF) was determined by ultrasound Doppler, and blood samples were drawn from the femoral artery and vein for calculation of leg oxygen uptake (LVO2) at rest and during one-legged knee extensor exercise. A skeletal muscle biopsy was obtained from the vastus lateralis and analyzed for capillarization and vascular endothelial growth factor (VEGF) and mitochondrial OXPHOS proteins. Platelets were isolated from venous blood and analyzed for VEGF content and effect on endothelial cell proliferation. RESULTS: The exercise-induced rise in LBF and LVO2 was faster (P = 0.008) in VERY compared with SED and MOD. Steady-state LBF and LVO2 were lower (P < 0.04) in MOD and VERY compared with SED. Capillary-fiber ratio and capillary density were greater (P < 0.03) in VERY (1.65 ± 0.48 and 409.3 ± 57.5) compared with MOD (1.30 ± 0.19 and 365.0 ± 40.2) and SED (1.30 ± 0.30 and 356.2 ± 66.3). Skeletal muscle VEGF and OXPHOS complexes I, II, and V were ~1.6-fold and ~1.25-fold (P < 0.01) higher, respectively, in VERY compared with SED. Platelets from all groups induced an approximately nine-fold (P < 0.001) increase in endothelial cell proliferation. CONCLUSION: A very active lifestyle is associated with superior skeletal muscle exercise hemodynamics and greater potential for oxygen extraction concurrent with a higher skeletal muscle capillarization and mitochondrial capacity.

A Machine Learning Approach to Classifying Self-Reported Health Status in a Cohort of Patients With Heart Disease Using Activity Tracker Data.

Constructing statistical models using personal sensor data could allow for tracking health status over time, thereby enabling the possibility of early intervention. The goal of this study was to use machine learning algorithms to classify patient-reported outcomes (PROs) using activity tracker data in a cohort of patients with stable ischemic heart disease (SIHD). A population of 182 patients with SIHD were monitored over a period of 12 weeks. Each subject received a Fitbit Charge 2 device to record daily activity data, and each subject completed eight Patient-Reported Outcomes Measurement Information Systems short form at the end of each week as a self-assessment of their health status. Two models were built to classify PRO scores using activity tracker data. The first model treated each week independently, whereas the second used a hidden Markov model (HMM) to take advantage of correlations between successive weeks. Retrospective analysis compared the classification accuracy of the two models and the importance of each feature. In the independent model, a random forest classifier achieved a mean area under curve (AUC) of 0.76 for classifying the physical function PRO. The HMM model achieved significantly better AUCs for all PROs (p < 0.05) other than Fatigue and Sleep Disturbance, with a highest mean AUC of 0.79 for the physical function-short form 10a. Our study demonstrates the ability of activity tracker data to classify health status over time. These results suggest that patient outcomes can be monitored in real time using activity trackers.

Considering BMI, body image and desired weight change for suitable obesity management options

With prevalence of obesity increasing worldwide, understanding body image in individuals with excessive weight is important, as unawareness of weight excess can prevent weight loss attempts. We explored the associations among measured and self-reported body mass index (BMI), body image and body satisfaction among Spanish females and males with overweight or obesity, with a special focus in discriminating individuals who are and are not satisfied with their body and wish or not to change their appearance. Just unifying all individuals with excessive weight may lead to uncover or deny different realities and to develop unfitted clinical management options. Updating findings for the Spanish population, we found that most participants correctly estimated their weight, but 3 in 10 underestimated it. Similarly, their body images corresponded to adults with overweight or obesity who desired to be thinner, but in average they reported a perceived body just slightly overweight and a moderate satisfaction with their body. Complementing the existing evidence, BMI and sex-gender interacted for influencing body weight estimation and desired weight change. In addition, three different subgroups were found for desired change of weight and size, depending on their BMI and body satisfaction. Discovering and considering different subjective realities and corporeal experiences among individuals with weight excess will help professionals to develop appropriate therapeutic interventions. Thus, the personal experiences that individuals have with obesity, instead of obesity itself, should be considered for disentangling management efforts

No disponible

Situational judgment tests as measures of 21st century skills: evidence across Europe and Latin America / Los tests de juicio situacional como medida de las habilidades para el siglo XXI: evidencia en toda Europa y América Latina

Over the years, various governmental, employment, and academic organizations have identified a list of skills to successfully master the challenges of the 21st century. So far, an adequate assessment of these skills across countries has remained challenging. Limitations inherent in the use of self-reports (e.g., lack of self-insight, socially desirable responding, response style bias, reference group bias, etc.) have spurred on the search for methods that could complement or even substitute self-report inventories. Situational judgment tests (SJTs) have been proposed as one of the complements/alternatives to the traditional self-report inventories. SJTs are low-fidelity simulations that confront participants with multiple domain-relevant situations and request to choose from a set of predefined responses. Our objectives are twofold: (a) outlining how a combined emic-etic approach can be used for developing SJT items that can be used across geographical regions and (b) investigating whether SJT scores can be compared across regions. Our data come from Laureate International Universities (N = 5,790) and comprise test-takers from Europe and Latin America who completed five different SJTs that were developed in line with a combined emic-etic approach. Results showed evidence for metric measurement invariance across participants from Europe and Latin America for all five SJTs. Implications for the use of SJTs as measures of 21st century skills are discussed

A lo largo de los años, varias organizaciones gubernamentales de empleo y académicas han identificado una lista de habilidades para superar con éxito los desafíos del siglo XXI. Hasta ahora, una evaluación adecuada de estas habilidades en los países ha continuado siendo un reto. Las limitaciones inherentes al uso de autoinformes (p. ej., falta de autoconocimiento, respuestas socialmente deseables, sesgo en el estilo de respuesta, sesgo del grupo de referencia, etc.) han estimulado la búsqueda de métodos que puedan complementar o incluso sustituir inventarios de autoinforme. Los tests de juicio situacional (TJS) se han propuesto como uno de los complementos/alternativas a los inventarios tradicionales de autoinforme. Los TJS son simulaciones de baja fidelidad que enfrentan a los participantes con múltiples situaciones de dominio relevantes y solicitan elegir entre un conjunto de respuestas predefinidas. Tenemos un doble objetivo: (a) explicar cómo se puede utilizar un enfoque emic-etic combinado para desarrollar ítems de TJS que se puedan emplear en todas las regiones geográficas y (b) investigar si las puntuaciones de los TJS se pueden comparar entre regiones. Nuestros datos provienen de las Laureate International Universities (N = 5,790) y están compuestos por examinandos de Europa y América Latina que cumplimentaron cinco TJS diferentes que se desarrollaron de acuerdo a un enfoque emic-ethic. Los resultados mostraron la existencia de invarianza en la medición en los participantes de Europa y América Latina para los cinco TJS. Se discuten las implicaciones para el uso de TJS como medida para detectar habilidades en el siglo XXI

Manipulating the 5 Dimensions of the EuroQol Instrument: The Effects on Self-Reporting Actual Health and Valuing Hypothetical Health States.

Background. The EQ-5D instrument has 5 dimensions. This article reports on the effects of manipulating a) the order in which the 5 dimensions are presented (appearing first v. last), b) splitting of the composite dimensions ("pain or discomfort" and "anxiety or depression"), and c) removing or "bolting off" 1 of the 5 EQ-5D dimensions at a time. The effects were examined in 2 contexts: 1) self-reporting health and 2) health state valuations. Methods. Three different types of discrete choice experiments (DCE) including a duration attribute were designed. An online survey with 12 subtypes, each with 10 DCE tasks, was designed and completed by 2494 members of the UK general public. Results. Of the 3 manipulations in the self-reporting context, only b) splitting anxiety or depression had a significant effect. In the health state valuation context, b) splitting level 5 pain or discomfort (relative to pain) and splitting level 5 anxiety or depression (relative to anxiety) had significant effects as did c) bolting off dimensions. Conclusions. We find that the values given to certain health dimensions are sensitive to the way in which it is described and the other health dimensions presented. Of particular interest is the effect of splitting composite dimensions: a given EQ-5D(-5L) profile may mean different things depending on whether the profile is used to self-report one's health or to value hypothetical states, so that the health state values of EQ-5D(-5L) in population tariffs may not correspond to the states that patients self-report themselves in.

Neuroticismo e ideas suicidas: un estudio meta-analítico / Neuroticism and suicidal thoughts: a meta-analytic study

Fundamentos: Existen resultados discrepantes sobre la relación existente entre neuroticismo e ideas suicidas en población comunitaria. Los objetivos de este estudio fueron estimar la magnitud y dirección de la asociación entre neuroticismo e ideas suicidas, así como analizar la influencia de posibles variables moderadoras sobre el tamaño del efecto. Métodos: Se llevó a cabo una revisión sistemática y meta-análisis. La búsqueda de estudios se realizó en PubMed/MEDLINE, IME, Lilacs, CINAHL y EMBASE, siendo el límite temporal hasta enero de 2015. También se hizo una búsqueda manual y se contactó con los autores principales para localizar estudios. Los criterios de inclusión fueron: (a) estudios que analizaran la relación neuroticismo e ideación suicida; (b) estudios observacionales y descriptivos; (c) estudios realizados con población comunitaria mayor de 18 años; (d) en cualquier región geográfica; y (e) escritos en inglés, español, francés, portugués o italiano. Se utilizó el modelo de efectos aleatorios para la obtención del tamaño del efecto y el análisis de posibles variables moderadoras. Resultados: 13 artículos referidos a la relación entre neuroticismo e ideación suicida se incluyeron en el meta-análisis. El tamaño del efecto medio fue r + = 0,446 (IC 95%: 0,266-0,595). Se descartó la presencia de sesgo de publicación como una amenaza contra la validez de los resultados. Se estableció un modelo predictivo con dos variables moderadoras: sexo y tipo de autoinforme para medir neuroticismo. Conclusión: El neuroticismo puede considerarse un factor de riesgo para presentar ideas suicidas. Este resultado es importante de cara a la prevención del fenómeno suicida

Background: There are conflicting results on the relationship between neuroticism and suicidal ideation in community population. The objectives of this study were to estimate the magnitude and direction of the association between neuroticism and suicide ideation, and to analyze the influence of moderator variables on the effect size. Methods: A systematic review and a meta-analysis were carried out. The search for studies was conducted in PubMed/MEDLINE, IME, Lilacs, CINAHL, and EMBASE, until January 2015. A manual search was also carried out and main researchers were contacted. The inclusion criteria were: (a) studies of the association between neuroticism and suicidal ideation; (b) observational and descriptive studies; (c) studies carried out with community population over 18 years; (d) in any geographic region; and (e) written in English, Spanish, French, Portuguese or Italian. The random-effects model was applied to obtain the mean effect size and to explore moderators. Results: Thirteen articles focused on the association between neuroticism and suicide ideation were included in the meta-analysis. The mean effect size was r + = 0.446 (IC 95%: 0.266-0.595). Publication bias was discarded as a threat against the validity of the results. A predictive model was stablished with two moderator variables: gender and type of self-report to measure neuroticism. Conclusion: Neuroticism can be considered as a risk factor for suicide ideation. This result is important to prevent both suicidal ideation and suicide behavior

Comparison of machine classification algorithms for fibromyalgia: neuroimages versus self-report.

UNLABELLED: Recent studies have posited that machine learning (ML) techniques accurately classify individuals with and without pain solely based on neuroimaging data. These studies claim that self-report is unreliable, making "objective" neuroimaging classification methods imperative. However, the relative performance of ML on neuroimaging and self-report data have not been compared. This study used commonly reported ML algorithms to measure differences between "objective" neuroimaging data and "subjective" self-report (ie, mood and pain intensity) in their ability to discriminate between individuals with and without chronic pain. Structural magnetic resonance imaging data from 26 individuals (14 individuals with fibromyalgia and 12 healthy controls) were processed to derive volumes from 56 brain regions per person. Self-report data included visual analog scale ratings for pain intensity and mood (ie, anger, anxiety, depression, frustration, and fear). Separate models representing brain volumes, mood ratings, and pain intensity ratings were estimated across several ML algorithms. Classification accuracy of brain volumes ranged from 53 to 76%, whereas mood and pain intensity ratings ranged from 79 to 96% and 83 to 96%, respectively. Overall, models derived from self-report data outperformed neuroimaging models by an average of 22%. Although neuroimaging clearly provides useful insights for understanding neural mechanisms underlying pain processing, self-report is reliable and accurate and continues to be clinically vital. PERSPECTIVE: The present study compares neuroimaging, self-reported mood, and self-reported pain intensity data in their ability to classify individuals with and without fibromyalgia using ML algorithms. Overall, models derived from self-reported mood and pain intensity data outperformed structural neuroimaging models.

Pain phenotype in patients with knee osteoarthritis: classification and measurement properties of painDETECT and self-report Leeds assessment of neuropathic symptoms and signs scale in a cross-sectional study.

OBJECTIVE: Multiple mechanisms are involved in pain associated with osteoarthritis (OA). The painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaires screen for neuropathic pain and may also identify individuals with musculoskeletal pain who exhibit abnormal central pain processing. The aim of this cross-sectional study was to evaluate painDETECT and S-LANSS for classification agreement and fit to the Rasch model, and to explore their relationship to pain severity and pain mechanisms in OA. METHODS: A total of 192 patients with knee OA completed questionnaires covering different aspects of pain. Another group of 77 patients with knee OA completed questionnaires and underwent quantitative sensory testing for pressure-pain thresholds (PPTs). Agreement between painDETECT and S-LANSS was evaluated using kappa coefficients and receiver operator characteristic (ROC) curves. Rasch analysis of both questionnaires was conducted. Relationships between screening questionnaires and measures of pain severity or PPTs were calculated using correlations. RESULTS: PainDETECT and S-LANSS shared a stronger correlation with each other than with measures of pain severity. ROC curves identified optimal cutoff scores for painDETECT and S-LANSS to maximize agreement, but the kappa coefficient was low (κ = 0.33-0.46). Rasch analysis supported the measurement properties of painDETECT but not those of S-LANSS. Higher painDETECT scores were associated with widespread reductions in PPTs. CONCLUSION: The data suggest that painDETECT assesses pain quality associated with augmented central pain processing in patients with OA. Although developed as a screening questionnaire, painDETECT may also function as a measure of characteristics that indicate augmented central pain processing. Agreement between painDETECT and S-LANSS for pain classification was low, and it is currently unknown which tool may best predict treatment outcome.

Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs).

BACKGROUND: Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. METHODS: Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. RESULTS: Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, 'physical function' in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. CONCLUSION: This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials.

Self-reported adherence to the physical activity recommendation and determinants of misperception in older adults.

We aimed to compare self-reported adherence to the physical activity recommendation with accelerometry in older adults and to identify determinants of misperception. The sample included 138 adults age 65-75 yr old participating in the Longitudinal Aging Study Amsterdam. Participants completed a lifestyle questionnaire and wore an accelerometer for one week. More than half (56.8%) of the participants reported to adhere to the physical activity recommendation (in 5-min bouts), however, based on accelerometry, this percentage was only 24.6%. Of those who reported to adhere, 65.3% did not do so based on accelerometry. The misperceivers were older (p < .009), more often female (p = .007), had a poorer walking performance (p = .02), reported a lower social support (p = .04), and tended to have a lower self-efficacy (p = .09) compared with those who correctly perceived their adherence to the recommendation. These results suggest that misperception of adherence to the physical activity recommendation is highly prevalent among specific subgroups of older adults.

International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies.

OBJECTIVE: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Borderline Personality Disorder (BPD) diagnosis with the self-report Personality Diagnostic Questionnaire­4+(PDQ-4+): confirmation of the 3-factor structure.

INTRODUCTION: The clinical heterogeneity and elevated comorbidity of Borderline Personality Disorder (BPD) have suggested the possible existence of several factors or subtypes of this construct. Studies published to date mainly show that this diagnosis could be represented either as a 1-dimensional model or 3-factor model. However, most of the studies have analyzed the factorial structure of the BPD DSM-IV criteria only using semi-structured interviews. This study has aimed to analyze the factorial structure of BPD DSM-IV criteria used in the self-report PDQ-4+. METHOD: A total of 159 psychiatric outpatients with suspicion of BPD diagnosis were evaluated. Confirmatory Factor Analyses (CFA) was performed for BPD criteria in PDQ-4+ and two previously defined structures were examined and compared: a 1-dimensional model and a 3-factor model. RESULTS: Both models showed good fit indexes. However, the results of the CFA showed better goodness of fit indexes (χ(2)/gl; CFI; RMSEA; TLI; AIC and GFI) for the 3-factor model. CONCLUSIONS: BPD is a construct that can be used to describe three factors of criteria that represent different features of this disorder. The three factors, which could be called Disturbed Relatedness, Affective Instability and Behavioral Dyscontrol, can also be explained by the combination of different diagnostic criteria. The existence of these factors could indicate the presence of different subgroups of BPD patients with different clinical patterns.

The accuracy of the Goldberg method for classifying misreporters of energy intake on a food frequency questionnaire and 24-h recalls: comparison with doubly labeled water.

BACKGROUND/OBJECTIVES: Adults often misreport dietary intake; the magnitude varies by the methods used to assess diet and classify participants. The objective was to quantify the accuracy of the Goldberg method for categorizing misreporters on a food frequency questionnaire (FFQ) and two 24-h recalls (24HRs). SUBJECTS/METHODS: We compared the Goldberg method, which uses an equation to predict total energy expenditure (TEE), with a criterion method that uses doubly labeled water (DLW), in a study of 451 men and women. Underreporting was classified using recommended cut points and calculated values. Sensitivity and specificity, positive predictive value (PPV) and negative predictive value and the area under the receiver operating characteristic curve (AUC) were calculated. Predictive models of underreporting were contrasted for the Goldberg and DLW methods. RESULTS: AUCs were 0.974 and 0.972 on the FFQ, and 0.961 and 0.938 on the 24HR for men and women, respectively. The sensitivity of the Goldberg method was higher for the FFQ (92%) than the 24HR (50%); specificity was higher for the 24HR (99%) than the FFQ (88%); PPV was high for the 24HR (92%) and FFQ (88%). Simulation studies indicate attenuation in odds ratio estimates and reduction of power in predictive models. CONCLUSIONS: Although use of the Goldberg method may lead to bias and reduction in power in predictive models of underreporting, the method has high predictive value for both the FFQ and the 24HR. Thus, in the absence of objective measures of TEE or physical activity, the Goldberg method is a reasonable approach to characterize underreporting.

Association of clinical findings of temporomandibular disorders (TMD) with self-reported musculoskeletal pains.

BACKGROUND AND AIMS: Temporomandibular disorders (TMD) can be related to self-reported musculoskeletal pains. The aim of the study was to investigate the association of clinical findings of TMD with self-reported pain in other parts of the body, and to discriminate pain clusters according to definite profiles of pain conditions including TMD among subjects in general population. METHODS: A nationally representative Health 2000 Survey was carried out in 2000-2001 in Finland. The data were obtained from 6227 subjects aged ⩾30years. Information about pain in different parts of the body was collected from a questionnaire. The associations between clinically assessed TMD findings and pain in other areas were analyzed using chi-square test and logistic regression analyses. Latent class analysis (LCA) was used to form natural clusters, i.e., groups in which the individuals had similar profiles of pain conditions. RESULTS: Masticatory muscle pain on palpation associated with back, neck and shoulder pain and pain in joints. Temporomandibular joint (TMJ) pain on palpation associated with back, neck, shoulder and other joint pain. These associations did not change essentially after adjustment for confounders. After clustering of the study population with the LCA, 5.8% of the study population showed a multiple pain condition linked with TMD findings. Female gender, intermediate/poor self-reported health and presence of a longstanding illness increased the probability to belong to this cluster. CONCLUSIONS: TMD findings associate with pain in several locations. Female gender and presence of impaired health were particularly related to occurrence of multiple pain conditions.