Spanish Adaptation of the Mentalization Questionnaire (MZQ) in Community Adolescents and Adults.

BACKGROUND: Despite the role of mentalization in mental health outcomes and prevention, psychometrically-evaluated screening measures for mentalization remain sparse. One widely-used mentalization questionnaire is the Mentalization Questionnaire (MZQ; Hausberg et al., 2012), which we aimed to adapt and validate for use in Spanish. METHOD: We adapted the MZQ to European Spanish and evaluated its psychometric properties in both adolescent (n = 389, ages 12-19, M = 14.5) and adult community samples (n = 382, M = 48). RESULTS: Confirmatory factor analysis resulted in a unidimensional structure including all items. This model had better goodness of fit than the original and other adaptations. Invariance analysis showed the same structure in adolescents compared by sex and age, and additionally in the adult versus adolescent samples. Evidence for convergent and discriminant validity was found. Internal consistency values in both adolescents and parents were fair and in the adolescent sample the MZQ scores remained moderately stable after re-test. CONCLUSIONS: The Spanish adaptation of the MZQ presents similar evidence of reliability and validity in the adolescent and adult samples. The results support this being a suitable version for evaluating mentalization in the general population.

Spanish Adaptation of the Mentalization Questionnaire (MZQ) in Community Adolescents and Adults / Adaptación Española del Cuestionario de Mentalización (MentalizationQuestionnaire; MZQ) para Adolescentes y Adultos de Población General

Background: Despite the role of mentalization in mental health outcomes and prevention, psychometrically-evaluated screening measures for mentalization remain sparse. One widely-used mentalization questionnaire is the Mentalization Questionnaire (MZQ; Hausberg et al., 2012), which we aimed to adapt and validate for use in Spanish. Method: We adapted the MZQ to European Spanish and evaluated its psychometric properties in both adolescent (n = 389, ages 12-19, M = 14.5) and adult community samples (n = 382, M = 48). Results: Confirmatory factor analysis resulted in a unidimensional structure including all items. This model had better goodness of fit than the original and other adaptations. Invariance analysis showed the same structure in adolescents compared by sex and age, and additionally in the adult versus adolescent samples. Evidence for convergent and discriminant validity was found. Internal consistency values in both adolescents and parents were fair and in the adolescent sample the MZQ scores remained moderately stable after re-test. Conclusions: The Spanish adaptation of the MZQ presents similar evidence of reliability and validity in the adolescent and adult samples. The results support this being a suitable version for evaluating mentalization in the general population.(AU)

Antecedentes: A pesar del creciente reconocimiento de la mentalización como factor en el desarrollo de la salud mental y la prevención, las medidas de cribado validadas psicométricamente siguen siendo escasas. El Cuestionario de Mentalización (MZQ; Hausberg et al., 2012) es uno de los más utilizados. El objetivo es adaptar y validar su uso al español. Método: Adaptamos el MZQ al español europeo en muestras comunitarias de adolescentes (n = 389, edades 12-19, M = 14,5) y de adultos (n = 382, M = 48). Resultados: Se realizó un análisis factorial confirmatorio que expuso una estructura unifactorial para ambas muestras. Este modelo presentó mejores índices de ajuste que los modelos presentados en la versión original y en las adaptaciones. El estudio de invariancia mostró la misma estructura en la muestra de adolescentes cuando se compararon por sexo y edad, y también en la muestra de adultos comparada con la muestra de adolescentes. Se encontraron evidencias de validez convergente y discriminante. Conclusiones: La adaptación del MZQ al español presenta evidencias de validez y fiabilidad similares en la muestra de adolescentes y en la de adultos. Los resultados apoyan que se trata de una versión apta para evaluar la mentalización en población general.(AU)

Over 40 years (1981-2023) assessing stigma with the Community Attitudes to Mental Illness (CAMI) scale: a systematic review of its psychometric properties.

BACKGROUND: The Community Attitudes to Mental Illness (CAMI) scale measures social stigma towards people with mental illness. Although it has been used worldwide, the psychometric properties of the CAMI have not been systematically reviewed. The main aim of this study was to systematically review the psychometric properties of the different versions of the CAMI more than 40 years after of its publication. METHODS: A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, and EMBASE from 1981 (year of publication) to 2023 (present). A double review was performed for eligibility, data extraction, and quality assessment. RESULTS: A total of 15 studies enrolling 10,841 participants were included. The most frequently reported factor structure comprises 3 or 4 factors. Overall, the internal consistency seems adequate for the global scale (α ≥ 0.80), except for CAMI-10 (α = 0.69). Internal consistency of the subscales are not supported, with authoritarianism being the weakest factor (α = 0.27 to 0.68). The stability over time of the total scale has been assessed in the CAMI-40, CAMI-BR, and CAMI-10 (r ≥ 0.39). Few studies have assessed the temporal stability of the CAMI subscales. Most of the correlations with potentially related measures are significant and in the expected direction. CONCLUSIONS: The 3 and 4 factor structure are the most widely reported in the different versions of the CAMI. Even though reliability and construct validity are acceptable, further item refinement by international consensus seems warranted more than 40 years after the original publication. SYSTEMATIC REVIEW REGISTRATION: PROSPERO identification number: CRD42018098956.

Coefficient Alpha: The Resistance of a Classic.

BACKGROUND: During the 20th century the alpha coefficient (α) was widely used in the estimation of the internal consistency reliability of test scores. After misuses were identified in the early 21st century alternatives became widespread, especially the omega coefficient (ω). Nowadays, α is re-emerging as an acceptable option for reliability estimation. METHOD: A review of the recent academic contributions, journal publication habits and recommendations from normative texts was carried out to identify good practices in estimation of internal consistency reliability. RESULTS: To guide the analysis, we propose a three-phase decision diagram, which includes item description, fit of the measurement model for the test, and choice of the reliability coefficient for test score(s). We also provide recommendations on the use of R, Jamovi, JASP, Mplus, SPSS and Stata software to perform the analysis. CONCLUSIONS: Both α and ω are suitable for items with approximately normal distributions and approximately unidimensional and congeneric measures without extreme factor loadings. When items show non-normal distributions, strong specific components, or correlated errors, variants of ω are more appropriate. Some require specific data gathering designs. On a practical level we recommend a critical approach when using the software.

Coefficient Alpha: The Resistance of a Classic / Coeficiente Alfa: la Resistencia de un Clásico

Background: During the 20th century the alpha coefficient (α) was widely used in the estimation of the internal consistency reliability of test scores. After misuses were identified in the early 21st century alternatives became widespread, especially the omega coefficient (ω). Nowadays, α is re-emerging as an acceptable option for reliability estimation. Method: A review of the recent academic contributions, journal publication habits and recommendations from normative texts was carried out to identify good practices in estimation of internal consistency reliability. Results: To guide the analysis, we propose a three-phase decision diagram, which includes item description, fit of the measurement model for the test, and choice of the reliability coefficient for test score(s). We also provide recommendations on the use of R, Jamovi, JASP, Mplus, SPSS and Stata software to perform the analysis. Conclusions: Both α and ω are suitable for items with approximately normal distributions and approximately unidimensional and congeneric measures without extreme factor loadings. When items show non-normal distributions, strong specific components, or correlated errors, variants of ω are more appropriate. Some require specific data gathering designs. On a practical level we recommend a critical approach when using the software.(AU)

Antecedentes: Durante el siglo XX el coeficiente alfa (α) fue ampliamente utilizado en el cálculo de la consistencia interna de las puntuaciones de los test. Después de identificar algunos malos usos, a principios del siglo XXI se difundieron alternativas, especialmente el coeficiente omega (ω). Actualmente α resurge como una opción aceptable. Método: Revisamos aportaciones académicas, hábitos de publicación en revistas y recomendaciones de textos normativos con el fin de identificar buenas prácticas en la estimación de la fiabilidad de consistencia interna. Resultados: Para guiar el análisis, proponemos un diagrama de decisión en tres fases, a saber, descripción de los ítems, ajuste del modelo de medida del test y elección del coeficiente de fiabilidad de las puntuaciones. Para su ejecución proporcionamos recomendaciones sobre el uso de los programas R, Jamovi, JASP, Mplus, SPSS y Stata. Conclusiones: Tanto α como ω son adecuados para ítems que se distribuyen de forma aproximadamente normal y medidas aproximadamente unidimensionales y congenéricas sin cargas factoriales extremas. Cuando los ítems tienen otra distribución, un fuerte componente específico o sus errores están correlacionados, resultan más adecuadas variantes de ω. Algunas de ellas requieren diseños específicos de obtención de datos. A nivel práctico recomendamos un uso crítico del software.(AU)

Octava evaluación de test editados en España: una experiencia participativa / Eighth Review Of Tests Published In Spain: A Participative Experience

La Comisión de Test del Consejo General de la Psicología en España promueve anualmente la revisión de la calidad de diferentes test publicados. Este trabajo tiene un doble objetivo: a) presentar los resultados de la octava edición y b) considerar la aportación dela universidad en dicho proceso. En esta edición participaron 10 especialistas, 332 estudiantes y siete profesores, adaptándose el protocolo estándar de revisión al formato aprendizaje-servicio. En cuanto a los resultados, la calidad de los 11 test evaluados fue adecuada (promedio de 3,9 puntos en una escala 1-5) y similar a años anteriores (r = 0,90). El desarrollo y la baremación fueron puntos fuertes, mientras que se proponen mejoras en otros aspectos. El aprendizaje-servicio contribuyó a la diversificación de voces en el proceso observándose una calidad similar entre los informes del estudiantado y los emitidos por especialistas y un grado de acuerdo esperable (r = 0,67) entre ellos. Concluimos que el presente proyecto ha permitido identificar la oportunidad de profundizaren el uso de lenguaje compartido para fortalecer la comunicación entre las casas editoriales, la comisión promotora del modelo español de revisión de test, y las personas usuarias de los test, particularmente si se trata de principiantes. (AU)

Every year, the Test Commission of the Spanish Psychological Association promotes the assessment of the test quality of several published tests. The aim of the present study is two-fold: a) to present results for the eighth review, and b) to consider the contribution of the universities in this process. Ten experts, 332 students, and seven professors participated in this edition and the standardprotocol for review was aligned towards a service-learning format. For the 11 tests assessed, results showed an adequate quality(average of 3.9 points on a 1-5 rating scale) similar to previous years (r = .90). The strengths were test development andstandardization, and a number of proposals for improving other sections were suggested. The service-learning approach contributed to the diversification of voices in the process with students’ and experts’ reports showing similar quality and an expectedlevel of agreement (r = .67). We conclude that this project has helped to identify the opportunity to further deepen the use of shared language in order to strengthen the communication between the test publishers, the promoters of the Spanish model of testassessment, and the test users, especially in the case of beginners. (AU)

Salud del cuidador: adaptación y validación del cuestionario Experience of Caregiving Inventory (ECI) en población española / Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)

Objetivo: Adaptar y validar el Experience of Caregiving Inventory (ECI) en población española, aportando evidencia empírica de su consistencia interna, estructura interna y validez. Método: Validación psicométrica de la versión adaptada del ECI. Participaron 172 personas cuidadoras (69,2% mujeres) con una edad media de 57,51 años (rango: 21-89). Se usaron datos sociodemográficos y clínicos, e instrumentos estandarizados (ECI, escala de sufrimiento SCL-90-R y escala de sobrecarga Zarit). Se analizaron las dos escalas de apreciación negativa del ECI más relacionadas con trastornos mentales graves (conductas disruptivas [CD] y síntomas negativos [SN]) y las dos escalas de apreciación positiva (experiencias personales positivas [EPP] y aspectos buenos de la relación [ABR]). Se utilizó unExploratory Structural Equation Modelingpara analizar la estructura interna. También se estudió la relación entre las escalas del ECI y las puntuaciones de SCL-90-R y Zarit. Resultados: El modelo de cuatro factores presentó buen ajuste. El alfa de Cronbach (CD: 0,873; SN: 0,825; EPP: 0,720; ABR: 0,578) mostró una mayor homogeneidad en las escalas negativas. Las puntuaciones del SCL-90-R se correlacionaron con las escalas negativas del ECI, y ninguna de las escalas del ECI se correlacionó con la escala Zarit. Conclusiones: La versión ECI en español puede considerarse un instrumento válido, fiable y factible para su administración en los contextos sanitario y comunitario

Objective: To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity. Method: Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied. Results: The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale. Conclusions: The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context

[Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)]. / Salud del cuidador: adaptación y validación del cuestionario Experience of Caregiving Inventory (ECI) en población española.

OBJECTIVE: To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity. METHOD: Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied. RESULTS: The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale. CONCLUSIONS: The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context.

A journey around alpha and omega to estimate internal consistency reliability / Un viaje alrededor de alfa y omega para estimar la fiabilidad de consistencia interna

Based on recent psychometric developments, this paper presents a conceptual and practical guide for estimating internal consistency reliability of measures obtained as item sum or mean. The internal consistency reliability coefficient is presented as a by-product of the measurement model underlying the item responses. A three-step procedure is proposed for its estimation, including descriptive data analysis, test of relevant measurement models, and computation of internal consistency coefficient and its confidence interval. Provided formulas include: (a) Cronbach’s alpha and omega coefficients for unidimensional measures with quantitative item response scales, (b) coefficients ordinal omega, ordinal alpha and nonlinear reliability for unidimensional measures with dichotomic and ordinal items, (c) coefficients omega and omega hierarchical for essentially unidimensional scales presenting method effects. The procedure is generalized to weighted sum measures, multidimensional scales, complex designs with multilevel and/or missing data and to scale development. Four illustrative numerical examples are fully explained and the data and the R syntax are provided (AU)

En este trabajo se presenta una guía conceptual y práctica para estimar la fiabilidad de consistencia interna de medidas obtenidas mediante suma o promedio de ítems con base en las aportaciones más recientes de la psicometría. El coeficiente de fiabilidad de consistencia interna se presenta como un subproducto del modelo de medida subyacente en las respuestas a los ítems y se propone su estimación mediante un procedimiento de análisis de los ítems en tres fases, a saber, análisis descriptivo, comprobación de los modelos de medida pertinentes y cálculo del coeficiente de consistencia interna y su intervalo de confianza. Se proporcionan las siguientes fórmulas: (a) los coeficientes alfa de Cronbach y omega para medidas unidimensionales con ítems cuantitativos (b) los coeficientes omega ordinal, alfa ordinal y de fiabilidad no lineal para ítems dicotómicos y ordinales, y (c) los coeficientes omega y omega jerárquico para medidas esencialmente unidimensionales con efectos de método. El procedimiento se generaliza al aná- lisis de medidas obtenidas por suma ponderada, de escalas multidimensionales, de diseños complejos con datos multinivel y/o faltantes y también al desarrollo de escalas. Con fines ilustrativos se expone el análisis de cuatro ejemplos numéricos y se proporcionan los datos y la sintaxis en R (AU)

How does emotional exhaustion influence work stress? Relationships between stressor appraisals, hedonic tone, and fatigue in nurses' daily tasks: A longitudinal cohort study.

BACKGROUND: Work-related stress is a prevalent condition in the nursing profession, and its influence may vary according to changeable individual and situational factors. It is, therefore, important to investigate the real-time momentary changes in these factors and their relationship to emotional exhaustion experienced by nurses. OBJECTIVES: We aim to analyse how their perceptions of demand, control, effort and reward change according to the task performed through real-time assessment and interact with the emotional exhaustion level of ward nurses. DESIGN: The research design was longitudinal. METHOD: A three-level hierarchical model with a repeated measures design was used to assess the momentary self-reports of 96 hospital ward nurses, completed using a smartphone programmed with random alarms. RESULTS: Findings show that demand, effort, and control appraisals depend on the task performed. The task appraised as most demanding, effortful, and controllable was direct care. Reward appraisal depends on the task performed and personal variables, i.e. emotional exhaustion. The situations perceived as more rewarding were rest and direct care. Momentary hedonic tone can be explained by the task performed, demand, reward, emotional exhaustion and by the interaction between emotional exhaustion and demand appraisal. Momentary fatigue can be explained by the task performed, demand, reward, and the emotional exhaustion. CONCLUSIONS: This study highlights the importance of using momentary measures to understand complex and changeable inter-relationships. While also clarifying the targets of intervention programmes aimed at preventing burnout within the nursing profession.

Uso equitativo de tests en ciencias de la salud / Fair use of tests in health sciences

Los instrumentos de medida estandarizados (tests) se han convertido en una herramienta imprescindible en las ciencias de la salud. En los estándares para pruebas educativas y psicológicas publicados en 1999 por la American Educational Research Association, la American Psychological Association y el National Council on Measurement in Education se introduce el concepto de equidad en el desarrollo, la adaptación y la administración de los tests psicométricos. A pesar de su innegable relevancia, este concepto ha sido poco utilizado en el mundo de la salud pública y la epidemiología. Por ello, la presente nota metodológica tiene como objetivo explicar el concepto de equidad en los tests y dar herramientas e indicaciones para detectar y solventar su uso no equitativo (AU)

Standardized measurement instruments (tests) have become an essential tool in health sciences. The concept of equity in the development, adaptation and administration of psychometric tests was first introduced in «Standards for Educational and Psychological Testing» published in 1999 by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education. Despite its importance, this concept has been scarcely used in epidemiology and public health. Consequently, this methodological note aims to explain the concept of equity in testing and to provide tools and indications to detect and solve their inequitable use (AU)

[Fair use of tests in health sciences]. / Uso equitativo de tests en ciencias de la salud.

Standardized measurement instruments (tests) have become an essential tool in health sciences. The concept of equity in the development, adaptation and administration of psychometric tests was first introduced in "Standards for Educational and Psychological Testing" published in 1999 by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education. Despite its importance, this concept has been scarcely used in epidemiology and public health. Consequently, this methodological note aims to explain the concept of equity in testing and to provide tools and indications to detect and solve their inequitable use.

A brief and feasible paper-based method to screen for neurocognitive impairment in HIV-infected patients: the NEU screen.

OBJECTIVE: Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder. METHODS: A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated. RESULTS: Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes). CONCLUSIONS: The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.

The role of sensory modulation deficits and behavioral symptoms in a diagnosis for early childhood.

To contribute to the validation of the sensory and behavioral criteria for Regulation Disorders of Sensory Processing (RDSP) (DC:0-3R, 2005), this study examined a sample of toddlers in a clinical setting to analyze: (1) the severity of sensory modulation deficits and the behavioral symptoms of RDSP; (2) the associations between sensory and behavioral symptoms; and (3) the specific role of sensory modulation deficits in an RDSP diagnosis. Based on clinical observations, 78 toddlers were classified into two groups: toddlers with RDSP (N = 18) and those with "other diagnoses in Axis I/II of the DC:0-3R" (OD3R; N = 60). The parents completed the Infant Toddler Sensory Profile and the Achenbach Checklist. The results revealed that the RDSP group had more severe sensory modulation deficits and specific behavioral symptoms; stronger, although not significant, associations between most sensory and behavioral symptoms; and a significant sensory modulation deficit effect. These findings support the validity of RDSP.

Evidencias de calidad psicométrica de la versión en castellano del Screen For Child Anxiety Related Emotional Disorders (SCARED) de 41 ítems / Evidences of psychometric quality of the Spanish 41-items Screen for child Anxiety Related Emotional Disorder (SCARED)

El objetivo del estudio es valorar la calidad psicométrica de la versión castellana de 41 items del SCARED, escala diseñada para detectar síntomas de trastornos de ansiedad en niños y adolescentes a partir del autoinforme. El estudio se ha realizado en una población de 487 alumnos entre 9 y 17 años a los que se les ha administrado un cuestionario socieconómico y las versiones castellanas del STAIC y el SCARED. Los resultados apoyan la estructura de 5 factores propuesta por los autores de la versión original. Cuatro factores corresponden a trastornos de ansiedad del DSM-IV-R, y el quinto a la fobia escolar. La puntuación total tiene una consistencia interna de 0.83 y las de las escalas oscilan entre 0.44 y 0.72. Las puntuaciones se mantienen estable en el tiempo (correlaciones test-retest entre 0.55 y 0.76) y se relacionan de la forma esperada con las escalas del STAIC, ansiedad/rasgo (correlaciones entre 0.35 y 0.60) y ansiedad/estado (correlaciones entre 0.13 y 0.28). La versión castellana del SCARED puede, por tanto, considerarse un buen instrumento para la detección temprana de síntomas y trastornos de ansiedad en la población de niños y adolescentes de habla castellana (AU)

The aim of the study was to assess the psychometric properties of the Spanish version of the SCARED (41 items version), a self-report scale devised to detect symptoms of anxiety disorders in children and adolescents. The study was carried out on a sample of 487 pupils aged between 9 and 17, who were administered a socioeconomic questionnaire and the Spanish versions of the STAIC and SCARED. Our results support the five-factor structure of the SCARED, as the authors pointed out in their original work. Four factors have been identified an anxiety disorders in DSM-IV and the fifth as School Phobia. Cronbach´s alpha coefficient as a whole was 0.83 and scale reliability ranged between 0.44 and 0.72. These values remain stable over time (test-retest correlations between 0.55 and 0.76). Concurrent validity with the STAIC performed as expected: for the trait state scale correlations between 0.35 and 0.60 and for the state scale between 0.13 and 0.28. This Spanish version of the SCARED may be considered a good instrument for the early detection of anxiety symptoms and disorders in Spanish-speaking children and adolescent populations (AU)

Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study.

OBJECTIVES: Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA. METHODS: A randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks. RESULTS: The actuarial risk of remaining free of HE did not differ between groups (BCAA=47%, MDX=34%, P=0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function. CONCLUSIONS: Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.

Quality of life in cirrhosis is related to potentially treatable factors.

OBJECTIVE: Improvement of prognosis and availability of diverse therapeutic options for complications of advanced liver disease highlight the importance of health-related quality of life (HRQOL) in cirrhosis. The aim of this study was to identify factors that influence HRQOL and may be potentially treatable in patients with cirrhosis. METHODS: HRQOL was measured in 212 outpatients with cirrhosis using a generic questionnaire (Medical Outcomes Study Form, SF-36) and a liver-specific questionnaire (Chronic Liver Disease Questionnaire, CLDQ). All patients underwent a systematic clinical and neuropsychological assessment. Independent factors associated with poor HRQOL were identified by multiple linear regression. RESULTS: HRQOL scores exhibited by patients were: global CLDQ: 4.8+/-1.2; Physical Component Score of SF-36: 38.5+/-10.7; Mental Component Score of SF-36: 45.3+/-14.3. The independent variables for global CLDQ were female sex, nonalcoholic etiology, current ascites, and a decrease in albumin (R = 0.22). For Physical Component Score of SF-36, the independent variables were prior hepatic encephalopathy, current ascites, and a decrease in hemoglobin (R = 0.22). For Mental Component Score of SF-36, the independent variables were nonalcoholic etiology, the Grooved Pegboard test, and a decrease in hemoglobin (R = 0.14). CONCLUSION: Several clinical variables, potentially treatable, may alter particular aspects of HRQOL. Correction of ascites, hypoalbuminemia, minimal hepatic encephalopathy, and anemia may cause a positive impact on HRQOL of patients with cirrhosis.

Percepción de control y supervivencia en pacientes con cáncer de pulmón avanzado sometidos a tratamiento paliativo / Perceived control and survival in advanced lung cancer patients receiving supportive care

Se evaluó en 90 pacientes con cáncer de pulmón avanzado que participaban en un ensayo clínico, y justo antes de iniciar el tratamiento que les había sido asignado (radioterapia o quimioterapia), el grado en que consideraban que la resolución de su problema de salud dependía de sus propias ganas de curarse y de cumplir las prescripciones médicas. Los resultados indican que los pacientes que reciben radioterapia y que no creen que la evolución de su enfermedad dependa totalmente de lo que ellos hagan, tienen una supervivencia menor (todos habían fallecido al cabo de 18 meses después del diagnóstico) que el resto de pacientes del estudio (alrededor del 20 por ciento continúa con vida 18 meses después del diagnóstico) (AU)