Development and validation of Malaysia Medication Adherence Assessment Tool (MyMAAT) for diabetic patients.

Medication non-adherence remains a significant barrier in achieving better health outcomes for patients with chronic diseases. Previous self-reported medication adherence tools were not developed in the context of the Malaysia population. The most commonly used tool, MMAS-8, is no longer economical because it requires a license and currently every form used is charged. Hence, there is a need to develop and validate a new medication adherence tool. The Malaysia Medication Adherence Assessment Tool (MyMAAT) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. The face and content validities of the MyMAAT was established by a panel of experts. A total of 495 patients with type 2 diabetes were recruited from the Ministry of Health facilities consisting of five hospitals and five primary health clinics. A test-retest was conducted on 42 of the patients one week following their first data collection. Exploratory factor analysis was performed to evaluate the validity of the MyMAAT. The final item for MyMAAT was compared with SEAMS, HbA1c%, Medication Possession ratio (MPR) score, and pharmacist's subjective assessment for its hypothesis testing validity. The MyMAAT-12 achieved acceptable internal consistency (Cronbach's alpha = 0.910) and stable reliability as the test-retest score showed good to excellent correlation (Spearman's rho = 0.96, p = 0.001). The MyMAAT has significant moderate association with SEAMS (Spearman's rho = 0.44, p = < 0.001) and significant relationship with HbA1c (< 8% and ≥ 8%) (χ2(1) = 13.4, p < 0.001), MPR (χ2(1) = 13.6, p < 0.001) and pharmacist's subjective assessment categories (χ2(1) = 31, p < 0.001). The sensitivity of MyMAAT-12, tested against HbA1c% was 72.9% while its specificity was 43%. This study demonstrates that the MyMAAT-12 together with other methods of assessment may make a better screening tool to identify patients who were non-adherence to their medications.

Measurement properties of preference-based measures for economic evaluation in COPD: a systematic review.

PURPOSE: Preference-based measures can provide measurements of health-related quality of life and be utilized for cost-effectiveness analyses of interventions in individuals with chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate whether generic preference-based measures are reliable, valid, and responsive in COPD. METHODS: A systematic review was performed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Three databases were searched: MEDLINE, EMBASE, and CINAHL. Studies were included if the sample represented individuals with COPD and the aim was to evaluate one or more psychometric properties or the interpretability of generic preference-based measures. RESULTS: Six hundred and sixty-seven abstracts were screened, 65 full-text articles were reviewed and 24 articles met the inclusion criteria. Measures which emerged from the search were the EQ-5D, the SF-6D, the Quality of Well-being scale, the 15D, and the Health Utilities Index 3. Evidence for the test-retest reliability of these measures was limited. Construct validity of the measures was well supported with correlations with generic health profiles being 0.37-0.68, and correlations with COPD-specific health profiles being 0.53-0.75. Evidence for known-groups validity of these measures was poor and data on responsiveness were mixed. CONCLUSION: Generic preference-based measures' sensitivity to change and ability to discriminate between different disease severities in COPD was poorly supported. Future research may consider examining the development of COPD-specific preference-based measures that may allow for a more accurate detection of change and discrimination among disease severities to facilitate cost-effectiveness evaluations.

The validation of the Italian version of the COmprehensive Score for financial Toxicity (COST).

PURPOSE: Financial toxicity (FT) is the unintended, potential economic harm or damage of oncologic treatments that has become a medical problem with political implications. To assess FT, the COmprehensive Score for financial Toxicity (COST) questionnaire was developed. Since an Italian version is not available yet, we aimed to validate the Italian version of the COST questionnaire in a population of cancer patients during oncologic treatments or follow-up. METHODS: A sample of Italian native outpatients were asked to fill the Italian version of the COST and five other self-administered questionnaires to assess quality of life, treatment-related symptoms, hope, distress, and unmet needs. Additionally, a subsample of patients was asked to retake the COST after 2-6 weeks. RESULTS: A single factor better represents the scale structure. Internal consistency and test-retest reliability were good. Evidence of convergent and discriminant validity was provided and criterion validity was established, showing that financial toxicity predicts the patient's distress. Finally, known-groups validity was confirmed, testing the differences related to treatment-related expenses, sociodemographic characteristics, stage of the disease, and performance status. CONCLUSION: The current findings suggest the Italian version of the COST is a psychometrically sound scale that potentially offers an added value in assessing FT in patients with cancer.

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature.

PURPOSE: Given increasing interest in using the capability approach for health economic evaluations and a growing literature, this paper aims to synthesise current information about the characteristics of capability instruments and their application in health economic evaluations. METHODS: A systematic literature review was conducted to assess studies that contained information on the development, psychometric properties and valuation of capability instruments, or their application in economic evaluations. RESULTS: The review identified 98 studies and 14 instruments for inclusion. There is some evidence on the psychometric properties of most instruments. Most papers found moderate-to-high correlation between health and capability measures, ranging between 0.41 and 0.64. ASCOT, ICECAP-A, -O and -SCM instruments have published valuation sets, most frequently developed using best-worst scaling. Thirteen instruments were originally developed in English and one in Portuguese; however, some translations to other languages are available. Ten economic evaluations using capability instruments were identified. The presentation of results show a lack of consensus regarding the most appropriate way to use capability instruments in economic evaluations with discussion about capability-adjusted life years (CALYs), years of capability equivalence and the trade-off between maximisation of capability versus sufficient capability. CONCLUSION: There has been increasing interest in applying the capability-based approach in health economic evaluations, but methodological and conceptual issues remain. There is still a need for direct comparison of the different capability instruments and for clear guidance on when and how they should be used in economic evaluations.

Utility of the Dependence Scale in dementia: validity, meaningfulness, and health economic considerations.

BACKGROUND: The concept of dependence has been proposed as a unified representation of disease severity to quantify and stage disease progression in a manner more informative to patients, caregivers, and healthcare providers. METHODS: This paper provides a review of the Dependence Scale (DS) as a quantitative measure of Alzheimer's disease severity, its properties as an outcome measure, a metric of disease progression, and a correlate of medical costs. RESULTS: The literature supports the notion that the DS is related to, but distinct from, key severity measures, including cognition, function, and behavior, and captures the full spectrum of patient needs. It also presents as a useful measure for assessing disease progression. CONCLUSIONS: Results underscore the importance of the DS as a unique endpoint in Alzheimer's disease clinical trials, providing important information about the impact of therapeutic interventions. The DS also is a useful measure for economic evaluation of novel interventions aimed at delaying progression.

A (five-)level playing field for mental health conditions?: exploratory analysis of EQ-5D-5L-derived utility values.

PURPOSE: Economic evaluations of mental health interventions often measure health benefit in terms of utility values derived from the EQ-5D. For the five-level version of the EQ-5D, there are two methods of estimating utility [crosswalk and stated preference (5L-SP)]. This paper explores potential impacts for researchers and decision-makers when comparing utility values derived from either method in the specific context of mental health. METHODS: Baseline EQ-5D-5L data from three large randomised controlled trials of interventions for mental health conditions were analysed. Utility values were generated using each method. Mean utility values were compared using a series of t tests on pooled data and subgroups. Scenario analyses explored potential impacts on cost-effectiveness decisions. RESULTS: EQ-5D data were available for 1399 participants. The mean utility value for each trial was approximately 0.08 higher when estimated using the 5L-SP approach compared to crosswalk (p < 0.0001). The difference was greatest among people reporting extreme anxiety/depression (mean utility 5L-SP 0.309, crosswalk 0.084; difference = 0.225; p < 0.0001). Identical improvements in health status were associated with higher costs to gain one QALY with the 5L-SP approach; this is more pronounced when improvements are across all domains compared to improvements on the anxiety/depression domain only. CONCLUSIONS: The two approaches produce significantly different utility values in people with mental health conditions. Resulting differences in cost per QALY estimates suggest that thresholds of cost-effectiveness may also need to be reviewed. Researchers and decision-makers should exercise caution when comparing or synthesising data from trials of mental health interventions using different utility estimation approaches.

Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review.

BACKGROUND: A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations. METHODS: A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools. RESULTS: 153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts. CONCLUSIONS: Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.

Providing an extended use of an otological-specific outcome instrument to derive cost-effectiveness estimates of treatment.

OBJECTIVES: Although quality-adjusted life years (QALYs) are increasingly being used by decision-makers to make comparisons of cost-effectiveness, there are no otological-specific outcome measures that fit within this QALY framework. This study had two main objectives. The first was to provide a means to derive QALYs from a condition-specific otological instrument (Cambridge Otology Quality of Life, COQOL), and the second was to assess the convergent validity, or degree of correlation, between the COQOL and SF-6D, an established QALY instrument. DESIGN: Longitudinal cohort study designed to assess the convergent validity between SF-6D and COQOL and to generate a mapping function to enable SF-6D values to be predicted from the COQOL responses. SETTING: Cambridge University Hospital, UK. PARTICIPANTS: A total of 207 patients attending a routine outpatient general otology clinic. MAIN OUTCOME MEASURES: SF-6D and the COQOL instrument completed at baseline and again 3 months later. RESULTS: Convergent validity was demonstrated with mean SF-6D values decreasing linearly with increasing severity on the COQOL instrument. Overall, the correlation between the COQOL scores and the SF-6D values was moderate and statistically significant (r = 0.490, P = <0.001). A simple mapping model based on an ordinary least squares (OLS) regression function predicted SF-6D values from the COQOL data with a reasonable degree of accuracy. Further validation using the follow-up 3-month data confirmed the prediction power of this mapping model. CONCLUSIONS: This study provides a method for estimating QALYs from condition-specific COQOL data and provides the opportunity for the cost-effectiveness of otological treatment to be measured and placed within the national QALY framework.

Modelling utility weights for the Assessment of Quality of Life (AQoL)-8D.

PURPOSE: The objective of this paper is to describe the four-stage methodology used to obtain utility scores for the Assessment of Quality of Life (AQoL)-8D, a 35-item 8 dimension multi-attribute utility instrument, which was created to achieve a high degree of sensitivity to psycho-social health. METHODS: Data for the analyses were obtained from a representative group of 347 members of the Australian public and from 323 mental health patients each of whom provided VAS and time trade-off valuations of multiple health states. Data were used initially to create multiplicative scoring algorithms for each of the instrument's 8 dimensions and for the overall instrument. Each of the algorithms was then subject to a second-stage econometric 'correction'. RESULTS: Algorithms were successfully created for each of the AQoL-8D's dimensions, for physical and mental 'super-dimensions' and for the overall AQoL-8D instrument. The final AQoL-8D algorithm has good predictive power with respect to the TTO valuations. CONCLUSIONS: The AQoL-8D is a suitable instrument for researchers conducting cost utility analyses generally but, in particular, for the analysis of services affecting psycho-social health.

Comparing the accuracy of brief versus long depression screening instruments which have been validated in low and middle income countries: a systematic review.

BACKGROUND: Given the high prevalence of depression in primary health care (PHC), the use of screening instruments has been recommended. Both brief and long depression screening instruments have been validated in low and middle income countries (LMIC), including within HIV care settings. However, it remains unknown whether the brief instruments validated in LMIC are as accurate as the long ones. METHODS: We conducted a search of PUBMED, the COCHRANE library, AIDSLINE, and PSYCH-Info from their inception up to July 2011, for studies that validated depression screening instruments in LMIC. Data were extracted into tables and analyzed using RevMan 5.0 and STATA 11.2 for the presence of heterogeneity. RESULTS: Nineteen studies met our inclusion criteria. The reported prevalence of depression in LMIC ranged from 11.1 to 53%. The area under curve (AUC) scores of the validated instruments ranged from 0.69-0.99. Brief as well as long screening instruments showed acceptable accuracy (AUC≥0.7). Five of the 19 instruments were validated within HIV settings. There was statistically significant heterogeneity between the studies, and hence a meta-analysis could not be conducted to completion. Heterogeneity chi-squared = 189.23 (d.f. = 18) p<.001. CONCLUSION: Brief depression screening instruments in both general and HIV-PHC are as accurate as the long ones. Brief scales may have an edge over the longer instruments since they can be administered in a much shorter time. However, because the ultra brief scales do not include the whole spectrum of depression symptoms including suicide, their use should be followed by a detailed diagnostic interview.

Validation study of the prototype of a disease-specific index measure for health-related quality of life in dementia.

BACKGROUND: Index measures for health-related quality of life (HRQoL) quantify the desirability (utility) of a certain health state. The commonly used generic index measure, e.g. EuroQol: EQ-5D, may underestimate relevant areas of specific diseases, resulting in lower validity. Disease-specific index measures on the other hand combine disease-specificity and quantification of perceived quality on several health domains of a certain disease into one single figure. These instruments have been developed for several diseases, but a dementia-specific HRQoL index instrument was not yet available. Facing the increasing individual and societal burden of dementia, specific HRQoL values with metric characteristics are especially useful because they will provide vital information for health outcome research and economic evaluations. AIMS OF THE STUDY: To develop and validate the prototype of a dementia-specific HRQoL index measure: Dementia Quality of life Instrument (DQI), as the first step towards valuation of the dementia health state. METHODS: For development of the DQI we created a conceptual framework based on a review of the literature, qualitative interviews with people with dementia and their carers, expert opinion and team discussion. To assess validity we undertook a survey under 241 dementia professionals. Measurements consisted of ranking (1-5) and rating (1-10) of 5 dementia-specific DQI domains (memory, orientation, independence, social activities and mood) and simultaneously rating of 9 DQI-derived health states on a visual analogue scale (VAS). We also performed a cross-sectional study in a large sample of people with very mild to moderate dementia and their caregivers (N=145) to assess feasibility and concurrent validity. In addition, caregivers valued 10 DQI and 10 EQ-5D + C derived health states of the patient simultaneously on the same VAS. SETTING: outpatient clinics, nursing homes and patient residences. RESULTS: All professionals judged the selected DQI domains to be relevant. Differences in ranking and rating behaviors were small. Mood was ranked (≥ 3.3) and rated (≥ 8.2) as most, orientation as least important (rank ≤ 2.6, value 7.5) health domain for dementia. For the validation part of this study the completion rates for all domains were above 98% for patients and 100% for caregivers on patients. A priori hypothesized DQI versus QOL-AD correlations that were significant in both patients and caregivers were: memory/memory, orientation/memory, independence/physical health, social activities/energy and mood/mood. Patient/caregiver inter-rater agreement was low (K <0.2) for memory/independence, fair (K 0.2-0.4) for orientation/mood, and moderate (K 0.4-0.6) for social activities. Concurrent validity of the DQI with the EQ-5D +C was moderate. The fact that most of the correlations between the domains of these two instruments were low (≤ 0.40) showed that both instruments measure different elements of health status. As expected, modest correlations (≥ 0.40) were observed between corresponding domains of the two instruments. CONCLUSIONS: Professionals judged all domains as relevant. The DQI prototype proved valid and feasible for patients and caregivers and is appropriate for very mild to moderate dementia. The differences in concurrent correlations with generic health status instruments imply that the dementia-specific DQI health domains indeed provide different information. The finding that patient HRQoL measured with the DQI was lower supports this notion. The new DQI shows comparable psychometric properties to the best available dementia-specific (QOL-AD) and generic (EQ-5D +C) measures. Further research is needed to generate values in the general population for each of the possible DQI states and to derive an algorithm that converts the 5 separate DQI domain scores into one single DQI Index score. Introducing the DQI Index will advance dementia-related HRQoL measurement by overcoming the shortcomings of generic and non-index instruments. This will allow more unequivocal interpretation of subjective dementia HRQoL states in dementia research.

The identification of children with, or at significant risk of, intellectual disabilities in low- and middle-income countries: a review.

BACKGROUND: Developmental monitoring of children is an important strategy for the early detection and management of intellectual disabilities (ID) in high-income countries. This review summarizes the literature on identifying children with ID in low- and middle-income (LAMI) countries. MATERIALS AND METHODS: Electronic literature database searches were conducted to identify articles in the English language published since 1990 relating to the identification of children with, or at risk of, ID in LAMI countries. Requests for information were also sent to the membership of International Association for the Scientific Study of Intellectual Disabilities and relevant organizations in selected LAMI countries. RESULTS: A total of 37 articles were identified for inclusion in the review, the majority of which concerned validation of specific screening tools. Information is presented on sensitivity, specificity, positive predictive value, negative predictive value and reliability of identified screening tools. CONCLUSION: Studies were mainly concerned with identifying child disability. Research and development should develop specific approaches to identifying ID among children in LAMI countries.

The positivity scale.

Five studies document the validity of a new 8-item scale designed to measure positivity, defined as the tendency to view life and experiences with a positive outlook. In the first study (N = 372), the psychometric properties of Positivity Scale (P Scale) were examined in accordance with classical test theory using a large number of college participants. In Study 2, the unidimensionality of the P Scale was corroborated with confirmatory factor analysis in 2 independent samples (N1 = 322; N2 = 457). In Study 3, P Scale invariance across sexes and its relations with self-esteem, life satisfaction, optimism, positive negative affect, depression, and the Big Five provided further evidence of the internal and construct validity of the new measure in a large community sample (N = 3,589). In Study 4, test-retest reliability of the P Scale was found in a sample of college students (N = 262) who were readministered the scale after 5 weeks. In Study 5, measurement invariance and construct validity of P Scale were further supported across samples in different countries and cultures, including Italy (N = 689), the United States (N = 1,187), Japan (N = 281), and Spain (N = 302). Psychometric findings across diverse cultural context attest to the robustness of the P Scale and to positivity as a basic disposition.

Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study.

BACKGROUND: Despite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries. We conducted a study to determine the extent, domains and correlates of internalized stigma amongst outpatients with schizophrenia in Ethiopia. METHODS: The study was a cross-sectional facility-based survey conducted at a specialist psychiatric hospital in Addis Ababa, Ethiopia. Consecutive consenting individuals with a diagnosis of schizophrenia were recruited and assessed using an Amharic version of the Internalized Stigma of Mental Illness (ISMI) scale. RESULTS: Data were collected from 212 individuals, who were mostly single (71.2%), unemployed (70.3%) and male (65.1%). Nearly all participants (97.4%) expressed agreement to at least one stigma item contained in the ISMI; 46.7% had a moderate to high mean stigma score. Rural residence (OR = 5.67; 95% CI = 2.30, 13.00; p < 0.001), single marital status (OR = 3.39; 95% CI = 1.40, 8.22; p = 0.019) and having prominent psychotic symptoms (OR = 2.33; 95% CI = 1.17, 4.61; p = 0.016) were associated independently with a higher stigma score. Almost half of those who discontinued their treatment reported that they had done so because of perceived stigma. Those who had attempted suicide (45.3%) were more likely to have a high stigma score (OR = 2.29; 95% CI = 1.27, 4.11; p = 0.006). Over 60% of the variation in the experience of stigma was explained by four factors: social withdrawal (16.7%), perceived discrimination (14.1%), alienation (13.9%) and stereotype endorsement (12.7%). CONCLUSION: Internalized stigma is a major problem among persons with schizophrenia in this outpatient setting in Ethiopia. Internalized stigma has the potential to substantially affect adherence to medication and is likely to affect the recovery process.

Correlation between adherence rates measured by MEMS and self-reported questionnaires: a meta-analysis.

PURPOSE: It is vital to understand the associations between the medication event monitoring systems (MEMS) and self-reported questionnaires (SRQs) because both are often used to measure medication adherence and can produce different results. In addition, the economic implication of using alternative measures is important as the cost of electronic monitoring devices is not covered by insurance, while self-reports are the most practical and cost-effective method in the clinical settings. This meta-analysis examined the correlations of two measurements of medication adherence: MEMS and SRQs. METHODS: The literature search (1980-2009) used PubMed, OVID MEDLINE, PsycINFO (EBSCO), CINAHL (EBSCO), OVID HealthStar, EMBASE (Elsevier), and Cochrane Databases. Studies were included if the correlation coefficients [Pearson (rp) or Spearman (rs)] between adherences measured by both MEMS and SRQs were available or could be calculated from other statistics in the articles. Data were independently abstracted in duplicate with standardized protocol and abstraction form including 1) first author's name; 2) year of publication; 3) disease status of participants; 4) sample size; 5) mean age (year); 6) duration of trials (month); 7) SRQ names if available; 8) adherence (%) measured by MEMS; 9) adherence (%) measured by SRQ; 10) correlation coefficient and relative information, including p-value, 95% confidence interval (CI). A meta-analysis was conducted to pool the correlation coefficients using random-effect model. RESULTS: Eleven studies (N = 1,684 patients) met the inclusion criteria. The mean of adherence measured by MEMS was 74.9% (range 53.4%-92.9%), versus 84.0% by SRQ (range 68.35%-95%). The correlation between adherence measured by MEMS and SRQs ranged from 0.24 to 0.87. The pooled correlation coefficient for 11 studies was 0.45 (p = 0.001, 95% confidence interval [95% CI]: 0.34-0.56). The subgroup meta-analysis on the seven studies reporting rp and four studies reporting rs reported the pooled correlation coefficient: 0.46 (p = 0.011, 95% CI: 0.33-0.59) and 0.43 (p = 0.0038, 95% CI: 0.23-0.64), respectively. No differences were found for other subgroup analyses. CONCLUSION: Medication adherence measured by MEMS and SRQs tends to be at least moderately correlated, suggesting that SRQs give a good estimate of medication adherence.

Design of experiments with multiple independent variables: a resource management perspective on complete and reduced factorial designs.

An investigator who plans to conduct an experiment with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy. Considerations in making design decisions include whether research questions are framed as main effects or simple effects; whether and which effects are aliased (confounded) in a particular design; the number of experimental conditions that must be implemented in a particular design and the number of experimental subjects the design requires to maintain the desired level of statistical power; and the costs associated with implementing experimental conditions and obtaining experimental subjects. In this article 4 design options are compared: complete factorial, individual experiments, single factor, and fractional factorial. Complete and fractional factorial designs and single-factor designs are generally more economical than conducting individual experiments on each factor. Although relatively unfamiliar to behavioral scientists, fractional factorial designs merit serious consideration because of their economy and versatility.

Efficacy and safety of memantine in moderate-to-severe Alzheimer disease: the evidence to date.

Memantine, a moderate-affinity, uncompetitive N-methyl-D-aspartate receptor antagonist, is currently the only agent approved for moderately severe to severe Alzheimer disease (AD) in Europe and for moderate-to-severe Alzheimer disease in the United States. In clinical trials, memantine has consistently demonstrated a reduced rate of deterioration on global, cognitive, functional, and behavioral measures, across a range of outcome measures compared with usual care. Notably, improvements versus placebo were seen in individual activities of daily living and behavior, particularly agitation. Efficacy was demonstrated in patients with newly diagnosed Alzheimer disease, patients previously or currently receiving acetylcholinesterase inhibitors, and both institutionalized and community-dwelling Alzheimer disease patients. Memantine has a tolerability profile similar to placebo. This review presents the results of key clinical trials, and includes clinically relevant analyses, such as numbers-needed-to-treat and effect sizes. Increased dependency and institutionalization are significant cost drivers in Alzheimer disease. Memantine is able to reduce dependency, caregiver time required, and mean monthly caregiver and societal costs. Recent studies of the relationship between Alzheimer disease progression, caregiver burden, and healthcare costs emphasize the need for treatments such as memantine that can slow the rate of decline in Alzheimer disease.

Assessment of young children using the Achenbach System of Empirically Based Assessment (ASEBA).

After providing a brief review of three other approaches to assessment of preschool children (DSM-IV diagnoses, "Zero to Three" diagnoses, and temperament scales), this paper focuses on the Achenbach System of Empirically Based Assessment (ASEBA). The empirically based assessment paradigm provides user-friendly, cost-effective, reliable, and valid procedures for assessing children's behavioral/emotional problems from the perspectives of multiple informants. The ASEBA preschool forms, the Child Behavior Checklist for ages 1.5-5 (CBCL/1.5-5) and the Caregiver-Teacher Report Form (C-TRF), are usable by many different kinds of professionals in diverse settings. The CBCL/1.5-5 also includes the Language Development Survey (LDS), which provides a quick screen for delays in vocabulary and word combinations. The problem items of the CBCL/1.5-5 and the C-TRF are scored on both empirically based syndromes and DSM-oriented scales, which are normed on the same general population sample. Variations in children's functioning across contexts and interaction partners make it essential to obtain and integrate data from multiple sources. Therefore, ASEBA software provides side-by-side comparisons of item and scale scores from up to eight assessment forms per child. Clinical and research applications of ASEBA preschool forms are summarized in the paper, and strengths and limitations are discussed.

To transform or not transform skewed data for psychometric analysis: that is the question!

BACKGROUND: Although data transformation is generally recommended, its benefits of have not been widely studied. This report reviews evidence regarding the costs and benefits of transforming skewed data with respect to two statistics commonly used in psychometric analyses: the Cronbach alpha and the Pearson product-moment correlation. METHODS: Data describing 758 immigrants from the former Soviet Union who completed a Russian language version of the Symptom Checklist-90-Revised (SCL-90-R) were used to demonstrate the effects of transformation. More than half (55%) of the SCL-90-R items had a problematic skew. The Cronbach alpha and the Pearson product-moment correlation were calculated for original item responses as well as for square root and log transformations of these responses. Sample size (full, 30%, 20%), transformation type (square root or log transformation), and transformation method (sum items first and then transform, transform items first and then sum) were manipulated to evaluate the relevance of these factors to transformation. RESULTS: Regardless of sample size, neither the Cronbach alpha nor the Pearson product-moment correlation showed a difference between original and transformed data, with one exception. When items were transformed first before being summed in the calculation of the Pearson product-moment correlation, inconsistently higher (+.05) or slightly lower values (-.01) were observed relative to those created with the nontransformed data across the different sample sizes. CONCLUSIONS: These findings suggest that data transformation is not always needed or advisable when the Cronbach alpha or Pearson product-moment correlation is calculated for instruments with skewed item responses.