Validación de la versión española de la escala QoL-AD en pacientes con enfermedad de Alzheimer, cuidadores y profesionales sanitarios / Validation of the Spanish version of the QoL-AD Scale in alzheimer disease patients, their carers, and health professionals

Background: Quality of life (QOL) is becoming increasingly important to measure the effect of interventions on the life of patients with Alzheimer's disease (AD), particularly on the most meaningful issues. However, most of the instruments used to measure QOL have not been validated in the Spanish population. The aim of this study was to determine the psychometric properties of a Spanish version of QoL Scale in patients with AD, carers and health professionals. Material and methods: On hundred and two patients, their carers and 25 health professionals were recruited from day centres. Patients’ QOL was rated by patients, carers and health professionals. The Health Utilities Index, Clinical Insight Rating Scale and Mini Mental State Examination were also administered. Results: The internal and external reliability of QoL-AD were excellent. Criterion validity was indicated by a significant correlation of QoL-AD scores with HUI-3 and QoL-AD global item scores (p<.05). Lack of insight and cognitive impairment did not have an effect on these properties. QoL-AD scores were not significantly different between groups made according sociodemographic characteristics and cognitive impairment (p>.05). The exploratory factor analysis result revealed a three factor solution, which accounted for 61.3% of variance: health factor, functional status factor, and social relationship-environment factor. Conclusions: QoL-AD Scale has proved to be a valid and reliable instrument to measure QoL of Spanish AD patients with mild-to-moderate cognitive impairment and a wide range of anosognosia (AU)

Introducción: La calidad de vida (CV) está adquiriendo cada vez más relevancia como medida para evaluar los resultados de las distintas intervenciones terapéuticas sobre los pacientes con enfermedad de Alzheimer (EA), dado que contempla aspectos que son especialmente valiosos en su vida diaria. Sin embargo, son escasos los instrumentos para medir la CV que han sido validados en población española. El objetivo de este estudio es explorar las propiedades psicométricas de la escala QoL-AD en pacientes, cuidadores y profesionales sanitarios. Pacientes y métodos: Se seleccionó a 102 pacientes con EA en fase leve-moderada, sus cuidadores y 25 profesionales sanitarios. La CV de los pacientes fue valorada por pacientes, cuidadores y profesionales mediante la escala QoL-AD. Además, se administraron MMSE, escala de valoración de insight clínico (CIR) e índice de utilidades de salud (HUI-3). Resultados: La fiabilidad interna y externa de la escala QoL-AD fueron excelentes. La escala presenta validez de criterio dado que sus puntuaciones correlacionaron con las de HUI-3 y la medida global de CV (p<0,05). La falta de insight y el deterioro cognitivo no tuvieron un efecto sobre estas propiedades. Las puntuaciones en la escala QoL-AD no difirieron entre grupos establecidos según MMSE y factores sociodemográficos (p>0,05). En el análisis factorial se obtuvo una solución de tres factores que explica el 61,3% de la varianza: factor salud, factor estado funcional y factor relaciones sociales-ambiente. Conclusiones: La escala QoL-AD es un instrumento válido y fiable para medir la CV en la pacientes españoles con AD que presenten deterioro cognitivo leve-moderado, sea cual fuese su grado de insight (AU)

[Validation of the Spanish version of the QoL-AD Scale in alzheimer disease patients, their carers, and health professionals]. / Validación de la versión española de la escala QoL-AD en pacientes con enfermedad de Alzheimer, cuidadores y profesionales sanitarios.

BACKGROUND: Quality of life (QOL) is becoming increasingly important to measure the effect of interventions on the life of patients with Alzheimer's disease (AD), particularly on the most meaningful issues. However, most of the instruments used to measure QOL have not been validated in the Spanish population. The aim of this study was to determine the psychometric properties of a Spanish version of QoL Scale in patients with AD, carers and health professionals. MATERIAL AND METHODS: On hundred and two patients, their carers and 25 health professionals were recruited from day centres. Patients' QOL was rated by patients, carers and health professionals. The Health Utilities Index, Clinical Insight Rating Scale and Mini Mental State Examination were also administered. RESULTS: The internal and external reliability of QoL-AD were excellent. Criterion validity was indicated by a significant correlation of QoL-AD scores with HUI-3 and QoL-AD global item scores (p<.05). Lack of insight and cognitive impairment did not have an effect on these properties. QoL-AD scores were not significantly different between groups made according sociodemographic characteristics and cognitive impairment (p>.05). The exploratory factor analysis result revealed a three factor solution, which accounted for 61.3% of variance: health factor, functional status factor, and social relationship-environment factor. CONCLUSIONS: QoL-AD Scale has proved to be a valid and reliable instrument to measure QoL of Spanish AD patients with mild-to-moderate cognitive impairment and a wide range of anosognosia.

Amenaza y persuasión en mensajes de salud sobre consumo de alcohol: de la teoría a la práctica / Threat and persuasion in health messages about alcohol consumpton: from theory to practice

La información sobre el alcohol y sus consecuencias proviene de dos polos contrapuestos. De un lado los mensajes acerca de los beneficios de beber alcohol provenientes de la publicidad, grupo de amigos o el ambiente social en general. De otro, la información proporcionada por los profesionales e instituciones sanitarias, basada, en su mayor parte, en exponer posibles consecuencias negativas del consumo con la intención de reducirlo o controlarlo. La utilización de la amenaza en un grado y otro es, por tanto, un recurso habitual en los mensajes acerca de los riesgos de consumir alcohol dirigidos a jóvenes. La presencia de información amenazante, sobre riesgos, en los mensajes preventivos y de promoción de salud, resulta difícilmente evitable y puede tener tanto efectos positivos como negativos dependiendo de sus características. En consecuencia, el planteamiento actual se dirige no tanto a evitar la amenaza, puesto que es difícilmente eludible, sino a determinar cuáles son las condiciones bajo las que la amenaza ejerce un efecto positivo sobre la adherencia a las recomendaciones. Para que la amenaza tenga mayor probabilidad de producir un efecto positivo deberían cumplirse algunas condiciones: debe servir para generar una respuesta atencional, que se apoye en argumentos relevantes y que vaya acompañada de una recomendación percibida como eficaz para eliminar el riesgo. Por otra parte, la eficacia de los mensajes dependerá también de otros factores como la utilización de distintos estilos, la variación en los temas y argumentos para mantener la atención, la utilización de información verídica, relevante y verosímil para la audiencia o la atención a las características específicas de la población a la que se dirigen. Por último, se hace hincapié en que disponemos de información suficiente sobre los comportamientos, creencias y actitudes de los jóvenes acerca del alcohol, al que se añaden orientaciones válidas para generar mensajes más eficaces, siempre que tengamos una idea clara de lo que queremos transmitirles (AU)

Information about alcohol and its consequences comes from two opposing poles. On the one hand, messages about the benefits of drinking alcohol coming from publicity, group of friends or the social milieu in general. On the other hand, the information provided by professionals and health authorities, which is based, mainly, in explaining the possible negative consequences of consumption, with the intention of reducing or controlling it. Therefore, use of threat, in different degrees, is a common resource in the communications about the risks of drinking alcohol designed for young people. Presence of threatening information, in health promotion and prevention messages, is hardly avoidable and can lead to both positive and negative results, depending on its characteristics. In consequence current models are not dealing with the dichotomy threat-not threat, but instead, are trying to determine the conditions under which threat exerts a positive effect on the adherence to message recommendations. In order for threat to increase the probability of producing a positive effect some basic conditions should be met: it needs to generate an attentional response; it must lean on in strong arguments and has to be accompanied by a recommendation perceived as effective to eliminate the risk. On the other hand, message effectiveness will also depend on other factors like use of different message styles, variation in topics and arguments to maintain attention, use of truthful and relevant information or taking into account the specific characteristics from the target group. Finally it is stressed that we have enough information about young people’s behavior, beliefs and attitudes about alcohol, and that we have useful orientations to generate more effective messages, whenever we have a clear idea of what we want to transmit to them (AU)

Gender differences in cardiovascular and electrodermal responses to public speaking task: the role of anxiety and mood states.

Gender moderates psychophysiological responses to stress. In addition to the hormonal background, different psychological states related to social stressors, such as anxiety and mood, could affect this response. The purpose of this study was to examine the existence of gender differences in the cardiovascular and electrodermal responses to a speech task and their relationship with anxiety and the mood variations experienced. For this, non-specific skin conductance responses (NSRs), heart rate (HR), and finger pulse volume (FPV) were measured at rest, and during preparation, task and recovery periods of an academic career speech in undergraduate men (n=15) and women (n=23), with assessment of changes in the state version of the State-Trait Anxiety Inventory (STAI-S) and in the Profile of Mood States (POMS) questionnaires. Men and women did not differ in trait anxiety, hostility/aggressiveness, or in the appraisal of the task, which were evaluated with the trait version of the State-Trait Anxiety Inventory (STAI-T), the Buss and Durkee Hostility Inventory (BDHI), and a self-report elaborated by ourselves, respectively. Women had higher FPV in all periods except during the task, and were more reactive to the stressor in state anxiety, and in the amplitude of NSRs. No gender differences for HR and for the frequency of NSRs were found. Anxiety and mood states were differently related to cardiovascular and electrodermal measurements in men and women. Further studies should consider the hormonal variations in addition to the psychological dimensions, in order to offer a more integrative perspective of the complex responses to stress.

El uso del miedo en los mensajes de salud / Use of fear in health messages

Gran parte de las intervenciones en promoción de salud y prevención de la enfermedad incluyen mensajes, dirigidos a la población, que se basan en las consecuencias negativas para la salud que acarrea una determinada conducta. De esta forma se pretende conseguir la adherencia del público a las recomendaciones que, habitualmente, son transmitidas en el mismo mensaje. Estas comunicaciones que utilizan la amenaza como elemento persuasivo fundamental han sido llamadas «mensajes de miedo» y, a pesar de la frecuencia con que se utilizan, su eficacia para promover las conductas que recomiendan está sujeta a controversia. Distintos autores han llegado a la conclusión de que el uso de la amenaza en los mensajes de salud parece influir en el desarrollo posterior de actitudes y conductas preventivas. Esto, no significa, sin embargo, que los mensajes amenazadores tengan necesariamente consecuencias positivas. Para ello deben cumplir dos condiciones básicas: provocar la atención del sujeto en lugar de miedo e incluir una recomendación para eliminar la amenaza del mensaje, que sea percibida por el sujeto como eficaz y fácil de realizar. De estas condiciones se derivan una serie de recomendaciones prácticas para el desarrollo de mensajes de promoción de salud (AU)

Many activities in health promotion and disease prevention address to the target group messages which are based in the negative consequences for health linked to a certain behavior. This infomation is supposed to promote adherence to the recommendations that are usually included in the same message. These kind of communications, which use threat as the basic persuasive strategy, are defined as «fear appeals» and, in spite of being a frequent resource for practicioners their effectiveness to promote the recommended behaviors have caused much controversy. In trying to answer this question several authors have concluded that the use of threat in health messages can influence the subsequent development of preventive attitudes and behaviors. However, this does not mean that fear appeals necessarily have positive consequences. To achieve its objective threat messages must meet two basic conditions: they must induce attention, instead of fear, in the subject; and be accompanied by a recommendation percibed as effective to avoid the threat and easily carried out by the subject. Some practical advices for the developmente of health promotion messages are derived from these two conditions (AU)

Electrodermal activity in menstrual cycle phases: a comparison of within- and between-subjects designs.

Electrodermal activity (EDA) changes in menstrual cycle were studied in two experiments. In both experiments subjects were presented with 16 80-dB tones; 15 tones were 4 s, 1000 Hz, and the last one - change trial - was a 6-s, 3000-Hz tone. In Expt. 1, a within-subjects design was employed, and 15 women were studied throughout a complete menstrual cycle. No significant changes in EDA associated with menstrual cycle phases were found, but significant decreases in electrodermal responsiveness during experimental sessions in EDA parameters were observed. In Expt. 2, with a between-subjects design, 56 women were divided in menstrual (n = 10), follicular (n = 12), ovulatory (n = 14), luteal (n = 13) and premenstrual (n = 7) groups, according to the cycle phase in which the subject was at the time of recording. At the ovulatory phase there were significant increases in skin conductance response (SCR) magnitude, skin conductance level, SCR habituation rate, and SCR amplitude to stimulus change, in relation to menstrual, luteal, and premenstrual phases. The discrepancies in the EDA data coming from the two experiments may be explained by practice effects appearing in Expt. 1.

Electrodermal activity, hormonal levels and subjective experience during the menstrual cycle.

Changes in electrodermal activity and subjective experience were studied during the menstrual cycle. Sixty-two women, grouped into menstrual, follicular, ovulatory, luteal and premenstrual phases, were presented with 15, 4-s, 80-dB, 1000-Hz tones. Psychological states and psychosomatic symptoms were tested with Spielberger's State-Trait Anxiety Inventory and a self-report questionnaire. Two estimation procedures of the hormonal phases were used: one based on the onset of menses and cycle length, and another on the basal body temperature. Subjects were grouped into low or high levels of luteinizing hormone, follicle-stimulating hormone and progesterone. There were significant increases in nonspecific response frequency, skin conductance response magnitude, skin conductance level, and a decrease in habituation rate at the ovulatory phase in comparison with luteal and premenstrual phases. No changes between the cycle phases were found in subjective experience. High follicle-stimulating hormone levels were associated with slower habituation rates and low trait-anxiety. The relationship between arousal changes and subjective experience in menstrual cycle is discussed.

Sex differences and bilateral electrodermal activity: a replication.

The present study was aimed at replicating the results of a previous work on sex differences and electrodermal asymmetry from our laboratory (Román, et al. 1987). Skin conductance was bilaterally recorded in a sample of 44 dextral volunteers (22 males and 22 females) during a stimulus-free period, and the performance of two tasks (verbal and spatial). Subjects were grouped into two groups of right-hand and left-hand dominance in their electrodermal responses (EDRs) in accordance with their laterality coefficient scores at rest. During the tasks subjects appeared clearly differentiated by their lateralization in the magnitude and frequency of EDRs independently of gender: right-hand responders showed higher electrodermal activity on their right hand, while left-hand responders showed higher electrodermal activity on their left hand. Sex differences were not observed within each responsiveness pattern. The orientation of phasic electrodermal changes remained constant throughout the different conditions.

Sex differences and the asymmetry of specific and non-specific electrodermal responses.

Phasic electrodermal conductance responses were bilaterally recorded from 30 subjects (15 males and 15 females). After a 5-min adaptation period subjects were presented with two series of ten 80-dB tones each, with a 4-min rest period between the two series. Data from sinistrals, ambidextrous, and from subjects with familial sinistrality were excluded from statistical analysis. Males displayed more asymmetry between hands both in their non-specific and specific responses, with larger skin conductance responses on the left hand. Females showed a less marked asymmetry, with larger skin conductance responses on the right hand. Similar results were found in skin conductance levels. It was concluded that sex differences are an important variable in the study of electrodermal asymmetry.

Sex differences, activation level, and bilateral electrodermal activity.

The effects of the activation level and subject's sex on bilateral skin conductance measures were studied. Thirty right-handed subjects (15 males and 15 females) were exposed to three types of stimulus conditions: rest-period, verbal task and spatial task. Results showed that no relationship was observed between EDA asymmetry and the increase in the activation level induced by the verbal and the spatial tasks. Males showed both higher SCRs and greater frequency of responses on the left than on the right hand. The direction of electrodermal asymmetry remained constant regardless of the stimulus conditions. It was concluded that sex differences are important in the study of EDA asymmetry and that this asymmetry appeared to depend on peripheral variations.