Validity of the distress tolerance inventory in predicting response to the Cold-Pressor Test.

Distress intolerance-a broad band dispositional variable has been shown to serve as a transdiagnostic risk factor for psychopathology. We investigated the predictive validity of the physical and emotional subscales of the Distress Tolerance Inventory (DTI) on behavioral responding (immersion time) and moment-to-moment subjective distress ratings to the Cold-Pressor Test. College students (N = 134) completed self-report questionnaires indexing physical and emotional distress tolerance and then completed a cold pressor challenge. The DTI displayed convergent validity with several well-established self-report measures assessing distress tolerance (i.e. DTS, PCS, DIS). Participants' scores on the DTI physical subscale (but not the DTS or DTI emotional subscale) predicted participants' immersion time on the cold pressor challenge, thus supporting the construct validity of the DTI physical distress subscale. The DIS also predicted immersion time, though its internal consistency was marginal. These data suggest that the DTI is a valid measure for both emotional and physical distress tolerance and should be considered as a viable alternative to the DTS, especially for investigative domains involving physical distress such as chronic pain, or screening personnel for physically demanding tasks.

Validation of the structured interview section of the penn computerized adaptive test for neurocognitive and clinical psychopathology assessment (CAT GOASSESS).

Large-scale studies and burdened clinical settings require precise, efficient measures that assess multiple domains of psychopathology. Computerized adaptive tests (CATs) can reduce administration time without compromising data quality. We examined feasibility and validity of an adaptive psychopathology measure, GOASSESS, in a clinical community-based sample (N = 315; ages 18-35) comprising three groups: healthy controls, psychosis, mood/anxiety disorders. Assessment duration was compared between the Full and CAT GOASSESS. External validity was tested by comparing how the CAT and Full versions related to demographic variables, study group, and socioeconomic status. The relationships between scale scores and criteria were statistically compared within a mixed-model framework to account for dependency between relationships. Convergent validity was assessed by comparing scores of the CAT and the Full GOASSESS using Pearson correlations. The CAT GOASSESS reduced interview duration by more than 90 % across study groups and preserved relationships to external criteria and demographic variables as the Full GOASSESS. All CAT GOASSESS scales could replace those of the Full instrument. Overall, the CAT GOASSESS showed acceptable psychometric properties and demonstrated feasibility by markedly reducing assessment time compared to the Full GOASSESS. The adaptive version could be used in large-scale studies or clinical settings for intake screening.

Pressure injury risk factors in adult orthopaedic surgical patients: a cross-sectional study and random forest.

OBJECTIVE: To identify the most important risk factors for predicting pressure injury (PI) occurrence in adult orthopaedic surgical patients based on investigation data, thereby identifying at-risk patients and facilitating formulation of an effective patient care strategy. METHOD: Patients were assessed with an instrument designed by the authors specifically for this study in a cross-sectional investigation following the STROBE checklist. The random forest method was adopted to select the most important risk factors and predict occurrence of PIs. RESULTS: A dataset of 27 risk factors from 1701 patients was obtained. A subset of the 15 most important risk factors was identified. The random forest method had a high prediction accuracy of 0.9733 compared with 0.9281 calculated with a logistic model. CONCLUSION: Results indicated that the selected 15 risk factors, such as activity ability, friction/shear force, skin type and anaesthesia score, performed very well in predicting the occurrence of PIs in adult orthopaedic surgical patients.

Assessing psychometric properties and measurement invariance of the Sleep Quality Questionnaire among healthcare students.

OBJECTIVE: The sleep of healthcare students is worth discovering. Mental health and self-rated health are thought to be associated with sleep quality. As such, valid instruments to assess sleep quality in healthcare students are crucial and irreplaceable. This study aimed to investigate the measurement properties of the Sleep Quality Questionnaire (SQQ) for Chinese healthcare students. METHODS: Two longitudinal assessments were undertaken among healthcare students, with a total of 595, between December 2020 and January 2021. Measures include the Chinese version of the SQQ, Patient Health Questionnaire-4 (PHQ-4), Self-Rated Health Questionnaire (SRHQ), and sociodemographic questionnaire. Structural validity through confirmatory factor analysis (CFA) was conducted to examine factor structure of the SQQ. T-tests and ANOVAs were used to examine sociodemographic differences in sleep quality scores. Multi Group CFA and longitudinal CFA were respectively used to assess cross-sectional invariance and longitudinal invariance across two-time interval, i.e., cross-cultural validity. Construct validity, internal consistency, and test-retest reliability were correspondingly examined via Spearman correlation, Cronbach's alpha and McDonald's omega, and intraclass correlation coefficient. Multiple linear regression analysis was performed to examine incremental validity of the SQQ based on the PHQ-4 and SRHQ as indicators of the criterion variables. RESULTS: CFA results suggested that the two-factor model of the SQQ-9 (item 2 excluded) had the best fit. The SQQ-9 scores differed significantly by age, grade, academic stage, hobby, stress coping strategy, anxiety, depression, and self-rated health subgroups. Measurement invariance was supported in terms of aforesaid subgroups and across two time intervals. In correlation and regression analyses, anxiety, depression, and self-rated health were moderately strong predictors of sleep quality. The SQQ-9 had good internal consistency and test-retest reliability. CONCLUSION: Good measurement properties suggest that the SQQ is a promising and practical measurement instrument for assessing sleep quality of Chinese healthcare students.

Development and Psychometric Properties of the Chronic Uveitis-Specific Quality of Life Instrument for Patients with Chronic Uveitis.

PURPOSE: To develop and assess psychometric properties of a disease-specific quality of life (QOL) assessment tool for patients with chronic uveitis. METHODS: The initial 42-item chronic uveitis-related QOL questionnaire (CUQOL) was developed by literature review, semi-structured interviews, and expert consultation. Further development and assessment of the CUQOL were performed using Classic Test Theory and Rasch analysis. RESULTS: The CUQOL version 1.0 was constructed with 28 items in five dimensions. The five subscales satisfied the requirements of unidimensionality, local independence, and threshold ordering. Cronbach's α coefficient for overall and each scale of the CUQOL 1.0 ranged from 0.75 to 0.94, with test-retest intraclass correlation ranging from 0.95 to 0.99. The CUQOL 1.0 has satisfactory convergent validity (r = 0.41-0.82), reasonable known group validity (p < .05), and good responsiveness (p < .05). CONCLUSIONS: The CUQOL 1.0 is reliable and vaild for evaluating the QOL of patients with chronic uveitis.

Psychometric Validation of the Tactical Assessment Instrument in Football for Use in Physical Education and with Youth Sport Teams.

Recently, the Tactical Assessment Instrument in Football (TAIS) was developed to address football's tactical requirements in terms of game phases, learners' roles, and organizational levels of play. In this study, we sought to evaluate the psychometric properties of this existing instrument in the Physical Education (PE) context and for youth sport teams (ages 8-12 years). Our research design involved: (a) participants playing 37 football games, (b) assessing participants via observation with the TAIS and (c) conducting psychometric analysis on the obtained assessment data. For the psychometric analysis, we carried out our work in four phases: (a) a statistical analysis of the evaluation criteria, (b) analysis of the instrument's structural dimensions, (c) internal item reliability analysis, and (d) provision of evidence for external validity. Participants were 592 children (156 girls, 436 boys; ages 8-12 years) from 74 PE classes or sport teams (from three institutional contexts - schools, community-based sports, and sports clubs) in Spain. We selected 12 tactical criteria and grouped them into four theoretical dimensions (appropriate attack, inappropriate attack, appropriate defense, inappropriate defense) to confirm the instrument's structural dimensions. The Cronbach alpha and Omega McDonald coefficients were greater than .70. The TAIS discriminated between participants from the three institutional contexts, offering evidence of the instrument's external validity. Thus, the TAIS now has sufficient psychometric support for assessing learning of football tactics in PE and youth sport teams. This instrument facilitates an ecological assessment of youth players' understanding of football tactics through four theoretical tactical dimensions and 12 criteria involving information about four learners' roles (both attack and defense, on- and off-the-ball) and three organizational tactical levels of play (whole team, small groups of learners, and individual learners).

Development and validation of Simulation Scenario Quality Instrument (SSQI).

BACKGROUND: Due to the unmet need for valid instruments that evaluate critical components of simulation scenarios, this research aimed to develop and validate an instrument that measures the quality of healthcare simulation scenarios. METHODS: A sequential transformative mixed-method research design was used to conduct the study. The development and validation of the instrument involved two phases: the qualitative phase, which included defining the instrument's theoretical background and instrument construction, followed by the quantitative phase, where the instrument was piloted and validated. The qualitative study included 17 healthcare simulation experts, where three focus group was conducted, and the first version of the instrument was constructed based on the focus group analysis and the theoretical framework constructed using the literature review. During the quantitative phase, the instrument's quantitative piloting included 125 healthcare simulation scenarios; then, the instrument went through construct validity and reliability testing. RESULTS: Content experts confirmed the theoretical model and instrument framework. The average item content validity index (I-CVI) scores and the average of the I-CVI scores (S-CVI/Ave) for all items on the scale or the average proportion relevance judged by all experts was 0.87. The conformity factor analysis results showed a good fit for the proposed 10-factor model (CFI (the comparative fit index) = 0.998, Tucker-Lewis index = 0.998, Root mean square error of approximation (RMSEA) = 0.061. The final instrument included ten domains: 1. Learning objectives, 2. Target group, 3. Culture, 4. Scenario case, 5. Scenario narrative briefing, 6. Scenario complexity, 7. Scenario flow, 8. Fidelity, 9. Debriefing, and 10. ASSESSMENT: The SSQI included 44 items that are rated on a 3-point scale (Meets Expectations = (2), Needs Improvement, (1), Inadequate (0)). CONCLUSION: This validated and reliable instrument will be helpful to healthcare educators and simulation experts who want to develop simulation-based training scenarios and ensure the quality of written scenarios.

Psychometric properties of the Chinese Family Assessment Instrument: evidence from mainland China.

Regarding the assessment of family functioning in Chinese people, there are several research gaps. First, although there are some instruments in the field, there are very few validated instruments. Second, while some translated measures have been developed, there are very few assessment tools based on indigenous Chinese concepts. Third, compared to Hong Kong, research on family assessment is relatively inactive in mainland China. Fourth, there are very few family assessment tools to assess perceived family functioning in older children and early adolescents. Fifth, few studies used large samples to validate family assessment tools. Sixth, researchers seldom utilized longitudinal data to examine the psychometric properties of family assessment tools. Finally, few studies have examined factorial validity across samples and time to demonstrate the stability of Chinese family assessment measures. In Hong Kong, based on focus group data (i.e., indigenous concepts of family functioning) and an integration with the family science literature, we have developed the Chinese Family Assessment Instrument (C-FAI) to assess perceived family functioning according to the perception of adolescents. Results showed that the C-FAI possessed good reliability and validity. Specifically, five dimensions of the measure (mutuality, communication, conflict, parental concern and parental control) were supported via exploratory factor analysis and confirmatory factor analysis. Convergent validity and reliability of the C-FAI were illustrated. To understand the psychometric properties of the C-FAI in mainland China, we collected three waves of data from students in the period of preadolescence and early adolescence in mainland China (N = 3,732). Based on the data, we examined the psychometric properties of the measure, particularly factor invariance in different samples and at different times. Confirmatory factor analysis provided support for the five dimensions in C-FAI, including factorial invariance in terms of configuration, factor loading, intercepts, and over time. There was evidence for convergent validity and discriminant validity of the measure. Finally, reliability analyses showed that the total C-FAI scale and its subscales are internally consistent. The present findings suggest that family researchers and practitioners can use the C-FAI to objectively assess perceived family functioning in preadolescence and early adolescence in different Chinese communities.

Development and Validation of Nutrition Literacy Assessment Instrument for Chinese Lactating Women: A Preliminary Study.

This study focused on the development and validation of a nutrition literacy assessment instrument for Chinese lactating women (NLAI-L). A comprehensive literature review and group discussion by experts in relevant fields were adopted to determine the dimension, topics and questions of NLAI-L. Content validity was evaluated by a panel of experts. The exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were used to evaluate the construct validity. Cronbach's α and split-half reliability were applied to examine the reliability of NLAI-L. The final NLAI-L consisted of 38 questions covering three dimensions: knowledge, behavior and skill. The EFA revealed four sub-domains for knowledge, one sub-domain for behavior and four sub-domains for skill. The results showed that NLAI-L had satisfactory content validity (CVI = 0.98, CVR = 0.96), good reliability (Cronbach's α coefficient = 0.84) and acceptable construct validity (χ2/df = 2.28, GFI = 2.81, AGFI = 0.79, RMSEA = 0.057). In the application part, the average NL score was 46.0 ± 9.3. In multivariate linear regression, education level, age, postnatal period and occupation were the potential influencing factors of NL for Chinese lactating women. The study established an effective and reliable assessment instrument for Chinese lactating women (NLAI-L) through qualitative and quantitative methods. The establishment of NLAI-L will provide an effective tool for exploring the role of NL in health or disease and provide a basis for the formulation of targeted nutrition interventions.

Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving?

BACKGROUND AND AIMS: Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments. METHODS: The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication. RESULTS: This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire. CONCLUSION: This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure 'sexual craving' is needed and could be based on the data from our review.

Development and validation of experienced work-integrated learning instrument (E-WIL) using a sample of newly graduated registered nurses - A confirmatory factor analysis.

INTRODUCTION: Research indicates that newly graduated registered nurses struggle to develop practical skills and clinical understanding and to adapt to their professional role. To ensure quality of care and support new nurses, it is vital that this learning is elucidated and evaluated. Aim The aim was to develop and evaluate the psychometric properties of an instrument assessing work-integrated learning for newly graduated registered nurses, the Experienced Work-Integrated Learning (E-WIL) instrument. METHOD: The study utilized the methodology of a survey and a cross-sectional research design. The sample consisted of newly graduated registered nurses (n = 221) working at hospitals in western Sweden. The E-WIL instrument was validated using confirmatory factor analysis (CFA). RESULTS: The majority of the study participants were female, the average age was 28 years, and participants had an average of five months' experience in the profession. The results confirmed the construct validity of the global latent variable E-WIL, "Transforming previous notions and new contextual knowledge into practical meaning," including six dimensions representing work-integrated learning. The factor loadings between the final 29 indicators and the six factors ranged from 0.30 to 0.89, and between the latent factor and the six factors from 0.64 to 0.79. The indices of fit indicated satisfactory goodness-of-fit and good reliability in five dimensions with values ranging from α = 0.70 to 0.81, except for one dimension showing a slightly lower reliability, α = 0.63, due to the low item number. Confirmatory factor analysis also confirmed two second-order latent variables, "Personal mastering of professional roles" with 18 indicators, and "Adapting to organisational requirements" with 11 indicators. Both showed satisfactory goodness-of-fit, and factor loading between indicators and the latent variables ranged from 0.44 to 0.90 and from 0.37 to 0.81, respectively. CONCLUSION: The validity of the E-WIL instrument was confirmed. All three latent variables could be measured in their entirety, and all dimensions could be used separately for the assessment of work-integrated learning. The E-WIL instrument could be useful for healthcare organisations when the goal is to assess aspects of newly graduated registered nurses' learning and professional development.

Prompt identification of struggling candidates in near peer-led basic life support training: piloting an online performance scoring system.

BACKGROUND: Bristol Medical School has adopted a near peer-led teaching approach to deliver Basic Life Support training to first year undergraduate medical students. Challenges arose when trying to identify early in the course which candidates were struggling with their learning, in sessions delivered to large cohorts. We developed and piloted a novel, online performance scoring system to better track and highlight candidate progress. METHODS: During this pilot, a 10-point scale was used to evaluate candidate performance at six time-points during their training. The scores were collated and entered on an anonymised secure spreadsheet, which was conditionally formatted to provide a visual representation of the score. A One-Way ANOVA was performed on the scores and trends analysed during each course to review candidate trajectory. Descriptive statistics were assessed. Values are presented as mean scores with standard deviation (x̄±SD). RESULTS: A significant linear trend was demonstrated (P < 0.001) for the progression of candidates over the course. The average session score increased from 4.61 ± 1.78 at the start to 7.92 ± 1.22 at the end of the final session. A threshold of less than 1SD below the mean was used to identify struggling candidates at any of the six given timepoints. This threshold enabled efficient highlighting of struggling candidates in real time. CONCLUSIONS: Although the system will be subject to further validation, our pilot has shown the use of a simple 10-point scoring system in combination with a visual representation of performance helps to identify struggling candidates earlier across large cohorts of students undertaking skills training such as Basic Life Support. This early identification enables effective and efficient remedial support.

Development of the reading literacy questionnaire for EFL learners at primary schools.

Previous studies have indicated that there are a variety of factors influencing reading literacy assessment, including linguistic, cognitive, and affective factors, but little has been done on how to integrate these influential factors reasonably in a reading literacy instrument. As such, the purpose of this study is to develop and validate an English Reading Literacy Questionnaire (ERLQ) for English as foreign language (EFL) learners at the elementary level. The ERLQ was designed and revised through three rounds of validation with a sample of 784 pupils (Grades 3-6) in six primary schools from six provinces in China. Validity and reliability tests of the questionnaire were conducted with item analysis, Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), reliability test, and the analysis of criterion validity in SPSS 26.0 and AMOS 23.0. Results indicated that the revised ERLQ had high internal consistency, ranging from 0.729 to 0.823. The criterion validity of the ERLQ was supported by significant correlations to the Chinese Students' English Rating Scale verified by the authoritative department, with a correlation coefficient of 0.871. The study shows that the revised questionnaire, with 3 dimensions of 14 items, has high reliability and validity, which can be used as an assessment instrument for the intended audience. It also suggests that modifications may be made for further use in other regions and countries, depending on the background information of the learners.

Measuring the intensity of mental healthcare: development of the Mental Healthcare Intensity Scale (MHIS).

BACKGROUND: There are considerable differences among mental healthcare services, and especially in developed countries there are a substantial number of different services available. The intensity of mental healthcare has been an important variable in research studies (e.g. cohort studies or randomized controlled trials), yet it is difficult to measure or quantify, in part due to the fact that the intensity of mental healthcare results from a combination of several factors of a mental health service. In this article we describe the development of an instrument to measure the intensity of mental healthcare that is easy and fast to use in repeated measurements. METHODS: The Mental Healthcare Intensity Scale was developed in four stages. First, categories of care were formulated by using focus group interviews. Second, the fit among the categories was improved, and the results were discussed with a sample of the focus group participants. Third, the categories of care were ranked using the Segmented String Relative Rankings algorithm. Finally, the Mental Healthcare Intensity Scale was validated as a coherent classification instrument. RESULTS: 15 categories of care were formulated and were ranked on each of 12 different intensities of care. The Mental Healthcare Intensity Scale is a versatile questionnaire that takes 2-to-3 min to complete and yields a single variable that can be used in statistical analysis. CONCLUSIONS: The Mental Healthcare Intensity Scale is an instrument that can potentially be used in cohort studies and trials to measure the intensity of mental healthcare as a predictor of outcome. Further study into the psychometric characteristics of the Mental Healthcare Intensity Scale is needed.

Measurement instruments to evaluate diaper dermatitis in children: Systematic review of measurement properties.

AIM: The aim of this study was to summarize and evaluate the empirical evidence on the measurement properties of diaper dermatitis (DD) measurement instruments in children. DESIGN: Systematic review. METHODS: MEDLINE, CINAHL and EMBASE were systematically searched until 14 June 2021. Citation searching was conducted in Scopus. The risk of bias, the reported measurement properties and the quality of evidence were evaluated using the COSMIN framework. The reporting follows the PRISMA 2020 statement. RESULTS: We identified 1200 records in the databases and 108 records during citation searching and included four studies describing three measurement instruments for DD in children and their measurement properties. We considered the content validity inconsistent for all three instruments. The study authors reported internal consistency, reliability and construct validity for one instrument. We rated the quality of evidence from very low to moderate.

Natural language processing and String Metric-assisted Assessment of Semantic Heterogeneity method for capturing and standardizing unstructured nursing activities in a hospital setting: a retrospective study.

Background: Nurses record data in electronic health records (EHRs) using different terminologies and coding systems. The purpose of this study was to identify unstructured free-text nursing activities recorded by nurses in EHRs with natural language processing (NLP) techniques and to map these nursing activities into standard nursing activities using the SMASH method. Study design: A retrospective study using NLP techniques with a unidirectional mapping strategy called SMASH. Methods: The unstructured free-text nursing activities recorded in the Medicine, Neurology and Gastroenterology inpatient units of the Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy were collected for 6 months in 2018. Data were analyzed by three phases: a) text summarization component with NLP techniques, b) a consensus analysis by four experts to detect the category of word stems, and c) cross-mapping with SMASH. The SMASH method calculated the string comparison, similarity and distance of words through the Levenshtein distance (LD), Jaro-Winker distance and the cross-mapping's cut-offs: map [0.80-1.00] with < 13 LD, partial-map [0.50-0.79] with <13 LD and no map [0.0-0.49] with >13 LD. Results: During the study period, 491 patient records were assessed. 548 different unstructured free-text nursing activities were recorded by nurses. 451 unstructured free-text nursing activities (82.3%) were mapped to standard PAI nursing activities, 47 (8.7%) were partial mapped, while 50 (9.0%) were not mapped. This automated mapping yielded recall of 0.95%, precision of 0.94%, accuracy of 0.91%, F-measure of 0.96. The F-measure indicates good reliability of this automated procedure in cross-mapping. Conclusions: Lexical similarities between unstructured free-text nursing activities and standard nursing activities were found, NLP with the SMASH method is a feasible approach to extract data related to nursing concepts that are not recorded through structured data entry.

The Association of Long-Term Opioid Use With Health Care and Home Care Service Use Among Aged Home Care Clients.

OBJECTIVES: To compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients. DESIGN: A retrospective cohort study based on the Resident Assessment Instrument-Home Care (RAI-HC) assessments and electronic medical records. SETTING AND PARTICIPANTS: The study sample included all regular home care clients aged ≥65 years (n = 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants). METHODS: Health care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use. RESULTS: Compared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08-1.48), home visits (1.23; 1.01-1.49), phone contacts (1.38; 1.13-1.68), and consultations without a patient attending a practice (1.22; 1.04-1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses' median work hours per week were 4.3 (Q1-Q3 1.5-7.7) among opioid users and 2.8 (1.0-6.1) among nonusers. Mortality and long-term care admissions were not associated with opioid use. CONCLUSIONS AND IMPLICATIONS: Long-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients' needs. The exact reasons for opioid users' greater health care utilization should be examined in future.

Libras no contexto escolar: instrumento ilustrado de avaliação de narrativas sinalizadas1 / Libras in the school context: illustrated instrument for evaluation of signed narratives

RESUMO O contato inicial com uma língua acessível ocorre, para os estudantes surdos brasileiros, frequentemente no ambiente escolar, ao entrar em contato com outras crianças surdas e com interlocutores adultos fluentes em Língua Brasileira de Sinais (Libras). Esse acesso tardio pode ocasionar um certo atraso na aquisição e no desenvolvimento da linguagem. Assim, a educação bilíngue de surdos coloca os professores frente ao desafio de como avaliar a Libras no contexto escolar. Diante das propostas educacionais, ainda há poucos instrumentos que contribuam para avaliar os conhecimentos em Libras dos estudantes surdos. Portanto, o objetivo deste estudo é, por meio de um instrumento ilustrado de investigação de narrativas sinalizadas, contribuir com a avaliação da Libras e com o trabalho pedagógico de professores que atuam na educação bilíngue de surdos. O instrumento de avaliação de textos narrativos mostra-se bastante sensível para detectar o desenvolvimento linguístico dos discursos narrativos sinalizados, contribuindo intrinsicamente para a observação de funções/necessidades comunicativas.

ABSTRACT The initial contact with an accessible language occurs, for Brazilian deaf students, often in the school environment, when they encounter other deaf children and with adult interlocutors who are fluent in Brazilian Sign Language (LIBRAS). This late access can cause a certain delay in language acquisition and development. Thus, bilingual education for the deaf place's teachers in the face of the challenge of how to evaluate LIBRAS in the school context. In view of the educational proposals, there are still few instruments that contribute to assessing deaf students' knowledge in LIBRAS. Therefore, the objective of this study is, through an illustrated instrument for investigating signaled narratives, to contribute to the evaluation of LIBRAS and to the pedagogical work of teachers who work in bilingual education for the deaf. The instrument for evaluating narrative texts proves to be quite sensitive to detect the linguistic development of signaled narrative discourses, intrinsically contributing to the observation of communicative functions/needs.

Casa Colina Fall Risk Assessment Scale-Revised: Predicting Falls in Inpatient Rehabilitation Facilities.

Objective: To revise the Casa Colina Fall risk assessment scale (CCFRAS) using the new Medicare standards required functional ability quality measures and to assess the sensitivity and specificity of this revised fall risk assessment tool. Design: The Casa Colina Fall risk assessment scale-revised (CCFRAS-R) was assessed both retrospectively and prospectively on consecutive patients at 3 inpatient rehabilitation facilities (IRFs) to determine the sensitivity and specificity of this tool in predicting fall risk. Setting: Three IRFs. Participants: A total of 6253 adult patients (N=6253) admitted to 1 of 3 IRF settings including those with stroke, brain injury, spinal cord injury, and other conditions requiring medical rehabilitation, with mean age of 66 years; 50% were female and 50% were male. Interventions: Not applicable. Main Outcomes: Each IRF quantified the number of falls detected for the patient population under evaluation and determined the site-specific sensitivity and specificity of the CCFRAS-R. Results: Quality measures were analyzed for predicting fall risk using logistic regression analyses and found that impaired toileting hygiene, impaired toilet transfer, impaired chair/bed transfer, and difficulty walking 3 meters were the most significant predictors for falls. The area under the curve was used to determine the cut-off score and new scoring for the revised falls scale. A second data set was used to validate the tool showing a sensitivity and specificity of 0.6 and 0.62, respectively (P=.001). The degree of "agreeability" between the original scale and the revised scale was 0.72. Conclusion: This multi-site data set predicted quality measures for the risk of falling resulting in a revised fall risk assessment scale for IRFs. Evaluation of this revised assessment tool indicates that the CCFRAS-R is effective and broadly generalizable for predicting patients at high risk for falling although the sensitivity and specificity of the tool may vary slightly based on environmental differences and patient acuity.

A Cross-Sectional, Correlational Study Comparing Individual Characteristics of Younger and Older Nursing Home Residents using Western Canadian Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0.

OBJECTIVE: To compare characteristics of nursing home (NH) residents by age categories in Western Canada. DESIGN: A cross-sectional, correlational analysis of secondary data. SETTING AND PARTICIPANTS: 89,231 residents living in Western Canada NHs in the provinces of Alberta, Manitoba, and British Columbia in 2016 and 2017. METHODS: Resident characteristics (age, sex, marital status, body mass index, medical diagnoses, cognitive function, physical function, depressive symptoms) came from the Resident Assessment Instrument-Minimum Data Set 2.0 and were analyzed using chi-square, analysis of variance, and post hoc pairwise tests. Human developmental stage age categories were used to create 5 age groups: 18-34, 35-50, 51-64, 65-80, and 81 years and older. RESULTS: The demographics, medical diagnoses, cognitive function, and physical function characteristics of NH residents among 5 age groups differed considerably (all P < .001). Residents aged 18-34 years were predominately male, never married, with a higher incidence of paralysis and traumatic brain injury. Residents aged 35-50 years had a higher incidence of stroke and multiple sclerosis, and residents aged 51-64 years mainly were morbidly obese and more prone to depression. Residents aged 65-80 years were predominately married and more prone to diabetes, and residents aged 81 years and older were predominately widowed, with a higher incidence of dementia compared with others. CONCLUSIONS AND IMPLICATIONS: Findings describe the uniqueness of younger NH age groups and indicate that the youngest NH residents often have the severe disability and a modest support system (as defined by partnered status) compared to older residents in NHs. Future studies must analyze longitudinal data that track the growth of, and changes in, residents' health and functional status.