Is it quality, is it redundancy, or is model inadequacy? Some strategies for judging the ap-propriateness of high-discrimination items / ¿Es calidad, redundancia o inadecuación del modelo? Algunas estrategias para determinar la idoneidad de los ítems altamente discriminativos

Cuando se desarrollan nuevos cuestionarios, tradicionalmente se asume que los ítems deben ser lo más discriminativos posible, como si esto fuera siempre indicativo de su calidad. Pero en algunos casos estas discriminaciones elevadas pueden estar ocultando algunos problemas como redundancias, residuales compartidos, distribuciones sesgadas o limitaciones del modelo que pueden contribuir a inflar las estimaciones de la discriminación. Por lo tanto, la inspección de estos índices puede llevar a decisiones erróneas sobre qué ítems mantener o eliminar. Para ilustrar este problema, se describen dos escenarios diferentes con datos reales. El primero se centra en un cuestionario que contiene un ítem aparentemente muy discriminante, pero redundante. El segundo se centra en un cuestionario clínico administrado a una muestra comunitaria, lo que da lugar a distribuciones de respuesta de los ítems muy sesgadas y a índices de discriminación inflados, a pesar de que los ítems no discriminan bien entre la mayoría de los sujetos. Proponemos algunas estrategias y comprobaciones para identificar estas situaciones, para facilitar la identificación y eliminación de los ítems inapropiados. Por lo tanto, este artículo pretende promover una actitud crítica, que puede implicar ir en contra de los principios rutinarios establecidos cuando no son apropiados.(AU)

When developing new questionnaires, it is traditionally assumed that the items should be as discriminative as possible, as if this was always indicative of their quality. However, in some cases these high discrimina-tions may be masking some problems such as redundancies, shared residu-als, biased distributions, or model limitations which may contribute to in-flate the discrimination estimates. Therefore, the inspection of these indi-ces may lead to erroneous decisions about which items to keep or elimi-nate. Toillustrate this problem, two different scenarios with real data are described. The first focuses on a questionnaire that contains an item ap-parently highly discriminant, but redundant. The second focuses on a clini-cal questionnaire administered to a community sample, which gives place to highly right-skewed item response distributions and inflated discrimi-nant indices, despite the items do not discriminate well among the majority of participants. We propose some strategies and checks to identify these situations, so that the items that are inappropriate may be identified and removed. Therefore, this article seeks to promote a critical attitude, which may involve going against routine stablished principles when they are not appropriate.(AU)

Evaluation of the effect of melatonin in patients with Burning mouth syndrome: a double-blind, placebo-controlled randomized clinical trial

Abstract The present study was carried out to evaluate the effect of Melatonin and Placebo in the patient with the Burning mouth (BMs). This double-blind, placebo-controlled randomized clinical trial study was carried out on 30 patients who were suffering from BMS. During this period patients were divided into 2 study and control groups. The study group used four 3 mg Melatonin daily and the control group received a placebo. Then the severity of the burning sensation was measured by the physician Sleep quality was measured using the VAS scale using the Petersburg questionnaire. Data in the application Enter SPSS 20 and then using T test or equivalent Nonparametric was analyzed, mean sleep score and mean severity of oral irritation before and after treatment in two the group was evaluated using T-test Independent. Level significance was considered 0.05. The results of the present study show that the use of melatonin and a placebo in patients with BMS reduces sensation and improves their sleep quality, although it may not reduce it completely. In this study severity of burning was 4.93±2.56 after treatment in the study group and 6.93±2.12 in the control group, which was statistically significant (P =0.036). No significant difference was observed between the two groups in the sleep quality score (P-value = 0.43). Using Melatonin can be a reliable way to treat pain for which there is no standard treatment to date. Although evidence suggests an association between sleep disorders and BMS, melatonin was not superior to a placebo in reducing BMS-induced burning in the present study. Identification of stressors and the ways to struggle with them, further studies with larger samples and higher oral doses, extended follow-up periods and control of psychological factors, and measurement of body mass index that may affect pharmacokinetics are recommended.

[Patient owner surveys in small animal medicine - importance, benefits and pitfalls in planning, execution and analysis]. / Patientenbesitzerbefragungen in der Kleintiermedizin ­ Bedeutung, Nutzen und Fallstricke bei Planung, Durchführung und Auswertung.

OBJECTIVE: In the present study, the benefits and difficulties of planning and conducting patient surveys in veterinary medicine were examined using 2 examples. One focus was placed on the comparison of the subjective assessment and perception of patient owners with regard to long-term investigation of disease progression. STUDY POPULATION: An owner survey was conducted in dogs with chronic enteropathy (CE) and degenerative mitral valve disease (DMVD). In both surveys, the case system of the Clinic for Small Animals of the University of Veterinary Medicine Hannover was used to identify suitable cases based on appropriate diagnoses. Owners were contacted and invited to complete (digitally or postally) a multipart questionnaire on their dogs. The results of the survey were evaluated regarding their agreement with literature data. Based on the results of this evaluation, the study design, reliability of owner perception and the benefit of the survey were examined critically. RESULTS: The search in the clinic's case system provided 125 suitable cases for CE and 145 for DMVD. A total of 81 (CE, response rate 64.8 %) and 72 (DMVD, response rate 49,7 %) owners answered the questionnaire. The owners provided considerably different information concerning the diagnostic examination of their animals. While the statements on the course and forms of disease in CE corresponded to the information from the literature, this was not always the case with DMVD. CONCLUSION AND CLINICAL RELEVANCE: Patient owner surveys may provide important information about disease progression from the owner's perspective. This is particularly valuable in chronic diseases, the management of which requires good owner compliance. An identical approach to patient selection may lead to results differing in their informative value depending on the disease.

Las encuestas online y la falsa ilusión de la n grande. A propósito de una encuesta sobre la eutanasia en profesionales médicos / Online surveys and the false illusion of the large n. On a survey on euthanasia among medical practitioners

El uso de estudios basados en encuestas online se ha extendido de manera notable. A pesar de tener tasas de respuesta especialmente pequeñas, permiten obtener con facilidad un gran tamaño de muestra. Sin embargo, esta estrategia puede conllevar un sesgo de selección que comprometa notablemente los resultados. Se comparan los resultados de dos encuestas sobre la regulación de la eutanasia y el suicidio asistido, una online con muestra autoseleccionada y la otra con muestreo aleatorio, realizadas en 2018 entre los/las colegiados/as del Colegio de Médicos de Bizkaia. Las tasas de respuesta fueron del 10,4% (encuesta online) y del 87,8% (encuesta aleatoria). No se encontraron diferencias en las características sociodemográficas, aunque sí en las de opinión, de manera que el porcentaje de personas contrarias a la regulación de la eutanasia estaba sobrestimado. Los resultados de este estudio muestran que dicha estrategia de muestreo genera sesgos en los resultados, alguno de ellos difícilmente detectable y reparable

The use of studies based on online surveys has expanded significantly. Despite having particularly small response rates, they allow a large sample size to be easily obtained. However, this strategy may entail a selection bias that significantly compromises the results. The results of two surveys on the regulation of euthanasia and assisted suicide are compared. One is an online survey with a self-selected sample and the other a survey with random sampling, conducted in 2018 among the members of the Medical Association of Bizkaia. The response rates were 10.4% (online survey) and 87.8% (random survey). No differences were found in sociodemographic characteristics, although there were differences in the opinion variables, so that the percentage of people who opposed euthanasia regulation was overestimated. The results of this study show that this sampling strategy generates biases in the results, some of which are difficult both to detect and to repair

Sobre los cuestionarios de calidad de vida en fibrilación auricular / On the quality of life questionnaires in atrial fibrillation

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Réplica a «Sobre los cuestionarios de calidad de vida en fibrilación auricular» / Reply to 'On the quality of life questionnaires in atrial fibrillation'

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Content analysis of clinical questions from Australian general practice which are prioritised for answering: identifying common question types and perceived knowledge gaps.

Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their diverse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information service using established and inductive coding systems. We analysed 126 clinical questions submitted by 53 Australian GPs over a 1.5-year period. Questions were coded using the International Classification of Primary Care (ICPC-2 PLUS) and Ely and colleagues' generic questions taxonomy by two independent coders. Inductive qualitative content analysis was also used to identify perceived knowledge gaps. Treatment (71%), diagnosis (15%) and epidemiology (9%) were the most common categories of questions. Using the ICPC-2 classification, questions were most commonly coded to the endocrine/metabolic and nutritional chapter heading, followed by general and unspecified, digestive and musculoskeletal. Seventy per cent of all questions related to the need to stay up-to-date with the evidence, or be informed about new tests or treatments (including complementary and alternative therapies). These findings suggest that current guideline formats for common clinical problems may not meet the knowledge demands of GPs and there is gap in access to evidence updates on new tests, treatments and complementary and alternative therapies. Better systems for 'pulling' real-time questions from GPs could better inform the 'push' of more relevant and timely evidence for use in the clinical encounter.

Reclassification of the work-related stress questionnaires scales based on the work system model: A scoping review and qualitative study.

BACKGROUND: Given the wide variety of factors affecting work-related stress, a work system approach could be adopted in order to better identify factors that impact individual stress. OBJECTIVES: To provide a scoping review of the available work-related stress questionnaires and to reclassify their scales on the basis of the five elements included in the work system model using a content analysis method. METHODS: The main available work-related stress questionnaires used in previous studies in the time range of 1975 to 2017 were collected through a search in several indexing and citation databases. To reclassify the scales of these questionnaires, a qualitative content analysis was used and then reclassified in accordance with the five components of work system model: job (tasks), organizational condition, individual characteristics, technology and tools, and physical environmental. RESULTS: In total, 22 questionnaires met the conditions required to be entered into the final stage of the study. Emphasis of these questionnaires was on measuring job-related factors and organizational condition-related factors. 22.7% of them had considered no scales to measure the individual characteristics-related factors. CONCLUSIONS: The results of the reclassification can help organizations select areas that encompass their own specific problems. Practical implications are also discussed.

Identifying and Classifying Quality of Life Tools for Assessing Neurogenic Bowel Dysfunction After Spinal Cord Injury.

Objectives: To identify and classify tools for assessing the influence of neurogenic bowel dysfunction (NBD) on quality of life (QoL) after spinal cord injury (SCI). Methods: In this systematic review, MEDLINE/PubMed, CINAHL, and PsycInfo were searched to identify studies assessing the influence of NBD on QoL (or related construct) after SCI. Two independent reviewers screened titles and abstracts, and both reviewers classified tools as subjective or objective according to Dijkers' theoretical QoL framework. Results: Seventy-two studies were identified, and 35 studies met the inclusion criteria. Five objective measures assessed the influence of NBD on QoL, which were validated for use in SCI, but no measure was condition-specific to NBD. Eight measures were classified as subjective tools; two had an established reliability and validity for SCI while six had some psychometric evidence for use in the SCI population. Five subjective measures (NBD score, Burwood QoL Questionnaire, Impediments to Community Integration [ICI] Scale, SCI-QoL Bowel Management Difficulties, and Survey of Neurogenic Bowel Characteristics) were developed specifically for SCI. The NBD score showed sensitivity to the influence of NBD on QoL in experimental trials. Conclusion: Thirteen tools assessed the influence of NBD on QoL in SCI. Although not developed specifically for SCI, the Health Utility Index (HUI-III) was the only tool identified that provided data on "QoL as utility" on the impact of NBD. The validated NBD score was the only condition-specific tool to assess QoL as "subjective well-being." Further validation of existing tools could help to inform practice and policy related to resource allocation for bowel care post SCI.

Comfort assessment of running footwear: Does assessment type affect inter-session reliability?

Assessing comfort of running footwear reliably is challenging. The purpose of this study was to compare the intra-rater reliability between different assessment types, to calculate intra-individual reliability scores and to evaluate the effect of rater selection based on individual reliability scores on group level reliability. Three assessment types: ranking, Visual Analogue Scale (VAS), and Likert Scale (LS) were provided twice in six separate sessions among 30 participants, who assessed comfort of five shoes after treadmill running. Spearman's rho provided an evaluation of inter-session relative reliability and typical error as a measure of absolute reliability for each assessment type. Ranking (r = 0.70, 95% confidence interval [CI] 0.61-0.78) yielded the highest relative reliability for overall comfort, followed by VAS (r = 0.67, 95% CI 0.56-0.75) and LS (r = 0.63, 95% CI 0.52-0.72), with large-scale overlaps of CIs between assessment types. The same order of assessment types was found for the percentage of reliable raters (r ≥ 0.7) with 60% in ranking scale, 47% in VAS and 37% in LS. Forming subgroups corresponding to the intra-individual reliability substantially increased group level reliabilities. Based on measures of relative reliability, an extreme reduction in resolution as provided by the ranking from pairwise comparisons seems to be a valuable tool in footwear comfort assessments if assessment time is of minor importance. No preference can be provided for the two investigated rating scales. Besides the assessment type, a selection of the best raters in additional reliability checks seems to be a prerequisite for further comfort-related studies.

Qualidade de vida e autoestima em idosas submetidas e não submetidas à cirurgia estética / Quality of life and self-esteem in elderly patients who did or did not have cosmetic surgery

Introdução: A realidade do envelhecimento populacional chegou ao campo da Cirurgia Plástica, provada pelo crescimento do número de idosos que se submetem à cirurgia estética (CE). A pesquisa objetiva avaliar a importância da CE para o idoso, e se existe diferença de qualidade de vida e autoestima entre idosas que se submeteram e que não se submeteram à cirurgia estética. Métodos: Pesquisa casocontrole, sendo o grupo-caso formado por 25 idosas que se submeteram à CE e o grupo-controle por 25 idosas que não fizeram CE, pareados pelos dados socioeconômicos. Os instrumentos aplicados foram: Minimental, questionário de qualidade de vida (WHOQOL-BREF), escala de autoestima de Rosenberg e um questionário elaborado para pesquisa de dados sociodemográficos, motivação e satisfação com a CE. Resultados: A média de idade foi 67,26 anos e a escolaridade média, de 9,96 anos. As cirurgias mais realizadas foram a abdominoplastia e a blefaroplastia. Os motivos mais escolhidos foram o desconforto físico, o desejo de melhoria da qualidade de vida (QV) e a insatisfação com a autoimagem. Não foram encontradas idosas com baixa autoestima e o nível de satisfação foi alto quando relacionado com a própria vida ou a vida social. Não houve diferença de QV e autoestima entre os dois grupos analisados. Conclusão: As motivações das idosas para realização de CE são de ordem física e psicológica. Não houve diferença de QV e autoestima entre idosas submetidas e não submetidas à CE. Analisando-se as idosas submetidas à CE, foram comprovados altos níveis de satisfação pessoal e na vida social.

Introduction: The reality of aging has caught up with the field of plastic surgery, shown by the growth in the number of elderly patients who undergo cosmetic surgery (CS). To evaluate its importance in elderly women, this study examined differences in quality of life and self-esteem among those who did or did not undergo CS. Methods: This casecontrol study included 25 elderly women who underwent CS and a control group of 25 elderly women who did not undergo CS; the groups were matched by socioeconomic data. Assessment methods included the Mini-Mental State Examination, a quality of life (QOL) questionnaire (World Health Organization Quality of Life-Bref), the Rosenberg Self-Esteem Scale, and a questionnaire developed for the study of sociodemographic data, motivation, and satisfaction with CS. Results: The mean age was 67.26 years, with a mean of 9.96 years of education. The most common surgeries were abdominoplasty and blepharoplasty. The most common motivations were physical discomfort, desire to improve QOL, and dissatisfaction with self-image. No subjects were found to have low self-esteem and the level of satisfaction with personal or social life was high. There was no difference in QOL or self-esteem between the 2 groups. Conclusion: Physical and psychological motivations cause the elderly to undergo CS. There was no difference in QOL or self-esteem among elderly women who did or did not have CS. Elderly women who underwent CS showed high levels of satisfaction with their personal and social life.

Development of Questionnaire for Auditory Localization.

OBJECTIVE: Localization plays an important role in identifying the source of the stimuli. Aural localization is based on the phase (period-related time), intensity level, and spectral differences between the sounds at each ear. Various behavioral measures are available to check the interaural level, time, and frequency differences, which provide information on an individual's ability to localize the sound source. This might vary depending on the audibility and amplification devices. Although these behavioral measures are available, the perceptual quality of localization cannot be obtained using these measures. This study aimed to develop a questionnaire for auditory localization. MATERIALS AND METHODS: A questionnaire was prepared, the content validated, and administered on 120 individuals in the age range of 18-50 years who were divided into three different groups. RESULTS: The results of the descriptive and item analysis revealed a significant difference between the groups, with group I showing better localization ability. No significant difference was observed between the groups II and III. The receiver operating curve and cut-off scores were obtained. Individuals with a score of <42.5 on the questionnaire have better or good localization ability. The area covered under the curve is 0.987; therefore, the sensitivity and specificity of the questionnaire is also high. CONCLUSION: It can be concluded that this questionnaire is a simple, valid, and preliminary measure for the auditory localization ability of an individual.

La investigación clínica: razón de ser de una Sociedad Científica / Clinical research: reason for being of a Scientific Society

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Cross-cultural validation of the Child Adolescent Teasing Scale for Colombian students / Validação transcultural da Child Adolescent Teasing Scale para estudantes colombianos / Validación transcultural del Child Adolescent Teasing Scale para escolares colombianos

ABSTRACT Objective: to carry out the cross-cultural validation of the instrument "Child Adolescent Teasing Scale" for the Colombian student population. Method: methodological study carried out with students aged 8 to 15, from public and private educational institutions in the municipality of Ibagué, Colombia. The form for the characterization of students and the Child Adolescent Teasing Scale were used. Results: the cross-cultural adaptation process was organized in seven steps: comparison of the Spanish version of the instrument with the original English version, back-translation, consensus version, face validity and terminology adjustment by students, face and content validity by experts, assessment committee for the final version, pilot test and reliability. Conclusion: the version adapted to the Spanish spoken in Colombia of the Child Adolescent Teasing Scale (Escala de burlas para niños y adolescentes), which assesses the frequency and distress caused by teasing, showed desirable results in terms of validity and reliability.

RESUMO Objetivo: realizar a validação transcultural do instrumento "Child Adolescent Teasing Scale" para a população de estudantes colombianos. Método: estudo metodológico com estudantes de 8 a 15 anos, de instituições educacionais públicas e privadas de Ibagué, Colômbia. Utilizou-se o formulário de caracterização e a "Child Adolescent Teasing Scale". Resultados: o processo de adaptação transcultural foi organizado em sete etapas: comparação da versão em espanhol do instrumento com a versão original em inglês, retrotradução, versão consenso, validade facial e adaptação da terminologia pelos estudantes, validade facial e de conteúdo por especialistas, comissão de avaliação para a versão final, teste piloto e confiabilidade. Conclusão: a versão adaptada ao espanhol usado na Colômbia da "Child Adolescent Teasing Scale" (Escala de zombarias para crianças e adolescentes), que mede a frequência e o incômodo devido às zombarias, mostrou resultados recomendáveis em termos de validade e confiabilidade.

RESUMEN Objetivo: realizar la validación transcultural del instrumento "Child Adolescent Teasing Scale" para la población de escolares colombianos. Método: estudio metodológico con escolares de 8 a 15 años, de instituciones educativas públicas y privadas de Ibagué, Colombia. Se usó la ficha de caracterización y el Child Adolescent Teasing Scale. Resultados: el proceso de adaptación transcultural se organizó en siete etapas: comparación de la versión en español del instrumento con la versión original en inglés, retrotraducción, versión consenso, validez facial y adaptación al lenguaje por escolares, validez facial y de contenido por expertos, comité de evaluación para la versión final, prueba piloto y confiabilidad. Conclusión: la versión adaptada al español usado en Colombia del Child Adolescent Teasing Scale (Escala de burlas para niños y adolescentes), que mide frecuencia y molestia por las burlas, mostró resultados recomendables de validez y confiabilidad.

Validity of questions about activities of daily living to screen for dependency in older adults.

OBJECTIVE: To determine the criterion validity of the activities of daily living present in functionality questionnaires in older adults for population surveys and to identify which activities are valid to quantify the real daily need for help of this population. METHODS: This is a population sample of older adults stratified by levels of functionality, according to self-perception of dependency in the activities of daily living. Self-perception was compared with the gold standard - direct observation of these activities in the household of older adults by a trained professional, blinded to the answers in the questionnaire. At the visit, it was decided if the older adult needed help to perform any of the activities of daily living for the research. The sensitivity of each activity of daily living was greater when the self-assessment that there was no need for help coincided with the assessment of the professional. Specificity indicates coincidence regarding the need for help in the activities of daily living - coefficients of sensitivity and specificity above 70% were considered as indicative of good validity. RESULTS: Self-assessments showed better sensitivity than specificity - older adults and observers agreed more on daily independency than on dependency. All activities showed sensitivity above 70%. Some activities had low (go shopping: 55%) or very low specificity (brush the hair: 33%). The best specificities were to take a shower and dress up (95.8% for both), among the personal ones, and to use transportation and perform banking transactions (78% for both), among the instrumental ones. CONCLUSIONS: Activities of daily living can be valid indicators of functional dependence. The best coefficients of validity were generally obtained for personal activities. Some activities with good sensitivities and specificities - walk 100 meters, take a shower, and lie down in and get out of the bed - can be used to classify older adults into low, average, and high need for help depending on the affected activities and, therefore, can help in the planning of health services aimed at them. OBJETIVO: Determinar a validade de critério das atividades de vida diária constantes em questionários de funcionalidade em idosos para inquéritos populacionais e identificar quais atividades são válidas para quantificar a necessidade real de ajuda diária dessa população. MÉTODOS: Amostra populacional de idosos estratificada por níveis de funcionalidade, segundo a autopercepção de dependência nas atividades de vida diária. Autopercepção foi comparada com o padrão ouro - observação direta no domicílio dos idosos nessas atividades por profissional treinado e cego para respostas no questionário. Na visita decidiu-se, para efeito da pesquisa, se o idoso precisava de ajuda para realizar alguma das atividades de vida diária. A sensibilidade de cada atividade de vida diária foi maior quando a autoavaliação de que não havia necessidade de ajuda coincidiu com a avaliação do profissional. A especificidade indica coincidência quanto à necessidade de ajuda na atividades de vida diária - coeficientes de sensibilidade e especificidade acima de 70% foram considerados indicativos de boa validade. RESULTADOS: As autoavaliações mostraram sensibilidade melhor que especificidade - idosos e observadores concordaram mais quanto à independência do que quanto à dependência cotidiana. Todas as atividades mostraram sensibilidade acima de 70%. Algumas atividades tiveram uma especificidade baixa (fazer compras: 55%) ou muito baixa (pentear os cabelos: 33%). As melhores especificidades foram tomar banho e vestir-se (95,8% ambas), entre as pessoais, e utilizar transporte e realizar movimento bancário (ambas com 78%), entre as instrumentais. CONCLUSÕES: Atividades de vida diária podem ser indicadores válidos de dependência funcional. Os melhores coeficientes de validade em geral foram obtidos pelas atividades pessoais. Destacam-se algumas atividades com boas sensibilidades e especificidades - andar 100 metros, tomar banho e levantar/deitar na cama - que podem servir para classificar os idosos em baixa, média e alta necessidade de ajuda dependendo das atividades afetadas e, dessa forma, auxiliar no planejamento dos serviços de saúde voltados aos idosos.

Estudio comparativo de los formatos en lápiz y papel y electrónicos de los cuestionarios GHQ-12, WHO-5 y PHQ-9 / Comparative study of pencil-and-paper and electronic formats of GHQ-12, WHO-5 and PHQ-9 questionnaires

Introducción. El auge de la telemedicina en el campo de la salud mental está haciendo que el uso de instrumentos psicométricos, tradicionalmente basados en un soporte de «lápiz-y-papel», se adapte al formato electrónico. El objetivo de este trabajo es verificar si los 2 formatos de conocidos instrumentos como las escalas GHQ-12, WHO-5 y PHQ-9 son intercambiables. Material y métodos. Cuarenta y siete voluntarios completaron los cuestionarios GHQ-12, WHO-5 y PHQ-9 en papel y en las siguientes 24h en su versión electrónica a través de la web www.memind.net (24 en formato electrónico-Likert y 23 en formato electrónico-slider). Se midió la consistencia interna mediante el índice α-Cronbach y el coeficiente omega, la fiabilidad test-retest mediante el coeficiente de correlación intraclase (CCI), el grado de acuerdo de los ítems mediante el coeficiente kappa ponderado y comparamos la estructura dimensional de los 2 formatos con el índice de ajuste comparativo (IAC). Resultados. La consistencia interna de los instrumentos fue mayor de 0,8 para todos los instrumentos a excepción del PHQ-9. Los CCI oscilaron entre 0,655 para PHQ-9 lápiz-y-papel/electrónico-slider y 0,901 para GHQ-12 lápiz-y-papel/electrónico-slider. El acuerdo entre los ítems en las versiones en lápiz-y-papel y electrónica-Likert fue variable, desde acuerdos muy bajos en el del ítem PHQ-1 (κ ponderada=0,143; p=0,384) hasta acuerdos altos en el ítem PHQ-5 (κ ponderada=0,769; p=0,000). La equivalencia arrojada con el IAC fue adecuada. Conclusiones. Con la excepción del PHQ-9 electrónico-Likert, los cuestionarios mantienen su estructura en la versión electrónica. Encontramos discrepancias en el acuerdo entre los ítems, lo que apoya la idea de que el paso de un instrumento diseñado en papel al medio digital no es un proceso automático, sino que requiere un proceso de adaptación y de verificación sobre el tipo de diseño en formato electrónico (AU)

Introduction. The increase in telemedicine in the mental health field has led to psychometric instruments changing from paper-and-pencil administration to an electronic format. A study is performed to determine if both formats are equivalent for well-known questionnaires such as GHQ-12, WHO-5, and PHQ-9. Material and methods. Forty-seven volunteers completed GHQ-12, WHO-5 and PHQ-9 questionnaires in paper-and-pencil format, and in the following 24h they completed their electronic versions via the web site www.memind.net. An electronic-Likert format was used by 24 participants, and 23 used an electronic-slider format. Internal consistency was measured by α-Cronbach index and omega coefficient, and test-retest was measured by the intraclass correlation coefficient (ICC). Agreement between individual items was compared using Weighted Kappa coefficients, and dimensional structure between formats using the Comparative Fit Index (CFI). Results. Internal consistency was higher than 0.8 for GHQ-12 and WHO-5. The ICC ranged between 0.655 for PHQ-9 paper-and-pencil/electronic-slider and 0.901 for GHQ-12 paper-and-pencil/electronic- slider. Agreement for individual items in paper-and-pencil and electronic-Likert versions was variable, ranging from low agreement in PHQ-1 (weighted κ=0.143; P=.384) to high agreement in PHQ-5 (weighted κ=0.769; P=.000). The CFI results showed an adequate equivalence between formats. Conclusions. Except for the PHQ-9 electronic-Likert, questionnaires keep their structure in electronic formats. Discrepancies were found in items agreement. This study supports previous works indicating that the change from paper-and-pencil to electronic formats is not an immediate process, and needs a proper adaptation (AU)

A Machine Learning-based Method for Question Type Classification in Biomedical Question Answering.

BACKGROUND AND OBJECTIVE: Biomedical question type classification is one of the important components of an automatic biomedical question answering system. The performance of the latter depends directly on the performance of its biomedical question type classification system, which consists of assigning a category to each question in order to determine the appropriate answer extraction algorithm. This study aims to automatically classify biomedical questions into one of the four categories: (1) yes/no, (2) factoid, (3) list, and (4) summary. METHODS: In this paper, we propose a biomedical question type classification method based on machine learning approaches to automatically assign a category to a biomedical question. First, we extract features from biomedical questions using the proposed handcrafted lexico-syntactic patterns. Then, we feed these features for machine-learning algorithms. Finally, the class label is predicted using the trained classifiers. RESULTS: Experimental evaluations performed on large standard annotated datasets of biomedical questions, provided by the BioASQ challenge, demonstrated that our method exhibits significant improved performance when compared to four baseline systems. The proposed method achieves a roughly 10-point increase over the best baseline in terms of accuracy. Moreover, the obtained results show that using handcrafted lexico-syntactic patterns as features' provider of support vector machine (SVM) lead to the highest accuracy of 89.40 %. CONCLUSION: The proposed method can automatically classify BioASQ questions into one of the four categories: yes/no, factoid, list, and summary. Furthermore, the results demonstrated that our method produced the best classification performance compared to four baseline systems.

Testing whether patients with diabetes and healthy people perceive the meaning of the items in the Persian version of the SF-36 questionnaire similarly: a differential item functioning analysis.

PURPOSE: It has been rarely studied whether observed disparity in health-related quality-of-life (HRQoL) scores between patients with diabetes and healthy individuals is due to differential item functioning (DIF) or a true difference in the underlying construct. This study aimed to examine DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores between patients with diabetes and healthy people. METHODS: The sample consisted of 230 patients with type 2 diabetes and 642 healthy individuals who filled out the Persian version of the SF-36 questionnaire. To detect DIF across patients with diabetes and healthy individuals, multiple-group multiple-indicator multiple-causes model was used. In addition, item calibration strategy was used to determine whether the effect of item-level DIF was transferred to the scale level. RESULTS: Nine out of thirty-six (25 %) items were detected as DIF, of which one item (11 %) was flagged as uniform and eight items (89 %) as non-uniform DIF. Most of the DIF items were detected in the mental health component which includes vitality, perceived mental health and social functioning subscales rather than in physical health component. Moreover, nonsignificant latent mean differences for general health perception and social functioning subscales became significant after DIF calibration. CONCLUSION: The findings of the present study show that patients with diabetes and healthy individuals perceived some items in the SF-36 questionnaire differently. More importantly, in some subscales, the effect of item-level DIF was transferred to the scale level. Consequently, considerable caution should be taken in comparing HRQoL scores between patients with diabetes and healthy individuals.

Validity of questions about activities of daily living to screen for dependency in older adults / Validade das perguntas sobre atividades da vida diária para rastrear dependência em idosos

ABSTRACT OBJECTIVE To determine the criterion validity of the activities of daily living present in functionality questionnaires in older adults for population surveys and to identify which activities are valid to quantify the real daily need for help of this population. METHODS This is a population sample of older adults stratified by levels of functionality, according to self-perception of dependency in the activities of daily living. Self-perception was compared with the gold standard - direct observation of these activities in the household of older adults by a trained professional, blinded to the answers in the questionnaire. At the visit, it was decided if the older adult needed help to perform any of the activities of daily living for the research. The sensitivity of each activity of daily living was greater when the self-assessment that there was no need for help coincided with the assessment of the professional. Specificity indicates coincidence regarding the need for help in the activities of daily living - coefficients of sensitivity and specificity above 70% were considered as indicative of good validity. RESULTS Self-assessments showed better sensitivity than specificity - older adults and observers agreed more on daily independency than on dependency. All activities showed sensitivity above 70%. Some activities had low (go shopping: 55%) or very low specificity (brush the hair: 33%). The best specificities were to take a shower and dress up (95.8% for both), among the personal ones, and to use transportation and perform banking transactions (78% for both), among the instrumental ones. CONCLUSIONS Activities of daily living can be valid indicators of functional dependence. The best coefficients of validity were generally obtained for personal activities. Some activities with good sensitivities and specificities - walk 100 meters, take a shower, and lie down in and get out of the bed - can be used to classify older adults into low, average, and high need for help depending on the affected activities and, therefore, can help in the planning of health services aimed at them.

RESUMO OBJETIVO Determinar a validade de critério das atividades de vida diária constantes em questionários de funcionalidade em idosos para inquéritos populacionais e identificar quais atividades são válidas para quantificar a necessidade real de ajuda diária dessa população. MÉTODOS Amostra populacional de idosos estratificada por níveis de funcionalidade, segundo a autopercepção de dependência nas atividades de vida diária. Autopercepção foi comparada com o padrão ouro - observação direta no domicílio dos idosos nessas atividades por profissional treinado e cego para respostas no questionário. Na visita decidiu-se, para efeito da pesquisa, se o idoso precisava de ajuda para realizar alguma das atividades de vida diária. A sensibilidade de cada atividade de vida diária foi maior quando a autoavaliação de que não havia necessidade de ajuda coincidiu com a avaliação do profissional. A especificidade indica coincidência quanto à necessidade de ajuda na atividades de vida diária - coeficientes de sensibilidade e especificidade acima de 70% foram considerados indicativos de boa validade. RESULTADOS As autoavaliações mostraram sensibilidade melhor que especificidade - idosos e observadores concordaram mais quanto à independência do que quanto à dependência cotidiana. Todas as atividades mostraram sensibilidade acima de 70%. Algumas atividades tiveram uma especificidade baixa (fazer compras: 55%) ou muito baixa (pentear os cabelos: 33%). As melhores especificidades foram tomar banho e vestir-se (95,8% ambas), entre as pessoais, e utilizar transporte e realizar movimento bancário (ambas com 78%), entre as instrumentais. CONCLUSÕES Atividades de vida diária podem ser indicadores válidos de dependência funcional. Os melhores coeficientes de validade em geral foram obtidos pelas atividades pessoais. Destacam-se algumas atividades com boas sensibilidades e especificidades - andar 100 metros, tomar banho e levantar/deitar na cama - que podem servir para classificar os idosos em baixa, média e alta necessidade de ajuda dependendo das atividades afetadas e, dessa forma, auxiliar no planejamento dos serviços de saúde voltados aos idosos.