Development and validation of a goal attainment scale for families affected by maternal substance use.

The Team for Infants Exposed to Substance use (TIES) Program is a longstanding home-based family support program that provides a multidisciplinary, community-facing model to address the complex needs of families with young children affected by maternal substance use. The model required a comprehensive assessment tool to guide creation of individualized family goals with steps to achievement and measurement of progress on those goals. This article describes the development of a goal attainment scale and the analysis conducted to validate the scale for the service population. TIES model developers and community partners developed the goal attainment scale to assess outcomes in key domains: maternal substance use, parenting, child and maternal health, income, and housing. Data were collected from 2012 to 2019 from 220 participants and analyzed in 2020. Exploratory factor analysis (EFA) and confirmatory factor analysis were conducted. Twenty-five of the original 30 items were retained in a six-factor structure. The total percentage of variance explained was 64.44% with six factors, and Cronbach's alpha was .90. For the split-half method, the reliability of scale was .90 for unbiased conditions. Therefore, the scale reached acceptable reliability and validity. The scale provides a comprehensive approach to measure family outcomes across multiple domains addressing key risk and protective factors. This family-centered scale serves both therapeutic and evaluation purposes, acting as an intervention guide and a goal attainment measurement tool.

El Programa del Equipo para los Infantes Expuestos al Uso de Sustancias (TIES) es un programa de apoyo familiar con base en el hogar que ha existido mucho tiempo y que ofrece un multidisciplinario método de cara a la comunidad que se ocupa de las complejas necesidades de familias con niños pequeños afectados por el uso materno de sustancias. Quienes desarrollaron el modelo TIES crearon una herramienta comprensiva de evaluación para guiar la creación de metas familiares individualizadas, pasos para alcanzar y el progreso en cuanto a esas metas. Esta escala de alcance de logros evalúa los resultados en dominios claves: uso materno de sustancias, crianza, salud del niño y de la madre, entradas económicas y vivienda. Este artículo describe el desarrollo y la validez de la escala de alcance de metas. Los datos recogidos del 2012 al 2019 y de 220 participantes se analizaron en 2020. Se llevaron a cabo análisis exploratorios y confirmatorios de factores. Veinticinco de los 30 puntos originales se mantuvieron en una estructura de seis factores. El porcentaje total de variación explicado fue de 64.44% con seis factores y el factor Alpha de Cronbach fue de .90. En cuanto al método dividido en mitades, la confiabilidad de la escala fue de .90 en el caso de condiciones no prejuiciadas. Por tanto, la escala alcanzo una confiabilidad y validez aceptable. La escala ofrece un acercamiento comprensivo para medir los resultados familiares a lo largo de múltiples dominios, ocupándose de factores claves de riesgo y protección. Esta escala centrada en la familia sirve propósitos terapéuticos evaluación y actúa como una guía de intervención y medida de alcance de metas.

Le Programme de l'Equipe pour les Nourrissons Exposés à la Toxicomanie (abrégé TIES, suivant l'anglais The Team for Infants Exposed to Substance use) est un programme de soutien à la famille à domicile mis en place de longue date qui offre un modèle pluridisciplinaire et tourné vers la communauté afin de répondre aux besoins complexes des familles avec de jeunes enfants affectées par la toxicomanie maternelle. Les personnes ayant conçu et développé le modèle TIES ont créé un outil d'évaluation complet afin de guider le développement d'objectifs familiaux individualisés, d'étapes de réussite et de progrès quant à ces objectifs. L'échelle d'étape de réussite évalue les résultats dans des domaines clés: la toxicomanie maternelle, le parentage, la santé de l'enfant et la santé maternelle, les revenus, et le domicile. Cet article décrit le développement et la validation de l'échelle de réussite. Les données ont été recueillies de 2012 à 2019 de 220 participantes et elles ont été analysées en 2020. Des analyses factorielles exploratoires et des analyses factorielles confirmatoires ont été faites. Vingt-cinq des 30 éléments d'origine ont été retenus dans une structure à six facteurs. Le pourcentage total de variance expliquée était de 64,44% avec six facteurs, et l'alpha de Cronbach était de 0,90. Pour la méthode à demi-fraction la fiabilité de l'échelle était de,90 pour des conditions impartiales. L'échelle a donc atteint la fiabilité et la validité. L'échelle offre une approche complète afin de mesurer les résultats de la famille au travers de multiples domaines traitant le risque clé et les facteurs de protection. Cette échelle centrée sur la famille sert un but à la fois thérapeutique et d'évaluation, agissant comme un guide d'intervention et une mesure d'atteinte du but.

Effects of experience with access regimes on stewardship behaviors of small-scale fishers.

Governance regimes that assign exclusive access to support collective action are increasingly promoted to manage common-pool resources under the premise that they foster environmental stewardship. However, experimental evidence linked to existing policies that support this premise is lacking. Overlapping access policies in small-scale fisheries provide a unique opportunity to test the effects of access regimes on users' stewardship behaviors. We performed a lab-in-the-field experiment to assess how fishers' previous experience with access regimes relates to compliance and peer enforcement (n = 120). Fishers' compliance and peer-enforcement decisions were compared in a common-pool-resource game. Treatments differed in framing to represent exclusive access and pseudo-open access regimes, both of which fishers face in real life. To contrast behavior in the game with real-life observations, we compared fishers' associations that have shown relatively high and low management performance under exclusive access policies. Compliance and peer enforcement were higher under the exclusive access treatment than under the pseudo-open access treatment only for fishers' associations with high management performance in real life. Behaviors in the game reflected differences between associations in real life. Our results support previous research on ocean governance by experimentally assessing the role of access regimes in determining users' stewardship and suggest potential mechanisms for stewardship internalization.

Efectos de la experiencia con regímenes de acceso sobre comportamientos de gestión responsable de pescadores a pequeña escala Resumen Las políticas que asignan acceso exclusivo a grupos de usuarios para apoyar la acción colectiva son cada vez más promovidas para el manejo de recursos de uso comunitario bajo la premisa de que fomentan la gestión ambiental responsable. Sin embargo, la evidencia experimental vinculada a políticas existentes que respalde esta premisa es insuficiente. La superposición de diversas políticas de acceso en las pesquerías a pequeña escala proporciona una oportunidad única para analizar los efectos de los regímenes de acceso sobre el comportamiento de gestión de los usuarios. Realizamos un experimento, llevando el laboratorio al campo, para evaluar cómo la experiencia previa de los pescadores con regímenes de acceso se relaciona con sus comporatamientos de cumplimiento y de sanción de pares (n = 120). Comparamos el cumplimiento con cutoas de extracción de los pescadores y sus decisiones de sancionar a pares que incumplian las cuotas en un juego de recursos de uso comunitario entre dos tratamientos. Los tratamientos variaban en la contextualización del juego para representar una pesquería de acceso exclusivo y una de pseudo libre acceso, a las que se enfrentan los pescadores en la vida real. Para contrastar el comportamiento en el juego con las observaciones de la vida real, comparamos los resultados de asociaciones de pescadores que han mostrado un desempeño de manejo relativamente alto y bajo con las políticas de acceso exclusivo. El cumplimiento y la sanción de pares fueron mayores bajo el tratamiento de acceso exclusivo que bajo el de pseudo libre acceso sólo para aquellas asociaciones de pescadores con un alto desempeño de manejo en la vida real. Los comportamientos en el juego reflejaron las diferencias entre las asociaciones en la vida real. Nuestros resultados respaldan investigaciones previas sobre la governanza de recursos marinos mediante la evaluación experimental del papel que tienen las políticas de acceso en la determinación de la gestión del usuario y sugieren mecanismos potenciales para la internalización de dicha gestión.

Evaluation of the use of psychometric scales in human-wildlife interaction research to determine attitudes and tolerance toward wildlife.

Studies evaluating human-wildlife interactions (HWIs) in a conservation context often include psychometric scales to measure attitudes and tolerance toward wildlife. However, data quality is at risk when such scales are used without appropriate validation or reliability testing, potentially leading to erroneous interpretation or application of findings. We used 2 online databases (ProQuest Psych Info and Web of Science) to identify published HWI studies that included attitude and tolerance. We analyzed these studies to determine the methods used to measure attitudes or tolerance toward predators and other wildlife; determine the proportion of these methods applying psychometric scales; and evaluate the rigor with which the scales were used by examining whether the psychometric properties of validity and reliability were reported. From 2007 to 2017, 114 published studies were identified. Ninety-four (82%) used questionnaires and many of these (53 [56%]) utilized a psychometric scale. Most scales (39 [74%]) had at least 1 test of reliability reported, but reliance on a single test was notable, contrary to recommended practice. Fewer studies (35 [66%]) reported a test of validity, but this was primarily restricted to structural validity rather than more comprehensive testing. Encouragingly, HWI investigators increasingly utilized the necessary psychometric tools for designing and analyzing questionnaire data, but failure to assess the validity or reliability of psychometric scales used in over one-third of published HWI attitude research warrants attention. We advocate incorporation of more robust application of psychometric scales to advance understanding of stakeholder attitudes as they relate to HWI.

Análisis del Uso de Escalas Psicométricas en la Investigación sobre la Interacción Humano-Fauna para Determinar Actitudes y Tolerancia hacia la Fauna Resumen Los estudios que analizan las interacciones humano-fauna (IHF) dentro de un contexto de conservación con frecuencia incluyen escalas psicométricas para medir las actitudes y la tolerancia hacia la fauna. Sin embargo, la calidad de los datos se encuentra en riesgo cuando dichas escalas se usan sin una validación apropiada o una prueba de confiabilidad, lo que potencialmente puede llevar a interpretaciones o aplicaciones erróneas de los resultados. Usamos dos bases de datos virtuales (ProQuest Psych Info y Web of Science) para identificar estudios publicados sobre las IHF que incluyeran actitud y tolerancia. Analizamos estos estudios para determinar los métodos utilizados para medir las actitudes o la tolerancia hacia los depredadores y otros tipos de fauna; determinar la proporción de estos métodos aplicando escalas psicométricas; y evaluar el rigor con el cual se usaron las escalas al examinar si las propiedades psicométricas de validez y confiabilidad estuvieron reportadas en el estudio. Identificamos 114 estudios publicados entre 2007 y 2017. De estos estudios, 94 (82%) usaron cuestionarios y muchos de estos cuestionarios (53 [56%]) usaron una escala psicométrica. La mayoría de las escalas (39 [74%]) tuvieron al menos una prueba de confiabilidad reportada, pero la dependencia de una sola prueba fue notable, contrario a la práctica recomendada. Fueron menos los estudios (35 [66%]) que reportaron una prueba de validez, pero esto estuvo restringido primordialmente a una validez estructurada en lugar de un análisis más integral. De manera alentadora, los investigadores de las IHF cada vez usaron más las herramientas psicométricas necesarias para diseñar y analizar los datos de los cuestionarios, aunque la falta de análisis de la validez o confiabilidad de las escalas psicométricas utilizadas en más de un tercio de los estudios publicados sobre las actitudes hacia las IHF requiere de atención. Promovemos la incorporación de una aplicación más sólida de las escalas psicométricas para propiciar el entendimiento de las actitudes de los actores sociales conforme se relacionan con las IHF.

Validity and reliability of the Inflammatory Bowel Disease Fatigue Scale in Mexican patients.

INTRODUCTION: Fatigue is an extra-intestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE: To determine the construct validity, discriminant validity and reliability of an instrument for evaluating the Fatigue Scale for IBD in Mexican patients. METHODS: Two hundred patients with an IBD confirmed diagnosis were included. Current demographic and clinical characteristics of the condition were evaluated. Each patient answered the IBD Fatigue Scale (IBD-F) and the Pittsburgh Sleep Quality Index (PSQI), which was used to determine IBD-F discriminant validity. A factor analysis of each IBD-F section was performed, independent sample Student's t-tests were used to contrast the PSQI, and reliability was evaluated using Cronbach's alpha. RESULTS: The items in both IBD-F sections showed high factor loadings, which explained 68.3 and 38.4% of variance, respectively. Cronbach's alpha was > 0.80 in both, which discriminated patients with greater sleep disturbances. CONCLUSIONS: IBD-F is a valid and reliable scale for Mexican patients with IBD. Fatigue objective evaluation will allow timely interventions in order to reduce its impact on patients with IBD.

INTRODUCCIÓN: La fatiga es una manifestación extraintestinal de la enfermedad inflamatoria intestinal (EII). OBJETIVO: Obtener la validez de constructo, la validez discriminante y la confiabilidad de un instrumento para evaluar una escala de fatiga para EII en pacientes mexicanos. MÉTODOS: Se incluyeron 200 pacientes con diagnóstico confirmado de EII. Se evaluaron las características demográficas y clínicas actuales del padecimiento. Cada paciente contestó la Escala de Fatiga para EII (IBD-F) y el Índice de Calidad de Sueño de Pittsburgh (PSQI), empleado para determinar la validez discriminante de la IBD-F. Se realizó un análisis factorial de cada sección de la IBD-F, se utilizó la t de Student de muestras independientes para el contraste del PSQI y la confiabilidad se evaluó mediante alfa de ZCronbach. RESULTADOS: Los reactivos de ambas secciones de la IBD-F mostraron altas cargas factoriales, que explicaron 68.3 y 38.4 % de la varianza, respectivamente. El alfa de Cronbach fue > 0.80 en ambas, las cuales discriminaron a los pacientes con mayores alteraciones en el sueño. CONCLUSIONES: La IBD-F es una escala válida y confiable para pacientes mexicanos con EII. La evaluación objetiva de la fatiga permitirá realizar intervenciones oportunas para disminuir el impacto de esta manifestación en el paciente con EII.

Tools for assessing the psychometric adequacy of latent variables in conservation research.

Conservation psychology has a history of measuring variables that cannot be seen (e.g., values, attitudes, norms). Such latent variables are critical drivers of human action and are often measured using responses to survey questions. Tools for establishing the psychometric adequacy of unobservable, latent variables has been a century-long pursuit and challenge for quantitative psychologists and statisticians. Fundamental questions at the heart of this challenge include is what is claimed to be measured (validity) being measured and is measurement consistent (reliability)? We examined common methods used to establish the validity and reliability of psychometric instruments. Through a case study of anglers in Texas, we investigated the protocols and metrics used to evaluate the measurement of latent variables. The indicators we tested (identity, awareness of consequences, ascription of responsibility, and personal norms) validly and reliably assessed latent variables. Our findings also illustrated decision protocols (e.g., discriminant validity, convergent validity, internal consistency) involved in assessing the psychometric adequacy of latent variable indicators. The ability to correctly identify significant relationships among unobserved variables and their influence on human action is directly tied to the adequacy of measurement. In an era of instability and change that threatens social-ecological systems worldwide, the need for accuracy and precision in conservation social science has never been greater. Research that employs flawed measures has potential to lead to erroneous conclusions and undermine conservation and biodiversity protection.

Herramientas para Evaluar la Idoneidad Psicométrica de las Variables Latentes en la Investigación de la Conservación Resumen La psicología de la conservación tiene la reputación de medir variables que no pueden ser vistas (p. ej.: valores, actitudes, normas). Dichas variables latentes son impulsores importantes de la acción humana y con frecuencia se miden usando las respuestas dadas en una encuesta. Las herramientas para establecer la idoneidad psicométrica de las variables inobservables y latentes ha sido una búsqueda y un desafío de todo un siglo para los psicólogos cuantitativos y los estadistas. Las cuestiones fundamentales en el núcleo de este desafío son: si es medido lo que se dice está siendo medido (validez) y si la medición es uniforme (confiabilidad). Examinamos los métodos comunes usados para establecer la validez y la confiabilidad de los instrumentos psicométricos. Mediante un estudio de caso de pescadores en Texas, investigamos los protocolos y las medidas usadas para evaluar la medida de las variables latentes. Los indicadores que analizamos (identidad, noción de las consecuencias, adscripción de la responsabilidad y normas personales) evaluaron a las latentes variables en validez y confianza. Nuestros hallazgos también reflejaron los protocolos de decisión (p. ej.: x, y, z) involucrados en la evaluación de la idoneidad psicométrica de los indicadores de variables latentes. La habilidad para identificar correctamente las relaciones significativas entre las variables no observadas y su influencia sobre las acciones humanas está vinculada directamente a la idoneidad de la medición. Hoy en día, en esta época de inestabilidad y cambio que amenaza a los sistemas socio-ecológicos en todo el mundo, la necesidad de tener certeza y precisión en las ciencias sociales de la conservación nunca ha sido tan grande. Las investigaciones que emplean medidas imperfectas tienen el potencial de derivar en conclusiones erróneas y perjudicar a la conservación y a la protección de la biodiversidad.

The My Emotions Questionnaire: A self-report of mothers' emotional responses to infant crying.

The purpose of this article was to examine the psychometrics of the My Emotions Questionnaire, a self-report designed to assess mothers' emotional reactions when their infants cry. Participants were 240 first-time mothers. When infants were 6 months and 1 year old, mothers completed the new questionnaire and measures assessing beliefs and behavioral responses to infant crying, and interview-based measures of mothers' emotional reactions and causal attributions about crying were administered. Maternal sensitivity and negative behaviors were observed when infants were 6 months and 1 and 2 years old. Mothers reported on their discipline practices when children were 2 years old. Five emotion factors emerged based on exploratory factor analysis (EFA) of the 6-month data: Amusement, Anxiety, Frustration, Sympathy, and Protective. The five-factor structure was supported via a confirmatory factor analysis (CFA) of the 1-year data. All scales demonstrated adequate internal consistency reliability and significant stability from 6 months to 1 year. Amusement, Frustration, and Protectiveness demonstrated the best convergent validity with cry cognitions and predictive validity to parenting measures, followed by Anxiety, although effects tended to be small to moderate. Evidence for the validity of Sympathy was less compelling. The potential utility of the questionnaire for basic and applied research is discussed.

El propósito de este ensayo fue examinar la sicometría del Cuestionario Mis Emociones, un auto-reporte diseñado para evaluar las reacciones emocionales de las madres cuando sus infantes lloran. Las participantes fueron 240 madres primerizas. Cuando los infantes tenían 6 meses y 1 año de edad, las madres completaron el nuevo cuestionario y se les administraron medidas para evaluar creencias y la conducta de respuesta al llanto del infante, así como medidas basadas en entrevistas sobre las reacciones emocionales de las madres y atribuciones causales acerca del llanto. Cuando los infantes tenían 6 meses, 1 año y 2 años, se observaron la sensibilidad materna y las conductas negativas. Las madres reportaron acerca de sus prácticas disciplinarias cuando los niños tenían 2 años. Cinco factores de emoción surgieron de la información a los 6 meses, con base en los análisis exploratorios de factores: diversión, ansiedad, frustración, simpatía y actitud de protección. La estructura de cinco factores fue apoyada por medio de un análisis confirmatorio de factores de la información de 1 año. Todas las escalas demostraron una confiabilidad adecuada de consistencia interna y significativa estabilidad desde los 6 meses hasta 1 año. La diversión, la frustración y la actitud de protección demostraron la mejor validez convergente con conocimientos del llanto y validez predictiva hacia las medidas de crianza, y fueron seguidas por la ansiedad, aunque los efectos tendieron a ser entre pequeños y moderados. La evidencia por la validez de la simpatía fue menos convincente. Se discute la posible utilidad del cuestionario para la investigación básica y aplicada.

Le but de cet article était d'examiner la psychométrie du Questionnaire Mes Emotions, une auto-évaluation conçue pour évaluer les réactions émotionnelles des mères lorsque leurs bébés pleurent. Les participantes étaient 240 mères pour la première fois. Lorsque les bébés avaient 6 mois et 1 an, les mères ont rempli le nouveau questionnaire et les mesures évaluant les croyances et les réactions comportementales aux pleurs du bébé et des mesures basées sur des entretiens de réactions émotionnelles des mères et les attributions causales sur les pleurs ont été administrées. La sensibilité maternelle et les comportements négatifs ont été observés lorsque les enfants avaient 6 mois, 1 an, 2 ans. Les mères ont fait état de leurs disciplinaires quand les enfants avaient 2 ans. Cinq facteurs d'émotion ont émergé, basé sur l'analyse des facteurs exploratoires des données de 6 mois : amusement, anxiété, frustration, sympathie et protectrice. La structure de 5 facteurs a été soutenue au travers d'une analyse des facteurs de confirmation des données d'une année. Toutes les échelles ont démontré une fiabilité adéquate de la cohérence interne et une stabilité importante de 6 mois à 1 an. L'amusement, la frustration et la protection ont démontré la meilleure validité convergente avec les cognitions des pleurs et la validité prédictive aux mesures de parentages suivies par de l'anxiété, bien que les effets avaient tendance à être petits à modérés. Les preuves de la validité de la sympathie étaient moins convaincantes. L'utilité potentiel du questionnaire pour les recherches de base et les recherches appliquées sont discutées.

Validity and consistency of an outpatient department user satisfaction rapid scale.

BACKGROUND: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). METHOD: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach's a, Spearman's correlation and intra-class correlation coefficient (ICC) were used. RESULTS: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach's a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman's rho. CONCLUSION: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

ANTECEDENTES: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). MÉTODO: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). RESULTADOS: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. ­. CONCLUSIONES: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

[Validity of adjusted morbidity groups with respect to clinical risk groups in the field of primary care]. / Validez de los grupos de morbilidad ajustados respecto a los clinical risk groups en el ámbito de la atención primaria.

OBJECTIVE: To compare the performance in terms of goodness of fit and explanatory power of 2morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG). DESIGN: Cross-sectional study. LOCATION: PC in the Catalan Institute for the Health (CIH), Catalonia, Spain. PARTICIPANTS: Population allocated in primary care centers of the CIH for the year 2014. MAIN MEASUREMENTS: Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change. RESULTS: The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy. CONCLUSIONS: The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs.

[Validity of the abdominal ecography in primary care for detection of aorta abdominal aneurism in male between 65 and 75 years]. / Validez de la ecografía abdominal en Atención Primaria para detección de aneurisma de aorta abdominal en varones de entre 65 y 75 años.

OBJECTIVE: To determine the usefulness of ultrasound examination in Primary Care (PC) for the detection of abdominal aortic aneurysm (AAA) in male patients from 65-75 years old, as well as the consistency between observers on the diagnosis between general practitioners and the reference specialty in this area, Vascular Surgery. To estimate the prevalence of AAA in that population and its association with risk factors. DESIGN: Cross-sectional descriptive study. LOCATION: Healthcare Centres of Coto and Calzada II (Gijón, Spain). PARTICIPANTS: Males born between 1 January 1939 and 31 December 1950. INTERVENTIONS: From the 2,511 males found, 407 were selected using stratified random sampling. Aortic diameter was measured, with those ≥3cm and 20% from the <3cm being referred for a second measurement by a vascular surgeon. VARIABLES: Dependent: presence/absence of aneurism. Independent: age, abdominal perimeter, smoking, arterial hypertension, diabetes, dyslipidaemia, familial cases of AAA, cerebrovascular accident, and coronary disease. The analysis was performed using Bayesian inference with models for proportions and a multivariate logistic regression. RESULTS: From 304 ultrasound scans performed, 13 were referred with suspicion of AAA, and 63 with were within normal. The sensitivity was 93.3% and specificity 98.5% with a 95% credibility interval (CredI) of 75.4-99.9%, and 94.3-100%, respectively. The prevalence was 4.6% (95% CredI: 2.5-7.2%, and the intraclass correlation coefficient between PC and Vascular Surgery was 0.88 (95% CredI: 0.79-0.94). Age, smoking, dyslipidaemia, and diabetes tended to increase the odds of prevalence of AAA. CONCLUSION: The ultrasound performed by GPs for the detection of AAA had high diagnostic validity. Further studies on the effectiveness should be conducted in order to assess the appropriateness of introducing a system of early detection of AAA in the risk population.

Validation of the Spanish-language version of the Relevant Outcome Scale for Alzheimer's Disease. / Estudio ROSA: validación de la versión española de la Relevant Outcome Scale for Alzheimer's Disease.

INTRODUCTION AND OBJECTIVES: The Relevant Outcome Scale for Alzheimer's Disease (ROSA) is a useful tool for evaluating and monitoring dementia patients. This study aims to evaluate the validity and reliability of the Spanish version of ROSA. PATIENTS AND METHODS: Spanish multicentre study involving 39 researchers and including 237 patients with Alzheimer disease (78 mild, 79 moderate, and 80 severe). The patients were tested with the following: Mini-Mental State Examination (MMSE), Fototest, Neuropsychiatric Inventory (NPI), Blessed dementia scale, and a Spanish-language version of ROSA. A subsample of 40 subjects was retested in the 14 days following the initial evaluation. The construct validity was evaluated with the Spearman correlation coefficient (r), internal consistency with Cronbach's alpha (alpha), and test-retest reliability with the intraclass correlation coefficient (ICC). RESULTS: ROSA requires 13.8±7.4minutes to administer and its results show a significant association with the clinical stage of AD (mild, 116.7±23.1; moderate, 92.9±19.8; and severe, 64.3±22.6), and with results on the MMSE (r=0.68), Fototest (r=0.63), NPI (r=0.53), and Blessed dementia scale (r=-0.80). ROSA shows high internal consistency (alpha=0.90) and excellent test-retest reliability (ICC0.97). CONCLUSION: The Spanish version of ROSA is a brief, valid, and reliable tool permitting overall evaluation of patients with dementia.

Reliability and validity of the EASYCare-2010 Standard to assess elderly people in Portuguese Primary Health Care.

INTRODUCTION: The EASYCare is a multidimensional assessment tool for older people, which corresponds to the concerns and priorities of older people in relation to their needs, health, and quality of life. The EASYCare instrument has been used in many countries worldwide. Lack of reliability evidence has recently been raised by researchers. This study aimed to test the validity and reliability of the EASYCare-2010 instrument in community-dwelling Portuguese older people attended in Primary Health Care centres. METHODS: The sample for this transversal study (N=244) was collected from Portuguese Primary Health Care Centers. Categorical Principal Component Analysis was used to assess the underlying dimensions of EASYCare-2010. Construct validity was evaluated through correlation with the World Health Organization Quality of Life Assessment Instrument-Short Form. RESULTS: A two-factor model (labelled "mobility and activities of daily life", and "general well-being and safety") was found. The EASYCare-2010 instrument showed acceptable levels for internal consistency (≥0.70). The EASYCare-2010 factors were correlated with measures of quality of life. Results showed that in most polytomous items, some of the more extreme categories were not considered at all or only by a residual number of participants. CONCLUSION: EASY Care -2010 version is a valid and reliable instrument for holistic assessment of the older people attended in Primary Health Care centres in Portugal.

[Prospective validation of the Spanish version of the Short Form-Liver Disease Quality of life]. / Validación prospectiva de la versión corta en español del test específico de calidad de vida Short form-liver disease quality of life (SF-LDQOL) para hepatopatías crónicas y trasplante hepático.

UNLABELLED: Health-Related Quality of Life (HRQL) assessed by a specific, validated, brief test is an important measure of the health status perceived by patients diagnosed with chronic liver disease. AIM: To prospectively validate the SF-LDQOL (Short Form-Liver Disease Quality of Life) instrument in Spanish, in patients diagnosed with liver disease of diverse etiologies and distinct severity levels, attended at the Hospital Universitari de Bellvitge (Barcelona). METHODS: This observational, longitudinal study was conducted by using the SF-LDQOL in outpatients diagnosed with chronic liver disease. This instrument contains the generic SF-36 test, and 9 liver disease-specific dimensions. We also evaluated socio-demographic features, the number of missing responses, and internal consistency (Cronbach's alpha), as well as Pearson's correlation between SF-36 and SF-LDQOL scores on specific dimensions by means of a multi-trait multi-method technique. The sample consisted of 340 patients. RESULTS: In 6 out of 9 liver disease-specific dimensions, reliability coefficients for internal consistency exceeded 0.70. The convergent validity of these items was acceptable in 8 out of 9 dimensions, with a scaling success of 100% in each item. Missing items were under 1.5% in all dimensions, except for Sexual Functioning. CONCLUSIONS: The Spanish version of the SF-LDQOL has, in general, good psychometric properties, making it a useful instrument for clinical practice in a population of patients diagnosed with chronic liver disease, with or without liver transplantation.

Test Your Memory is sensitive to cognitive change but lacks prospective validity.

OBJECTIVE: To determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state. METHODS: This longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2 ± 15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score ≤ 1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale. RESULTS: Sixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, -0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, -0.19 to -0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms. CONCLUSIONS: While the TYM lacks prospective validity, it is sensitive to changes in cognitive state.

[Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies]. / Fiabilidad y validez externa de un cuestionario de conocimiento sobre riesgo y enfermedad cardiovascular en pacientes que acuden a farmacias comunitarias de España.

OBJECTIVES: To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. DESIGN: Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. LOCATION: Spanish Community Pharmacies. PARTICIPANTS: There were 323 patients in the control group, from the 640 who completed the study. MAIN MEASUREMENTS: Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. RESULTS: For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < .0001). CONCLUSIONS: According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity.

Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients.

OBJECTIVE: To assess the psychometric properties of the behavioral indicators of pain scale (ESCID) when applied to a wide range of medical and surgical critical patients. DESIGN: A multicentre, prospective observational study was designed to validate a scale measuring instrument. SETTING: Twenty Intensive Care Units of 14 hospitals belonging to the Spanish National Health System. PARTICIPANTS: A total of 286 mechanically ventilated, unable to self-report critically ill medical and surgical adult patients. PROCEDURE: Pain levels were measured by two independent evaluators simultaneously, using two scales: ESCID and the behavioral pain scale (BPS). Pain was observed before, during, and after two painful procedures (turning, tracheal suctioning) and one non-painful procedure. MAIN VARIABLES: ESCID reliability was measured on the basis of internal consistency using the Cronbach-α coefficient. Inter-rater and intra-rater agreement were measured. The Spearman correlation coefficient was used to assess the correlation between ESCID and BPS. RESULTS: A total of 4386 observations were made in 286 patients (62% medical and 38% surgical). High correlation was found between ESCID and BPS (r=0.94-0.99; p<0.001), together with high intra-rater and inter-rater concordance. ESCID was internally reliable, with a Cronbach-α value of 0.85 (95%CI 0.81-0.88). Cronbach-α coefficients for ESCID domains were high: facial expression 0.87 (95%CI 0.84-0.89), calmness 0.84 (95%CI 0.81-0.87), muscle tone 0.80 (95%CI 0.75-0.84), compliance with mechanical ventilation 0.70 (95%CI 0.63-0.75) and consolability 0.85 (95%CI 0.81-0.88). CONCLUSION: ESCID is valid and reliable for measuring pain in mechanically ventilated unable to self-report medical and surgical critical care patients. CLINICALTRIALS.GOV: NCT01744717.

Usefulness of administrative databases for risk adjustment of adverse events in surgical patients.

PURPOSE: The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. METHODS: The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. RESULTS: The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CONCLUSION: CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients.

[Internal consistency and criterion validity and reliability of the Mexican Version of the Child Behavior Checklist 1.5-5 (CBCL/1.5-5)]. / Consistencia interna y validez de criterio de la versión mexicana del Child Behavior Checklist 1.5-5 (CBCL/1.5-5).

OBJECTIVE: To investigate the validity and internal consistency of the Mexican version of the CBCL/1.5 -5 that assesses the most common psychopathology in pre-school children in clinical and epidemiological settings. PATIENTS AND METHOD: A total of 438 parents from two groups, clinical-psychiatric (N= 62) and community (N= 376) completed the CBCL/1.5-5/Mexican version. RESULTS: The internal consistency was high for total problems α=0.95, and internalized α=0.89 and externalized α=0.91 subscales. The test re-test (one week) using the intraclass correlation coefficient (ICC) was ≥ 0.95 for the internalized, externalized, and total problems subscales. The ROC curve for the criterion status of clinically-referred vs. non-referred using the total problems scale ≥ 24 resulted in an AUC (area under curve) of 0.77, a specificity 0.73, and a sensitivity of 0.70. CONCLUSIONS: The CBCL/1.5 -5/Mexican version is a reliable and valid tool.

[Detection of an intrapulmonary shunt in patients with liver cirrhosis through contrast-enhanced transcranial Doppler. A study of prevalence, pattern characterization, and diagnostic validity]. / Detección del shunt intrapulmonar en pacientes con cirrosis hepática mediante doppler transcraneal con contraste. Estudio de prevalencia, caracterización del patrón y validez diagnóstica.

INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n=43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n=37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n=37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95%CI: 0.666-0.959; P=.001), sensitivity was 76.2% (95%CI: 54.9-89.4) and specificity was 90% (95%CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison.

THE SURVEY OF WELL-BEING OF YOUNG CHILDREN: RESULTS OF A FEASIBILITY STUDY WITH AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES.

This study examined the feasibility of the Survey of Well-Being of Young Children (SWYC), a new screener for socioemotional and developmental problems and family risk in children birth to age 5 years, for use in American Indian and Alaska Native (AIAN) communities. A Community of Learning within the Tribal Early Childhood Research Center, composed of university researchers, tribal early childhood program staff and evaluators, and federal partners, utilized a community-based participatory research approach to guide this qualitative study. Thirty-two focus groups and 20 key informant interviews (N = 199) were conducted with staff from Head Start, Home Visiting, and Child Care programs; pediatricians; behavioral health providers; parents of young children; tribal leaders; and other stakeholders in seven diverse AIAN communities. Three themes emerged: (a) a strong need to screen early for socioemotional and developmental problems and family risk; (b) the importance of a carefully designed process for screening; and (c) the importance of examining the content of the SWYC for cultural fit specific to tribal communities. Findings support two recommendations: (a) the development of guidelines for using the SWYC in tribal early childhood settings and (b) a full-scale validation study to determine appropriate use with and norms for children in tribal communities.

A tool to assess sex-gender when selecting health research projects.

OBJECTIVE: To validate the questionnaire "Gender Perspective in Health Research" (GPIHR) to assess the inclusion of gender perspective in research projects. DESIGN: Validation study in two stages. Feasibility was analysed in the first, and reliability, internal consistence and validity in the second. WHERE: Aragón Institute of Health Science, Aragón, Spain. PARTICIPANTS: GPIHR was applied to 118 research projects funded in national and international competitive tenders from 2003 to 2012. MAIN MEASUREMENTS: Analysis of inter- and intra-observer reliability with Kappa index and internal consistency with Cronbach's alpha. Content validity analysed through literature review and construct validity with an exploratory factor analysis. RESULTS: Validated GPIHR has 10 questions: 3 in the introduction, 1 for objectives, 3 for methodology and 3 for research purpose. Average time of application was 13min Inter-observer reliability (Kappa) varied between 0.35 and 0.94 and intra-observer between 0.40 and 0.94. Theoretical construct is supported in the literature. Factor analysis identifies three levels of GP inclusion: "difference by sex", "gender sensitive" and "feminist research" with an internal consistency of 0.64, 0.87 and 0.81, respectively, which explain 74.78% of variance. CONCLUSIONS: GPIHR questionnaire is a valid tool to assess GP and useful for those researchers who would like to include GP in their projects.