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Problem elicitation to assess patient priorities in ankylosing spondylitis and fibromyalgia.

OBJECTIVE: To elicit patient priorities as outcome measures in ankylosing spondylitis (AS) and fibromyalgia (FM); to relate these measures to other outcomes; to assess construct validity and sensitivity to change of the problem elicitation technique (PET) questionnaire. METHODS: One hundred thirty-four patients with AS were randomly allocated to weekly sessions of group physical therapy or daily exercises at home, whereas 73 patients with FM were randomized into one of 3 groups (low impact fitness, biofeedback, controls). The PET questionnaire was applied by trained interviewers at baseline and at 6 (FM) and 9 (AS) month followup. A PET score was calculated at each assessment. Construct validity of the PET was assessed by correlation and multiple regression of baseline values with other disease outcomes (pain, stiffness, patient's global assessment, Sickness Impact Profile (SIP), Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scale (AIMS), patient utilities). Sensitivity to change of PET was assessed against changes in these outcomes and by comparing the efficiency of the PET with other outcomes. RESULTS: Patients with FM identified more problems (mean 6.8) than patients with AS (mean 4.4). Moreover, more patients with AS than with FM were unable to identify any problem at baseline (10% compared to 1%). The PET score improved from 14.9 to 11.3 (p = 0.0001) in patients with AS but did not change from 21.8 to 21.1 (p = 0.24) in patients with FM. Construct validity testing of the PET score showed statistically significant (p < 0.05) correlations with AIMS, utilities, SIP, HAQ, pain, stiffness, and patient's global health in both groups of patients (r varying from 0.22 to 0.66). By multiple regression pain explained 29% of the variance in PET scores among patients with AS. In FM patient global assessment accounted for 39% of total variance of PET scores, whereas pain explained another 15%. Changes in PET scores correlated significantly (p < 0.05) with changes in AIMS, utilities, pain, stiffness, and patient global health in both AS and FM (r varying from 0.22 to 0.51). Some 6% of the variance in changes in PET scores was explained by changes in pain in patients with AS and 35% by changes in pain and subjective health in patients with FM. Assessment of sensitivity to change revealed that efficiency of the PET score was 0.6 in patients with AS and 0.09 in those with FM. Compared to other outcomes this was reasonable in patients with AS but low in those with FM. CONCLUSION: Obtaining patient priorities was generally feasible. In both groups of patients construct validity of the PET questionnaire was satisfactory. The PET was much more sensitive to change in patients with AS than in patients with FM.

Adolescent↗

The construction and validation of a new scale for measuring emotional response style in adolescents.

BACKGROUND: Research on children's emotional behaviour has been hampered by the lack of psychometric assessment scales. The present study reports on the construction and validation of a new self-report instrument to measure the emotional response styles of adolescents. METHOD: Exploratory and confirmatory factor analyses were carried out on the responses of three samples of adolescents aged between 11 and 14 years (total = 609) to an item pool derived from a scenario study. In addition to assessing reliability, the final form of the questionnaire was concurrently validated using a variety of related psychometric instruments as well as teacher ratings of pupils' behaviour. RESULTS: The factor analyses of the item pool yielded three independent factors labelled social anxiety, malevolent aggression, and social self-esteem. These categories correspond closely to the three dimensions that have emerged consistently from studies of children's temperament, labelled inhibited, undercontrolled and well-adjusted. The three factors comprising the final Emotional Behaviour Scale (EBS) all demonstrated satisfactory internal (coefficient alpha) and re-test reliability. Concurrent validation showed that the three factors were related in predictable ways to other related constructs, and comparisons with teacher ratings of pupils confirmed the relationship between the EBS subscales and children's actual social and emotional behaviour. CONCLUSION: The new scale offers a valid and reliable instrument for assessing adolescent emotional behaviour, and current work is aimed at extending the research to the assessment of young offenders.

Adolescent↗

[Construction and validation of a new screnning questionnaires for eating disorders: the inventory for the screening of eating disorders/(ISED)].

OBJECTIVE: The study aims to construct and validate a new screening questionnaire for the identification of cases at risk for eating disorders. SETTING AND SAMPLE: We assessed 218 female adolescent students recruited in a vocational school in Mestre (VE) and 88 patients consecutively referred to the Eating Disorders Unit of the University of Padova. PROCEDURE AND MAIN OUTCOME MEASURES: All subjects completed the new questionnaire, the Inventory for the Screening of Eating Disorders (ISED), and the Eating Attitudes Test (EAT). Sixty-two percent of female students and all the patients underwent a structured diagnostic interview (SCID for DSM-IV) for the diagnosis of eating disorders. The reliability, validity and screening ability of the questionnaire have been assessed. RESULTS: The reliability of the ISED, measured by Cronbach's alpha, is good (alpha = 0.87), as is the convergent validity (correlations with EAT). In order to improve the screening ability, the questionnaire has been further divided in two subscales: one for the identification of cases at risk for anorexia nervosa (ISED-AN) and the other for cases at risk for bulimia nervosa (ISED-BN). The screening ability of the two subscales is greater than that of EAT, although the difference is not statistically significant. The ISED cutoff points have greater positive predictive values than those of EAT in the screening of both anorexia nervosa and bulimia nervosa. CONCLUSIONS: The ISED appears to be a valid and reliable questionnaire among female adolescents. Its use might improve the identification of cases at risk for eating disorders and in particular those at risk for anorexia nervosa. Other studies are needed to confirm the validity and performance of the questionnaire among samples of different ages and socio-economic status.

Adult↗

Evaluating patient distress from cancer-related fatigue: an instrument development study.

PURPOSE/OBJECTIVES: To develop a clinically useful and psychometrically sound tool for the measurement of the distress from fatigue in patients with cancer. DESIGN: Instrument development of a numeric rating scale to assess cancer-related fatigue (CRF) distress. SETTING: A comprehensive cancer center and a Veterans Administration hospital. SAMPLE: The interview sample consisted of 17 adults with cancer experiencing CRF. The sample for instrument testing consisted of 221 adults with cancer. Twenty-nine different types of cancers were among the diagnoses. Seventy-eight percent of the participants were receiving some form of cancer treatment. The mean age was 60. METHODS: The Cancer-Related Fatigue Distress Scale (CRFDS) was developed from 23 in-depth audiotaped interviews with patients experiencing CRF. Krippendorff's content analysis procedures were used for interview analysis. Twenty-three items were generated. Five cancer survivors assessed content validity. Factor analysis was used to assess construct validity, and coefficient alpha was used to estimate the reliability of the CRFDS. FINDINGS: Factor analysis resulted in all items loading on one factor, indicating a single scale. The coefficient alpha was 0.98 after the elimination of three items. CONCLUSIONS: The CRFDS has strong content validity, high reliability, and very good construct validity. IMPLICATIONS FOR NURSING PRACTICE: The CRFDS is a clinically useful and psychometrically sound tool for the measurement of CRF distress. This tool is clinically useful because of its brevity (20 items), clear instructions that required no training to use, and a readability score at the third-grade level.

Adult↗

Differentiating anxious, aggressive, and socially competent preschool children: validation of the Social Competence and Behavior Evaluation-30 (parent version).

The present study examined the factor structure, internal consistency, and construct validity of the parent version of the Social Competence and Behavior Evaluation-30 for preschoolers (SCBE-30; LaFreniere, P. J. (1990). Social competence and behavior evaluation-30. Unpublished measure.), an adaptation of the validated teacher version of the same measure (LaFreniere & Dumas, Psychol. Asses. 8 (1996) 369). The parent version of the SCBE-30 is a 30-item Likert rating scale questionnaire designed to assess patterns of anxiety/withdrawal, anger/aggression, and social competence. Principal components analysis was used to identify the factor structure of the parent version of the SCBE-30 (N = 218 preschool children). To assess construct validity, a compliance task was utilized to determine whether children identified as high on anxiety/withdrawal, anger/aggression, or social competence with the parent version of the SCBE-30 (n = 20 for each group) could be distinguished behaviorally on several observational variables. Principal components analysis identified three factors accounting for 44% of the variance. Ten items positively loaded onto each factor and matched conceptual expectations. A between-subjects MANOVA demonstrated significant group differences in observed child behaviors including compliance, noncompliance, subtypes of noncompliance, and aversive behavior. Results of the current study suggested that the parent version of the SCBE-30 demonstrated both internal consistency and construct validity, and findings paralleled many of the results from LaFreniere and Dumas' validation of the teacher version of the SCBE-30.

Aggression↗

Validation of a two-item quantitative questionnaire for the triage of women with urinary incontinence.

OBJECTIVE: To evaluate the reproducibility, construct validity, and preferences for the 2-item Stress/Urge Incontinence Questionnaire. METHODS: The questionnaire asks a patient to recall the number of stress urinary incontinence and urge urinary incontinence episodes she experienced during the preceding week. The 4-week prospective study included 3 office visits and enrolled women with stress, urge, or mixed urinary incontinence symptoms. The test-retest reproducibility was assessed after 3 days, and the construct validity of the questionnaire was evaluated against a diary and other measures of incontinence severity and effect. The bother associated with completing (patients) or analyzing (physicians) the diary was assessed. Both groups also reported their time requirements and preferences for the questionnaire or diary. RESULTS: Reproducibility for the classification of symptoms was moderately strong (kappa = .536). Test-retest agreement was good (64-80%) for all but balanced mixed incontinence (38%). Intraclass correlations revealed good reproducibility for the number of stress (.694), urge (.703), and total (.726) incontinence episodes. Significant (P < .01) correlations with other measures of incontinence established construct validity. Patients and physicians reported it took less time to complete the questionnaire than the diary, but the majority said the completion or analysis of the diary was of little or no bother and preferred the diary. CONCLUSION: The Stress/Urge Incontinence Questionnaire is a valid tool that can be used in clinical practice to differentiate between symptoms of stress and urge urinary incontinence to make an initial diagnosis, especially in primary care where incontinence is not a focus of the practice.

Adult↗

The Southampton Needs Assessment Questionnaire (SNAQ): a valid tool for assessing the rehabilitation needs of disabled people.

OBJECTIVE: To validate the Southampton Needs Assessment Questionnaire (SNAQ) for use with disabled people during face-to-face interviews. DESIGN: The SNAQ was designed to be used in a cross-sectional survey of disabled people with a physical disability with a follow-up study one year later. Content and criterion validity was examined using 32 disabled people who took part in the pilot study. Construct validity and internal reliability was examined using data from 93 disabled people who took part in the main survey. Responsiveness of the questionnaire was evaluated using the data gathered during a follow-up study of 77 people had taken part in the original study. OUTCOME MEASURES: The OPCS Disability Severity Scales (OPCS) and the Functional Independence Measure (FIM) were used to measure level of disability of participants, the Nottingham Health Profile (NHP) and the UK version of the SF-36 to examine perceived health status. PARTICIPANTS: People with a primary physical disability, aged 16-65, randomly selected from two disability registers in southern England. MAIN RESULTS: Content and criterion validity were established. Construct validity and internal reliability of the SNAQ was good. Inter-rater reliability was not tested since only one researcher conducted the interviews. Test-retest reliability was not formally tested because of the probability that participants would learn from the first needs assessment questionnaire and that different results on a retest occasion could arise from this. The SNAQ was sensitive in picking up changes over time. CONCLUSION: The SNAQ has shown good validity (content, coverage and construct), internal reliability, sensitivity and responsiveness. Further studies are needed to define the consequences of meeting or not meeting the rehabilitation needs of disabled people. Inter-rater reliability remains to be established.

Adolescent↗

Construction of validated, non-redundant composite protein sequence databases.

A strategy has been developed for the construction of a validated, comprehensive composite protein sequence database. Entries are amalgamated from primary source data bases by a largely automated set of processes in which redundant and trivially different entries are eliminated. A modular approach has been adopted to allow scientific judgement to be used at each stage of database processing and amalgamation. Source databases are assigned a priority depending on the quality of sequence validation and commenting. Rejection of entries from the lower priority database, in each pairwise comparison of databases, is carried out according to optionally defined redundancy criteria based on sequence segment mismatches. Efficient algorithms for this methodology are embodied in the COMPO software system. COMPO has been applied for over 2 years in construction and regular updating of the OWL composite protein sequence database from the source databases NBRF-PIR, SWISS-PROT, a GenBank translation retrieved from the feature tables, NBRF-NEW, NEWAT86, PSD-KYOTO and the sequences contained in the Brookhaven protein structure databank. OWL is part of the ISIS integrated data resource of protein sequence and structure [Akrigg et al. (1988) Nature, 335, 745-746]. The modular nature of the integration process greatly facilitates the frequent updating of OWL following releases of the source databases. The extent of redundancy in these sources is revealed by the comparison process. The advantages of a robust composite database for sequence similarity searching and information retrieval are discussed.

Amino Acid Sequence↗

Validity of an orthodontic treatment priority index to measure need for treatment.

In establishing the validity of an index for identifying individuals needing orthodontic treatment, we must concern ourselves with the construct validity of the measure. Since it is clear that the relevant theory concerning need for treatment must include esthetics and the accompanying social and psychological characteristics, the construct validation of an index to measure need for treatment must include tests of hypotheses with these dimensions. If we consider a child's self-perception of occlusion as a psychological variable and another person's perception of a child's occlusion as a social variable, theory relevant to an index of need for treatment would hypothesize that each should correlate positively with need for treatment. Subjects were eighth and ninth grade students from a metropolitan area in western New York State. Fifty-two of the children were planning to obtain orthodontic treatment, and 102 were not. Data were also obtained, whenever possible, from both parents and from a sibling (if any) nearest in age to the child. Data were collected in one session by a trained interviewer who used a structured interview and also photographed the child's teeth and jaws. In addition, the child was given an orthodontic Treatment Priority Index (TPI) examination by a dentist enrolled in a graduate program in orthodontics, who had previously been trained and standardized in the use of the TPI. In addition, to the TPI, scores obtained included three psychological measures and eight social measures. Each of the psychological and social variables correlated significantly with TPI at the 0.05 level, with values ranging from 0.21 to 0.54 and a median value of 0.42. On the basis of these correlations, evidence is presented for the construct validity of the TPI when measuring need for treatment.

Adolescent↗

[Validation of the Job Content Questionnaire in hospital nursing staff].

OBJECTIVE: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff. METHODS: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire. RESULTS: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions. CONCLUSION: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.

Job Description↗

Reliability and validity of a new measure of severity of delirium.

The objective of this study was to assess the psychometric properties of a new instrument, the Delirium Index (DI), to measure changes in the severity of the symptoms of delirium among patients previously diagnosed with delirium. Subjects were medical inpatients aged 65 and over diagnosed with delirium by the Confusion Assessment Method. Interrater reliability of the DI was .78 between research assistants (concordance coefficient) and was .88 between research assistants and geriatric psychiatrists. Criterion validity, assessed by the correlation between DI and Delirium Rating Scale scores (Spearman's correlation coefficient, r), was .84. Construct validity was assessed using correlations of the DI with two measures of current function for convergent validity (r = -.60, -.70) and two measures of function before admission for discriminant validity (r = .26,-.42). We conclude that the DI has acceptable levels of interrater reliability, criterion validity, and construct validity.

Aged↗

Testing the Health Practices in Pregnancy Questionnaire-II.

OBJECTIVE: To revise and test a 34-item self-administered questionnaire that measures health practices important to pregnancy outcome. DESIGN: Three studies were conducted: a content validity study with nurse experts, a content validity study with pregnant women, and a cross-sectional study using mailed surveys to test the reliability and construct validity of the Health Practices in Pregnancy Questionnaire-II (HPQ-II). SETTINGS: Nurse-midwifery and obstetric physician practices. PARTICIPANTS: Clinical experts (n = 8) and pregnant women (n = 10 for Study 2; n = 312 for Study 3). MAIN OUTCOME MEASURE: The HPQ-II, a self-report instrument that measures pregnancy health practices. RESULTS: Content validity was established with two reviews of the HPQ-II conducted by clinical experts and pregnant women and by a satisfactory Content Validity Index. Construct validity was supported by statistically significant correlations with a measure of prepregnancy health practices, scores on individual prepregnancy health practice items, and a theoretically related measure of women's attitudes toward their pregnancies and babies. Reliability (internal consistency) was satisfactory. CONCLUSIONS: This instrument promises to be useful in research and practice involving health practices during pregnancy.

Adolescent↗

[Scale of psychological violence against adolescents].

OBJECTIVE: To present strategies and results of a cross-cultural adaptation of a psychological violence scale to be used in Brazilian studies. METHODS: The scale of violence, a translated version in Portuguese of the original in English, was applied to a sample of 266 7th and 8th grade and junior high school students of public and private schools of the municipality of São Gonçalo, Southeastern Brazil. Several types of equivalences were investigated. The semantic equivalence was evaluated in the referential and general meaning of each item. The measurement equivalence was assessed through psychometric properties such as test and retest reliability, construct validity, internal consistency and factorial analysis. Reliability was measured by Kappa and intraclass correlation coefficients and construct validity was evaluated by Pearson's coefficient. RESULTS: The theoretical-conceptual discussions were deemed adequate concerning conceptual and items equivalences. The semantic equivalence was above 60 percentile in the evaluation of the referential and general item meaning. Cronbach's alpha was 0.94, Kappa index agreement was discreet, intraclass correlation coefficient was 0.82 and the factorial analysis with one factor structure had a degree of explanation of 43.5% variance. Construct validity showed significant negative correlation with self-esteem, social support, and a positive correlation with parent violence. CONCLUSIONS: The study results indicate the applicability of the instrument in the Brazilian teenager population.

Adolescent↗

The SEIQoL-DW is a valid method for measuring individual quality of life in stroke survivors attending a secondary prevention clinic.

OBJECTIVES: This paper examines the applicability and construct validity of the Schedule for the Evaluation of Individual Quality of Life-Direct Weight (SEIQoL-DW) for measuring quality of life in stroke survivors living at home that attend a secondary prevention clinic. PARTICIPANTS AND METHODS: Forty-six individuals attending a secondary prevention clinic following a stroke or transient ischaemic attack participated in a semi-structured interview to complete a range of outcome measures. Assessments of cognitive impairment, disability, and handicap were conducted using the Mini mental State Examination (MMSE), Barthel Index (BI), and Rankin Scale (RS). Measures to assess quality of life included perceived health status (PHS), Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the SEIQoL-DW. The construct validity of the SEIQoL-DW was assessed by correlation with the other measures. RESULTS: According to the cues elicited from the SEIQoL-DW, participants nominated 'relationships with family and friends' as the most important life domain, followed by 'social and leisure activities', and 'health'. Spearman's rho correlation coefficients demonstrated significant relationships between the SEIQoL-DW index scores, PHS (r = 0.35, p = 0.016), VAMS (r = 0.419, p = 0.004), and the HADS anxiety (r = -0.546, p < 0.0001) and depression (r = -0.701, p < 0.0001) subscale scores. CONCLUSIONS: The SEIQoL-DW demonstrated reasonable construct validity for use in assessing individual quality of life in a group of individuals following stroke or TIA that attend a secondary prevention clinic.

Adult↗

The Strain of Care for Delirium Index: a new instrument to assess nurses' strain in caring for patients with delirium.

This study evaluated content validity, internal consistency and construct validity of the Strain of Care for Delirium Index (SCDI), a newly constructed instrument to measure the strain nurses experience in caring for patients with delirium. Content validity, evaluated by eight experts, reduced the initial pool of items from 38 to 28. Using a convenience sample of 190 nurses, Cronbach's alpha for the 28-item version was 0.88. Using non-linear principal components analysis another eight items were eliminated and a four-factor structure was identified. The proportion of variance explained by the remaining 20 items was 61.51%. Preliminary psychometric evaluation of the SCDI supported content validity, internal consistency and construct validity; however additional psychometric evaluation is warranted.

Adult↗

The construction and validation of a scale for consumer satisfaction of residential care in Hong Kong.

Consumer satisfaction has been adopted by many service industries as an outcome measure of service quality. This paper reports and discusses the construction of validation of a set of quality indicators that have been used to measure the domains of satisfaction among residents of old age homes in Hong King. The quality indicators were firstly constructed through residents' focus group discussions in Hong Kong and through reference to theories of social gerontology. A team of multi-disciplinary professionals, including social workers, nurses and social gerontology researchers, then reviewed the indicators. Residents' views and reactions to the indicators were also solicited through face-to-face interviews with 20 residents. The 55-item scale was then validated and modified to 35 items after a pilot study of 98 residents. Finally, the indicators were used in a study of 405 residents selected by stratified random sampling. A 28-item scale representing nine quality indicators for the residential home service was finally validated. The paper concludes with recommendations on the use of this set of quality indicators to promote service quality in residential care.

Aged↗

[Validity of the Hoppe List. An empirical study of patients with backache].

Construct validity, criterion-oriented validity, and differential validity were assessed to determine the validity of the Hoppe-Liste (HL). Construct validity was ascertained by the multitrait-multimethod analysis suggested by Campbell & Fiske. Data regarding both convergent and discriminant validity show that the HL measures the construct pain. A comparison of the HL with the Revised Multidimensional Pain Scale and the Visual Analogue Scale suggests the criterion-oriented validity of the HL. Group-specific scores of the HL scales and of correlation patterns between scales tentatively support differential validity. It is concluded that the HL seems to be a suitable instrument for measuring the intensity and quality of pain.

Back Pain↗

[Clinical assessment of schizophrenic syndrome (CASS): validity evaluation of the new diagnostic tool].

AIM: The aim of the study was an evaluation of validity measures of the CASS (Clinical Assessment of Schizophrenic Syndromes)--a new multi-purpose and multi-level clinical diagnostic instrument consisting of a diagnostic questionnaire (CASS-D) allowing to analyze a diagnosis of schizophrenia according to DSM-IV and ICD-10 criteria as well as of three rating scales designed for description and intensity evaluation of schizophrenic syndromes on the global (CASS-G), dimensional (CASS-P, a profile of 13 basic dimensions) or symptomatological (CASS-S, a set of 31 symptoms) level. SUBJECTS: 194 inpatients consecutively admitted to the Department within approximately 6 months were assessed twice (at the start and end of their hospitalization) by 12 trained diagnosticians. METHOD: Several measures of validity were analyzed. Results obtained by means of CASS were compared with results of the SANS/SAPS, BPRS, and PANSS as reference rating scales (diagnostic validity). Characteristics of frequency, intensity, dynamics and specificity of scale items were used to analyze content validity. Factorial structure of CASS scales was applied as a measure of construct validity. FINDINGS: Diagnostic validity of the new instrument seems to be confirmed by its very high correlation coefficients with rating scales recognized as international standards: BPRS, PANSS, and SANS/SAPS. Reasonable characteristics of frequency, intensity, dynamics and specificity of individual items (dimensions, symptoms) and sum scores of CASS scales and relationships between their values strongly suggest their content validity. Both sum (CASS-P, CASS-S) and global (CASS-G) scores of scales under study revealed some specificity--they had significantly higher values in patients with schizophrenia than in patients with other diagnoses. It allows to distinguish in a schizophrenic syndrome described by CASS components which are specific and not specific for this disorder. The latter have been left also in the final version for their practical and clinical importance. Construct validity of the CASS was studied separately for different scales (CASS-P, CASS-S) and different groups (all or only schizophrenic patients) by means of several factor analyses, and performed along identical statistical procedure (principal component method of extraction with criterion eigenvalue > 1, followed by Equamax rotation). Resulting solutions could be interpreted reasonably and consistently with contemporary attempts to find adequate factorial models of intrinsic structure of schizophrenic syndrome. Thus they support confidence for constructive aspect of the CASS validity. CONCLUSIONS: Ultimately, results obtained in the study suggest that the CASS may be considered as an instrument with some promising indices of diagnostic, content and construct validity, which may be potentially useful for clinical and research purposes.

Humans↗