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PubMed2001

A factor analytic and psychometric examination of pathology of separation-individuation.

Two studies are described that attempt to determine if standard-scale-reduction techniques could yield a construct-valid diagnostic screen of pathology of separation-individuation for use in nonclinical university settings. In Study 1 (N = 210), a measure of pathology of separation-individuation (PATHSEP) was reduced successfully to a single, internally consistent factor, accounting for 36% of the variance. In Study 2 (N = 304), these items also coalesced around a single factor, accounting for 35% of the variance. Study 2 also showed that PATHSEP is correlated moderately and positively with indices of insecure attachment, with the Center for Epidemiological Studies-Depression Scale, and with indices of psychiatric symptomatology (Hopkins Symptom Checklist). PATHSEP also was associated with a poorer profile of adjustment to college. Males reported more pathology of separation-individuation than did females. Evidence supports the construct validity of a shortened version of PATHSEP. Directions for future research are noted.

Adult↗

PubMed1999

Linking health-related quality-of-life indicators to large national data sets.

OBJECTIVE: This study investigated the feasibility and usefulness of linking algorithms for well known quality-of-life (QOL) indicators to large nationally representative databases. DESIGN AND SETTING: The National Medical Expenditure Survey (NMES) was utilised. We developed an algorithm to match the EuroQOL health indicator and drew on a previous match of the Health Utilities Index (HUI) in a companion paper. This process allowed the sensitivity and detail of health-related quality-of-life (HR-QOL) indicators to be combined with the benefits of large, nationally representative data sets. PATIENTS AND PARTICIPANTS: A total of 19,525 individuals aged 18 years and older (constituting a nationally representative sample of the non-institutionalised civilian population of the US contained within the 1987 NMES database) were investigated. INTERVENTIONS: Sensitivity analyses using several related specifications of each indicator were performed. We analysed the correlations of these alternatives for both the HUI and EuroQOL measures. Correlations between the HUI and EuroQOL measures were also examined. We investigated the construct validity by examining the performance of the HUI and EuroQOLs in empirical situations in which we had knowledge about the relationships (e.g. health decreases with age). MAIN OUTCOME MEASURES AND RESULTS: The benefits of HR-QOL measures can be achieved relatively cheaply and efficiently via linking rather than developing a large scale QOL survey. Although the NMES data allowed a good match with the EuroQOL and the HUI, the matches were not perfect. By examining the within-domain correlations and the between-domain correlations, we found that the alternate specifications within-domain were very similar and that the 2 HR-QOL indicators were comparable in many (but not all) aspects. CONCLUSIONS: The results of this study suggested good construct validity. Thus, linked HR-QOL measures of the types derived in this study may be useful in characterising the health of large populations, and in investigating the causes and consequences of health.

Adult↗

PubMed2005

The development of the Pictorial Thai Quality of Life.

BACKGROUND: "Quality of life" has become a main focus of interest in medicine. The Pictorial Thai Quality of Life (PTQL) was developed in order to measure the Thai mental illness both in a clinical setting and community. OBJECTIVES: The purpose of this study was to develop the Pictorial Thai Quality of Life (PTQL), having adequate and sufficient construct validity, discriminant power, concurrent validity, and reliability. MATERIAL AND METHOD: To develop the Pictorial Thai Quality of Life Test, two samples groups were used in the present study: (1) pilot study samples: 30 samples and (2) survey samples were 672 samples consisting of normal, and psychiatric patients. The developing tests items were collected from a review of the literature in which all the items were based on the WHO definition of Quality of Life. Then, experts judgment by the Delphi technique was used in the first stage. After that a pilot study was used to evaluate the testing administration, and wording of the tests items. The final stage was collected data from the survey samples. RESULTS: The results of the present study showed that the final test was composed 25 items. The construct validity of this test consists of six domains: Physical, Cognitive, Affective, Social Function, Economic and Self-Esteem. All the PTQL items have sufficient discriminant power It was found to be statistically significant different at the. 001 level between those people with mental disorders and normal people. There was a high level of concurrent validity association with WHOQOL-BREF, Pearson correlation coefficient and Area under ROC curve were 0.92 and 0.97 respectively. The reliability coefficients for the Alpha coefficients of the PTQL total test was 0.88. The values of the six scales were from 0.81 to 0:91. CONCLUSIONS: The present study was directed at developing an effective psychometric properties pictorial quality of life questionnaire. The result will be a more direct and meaningful application of an instrument to detect the mental health illness poor quality of life in Thai communities.

Adolescent↗

PubMed2004

Effects of low-dose risperidone and low-dose zuclopenthixol on cognitive functions in first-episode drug-naive schizophrenic patients.

BACKGROUND: Studies on the effects of antipsychotics on cognitive deficits in schizophrenia mostly suggest a superior effect of atypical over typical compounds, although findings are inconsistent and effect sizes small. Several methodological issues, such as heterogeneous patient samples, incomparable drug doses, effects of prior medication, construct validity, and retest effects on neuropsychological tasks, confound most results and the comparability between studies. Consequently, the conclusion concerning effects of antipsychotics on cognition is still equivocal. OBJECTIVE: The present randomized clinical trial examined the effects on cognition of comparatively low doses of a typical antipsychotic (zuclopenthixol) and an atypical antipsychotic (risperidone) in a homogeneous group of drug-naive first-episode schizophrenic patients in a longitudinal setting. METHODS: First-episode schizophrenic patients who had never previously been exposed to antipsychotic treatment (N=25) were randomly allocated to treatment with flexible doses of zuclopenthixol or risperidone in an open-label design. Cognitive functions were examined both when patients were drug-naive, and after 13 weeks of treatment. A comprehensive neuropsychological battery was used in order to optimize construct validity, and principal components of cognitive functions were extrapolated in order to reduce type I errors. A healthy control group was tested at baseline and after 13 weeks, in order to examine retest effects. The cognitive domains studied were executive functions, selective attention, and reaction time. RESULTS: The patients showed considerable cognitive deficits when drug-naive. There were few differential effects of risperidone and zuclopenthixol on cognitive deficits, except for a differential significance, respectively, tendency towards improved reaction and movement times in the risperidone group, and a lack of such in the zuclopenthixol group. These differences were no longer significant after covarying for extrapyramidal side effects and anticholinergic medication that were more prevalent in the zuclopenthixol group and the increases after medication were comparable with retest effects in controls. CONCLUSION: The study underscores the importance of examining impact of factors, such as clinical improvement, extrapyramidal side effects, anticholinergic medication and retest effects in longitudinal efficacy studies. This study does not support efficacy of either risperidone or zuclopenthixol on cognitive functions in drug-naive schizophrenia patients after 3 months of medication, because neither could be distinguished from retest effects of the healthy control group.

Adult↗

PubMed2002

A multi-site study of alcohol subtypes: classification and overlap of unidimensional and multi-dimensional typologies.

AIMS: The current study examined the usefulness of four prevailing alcohol typologies, assessed in terms of replicability of the multi-dimensional schemas, percentage of the sample classified by each typology, distribution of subtypes by gender and treatment site and construct validity of Type 1/Type 2. In addition, overlap of classification systems was examined to determine whether the four typologies may be narrowed to a smaller set of meaningful, non-redundant subtype schemas. DESIGN: Baseline data from five treatment outcome studies were used to facilitate subtyping according to four alcohol typologies: antisocial (ASP) versus non-ASP, early versus late onset, Type 1/Type 2 and Type A/Type B. SETTING: The studies were conducted at several in-patient and out-patient treatment sites. PARTICIPANTS: The sample included 342 participants (23% female) who met DSM-III-R criteria for alcohol abuse or dependence. MEASUREMENTS: Subjects were assessed on substance use severity, family history, psychopathology, personality and psychosocial functioning. FINDINGS: Type 1/Type 2 and Type A/B typologies were replicated. Type 1/Type 2 had poor construct validity due to symptom cluster overlap between the two subgroups. Only 14% of the subjects met criteria for ASP. The two strongest associations including that between early versus late onset and Type 1/Type 2 and that between ASP versus non-ASP and Type A/Type B, were expected and reflect overlaps in conceptual definitions. In comparison, the relationship between early versus late onset and ASP versus non-ASP and Type A/B was weak. CONCLUSIONS: Clinical utility of the ASP/non-ASP typology is limited in non-Veterans Administration (VA) samples, due to low prevalence. The Type 1/Type 2 subtyping schema was redundant with the age of onset schema, and was the least internally valid of all four typologies. In general, the Type A/B schema was most promising of prevailing typologies studied. It was relatively inclusive, and the A, B groups were distinct from one another. However, dichotomous typologies may not be complex enough to be clinically useful descriptors of alcoholic samples. Aside from ASP and Type B, there appears to be heterogeneity within groups typically considered homogeneous, such as 'early versus late onset' alcoholics.

Adult↗

PubMedDate not supplied

Testing the psychometric properties of the Minnesota Living with Heart Failure questionnaire.

BACKGROUND: Health-related quality of life (HRQOL) is an important outcome in patients with heart failure. One of the most commonly used instruments to measure HRQOL in this population is the Minnesota Living With Heart Failure Questionnaire (LHFQ). Although the psychometric properties of the LHFQ have been tested, the results do not definitively support the psychometric soundness of the instrument. OBJECTIVE: To examine the psychometric properties of the LHFQ. METHOD: Data from 638 patients with heart failure were used to assess the reliability, homogeneity, representativeness, discriminative ability, and construct validity of the LHFQ before and after deletion of 5 items that showed lack of representativeness and contributed to inadequate factor structure. RESULTS: Cronbach's alphas for the LHFQ Total and subscales were greater than .80. Interitem correlation coefficients in 17 of the 21 items, item-total correlation coefficients in 20 items, and discriminative ability in all items were acceptable. The total and both subscales of the LHFQ differentiated New York Heart Association functional groups. The Physical subscale was moderately related to the physical measures (the Specific Activity Scale and symptom status), whereas the emotional subscale was weakly related to the measures. The results of item p level testing and factor analysis demonstrated that 7 items were consistently problematic and 5 items were recommended to be deleted. The results of the reliability, homogeneity, and construct validity after deletion of these items demonstrated that the psychometric properties of the LHFQ were improved as a result. DISCUSSION: The initial results provided additional support for the reliability and substantial evidence for the validity of the LHFQ. However, the results of item and factor analyses did not fully support the psychometric soundness of several items. The psychometric properties of the LHFQ after deleting these items were improved. These results could provide researchers and clinicians a more useful measure of HRQOL.

Activities of Daily Living↗

PubMed2004

Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders.

OBJECTIVE: Describe the development and evaluation of a new self-report instrument, the patient assessment of upper gastrointestinal disorders-symptom severity index (PAGI-SYM) in subjects with gastroesophageal reflux disease (GERD), dyspepsia, or gastroparesis. METHODS: Recruited subjects with GERD (n=810), dyspepsia (n = 767), or gastroparesis (n = 169) from the US, France, Germany, Italy, the Netherlands, and Poland. Subjects completed the PAGI-SYM, SF-36, a disease-specific HRQL measure (PAGI-QOL), and disability day questions. Two-week reproducibility was evaluated in 277 stable subjects. We evaluated construct validity by correlating subscale scores with SF-36, PAGI-QOL, disability days, and global symptom severity scores. RESULTS: The final 20-item PAGI-SYM has six subscales: heartburn/regurgitation, fullness/early satiety, nausea/vomiting, bloating, upper abdominal pain, and lower abdominal pain. Internal consistency reliability was good (alpha = 0.79-0.91); test-retest reliability was acceptable (Intraclass correlation coefficients alpha=0.60-0.82). PAGI-SYM subscale scores correlated significantly with SF-36 scores (all p < 0.0001), PAGI-QOL scores (all p < 0.0001), disability days (p < 0.0001), and global symptom severity (p < 0.0001). Mean PAGI-SYM scores varied significantly in groups defined by disability days (all p < 0.0001), where greater symptom severity was associated with more disability days. CONCLUSIONS: Results suggest the PAGI-SYM, a brief symptom severity instrument, has good reliability and evidence supporting construct validity in subjects with GERD, dyspepsia, or gastroparesis.

Analysis of Variance↗

PubMed1993

Body composition of sedentary and physically active spinal cord injured individuals estimated from total body electrical conductivity.

Reliability and evidence of construct validity of Total Body Electrical Conductivity (TOBEC) for estimating body composition in spinal cord injured subjects was evaluated using 17 males with C6-L2 spinal cord transections. Subjects reporting regular exercise were categorized as active (n = 12); nonexercisers were considered sedentary (n = 5). Measures included body weight, length, circumferences, skinfolds, and three TOBEC readings. Reliability for percent fat of both single and multiple TOBEC trials (t = 3) ranged from .994 to .999. Average percent fat values were significantly (p < .009) higher in sedentary subjects. Sum of seven skinfolds was significantly correlated (r[15] = 0.73, p < .01) with percent fat measured by TOBEC. Results suggest TOBEC is reliable (rtt > 0.99) in estimating body composition in spinal cord injured individuals. High reliability estimates for single and multiple trials indicate use of a single trial will provide reliable body fat estimates. Construct validity evidence infers that TOBEC measured body composition discriminates between active and sedentary paraplegics.

Adult↗

PubMed2006

Psychometric properties of brief indexes designed to measure social-cognitive predictors of smoking initiation.

BACKGROUND: Constructing indexes which measure factors that may predict smoking initiation is essential for planning prevention programs. Our aim was to examine the criterion-related construct validity of brief psychological indexes of attitude, social influence and self-efficacy to be used in future studies for predicting smoking initiation in adolescents. METHODS: Five indexes were evaluated using cross-sectional data on 4819 adolescents age 13 in a random sample of schools in six Danish counties. Item analyses were performed with the graphical log-linear Rasch model, a modification of the Rasch model that allows for differential item functioning and positive local dependence. RESULTS: The three indexes social influence-norms, social influence-pressure and attitude showed acceptable deviations from the Rasch model, while the two indexes self-efficacy and social influence-behavior were invalidated by negative local dependence. CONCLUSION: Of the five tested indexes, three (social influence-norms, social influence-pressure and attitude) showed acceptable criterion-related construct validity and may be considered unbiased representations of the theory-based factors if statistical analyses are appropriately adjusted. The results of this population-based study show that the graphical log-linear Rasch model is useful for evaluating health-related behavior indexes and identifying problems, which can be dealt with when using the indexes in future studies.

Adolescent↗

PubMedDate not supplied

Use of a standardized menopause symptom rating scale in a sample of women with physical disabilities.

OBJECTIVE: To determine the psychometric properties of a menopause symptom rating scale developed on nondisabled women in a sample of women polio survivors with physical disabilities. DESIGN: The 25-item Menopause Symptom List (MSL) was administered to 190 women between ages 40 and 65 not taking hormone or estrogen therapy. Factor analysis, bivariate correlation, and analysis of variance were performed to determine the scale's underlying structure, construct validity, and association with menopausal status. RESULTS: Factor analysis revealed four factors: (1) psychological, (2) somatic-sensory, (3) somatic-sleep, and (4) vasomotor. Factors 1 and 3 were associated with postpolio sequelae, self-rated health, positive and negative affect, life satisfaction, and perceived stress. Factor 2 was associated with postpolio sequelae, basic activities of daily living, self-rated health, negative affect, life satisfaction, and perceived stress. Factor 4 was associated with postpolio sequelae, self-rated health, negative affect, and perceived stress. Comparison by menopause status found Factors 1 and 3 significantly differed between groups (F(2,181) = 6.68 and 4.17, respectively; P = 0.02). Contrary to expectations, vasomotor factor severity was not distinguished by menopause status. CONCLUSIONS: Menopause symptom scales standardized on nondisabled women should be used cautiously with women with physical disabilities. Associations between construct validity measures and menopause symptomatology suggest a complex relationship between physical disability and menopause.

Adult↗

PubMed2005

Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children.

BACKGROUND: The aim of this investigation was to examine the construct validity and distinctiveness of the inattentive type (IT) and combined type (CT) of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Latino/Hispanic sample. METHOD: A comprehensive assessment was conducted with a clinically diagnosed school-based sample of 98 children aged 6 to 11 (CT=44; IT=25; control group=29). RESULTS: Both ADHD groups were impaired on academic achievement measures, presented more ADHD-type behaviors during math and vigilance tasks, and exhibited greater internalizing symptoms. The IT group had a later onset of inattention symptoms, presented more sluggish cognitive tempo symptoms, was less prone to initiate social interactions or to be assertive and more self-controlled in social interchanges, was less likely to have externalizing behaviors, had mothers who reported less child-related family stress, and was less impaired in their adaptive functioning. CONCLUSIONS: Findings supported the construct validity of ADHD in this culturally different sample and suggested that the CT and IT represent distinct disorders.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial.

BACKGROUND: To compare the impact of sleep deprivation after 24-hour duty (post-call) with that of 8-hour work (post-work) on product quality (PQ) and procedure effectiveness (PE) in a laparoscopic physical simulator. METHODS: Voluntary surgeons and nurses were pretested with the Epworth Sleepiness Scale (ESS) and Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Surgical task was suturing perforated ulcer on a foam stomach in a physical simulator. PQ and PE were measured by accuracy error (AE), tissue damage (TD) leak rate (LR), goal- (GDA) non-goal-directed actions (NGDA), and operating time (OT), respectively. Construct validity was assessed comparing measures when surgeons and nurses performed the surgical task. Inter-rater reliability (IRR) was assessed by Kendall's tau b coefficient. An 80% power parallel block randomization design at alpha = .05 required 60 subjects. RESULTS: Thirty-two post-call surgeons and 32 post-work surgeons were well matched for age, gender, practice duration, and ESS and MIST-VR scores. The amount of time slept in the previous 24 hours was 1.5 versus 6.5 hours (P < .05). AE (1.0 mm vs. .5 mm), TD (2.18 mm vs. 2.18 mm), LR (56.2% vs. 65.6%), GDA (33.5 vs. 32.5), NGDA (.56 vs. .31), and OT (381.0 seconds vs. 364.5 seconds) were not significantly different when 32 surgeons in the post-call arm were compared with their 32 counterparts in the post-work arm, respectively. Construct validity was shown by significant improvement in 4 outcome measures (AE 1.0 mm vs. 2.0 mm, P = .00001; GDA 32.5 vs. 39.0, P = .07, NGDA .43 vs. .96, P = .045; and OT 377.5 vs. 557.0, P = .0005) when 64 surgeons performed the task as compared to 64 nurses. Tau b for IRR was 1.0 (P < .0001) for AE, TD, LR, and OT, .75 (P = .325) for GDA, and .77 (P = .305) for NGDA. CONCLUSIONS: Sleep deprivation had no impact on the studied outcome measures of a surgical task performed in a laparoscopic simulator.

Adult↗

PubMed2002

Reliability of selected measures of nicotine dependence among adolescents.

PURPOSE: To examine the test retest reliability, internal consistency, and convergent construct validity of selected measures of nicotine dependence (ND) among adolescents. METHODS: Self-reports of sociodemographic characteristics and smoking behavior were collected in a convenience sample of 238 high school students aged 13 to 19 years. ND was measured in the Hooked on Nicotine Checklist (HONC), the Stanford Dependence Index (SDI) and in 45 new items identified in consultation with experts and focus group interviews with adolescent smokers. RESULTS: Test retest reliability among past 3-month smokers indicated good to excellent reliability coefficients for HONC items (kappa 0.61 to 0.93), except one item that tapped feelings of depression on withdrawal (kappa = 0.34). Intraclass correlation coefficients for SDI items ranged from 0.71 to 0.77. Test retest reliability coefficients for the 45 new items ranged from 0.20 to 0.90. The HONC and SDI demonstrated good internal consistency (Cronbach's alpha = 0.90 and 0.78, respectively). Convergent construct validity against cigarette exposure was demonstrated for the HONC, SDI, and most of the 45 new items. CONCLUSIONS: The HONC and SDI demonstrated excellent and good psychometric properties, respectively. Most of the 45 new items hold promise as indicators of ND in youth, and should be further investigated.

Adolescent↗

PubMed2001

Correlation of scores for the Comprehensive Osteopathic Medical Licensing Examination with osteopathic medical school grades.

The authors evaluated construct validity of scores for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), the examination used to evaluate osteopathic physicians for licensure. They computed correlations between students' grades in the first 2 years of osteopathic medical school and their scores on the COMPLEX-USA Level 1 (N = 187) and Level 2 (N = 86), as well as correlations between third- and fourth-year clerkship grades and the COMLEX-USA Level 2. Correlations of Level 1 scores with grades for years one, two, and the first 2 years combined were .74, .80, and .81, respectively; for Level 2, correlations were .59, .70, and .71. Correlation between clerkship grades and scores for the COMLEX-USA Level 2 was .26. The strong correlation between COMLEX-USA results and grades for the didactic curriculum in the first 2 years of medical school provides evidence for the construct validity of scores for the COMLEX-USA Levels 1 and 2.

Adult↗

PubMed2006

Development of a questionnaire to assess vision problems under low luminance in age-related maculopathy.

PURPOSE: To develop a questionnaire for assessing self-reported visual problems under low luminance and at night for use in studies on age-related maculopathy (ARM). METHODS: The questionnaire was developed in three steps: (1) Content for questionnaire items was identified through focus groups of older adults with ARM and those exhibiting normal retinal aging. The topic for discussion was "vision at night and under low lighting." Discussion was audiotaped, transcribed, and subjected to content analysis to identify problem categories expressed by patients. (2) This content was used to develop a preliminary questionnaire administered by telephone to persons with ARM or normal retinal aging. Principal-components analysis identified groups of items that formed the questionnaire's subscales that were evaluated for internal consistency, and an item-reduction strategy was implemented to generate a briefer questionnaire. (3) Psychometric properties of the shortened Low-Luminance Questionnaire (LLQ) were determined, including construct validity, criterion validity, and test-retest reliability. RESULTS: The 32-item LLQ has six subscales (driving, extreme lighting, mobility, emotional distress, general dim lighting, and peripheral vision), all with good internal consistency (Cronbach alpha > or = 0.82). Scores on LLQ subscales correlated moderately with nearly all National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 subscales and decreased in value (indicating more disability) for patients with increasing ARM disease severity. Whereas rod-mediated parameters of dark adaptation were significantly associated with LLQ subscale scores (r = 0.19-0.43, all P < 0.03), cone-mediated parameters were not. Test-retest reliability ranged from 0.74 to 0.88 for all subscales (P < 0.0001), except for peripheral vision (0.46; P = 0.0003), which also exhibited a ceiling effect in almost half of the respondents. CONCLUSIONS: The 32-item LLQ, derived from the content of focus group comments by persons with ARM, has good construct validity, subscale scores related to rod-mediated visual function, and good test-retest reliability for five of six subscales. The LLQ may ultimately be useful in patient-centered evaluation of the outcome of interventions to prevent ARM or to arrest progression of early disease.

Aged↗

PubMed2005

[Factor structure of the SOC scale 13-item version in Japanese university students].

The purpose of the present study was to examine the construct validity of Antonovsky's (1987) sense of coherence scale (SOC) 13-item version, with a sample of Japanese university students. Subjects were 1,110 university students who completed a self-administered questionnaire including items on individual characteristics (age, sex), the Zung self-rating depression scale (SDS) and the SOC scale. Exploratory factor analysis of the SOC scale yielded an interpretable two-factor solution with "comprehensibility-manageability" and "meaningfulness". Confirmatory factor analysis demonstrated an a priori defined SOC second-order factor model composed of comprehensibility-manageability and meaningfulness factor to have an acceptable fit (chi-square=327.065, df=64, GFI=0.957, CFI=0.872, RMSEA= 0.061). Moreover, structural equation modeling showed that there are theoretically consistent relationships among individual SOC factors and depression. In particular, the meaningfulness factor proved better predictor of depression than the comprehensibility-manageability factor. These findings support the construct validity of the SOC scale and suggest that two SOC sub scores may provide clinically applicable information, rather than the total score.

Adult↗

PubMed2006

Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory.

BACKGROUND/AIMS: To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. METHODS: The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home or outreaching nursing home care. Exploratory factor analysis was used to examine the behavioral dimensions underlying CMAI-D observations. RESULTS: A restricted 3-factor solution showed 3 factors, i.e. physical aggression, physically nonaggressive behavior and verbally agitated behavior, with prevalences of 62, 67 and 62%, respectively. An unrestricted factor solution revealed 3 additional behavioral dimensions: hiding/hoarding, vocal agitation and a factor of miscellaneous items (i.e. repetitious mannerisms, spitting), which occurred in 30, 28 and 35% of the patients, respectively. CONCLUSION: The 3-factor solution of physical aggression, physically nonaggressive behavior and verbally agitated behavior corroborates earlier findings in other patient samples and therefore establishes the construct validity in institutionalized patients with severe dementia. The robustness of these findings across different care settings suggests that agitated behaviors have a common basis. In addition, unrestricted factor analysis showed 3 other important independent behavioral symptoms in dementia, but they are in fact too small to be used as a subscale. These findings might add to the taxonomy of agitation and aggression in dementia.

Adult↗

PubMed1996

Disease-specific quality of life: the Gallstone Impact Checklist.

OBJECTIVE: To develop a disease-specific quality-of-life scale for symptomatic cholelithiasis for use in clinical trials, and to evaluate its reliability, construct validity and responsiveness. DESIGN: Questionnaire. PARTICIPANTS: Health care professionals, patients with symptomatic cholelithiasis and their significant others. INTERVENTIONS: A 114-item questionnaire was developed from open-ended questions completed by the participants. Questions dealt with physical symptoms, activities of daily living, job performance, leisure activities, emotional factors, marital and sexual relations, support networks and financial situation. The questionnaire was administered by an interviewer to 50 subjects booked for elective cholecystectomy: frequency-importance products were calculated for each of the 114 items. A final shortened scale (the Gallstone Impact Checklist [GIC]) contained 41 items and was completed by patients with symptomatic cholelithiasis on two occasions, 4 to 6 weeks apart. RESULTS: The checklist requires 10 to 15 minutes to complete. Reliability of the questionnaire and its four subscales was assessed by Cronbach's alpha (overall questionnaire 0.88, pain 0.60, dyspepsia 0.73, emotional impact 0.78 and food and eating 0.84). Construct validity was established by comparison of questionnaire subscales with global ratings of physical and emotional health. Among subjects who reported a difference in their symptoms attributed to gallstones, there was a significant change in total GIC score and in each of the four subscales. Among patients who had undergone cholecystectomy, the absolute value of the effect size was 1.63. CONCLUSIONS: The GIC has content validity and appears to be a reliable, responsive measure of within-person change for subjects with symptomatic cholelithiasis.

Adult↗