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PubMed2006

Scale-dependent interaction of fire and grazing on community heterogeneity in tallgrass prairie.

Natural disturbances affect spatial and temporal heterogeneity in plant communities, but effects vary depending on type of disturbance and scale of analysis. In this study, we examined the effects of fire frequency (1-, 4-, and 20-yr intervals) and grazing by bison on spatial and temporal heterogeneity in species composition in tallgrass prairie plant communities. Compositional heterogeneity was estimated at 10-, 50-, and 200-m2 scales. For each measurement scale, we used the average Euclidean Distance (ED) between samples within a year (2000) to measure spatial heterogeneity and between all time steps (1993-2000) for each sample to measure temporal heterogeneity. The main effects of fire and grazing were scale independent. Spatial and temporal heterogeneity were lowest on annually burned sites and highest on infrequently burned (20-yr) sites at all scales. Grazing reduced spatial heterogeneity and increased temporal heterogeneity at all scales. The rate of community change over time decreased as fire frequency increased at all scales, whereas grazing had no effect on rate of community change over time at any spatial scale. The interactive effects of fire and grazing on spatial and temporal heterogeneity differed with scale. At the 10-m2 scale, grazing increased spatial heterogeneity in annually burned grassland but decreased heterogeneity in less frequently burned areas. At the 50-m2 scale, grazing decreased spatial heterogeneity on 4-yr burns but had no effect at other fire frequencies. At the 10-m scale, grazing increased temporal heterogeneity only on 1- and 20-yr burn sites. Our results show that the individual effects of fire and grazing on spatial and temporal heterogeneity in mesic prairie are scale independent, but the interactive effects of these disturbances on community heterogeneity change with scale of measurement. These patterns reflect the homogenizing impact of fire at all spatial scales, and the different frequency, intensity, and scale of patch grazing by bison in frequently burned vs. infrequently burned areas.

Animals↗
PubMedDate not supplied

[Scales for functional assessment in multiple sclerosis].

OBJECTIVE: To review the characteristics which should be met by the scales for functional assessment of patients with multiple sclerosis in relation to the degree of invalidity, incapacity and handicap. DEVELOPMENT: The functional scales for neurological patients which we review are Barthel's index, the PULSES Scale, Katz Index, Rankin Scale, Kenny Scale, Donaldson Scale, Garno Scale, ISS (Incapacity Status Scale) FAM Scale (Functional Assessment Measure), Hauser's Ambulant Index, Cambridge Scale (CAMBS) and London Handicap Scale (LHS). CONCLUSIONS: There is no single scale for the functional assessment of patients with multiple sclerosis which covers all the aspects to be assessed. Therefore it is necessary to use a combination of various scales to find exactly the degree of invalidity, incapacity and handicap. From our point of view the scales with which this assessment may be done are--apart from the usually used NRS (Neurological Scoring System) and EDSS--the Hauser Index, Cambridge Scale and London Handicap Scale.

Humans↗
PubMed2001

[Comparison of three scales to assess health risk perception].

BACKGROUND: Health risks management consists of quantitative and qualitative assessment of risks including risk perception among different samples of the population. Little work has been done to develop and validate scales to measure risk perception. METHODS: We conducted, in December, 1999, a study among 1358 French GPs, members of the Sentinels network, in order to compare three scales: a visual analog scale, a verbal scale and a numerical scale. GPs were asked about their own perception of two risks: the Creutzfeldt-Jakob disease new variant (vMCJ) and the bug. RESULTS: The response rate was 55%, with no difference between the three groups (p=0.85). No statistically significant difference was observed between the distributions of the visual analog scale and the numerical scale (p=0.11 for the question about the vMCJ and p=0.98 for the question about the bug). Conversely, distributions of the verbal scale were significantly different from those of the visual analog scale (p<0.0001 for both of the questions) and from those of the numerical scale (p<0.0001 for both of the questions). Separation between worried and non worried people didn't occur in the middle of the visual analog scale but at 33 millimeters from the left extremity for the question about the vMCJ and at 41 millimeters from the same extremity for the question about the bug. CONCLUSION: We recommend the use of verbal scales to measure instantaneous perception of a given risk. Visual analog scales and numerical scales are known to be the best scales to detect minimum changes in the perception of functional signs such as pain. On this purpose, their superiority with regard to verbal scales has to be confirmed in the field of risk perception.

Attitude of Health Personnel↗
PubMed2001

[The European Evaluation of Vertigo (EEV) scale: a clinical validation study].

Up until now, the questionnaires used to evaluate vertigo have been self-administered questionnaires that rate either symptoms and/or their consequences. In contrast, the European Evaluation of Vertigo scale (EEV) is a physician-administered questionnaire that only assesses symptoms of the vestibular syndrome: illusion of movement, duration of illusion, motion intolerance, neurovegetative signs, and instability. Twenty-six ear, nose, and throat (ENT) specialists participated in this validation study conducted among 123 patients suffering from different types of vertigo. The reliability, responsiveness and construct, convergent and discriminant validity of the EEV scale were assessed. Construct, convergent and discriminant validity was determined by comparing the scores on the EEV scale with those obtained using the following validated scales: patient diary and conventional scale designed by the DPHM, functional scale of the AAO-HNS, and SF-36 scale, a generic quality of life scale. With the exception of the "neurovegetative signs" item, the reliability of the EEV scale is good, particularly in terms of interrater reliability (r = 0.93 for the global score), and responsiveness is high (p < 0.01). EEV scale has good correlations with the items of patient diary, DPHM scale and "physical" dimensions of SF-36, from the first evaluation, whereas this scale has poor correlation at Day 0, with the items of AAO scale and the "psychological" dimensions of SF-36. These results confirm that EEV scale is exclusively a symptomatic scale and does not interfere with the psychism. The EEV scale is therefore a validated physician-administered questionnaire capable of monitoring the course of vertigo and of assessing the efficacy of anti-vertigo treatments.

Adolescent↗
PubMed1993

Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study.

OBJECTIVE: To investigate the ability of the Glasgow Coma Scale score to predict hospital mortality rate for adult medical-surgical intensive care unit (ICU) patients without trauma. DESIGN: A prospective cohort analysis of adult medical-surgical patients from a nationally representative sample of 40 U.S. hospitals. PATIENTS: 15,973 consecutive, nontraumatic ICU admissions and a comparison group of 687 head trauma admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients' gender, age, treatment location before ICU admission, comorbidities, admission diagnosis, daily physiologic measurements, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation (APACHE III) score, subsequent hospital mortality rate, and unit-specific sedation practices were noted. Hospital mortality rates were stratified by the first ICU day Glasgow Coma Scale score for all admissions. The relationship between the Glasgow Coma Scale score and outcome for two high mortality medical diagnoses (post-cardiac arrest and sepsis) were also examined and compared to the relationship found in patients with head trauma. The Glasgow Coma Scale score on ICU admission had a highly significant (r2 = .922, p < .0001) but nonlinear relationship with subsequent outcome in ICU patients without trauma. Discrimination of patients into high- or low-risk prognostic groups was good, but discrimination in the intermediate levels (Glasgow Coma Scale score of 7 to 11) was reduced. This relationship varied within the operative and nonoperative groups, and also within different disease categories, various age groups, and certain ranges of the Glasgow Coma Scale score. A reduced initial Glasgow Coma Scale score associated with sepsis was a combination of factors associated with a higher mortality rate than that found in patients with head trauma. The proportion of patients who could not be assigned a Glasgow Coma Scale score because of sedation/paralysis varied widely across ICUs. The overall predictive capability of the APACHE III Prognostic Scoring System was improved by incorporating the Glasgow Coma Scale score. CONCLUSIONS: We demonstrated the prognostic importance of admission levels of consciousness as measured by the Glasgow Coma Scale score on ICU and hospital mortality rates. We concluded that the Glasgow Coma Scale score may be used to stratify and predict mortality risk in general intensive care patients, but lack of sensitivity in the intermediate range of Glasgow Coma Scale Score should be noted. Ideally, the Glasgow Coma Scale score should also be applied in the context of other physiologic information and the patient's specific diagnosis. Variation in the use of sedatives in different ICUs means that imputing or substituting a value other than normal for an unobtainable Glasgow Coma Scale score may introduce a substantial treatment bias into subsequent outcome predictions.

Coma↗
PubMed2005

Osteoblastic activity and estrogenic response in the regenerating scale of goldfish, a good model of osteogenesis.

Osteogenesis in the teleost was morphologically observed using regenerating scales of goldfish. Histological observations indicated that osteoblasts around the regenerating scales on days 7 to 10 were greater in size and number than those at other stages. Therefore, further experiments were carried out to examine the activity of osteoblasts in the regenerating period. To quantify their osteoblastic activities, scales on the left side of the body were taken, and the regenerating scales were then used to measure the activities of alkaline phosphatase (ALP), a marker of osteoblasts, on days 7, 10, and 15. The ontogenic scales on the right side of the body were also collected and used to measure ALP activity on the same days. Osteoblasts at all stages of regenerating scales were more active than those in the remaining ontogenic scales. The regenerating scales on day 10 had the highest activity. Furthermore, we found that estrogen receptor (ER) mRNA was expressed in the regenerating scales because estrogen participates in osteoblastic growth and differentiation in mammals. Therefore, using a scale culture system reported previously, the estrogenic response was examined in the ontogenic and regenerating scales on day 10. The reactivity was much higher in regenerating scales, although estrogen treatment significantly activated the osteoblastic activities in both scales. We are the first to demonstrate that ER is expressed in regenerating scales and that estrogen participates in osteogenesis as it does in mammalian bone. Our findings strongly suggest that regenerating scales can be used as a model of osteogenesis in vertebrates.

Alkaline Phosphatase↗
PubMed2004

Validation of a new scale for the assessment of bowel preparation quality.

BACKGROUND: Bowel preparation quality scales are used to document the superiority of one preparation regime vs. another. The validity and reliability of these scales are not routinely stated in reports of studies in which the scales are used. A new colonoscopy bowel preparation scale (the Ottawa bowel preparation scale) was developed and validated prospectively. METHODS: Ninety-seven consecutive patients undergoing elective outpatient colonoscopy were entered into the study. The quality of the bowel preparation was assessed independently by two investigators who used the Ottawa scale, and the only other validated scale (Aronchick scale) that could be identified. The interobserver agreement and reliability of each scale was assessed by the Pearson correlation coefficient (r), the intraclass correlation coefficient, and regression analysis. RESULTS: The Pearson correlation coefficients were, respectively, 0.89 and 0.62 for the Ottawa and Aronchick scales (p<0.001). The values for the kappa statistic, an intraclass correlation coefficient measuring agreement over and above chance agreement, were, respectively, 0.94 and 0.77 (p<0.001). Linear regression analysis, mapping the line best describing the scatter of scores by raters, for the Ottawa scale revealed a slope of the line of 0.93 and a y intercept of 0.10. The Aronchick scale revealed a slope of 0.65 and a y intercept of 0.46. The Ottawa scale thus was closer to an identity line comparing raters (i.e., closer to a line with slope of 1.00 and y intercept of 0.00). The Ottawa scale demonstrated a right colon kappa (intraclass correlation coefficient) of 0.92: 95% CI[0.88, 0.95], a mid colon kappa (intraclass correlation coefficient) of 0.88: 95% CI[0.82, 0.92], and a rectosigmoid kappa (intraclass correlation coefficient) of 0.89: 95% CI[0.83, 0.92]. CONCLUSIONS: The Ottawa scale was validated prospectively and demonstrates high interobserver agreement and reliability, whether used as a total score or for individual colon segments.

Cathartics↗
PubMed2006

[Functional rating scales for amyotrophic lateral sclerosis].

Amyotrophic lateral sclerosis (ALS) is a progressive degeneration of the peripheral and central motor neurons. The principal consequence is a loss of motor functions. Evaluation of motor deficit implies an assessment of the resulting deficiency or incapacity and final disability. Many evaluation are proposed for patient follow-up in order to analyze the state of motor function and their consequences on activities of everyday life. Few recommendations can be formulated. Scales must be validated and relatively simple to use and generate ordinate results allowing statistical analysis. The choice of which scale to use depends on the clinical objective. Global scales (ALS Functional rating Scale, ALS Severity Scale, Appel scale, Norris scale and Honda scale) can be used to evaluate progression of the disability. Some of these scales are strongly correlated with patient survival. Other scales (ALS Health State Scale, global clinical impression) are used to classify patients by homogeneous stage of gravity. Still other scales, such as the Sadoul and Borg scales and the Epworth score are designed for more specific evaluation of a given function. The clinician should be aware of these different scales and their relative utility. Knowledge of these scales, their validity, their sensitivity to modification, and their specificity and interpretation pitfalls is a prerequisite to good evaluation in daily practice and clinical research.

Activities of Daily Living↗
PubMed1999

A comparison of faces scales for the measurement of pediatric pain: children's and parents' ratings.

Faces scales have become the most popular approach to eliciting children's self-reports of pain, although different formats are available. The present study examined: (a) the potential for bias in children's self-reported ratings of clinical pain when using scales with smiling rather than neutral 'no pain' faces; (b) levels of agreement between child and parent reports of pain using different faces scales; and (c) preferences for scales by children and parents. Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture, and their parents. Following venepuncture, children and parents independently rated the child's pain using five different randomly presented faces scales and indicated which of the scales they preferred and why. Children's ratings across scales were very highly correlated; however, they rated significantly more pain when using scales with a smiling rather than a neutral 'no pain' face. Girls reported significantly greater levels of pain than boys, regardless of scale type. There were no age differences in children's pain reports. Parents' ratings across scales were also highly correlated; however, parents also had higher pain ratings using scales with smiling 'no pain' faces. The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used; parents overestimated their children's pain using all five scales. Children and parents preferred scales that they perceived to be happy and cartoon-like. The results of this study indicate that subtle variations in the format of faces scales do influence children's and parents' ratings of pain in clinical settings.

Adult↗
PubMed2003

Scaling up of the fluidized bed granulation process.

The scaling up of a fluidized bed granulation process from small scale to production scale is often done empirically in the pharmaceutical industry. In this study, a more practical and systematic method was developed in order to achieve a similar granule size in the scaled up fluid bed. The scaling up is based on the relative droplet size, and the powder bed moisture content at the end of the spraying cycle. The present study describes the scaling up of the fluidized granulation process from small (5 kg scale) to medium (30 kg scale) and to production fluid bed scale (120 kg scale). The granulation process is scaled up with as target a geometric mean granule size of 400 microm. First, the effect of the relative droplet size on the granule size was investigated in the different fluid beds. The effect of the change in relative droplet size on the granule size was different for each fluid bed. Second, experimental design is applied on the small and the medium fluid scale, and regression models for the granule size are proposed in order to scale up the granulation process on the small to medium scale. The granulation process was also successful by scaling-up to the large fluid bed, considering only the relative droplet size.

Powders↗
PubMed2002

The Dental Neglect and Dental Indifference scales compared.

OBJECTIVES: The objective was to determine whether the Dental Neglect and Dental Indifference scales measure similar constructs and have similar associations in the same population sample. METHODS: A random sample of 600 residents in the Dunedin South Electorate were sent a self-report questionnaire containing the Dental Neglect scale and the Dental Indifference scale. Socio-demographic and dental service-use data were also collected. RESULTS: In all, 478 people (78.2%) returned the questionnaire. The mean Dental Neglect score was 12.4 (SD 4.4). The mean Dental Indifference scale score was 3.1 (SD 1.9). The association between the scales' scores was moderate (r = 0.58; P < 0.01), and there was only a moderate degree of concordance between the two. The two scales had largely similar associations with socio-demographic, oral care and self-care, and oral health impact characteristics, although slightly more associations were found with the Dental Indifference scale. The Dental Neglect scale was found to be easier to use than the Dental Indifference scale because it did not require a complex algorithm to compute scale scores. CONCLUSIONS: The degree of concordance between the Dental Neglect and Dental Indifference scales was not as high as expected, which suggests that the scales may measure different constructs. However, the largely similar associations with important oral health and socio-demographic variables of the scales suggest the opposite. Although the Dental Indifference scale was slightly more discriminative, the Dental Neglect scale was easier to use in practice.

Adolescent↗
PubMed2006

An independent evaluation of four quantitative emergency department crowding scales.

BACKGROUND: Emergency department (ED) overcrowding has become a frequent topic of investigation. Despite a significant body of research, there is no standard definition or measurement of ED crowding. Four quantitative scales for ED crowding have been proposed in the literature: the Real-time Emergency Analysis of Demand Indicators (READI), the Emergency Department Work Index (EDWIN), the National Emergency Department Overcrowding Study (NEDOCS) scale, and the Emergency Department Crowding Scale (EDCS). These four scales have yet to be independently evaluated and compared. OBJECTIVES: The goals of this study were to formally compare four existing quantitative ED crowding scales by measuring their ability to detect instances of perceived ED crowding and to determine whether any of these scales provide a generalizable solution for measuring ED crowding. METHODS: Data were collected at two-hour intervals over 135 consecutive sampling instances. Physician and nurse agreement was assessed using weighted kappa statistics. The crowding scales were compared via correlation statistics and their ability to predict perceived instances of ED crowding. Sensitivity, specificity, and positive predictive values were calculated at site-specific cut points and at the recommended thresholds. RESULTS: All four of the crowding scales were significantly correlated, but their predictive abilities varied widely. NEDOCS had the highest area under the receiver operating characteristic curve (AROC) (0.92), while EDCS had the lowest (0.64). The recommended thresholds for the crowding scales were rarely exceeded; therefore, the scales were adjusted to site-specific cut points. At a site-specific cut point of 37.19, NEDOCS had the highest sensitivity (0.81), specificity (0.87), and positive predictive value (0.62). CONCLUSIONS: At the study site, the suggested thresholds of the published crowding scales did not agree with providers' perceptions of ED crowding. Even after adjusting the scales to site-specific thresholds, a relatively low prevalence of ED crowding resulted in unacceptably low positive predictive values for each scale. These results indicate that these crowding scales lack scalability and do not perform as designed in EDs where crowding is not the norm. However, two of the crowding scales, EDWIN and NEDOCS, and one of the READI subscales, bed ratio, yielded good predictive power (AROC >0.80) of perceived ED crowding, suggesting that they could be used effectively after a period of site-specific calibration at EDs where crowding is a frequent occurrence.

Crowding↗
PubMed1998

A new perspective on gender orientation measurement with the MMPI-2: development of the Masculine-Feminine Pathology Scale.

A new scale of gender orientation for the MMPI-2 (Minnesota Multiphasic Personality Inventory-II; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) called the Masculine-Feminine Pathology Scale, or Mfp, was developed as an alternative to the available Mf, GM, and GF scales. It differs from previous scales in its emphasis on symptomatic correlates of gender. Items were included in the new scale if they (a) discriminated between male and female psychiatric patients and (b) were likely to be indicators of psychopathology. Statistical analyses suggested an acceptably reliable but factorially complex scale. When used to predict clinician ratings of global psychopathology, the scale demonstrated incremental validity over both the existing gender-related scales and the traditional clinical scales. Scores at the "feminine" end of the Mfp scale seem to reflect distress characterized by high levels of anxiety. Scores at the "masculine" end of the Mfp scale suggest a more composed interpersonal presentation, which may reflect an amoral attitude. It is suggested that the new scale may prove superior to the existing gender role scales as a supplement to other clinical scales. Avenues for future research with the Mfp scale are discussed.

Adult↗
PubMed2005

An examination of three sets of MMPI-2 personality disorder scales.

Three sets of personality disorder scales (PD scales) can be scored for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Two sets (Levitt & Gotts, 1995; Morey, Waugh, & Blashfield, 1985) are derived from the MMPI (Hathaway & McKinley, 1983), and a third set (Somwaru & Ben-Porath, 1995) is based on the MMPI-2. There is no validity research for the Levitt and Gotts scale, and limited validity research is available for the Somwaru and Ben-Porath scales. There is a large body of research suggesting that the Morey et al. scales have good to excellent convergent validity when compared to a variety of other measures of personality disorders. Since the Morey et al. scales have established validity, there is a question if additional sets of PD scales are needed. The primary purpose of this research was to determine if the PD scales developed by Levitt and Gotts and those developed by Somwaru and Ben-Porath contribute incrementally to the scales developed by Morey et al. in predicting corresponding scales on the MCMI-II (Millon, 1987). In a sample of 494 individuals evaluated at an Army medical center, a hierarchical regression analysis demonstrated that the Somwaru and Ben-Porath Borderline, Antisocial, and Schizoid PD scales and the Levitt and Gotts Narcissistic and Histrionic scales contributed significantly and meaningfully to the Morey et al. scales in predicting the corresponding MCMI-II (Millon, 1987) scale. However, only the Somwaru and Ben-Porath scales demonstrated acceptable internal consistency and convergent validity.

Adult↗
PubMed2002

International dairy bull evaluations expressed on national, subglobal, and global scales.

Genetic evaluations on a global scale were calculated for Holstein bulls using the May 2001 International Bull Evaluation Service (Interbull) evaluations expressed on each of 27 national scales. National scale data were weighted by the country's proportion of total daughters from all bulls (population size) to represent market share. Correlations between Interbull evaluations on national scales and evaluations on a global scale ranged from 0.961 to 0.998 (mean of 0.988). Number of top 100 bulls for protein yield that were in common between national and global scales ranged from 54 to 94 and was related significantly to mean genetic correlation between a country and the other 26 countries. Weighting of evaluations on national scales by population size, inverse of population size weight, or equal weight produced practically the same group of top bulls and correlations among the three global scales were 0.999. Thus, the method for combining Interbull evaluations expressed on national scales had only minor impact and was much less important than use of all data. Subglobal scales were established by a clustering technique that gave two to five groups. For grazing countries or other atypical systems, a subglobal scale may provide better guidance, although a scale representing three grazing countries did not provide the expected improvement over a global scale in the relationship with the three country scales. If conditions in non-participating countries are generally represented by participating countries, most needs are met by a global scale.

Animals↗
PubMed1975

Nutritional status of black preschool children in Mississippi. Assessment by food frequency scale.

Food frequency data were studied in relation to the nutritional status of 372 black preschool children in three Mississippi counties. The following data were utilized: quantitative dietary intakes for four or seven days, from which intakes of eight nutrients and energy were calculated and frequency of consumption of all individual foods was obtained; and anthropometric (height) and biochemical (hemoglobin) meausres. Six Guttman scales of food consumption frequencies were constructed: in four scales, all foods consumed in four or seven days were assigned to one of nine food groups which formed scale steps; two scales represented foods from single food groups--breads and milk and milk products. The wide range of individual consumption frequencies required special handling of the data, using a method devised by TenHouten in his work on scale gradient analysis. Kendall's tau correlation coefficients were calculated for relationships between all scales and commonly used indicators of nutritional status, including calculated intakes of eight nutrients and energy, height percentiles, and hemoglobin values. Two total food consumption scales based on seven-day dietary intakes were valid indicators of nutritional status, i.e., the scales were significantly correlated with all three indicators of nutritional status. The milk scale was significantly correlated woth two total food consumption scales, height percentiles, and nine calculated intakes; this finding suggests that a milk scale warrants further investigation. This research focused on relationships between the food scales and nutritional status indicators as an initial step in a study of overall family development. According to the family development model, the food scales and scales dealing with other areas of home and family life are all measuring the capacity of the family to process information. The food scale alone, which has meaning for both the nutritionist and the sociologist, has implications for nutrition education in determining what to teach, selecting teachers, and evaluating change in food practices.

Black or African American↗
PubMedDate not supplied

[Development of a scale for assessing lack of motivation in elderly persons].

OBJECTIVE: Apathy is made of depression and of loss of motivation. For patients with senile dementia of Alzheimer-type, the MMS score is inversely correlated with apathy and depression. The aim of this study is to build a scale aimed at loss of motivation and validated for elderly people. METHODS: The study was performed on 44 non-demented elderly people, 54 outpatients with dementia, mainly Alzheimer's type. After agreement of the patients and the family, patients were assessed using different scales: Cornell's for depression, Marin's for apathy, MMS for cognitive disorders. At the same time, we tested with caregivers a 21 items indirect scale listing various disorders related to loss of motivation, scored from 1 to 4: very often, often, sometimes, never. Patients were retested by 7 different caregivers, and different investigators, immediately and a month later to evaluate reproducibility, temporal stability using Cohen's Kappa and Spearman coefficients. The demotivation scale was then correlated with the other scales and Cronbach's alpha coefficient was studied. RESULTS: The 44 non-demented people were 80.25 years old +/- 7.75. 54 demented patients were included: 15 men and 39 women. The mean age was 81.47 years +/- 8.03. As Cohen's Kappa and Spearman coefficients were not sufficient for 6 items, the scale was reduced to 15 items (Presented). The depression scale is strongly and significantly correlated with the Marin's apathy scale. Internal coherence is particularly significant: Cronbach's alpha coefficient = 0.91. For the 54 patients with dementia, the depression score worsens significantly as cognitive disorders worsen. In these patients Marin's scale shows a progression of apathy with the impairment observed in MMS, but the MMS is not correlated with the score at the demotivation scale. So this latter scale seems to measure something close but independent from apathy. DISCUSSION: The loss of motivation is a frequent behavioral disorder in old patients. Loss of motivation can be present in any chronic disease with asthenia. This disorder is frequent in depression, in dementia and even in endocrine disease, for instance hyperthyroidism. It triggers a loss of commitment of old people and paves the way for the loss of autonomy. Apathy is a loss of motivation associated with an affective blunting. Demotivation is congruent with the actual presence of apathy in patients as measured using Marin's scale that has been used as a standard in this study. This paper presents a methodology for an evaluation scale aimed at the loss of motivation in old people. A psychologist and seven different caregivers working in a day care hospital on 98 patients performed an indirect assessment. An estimation of specificity, sensibility, reproducibility and homogeneity was tested with appropriate techniques. The results obtained with this scale answer the preliminary methodological queries, allowing us to trigger further researches for a final validation. According to our results, demotivation does not increase with age neither in demented nor in non-demented patients. Conversely, the aggravation of cognitive disorders in dementia is associated with increasing demotivation and depression. The loss of motivation participates to the learnt and acquired helplessness. Its care is necessarily global, using pharmacological, psychological and sociotherapeutic treatment. CONCLUSION: EAD scale appears a reliable tool to assess loss of motivation in old and very old patients.

Aged↗
PubMed2006

Hyperarousal, depression and quality of life--validity and reliability of the Swedish version of the Hyperarousal Scale.

AIM: Research focusing on hyperarousability in association with general sensitivity to stress has increased. This study aimed to: (i) describe values for self-reported hyperarousal behaviour traits, depression, sleeplessness behaviour and health-related quality of life [The Short Form 36 Health Survey Questionnaire (SF-36)] in a gender-stratified random sample from the Swedish population; and (ii) test the validity and reliability of the Swedish version of the Hyperarousal Behavioural Trait Scale (H-scale). METHODS: In this study, 402 women and 391 men from Sweden were included. A test-retest study was performed on 297 subjects. RESULTS: The total mean score on the H-scale was 29.5 (SD 10.0, 95% CI 28.8-30.2). Compared to men, women scored higher on the H-scale (total score, sub-scales and many items), whereas no evidence of an age trend was seen. The H-scale has proven to be a valid and reliable scale. Pearson's correlation coefficient showed similar magnitude and direction between the H-scale and the Zung's Self-rating Depression Scale, as between the H-scale and the Vicious Cycle of Sleeplessness Behaviour Scale, Vitality, Mental Health and the Mental Component Summary index on the SF-36 respectively. The Cronbach's alpha for the H-scale was 0.84 and estimated stability test-retest point of time varies between 0.73 and 0.80. CONCLUSIONS: This study indicates gender differences in response style in association with altered health-related quality of life. The H-scale is a valid and reliable self-reported scale for measuring hyperarousal behavioural trait research outcome in clinical practice.

Adult↗