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Sex differences on the MMPI-2 substance abuse scales in psychiatric inpatients.

Sex differences on the MMPI-2 addiction scales (MacAndrew Alcoholism Scale-Revised, Addiction Acknowledgement Scale, Addiction Potential Scale) and their ability to distinguish between substance-abusing and nonabusing psychiatric inpatients were examined. Men obtained higher mean raw scores than women on the MacAndrew Alcoholism Scale-Revised and the Addiction Acknowledgement Scale, and substance abusers scored higher on all three scales. Even relatively low cutoff scores, however, on the MacAndrew Alcoholism Scale-Revised resulted in false negative rates of 37 to 39%. The results support the utility of the MMPI-2 substance abuse scales; however, lower cutoff scores should be used with women and within a psychiatric population.

Adult↗

Divergent, criterion-related, and discriminant validities for the Kuwait University Anxiety Scale.

Three analyses were carried out. Analysis I estimated the correlation between the total score of the Kuwait University Anxiety Scale and a self-rating scale of happiness with large sample of male (n = 1,312) and female (n = 1,272) Kuwaiti adolescents. Pearson product-moment correlations were -.43 and -.44 (p < .001) for boys and girls, respectively, suggesting divergent validity of the anxiety scale. Analysis II examined the correlations between scores on the Kuwait University Anxiety Scale and the Somatic Symptoms Inventory for a nonclinical sample of women (n = 30), and female outpatients with anxiety disorder (n = 30). Pearson product-moment correlations were, respectively, .85 and .53, (p < .001), which support the criterion-related validity of the Kuwait University Anxiety Scale with respect to the Somatic Symptoms Inventory. In Analysis III a sample of 60 male and female outpatients with anxiety disorder and 60 nonclinical participants were matched on age, education, and occupation. All responded individually to the Kuwait University Anxiety Scale. Significant differences among groups, especially noticeable for men, support the discriminant validity of the scale. So, the clinical as well as research use of the scale can be recommended. By and large, the divergent, discriminant, and criterion-related validities of the scale have been adequately supported so subsequent replication is expected.

Adolescent↗

Knowledge and beliefs of breast cancer among elderly Puerto Rican women: validation process of scales.

This paper presents the results of the validation process to determine the concepts for knowledge and beliefs about breast cancer early detection practices among Puerto Rican elderly women. An initial questionnaire was designed based on the scientific literature review and focus group experiences. To determine its reliability and validity, 50 elderly women, stratified by type of profession and place of residence, were interviewed twice. Consistency of the questionnaire was analyzed using binomial test, matched t-test, Pearson correlation coefficient, and Cronbach's coefficient effect. Factor analysis (FA) was the statistical technique used to analyze the grouping of the knowledge and beliefs statements. FA indicated that three scales for knowledge and one for beliefs can be constructed. The purpose of the scales was to identify differences among groups, according to breast cancer early detection practices. Construct validity was performed to determine the number of statistical associations between the scales and these practices. The results showed that beliefs scales was associated with practice of mammogram (p < 0.05), and visit to the gynecologist (p < 0.05) while the knowledge scale for early-detection was associated with the clinical breast examination (p < 0.05). The beliefs scale had better consistency than the knowledge scale. The Cronbach's alpha was 0.75 for the beliefs' scale and 0.30, 0.41 and 0.43 for each defined knowledge scale, respectively.

Age Factors↗

Validation of an interval scaling: the sickness impact profile.

The Sickness Impact Profile (SIP) is a measure of sickness-related behavioral dysfunction consisting of 189 items in 14 topic categories. To increase its discrimination, precision, and sensitivity in accounting for variance, the decision was made to scale the instrument. A two-step direct scaling procedure was used in order to avoid the monumental scaling tasks required by indirect procedures that guarantee equal-interval results; but because an equal-interval scale was needed, it was necessary to validate the scale values obtained and investigated the equal-intervval properties of the obtained scale. A three-stage validation process is described, consisting of an initial scaling by a group of 25 health professionals and students in 1973, a second scaling by 108 members of a prepaid group health plan in 1975, and an investigation of the metric properties of the resulting scale values. In addition, the concept of dysfunction underlying the SIP was validated. SIP scores from a field trial were compared with mean ratings of severity of dysfunction represented by the combinations of checked items from which the scores were derived.

Activities of Daily Living↗

[Care levels in an intensive care unit. Analysis of therapeutic requirements and severity scales].

The APACHE II and TISS scales usually are used in intensive medicine services to assess patient's severity and therapeutic requirements, respectively. Both scales serve to classify ICU patient's into three care levels, each of which has its own well-defined surveillance and care requirements. Nursing personnel have used the TISS scale to determine work loads and plan nurse-patient ratios. However, this scale is complex and its application is time-consuming, thus impeding its routine use. In recent years, the NEMS (Nine Equivalents of Nursing Manpower) scale has been validated for this purpose. This scale uses just nine variables to objectively quantify nursing requirements. In order to determine if the NEMS scale could be used to evaluate the severity and nursing requirements of patient's admitted to our ICU and to establish care levels, we designed a descriptive study of a sample of 78 patients. The results showed that the APACHE II, TISS and NEMS scales has a good correlation and that the NEMS scale could be used to determine patient care requirements in our service. Based on the TISS and NEMS correlation, we determined discriminative numerical NEMS values for assigning patient's to different care levels.

Aged↗

[The development of a scale of life quality for diseases with visual impairment].

OBJECTIVE: To describe the development of a scale of life (QOL) quality which measures the quality of life of Chinese patients with visual impairment. METHODS: 20 items were chosen to form a scale. 57 cataractous patients with visual impairment and 60 glaucomatous patients with visual impairment and visual field loss at different levels simultaneously were measured by the scale to evaluate the validity, reliability and responsiveness of the scale. RESULTS: The scale consists of 20 items which cover four domains of QOL. The criterion related to the validity of the scale: r = 0.6865 (P = 0.000). The test-retest reliability of the scale: r = 0.8959 (P = 0.000). Coronback's alpha was 0.9358. The variance ratio (VR) of intra-individual variance to inter-individual variance was 0.0551 for overall scores. This correlation coefficient of split-half method was 0.9553. The responsiveness: t-test, t = 5.95 (P = 0.000). The effect size statistic was 1.533. CONCLUSION: The results also demonstrate that the scale has a satisfactory validity, reliability and responsiveness. It is suggested that the scale can be applied in clinical trails.

Cataract↗

Development and testing of the Urinary Incontinence Scales.

The Urinary Incontinence Scales were developed to measure RNs' attitude, belief, practice, and knowledge about urinary incontinence in adults. The purpose of this article is to introduce the scales and discuss their development and testing. These scales include the Urinary Incontinence Attitude Scale, the Urinary Incontinence Belief Scale, the Urinary Incontinence Practice Scale, and the Urinary Incontinence Knowledge Scale. Evaluation using confirmatory factor analysis showed the attitude, belief, and practice scales to be reliable and valid. Reliability of the knowledge scale was slightly lower than desired using both Cronbach's alpha coefficient and squared multiple correlation. While the hypothesized measurement model demonstrated acceptable goodness-of-fit, further testing is needed for generalizability of findings.

Adult↗

[Psychometric properties of French version of the Calgary depression scale for schizophrenics (CDSS)].

The Calgary Depression scale for schizophrenia (CDSS) is a 9 items scale, simple, quick and easy to use. It allows a quantitative approach of the subjective (or cognitive) dimension of the depression, and was developed by Addington et al. (1-5). In this work, we studied the psychometric properties of the CDSS in a population of 95 schizophrenic patients, and 41 non schizophrenic depressed patients. The CDSS was compared with commonly used hetero-questionnaires as the Hamilton Depression Scale (HDRS), the Montgomery-Asberg Depression Scale (MADRS), the Widlöcher depressive slowness scale (ERD), and auto-questionnaires as the Beck Depression Inventory (BDI), and the Beck Hopelessness scale (H). In the schizophrenic group, psychotic symptoms were evaluated with the Positive and Negative Symptoms Scale (PANSS), and the extrapyramidal symptoms with the Extrapyramidal symptoms scale (EPRS). In the two populations, the CDSS has similar psychometric properties. The principal component analyses accounts for a unifactorial structure in both groups. In schizophrenics the total score of the CDSS is strongly correlated with the total scores of the HDRS, the MADRS, the ERD, and the G6 item of the PANSS. In non schizophrenic depressed patients, the total score of the CDSS is highly correlated to the total scores of the HDRS, the MADRS and the BDI, with a weaker correlation with the ERD and the H total scores. In these patients, a cut-point strictly superior to 13 may be proposed as a severity criterion for depression in these patients. The internal consistency is satisfactory in both groups, with a Cronbach's alpha of 0.82 in schizophrenics and 0.59 in non schizophrenic depressed subjects. In schizophrenics, items C4 (guilty ideas of reference) and C7 (early awakening) are not necessary to the constitution of the scale. In depressed patients, the deletion of item C6 (morning depression) might increase the internal consistency. Inte-raters agreement is high, with weighted kappas all superior to 0.75 in schizophrenics and to 0.61 in depressed patients. Stability over time is good, and the 72 hours test-retest total score of the CDSS is independent from negative and extrapyramidal symptoms. On the other hand, the positive sub-score and the positive factor of the PANSS are correlated to the CDSS total score. The validation of the CDSS is still not complete: sensitivity to change and stability of the factorial structure remain to be explored. Nevertheless, the CDSS is an interesting tool for a quantitative approach of the subjective dimension of depression in both schizophrenic and non schizophrenic patients.

Adult↗

Interrater reliability of 2 sedation scales in a medical intensive care unit: a preliminary report.

BACKGROUND: Critical care nurses must assess the effectiveness of sedatives and analgesic agents in order to titrate doses. OBJECTIVES: To measure the interrater reliability of 2 sedation scales used to assess patients in medical intensive care units. METHODS: The interrater reliabilities of the Motor Activity Assessment Scale and the Luer sedation scale were compared prospectively in 31 patients receiving mechanical ventilation in an 18-bed medical intensive care unit of a tertiary care institution. Three registered nurses, 1 clinical pharmacist, and 1 physician simultaneously and independently followed a standardized procedure to rate each patient by using the 2 scales. Scales were randomly ordered to counteract ordering effect. Analysis of variance with post hoc Duncan multiple range tests was used to detect bias; a correlation coefficient matrix was used to examine degree of association among raters; and the intraclass correlation coefficient was measured to control for multiple raters. RESULTS: No significant bias was detected with either scale. The Motor Activity Assessment Scale had less variation (Pearson r = 0.75-0.92) than did the Luer scale (Pearson r = 0.37-0.94) and had a stronger intraclass correlation coefficient (0.81 vs 0.79). CONCLUSIONS: The Motor Activity Assessment Scale showed the highest consistency among raters.

Analgesics↗

Assessment of the validity and reliability of the University of Wisconsin Children's Hospital Pain scale for Preverbal and Nonverbal Children.

PURPOSE: This study tested the reliability and validity of a pain scale that was developed at University of Wisconsin Children's Hospital for the preverbal child (less than 3 years old) and the nonverbal child (children who cognitively were not able to communicate a pain rating on traditional pain scales). METHOD: Content validity was established by expert review. Construct validity was demonstrated by having the nurse rate the child's pain before and after analgesic and during a procedure. Inter-rater reliability was achieved by two nurses simultaneously and independently rating the child's pain. Criterion validity was determined by comparing ratings with those obtained on the Wong-Baker Faces scale. Internal consistency was calculated using Cronbach's alpha. FINDINGS: Seventy-four patients provided data for 124 observation times. At 58 of the observation times, two nurses independently used the newly developed University of Wisconsin Children's Hospital (UWCH) scale, resulting in 182 pain ratings. Internal consistency of the scale (Cronbach's alpha) was 0.93. Mean pain scores were significantly higher prior to pain medication administration and during procedures than following analgesic administration. Inter-rater reliability was 0.92. Correlation of the new scale with the Wong-Baker Faces Scale was r = .62. CONCLUSIONS: Initial testing of the construct validity, internal reliability, and internal consistency of the UWCH Pain Scale for Preverbal and Nonverbal Children were acceptable. Parents provided ratings for most of the faces scale, which could account for the low correlation in the construct validity testing.

Child Behavior↗

A comparison of autotrophic ammonia-oxidizing bacteria in full- and laboratory-scale wastewater treatment reactors.

Lab-scale reactors are commonly used to simulate full-scale plants as they permit the effects of defined experimental perturbations to be evaluated. Ideally, lab- and full-scale reactors should possess similar microbial populations. To determine this we compared the diversity of the beta-proteobacterial autotrophic ammonia-oxidising bacteria (AOB) in a full-scale and lab-scale biological aerated filter (BAF) using PCR with AOB selective primers combined with denaturing gradient gel electrophoresis (DGGE). PCR amplified 16S rRNA gene fragments from the nitrification unit of the lab-and full-scale BAF were subjected to cloning and sequencing to determine the phylogenetic affiliation of the AOB. A high degree of comparability between the lab-and full-scale BAF was observed with respect to AOB populations. However minor differences were apparent. The importance of these minor constituents in the overall performance of the reactor is unknown. Nonetheless the lab-scale reactor in this study did appear to reflect the dominant AOB community within the full-scale equivalent.

Ammonia↗

Scale-up of polymerization processes.

Scale-up and/or scale-down procedures are crucial during the development of chemical processes. These procedures should be integrated to form a multidisciplinary approach encompassing several branches of science and engineering. The challenge is to find a balance between chemistry, design, environment, hygiene and safety (EHS) compliance and economic factors. The iterative process of scale-up procedures also requires concept discrimination at early stages of process development. Scale-up studies should predict the reactor behavior and the quality and properties of a product from laboratory and pilot plant to full scale; however, not every pilot scale presents a valid industrial scaled-down size. A rational mathematical model describing the process reasonably well for large scale is important for designing industrial processing units, but this is only feasible if a phenomenological understanding is achieved, and if the necessary constants and parameters are estimated accurately. An accomplished process development procedure must lead to products presenting the same properties at both small and large scale.

Animals↗

Learning from pain scales: patient perspective.

OBJECTIVE: Rheumatologists often deal with patients' pain, as commonly measured by clinical scales. However, no published study in the last 25 years has explored patient preferences for the 2 most frequently used clinical scales the verbal rating scale (VRS) and the visual analog scale (VAS). We (1) evaluated patient preferences for the 10 cm horizontal VAS versus the 5 point VRS and identified associated reasons for their preferences; and (2) validated the test-retest reliability and construct validity of these scales. METHODS: Patients with painful rheumatological conditions rated the VAS and the VRS to assess pain intensity and stated which scale they preferred and why. Exploration of tender points and dolorimetry was performed in all cases. RESULTS: Of 113 patients in the sample, 93% were women, 85% of whom had rheumatoid arthritis. In this sample, 52.8% preferred the VRS, 28.3% the VAS, and 18.9% expressed no preference. Patients who preferred the VRS said it was easier than the VAS to understand and rate. They also reported being more comfortable using words than numbers. Patients who preferred the VAS said that numbers classified pain better and that this allowed them to be objective and precise. Patients with 0-6 years of schooling preferred the VRS, while those with > 6 years preferred the VAS. There was a significant association between the number of tender points and pain intensity with both scales, as well as between threshold and tolerance with the VAS. High correlations were found between the VAS and the VRS (r = 0.79) and between tolerance and threshold (r = 0.96). Test-retest showed a high correlation for both scales: VAS = 0.97 and VRS = 0.89. CONCLUSION: Both scales are valid measures of pain intensity. The choice should depend on the setting, the clinician's goal, and the patient's level of education. Patient preference is central to better physician-patient communication.

Attitude to Health↗

[Multidimensional anger scale].

OBJECTIVE: To develop a new and original scale which can measure anger on a multidimensional level. METHOD: In the first phase of this study, 2 pilot studies were conducted. The first pilot study was conducted on a sample of 60 individuals to develop an item pool. A second pilot study was conducted with another group of 148 individuals using a 429 item scale that was developed from this item pool. After the item analyses, a 158 item 'Multidimensional Anger Scale' (MAS) was derived for use in the second phase of the study to investigate the psychometric properties of the instrument. In the second phase reliability and validity analyses of this scale with 5 dimensions, Anger symptoms, Anger eliciting situations, Anger related cognitions, Anger reactions and Interpersonal Anger, were conducted on a sample of 756 individuals. RESULTS: Psychometric analysis of the scale showed that it possessed adequate internal consistency (alpha coefficients between 0,64 and 0,95). The validity of the scale was supported by the expected pattern of relations with other inventories (Brief Symptom Inventory and Guilt and Shame Scale). CONCLUSION: Multidimensional Anger Scale, for Turkish culture, may be suggested as a valid and reliable scale to measure anger in different dimensions.

Adolescent↗

[Translation and validation of a French version of the Young Mania Rating Scale (YMRS)].

Both the Young Mania Rating Scale (YMRS) and the Mania Assessment Scale (MAS) have been widely used during the last decade for the evaluation of severity of mania in clinical trials. For both scales good inter-rater reliability, validity and sensitivity to change have been reported. The French version of the MAS has been validated. To our know-ledge, the YMRS has not yet been translated into French and validated. The main objective of the present study was to validate a French version of the YMRS and to test its use in manic patients entering a study on the effectiveness of valproic acid and olanzapine combination. After translating the items in French, we tested this version of the YMRS on two samples of psychiatric patients recruited in a ward of adult inpatients (18 to 65 Years old) at the Department of Psychiatry, Geneva University Hospital. The first sample included 18 (hypo) manic inpatients (10 males, 8 females). Mean age was 37.0 (standard deviation 10.1). Interviews were video taped and assessed by three different judges on both scales (YMRS and MAS). The second sample included 20 inpatients (5 males, 15 females) who provided written informed consent to enter a study on the association of valproic acid and olanzapine in the treatment of mania. Mean age was 40.0 (standard deviation 11.3). Patients were followed over four weeks and assessed on both scales (YMRS and MAS) every seven days (day 0, 7, 14, 21 and 28). On day 7, patients were assessed during a joint interview by two of three judges who independently administered both scales in permuted order. On days 0, 14, 21 and 28, patients were evaluated by one of the same three raters. Inter-rater reliability was assessed by comparing item scores and total scores assigned by different judges with intra-class correlation coefficient ICC (2,1). Three judges were considered for patients in sample 1. Two judges were considered for patients in sample 2 (day 7 assessment). Concurrent validity with the MAS was analysed in sample 2 on days 0, 7, 14, 21 and 28 using Spearman rank-order correlation coefficient. Sensitivity to change was assessed in sample 2 by comparing total score at inclusion and at last observation using Wilcoxon signed ranks test. For both the MAS and YMRS, intraindividual change was calculated as the difference between total scores at inclusion and discharge (last observation carried forward approach). The relationship between changes on the two scales was analysed through Spearman correlation coefficient. Significance level was set to 0.05 for each test. Ranges of YMRS total scores were 2 to 32 in sample 1 and 1 to 28 in sample 2, indicating symptom severity from euthymic to moderately manic. Inter-rater reliability was very good for the total scores in both samples, both for the MAS and the YMRS (ICC>0.89). When considering YMRS individual items, correlation coefficient varied from 0.61 to 0.96 in the first sample. In the second sample, 9 of 11 items displayed values above 0.63. The remaining two items, increased motor activity and energy and Language-thought disorder, presented modest inter-rater reliability (ICC=0.54 and 0.50 respectively). This was largely attributable to a single patient, who was perceived very differently by the two judges (scores 0-2 for increased motor activity and energy; 1-4 for Language-thought disorder). When this patient was excluded, intra-class correlation coefficients were above 0.69 for both items. Overall, inter-rater reliability of the YMRS items was in the same range as for the MAS items (0.61-0.96 vs 0.61-0.93 in sample 1; 0.50-0.93 vs 0.54-0.83 in sample 2). Correlation between the two instruments was very high and statistically significant at each weekly assessment (rs>0.91, p<0.001) except for day 21 which displayed a somewhat lower correlation (rs=0.75, p<0.01). This latter result was attributed to a reduced spread of values and number of patients on day 21. YMRS and MAS total scores as a function of time in patients receiving combined treatment with olanzapine and valproic acid (sample 2) show that for both at for both scales, total scores significantly decreased from day 0 to last observation (Wilcoxon signed ranks test, p<0.001), with median decrease of 18 points both on the YMRS (range 9-32) and MAS (range 10-33). Median relative decrease was 67% for the YMRS and 69% for the MAS. When analysing the relationship between intraindividual changes on the YMRS and MAS, highly significant correlation was observed (Spearman rs=0.93, p<0.001), showing that the two scales were virtually interchangeable in assessing treatment efficacy. In conclusion, the YMRS is a simple and easy-to-use instrument for measuring severity of manic symptoms The newly translated French version was satisfactory in terms of inter-rater reliability, concurrent validity with the MAS, and sensitivity to change in patients receiving treatment for manic symptoms. This should allow its future use for international comparison studies.

Adolescent↗

A review of scales for assessment of the quality of life (QOL) in patients with oral cavity cancer.

This article is a review of the quality of life (QOL) research in oral cavity cancer patients. The authors set out to carry out this study because research on the problem is still in its infantile period. Most authors use the following scales for assessment: Scale 1 - ability to eat in public; comprehensible speech; normal diet; change in taste, Scale 2 - social adaptation; pain and disfigurement, Scale 3 - determination of the physical and functional status; psychological status; social functioning, Scale 4 - reproduction/pastimes; sleep/rest; home management; work; eating, Scale 5 - fatigue and QOL. One of the indices most frequently used to measure cancer patients' quality of life is the Karnofsky's scale. The Karnofsky's index is determined by two independent factors: the patient oncologist and the nursing team, who perform evaluations on the basis of the patient's response. The differences between these two methods is not statistically significant. Taking into consideration the proposed scales in the literature the authors have prepared a questionnaire which includes a scale for QOL assessment of oral cavity cancer patients to be used in a future survey on the quality of life of cancer patients in some regions of Bulgaria.

Bulgaria↗

[Concept and methodology on up-scaling issue of small watershed prototypes for reconstructing ecological economies in Loess Plateau].

The general ecological situation of Loess Plateau is kept deteriorating, despite great efforts have been made and some achievements were gained after 50 years' endeavor to control soil erosion and renovate ecological landscape. Investigations on the past 20 years results from 11 experimental sites showed that the extension of prototypes and models derived from these sites, which were all based on one scale of small watershed, were unsatisfactory. The possible reasons for such a situation could be attributed to the too coarse scale of map, on which, the regional planning were set up and the locations of these experiment sites were decided, the too fine scale of the small watershed which were usually 3-10 km2 in size, the shortage of studies on various scales particularly on the meso-scale, and the lack of methods of scaling on up-scaling. Based on the analysis of restraints in management of small watershed, the specific concept and relevant proposed methods of resemblance-scaling and multi-scale complementarity were put forward and tested.

Biodiversity↗

Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients.

OBJECTIVE: Fatigue has been recognized as an important domain in rheumatoid arthritis (RA) clinical trials and in patient care and outcome. However, lengthy fatigue questionnaires cannot be easily used in clinical care, and there are no data for the comparative performance of various short and long questionnaires. We compared a single-item visual analog scale (VAS) with 3 longer fatigue questionnaires, investigating 4 fatigues scales: the Multi-dimensional Assessment of Fatigue (MAF), the vitality scale from the Medical Outcomes Study Short Form 36 (SF-36), the Brief Fatigue Inventory (BFI), and the VAS. METHODS: Participants in a longitudinal outcome study of RA (N = 7760) completed the 4 questionnaires, and a subset of 5155 completed the same fatigue scales 6 months later. RESULTS: All questionnaires were highly correlated and were correlated at similar levels with clinical variables. The 3 longer questionnaires had slightly greater reliability in cross-sectional analyses, but the VAS was as good as or better than the longer questionnaires when sensitivity to change was considered. CONCLUSION: The single item VAS performs as well as or better than longer scales in respect to sensitivity to change, and is at least as well correlated with clinical variables as longer scales. The VAS fatigue scale is suitable for routine use in clinical care, an advantage that is lacking for the other scales. These results do not indicate advantages for longer fatigue scales compared with the VAS.

Activities of Daily Living↗