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CONTEXT Developmental psychopathology theory suggests a relationship between early childhood adversity and mental disorder. OBJECTIVE To examine the relationship between the specific items on the Adverse Childhood Experiences (ACE) survey and the International Classification of Diseases, Tenth Revision (ICD-10) categories of psychiatric diagnoses in a pediatric sample. DESIGN The sample included patients enrolled in the Child and Adolescent Addiction Mental Health and Psychiatry Program with both a completed ACE survey and at least 1 diagnosis of record (per admission). These criteria yielded 2 samples for each sex (ACE survey item frequencies and values in collapsed and multiple-admission groups). Data were analyzed employing tetrachoric correlation, hierarchical regression, and polychoric factor analysis. RESULTS Hierarchical regression analysis identified that ICD-10 diagnostic categories, except for substance disorders, were not consistently related to ACE total score and tended to reduce the magnitude of the ACE total score in the multiple-admission group. Tetrachoric correlation revealed very low (< 0.4) positive and negative correlations between ICD-10 categories and ACE items in both multiple-admission and collapsed sample groups. Polychoric factor analysis indicated that the ACE survey items and the ICD-10 categories for both sexes were independent, with only the diagnostic ICD-10 category substance disorders being marginally associated with the ACE items factor for females. CONCLUSION The nominal relationship between ACE items and ICD-10 diagnostic categories indicates the need to include ACE assessment in advance of differential diagnosis and implementation of conventional mental health interventions for children and adolescents.

The present study presents psychometric information on a new instrument, the Digital Intimate Partner Violence Questionnaire (DIPVQ), and explores the similitudes and differences between in-person and digital-based abuses (those that involve the use of information and communication technologies [ICTs]). In all, 449 Peruvian students took part in the study ( X = 21.2 years; SD = 4.3 years; 73% women). DIPVQ structure was determined by carrying out an exploratory factor analysis (EFA) with polychoric correlation matrices and oblique rotation. In-person violence was assessed using the Dating Violence Questionnaire (DVQ) and self-labeling questions (e.g., feeling trapped, afraid, and abused). Relationship satisfaction was assessed using the Perceived Relationship Quality Components–Short Form (PRQC-SF). EFA showed a two-scale structure for the DIPVQ: control-centered cyberabuse ( N = 5; control, monitoring, and identity theft; EAP alpha = .96) and damage-centered cyberabuse ( N = 7; unwanted sexual contents, blackmailing, and causing debts throughout ICT; Expected-A-Posteriori alpha = .97). DIPVQ had direct relationship to DVQ and self-labeling ( p < .001; d = 0.38-1.18), and inverse to PRQC-SF ( p = .11; d = .22-.33). Behaviors such as impersonation and monitoring were reported by more than 20% of participants. Online and offline victimization coexist in 42% of cases, while 3.6% of aggressions happened exclusively via ICT. DIPVQ is a valid and reliable measure of digital victimization. The control-centered scale had a higher frequency, although the damage-centered scale had stronger relationship to feeling afraid and abused. While previous literature has classified online aggressions regarding their aesthetic appearance, it seems that their functional value (control vs. hurting) could provide a better framework for understanding these aggressions.

Background: Children in mental health inpatient care require multiple treatments. There is not a comprehensive instrument to assess perceived helpfulness of this combination of interventions. Aims: To develop and evaluate the psychometric properties of the What was Helpful Questionnaire (WHQ), a tool designed to capture parental perceived helpfulness of the multidimensional management approach used in inpatient children's units. Methods: A total of 73 inpatients and their families were included in this study. The WHQ consists of six items exploring the perceived helpfulness of different aspects of care. Demographic and clinical variables were collected on admission and discharge. An exploratory factor analysis using polychoric correlations was performed to assess the item structure of the scale and the Cronbach's alpha coefficient was used for internal reliability. Associations were assessed using regressions models. Results: WHQ is a unidimensional scale with an internal reliability of 0.77. No associations were identified between WHQ total score and age, gender, and Children's Global Assessment Scale scores change. A strong relationship between the WHQ total score and parental Acorn Satisfaction Questionnaire total score was found. Conclusions: Results add evidence for the validity and the reliability of the WHQ to measure parental perceived helpfulness of interventions offered in inpatient children's units.

This chapter presents analysis and results primarily based on information collected in National Science Survey, 2004 undertaken by the National Council of Applied Economic Research. It discusses missing data to explain the impact of missing values on analysis of public attitude towards S&T. The chapter also presents a confirmatory factor analysis (CFA) model to assess the public attitude towards S&T in states of India. Since all the attitude items were recoded as dichotomous variables, weighted least squares method with tetrachoric correlation was used to construct the CFA model. Before constructing any model for Indian public attitude to S&T, missing value analysis was carried out on ISS-2004 data to detect any potential bias introduced by missing at random or missing not at random types of missingness. India Science Report was the first ever attempt at measuring public's science literacy, knowledge, interest and attitude in India through structured primary survey data collected with specific objective of measuring the aforementioned science indicators.

A stochastic approximation EM algorithm (SAEM) is described for exploratory factor analysis of dichotomous or ordinal variables. The factor structure is obtained from sufficient statistics that are updated during iterations with the Robbins-Monro procedure. Two large-scale simulations are reported that compare accuracy and CPU time of the proposed SAEM algorithm to the Metropolis-Hasting Robbins-Monro procedure and to a generalized least squares analysis of the polychoric correlation matrix. A smaller-scale application to real data is also reported, including a method for obtaining standard errors of rotated factor loadings. A simulation study based on the real data analysis is conducted to study bias and error estimates. The SAEM factor algorithm requires minimal lines of code, no derivatives, and no large-matrix inversion. It is programmed entirely in R.

Objective To analyse the psychometric properties, internal structure, and relationship with anthropometric indicators of the Body Shape Questionnaire (BSQ) among Mexican university students according to the measurement invariance approach. Methods An instrumental study was carried out to assess the psychometric properties, validity, and reliability of the BSQ. The analysis of the measurement invariance was performed using the Least Squares Estimation, and weighted by adjusted variance and polychoric correlations after assessing different measurement models for BSQ in each group. The scores of the final version were correlated with anthropometric indicators by the Pearson correlation coefficient. Results As regards the dimensional analysis, all of the previous models for BSQ have favourable adjustment rates, although those with a single factor show more robust evidence. The configural invariance was accepted; suggesting that the one-dimensional structure is common for both men and women. However, 16-item factorial loadings were statistically different between the groups. Hence, they were discarded and an 18-item version (BSQ-18) was obtained, which is considered invariant as regards gender. In addition, there is a direct relationship between the scores of the BSQ-18 version and the body mass index, waist circumference, and fat percentage. Satisfactory indicators were found as regards stability. Conclusions The BSQ-18 can be used with men and women, and has high reliability indicators to be conducted in clinical settings to assess eating disorders and obesity among university students.

Item response theory (IRT) is a set of psychometric models used in the social and behavioral sciences. As part of applying these models in practice, a number of assumptions are made. A large literature exists assessing the extent to which these assumptions are satisfied in a given data set. One of these assumptions, local independence, is the focus of the research described here. When the local independence assumption is violated, there is said to be local dependence (LD). Several different models of LD have been proposed, and a number of studies have been conducted examining the performance of different methods at detecting LD. Underlying LD (ULD) and surface LD (SLD) were proposed as two possible mechanisms underlying observed LD in an early exploration of detection procedures. In a number of previous studies, it appears as though ULD is more difficult to detect than SLD. In this article, the authors demonstrate a procedure to examine comparability of induced LD and present results, which suggest a re-interpretation of existing studies on LD detection.

Mobile phone use and its potential addiction has become a point of interest within the research community. The aim of the study was to translate and validate the Test of Mobile Dependence (TMD), and to investigate if there are any associations between mobile phone use and problem gambling. This was a cross-sectional study on a Swedish general population. A questionnaire consisting of a translated version of the TMD, three problem gambling questions (NODS-CLiP) together with two questions concerning previous addiction treatment was published online. Exploratory factor analysis based on polychoric correlations was performed on the TMD. Independent samples T-tests, Mann-Whitney test, logistic regression analyses and ANOVA were performed to examine mean differences between subjects based on TMD test score, gambling and previous addiction treatment. A total of 1,515 people (38.3% men) answered the questionnaire. The TMD showed acceptable internal consistency (Cronbach's alpha: 0.905), and significant correlation with subjective dependence on one's mobile phone. Women scored higher on the TMD and 15-18 year olds had the highest mean test score. The TMD test score was significantly associated with problem gambling, but only when controlling for age and sex. Various separated items related to mobile phone use were associated with problem gambling. The TMD had acceptable internal consistency and correlates with subjective dependence, while future confirmatory factor analysis is recommended. An association between mobile phone use and problem gambling may be possible, but requires further research.

In this study, it was aimed to develop a multiple choice test in orderto measure about spatial visualization skills, which is one of the componentsof spatial ability. In the test development phase, after taking expert opinionfor content validity, six items were removed from the test and the test with32-item was applied to seventh-grade student for validity and reliabilitystudies. In order to determine the factor structure of the test, explanatoryfactor analysis was performed via the Tetrachoric Correlation Matrix betweenthe items and a two-factor structure was obtained by being removed the one itemfrom the test. Afterwards, confirmatory factor analysis was applied by usingthe Asymptotic Covariance Matrix and the Weighted Least Squares Method in orderto determine whether the two-factor structure of the test was confirmed as amodel. After being removed of two items from the test and modifications weremade between items close to each other theoretically, it was found that thetwo-factor structure had adequate fit indices. Item analysis was performed forthe remaining 29 items; the test was found to be moderately difficult andhighly distinctive which consists of items with different difficulty levels andhighly distinctive. The test was foundto be reliable in terms of KR-20 internal consistency with the reliabilitystudy that was done., Bu araştırmada, uzamsal yeteneğin bileşenlerinden biriolan uzamsal görselleştirme becerisini ölçmek için çoktan seçmeli bir testgeliştirmek amaçlanmıştır. Testin geliştirilme aşamasında, kapsam geçerliğiiçin uzman görüşü alınmış ve testten altı madde çıkarılarak, 32 maddelik testgeçerlik ve güvenirlik çalışmaları için yedinci sınıf öğrencilerine uygulanmıştır.Testin faktör yapısını belirlemek amacıyla maddeler arası Tetrakorik KorelasyonMatrisi üzerinden açımlayıcı faktör analizi gerçekleştirilmiş ve bir maddetestten çıkarılarak iki faktörlü bir yapı elde edilmiştir. Daha sonra testiniki faktörlü yapısının bir model olarak doğrulanıp doğrulanmadığını belirlemekiçin Asimptotik Kovaryans Matrisi ile Ağırlıklı En Küçük Kareler Yöntemi’ndenyararlanılarak doğrulayıcı faktör analizi uygulanmıştır. İki madde testten çıkarılıp, kuramsal olarak birbirlerine yakınmaddeler arasında modifikasyon yapıldıktan sonra, iki faktörlü yapının yeterliuyum indekslerine sahip olduğu görülmüştür. Kalan 29 madde için madde analiziyapılmış; testin farklı güçlükdüzeylerine ve yüksek ayırt ediciliğe sahip maddelerden oluşan, orta güçlükte ve ayırt ediciliği yüksek bir test olduğu ortayaçıkmıştır. Yapılan güvenirlik çalışması ile de testin KR-20 iç tutarlılıkaçısından güvenilir olduğu tespit edilmiştir.

The Dating Violence Questionnaire (DVQ) is a 42-item questionnaire that measures victimization in romantic relationships between young people, through eight interrelated scales assessing detachment, humiliation, coercion, emotional punishment, gender-based, sexual, physical, and instrumental violence. It has been validated in a myriad of countries and languages and is commonly used in Spanish-speaking countries; however, two scales (emotional punishment and instrumental violence) have shown reliability issues. The aim of present study is to analyze the psychometric proprieties of the adapted version of the DVQ for the Chilean population, reviewing evidence of structure validity, external validity, and reliability—using polychoric and ordinal analysis—and including new items to improve instrumental and emotional punishment scales (DVQ+). Eight hundred forty-six high school and university students (14-24 years old) participated in the study. Results showed that both DVQ and DVQ+ versions had an adequate fit with the original correlated eight-factor model (root mean square error of approximation [RMSEA] = .023; comparative fit index [CFI] = .97, in both cases), as well as with a more parsimonious second-order factor model (RMSEA = .024-.025; CFI = .97-.97, respectively). Reliability analysis also showed both version presented satisfactory values for internal consistency. Finally, scores of DVQ were correlated—as expected—negatively with quality of the relationship and positively with fear, perceived abuse, and attachment-related anxiety, thus providing new evidences of validity.

Context There is a movement toward trauma-informed, trauma-focused psychiatric treatment. Objective To examine Adverse Childhood Experiences (ACE) survey items by sex and by total scores by sex vs clinical measures of impairment to examine the clinical utility of the ACE survey as an index of trauma in a child and adolescent mental health care setting. Design Descriptive, polychoric factor analysis and regression analyses were employed to analyze cross-sectional ACE surveys (N = 2833) and registration-linked data using past admissions (N = 10,400) collected from November 2016 to March 2017 related to clinical data (28 independent variables), taking into account multicollinearity. Results Distinct ACE items emerged for males, females, and those with self-identified sex and for ACE total scores in regression analysis. In hierarchical regression analysis, the final models consisting of standard clinical measures and demographic and system variables (eg, repeated admissions) were associated with substantial ACE total score variance for females (44%) and males (38%). Inadequate sample size foreclosed on developing a reduced multivariable model for the self-identified sex group. Conclusion The ACE scores relate to independent clinical measures and system and demographic variables. There are implications for clinical practice. For example, a child presenting with anxiety and a high ACE score likely requires treatment that is different from a child presenting with anxiety and an ACE score of zero. The ACE survey score is an important index of presenting clinical status that guides patient care planning and intervention in the progress toward a trauma-focused system of care.

This research concerns the estimation of polychoric correlations in the context of fitting structural equation models to observed ordinal variables by multistage estimation. The first main contribution of this research is to propose and evaluate a Monte Carlo estimator for the asymptotic covariance matrix (ACM) of the polychoric correlation estimates. In multistage estimation, the ACM plays a prominent role, as overall test statistics, derived fit indices, and parameter standard errors all depend on this quantity. The ACM, however, must itself be estimated. Established approaches to estimating the ACM use a sample-based version, which can yield poor estimates with small samples. A simulation study demonstrates that the proposed Monte Carlo estimator can be more efficient than its sample-based counterpart. This leads to better calibration for established test statistics, in particular with small samples. The second main contribution of this research is a further exploration of the consequences of violating the normality assumption for the underlying response variables. We show the consequences depend on the type of nonnormality, and the number and location of thresholds. The simulation study also demonstrates that overall test statistics have little power to detect the studied forms of nonnormality, regardless of the ACM estimator.

The World Health Organization recommends exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for at least 2 years. Social support has been widely recognized to influence breastfeeding practices. However, existing scales do not measure exclusive breastfeeding social support (EBFSS), rather, they assess social support for any breastfeeding. Further, they are tailored towards high-income settings. Therefore, our objectives were to develop and validate a tool to measure EBFSS in low-income settings. To develop the scale, local and international breastfeeding experts were consulted on modifications to the Hughes’ Breastfeeding Social Support Scale. It was then implemented in an observational cohort in Gulu, Uganda at 1 (n=238) and 3 (n=237) months postpartum (NCT02925429). We performed polychoric and polyserial correlations to remove redundant items, and exploratory factor analysis at 1 month postpartum to determine the latent factor structure of EBFSS. We further applied confirmatory factor analysis to assess dimensionality of the scale at 3 months postpartum. We then conducted tests of predictive, convergent, and discriminant validity against exclusive breastfeeding, self-efficacy, general social support, and depression. The modification of the Hughes’ scale resulted in 18 items, which were reduced to 16 after examining variances and factor loadings. Three dimensions of support emerged: Instrumental, Emotional and Informational, with alpha coefficients of 0.79, 0.85 and 0.83, respectively. Predictive, convergent, and discriminant validity of the resultant EBFSS scale was confirmed. The EBFSS Scale is valid and reliable for measuring EBFSS in northern Uganda, and may be of use in other low-income settings to assess determinants of EBF.

Objectives: To compare prevalence estimates of food insecurity using a single-item measure, with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA-FSSM). Methods: Data were collected by postal survey, from individuals aged ≥18 years from disadvantaged suburbs of Brisbane, Australia (n= 505, 53% response). Food security status was ascertained by the Australian single-item measure, and the 6-, 10- and 18-item versions of the USDA-FSSM. Prevalence estimates of food insecurity and different levels of severity of food insecurity estimated by each tool were determined. Data were analysed using McNemar’s test, polychoric correlation and Rasch analyses. Results: The prevalence of food insecurity was 19.5% using the single-item measure; significantly less than the 24.4%, 22.8% and 21.1% identified using the 18-item, 10-item and 6-item versions of the USDA-FSSM, respectively. Rasch analyses revealed that overall the USDAFSSM may be a valid tool for the measurement of food insecurity within the current sample. Conclusion: The measure of food insecurity employed in national surveys in Australia may underestimate its prevalence and public health significance. Implications for public health: Future monitoring and surveillance efforts should seek to employ a more accurate measure as the first step in recognising the right to food for all Australians.

This study compared several rater agreement indices using data simulated using a generalizability theory framework. Information from previous generalizability studies conducted with data from large-scale writing assessments was used to inform the variance components in the simulations. Rater agreement indices, including percent agreement, weighted and unweighted kappa, polychoric, Pearson, Spearman, and intraclass correlations, and Gwet’s AC1 and AC2, were compared with each other and with the generalizability coefficients. Results showed that some indices performed similarly while others had values that ranged from below 0.4 to over 0.8. The impact of the underlying score distributions, the number of score categories, rater/prompt variability, and rater/prompt assignment on these indices was also investigated.

The aim of the study is to analyze the mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in South American immigrants in Chile. An analytical, cross sectional, non-experimental design was used. We evaluated 853 Peruvians and Colombians living in the northern cities of Arica, Antofagasta, and Santiago de Chile, the capital located in the center of the country. The instruments used were the Ryff Psychological Well-being Scale, the Rosenberg Self-Esteem Scale and the Perceived Discrimination Scale by Basabe, Paez, Aierdi and Jimenez-Aristizabal. We used the estimation method (RWLS) and polychoric correlation matrices, to estimate the effect size and overall fit of the direct effect models of discrimination and self-esteem on psychological well-being, and indirect and total effects of discrimination mediated by self-esteem. While both populations reported similar levels of perceived discrimination, it was found that the means in psychological well-being and self-esteem of the Colombian population were significantly higher than that of the Peruvian population. Regarding self-esteem, the results provided evidence for the possible mediating effect on the relationship between perceived discrimination and psychological well-being. This research aims to contribute to the development of interventions seeking to strengthen self-esteem in order to circumvent possible negative consequences of perceived discrimination, as a consequent, improving immigrants´ personal resources to successfully cope with the diverse demands of their new context.

A new method for the estimation of polychoric correlations is proposed in this paper, which uses the Expectation-Maximization (EM) algorithm and the Conditional Covariance Formula. Simulation results show that this method attains the same level of accuracy as other methods, and is robust to deteriorated data quality.

The subject of our research is the environmental management practices (EMPs) adopted by small and medium-sized hotel enterprises (SMHEs) to foster the development of sustainable business models. The aim is to analyse operational, communication and organizational practices and to explore whether or not the availability of public incentives encourages SMHEs to adopt EMPs, and, if it does, how. We use a framework based on a multi-dimensional approach according to the classification proposed by Gonzalez-Benito and Gonzalez-Benito (2006) and we add a supplementary variable (access to subsidies) to capture the importance of the public actor. The research was carried out in Trentino, a traditional tourist destination in the Italian Alpine Arc. We received 351 completed online questionnaires, of which 247 were considered valid. The data were analysed using Principle Component Analysis (PCA) applied to a polychoric correlation matrix. The PCA evidences three relevant latent dimensions which summarized more than 72% of the sample variance. The results demonstrate that the SMHEs adopted three different sets of EMPs, and that the role of public actor is crucial for financing the most expensive operational activities. The research narrows the knowledge gap with regard to a) the types of EMPs adopted by the SMHEs, b) the methods used to achieve this implementation. The research validates the inclusion of the supplementary variable within the framework, and thus the original nature of our study.

Background Context Predictors of outcome after surgery for degenerative cervical myelopathy (DCM) have been determined previously through hypothesis-driven multivariate statistical models that rely on a priori knowledge of potential confounders, exclude potentially important variables because of restrictions in model building, cannot include highly collinear variables in the same model, and ignore intrinsic correlations among variables. Purpose The present study aimed to apply a data-driven approach to identify patient phenotypes that may predict outcomes after surgery for mild DCM. Study Design This is a principal component analysis of data from two related prospective, multicenter cohort studies. Patient Sample The study included patients with mild DCM, defined by a modified Japanese Orthopaedic Association score of 15–17, undergoing surgical decompression as part of the AOSpine CSM-NA or CSM-I trials. Outcome Measures Patient outcomes were evaluated preoperatively at baseline and at 6 months, 1 year, and 2 years after surgery. Quality of life (QOL) was evaluated by the Neck Disability Index (NDI) and Short Form-36 version 2 (SF-36v2). These are both patient self-reported measures that evaluate health-related QOL, with NDI being specific to neck conditions and SF-36v2 being a generic instrument. Materials and Methods The analysis included 154 patients. A heterogeneous correlation matrix was created using a combination of Pearson, polyserial, and polychoric regressions among 67 variables, which then underwent eigen decomposition. Scores of significant principal components (PCs) (with eigenvalues>1) were included in multivariate logistic regression analyses for three dichotomous outcomes of interest: achievement of the minimum clinically important difference [MCID] in (1) NDI (≤−7.5), (2) SF-36v2 Physical Component Summary (PCS) score (≥5), and (3) SF-36v2 Mental Component Summary (MCS) score (≥5). Results Twenty-four significant PCs accounting for 75% of the variance in the data were identified. Two PCs were associated with achievement of the MCID in NDI. The first (PC 1) was dominated by variables related to surgical approach and number of operated levels; the second (PC 21) consisted of variables related to patient demographics, severity and etiology of DCM, comorbid status, and surgical approach. Both PC 1 and PC 21 also correlated with SF-36v2 PCS score, in addition to PC 4, which described patients' physical profile, including gender, height, and weight, as well as comorbid renal disease; PC 6, which received large loadings from variables related to cardiac disease, impaired mobility, and length of surgery and recovery; and PC 9, which harbored large contributions from features of upper limb dysfunction, cardiorespiratory disease, surgical approach, and region. In addition to PC 21, a component profiling patients' socioeconomic status and support systems and degree of physical disability (PC 24) was associated with achievement of the MCID in SF-36 MCS score. Conclusions Through a data-driven approach, we identified several phenotypes associated with disability and physical and mental health-related QOL. Such data reduction methods may separate patient-, disease-, and treatment-related variables more accurately into clinically meaningful phenotypes that may inform patient care and recruitment into clinical trials.

Background This study aims to examine potential road crash disparities across relative wealth and location of residence in Kenya by analyzing population-representative Demographic and Health Survey data. Methods Relative wealth was measured by household assets, converted into an index by polychoric principal components analysis. Location and sex-stratified associations between wealth quantiles and crashes were flexibly estimated using fractional polynomial models. Structural equation models were fit to examine whether observed differences may operate through previously identified determinants. Results In rural areas, crashes were least common for both the poorest men (-5.2 percentage points, 95% CI: -7.3 to -3.2) and women (-1.6 percentage points, 95% CI: -2.9 to -0.4). In urban areas, male crashes were lowest (-3.0 percentage points, 95% CI: -5.2 to -0.8) among the wealthiest, while they peaked in the middle of the female wealth distribution (2.0 percentage points, 95% CI: 0.3-3.8). Male differences operate partially though occupational driving and vehicle ownership. Urban female differences operate partially through household vehicle ownership, but differences for rural women were not explained by modeled determinants. Conclusions Relative wealth and road crash have opposite associations in rural and urban areas. Especially in rural areas, it is important to mitigate potential unintended effects of economic development.

International audience; Our article aims at understanding the determinants of households’ selective waste-sorting behaviours, based on data from an original survey of 694 individuals in the French Provence–Alpes–Côte d’Azur region. The applied literature focuses mainly on countries with high recycling rates. We focus on a region with the lowest recycling rate in France, a country that recycles lessthan the European country average. We first apply polychoric principal components analysis to reduce the number of explanatory variables to a set of six factors. In a second step, we use a probit model to estimate the probability of waste sorting as a function of these factors. This model tests several hypotheses emerging from the recent literature on behavioural economics applied to households’ selective sorting. This literature pays particular attention to the social influence on recycling behaviour, which has been studied mostly by sociologists and psychologists. The results of our empirical analysis confirm some of the findings in the literature. However, they also highlight some unique features, such as social influences having a negative impact on recycling. This finding contrasts with most of the literature, which finds a positive relationship of social influence on pro-environmental behaviour.

Purpose Significant gaps exist in health care transition (HCT) preparation that can impact care and outcomes in young adults with chronic illness. No quality measure exists to directly assess adolescent experiences of HCT preparation. Our objective was to develop an adolescent-reported measure of the quality of HCT preparation received from pediatric health care providers. Methods The Adolescent Assessment of Preparation for Transition (ADAPT) is a 26-item mailed survey designed for completion by 16- and 17-year-old adolescents with a chronic health condition. Adolescents from three samples (two large Medicaid insurance plans [n = 3,000 each] and one large tertiary care pediatric hospital [n = 623]) were mailed the survey. An iterative developmental process included focus groups and cognitive interviews, and validity was assessed using confirmatory factor analysis and ordinal reliability coefficients. Results Reliability and validity was evaluated for the following three prespecified composite measures: (1) counseling on transition self-management; (2) counseling on prescription medication; and (3) transfer planning. Across the three samples, all but one measure had good internal consistency (ordinal reliability coefficient ≥ .7). Confirmatory factor analysis using tetrachoric correlation coefficients was stable across samples and supported the construct validity of the first two composite measures. Conclusions ADAPT is a reliable, validated instrument measuring the quality of HCT preparation experiences reported by adolescents with chronic disease. ADAPT will enable clinical programs and health care delivery systems to assess the quality of HCT preparation and provide targets for improvement in adolescent counseling related to transition.

The "exposome" is defined as "the totality of human environmental exposures from conception onward, complementing the genome" and its holistic approach may advance understanding of disease etiology. We aimed to describe the correlation structure of the exposome during pregnancy to better understand the relationships between and within families of exposure and to develop analytical tools appropriate to exposome data. Estimates on 81 environmental exposures of current health concern were obtained for 728 women enrolled in The INMA (INfancia y Medio Ambiente) birth cohort, in Sabadell, Spain, using biomonitoring, geospatial modeling, remote sensors, and questionnaires. Pair-wise Pearson's and polychoric correlations were calculated and principal components were derived. The median absolute correlation across all exposures was 0.06 (5th-95th centiles, 0.01-0.54). There were strong levels of correlation within families of exposure (median = 0.45, 5th-95th centiles, 0.07-0.85). Nine exposures (11%) had a correlation higher than 0.5 with at least one exposure outside their exposure family. Effectively all the variance in the data set (99.5%) was explained by 40 principal components. Future exposome studies should interpret exposure effects in light of their correlations to other exposures. The weak to moderate correlation observed between exposure families will permit adjustment for confounding in future exposome studies. (Figure Presented). © 2015 American Chemical Society., We would like to thank all INMA researchers on whose previous work this study is based. We thank all the INMA study participants and the members of the HELIX-EXPOsOMICs statistical working group who provided helpful discussions This research received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under Grant Agreement 308333−the HELIX project. The INMA Sabadell cohort was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041), Spanish Ministry of Health (FIS-PI041436, FIS- PI081151), Generalitat de Catalunya (CIRIT 1999SGR 00241), Fondo de Investigacion Sanitaria (ISCIII: FIS-PI12/01890), Fundació La Marató De TV3 (090430), and Recercaixa (2010ACUP 00349). We acknowledge the following studies, funded by the European Community’s Sixth and Seventh Framework Programmes, for generating exposure estimates used in this analysis: The ESCAPE study (Grant 211250) provided estimates on exposure to air pollutants; the HIWATE study (Contract No. Food-CT-2006-036224) provided estimates on exposure to water disinfection byproducts; and the PHENOTYPE study (Grant 282996) provided estimates on green spaces.

El estudio de las relaciones de pareja cobra especial importancia, ya que esta unión constituye la base de la familia. La satisfacción con la relación se puede definir como la actitud global hacia la relación y la pareja. La escala de Valoración de la Relación (RAS) de Hendrick es un instrumento comúnmente usado para evaluar el constructo. Esta escala ha demostrado tener consistencia interna alta y una estructura unidimensional. Aunque existen estudios de validación de la RAS, estos han empleado técnicas estadísticas inadecuadas para analizar sus ítems tipo Likert y para determinar el número de factores; además, previamente no se ha contrastado su invarianza factorial por sexo. Por tanto, en este estudio se plantean las siguientes preguntas de investigación: ¿la RAS tiene ítems consistentes y discriminativos? Basados los análisis en la matriz de correlaciones policóricas, ¿cuál es su nivel de consistencia interna?, ¿cuál es su número de factores usando métodos empíricos rigurosos?, y ¿el modelo de un factor es invariante por sexo? A fin de responder a estas preguntas de investigación, se usó un muestreo probabilístico de rutas aleatorias en este estudio instrumental de validación de la RAS. La muestra se extrajo de la población de personas casadas o en unión libre de la ciudad de Monterrey en México. Hubo 431 participantes femeninas y 376 participantes masculinos en este estudio. Los siete ítems de la RAS fueron consistentes y discriminativos. La consistencia interna de la escala fue excelente en la muestra conjunta (α ordinal = .93), en la de mujeres (α ordinal = .94) y en la de hombres (α ordinal = .92). El análisis paralelo de Horn y la prueba de la correlación parcial media mínima de Velicer sugirieron una solución de un factor. Además, el modelo de un factor (con una correlación entre los residuos de los dos ítems inversos) tuvo buen ajuste a los datos y sus propiedades de invarianza por sexo fueron aceptables por el método de Mínimos Cuadrados No Ponderados. Se concluye que la escala presenta consistencia interna y validez cruzada por sexo. Se recomienda el uso de la escala en la población estudiada de parejas casadas y que viven juntas.

Objective: The validity of measures across groups is a major concern for social work researchers and practitioners. Many social workers use scales, or sets of questionnaire items, with ordinal response options. However, a review of social work literature indicates the appropriate treatment of ordinal data in measurement invariance tests is rare; only 3 of 57 articles published in 26 social work journals over the past 12 years used proper testing procedures. This article synthesizes information from the literature and provides recommendations for appropriate measurement invariance procedures with ordinal data. Method: We use data from the Cebu Longitudinal Health and Nutrition Survey to demonstrate applications of invariance testing with ordinal data. Using a robust weighted least squares estimator and polychoric correlation matrix, we examine invariance of a 10-item Perceived Stress Scale (PSS) across 2 young adult groups defined by health status. We describe 2 competing approaches: a 4-step appro...

Los estudios sobre la dimensionalidad del Test de Orientación Vital-Revisado (LOTR), considerado el estándar en la medida del optimismo disposicional, resultan controvertidos al encontrar diversas soluciones factoriales. Así, no se ha establecido la estructura factorial definitiva de la prueba. El objetivo del presente estudio es determinar la estructura factorial del LOT-R mediante la comparación de los siete modelos empíricos existentes en la literatura. El instrumento fue administrado a 906 participantes españoles, de edades comprendidas entre los 18 y los 61 años (edad media = 23; 56% hombres). Se llevaron a cabo análisis factoriales confirmatorios sobre la matriz de correlaciones policóricas. Teniendo en cuenta los modelos teóricos existentes y los mejores índices de ajuste (RMSEA = 0,038; CFI = 0,98), concluimos que el LOT-R presenta una estructura factorial de segundo orden (orientación vital), compuesta por dos factores (Optimismo y Pesimismo). En consecuencia, recomendamos utilizar una única puntuación global que puede denominarse orientación vital y que, en último término, representa el nivel de optimismo disposicional. Studies of the dimensionality of the Life Orientation Test-Revised (LOT-R), considered as the gold standard in the measurement of dispositional optimism, yield controversial results due to the various factorial solutions found. Consequently, the factorial structure of the test has not yet been fully established. The aim of this study is to determine the factorial structure of the LOT-R by comparing seven previous models and their empirical evidence. The test was administered to 906 Spanish participants, ages 18 to 61 (mean age: 23; 56% males). Confirmatory factor analyses were conducted using polychoric correlations. Considering the theoretical background and the best model fit indices (RMSEA=.038; CFI=.98), we conclude that the test presents a factorial structure of a second-order factor (life orientation) composed of two factors (optimism and pessimism). Thus, we recommend using a single global score that could be referred to as life orientation but which ultimately represents the level of dispositional optimism.

Women in the justice system are a highly marginalized population that are disproportionately affected by violent victimization and psychological distress. Social support is a key mechanism in understanding these experiences. However, rigorous psychometric testing of existing social support instruments is scant and to date there are no studies specifically testing instruments for use with justice involved women. In order to address this gap, the present study sought to confirm the factor structure of the 12- and 4-item Medical Outcomes Study – Social Support Survey (MOS-SSS), a widely used measure of social support. Confirmatory factor models were estimated via robust weighted least squares and polychoric correlations among a sample of 406 victimized women on probation and parole. Findings supported the use of the 4-item version of the MOS-SSS as a reliable, valid, and extremely parsimonious measure of social support among victimized women on probation and parole.

The purpose of this study is to validate the Mexican version of the Short-Form Supportive Care Needs survey (SCNS-SFM). A cross-sectional survey was conducted from June to December 2013 at the Oncology Hospital of the Mexican Institute of Social Security in Mexico City. The study included 825 subsequent cancer patients >20 years of age with all forms of solid cancer. Patients had prior surgical removal of histologically confirmed cancer and attended outpatient consultations. Validation of SCNS-SFM included the following: (1) content validity through a group of experts; (2) construct validity through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach’s alpha; (4) convergent validity between SCNS-SFM and quality of life, anxiety, and depression scales by calculating Pearson’s correlation coefficient; (5) discriminative validity through analysis of MANOVAs; and (6) test–retest reliability using intraclass correlation coefficient calculations. SCNS-SFM has 33 items with five factors accounting for 59 % of total variance. Cronbach’s alpha values ranged from 0.78 to 0.90 among factors. SCNS-SFM has good convergent validity compared with quality of life and depression and anxiety scales and good discriminative validity, revealing great information, psychological support, and physical daily living needs for women, patients

Data collection process in most observational and experimental studies yield different types of variables, leading to the use of joint models that are capable of handling multiple data types. Evaluation of various statistical techniques that have been developed for mixed data in simulated environments requires concurrent generation of multiple variables. In this article, I present an important augmentation to a unified framework proposed in our previously published work for simultaneously generating binary and nonnormal continuous data given the marginal characteristics and correlation structure, via fifth-order power polynomials that are known to extend the area covered in the skewness-elongation plane and to provide a better approximation to the probability density function of the continuous variables. I evaluate how well the improved methodology performs in comparison to the original one, in a simulated setting with illustrations of algorithmic steps. Although the relative gains for the associa...

Planned missingness in commonly administered proportions of LibQUAL+® and Lite instruments may lead to loss of information. Data from three previous administrations of LibQUAL+® protocol were used to simulate data representing five proportions of administration. Statistics of interest (i.e., means, adequacy and superiority gaps, standard deviations, and Pearson and polychoric correlations) and their confidence intervals (CIs) from simulated and real data were compared. All CIs for the statistics of interest for simulated data contained the original values. Root mean squared errors, and absolute and relative biases showed that accuracy in the estimates decreased with increase in Lite proportion. The recommendation is to administer the Lite version to not more than 20% of the respondents if the purpose of the data collection is to conduct any inferential analysis. If researchers are interested in calculating means alone, up to 80% Lite version may be used to capture the true values adequately. However, standard deviations need to be interpreted to understand the quality of the means. Loss of accuracy in estimates may be compounded in analyses that use at least two statistics of interest.

Measuring farm sustainability performance is a crucial component for improving agricultural sustainability. While extensive assessments and indicators exist that reflect the different facets of agricultural sustainability, because of the relatively large number of measures and interactions among them, a composite indicator that integrates and aggregates over all variables is particularly useful. This paper describes and empirically evaluates a method for constructing a composite sustainability indicator that individually scores and ranks farm sustainability performance. The method first uses non-negative polychoric principal component analysis to reduce the number of variables, to remove correlation among variables and to transform categorical variables to continuous variables. Next the method applies common-weight data envelope analysis to these principal components to individually score each farm. The method solves weights endogenously and allows identifying important practices in sustainability evaluation. An empirical application to Wisconsin cranberry farms finds heterogeneity in sustainability practice adoption, implying that some farms could adopt relevant practices to improve the overall sustainability performance of the industry.

In this article, operational details of an R package MultiOrd that is designed for the generation of correlated ordinal data are described, and examples of some important functions are given. The package provides a valuable and needed tool that has been lacking for generating multivariate ordinal data.

Parent satisfaction is vital in improving the delivery of paediatric health care. However, there are no linguistically appropriate instruments that measure parent satisfaction among Filipino parents of children receiving occupational therapy, physical therapy, and speech pathology services. This study aimed to provide preliminary information about the reliability of the Filipino version of the Parent Satisfaction Scale (F-PSS). Research procedures included forward- and backward-translation of the PSS, cognitive interview, and data collection for reliability. These were conducted on primary caregivers of children who were receiving therapy services in a local clinic. Internal consistency and reproducibility of the translated tool were determined. Internal consistency was measured using an ordinal α value based on a polychoric correlation matrix, reproducibility using Randolph's κ, and standard error of measurement (SEM). Data analysis showed an ordinal α value of 0.96, κ values ranging from 0.56 to 0.72, and a standard error of measurement of 0.11. In summary, the F-PSS has excellent internal consistency, moderate to substantial agreement after repeated measures, and excellent absolute reliability for determining parent satisfaction in paediatric health care. Supplementary studies on its validity are needed to further ascertain its clinical utility.

Ineffective or inefficient transitions threaten patient safety, hinder communication, and worsen patient outcomes. The Hospital Culture of Transitions (H-CulT) survey was designed to assess a hospital's organizational culture related to within-hospital transitions in care involving patient movement. In this article, psychometric properties of the H-CulT survey were examined to assess and refine the hospital culture of transitions.A cross-sectional, multicenter, multidisciplinary correlational design and survey methods were used to examine the psychometric properties of the H-CulT survey. Exploratory factor analysis was used to quantify the accuracy of the previously identified structure. Specifically, the analysis involved the principal axis factor method with an oblique rotation, based on a polychoric correlation matrix.A sample of 492 respondents from 13 diverse hospitals participated. Cronbach's alpha for the instrument was 0.88, indicating strong internal consistency. Seven subscales emerged and were labeled: Hospital Leadership, Unit Leadership, My Unit's Culture, Other Units' Culture, Busy Workload, Priority of Patient Care, and Use of Data. Correlations between subscales ranged from 0.07 to 0.52, providing evidence that the subscales did not measure the same construct. Subscale correlations with the total score were near or above 0.50 (p 0.001). Use of a factor-loading cutoff of 0.40 resulted in the elimination of 12 items because of weak associations with the topic.The H-CulT is a psychometrically sound and practical survey for assessing hospital culture related to patient flow during transitions in care. Survey results may prompt quality improvement interventions that enhance in-hospital transitions and improve staff satisfaction and patient satisfaction with care.

The present study aims to validate the interRAI Child and Youth Mental Health (interRAI ChYMH), Disruptive/Aggression Behaviour Scale (DABS) and Hyperactive/Distraction Scale (HDS). Data were collected from children/youth aged 4–18 (N = 3464) across 39 mental health agencies in Ontario, Canada. Unrestricted factor analysis using polychoric correlation matrices and Samejima’s graded item response theory (IRT) parameterizations were conducted for both measures. Scores on the HDS and DABS were also compared amongst children/youth diagnosed with attention-deficit hyperactivity disorder (ADHD) and disruptive behaviour disorder (DBD) respectively using DSM-IV criteria. Results from the factor analysis and IRT analysis demonstrated good measurement properties. Using a receiver operating characteristics curve, the area under the curve (AUC) for the HDS and DABS is 0.79 and 0.75 for a diagnosis of ADHD and DBD respectively. Overall, converging results suggest that the interRAI HDS and DABS may serve as effective measures that detect externalizing mental health indicators.

Background Within nursing education, the clinical learning environment is of a high importance in regards to the development of competencies and abilities. The organization, atmosphere, and supervision in the clinical learning environment are only a few factors that influence this development. In Austria there is currently no valid instrument available for the evaluation of influencing factors. Objectives The aim of the study was to test the construct validity with principal component analysis as well as the internal consistency of the German Clinical Learning Environment, Supervision and Teacher Scale (CLES+T scale) in Austria. Method The present validation study has a descriptive-quantitative cross-sectional design. The sample consisted of 385 nursing students from thirteen training institutions in Austria. The data collection was carried out online between March and April 2016. Starting with a polychoric correlation matrix, a parallel analysis with principal component extraction and promax rotation was carried out due to the ordinal data. Results The exploratory ordinal factor analysis supported a four-component solution and explained 73% of the total variance. The internal consistency of all 25 items reached a Cronbach's α of 0.95 and the four components ranged between 0.83 and 0.95. Conclusion The German version of the CLES+T scale seems to be a useful instrument for identifying potential areas of improvement in clinical practice in order to derive specific quality measures for the practical learning environment.

15 páginas Objective To generate and evaluate an indicator of the health system’s performance in the area of maternal and reproductive health in Colombia. Materials and methods An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator’s score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. Results The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator’s behavior was found to have an association with the unsatisfied basic needs index and women’s education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. Discussion The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

BackgroundDepression is common mental health problem and leading contributor to the global burden of disease. The attitudes and beliefs of the public and of health professionals influence social acceptance and affect the esteem and help-seeking of people experiencing mental health problems. The attitudes of clinicians are particularly relevant to their role in accurately recognising and providing appropriate support and management of depression. This study examines the characteristics of the revised depression attitude questionnaire (R-DAQ) with doctors working in healthcare settings in Lahore, Pakistan.MethodsA cross-sectional survey was conducted in 2015 using the revised depression attitude questionnaire (R-DAQ). A convenience sample of 700 medical practitioners based in six hospitals in Lahore was approached to participate in the survey. The R-DAQ structure was examined using Parallel Analysis from polychoric correlations. Unweighted least squares analysis (ULSA) was used for factor extraction. Model fit was estimated using goodness-of-fit indices and the root mean square of standardized residuals (RMSR), and internal consistency reliability for the overall scale and subscales was assessed using reliability estimates based on Mislevy and Bock (BILOG 3 Item analysis and test scoring with binary logistic models. Mooresville: Scientific Software, 55) and the McDonald's Omega statistic. Findings using this approach were compared with principal axis factor analysis based on Pearson correlation matrix.Results601 (86%) of the doctors approached consented to participate in the study. Exploratory factor analysis of R-DAQ scale responses demonstrated the same 3-factor structure as in the UK development study, though analyses indicated removal of 7 of the 22 items because of weak loading or poor model fit. The 3 factor solution accounted for 49.8% of the common variance. Scale reliability and internal consistency were adequate: total scale standardised alpha was 0.694; subscale reliability for professional confidence was 0.732, therapeutic optimism/pessimism was 0.638, and generalist perspective was 0.769.ConclusionsThe R-DAQ was developed with a predominantly UK-based sample of health professionals. This study indicates that this scale functions adequately and provides a valid measure of depression attitudes for medical practitioners in Pakistan, with the same factor structure as in the scale development sample. However, optimal scale function necessitated removal of several items, with a 15-item scale enabling the most parsimonious factor solution for this population.

El artículo tiene por objetivo presentar la adaptación para adultos argentinos de la Escala de Felicidad de Lima construida por Alarcón. Se aplicó a 1004 sujetos (65% mujeres) con una media de edad de 31 años. Se realizó un Análisis Factorial Exploratorio con base en la matriz de correlaciones policóricas mediante el método de mínimos cuadrados no ponderados y utilizando rotación Promax. De las cuatro subescalas de la versión original se mantuvieron dos, de las cuales una de ellas, Sentido Positivo de la Vida, se dividió en dos dimensiones. La versión adaptada se compuso de 12 ítems distribuidos en tres subescalas que explican el 69 % de la varianza: Sentido de la Vida Perspectiva Externa, Sentido de la Vida Perspectiva Interna y Satisfacción con la Vida. Se obtuvieron evidencias de validez convergente y el nivel de consistencia interna de las subescalas fue, como mínimo, aceptable según el criterio de DeVellis. This article presents an adaptation of the Happiness Scale from Lima, designed by Alarcón, for Argentine adults. The scale was applied to 1004 individuals (65% women) with a mean age of 31. An exploratory factor analysis was carried out on the basis of a polychoric correlation matrix using the method of non-weighted least squares and promax rotation. Two subscales were kept out of the four included in the original version, and one of them, Positive Sense of Life, was itself divided into two dimensions. The adapted version was made up of 12 items divided into three subscales explaining 69% of variance: External Perspective of Sense of Life, Internal Perspective of Sense of Life and Life Satisfaction. Evidence was obtained of convergent validity, and internal consistency of the subscales was at least acceptable according to DeVellis criteria. Fil: Auné, Sofía Esmeralda. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina Fil: Abal, Facundo Juan Pablo. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Attorresi, Horacio Felix. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina

Background: Apathy, a prevalent and clinically relevant symptom in neurodegenerative disease, is often evaluated by the instrument Apathy Evaluation Scale (AES). However, this instrument has not been translated into Swedish, halting clinical and research efforts. Furthermore, previous studies lack analyses of some basic properties, such as the legitimacy of a total score, or have analysed dimensionality by questionable methods.Aim: To translate and psychometrically evaluate a Swedish version of the AES.Method: The AES was translated, and its psychometric properties were tested in the Swedish BioFINDER study, including cognitively well elderly, and subjects with mild cognitive or parkinsonian symptoms. Psychometric analyses were conducted according to classical test theory (CTT) and aimed to resemble those performed in the English original study by Marin et al. in 1991. Dimensionality was additionally analysed on a matrix of polychoric correlations and parallel analyses.Results: Data indicate that the Swedish AES performs satisfactorily regarding data completeness, scaling assumptions, targeting, and reliability. Principal component analyses (with parallel analysis) of polychoric correlation matrices identified a single component. Convergent and discriminative validity correlations accorded with a priori expectations.Conclusions: The study provides initial support that this Swedish AES performs similarly to the English original, and exhibits acceptable psychometric properties according to CTT, including supported unidimensionality, and may be adopted for use in clinical and research settings.Keywords: Apathy, Apathy Evaluation Scale (AES), neurodegenerative disease, neuropsychiatric assessment, psychometrics

Background: An association between cancer survival and socioeconomic status (SES) has been evaluated for many different cancers but calculating socioeconomic inequality in survival is very late. In this study we aimed to determine associations between socioeconomic inequality and survival risk factors in patients with gastric carcinoma (GC). Methods: In this cross-sectional study, we enrolled 235 patients with confirmed GC. SES data were retrieved from three sources pathological records, official death certificates and telephone interviews. Polychoric correlation matrix was used to reduce the number of variables. Inequality was measured by concentration index (CI) and we decomposed CI to determine contribution in inequality. All analyses were performed by standard statistical software STATA (version 11.2). Results: The overall CI for late diagnosis (2 stage onwards) and positive history of smoking were -0.020 (95% CI = -0.041 - 0.004) and -0.105 (95% CI = -0.110 - -0.076), respectively. Results of decomposition shows past medical history of gastrointestinal diseases (29%) and history of smoking (18%) have the largest contributions in inequality in GC survival. Conclusions: Results of this study showed risk factors in GC survival such as smoking, having a past medical history of gastrointestinal diseases and late diagnosis are more prevalent among people of lower SES.

Introduction Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia. Methods This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction. Results The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13–12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03–1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03–0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04–20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19–20.19) had positive significant effect on client satisfaction. Conclusion Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers’ skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.

In order for odds ratios to be suitable for effect size estimation in meta-analysis, a measure of their spread is required. Unfortunately, this is often missing in clinical reports. A tentative solution for the problem is the replacement of odds ratios with regression coefficients and correlation coefficients, for which it is easier to compute a measure of spread. In this chapter the Yule and Ulrich approximations and the tetrachoric correlation coefficients are explained as possible solutions for odds ratios without measure of spread. This subject is pretty new, and possible solutions are, so far, little used in present meta-analyses.

This note makes the point that, if a Bivariate Probit (BP) model is estimated on data arising from a Recursive Bivariate Probit (RBP) process, the resulting BP correlation parameter is a weighted average of the RBP correlation parameter and the parameter associated to the endogenous binary variable. Two corollaries follow this proposition: i) a zero correlation parameter in a BP model, usually interpreted as evidence of independence between the binary variables under study, may actually mask the presence of a RBP process; and ii) the interpretation of the correlation parameter in the RBP is not the same as in the BP — i.e. the RBP correlation parameter does not necessarily reflect the correlation between the binary variables under study.

Objective: Validated, reliable instruments to assess spasticity-related arm pain are not available. Non-specific pain-assessment scales have not been validated in this condition either and may be unsuitable for nursing-home patients. Without such validated scales, the effects of botulinum toxin on this condition cannot be investigated in a scientifically robust manner. The objective of this study was to evaluate the internal consistency, reliability, and validity of the Spasticity-Associated Arm Pain Scale (SAAPS) for adults with post-stroke upper-limb spasticity, and its sensitivity for detecting pain reduction following incobotulinumtoxinA treatment.Methods: Psychometric evaluation of a five-item pain-assessment tool was conducted in this prospective, multicenter, open-label, observational study, involving adults with post-stroke upper-limb spasticity (inter-rater reliability, n=25; all other measures, n=61). Internal consistency was analyzed using Cronbach’s alpha coefficients. Test-retest reliability was assessed using intraclass correlations, Spearman’s rho, polychoric correlation, and Kendall’s Tau-b coefficients. Inter-rater reliability was assessed using weighted kappa. SAAPS validity was assessed using correlations with patient/investigator ratings on an 11-point numerical rating scale. Sensitivity of SAAPS was investigated 4-6 weeks after an incobotulinumtoxinA injection.Results: Test-retest reliability was high (all measured coefficients >0.70) and weighted kappa for inter-rater reliability (0.45-0.69) indicated good/fair agreement. SAAPS scores were reduced by 3.7 points (mean) 4-6 weeks post-treatment (p