Search

ABSTRACT BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil. OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services. METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy. RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from −0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from −0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from −0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium. CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

ABSTRACT Purpose: To translate, adapt and validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms ICIQ-FLUTS for the Brazilian female population. Materials and Methods: A translation of the questionnaire into Brazilian Portuguese was made followed by an adaptation for better understanding by native speakers. After that, the ICIQ-FLUTS was answered by eighty volunteers (n=80) twice (for interviewers 1 and 2) with an interval of 30 minutes between them. Furthermore, after 15 days from the evaluation, the participants answered the ICIQ-FLUTS again in order to verify the questionnaire stability over time. The questionnaires Utian Quality Of Life (UQOL) and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), which are validated in Brazil were also applied to perform the validation. Results: The result of the Cronbach α coefficient of the instrument presented a value of 0.832. The values for test-retest were 0.907 (inter-observer) and 0.901 (intra-observer). The correlation between ICIQ-FLUTS (score I - domain of urinary incontinence) with the ICIQ-SF (final score) was strong and positive (r=0.836, p=0.000). In addition, the ICIQ-FLUTS showed moderate and negative correlation with the total score of UQOL (r=-0.691, p=0.017). Conclusion: The Portuguese version of the ICIQ-FLUTS questionnaire showed strong correlation to ICIQ-SF questionnaire and satisfactory values to test-retest and internal consistency.

Introduction: Using physiologic scoring systems for identifying high-risk patients for mortality has been considered recently. This study was designed to evaluate the values of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiologic Score (SAPS II) models in prediction of 1-month mortality of critically ill patients. Methods: The present prospective cross sectional study was performed on critically ill patients presented to emergency department during 6 months. Data required for calculation of the scores were gathered and performance of the models in prediction of 1-month mortality were assessed using STATA software 11.0. Results: 82 critically ill patients with the mean age of 53.45 ± 20.37 years were included (65.9% male). Their mortality rate was 48%. Mean SAPS II (p < 0.0001) and APACHE II (p = 0.0007) scores were significantly higher in dead patients. Area under the ROC curve of SAPS II and APACHE II for prediction of mortality were 0.75 (95% CI: 0.64 - 0.86) and 0.72 (95% CI: 0.60 - 0.83), respectively (p = 0.24). The slope and intercept of SAPS II were 1.02 and 0.04, respectively. In addition, these values were 0.92 and 0.09 for APACHE II, respectively. Conclusion: The findings of the present study showed that APACHE II and SAPS II had similar value in predicting 1-month mortality of patients. Discriminatory powers of the mentioned models were acceptable but their calibration had some amount of lack of fit, which reveals that APACHE II and SAPS II are partially perfect.

Purpose: The percutaneous renal access (PRA) is the most critical step of percutaneous renal surgery (PRS). For the training of PRA in the lab, a novel non-biological bench model was developed and set for validation test. Materials and Methods: Experts in PRS (> 60 cases) and novices were included to perform fluoroscopy guided PRA on the model. Overall time, X-ray exposure time and puncture attempts were recorded to establish construct validity. After accomplishment, the experts rated the model using a standardized questionnaire for face and content validity based on a 5-point Likert scale, with 1 denoting very bad and 5 as excellent. Baseline and post-training data of novices were analyzed for skill acquisition. Results: 9 experts and 30 novices were finally included. The overall appraisal was 4 by the experts, and consensus of all experts was reached for the model as an excellent training tool. Significant difference between experts and novices was detected with the experts using less total time 183.11 ± 29.40 vs. 278.00 ± 50.30 seconds (P < 0.001), shorter X-ray exposure time 109.22 ± 19.93 vs. 183.13 ± 38.83 seconds (P < 0.001), and fewer attempts 1.28 ± 0.44 vs. 2.35 ± 0.65 (P < 0.001). After training, the novices demonstrated significant skill improvement in total and fluoroscopy time, and number of attempts (P < 0.001). Conclusions: Our non-biological model provides a new method for PRA training. The face, content and construct validity were demonstrated. This model allows contact with PRA skills and could be applied to the first step in the learning curve.

Objectives Validation of the Expanded Prostate Cancer Index Composite (EPIC) questionnaire translated to Portuguese. This is an evaluation tool of the effects of treatment on quality of life of patients with prostate cancer. Materials and Methods In order to translate and validate, several recommended methodological techniques in the literature were included: initial translation, synthesis of translation, board committee review and back translation. Sample included 40 patients with localized prostate cancer submitted to surgical retropubic radical prostatectomy from 2008 to 2010. Results The internal consistency analysis of the scales of the questionnaire resulted in alpha Cronbach coefficients “very good” (> 0.9) and “good” (> 0.8) to 8 of 14 domains. The higher coefficients (0.94) were assigned to sexual score, subscales incontinence and sexual function. Post-operatory follow-up ranged from 3 to 35 months, median 18.7 months. Conclusions The Brazilian version of EPIC is reliable and valid, and is a useful tool to evaluate the impact of retropubic radical prostatectomy on quality of life of Brazilian patients with localized prostate cancer, in national and internationals studies.

Introduction: Using physiologic scoring systems for identifying high-risk patients for mortality has been considered recently. This study was designed to evaluate the values of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiologic Score (SAPS II) models in prediction of 1-month mortality of critically ill patients.Methods: The present prospective cross sectional study was performed on critically ill patients presented to emergency department during 6 months. Data required for calculation of the scores were gathered and performance of the models in prediction of 1-month mortality were assessed using STATA software 11.0.Results: 82 critically ill patients with the mean age of 53.45 ± 20.37 years were included (65.9% male). Their mortality rate was 48%. Mean SAPS II (p < 0.0001) and APACHE II (p = 0.0007) scores were significantly higher in dead patients. Area under the ROC curve of SAPS II and APACHE II for prediction of mortality were 0.75 (95% CI: 0.64 - 0.86) and 0.72 (95% CI: 0.60 - 0.83), respectively (p = 0.24). The slope and intercept of SAPS II were 1.02 and 0.04, respectively. In addition, these values were 0.92 and 0.09 for APACHE II, respectively.Conclusion: The findings of the present study showed that APACHE II and SAPS II had similar value in predicting 1-month mortality of patients. Discriminatory powers of the mentioned models were acceptable but their calibration had some amount of lack of fit, which reveals that APACHE II and SAPS II are partially perfect.

Abstract: Sant''Anna T, Escobar VC, Fontana AD, Camillo CA, Hernandes NA, Pitta F. Evaluation of a new motion sensor in patients with chronic obstructive pulmonary disease. Objective: To assess the criterion validity and reproducibility of a new pedometer in patients with chronic obstructive pulmonary disease (COPD). Design: Cross-sectional study. Setting: Outpatient physiotherapy clinic from a university hospital. Participants: Patients with COPD (N=30; 17 men; forced expiratory volume in the first second, 44±17% predicted) were videotaped while performing 2 protocols: one including 2 slow and 2 fast 5-minute walks, and another including a circuit of activities of daily living (ADLs). Concomitantly, patients wore 2 motion sensors: the new pedometer and a multisensor accelerometer. Interventions: None. Main Outcome Measures: Step counting (SC), energy expenditure (EE), walking distance (WD), activity time (AT), and walking intensity (WI) registered by the pedometer were compared with video and the multisensor as criterion methods. Results: Correlations between the pedometer and the criterion method were high for SC during slow and fast walking (r=.79 and r=.95) and for EE during fast walking (r=.83). Correlation was more modest for EE during slow walking (r=.65) and for WD and WI during both speeds (.47.79 for all). During the ADLs circuit, the pedometer underestimated AT by an average of 55% but provided an acceptable EE estimation in a group basis (average difference of 6% with the multisensor). Conclusions: In patients with COPD, the new pedometer analyzed in the present study is reproducible for most outcomes and highly valid for SC during slow and fast walking and EE during fast walking. The device''s validity is more limited for EE during slow walking, and WD and WI at both speeds. Furthermore, during the performance of ADLs, it significantly underestimates activity time but provides an acceptable estimation of EE in a group basis. [Copyright &y& Elsevier]

Abstract: Vereecken M, Vanderstraeten G, Ilsbroukx S. From “Wheelchair Circuit” to “Wheelchair Assessment Instrument for people with Multiple Sclerosis”: reliability and validity analysis of a test to assess driving skills in manual wheelchair users with multiple sclerosis. Objectives: To assess the reliability and validity of the Wheelchair Assessment Instrument for people with Multiple Sclerosis (WAIMS), a test to measure driving skills in manual wheelchair users with multiple sclerosis (MS). Design: Three test trials per subject were conducted by 2 raters to examine reliability (inter- and intrarater) and validity (concurrent and construct). Setting: A national multiple sclerosis rehabilitation center. Participants: Convenience sample of manual wheelchair users with MS (n=50), participating in an inpatient or outpatient rehabilitation program in a national multiple sclerosis center. Interventions: Not applicable. Main Outcome Measures: The WAIMS consists of 8 items and results in 3 final test scores: ability sum score, performance time sum score, and covered distance. These 3 scores are used to calculate inter- and intrarater reliability, concurrent validity, and construct validity. Concerning validity, the test scores on the WAIMS are compared with (1) the Belgian medical prescription of a wheelchair on the item d445 (hand and arm use), based on the International Classification of Functioning, Disability and Health, (2) the Expanded Disability Status Scale, and (3) the mobility (wheelchair) item of the FIM. Results: Intrarater reliability was found to be higher than interrater reliability. Except for the interrater reliability of the ability sum score, all intraclass correlation coefficients met our standard of 0.80. Concurrent validity was rather low, but construct validity showed that the WAIMS is a valid instrument to assess driving skills in manual wheelchair users with MS. Conclusions: The WAIMS is a promising tool to assess driving skills in manual wheelchair users with MS, but it needs some refinements and future studies to confirm this statement. [Copyright &y& Elsevier]

Context Many countries now use call centres as an integral part of out-of-hours primary care. Although some research has been carried out on safety issues pertaining to telephone consultations, there has been no published research on how to train and use standardised patients calling for medical advice or on the accuracy of their role-play. Objectives This study aimed to assess the feasibility and validity of using telephone incognito standardised patients (TISPs), the accuracy of their role-play and the rate of detection. Further objectives included exploring the experiences of TISPs and the difficulties encountered in self-recording calls. Methods Twelve TISPs were trained in role-play by presenting their problem to a general practitioner and a nurse. They were also trained in self-recording calls. Calls were made to 17 different out-of-hours centres (OOHCs) from home. Of the four or five calls made per evening, one call was assessed for accuracy of role play. Retrospectively, the OOHCs were asked whether they had detected any calls made by a TISP. The TISPs filled in a questionnaire concerning their training, the self-recording technique and their personal experiences. Results The TISPs made 375 calls over 84 evenings. The accuracy of role-play was close to 100%. A TISP was called back the same evening for additional information in 11 cases. Self-recording caused extra tension for some TISPs. All fictitious calls remained undetected. Conclusions Using the method described, TISPs can be valuable both for training and assessment of performance in telephone consultation carried out by doctors, trainees and other personnel involved in medical services. [ABSTRACT FROM AUTHOR]

Context Self-reflection, the practice of inspecting and evaluating one’s own thoughts, feelings and behaviour, and insight, the ability to understand one’s own thoughts, feelings and behaviour, are central to the self-regulation of behaviours. The Self-Reflection and Insight Scale (SRIS) measures three factors in the self-regulation cycle: need for reflection; engagement in reflection, and insight. Methods We used structural equation modelling to undertake a confirmatory factor analysis of the SRIS. We re-specified our model to analyse all of the data to explain relationships between the SRIS, medical student characteristics, and responses to issues of teaching and learning in professionalism. Results The factorial validity of a modified SRIS showed all items loading significantly on their expected factors, with a good fit to the data. Each subscale had good internal reliability (> 0.8). There was a strong relationship between the need for reflection and engagement in reflection ( r = 0.77). Insight was related to need for reflection (0.22) and age (0.21), but not to the process of engaging in reflection (0.06). Conclusions Validation of the SRIS provides researchers with a new instrument with which to measure and investigate the processes of self-reflection and insight in the context of students’ self-regulation of their professionalism. Insight is related to the motive or need for reflection, but the process of reflection does not lead to insight. Attending to feelings is an important and integral aspect of self-reflection and insight. Effective strategies are needed to develop students’ insight as they reflect on their professionalism. [ABSTRACT FROM AUTHOR]

Context This paper examines the criterion validity of the Graduate Medical School Admissions Test (GAMSAT), which has been used since 1996 in Australia and more recently in the UK and Ireland. The study provides evidence on the extent to which GAMSAT, in combination with grade point average (GPA) and interview scores, adds value to determining an individual’s capability for medical study. The study responds to increasing demand for information on the validity of selection processes. Criterion validity is important because it helps to empirically situate selection tests within their broader contexts by, for instance, providing an assurance to educators and the public that test results are valid and add value to selection decisions. Methods After introducing the rationale and focus of the study, the paper summarises the data and research methods, presents statistical results and draws conclusions that advance current insight into medical school admissions processes. The results are based on data from six institutions and 351 students. Results Analyses of GAMSAT, interview and GPA scores show, in summary, that: there are fairly high levels of divergence between these three measures; that relationships between the measures and Year 1 marks vary across institutions, and that a combination of GAMSAT and GPA scores provides the best means of predicting Year 1 performance. [ABSTRACT FROM AUTHOR]

Context The white paper ‘Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century’ proposes a single, generic multi-source feedback (MSF) instrument in the UK. Multi-source feedback was proposed as part of the assessment programme for Year 1 specialty training in histopathology. Methods An existing instrument was modified following blueprinting against the histopathology curriculum to establish content validity. Trainees were also assessed using an objective structured practical examination (OSPE). Factor analysis and correlation between trainees’ OSPE performance and the MSF were used to explore validity. All 92 trainees participated and the assessor response rate was 93%. Reliability was acceptable with eight assessors (95% confidence interval 0.38). Factor analysis revealed two factors: ‘generic’ and ‘histopathology’. Pearson correlation of MSF scores with OSPE performances was 0.48 ( P = 0.001) and the histopathology factor correlated more highly (histopathology r = 0.54, generic r = 0.42; t = − 2.76, d.f. = 89, P < 0.01). Trainees scored least highly in relation to ability to use histopathology to solve clinical problems (mean = 4.39) and provision of good reports (mean = 4.39). Three of six doctors whose means were < 4.0 received free text comments about report writing. There were 83 forms with aggregate scores of < 4. Of these, 19.2% included comments about report writing. Results Specialty-specific MSF is feasible and achieves satisfactory reliability. The higher correlation of the ‘histopathology’ factor with the OSPE supports validity. This paper highlights the importance of validating an MSF instrument within the specialty-specific context as, in addition to assuring content validity, the PATH–SPRAT (Histopathology–Sheffield Peer Review Assessment Tool) also demonstrates the potential to inform training as part of a quality improvement model. [ABSTRACT FROM AUTHOR]

Context Although concern has been raised about the value of clinical evaluation reports for discriminating among trainees, there have been few efforts to formalise the dimensions and qualities that distinguish effective versus less useful styles of form completion. Methods Using brainstorming and a modified Delphi technique, a focus group determined the key features of high-quality completed evaluation reports. These features were used to create a rating scale to evaluate the quality of completed reports. The scale was pilot-tested locally; the results were psychometrically analysed and used to modify the scale. The scale was then tested on a national level. Psychometric analysis and final modification of the scale were completed. Results Sixteen features of high-quality reports were identified and used to develop a rating scale: the Completed Clinical Evaluation Report Rating (CCERR). The reliability of the scale after a national field test with 55 raters assessing 18 in-training evaluation reports (ITERs) was 0.82. Further revisions were made; the final version of the CCERR contains nine items rated on a 5-point scale. With this version, the mean ratings of three groups of ‘gold-standard’ ITERs (previously judged to be of high, average and poor quality) differed significantly ( P < 0.05). Discussion The CCERR is a validated scale that can be used to help train supervisors to complete and assess the quality of evaluation reports. [ABSTRACT FROM AUTHOR]

Context Self-efficacy is an important factor in many areas of medical education, including self-assessment and self-directed learning, but has been little studied in resuscitation training, possibly because of the lack of a simple measurement instrument. Objective We aimed to assess the validity of a visual analogue scale (VAS) linked to a single question as an instrument to measure self-efficacy with respect to resuscitation skills by comparing the VAS with a questionnaire and using known-groups comparisons. Methods We developed questionnaires to measure self-efficacy for a number of resuscitation tasks and for computer skills. These were compared with VASs linked to a single question per task, using a multi-trait, multi-method matrix. We also used known-groups comparisons of self-efficacy in specific professional groups. Results There was good correlation between the questionnaires and the VASs for self-efficacy for specific resuscitation tasks. There was a less clear correlation for self-efficacy for paediatric resuscitation overall. There was no correlation between self-efficacy for resuscitation and computer tasks. In specific professional groups, measured self-efficacy accorded with theoretical predictions. Conclusions A VAS linked to a single question appears to be a valid method of measuring self-efficacy with respect to specific well defined resuscitation tasks, but should be used with caution for multi-faceted tasks. [ABSTRACT FROM AUTHOR]

Objective The drive towards valid and reliable assessment methods for health professions’ training is becoming increasingly focused towards authentic models of workplace performance assessment. This study investigates the validity of such a method, longitudinal evaluation of performance (LEP), which has been implemented in the assessment of postgraduate dental trainees in Scotland. Although it is similar in format to the mini-CEX (mini clinical evaluation exercise) and other tools that use global ratings for assessing performance in the workplace, a number of differences exist in the way in which the LEP has been implemented. These include the use of a reference point for evaluators’ judgement that represents the standard expected upon completion of the training, flexibility, a greater range of cases assessed and the use of frequency scores within feedback to identify trainees’ progress over time. Methods A range of qualitative and quantitative data were collected and analysed from 2 consecutive cohorts of trainees in Scotland (2002–03 and 2003–04). Results There is rich evidence supporting the validity, educational impact and feasibility of the LEP. In particular, a great deal of support was given by trainers for the use of a fixed reference point for judgements, despite initial concerns that this might be demotivating to trainees. Trainers were highly positive about this approach and considered it useful in identifying trainees’ progress and helping to drive learning. Conclusions The LEP has been successful in combining a strong formative approach to continuous assessment with the collection of evidence on performance within the workplace that (alongside other tools within an assessment system) can contribute towards a summative decision regarding competence. [ABSTRACT FROM AUTHOR]

Purpose: We validated a simple scale to measure urinary urgency. Materials and Methods: The new 10-item scale was validated using data from experiments using a single group repeated measure design. A total of 475 patients, including 411 females and 64 males, with a mean age of 57.3 years who had been diagnosed with overactive bladder were treated with a bladder retraining regimen and antimuscarinic agent (10 mg oxybutynin controlled release per night or 4 mg tolterodine slow release per night). At each visit patient urge symptoms were recorded by the scale. Reported average daily frequency and incontinence episodes were also recorded. Of patients who were not satisfied with the symptoms 130 had 25 mg imipramine per night added to their prescription and in 130 treatment was changed to 10 mg solifenacin per night. Results: Construct validity was tested by comparing the urgency scale to frequency and to incontinence (Spearman’s rank correlation coefficient r = 0.38, p <0.001 and r = 0.15, p <0.001, respectively). Internal consistency showed Cronbach’s α = 0.83. Test-retest reliability was determined in 30 patients and interobserver reliability was determined in 58 (Pearson’s r = 0.99, p <0.001 and r = 0.99, p <0.001, respectively). Internal responsiveness in the imipramine add-on study in 130 patients showed a standardized response mean of 0.6 (p <0.001) and in the solifenacin swap study in 130 it showed a standardized response mean of 0.69, while external responsiveness showed a standardized response mean of 0.69 (each p <0.001). Conclusions: This scale succeeded in all validation studies. This new scale may prove useful for measuring between-drug differences in efficacy and for monitoring treatment responses in patients with overactive bladder. It now must be tested in a proper double-blind, randomized, controlled trial. [Copyright &y& Elsevier]

Objective To determine whether items of progress tests used for inter-curriculum comparison favour students from the medical school where the items were produced (i.e. whether the origin bias of test items is a potential confounder in comparisons between curricula). Methods We investigated scores of students from different schools on subtests consisting of progress test items constructed by authors from the different schools. In a cross-institutional collaboration between 3 medical schools, progress tests are jointly constructed and simultaneously administered to all students at the 3 schools. Test score data for 6 consecutive progress tests were investigated. Participants consisted of approximately 5000 undergraduate medical students from 3 medical schools. The main outcome measure was the difference between the scores on subtests of items constructed by authors from 2 of the collaborating schools (subtest difference score). Results The subtest difference scores showed that students obtained better results on items produced at their own schools. This effect was more pronounced in Years 2–5 of the curriculum than in Year 1, and diminished in Year 6. Conclusions Progress test items were subject to origin bias. As a consequence, all participating schools should contribute equal numbers of test items if tests are to be used for valid and fair inter-curriculum comparisons. [ABSTRACT FROM AUTHOR]

Purpose: The limitations of prostate specific antigen as a biomarker for prostate cancer screening, characterized by low sensitivity for acceptable false-positive rates, are well known. New markers that differentiate indolent from aggressive cancers to decrease potential the over treatment of prostate cancer are needed. We reviewed current and potential biomarkers for prostate cancer detection. Materials and Methods: A literature search was performed to identify established and emerging biomarkers for prostate cancer detection. Recent suggested guidelines by the Early Detection Research Network for phases of biomarker studies were interpreted for use in prostate cancer and the existing status of marker studies were reviewed with respect to these phases of study. Results: Advances in high throughput bench research, including high dimensional genomic, proteomic and autoantibody signatures, have the potential to improve the operating characteristics of prostate specific antigen but they are undergoing reproducibility and multicenter validation studies. None of the prostate specific antigen derivatives or isoforms, such as prostate specific antigen density, velocity or percent complexed prostate specific antigen, improve operating characteristics enough to likely replace prostate specific antigen. Prostate stem cell antigen, alpha-methyl coenzyme-A racemase, PCA3, early prostate cancer antigen, human kallikrein 2 and hepsin are promising markers that are currently undergoing validation. Conclusions: The process of discovering novel biomarkers to replace or augment the existing best marker, prostate specific antigen, requires standardized phases of evaluation and validation. Several biomarkers are currently on the cusp of initial validation studies. [Copyright &y& Elsevier]

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context Self-assessment promotes reflective practice, helps students identify gaps in their learning and is used in curricular evaluations. Currently, there is a dearth of validated self-assessment tools in rheumatology. We present a new musculoskeletal self-assessment tool (MSAT) that allows students to assess their confidence in their skills in and knowledge of knee and shoulder examination. Objectives We aimed to validate the 15-item MSAT, addressing its construct validity, internal consistency, responsiveness, repeatability and relationship with competence. Methods Participants were 241 Year 3 students in Newcastle upon Tyne and 113 Year 3 students at University College London, who were starting their musculoskeletal skills placement. Factor analysis explored the construct validity of the MSAT; Cronbach's α assessed its internal consistency; standardised response mean (SRM) evaluated its responsiveness, and test-retest, before and after a pathology lecture, assessed its repeatability. Its relationship with competence was explored by evaluating its correlation with shoulder and knee objective structured clinical examinations (OSCEs). Results The MSAT was valid in distinguishing the 5 domains it intended to measure: clinical examination of the knee; clinical examination of the shoulder; clinical anatomy of the knee and shoulder; history taking, and generic musculoskeletal anatomical and clinical terms. It was internally consistent (α = 0.93), responsive (SRM 0.6 in Newcastle and 2.2 in London) and repeatable (intraclass correlation coefficient 0.97). Correlations between MSAT scores and OSCE scores were weak ( r < 0.2). Conclusions The MSAT has strong psychometric properties, thereby offering a valid approach to evaluating the self-assessment of confidence in examination skills by students. Confidence does not necessarily reflect competence; future research should clarify what underpins confidence. [ABSTRACT FROM AUTHOR]

Background Distance learning has been advocated increasingly as a modern efficient method of teaching surgery. Efficiency of knowledge transfer and validity of web-based courses have not been subjected to rigorous study to date. Methods An entirely web-based surgical 5-week lecture course was designed. Fifty per cent of the lectures were prepared as HTML slides with voice-over while the other group was presented in the text-only form. Only written material presented was examined. The lectures were presented via an educational web module. The lecture series was balanced specifically to reduce the pre-existent knowledge bias. Web usage was estimated utilising surrogates, including the number of hits as well as log-on timing. Face validity was assessed by a standardised questionnaire. Results Eighty-eight students took part in the lecture series and subsequent examination and questionnaire. Median multiple choice questionnaire (MCQ) marks were significantly higher in the aural lecture-derived stems versus the non-aural ( P = 0.012, Mann–Whitney U-test). There was widespread approval of web-based learning as an adjunct to conventional teaching. Usage rates were augmented significantly in the final week when compared to the previous 4 weeks (mean total hits weeks 1–4 ± SEM: 100.9 ± 9.7 and mean total hits week 5: 152.1 ± 13.1; P < 0.001, Kruskal–Wallis). However, total hits did not correlate with overall examination results ( r2 = 0.16). The aural lectures demonstrated higher face validity than the non-aural for content and presentation ( P < 0.05, Kruskal–Wallis). Conclusions The addition of aural files to the novel web-based lecture series is face valid and results in significantly increased examination performance. [ABSTRACT FROM AUTHOR]

Context Admissions interviews are unreliable and have poor predictive validity, yet are the sole measures of non-cognitive skills used by most medical school admissions departments. The low reliability may be due in part to variation in conditional reliability across the rating scale. Objectives To describe an empirically derived estimate of conditional reliability and use it to improve the predictive validity of interview ratings. Methods A set of medical school interview ratings was compared to a Monte Carlo simulated set to estimate conditional reliability controlling for range restriction, response scale bias and other artefacts. This estimate was used as a weighting function to improve the predictive validity of a second set of interview ratings for predicting non-cognitive measures (USMLE Step II residuals from Step I scores). Results Compared with the simulated set, both observed sets showed more reliability at low and high rating levels than at moderate levels. Raw interview scores did not predict USMLE Step II scores after controlling for Step I performance (additional r2 = 0.001, not significant). Weighting interview ratings by estimated conditional reliability improved predictive validity (additional r2 = 0.121, P < 0.01). Conclusions Conditional reliability is important for understanding the psychometric properties of subjective rating scales. Weighting these measures during the admissions process would improve admissions decisions. [ABSTRACT FROM AUTHOR]

Context Cognitive and learning styles research is limited by the lack of evidence supporting valid interpretations of style assessment scores. We sought evidence to support the validity of scores from 4 instruments: the Index of Learning Styles (ILS); the Learning Style Inventory (LSI); the Cognitive Styles Analysis (CSA), and the Learning Style Type Indicator (LSTI). The ILS assesses 4 domains: sensing−intuitive (SensInt), active−reflective (ActRefl), sequential−global (SeqGlob) and visual−verbal (VisVerb), each of which parallel a similar domain in at least 1 of the other instruments. Methods We administered the ILS, LSI and CSA to family medicine and internal medicine residents and Year 1 and 3 medical students and applied the multitrait−multimethod matrix to evaluate convergence and discrimination. After 3 months participants repeated the ILS and completed the LSTI. Results A total of 89 residents and medical students participated. Multitrait−multimethod analysis showed evidence of both convergence and discrimination for ActRefl (ILS, LSI and LSTI) and SensInt (ILS and LSTI) scores. ILS SeqGlob and SensInt scores showed unanticipated correlation. No other domains met the criteria for convergence or discrimination. Test-retest reliabilities for ILS scores were 0.856 for SensInt, 0.809 for ActRefl, 0.703 for SeqGlob and 0.684 for VisVerb. Cronbach's α values were ≥ 0.810 for LSI and 0.237–0.758 for LSTI. At least 9 participants misinterpreted the LSI instructions. Conclusions These data support the validity of ILS active−reflective and sensing−intuitive scores, LSI active−reflective scores and LSTI sensing−intuitive scores for determining learning styles in this population. Cognitive style and learning style scores may not be interchangeable, even for constructs with similar definitions. [ABSTRACT FROM AUTHOR]

The authors present the Minnesota Heart Failure Criteria (MHFC), derived using latent class analysis from widely available items in the Framingham Criteria. The authors used 1995 and 2000 data on hospitalized Minnesota Heart Survey subjects discharged after myocardial infarction or heart failure (N = 7,379). Selected Framingham Criteria variables (dyspnea, pulmonary rales, cardiomegaly, interstitial or pulmonary edema on chest radiograph, S3 heart sound, tachycardia) plus left ventricular ejection fraction were used. The discriminatory power of the MHFC was evaluated using age- and sex-adjusted 2-year mortality. A five-class latent class analysis model was collapsed into cases and noncases. Mortality estimates discriminated noncases (18%) from cases (43%) (p < 0.001). The MHFC performed better than previous truncated criteria (Framingham Criteria: 26% noncases, 43% cases; Duke Criteria: 29%, 40%; Killip Score: 31%, 44%; Boston Score: 28%, 45%). In a subset of patients admitted for heart failure (n = 5,128), the MHFC identified all but 2% (116/4,746) of cases found with a nearly full version of the Framingham Criteria. In terms of prognostic value, the MHFC are as precise as or more precise than several previous sets of truncated criteria. They closely approximate a nearly full version of the Framingham Criteria but require many fewer variables and can facilitate epidemiologic case-finding for heart failure. [ABSTRACT FROM AUTHOR]

The performance of the National Cancer Institute's food frequency questionnaire, the Diet History Questionnaire (DHQ), in estimating servings of 30 US Department of Agriculture Food Guide Pyramid food groups was evaluated in the Eating at America's Table Study (1997–1998), a nationally representative sample of men and women aged 20–79 years. Participants who completed four nonconsecutive, telephone-administered 24-hour dietary recalls (n = 1,301) were mailed a DHQ; 965 respondents completed both the 24-hour dietary recalls and the DHQ. The US Department of Agriculture's Pyramid Servings Database was used to estimate intakes of pyramid servings for both diet assessment tools. The correlation (ρ) between DHQ-reported intake and true intake and the attenuation factor (λ) were estimated using a measurement error model with repeat 24-hour dietary recalls as the reference instrument. Correlations for energy-adjusted pyramid servings of foods ranged from 0.43 (other starchy vegetables) to 0.84 (milk) among women and from 0.42 (eggs) to 0.80 (total dairy food) among men. The mean ρ and λ after energy adjustment were 0.62 and 0.60 for women and 0.63 and 0.66 for men, respectively. This food frequency questionnaire validation study of foods measured in pyramid servings allowed for a measure of food intake consistent with national dietary guidance. [ABSTRACT FROM AUTHOR]

Variations in the validity of hospital discharge diagnoses can complicate the assessment of trends in incidence of acute myocardial infarction (AMI). To clarify trends in the validity of discharge codes, the authors compared event classification based on published Atherosclerosis Risk in Communities (ARIC) Study criteria with the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge code for AMI (code 410). Between 1987 and 2000, 154,836 coronary heart disease events involving hospitalization in the four ARIC communities had ICD-9-CM codes screened for AMI. The sensitivity of ICD-9-CM code 410 for classifying AMI in men (sensitivity = 0.65, 95% confidence interval (CI): 0.63, 0.66) was statistically significantly greater than that found for women (sensitivity = 0.60, 95% CI: 0.58, 0.62) and was greater in Whites (sensitivity = 0.67, 95% CI: 0.65, 0.68) than in Blacks (sensitivity = 0.50, 95% CI: 0.47, 0.53). The ethnic difference was related to a greater frequency of hypertensive heart disease and congestive heart failure codes encompassing AMI among Blacks as compared with Whites. The authors found that although the validity of ICD-9-CM code 410 to identify AMI was generally stable from 1987 through 2000, differences between Blacks and Whites and across geographic locations support investment in validation efforts in ongoing surveillance studies. [ABSTRACT FROM AUTHOR]

Most existing coronary risk assessment methods are based on baseline data only. The authors compared the predictive ability of coronary multivariable risk scores based on updated versus baseline risk factors and investigated the optimal frequency of updating. Data from 16 biennial examinations of 4,962 subjects from the original Framingham Heart Study (1948–1978) were used. The predictive ability of three multivariable risk scores was evaluated through 10-fold cross-validation. The baseline-only multivariable risk score was computed using baseline values of coronary risk factors applied to a Cox model estimated from baseline data. The two other approaches relied on updated risk factors and included them in the models estimated from, respectively, baseline and updated data. All analyses were stratified by sex and age. For 30, 14, and 10 years of follow-up, the predictive ability of the baseline-only multivariable risk score was substantially poorer than that of the models using updated risk factors. Between the two latter models, the one estimated from updated data ensured better prediction than the one estimated from baseline data for 30 years of follow-up among younger subjects only. The results suggest that coronary risk assessment can be improved by utilizing updated risk factors and that the optimal frequency of updating may vary across subpopulations. [ABSTRACT FROM AUTHOR]

The reproducibility, relative validity, and responsiveness to change of an eight-item food frequency questionnaire designed to measure fruit and vegetable consumption was assessed among 157 women (mean age = 41 years) in the Netherlands from spring 2001 to spring 2002. Plasma concentrations of vitamin C and total and specific carotenoids served as biomarkers against which validity was assessed. The questionnaire was completed and biomarker concentrations were determined three times: immediately preceding and following a controlled intervention of 1 month aimed at increasing fruit and vegetable consumption and 1 year after the start of the intervention. The 1-month and 1-year reproducibility of total fruit and vegetable consumption assessed in the control group was 0.80 and 0.79 (Spearman’s r  ). Correlations between consumption and plasma carotenoids and vitamin C at baseline were 0.39 and 0.37, respectively, for fruits and 0.24 and 0.26, respectively, for vegetables. Correlations between changes in consumption and plasma carotenoids and vitamin C were 0.32 and 0.33, respectively, for fruits and 0.28 and 0.30, respectively, for vegetables. On the basis of similar correlations reported in the literature, the authors conclude that the questionnaire appears to be suitable for ranking individuals according to their consumption of fruits and vegetables and according to changes in their consumption. However, the validity of the questionnaire remains to be established in males, other age groups, and populations of lower educational levels. [ABSTRACT FROM AUTHOR]

A validation study evaluated the accuracy of self-reported use of commonly used medications among older women. Within a case-control study of breast cancer, drug information was ascertained by interview. Pharmacy records from 1990 to 1999 were obtained from a Washington State health maintenance organization (66% of subjects) and retail pharmacies (34% of subjects) on a sample of subjects (212 cases, 191 controls) and used as the “gold standard.” Recall accuracy was assessed for 6-month, 2-year, and 8-year time windows. Sensitivity of antihypertensive use was 92% (95% confidence interval (CI): 85, 96) for cases and controls in the 6-month period and slightly lower for the 2-year (90% (95% CI: 82, 94) and 87% (95% CI: 78, 92)) and 8-year (80% (95% CI: 69, 88) and 79% (95% CI: 68, 88)) periods. For statins, sensitivity was 83% (95% CI: 64, 93) for cases and 93% (95% CI: 69, 99) for controls in the 6-month period, 75% (95% CI: 55, 88) and 86% (95% CI: 60, 96) in the 2-year period, and 67% (95% CI: 42, 85) and 75% (95% CI: 41, 93) in the 8-year period. For self-report of antidepressants, sensitivities ranged from 66% (95% CI: 47, 80) in the 6-month period to 44% (95% CI: 30, 60) in the 8-year period. Specificity was high among all drug classes, ranging from 91% to 100%. Recall did not differ by case-control status. Trivial changes in estimates were observed when health maintenance organization records alone were used as the gold standard. Self-reported use of antihypertensives and statins appears to be relatively accurate among older women. [ABSTRACT FROM AUTHOR]

Purpose: To translate, adapt and validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms ICIQ-FLUTS for the Brazilian female population., Materials and Methods: A translation of the questionnaire into Brazilian Portuguese was made followed by an adaptation for better understanding by native speakers. After that, the ICIQ-FLUTS was answered by eighty volunteers (n=80) twice (for interviewers 1 and 2) with an interval of 30 minutes between them. Furthermore, after 15 days from the evaluation, the participants answered the ICIQ-FLUTS again in order to verify the questionnaire stability over time. The questionnaires Utian Quality Of Life (UQOL) and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), which are validated in Brazil were also applied to perform the validation., Results: The result of the Cronbach α coefficient of the instrument presented a value of 0.832. The values for test-retest were 0.907 (inter-observer) and 0.901 (intra-observer). The correlation between ICIQ-FLUTS (score I - domain of urinary incontinence) with the ICIQ-SF (final score) was strong and positive (r=0.836, p=0.000). In addition, the ICIQ-FLUTS showed moderate and negative correlation with the total score of UQOL (r=-0.691, p=0.017)., Conclusion: The Portuguese version of the ICIQ-FLUTS questionnaire showed strong correlation to ICIQ-SF questionnaire and satisfactory values to test-retest and internal consistency., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

ABSTRACT BACKGROUND: The Norwich Patellar Instability (NPI) score is a tool for evaluating the impact of patellofemoral instability on joint function. It has not been translated or culturally adapted for the Brazilian population before. OBJECTIVE: This study had the aims of translating and culturally adapting the NPI score for use in Brazilian Portuguese and subsequently assessing its validity for this population. DESIGN AND SETTING: Translation, cross-cultural adaptation and validation study conducted at the State Public Servants’ Institute of São Paulo, Brazil. METHODS: Sixty patients of both sexes (aged 16-40 years) with diagnoses of patellar dislocation were recruited. The translation and cultural adaptation were undertaken through translation into Brazilian Portuguese and back-translation to English by an independent translator. Face validity was assessed by a committee of experts and by 20 patients. Concurrent validity was assessed through comparing the Brazilian Portuguese NPI score with the Brazilian Portuguese versions of the Lysholm knee score and the Kujala patellofemoral disorder score among the other 40 patients. Correlation analysis between the three scores was performed using Pearson correlation coefficients with significance levels of P < 0.05. RESULTS: The Brazilian Portuguese version of the NPI score showed moderate correlation with the Brazilian Portuguese versions of the Lysholm score (r = -0.56; 95% confidence interval, CI: -0.74 to -0.30; P < 0.01) and Kujala score (r = -0.57; 95% CI: -0.75 to -0.31; P < 0.01). CONCLUSION: The Brazilian Portuguese version of the NPI score is a validated tool for assessing patient-reported patellar instability for the Brazilian population.

ABSTRACT Purpose Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese. Materials and Methods Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. Results Forty-six subjects were included in the symptomatic group (presence of “urgency”), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale “time to control urgency” and the item “impact” from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p

CONTEXT AND OBJECTIVE: Rheumatoid arthritis is a chronic systemic disease that causes joint damage. A variety of methods have been used to evaluate the general health status of these patients but few have specifically evaluated the hands. The objective of this study was to translate, perform cultural adaptation and assess the validity of the Michigan Hand Outcomes Questionnaire for Brazil.DESIGN AND SETTING: Validation study conducted at a university hospital in Curitiba, Brazil.METHODS: Firstly, the questionnaire was translated into Brazilian Portuguese and back-translated into English. The Portuguese version was tested on 30 patients with rheumatoid arthritis and proved to be understandable and culturally adapted. After that, 30 patients with rheumatoid arthritis were evaluated three times. On the first occasion, two evaluators applied the questionnaire to check inter-rater reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra rater reproducibility. To check the construct validity at the first assessment, one of the evaluators also applied other similar instruments.RESULTS: There were strong inter and intra rater correlations in all the domains of the Michigan Hand Outcomes Questionnaire. Cronbach's alpha was higher than 0.90 for all the domains of the questionnaire, thus indicating excellent internal validity. Almost all domains of the questionnaire presented moderate or strong correlation with other instruments, thereby showing good construct validity.CONCLUSION: The Brazilian Portuguese version of the Michigan Hand Outcomes Questionnaire was translated and culturally adapted successfully, and it showed excellent internal consistency, reproducibility and construct validity.

CONTEXT AND OBJECTIVE: Lifestyle includes the personal attitudes or behavioral patterns that result in risks or benefits to the individual's own health or that of others. Children's health is particularly determined by their mother's lifestyle. The objective here was to develop and evaluate the reliability of a questionnaire capable of describing the lifestyles of preschoolers' mothers in terms of their activities, interests, opinions and values. DESIGN AND SETTING: Cross-sectional study conducted in a public university. METHODS: This study was conducted between January 2010 and March 2011, among 255 mothers of preschoolers living in the southeastern region of the municipality of São Paulo. A proportional stratified random probabilistic sample with two strata was selected: schools were drawn and then the children. Three instruments found in the literature were used to create the lifestyle questionnaire. The questionnaire was developed in eight stages: preliminary pretest, cultural adaptation, second pretest, pilot study, semantic correction and adaptation, third pretest, final research and final retest. Cronbach's alpha and pairwise correlation coefficients were used. RESULTS: The Cronbach's alpha value in the final version was 0.83 and the pre and post-test pairwise correlation coefficients were greater than 0.5. Factor analysis identified five factors that explained 73.51% of the correlation variance. As a result, seven variables were eliminated from the questionnaire. CONCLUSIONS: The questionnaire described five lifestyle domains, with good reliability, and can be used in combination with preschoolers' health and nutritional outcomes.

Purpose: Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese., Materials and Methods: Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested., Results: Forty-six subjects were included in the symptomatic group (presence of "urgency"), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale "time to control urgency" and the item "impact" from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p<0.05), but the subscale "fear of incontinence" and the item "severity" of the VAS did not. All of the UQ subscales showed internal consistencies that were considered to be good or excellent., Conclusion: The Portuguese version of the UQ proved to be a valid tool for the evaluation of OAB in individuals whose native language is Portuguese., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Introduction: Using physiologic scoring systems for identifying high-risk patients for mortality has been considered recently. This study was designed to evaluate the values of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiologic Score (SAPS II) models in prediction of 1-month mortality of critically ill patients., Methods: The present prospective cross sectional study was performed on critically ill patients presented to emergency department during 6 months. Data required for calculation of the scores were gathered and performance of the models in prediction of 1-month mortality were assessed using STATA software 11.0., Results: 82 critically ill patients with the mean age of 53.45 ± 20.37 years were included (65.9% male). Their mortality rate was 48%. Mean SAPS II (p < 0.0001) and APACHE II (p = 0.0007) scores were significantly higher in dead patients. Area under the ROC curve of SAPS II and APACHE II for prediction of mortality were 0.75 (95% CI: 0.64 - 0.86) and 0.72 (95% CI: 0.60 - 0.83), respectively (p = 0.24). The slope and intercept of SAPS II were 1.02 and 0.04, respectively. In addition, these values were 0.92 and 0.09 for APACHE II, respectively., Conclusion: The findings of the present study showed that APACHE II and SAPS II had similar value in predicting 1-month mortality of patients. Discriminatory powers of the mentioned models were acceptable but their calibration had some amount of lack of fit, which reveals that APACHE II and SAPS II are partially perfect., Competing Interests: None