Cross-cultural adaptation and validation of the Portuguese version of the Oxford Knee Score (OKS)

The purpose of this study was to translate and culturally adapt the Oxford Knee Score (OKS) to the Portuguese language and to test its reliability and validity. This new version was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese OKS and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, visual analog scales (VAS) of pain and disability, and a form for the characteristics of the patients were administered to 80 subjects who underwent total knee replacement (TKR) for severe knee osteoarthritis (OA). Reliability was acceptable with a Cronbach's alpha coefficient of 0.87, and an intraclass correlation coefficient (ICC) of 0.97. Construct validity was supported by the confirmation of three predefined hypotheses involving expected significant correlations between OKS scale, SF-36 subscales and VAS that represent similar constructs. The Portuguese OKS exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity.     

The Japanese version of the Multiple Affect Adjective Checklist-Revised: development and validation

In order to develop a Japanese version of the Multiple Affect Adjective Checklist-Revised (MAACL-R), the 66 scored adjectives were translated into Japanese and translated back into English as recommended by Werner and Campbell (1971). Confirmatory factor analyses evidenced the existence of five first-order factors (i.e., the anxiety, depression, hostility, positive affect, and sensation-seeking factors) and the two second-order factors (i.e., the dysphoric and pleasant affect factors) underlying the response to the Japanese MAACL-R. Internal consistency ranged from .73 to .91, and four-week retest reliability ranged from .67 to .74 on the seven scales (Anxiety, Depression, Hostility, Positive Affect, Sensation Seeking, Dysphoria, and PASS). Although correlations with the scales of the State-Trait Personality Inventory, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression scale, a sensation-seeking scale, and a subjective well-being scale indicated only acceptable discriminant validity, adequate convergent validity was evidenced by the examination of these correlations. The Japanese version of the MAACL-R seems to be ready for use in research.     

Cross-cultural adaptation and validation of the health literacy assessment tool METER in the Portuguese adult population

Objective

We aimed to culturally adapt and validate METER in the Portuguese population, and to define cut-off values for adequate health literacy.

Methods

We used the standard procedure for the adaptation of the words and surveyed health professionals to select the non-words. The instrument was administered to a total sample of 249 participants and retested in a sub-sample of 45 after three months. Cut-offs were defined using the modified Angoff procedure. Construct validity was assessed through association with educational attainment and health-related occupation.

Results

Exploratory factor analysis revealed two dimensions of the instrument, one for words and another for non-words. METER showed a high degree of internal consistency, and acceptable test–retest reliability. Adequate health literacy was defined as scoring at least 35/40 in words and 18/30 in non-words. Physicians scored higher than any other group, followed by health researchers, researchers from other areas and by people with progressively lower levels of education (p < 0.001).

Conclusion

We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and reliable.

Practice implications

The Portuguese version of METER can be used to assess health literacy in Portuguese adults and to explore associations with health outcomes.     

Development and initial validation of an Arabic version of the Expanded Trail Making Test: implications for cross-cultural assessment.

The performances of Sudanese subjects, both normal and brain damaged, on an Arabic version of the Expanded Trail Making Test were compared to those of normal and brain-damaged subjects from the United States, who completed the standard English version of this test. Preliminary psychometric properties of the Arabic version of the Expanded Trail Making Test were defined. Significant intergroup differences in performance were observed. Interestingly, the performances of Sudanese normals were found to be similar to those of U.S. brain-damaged subjects. The results are discussed in terms of reducing neuropsychological diagnostic errors attributable to ethnocultural factors.     

The psychological mindedness assessment procedure – validation study of a Dutch version

Objective The Psychological Mindedness Assessment Procedure [PMAP; McCallum, M. & Piper, W. E. (1990) ] operationalizes psychological mindedness as a participant's understanding of the problem presented by two videotaped enacted patients. To possibly enhance predictive power for psychotherapy outcome, we added two video scenarios with emotionally high‐impact. This article describes psychometric properties of the Dutch translation of the PMAP and the extended version, the PMAP‐plus. Design A therapy‐analogue study with non‐clinical participants (N=100). Methods In individual sessions, participants watched the four video‐scenarios and responded to the PMAP‐question ‘What seems to be troubling this woman?’. Emotional reactions were measured using the Positive And Negative Affect Schedule [PANAS; Watson, D., Clark, L. E. & Tellegen, A. (1988) ]. Results The PMAP and the PMAP‐plus had good interrater reliability. As expected, PMAP‐levels were lower for the newly added high‐emotional scenarios. Validity was further supported by a negative relation of PMAP‐scores with the Negative Affect subscale. Conclusions The Dutch translation of the PMAP and the added scenarios of the PMAP‐plus are reliable instruments. The predictive power for psychotherapy outcome needs to be investigated in a patient group. The variation in presented clinical problems could also make it a useful instrument to assess psychological mindedness in psychotherapists.     

Cross-cultural validation of Antonovsky's Sense of Coherence scale

This study empirically validated Antonovsky's suggestion that a Sense of Coherence is important in managing stress and remaining both physically and psychologically healthy. In both Anglo-American and Native American cultures, Sense of Coherence Measures were found to correlate negatively with measures of physical and mental distress. More interestingly, this study supported Antonovsky's prediction that people from various cultures may attain a similar level of a Sense of Coherence, despite great socioeconomic differences. © 1996 John Wiley & Sons, Inc.     

A validation study of the Korean version of SPAN

Purpose

The SPAN, which is acronym standing for its four components: Startle, Physiological arousal, Anger, and Numbness, is a short post-traumatic stress disorder (PTSD) screening scale. This study sought to develop and validate a Korean version of the SPAN (SPAN-K).

Materials and Methods

Ninety-three PTSD patients (PTSD group), 73 patients with non-psychotic psychiatric disorders (psychiatric control group), and 88 healthy participants (normal control group) were recruited for this study. Participants completed a variety of psychiatric assessments including the SPAN-K, the Davidson Trauma Scale (DTS), the Clinician-Administered PTSD Scale (CAPS), and the State-Trait Anxiety Inventory (STAI).

Results

Cronbach''s α and test-retest reliability values for the SPAN-K were both 0.80. Mean SPAN-K scores were 10.06 for the PTSD group, 4.94 for the psychiatric control group, and 1.42 for the normal control group. With respect to concurrent validity, correlation coefficients were 0.87 for SPAN-K vs. CAPS total scores (p<0.001) and 0.86 for SPAN-K vs. DTS scores (p<0.001). Additionally, correlation coefficients were 0.31 and 0.42 for SPAN-K vs. STAI-S and STAI-T, respectively. Receiver operating characteristic analysis of SPAN-K showed good diagnostic accuracy with an area under the curve (AUC) of 0.87. The SPAN-K showed the highest efficiency at a cutoff score of 7, with a sensitivity of 0.83, a specificity of 0.81, positive predictive value (PPV) of 0.88, and negative predictive value (NPV) of 0.73.

Conclusion

These results suggest that the SPAN-K had good psychometric properties and may be a useful instrument for rapid screening of PTSD patients.     

Cross-cultural education in U.S. medical schools: development of an assessment tool.

PURPOSE: Medical education is responding to an increasingly diverse population and to regulatory and quality-of-care requirements by developing cross-cultural curricula in health care. This undertaking has proved problematic because there is no consensus on what elements of cross-cultural medicine should be taught. Further, less is known about what is being taught. This study hypothesized that a tool could be developed to assess common themes, concepts, learning objectives, and methods in cross-cultural education. METHOD: In 2001, 31 U.S. medical schools were invited to provide the researchers all written and/or Web-based materials related to implementing cross-cultural competency in their curricula. A tool was developed to measure teaching methods, skill sets, and eight content areas in cross-cultural education. RESULTS: A total of 19 medical schools supplied their curricular materials. There was considerable variation in approaches to teaching and in the content of cross-cultural education across the schools. Most emphasized teaching general themes, such as the doctor-patient relationship, socioeconomic status, and racism. Most also focused on specific cultural information about the ethnic communities they served. Few schools extensively addressed health care access and language issues. CONCLUSIONS: This assessment tool is an important step toward developing a standard nomenclature for measuring the success of cross-cultural education curricula. On the national level, the tool can be used to compare program components and encourage the exchange of effective teaching tools by promoting a common language, which will be essential for developing and implementing curricula, for comparing programs, and evaluating their effects on quality of care.     

The results of investigation by the Japanese version of Morningness-Eveningness Questionnaire

Morningness-Eveningness Questionnaire (MEQ) developed by Horne & Ostberg (1976) was translated into Japanese, and then, MEQ and Life Habits Inventory were administered to approximately 1,500 university students. The distribution of MEQ scores was essentially normal, and the reliability of this questionnaire was high (r alpha = .702). Comparing among the morning, evening, and intermediate types, it was found that the morning type retired and arose significantly earlier than other types, although there was no significant differences in sleep length. Furthermore, there were significant differences between the morning and evening types in sleep latency, mood on arising, adequate amount of sleep, frequency and duration of nap, and number of staying awake all night per month. These results suggested that the evening type had more irregular sleep-waking habits than the morning type. Since the above results were obtained only from student population, further investigation on various populations is requested.     

The Croatian version of the Body Image Scale: translation and validation

AimTo validate the Croatian translation of the Body Image Scale in breast cancer and chronic kidney disease patients.MethodsThe scale was administered to 172 breast cancer patients and to 89 chronic kidney disease patients. Measures of depression and anxiety were used to assess the convergent validity. Both groups were divided based on their treatment types.ResultsIn both samples, the scale showed high internal consistency (Cronbach''s Alpha 0.958 for breast cancer patients, 0.855 for chronic kidney disease patients) item-total correlations (0.72-0.88 for breast cancer patients, 0.46-0.65 for chronic kidney disease patients), and convergent validity. In the breast cancer group, the factor analysis showed a single-factor solution, while in the chronic kidney disease group it showed a two-factor solution. Good discriminant validity was obtained among breast cancer patients, with patients who underwent complete mastectomy scoring higher than patients who underwent partial mastectomy. The scale showed no discriminant validity among chronic kidney disease patients.ConclusionThe Croatian BIS shows good psychometric properties.

Body image (BI) is a multidimensional construct consisting of perceptions, feelings, and thoughts related to the general appearance, function, and physical competence of one''s body (1,2). Changes in body appearance and functioning as a result of cancer treatment and surgery can negatively affect patients'' BI. In patients undergoing conserving surgery and mastectomy, BI-related problems are often underestimated as survival is put to the forefront. Unfavorable physical changes in these patients greatly affect their self-perception (3-6). Negative BI in cancer patients correlates with a lower quality of life (QOL) (7). It can also prevent posttraumatic growth, which is defined as a positive change resulting from stressful and traumatic events (6,8).BI is assessed either by items in global measures of QOL or by separate BI questionnaires (9). Despite the importance of BI in cancer patients, relatively few BI assessment tools have been thoroughly validated for application in oncology. Several tools are specifically designed for use in breast cancer patients: the Body Image After Breast Cancer Questionnaire, the Body Image and Relationships Scale, the Breast-Impact of Treatment Scale, and Sexual Adjustment and Body Image Scale (SABIS). The SABIS was initially developed for breast cancer patients, but there is also a gynecologic version, SABIS-G (5). The assessment tools that have been validated in several types of cancer patients include Body Image Screener for Cancer Reconstruction and the Measure of Body Apperception, and the Body Image Scale (BIS) (10,11).The BIS is a 10-item scale developed by Hopwood et al (12) that measures affective, behavioral, and cognitive aspects of BI in all cancer patients, applicable in research and clinical settings. The respondents rate the severity of their symptoms on a four-point scale, from 0 (“not at all”) to 3 (“very much”), and the 10 item scores are combined into a total score ranging from 0 to 30 (12).The questionnaire was initially validated in a British sample of heterogeneous cancer patients and breast cancer patients, showing good measurement properties (12). Since then, the BIS has been validated in several languages, including Dutch, Greek, and Portuguese (11,12). Furthermore, it was applied in more cross-cultural studies compared with other BI assessment tools used in oncology (10). Although BIS has been designed for BI assessment in cancer patients, it has also been used in other populations, eg, to assess psychosocial outcomes in kidney donors after surgery (13).The aim of this study was to validate the Croatian translation of BIS in breast cancer patients and chronic kidney disease (CKD) patients. To the best of our knowledge, this is the first Croatian translation of the BIS, an important fact when considering the relatively few validated tools for BI assessment designed specifically for these patients. Furthermore, this valuable instrument can be used for further research in this largely under-researched scientific area in the Croatian population. A complete Croatian version is available in the supplement and can be freely used in other research.     

Validity of the Japanese version of the GHQ among antenatal clinic attendants

The validity of the Japanese version of the 30-item General Health Questionnaire (GHQ) was examined against the semi-structured interview-based Research Diagnostic Criteria (RDC) as external criteria. The GHQ total score discriminated 'cases' and 'non-cases' satisfactorily but its recommended cut-off point was higher (7/8) than that of the original English version (4/5). Discriminant function analysis revealed that only 13 items contributed to the discriminatory power and that their discriminant function score was better than a simple summation of the 30 GHQ item scores in terms of validity.     

Comprehensive assessment of P21 polymorphisms and lung cancer risk

The purpose of this study is to comprehensively evaluate potential functional polymorphisms in the P21 gene in relation to the risk of lung cancer. We first determined the frequencies of P21 polymorphisms in 27 healthy Koreans, and then examined three polymorphisms (−2266G > A, S31R, and IVS2 + 16G > C), based on their frequencies and haplotype-tagging status, in a case–control study. Individuals with at least one −2266A allele were at a significantly decreased risk of lung cancer compared with those harboring the −2266 GG genotype [adjusted odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.53–0.95, P = 0.02). The haplotypes (ht2–4) carrying 31R or IVS2 + 16C alleles were associated with a significantly decreased risk of lung cancer compared with the haplotype 31S/IVS2 + 16G, which carried wild-type alleles at both loci (adjusted OR = 0.65, 95% CI = 0.50–0.83, P = 0.007)]. When the −2266A allele and ht2–4 were considered to be protective alleles, the risk of lung cancer decreased in a dose-dependent manner as the number of protective alleles increased (P = 0.0002). These results suggest that a combined analysis of these three P21 polymorphisms might better predict the risk of lung cancer than the analysis of a single polymorphism.     

Pseudomesotheliomatous carcinoma of the lung. A variant of peripheral lung cancer.

Six cases of primary lung cancer that closely mimic malignant pleural mesothelioma clinically and anatomically are compared with four proven cases of malignant pleural mesothelioma. Findings on roentgenograms of the chest, clinical history, and gross examination of the lung specimens are not helpful in distinguishing between these two neoplasms. Microscopic examination of the hematoxylin and eosin-stained tissues is often inconclusive. Tissues were stained with hematoxylin and eosin, PAS with and without diastase treatment (DPAS), mucicarmine, alcian blue, toluidine blue, and colloidal iron with and without digestion by testicular hyaluronidase. Among these histochemical methods, DPAS was found to be particularly useful in distinguishing the primary lung cancers from the mesotheliomas. All primary lung cancers except one showed DPAS-positive material (mucin) in both the cytoplasm of the cancer cells and within the lumina of neoplastic glands. In contrast, none of the mesotheliomas showed the presence of DPAS-positive material. Histologically, all lung cancers were glandular. Five were classified as bronchiolar carcinoma, the remaining one as poorly differentiated adenocarcinoma. In two of the bronchiolar carcinomas, a small subpleural primary focus was demonstrated. This finding suggests a possible origin of these cancers as a small subpleural tumor that became widely disseminated via the subpleural lymphatics. This form of primary lung cancer possesses sufficient gross and microscopic characteristics that recognition should be given to it as a variant of primary lung cancer, with emphasis on differentiating it from pleural mesothelioma.     

Psychotherapy for the spouses of lung cancer patients: assessment of an intervention

This study was a randomized prospective clinical trial to test the effect of a professionally provided program of social support counselling on newly diagnosed lung cancer patients and their families. Over the 6 months of the intervention there was no differential change by experimental status for either the patients or their principal support in outcome measures of emotional, social, or physical function. This paper reviews methodological issues which must be considered before accepting these negative findings. Further, it discusses important design considerations relevant for any psychotherapy intervention study in medical patients.