Cross-cultural adaptation and validation of the simplified chinese version of the fremantle back awareness questionnaire in patients with low back Pain

Purpose

The Fremantle back awareness questionnaire (FreBAQ) was recently developed as simple and quick tool to assess back-specific body perception in Low back pain (LBP) patients. The aim of the present study was to translate and cross-culturally adapt the Fremantle back awareness questionnaire (FreBAQ) into a Simplified Chinese version (FreBAQ-C), and evaluate the reliability and validity of the FreBAQ-C in patients with non-specific Chronic Low back pain (CLBP).

Methods

The FreBAQ was translated into Chinese according to established methods. Internal consistency was assessed according to Cronbach’s alpha. Test–retest reliability was estimated by Intraclass correlation coefficient (ICC). Construct validity was evaluated by correlations between the FreBAQ-C and Visual analogue scale (VAS), Roland-Morris disability questionnaire (RDQ), Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK) as well as Hospital anxiety and depression scale (HADS).

Results

A total of 105 participants (38 males and 67 females) were included in this study with the mean age of 54.1 ± 15.6 years, mean duration of LBP of 6.8 ± 4.6 years. The FreBAQ-C total scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach’s alpha = 0.833). ICC of test–retest reliability was good (0.897, 95% confidence interval: 0.852–0.929). The limits of agreement (LOA) ranged from − 5.8 to 6.3. The Standard error of measurement (SEM) and Minimum detectable change (MDC) were 2.16 and 5.99. Construct validity was confirmed by significant correlation of The FreBAQ-C and VAS during motion (r = 0.274, p = 0.005) and rest (r = 0.243, p = 0.012), RDQ (r = 0.377, p < 0.001), PCS (r = 0.439, p < 0.001), and TSK(r = 0.311, p = 0.001).

Conclusions

The FreBAQ-C was demonstrated to have acceptable reliability and validity for patients with non-specific CLBP in Chinese mainland. It will allow evaluating body preception of the back in the Chinese population with CLBP.

     

Thiol–disulphide balance in infertility secondary to varicocele

Oxidative stress plays an important role in the development of infertility secondary to varicocele. We aimed to investigate the dynamic thiol–disulphide homeostasis as an oxidative stress marker in the spermatic vein of infertility secondary to varicocele. Sixty‐one patients with varicocele were included in the study. Blood was drawn from the median cubital vein and the testicular venous return side before the spermatic vein was separated during surgery. Total thiol, native thiol, disulphide, ischaemia modified albumin (IMA) and albumin values were measured from both the dilated spermatic vein and the median cubital vein. The disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were determined. The mean age of the patients was 27.0 ± 6.68 (15–50) years. While the albumin, native thiol and total thiol values and the native thiol/total thiol ratio were significantly lower (p = 0.004, p < 0.001, p < 0.001, p < 0.001 respectively), the IMA value and the disulphide/native thiol and disulphide/total thiol ratios were significantly higher (p < 0.001, p < 0.001, p < 0.001 respectively) in the samples taken from spermatic venous blood. Thiol–disulphide balance had deteriorated towards disulphide formation in the spermatic vein compared with the peripheral vein. Abnormal thiol–disulphide balance may be an independent risk factor for infertility secondary to varicocele.     

Differing effects of PTH 1–34, PTH 1–84, and zoledronic acid on bone microarchitecture and estimated strength in postmenopausal women with osteoporosis: An 18‐month open‐labeled observational study using HR‐pQCT

Whereas the beneficial effects of intermittent treatment with parathyroid hormone (PTH) (intact PTH 1–84 or fragment PTH 1–34, teriparatide) on vertebral strength is well documented, treatment may not be equally effective in the peripheral skeleton. We used high‐resolution peripheral quantitative computed tomography (HR‐pQCT) to detail effects on compartmental geometry, density, and microarchitecture as well as finite element (FE) estimated integral strength at the distal radius and tibia in postmenopausal osteoporotic women treated with PTH 1–34 (20 µg sc daily, n = 18) or PTH 1–84 (100 µg sc daily, n = 20) for 18 months in an open‐label, nonrandomized study. A group of postmenopausal osteoporotic women receiving zoledronic acid (5 mg infusion once yearly, n = 33) was also included. Anabolic therapy increased cortical porosity in radius (PTH 1–34 32 ± 37%, PTH 1–84 39 ± 32%, both p < 0.001) and tibia (PTH 1–34 13 ± 27%, PTH 1–84 15 ± 22%, both p < 0.001) with corresponding declines in cortical density. With PTH 1–34, increases in cortical thickness in radius (2.0 ± 3.8%, p < 0.05) and tibia (3.8 ± 10.4%, p < 0.01) were found. Trabecular number increased in tibia with both PTH 1–34 (4.2 ± 7.1%, p < 0.05) and PTH 1–84 (5.3 ± 8.3%, p < 0.01). Zoledronic acid did not impact cortical porosity at either site but increased cortical thickness (3.0 ± 3.5%, p < 0.01), total (2.7 ± 2.5%, p < 0.001) and cortical density (1.5 ± 2.0%, p < 0.01) in tibia as well as trabecular volume fraction in radius (2.5 ± 5.1%, p < 0.05) and tibia (2.2 ± 2.2%, p < 0.01). FE estimated bone strength was preserved, but not increased, with PTH 1–34 and zoledronic acid at both sites, whereas it decreased with PTH 1–84 in radius (?2.8 ± 5.8%, p < 0.05) and tibia (–3.9 ± 4.8%, p < 0.001). Conclusively, divergent treatment‐specific effects in cortical and trabecular bone were observed with anabolic and zoledronic acid therapy. The finding of decreased estimated strength with PTH 1–84 treatment was surprising and warrants confirmation. © 2013 American Society for Bone and Mineral Research.     

Psychological and Work Stress Assessment of Patients following Angioplasty or Heart Surgery: Results of 1‐year Follow‐up Study

The aim of this study was to explore changes in subjective psychological health and perceived work stress among patients who returned to work (RTW) after a multidisciplinary cardiac rehabilitation (CR) following cardiac interventions. A total of 108 patients were evaluated at the beginning of their CR, at 6 and 12 months after discharge. Self‐report questionnaires were used to assess depression, anxiety, illness perception and work stress at each time stage. Results showed reports of depressive symptoms significantly decreased (p < 0.05) and subjective mental (p = 0.001) and physical health (p < 0.001) improved over time. Patients revealed a decrease in Type A behaviour pattern (p < 0.001) and in job satisfaction levels (p = 0.01), greater internal locus of control (p < 0.01) and increased use of the coping strategy ‘Involvement’ (p < 0.01). Major findings are that cardiac patients had an improvement in subjective psychological health and did not perceive increased work stress after their RTW. Patients' psychological health and work stress need to be assessed during the CR and should be also carefully monitored after the RTW in order to identify patients' psychological and work‐related barriers and facilitate a safe and successful work reintegration. Copyright © 2014 John Wiley & Sons, Ltd.     

Background Stress Inventory: Developing a Measure of Understudied Stress

Background stress is an understudied source of stress that involves both ambient stress and daily hassles upon which new stressors are superimposed. To date, an accurate measure of the background stress construct has not been available. We developed the Background Stress Inventory, a 25‐item self‐report measure that asks respondents to indicate how distressed they have felt over the past month and the majority of the past year across five domains: financial, occupation, environment, health and social. Seven hundred seventy‐two participants completed the paper‐and‐pencil measure; the sample was randomly split into two separate subsamples for analyses. Exploratory factor analysis suggested five factors corresponding to these domains, and confirmatory factor analysis showed acceptable global fit (X²(255) = 456.47, comparative fit index = 0.94, root mean square error of approximation = 0.045). Cronbach's alpha (0.89) indicated good internal reliability. Construct validity analyses showed significant positive relationships with measures of perceived stressfulness (r = 0.62) and daily hassles (0.41), p's < 0.01. Depressive symptoms (0.62) and basal blood pressure (0.21) were both significantly associated with background stress, p's < 0.01. The importance of the proposed measure is reflected in the limited research base on the impact of background stress. Systematic investigation of this measure will provide insight into this understudied form of chronic stress and its potential influence on both psychological and physical endpoints. Copyright © 2013 John Wiley & Sons, Ltd.     

The Perceived Stress Scale for Kids (PeSSKi): Initial development of a brief measure for children aged 7–11 years

Perceived stress, a known risk factor for poor health, has been extensively assessed in adult populations. Yet an equivalent assessment tool for measurement of global perceived stress in children is lacking. This study aimed to develop and provide initial validation of a scale to measure perceived stress in children aged 7–11 years. Using a two-phase design, we conducted semi-structured interviews with thirteen child-parent dyads for development of items. In a sample of 123 children (age range 7–11 years, Mage = 9 years 7 months, 54.5% male) we administered the resulting Perceived Stress Scale for Kids (PeSSKi). Exploratory factor analysis of the 10-item PeSSKi yielded support for both a one-factor and a two-factor solution (negative, positive item wording). The PeSSKi was associated positively with the Penn-State Worry Questionnaire for Children (r = 0.748, p < 0.001) and negatively with the Students' Life Satisfaction Scale (r = 0.381, p < 0.001) indicating strong convergent/divergent validity respectively. Girls showed higher scores on the PeSSKi than boys with no effects observed by age. Initial psychometrics suggest the PeSSKi provides a robust scale for assessment of perceived stress in children. Further validation is needed across different child populations, over time and with physical measures of stress and health outcomes.     

Impact of physician assistance on the reliability of the International Index of Erectile Function

The aim of this study was to analyse the impact of assistance on the comprehensibility and reliability of the Turkish version of International Index of Erectile Function (IIEF). In this study, 458 patients were asked to complete the IIEF questionnaire by themselves during their first visit and then once again during their second visit with the assistance of a physician. The impact of physician assistance was evaluated by comparing the first and second questionnaires. The data were analysed using statistical package software (spss ). A t test, Cronbach's alpha analysis, test–retest correlation (Pearson) and comparison of two rates between two independent groups test were used to analyse the impact of physician assistance. A P value <0.05 was considered to be significant. The proportions of the patients who completed the questionnaires were 70.9% and 100% at the first and second visit respectively. Physician assistance significantly increased the number of patients who completed the questionnaire among patients ≥60 years old (P = 0.0009) and in patients with low levels of education (P = 0.0001). The Cronbach's alpha coefficients were 0.782 and 0.917 for the first and second questionnaires respectively. A high degree of internal consistency was observed for the ‘physician‐assisted’ questionnaire (P < 0.001), and relatively less internal consistency was found for the ‘self‐administered’ questionnaire (P < 0.05) A relatively weaker correlation was found between the first and second questionnaires in primary school graduates (r = 0.391, P < 0.05) and in patients ≥60 years old (r = 0.433, P < 0.05). There was a significant difference between the ‘self‐administered’ and ‘physician‐assisted’ IIEF scores in patients ≥60 years old (P < 0.0001) and primary school graduates (P < 0.0001). Physician assistance increased the comprehensibility and reliability of the IIEF questionnaire, especially in elderly patients and in patients with low education levels.     

Support for the Multidimensional Adolescent Stress Questionnaire in a Sample of Adolescents in the United Kingdom

Adolescence is a time of physical, social and emotional development, and this development can be accompanied by feelings of stress. The Adolescent Stress Questionnaire is a 56‐item scale measuring stress in 10 domains. Developed in Australia, the scale has been translated, and its reliability and validity have been tested in a number of countries across Europe, where the 10‐factor, 56‐item version of the scale has received little support. The present study tested the factor structure, construct validity and reliability in a sample (n = 610) of adolescents in the United Kingdom. Support was found for the 10‐factor, 56‐item version of the scale, and correlations with self‐concept measures, sex scores on stress factors and Cronbach's α‐values, suggesting that the scale may be a viable assessment tool for adolescent stress. Results for alcohol‐specific analyses support the domain‐specific nature of the scale. Future work may seek to investigate the stability of age‐specific stress domains (e.g. the stress of Emerging Adult Responsibility) in samples that include younger adolescents. Copyright © 2014 John Wiley & Sons, Ltd.     

Exploring Reliability and Validity of the Deployment Risk and Resilience Inventory‐2 Among a Nonclinical Sample of Discharged Soldiers Following Mandatory Military Service

The Deployment Risk and Resilience Inventory (DRRI) is a widely used questionnaire assessing deployment‐related risk and resilience factors among war veterans. Its successor, the DRRI‐2, has only been validated and used among veterans deployed for overseas military missions, but because many countries still enforce compulsory military service, validating it among nonclinical samples of healthy discharged soldiers following mandatory service is also a necessity. In the current study, a sample of 101 discharged Israeli soldiers (39 males, 62 females; mean time since discharge 13.92, SD = 9.09 years) completed the DRRI‐2. There were 52 participants who completed the questionnaire at a second time point (mean time between assessments 19.02, SD = 6.21 days). Both physical and mental health status were examined, as well as symptomatology of depression, anxiety, and posttraumatic stress disorder. Cronbach's αs for all latent variables in the inventory ranged from .47 to .95. The DRRI‐2 risk factors were negatively associated with psychological functioning, whereas resilience factors were positively associated with better self‐reported mental health. Test‐retest reliability coefficients were generally high (Pearson correlations were .61 to .94, all p values < .01). Our study provides evidence for the reliability and validity of the DRRI‐2 in assessing salient deployment experiences among a nonclinical sample following mandatory military service.     

Multicenter precision of cortical and trabecular bone quality measures assessed by high‐resolution peripheral quantitative computed tomography

High‐resolution peripheral quantitative computed tomography (HR‐pQCT) has recently been introduced as a clinical research tool for in vivo assessment of bone quality. The utility of this technology to address important skeletal health questions requires translation to standardized multicenter data pools. Our goal was to evaluate the feasibility of pooling data in multicenter HR‐pQCT imaging trials. Reproducibility imaging experiments were performed using structure and composition‐realistic phantoms constructed from cadaveric radii. Single‐center precision was determined by repeat scanning over short‐term (<72 hours), intermediate‐term (3–5 months), and long‐term intervals (28 months). Multicenter precision was determined by imaging the phantoms at nine different HR‐pQCT centers. Least significant change (LSC) and root mean squared coefficient of variation (RMSCV) for each interval and across centers was calculated for bone density, geometry, microstructure, and biomechanical parameters. Single‐center short‐term RMSCVs were <1% for all parameters except cortical thickness (Ct.Th) (1.1%), spatial variability in cortical thickness (Ct.Th.SD) (2.6%), standard deviation of trabecular separation (Tb.Sp.SD) (1.8%), and porosity measures (6% to 8%). Intermediate‐term RMSCVs were generally not statistically different from short‐term values. Long‐term variability was significantly greater for all density measures (0.7% to 2.0%; p < 0.05 versus short‐term) and several structure measures: cortical thickness (Ct.Th) (3.4%; p < 0.01 versus short‐term), cortical porosity (Ct.Po) (15.4%; p < 0.01 versus short‐term), and trabecular thickness (Tb.Th) (2.2%; p < 0.01 versus short‐term). Multicenter RMSCVs were also significantly higher than short‐term values: 2% to 4% for density and micro–finite element analysis (µFE) measures (p < 0.0001), 2.6% to 5.3% for morphometric measures (p < 0.001), whereas Ct.Po was 16.2% (p < 0.001). In the absence of subject motion, multicenter precision errors for HR‐pQCT parameters were generally less than 5%. Phantom‐based multicenter precision was comparable to previously reported in in vivo single‐center precision errors, although this was approximately two to five times worse than ex vivo short‐term precision. The data generated from this study will contribute to the future design and validation of standardized procedures that are broadly translatable to multicenter study designs. © 2013 American Society for Bone and Mineral Research.     

Analysis of Trabecular Microstructure and Vascular Distribution of Capital Femoral Epiphysis Relevant to Legg–Calve–Perthes Disease

Legg–Calve–Perthes disease is characterized by the capital femoral epiphyseal collapse, which occurs more reliably in the anterior quadrant than the more weight‐bearing lateral quadrant. The purpose of this study was to determine whether there is a vascular or microstructural predisposition for anterior femoral epiphyseal collapse in Perthes disease. Thirty‐two cadaveric proximal femoral epiphyses from 17 subjects (age 4–14 years old) underwent micro‐computed tomography at 10‐μm resolution. Each quadrant was analyzed for four markers of trabecular architecture: bone volume fraction (BV/TV), trabecular thickness, trabecular separation (TbSp), and trabecular number (TbN). Vascular channels were then mapped in each quadrant, identified by correlating surface topography with cross‐sectional imaging. One‐way analysis of variance revealed an overall difference between quadrants (p < 0.001) in BV/TV, TbN, and TbSp. However, post hoc analysis revealed there was no significant difference between the anterior and lateral quadrants for any of the four markers of trabecular architecture. Vascular channel mapping illustrated a predominance of vessels in the posterior half of the epiphysis compared to the anterior half (8.7 ± 4.0 vs. 3.4 ± 3.1 vascular channels, p < 0.001). The lack of microstructural differences between the anterior and lateral quadrants, and the predominance of vascular channels in the posterior half of the epiphysis with posteriorly‐based medial femoral circumflex and ligamentum teres vessels suggests that the anterior femoral epiphysis may be a relative vascular watershed region, which predisposes it to collapse after the vascular insult of Perthes disease. Clinical significance: Improved understanding of the pathophysiology of anterior femoral epiphyseal collapse may inform future treatments aimed at revascularization. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1784–1789, 2019     

Associations of Perceived Stress,Resilience and Social Support with Sleep Disturbance Among Community‐dwelling Adults

Sleep disturbance is often described as sleeping poorly, difficulty falling asleep and maintaining sleep, and waking early. Currently, most studies examining sleep disturbance have focused on negative psychological variables; however, few studies have combined both negative and positive psychosocial factors to assess sleep. The aim of this study was to investigate the prevalence of sleep disturbance and psychosocial correlates in Chinese community‐dwelling adults. A total of 1471 adults, between 18 and 60 years old, from eight selected community settings in Jinan, China, were surveyed using the Pittsburgh Sleep Quality Index, Perceived Stress Scale, 10‐item Connor–Davidson Resilience Scale and Multidimensional Scale of Perceived Social Support and provided sociodemographic information. We found that the prevalence of sleep disturbance was 33.9%. After adjusting for age, employment status and physical co‐morbidity, perceived stress was significantly associated with sleep disturbance [odds ratio (OR) = 1.14, p < 0.001], while resilience and social support were associated with a low likelihood of sleep disturbance (OR = 0.90, p < 0.001; OR = 0.97, p < 0.001). Furthermore, regression analysis showed that the interaction between perceived stress and resilience was significant (p < 0.05). Resilience buffered the negative impact of perceived stress on sleep disturbance. Given the close relationship between sleep disturbance and psychosocial correlates, the development of effective intervention programmes to improve sleep quality in this population should be considered. Copyright © 2015 John Wiley & Sons, Ltd.     

Development and validation of an Arabic version of the International Prostate Symptom Score

OBJECTIVE

To develop and validate an Arabic version of the International Prostate Symptom Score (IPSS).

PATIENTS, SUBJECTS AND METHODS

An Arabic version of the IPSS (IPSS‐Arb) was developed through a series of translations and modifications which involved the authors, urology and non‐urology medical and nursing staff. The validity and reliability were assessed in 76 patients with urinary symptoms due to benign prostatic hyperplasia (BPH) and in 63 control subjects without BPH; 25 patients had transurethral resection of prostate (TURP) whereas the remaining 51 patients were treated with terazosin. The reliability of the IPSS‐Arb was assessed by determining the internal consistency (Cronbach’s α coefficient) and by assessing the test‐retest reliability (intraclass correlation coefficient, ICC). Construct validity was assessed by determining the correlation between the IPSS‐Arb scores and the quality‐of‐life question (QoL‐Arb), and by determining the ability of the IPSS‐Arb to discriminate between the patients and controls by calculating the area under the receiver operating characteristic (ROC) curve.

RESULTS

The Cronbach’s α coefficient (internal consistency) for the IPSS‐Arb was 0.85, and 0.78–0.88 for the individual items. The test‐retest reliability (ICC) was 0.88 (P < 0.001). In addition, the IPSS‐Arb had a high correlation with the QoL‐Arb (Spearman rank correlation coefficient 0.82, P = 0.01). The mean (sem , 95% confidence interval) area under the ROC curve for the IPSS‐Arb was 0.93 (0.09, 0.89–0.97), whereas the area for its individual questions was 0.79–0.90. The IPSS‐Arb also showed a high sensitivity to change. The mean (sd ) IPSS‐Arb scores before and after TURP were 23.1 (6.4) and 6.9 (1.8), respectively (P < 0.001); in the terazosin group, the scores were 12.6 (7.4) and 8.2 (4.0), respectively (P < 0.001).

CONCLUSIONS

The IPSS‐Arb was shown to be a reliable and valid instrument for patients with BPH. We recommend using it for patient assessment and follow‐up, and as a research tool in Arabic‐speaking patients both in the Middle East and worldwide. In addition, this study provided another proof of the wide suitability of the IPSS among various nations worldwide.     

Validation of the International Consultation on Incontinence Questionnaire–Vaginal Symptoms (ICIQ-VS) in two south- Asian languages

Introduction

The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women.

Methods

The International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya.

Results

Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p?<?0.001), sexual symptoms score (SSS) (p?<?0.01), and quality of life (QoL) (p?<?0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r _s ?=?0.64, p?<?0.001, Tamil r _s ?=?0.65, p?<?0.001), and QoL (Sinhala r _s ?=?0.49, p?<?0.001, Tamil r _s ?=?0.60, p?<?0.001). Internal consistency as assessed using Cronbach’s coefficient alpha: 0.78 (0.76–0.78) and 0.83 (0.80–0.84) in Sinhala and Tamil, respectively. Test–retest reliability was assessed by weighted kappa scores (Sinhala 0.58–0.88 and Tamil 0.76–0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p?<?0.001).

Conclusion

The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.

     

Translation,cross-cultural adaptation,reliability and validity of the Persian version of the ACL-QOL questionnaire in patients with anterior cruciate ligament reconstruction

BackgroundQuality of life (QOL) measures can be used to make sound clinical decisions after reconstruction of the anterior cruciate ligament (ACL). The purpose of the present study was to translate and cross-culturally adapt the Anterior Cruciate Ligament Quality of Life (ACL-QOL) questionnaire into the Persian language and to evaluate its psychometric properties.MethodsThe process of translation and cross-cultural adaptation followed the World Health Organization method. One hundred and forty-five patients with ACL reconstruction (ACL-R) filled out the Persian versions of ACL-QOL and the SF-36 Questionnaire. The measurement properties of internal consistency, agreement, criterion validity, floor and ceiling effects were measured. 40 out of 145 patients with ACL-R completed the Persian version of the ACL-QOL questionnaire twice for the test-retest reliability.ResultsThe questionnaire had high internal consistency (Cronbach's α = 0.96). The intraclass correlation was excellent for reliability and agreement in five domains and overall score (ICC 0.87, 0.74, 0.90, 0.85, 0.81 and 0.89; p < 0.001). The standard error of measurement and the minimum detectable change were found to be 3.28 points and 9.9 points, respectively. There was a strong correlation between each item and the total score of the Persian version of ACL-QOL questionnaire. The questionnaire showed strong and moderate criterion validity (r = 0.61, r = 0.37) with SF-36 physical component score and mental component score, respectively. No ceiling and floor effects were observed.ConclusionsPersian version of the ACL-QOL questionnaire has acceptable reliability and validity and can be used in assessing Iranians quality of life after ACL reconstruction.     

Sphincter‐sparing anal‐fissure surgery: a 1‐year prospective,observational, multicentre study of fissurectomy with anoplasty

Aim Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1‐year outcomes of fissurectomy. Method This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self‐assessed anal symptoms and quality of life (using the 36‐item short‐form health survey [SF‐36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed‐rank test for paired samples. Results Two‐hundred and sixty‐four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n = 3), local infection (n = 4) and faecal impaction (n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P < 0.001), anal discomfort had decreased from 5.0/10 to 0.1/10 (P < 0.001) and the Knowles–Eckersley–Scott Symptom constipation score had decreased from 9/45 to 5/45 (P < 0.001). There was a nonsignificant increase in the Wexner anal incontinence score, from 1/20 to 2/20. De‐novo clinically significant anal incontinence (Wexner score > 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF‐36 domains significantly improved. Anoplasty did not impact any result. Conclusion Given its high rate of healing and low rate of de‐novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter‐sparing surgical treatment for chronic anal fissure.     

Cross cultural adaptation,reliability and validity of the Greek version of Identification of Functional Ankle Instability (IdFAI) questionnaire

BackgroundThe objectives of our study were to develop the Greek version of the Identification of Functional Ankle Instability (IdFAI) questionnaire and to evaluate its psychometric properties.MethodsThe IdFAI was translated and adapted into Greek according to the guidelines for cross-cultural adaptation of self report measures. It was tested for test-retest reliability, validity, internal consistency and floor-ceiling effects in 141 participants (54 males, 87 females; 23.5 ± 7.2 years). All participants were asked to fill the Greek IdFAI (IdFAI-GR), the Cumberland Ankle Instability Tool (CAIT), and the Lower Extremity Functional Scale (LEFS), in order to determine construct validity. To determine the test-retest reliability, fifty randomly selected individuals re-filled IdFAI seven days after the first session.ResultsThe IdFAI-GR had high internal consistency (Cronbach alpha = 0.94) and excellent test-retest reliability (ICC_2,1 = 0.97; SEM = 0.7). The IdFAI-GR had strong correlation with the CAIT (r = 0.7; p < 0.001) and moderate correlation with the LEFS (r = 0.5; p < 0.001). No ceiling or floor effects were observed.ConclusionThe Greek IdFAI questionnaire has proven to be a valid and reliable instrument to identify functional ankle instability. It can therefore, be used for both clinical and research purposes in Greek-speaking individuals.     

Effort–Reward Imbalance and Mental Health Problems in 1074 German Teachers,Compared with Those in the General Population

High degrees of premature retirement among teachers warrant investigating the occupational burden and the mental health status of this profession. A sample of 1074 German teachers participated in this study. Two samples of the general population (N = 824 and N = 792) were used as comparison groups. Work distress was assessed with the Effort–Reward‐Imbalance questionnaire, and mental health problems were measured with the General Health Questionnaire (GHQ‐12). Teachers reported more effort–reward imbalance (M = 0.64) compared with the general population (M = 0.57), and they perceived more mental health problems (GHQ: M = 12.1) than the comparison group (M = 9.5). School type was not associated with work stress and mental health. Teachers with leading functions perceived high degrees of effort and reward, resulting in a moderate effort–reward ratio and no heightened mental health problems. Teachers working full time reported more effort than teachers working part time, but the reward mean values of both groups were similar. This results in a somewhat unfavourable effort–reward ratio of teachers working full time. Moreover, teachers working full time reported more mental health problems. The results support the appropriateness of the effort–reward conception, applied to the profession of teachers. The higher degree of effort–reward imbalance and the level of mental health problems warrant preventive measures. Copyright © 2014 John Wiley & Sons, Ltd.     

Evaluation of inflammatory biomarkers associated with oxidative stress and histological assessment of low‐level laser therapy in experimental myopathy

The objective of the present work was to study the effect of helium–neon (He–Ne) and gallium–arsenide (Ga–As) laser upon inflammatory biomarkers associated with oxidative stress: fibrinogen, nitric oxide (NO), L ‐citrulline, and superoxide dismutase (SOD). These were evaluated through histological assessment, in rats with experimental myopathy. Materials and Methods: The groups studied were: (A) control, (B) injured, (C) injured and treated with He–Ne laser, (D) injured and treated with Ga–As laser, (E) irradiated with He–Ne; and (F) irradiated with Ga–As laser. Myopathy was induced by injecting 0.05 mg/rat/day of adrenaline in the left posterior limb muscle at the same point on 5 consecutive days, in groups B, C, and D. Low‐level laser therapy (LLLT) was applied with 9.5 J/cm² daily for 7 consecutive days with each laser. The determination of the biomarkers was made by spectrophotometry. The muscles (5/8, single blinded) were stained with Gomori Trichrome and examined by optic microscopy. The quantitative variables were statistically analyzed by the Fisher's test and categorical data by the Axionvision 4.8 program. Pearson's chi‐squared test was applied, setting significant difference at P < 0.05 for all cases. Results: In group B, the biomarkers were significantly increased compared to the other groups (P < 0.001), except for NO which in group B decreased significantly (P < 0.001). In group B, there was a higher inflammatory infiltration level (80.67%) in relation to destroyed fibers. Conclusions: LLLT caused significant changes in inflammatory biomarkers and oxidative stress: decreased levels of fibrinogen, L ‐citrulline and SOD as opposed to the increase of NO in rats with experimental myopathies and significant muscle recovery. Lasers Surg. Med. 42:577–583, 2010. © 2010 Wiley–Liss, Inc.     

Psychometric evaluation of a direct observation of procedural skills assessment tool for ultrasound‐guided regional anaesthesia

Assessment tools must be investigated for reliability, validity and feasibility before being implemented. In 2013, the Australian and New Zealand College of Anaesthetists introduced workplace‐based assessments, including a direct observation of a procedural skills assessment tool. The objective of this study was to evaluate the psychometric properties of this assessment tool for ultrasound‐guided regional anaesthesia. Six experts assessed 30 video‐recorded trainee performances of ultrasound‐guided regional anaesthesia. Inter‐rater reliability, assessed using absolute agreement intraclass correlation coefficients, varied from 0.10 to 0.49 for the nine individual nine‐point scale items, and was 0.25 for a ‘total score’ of all items. Internal consistency was measured by correlation between ‘total score’ and ‘overall performance’ scale item (r = 0.68, p < 0.001). Construct validity was demonstrated by the ‘total score’ correlating with trainee experience (r = 0.51, p = 0.004). The mean time taken to complete assessments was 6 min 35 s.