Structural validity of the Finnish Manchester-Oxford Foot Questionnaire (MOXFQ) using the Rasch model

BackgroundThe 16-item patient-reported Manchester-Oxford Foot Questionnaire (MOXFQ) with subscales of pain, social interactions, and walking/standing has been claimed for strongest scientific evidence in measuring foot and ankle complaints. This study tests the validity of the Finnish MOXFQ for orthopaedic foot and ankle population using the Rasch analysis.MethodsWe translated the MOXFQ into Finnish and used that translation in our study. MOXFQ scores were obtained from 183 patients. Response category distribution, item fit, coverage, targeting, item dependency, ability to measure latent trait (unidimensionality), internal consistency (Cronbach’s alpha), and person separation index (PSI) were analyzed.ResultsFifteen of the items had ordered response categories and/or sufficient fit statistics. The subscales provided coverage and targeting. Some residual correlation was noted. Removing one item in the pain subscale led to a unidimensional structure. Alphas and PSIs ranged between 0.68–0.90 and 0.67–0.92, respectively.ConclusionsDespite some infractions of the Rasch model, the instrument functioned well. The subscales of the MOXFQ are meaningful for assessing patient-reported complaints and outcomes in orthopaedic foot and ankle population.     

Epidural analgesia with 4 mg of morphine after caesarean section: modulating effect of epidural block compared to general anaesthesia

Forty patients had epidural catheters placed for analgesia in active labour. For caesarean section patients in the epidural (EA) group (n = 20) had epidural anaesthesia with 0.5% bupivacaine supplemented if necessary with 2% lidocaine with adrenaline. Patients in the general anaesthesia (GA) group (n = 20) had standardized general anaesthesia for surgery. In both groups 4 mg of morphine in 8 ml of 0.25% bupivacaine was given epidurally after delivery of the baby. During the first 3 h of the postoperative period, as long as the epidural block was effective, patients in the EA group experienced significantly less pain. At 6, 12 and 24 h pain estimations were equal in both groups. Patients in the EA group consumed significantly less pain medication during the first 24 h after surgery (P = 0.0002). Itching was less frequent in the GA group (P = 0.011). It is concluded that epidural administration of 4 mg of morphine produces more effective postoperative pain relief when emergency caesarean section is conducted under epidural than when it is conducted under general anaesthesia.     

Cellular fibronectin and tenascin in experimental perforating scleral wounds with incarceration of the vitreous

Background: Posterior perforating eye injury carries a high risk of visual loss due to the formation of intravireal and epiretinal scar tissue. Intraocular scar formation in patients with retinal detachment has been shown to be associated with elevated intravitreal FN levels. The extracellular matrix glycoproteins fibronectiu (FN) and tenascin (TN) have been located in epiretinal scar membranes. As both FN and TN are also involved in healing of cutaneous and corneal wounds, we undertook to study their expression in rabbit perforating scleral wounds with vitreous incarceration. Methods: A perforating scleral wound was produced and sutured without removal of vitreous from the wound in 18 pigmented rabbits. The rabbits were killed at various times (1 h to 21 days) after the operation, and the indirect immunohistochemical method was used for demonstration of FN and TN. Monoclonal mouse hybridoma antibodies 52 DH1 and 100 EB2, recognizing the cellular form of FN (cFN) and TN, respectively, were used. Results: During the first post-operative week immunoreaction for glycoproteins, both the locally produced cFN and TN, were observed at the scar tissue containing the prolabed vitreous and the adjacent sclera. Subsequently, the reaction gradually shifted to the vitreal side of the wound, and 3 weeks after the operation it was almost completely restricted to a separated mass of vitreous beneath the scar. Conclusion: The expression of cFN and TN in the scleral scar and vitreous is indicative of their local synthesis. The shift of the expression of those proteins to the vitreal side of the wound with time suggests that the scarring process in the vitreous is delayed compared to the sclera.     

Developing and testing instruments for improving cooperation and patient's participation in mental health care

The main purpose of the project was to develop computerized instruments that could be used by nurses and patients to assess their cooperation and mutual contributions to care. This paper presents a part of the project: the reliability and validity testing phase of a process of instrument development. To test the validity and reliability of the instruments, data were collected with questionnaires from nurses (n = 146) and patients (n = 286). The validity evaluated as construct validity and the reliability evaluated as internal consistency of the instruments were quite good. Construct validity was tested by factor analysis, and internal consistency was tested by Cronbach's alpha coefficient, which varied from 0.69 to 0.79. The instruments, which consisted of a software application that can be operated in a www environment, were meant to be used as tools in the psychiatric nursing context for assessing the cooperation between the nurses and patients and the patient's participation in his/her care. Furthermore, the computer programme can be used as a tool for developing and assessing the patient orientation in nursing.     

Vegetarianism and Eating-Disordered Thinking

Two studies compared food choice motives and symptoms of eating disorders among vegetarians and nonvegetarians. The participants filled in a food choice questionnaire and completed an eating attitude test (EAT, Study 1) and eating disorder inventory (EDI, Study 2). The vegetarians scored higher on EAT and on the ineffectiveness, interpersonal distrust, and maturity fears suhscales of EDI than the nonvegetarians. However, no difference was found in the reported importance of weight control among the two groups. The results indicate that vegetarianism and eating disorders are not independent but rather are intertwined phenomena. The potential common links, for example the possibility that vegetarianism is being used as a smokescreen for more severe eating pathology, are discussed.     

Vegetarianism and Eating-Disordered Thinking

Abstract

Two studies compared food choice motives and symptoms of eating disorders among vegetarians and nonvegetarians. The participants filled in a food choice questionnaire and completed an eating attitude test (EAT, Study 1) and eating disorder inventory (EDI, Study 2). The vegetarians scored higher on EAT and on the ineffectiveness, interpersonal distrust, and maturity fears suhscales of EDI than the nonvegetarians. However, no difference was found in the reported importance of weight control among the two groups. The results indicate that vegetarianism and eating disorders are not independent but rather are intertwined phenomena. The potential common links, for example the possibility that vegetarianism is being used as a smokescreen for more severe eating pathology, are discussed.     

Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

BackgroundPatient-reported outcomes (PROs) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments.MethodsAltogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester–Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed.ResultsBased on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument.ConclusionsThe ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies.     

Antiphospholipid and antinuclear antibodies in patients with epilepsy or new-onset seizure disorders

PURPOSE: The increased prevalence of autoantibodies in patients with epilepsy has been traditionally regarded to be a consequence of antiepileptic drugs. The purpose of this study was to measure autoantibodies in well-defined groups of patients with seizures to determine the effects of epilepsy and antiepileptic medications on the presence of autoantibodies. PATIENTS AND METHODS: We studied the frequency of antinuclear antibodies, anti-beta2-glycoprotein I antibodies, and anticardiolipin antibodies in 50 patients with therapy-resistant localization-related epilepsy, 50 patients with generalized epilepsy syndromes, 52 patients with a newly diagnosed seizure disorder but no antiepileptic medication, and 83 healthy controls. RESULTS: Compared with controls, newly diagnosed patients had a significantly greater prevalence of immunoglobulin (Ig) G class anticardiolipin antibodies (21% versus 7%); the prevalence was 14% in patients with localization-related epilepsy and 8% in patients with generalized epilepsy. The prevalence of IgM class anticardiolipin antibodies was significantly greater in all seizure groups (60% in localization-related epilepsy, 42% in generalized epilepsies, and 33% in newly diagnosed patients) compared with controls (7%). Antinuclear antibodies were significantly more common in newly diagnosed patients (21%) and localization-related epilepsy (24%) compared with controls (12%). When patients with generalized epilepsy (8%) were used as the reference group, antinuclear antibodies were also significantly more frequent in localization-related epilepsy (relative risk [RR] = 2.9, 95% confidence interval [CI]: 1.1 to 8.2) and newly diagnosed seizures (RR = 3.4, 95% CI: 1.2 to 9.3). There were no consistent associations between autoantibodies and specific antiepileptic medications. CONCLUSIONS: The prevalence of autoantibodies is greater in patients with epilepsy, including newly diagnosed seizure disorder. The increased prevalence of autoantibodies is more strongly associated with epilepsy than with antiepileptic drugs, perhaps indicating that immune dysregulation may be commonly associated with epilepsy.