Affective Subscale Research Articles

Psychometric properties of a Chinese version of the Measure of Empathy and Sympathy

Self-report measures of empathy have several limitations, including conceptual confusion with similar constructs (especially sympathy), ambiguous item wording and lack of brief forms. The Measure of Empathy and Sympathy (MES) has made important gains in addressing these problems. This study evaluated the psychometric properties of the MES based on a sample of 608 Chinese university students. Results showed that the MES was structurally reliable, internally consistent, test-retest stable, and acceptable in terms of criterion-related validity. In conclusion, the MES is a promising instrument to assess empathy and sympathy in the Chinese population. However, we recommended using separate subscale scores or the sum of the cognitive and affective empathy subscales according to Omega indices and incremental validity, but not using the total MES score because of the concept difference between sympathy and empathy.

End-of-Life Conversation Game Increases Confidence for Having End-of-Life Conversations for Chaplains-in-Training.

Discussing end-of-life issues with patients is an essential role for chaplains. Few tools are available to help chaplains-in-training develop end-of-life communication skills. This study aimed to determine whether playing an end-of-life conversation game increases the confidence for chaplain-in-trainings to discuss end-of-life issues with patients. We used a convergent mixed methods design. Chaplains-in-training played the end-of-life conversation game twice over 2 weeks. For each game, pre- and postgame questionnaires measured confidence discussing end-of-life issues with patients and emotional affect. Between games, chaplains-in-training discussed end-of-life issues with an inpatient. One week after game 2, chaplains-in-training were individually interviewed. Quantitative data were analyzed using descriptive statistics and Wilcoxon rank-sum t tests. Content analysis identified interview themes. Quantitative and qualitative data sets were then integrated using a joint display. Twenty-three chaplains-in-training (52% female; 87% Caucasian; 70% were in year 1 of training) completed the study. Confidence scores (scale: 15-75; 75 = very confident) increased significantly after each game, increasing by 10.0 points from pregame 1 to postgame 2 ( P < .001). Positive affect subscale scores also increased significantly after each game, and shyness subscale scores decreased significantly after each game. Content analysis found that chaplains-in-training found the game to be a positive, useful experience and reported that playing twice was beneficial (not redundant). Mixed methods analysis suggest that an end-of-life conversation game is a useful tool that can increase chaplain-in-trainings' confidence for initiating end-of-life discussions with patients. A larger sample size is needed to confirm these findings.

Pilot Study of an Exercise Intervention for Depressive Symptoms and Associated Cognitive-Behavioral Factors in Young Adults With Major Depression.

This study assesses the feasibility of integrating motivational interviewing (MI) with an exercise intervention. It also explores patterns of depressive symptom changes (cognitive, affective, and somatic subscales) and their relationship to cognitive, behavioral, and immunological factors (interleukin 6, IL-6, a marker for inflammation) across the exercise intervention. Twelve young adults (20.8 ± 1.7 years) meeting DSM-IV criteria for major depressive disorder received a brief MI intervention followed by a 12-week exercise intervention. Assessments were conducted preintervention, postintervention, throughout the intervention, and at follow-up. Preliminary results show differential effects of exercise, with the largest standardized mean improvements for the affective subscale (-1.71), followed by cognitive (-1.56) and somatic (-1.39) subscales. A significant relationship was observed between increased behavioral activation and lower levels of IL-6. Despite study limitations, the magnitude of changes suggests that natural remission of depressive symptoms is an unlikely explanation for the findings. A randomized controlled trial has commenced to evaluate effectiveness of the intervention.

Validation and psychometric properties of the commitment to hip protectors (C-HiP) index in long-term care providers of British Columbia, Canada: a cross-sectional survey

BackgroundIf worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool.MethodsWe conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, “Do you think of yourself as a champion of hip protectors”, rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn’t.ResultsHierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach’s alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home.ConclusionsWe offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care.

0151 COMPARISON OF THE EFFECTS OF ACUTE TOTAL SLEEP DEPRIVATION, CHRONIC SLEEP RESTRICTION AND RECOVERY SLEEP ON POSITIVE AFFECT

Introduction: Positive affect helps people in coping with difficult situations. People with high positive affect have been shown to be happier, have more success in life and better relationships than people scoring low. Positive affect is reduced during chronic and acute sleep loss. The aims of the present study were 1) to establish the adverse effect of 5 days of sleep restriction on positive affect, 2) to test whether one night of recovery sleep reverses this effect, and 3) to test whether the combined effects of prior sleep restriction and acute sleep deprivation are cumulative. Methods: In an ongoing investigation, 27 healthy volunteers completed two baseline nights (8h TIB) and either five nights of sleep restriction (experimental group: 5h TIB, N=18, mean age 26±3 years, 9 females) or regular sleep (control group: 8h TIB, N=9, mean age 25±5 years, 3 females). Thereafter, all participants had 8h of recovery sleep and 38h of total sleep deprivation. Participants filled out the mood scale PANAS at 9 a.m. on all days. Differences in the positive affect subscale between experimental days and the second baseline day were calculated. Results: Wilcoxon signed-rank tests with Bonferroni-adjusted alpha-level showed a decrease in positive affect after one night of sleep restriction (Δ5.06±3.78; p<.001). Positive affect scores of the last day of chronic sleep restriction and of the day after recovery sleep did not differ (Δ1.33±4.67; p=.18). Positive affect decreased from the last day of chronic sleep restriction to acute sleep deprivation (Δ4.11±4.27; p=.001) for the experimental group. No significant difference was found between chronic sleep restriction (last day) in the experimental group and total sleep deprivation in the control group (Mann-Whitney-U-Test, z(26)=-1.24; p=.5). Conclusion: Chronic sleep loss for five days exhibited long-lasting effects on the reduction of positive affect which were not reset by one recovery night. Positive affect decreased further following acute sleep deprivation, indicating that people’s sleep curtailing lifestyles make them more vulnerable to additional acute sleep loss. Five days of chronically reduced sleep exhibited a comparable reduction in positive affect as a sleepless night.

Positive affect predicts cerebral glucose metabolism in late middle-aged adults.

Positive affect is associated with a number of health benefits; however, few studies have examined the relationship between positive affect and cerebral glucose metabolism, a key energy source for neuronal function and a possible index of brain health. We sought to determine if positive affect was associated with cerebral glucose metabolism in late middle-aged adults (n = 133). Participants completed the positive affect subscale of the Center for Epidemiological Studies Depression Scale at two time points over a two-year period and underwent 18F-fluorodeoxyglucose-positron emission tomography scanning. After controlling for age, sex, perceived health status, depressive symptoms, anti-depressant use, family history of Alzheimer’s disease, APOE ε4 status and interval between visits, positive affect was associated with greater cerebral glucose metabolism across para-/limbic, frontal, temporal and parietal regions. Our findings provide evidence that positive affect in late midlife is associated with greater brain health in regions involved in affective processing and also known to be susceptible to early neuropathological processes. The current findings may have implications for interventions aimed at increasing positive affect to attenuate early neuropathological changes in at-risk individuals.

Association of Anxiety Symptom Clusters with Sleep Quality and Daytime Sleepiness

To better understand links between anxiety and sleep disturbances in older adults, we examined the association of different phenotypic presentations of anxiety (i.e., affective, cognitive, and somatic clusters) with global sleep quality and daytime sleepiness. 109 community-dwelling adults aged 66-92 years old (57% female) completed assessments of global sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), affective anxiety symptoms (Geriatric Anxiety Scale (GAS) affective subscale), cognitive anxiety symptoms (GAS cognitive subscale), and somatic anxiety symptoms (GAS somatic subscale). In hierarchical regression models adjusted for depressive symptoms and health status, greater affective and somatic anxiety were associated with poorer global sleep quality (affective B = 0.30, p = .01; somatic B = 0.41, p = .01). Somatic and cognitive anxiety were associated with greater daytime sleepiness (somatic B = 0.74, p < .001; cognitive B = 0.30, p = .03), but these associations were attenuated by covariates added to the models. These findings indicate that anxiety symptom clusters are differentially associated with specific sleep-related disturbances, underscoring the complex relationship of late-life anxiety to sleep. Results suggest that personalized treatments, such as targeted sleep interventions, may improve specific anxiety-symptom domains, or vice versa.

Migration-Related Stressors and Their Effect on the Severity Level and Symptom Pattern of Depression among Vietnamese in Germany

Objectives Vietnamese in Germany represent a scarcely researched and vulnerable group for mental health problems, especially under exposure to migration-related stressors (MRS). This study analyzes the effect of those MRS on the severity level and symptom pattern of depression. Design We analyzed the data of 137 depressed Vietnamese patients utilizing Germany's first Vietnamese psychiatric outpatient clinic. Hierarchical linear regression models were applied to investigate how the quantity of MRS influenced (1) the overall severity of self-reported depression symptoms; (2) the cognitive, affective, and somatic BDI-II subscale; and (3) the single BDI-II items of these subscales. Results A greater number of MRS were related to a higher severity level of depression in general, as well as to a higher level on the cognitive depression subscale in particular. The BDI-II single items pessimism, past failure, guilt feelings, punishment feelings, and suicidal thoughts were particularly associated with a higher quantity of perceived MRS. Conclusion Among depressed Vietnamese migrants in Germany, a higher number of reported MRS were associated with higher overall depression severity. Within the domains of depression, particularly the cognitive domain was linked to perceived MRS. The association between MRS and suicidal thoughts is clinically highly relevant.

Factors associated with problematic internet use among children and adolescents with Attention Deficit Hyperactivity Disorder.

OBJECTIVE:The aim of this study was to determine the association of problematic internet use with attention deficit hyperactivity disorder (ADHD), personal risk factors, and familial factors and compare with a healthy control group and investigate the risk factors.METHODS:The study sample consisted of 34 children aged 12–16 years and their families who applied to Ankara University Faculty of Medicine Department of Child and Adolescent Psychiatry with the diagnosis of ADHD. The control group consisted of 36 junior high and high school children aged 12–16 years and their families. The control group was matched with the ADHD group for age and sex. The Kiddie Schedule for Affective Disorders and Schizophrenia Present and LifetimeVersion (K-SADS-PL) version was used according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for patients with ADHD and the control group. Internet/Computer Use Assessment Questionnaire for Children/Adolescents, the Strengths and Difficulties Questionnaire adolescent form (SDQ), and Online Cognition Scale (OCS) were applied to children. Internet/Computer Use Assessment Questionnaire for Parents and SDQ-parent form and Family Assessment (FAS) were applied to the parents.RESULTS:Weekly internet usage was higher in the ADHD group than the control group. The OCS total scores and subscale scores were significantly higher in the ADHD group. The subscales of SDQ hyperactivity, conduct problems, and peer problems were significantly higher in the ADHD group. FAS-general functions, communication, roles and behavior control subscale scores were higher in the ADHD group. There was no significant difference between groups regarding the internet usage in the daily life, with the availability of a computer and internet at home. In the ADHD group, there was a significant correlation between the OCS scores, weekly internet usage, and psychiatric comorbidities Oppositional Defiant Disorder and Conduct Disorder. Also, affective responsiveness subscale scores of FAS were significantly correlated with OCS scores in the ADHD group.CONCLUSION:In this study, it was noted that problematic internet use was more frequent in ADHD. During ADHD treatment, problematic internet use may interfere in the treatment goals. Interventions to problematic internet use should consider familial emotional expression studies.

Effects of Gender Reassignment on Quality of Life and Mental Health in People with Gender Dysphoria

Our purpose was to compare the life style, family and social relationships (social adaptation) and the quality of life in people with gender dysphoria with and without history of sex reassignment surgery. Twenty individuals (SR group) who were earlier followed in Istanbul University Psychiatry Department Psychoneurosis and Psychotherapy Unit with gender dysphoria diagnosis in order to have confirmative reports for the sex reassignment (SR) surgery were interviewed at least one year after the surgery. For comparison, 50 individuals with gender dysphoria (NSR group) who had recently applied to the same unit were interviewed. Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), Family Assessment Device (FAD), Multidimensional Scale for Perceived Social Support (MSPSS), World Health Organization Quality of Life Scale (WHOQOL-BREF) were administered. In the SR group, concerns about gender related discrimination and victimization were lower, but concerns related to the disclosure of transgender identity were higher compared to the NSR group. The SR group scored lower on FAD Affective Involvement, Problem Solving, Affective Responsiveness subscales, but scored higher on MSPSS family subscale and psychological domain of WHOQOL-BREF. The sex reassignment surgeries (SRS) required for legal change in gender status of individuals with gender dysphoria are helpful in relieving the conflicts. SRS causes improvements in the quality of life, family support, interpersonal relationships and reduces the concerns about the gender related discrimination and victimization.

11C]-(R)-PK11195 positron emission tomography in patients with complex regional pain syndrome: A pilot study.

Complex regional pain syndrome (CRPS) is characterized by severe and chronic pain, but the pathophysiology of this disease are not clearly understood. The primary aim of our case–control study was to explore neuroinflammation in patients with CRPS using positron emission tomography (PET), with an 18-kDa translocator protein specific radioligand [11C]-(R)-PK11195. [11C]-(R)-PK11195 PET scans were acquired for 11 patients with CRPS (30–55 years) and 12 control subjects (30–52 years). Parametric image of distribution volume ratio (DVR) for each participant was generated by applying a relative equilibrium-based graphical analysis. The DVR of [11C]-(R)-PK11195 in the caudate nucleus (t(21) = −3.209, P = 0.004), putamen (t(21) = −2.492, P = 0.022), nucleus accumbens (t(21) = −2.218, P = 0.040), and thalamus (t(21) = −2.395, P = 0.026) were significantly higher in CRPS patients than in healthy controls. Those of globus pallidus (t(21) = −2.045, P = 0.054) tended to be higher in CRPS patients than in healthy controls. In patients with CRPS, there was a positive correlation between the DVR of [11C]-(R)-PK11195 in the caudate nucleus and the pain score, the visual analog scale (r = 0.661, P = 0.026, R2 = 0.408) and affective subscales of McGill Pain Questionnaire (r = 0.604, P = 0.049, R2 = 0.364). We demonstrated that neuroinflammation of CRPS patients in basal ganglia. Our results suggest that microglial pathology can be an important pathophysiology of CRPS. Association between the level of caudate nucleus and pain severity indicated that neuroinflammation in this region might play a key role. These results may be essential for developing effective medical treatments.

Vertex-wise examination of depressive symptom dimensions and brain volumes in older adults

Differences in brain volumes have commonly been reported in older adults with both subthreshold and major depression. Few studies have examined the association between specific symptom dimensions of depression and brain volumes. This study used vertex-wise analyses to examine the association between specific symptom dimensions of depression and brain volumes in older adults with subthreshold levels of depressive symptoms. Forty-three community-dwelling adults between the ages of 55 and 81 years underwent a structural Magnetic Resonance Imaging scan and completed the Center for Epidemiologic Studies Depression Scale (CES-D). Vertex-wise analyses were conducted using Freesurfer Imaging Suite to examine the relationship between CES-D subscale scores and gray matter volumes while controlling for sex, age, and education. We found distinct associations between depressed mood, somatic symptoms, and lack of positive affect subscales with regional volumes, including primarily positive relationships in temporal regions and a negative association with the lingual gyrus. The relationship between higher depressed mood subscale scores and larger volumes in the left inferior temporal lobe withstood Monte-Carlo correction for multiple comparisons. Results from this preliminary study highlight the importance of examining depression on a symptom dimension level and identify brain regions that may be important in larger studies of depression.

Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study.

Little is known about how well postoperative pain is managed in living liver donors, despite pain severity being the strongest predictor of persistent pain with long-lasting disability. We conducted a prospective multicenter study of 172 living liver donors. Self-reported outcomes for pain severity, activity interference, affective (emotional) reactions, adverse effects to treatment, and perceptions of care were collected using the American Pain Society Patient Outcomes Questionnaire-Revised. Mixed-effects linear regression was used to identify demographic and psychosocial predictors of subscale scores. Donors were young (36.8 ± 10.6) and healthy. Of 12 expert society analgesic recommendations for postoperative pain management, 49% received care conforming to 3 guidelines, and only 9% to 4 or 5. More than half reported adverse effects to analgesic treatment for moderate to severe pain that interfered with functional activity; however, emotional distress to pain was unexpectedly minimal. Female donors had higher affective (β = 0.88, P = 0.005) and adverse effects scores (β = 1.33, P < 0.001). Donors with 2 or more medical concerns before surgery averaged 1 unit higher pain severity, functional interference, adverse effects, and affective reaction subscale scores (β range 1.06-1.55, all P < 0.05). Receiving information about pain treatment options increased perception of care subscale scores (β = 1.24, P = 0.001), whereas depressive symptoms before donation were associated with lower scores (β = -1.58, P = 0.01). Donors have a distinct profile of pain reporting that is highly influenced by psychological characteristics. Interventions to improve pain control should consider modifying donor behavioral characteristics in addition to optimizing pain care protocols.

Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model

The present study investigated the mediating effects of emotion dysregulation on the relationship between child maltreatment and psychopathology. An adult sample (N=701) from diverse backgrounds of psychopathology completed the Childhood Trauma Questionnaire (CTQ), the Difficulties in Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the negative affect subscale of the Positive and Negative Affect Schedule (PANAS) in a cross-sectional online survey. Correlational analyses showed that all types of child maltreatment were uniformly associated with emotion dysregulation, and dimensions of emotion dysregulation were strongly related to psychopathology. Limited access to strategies for emotion regulation emerged as the most powerful predictor. Structural equation modeling analyses revealed that emotion dysregulation partially mediated the relationship between child maltreatment and psychopathology, even after controlling for shared variance with negative affect. These findings emphasize the importance of emotion dysregulation as a possible mediating mechanism in the association between child maltreatment and later psychopathology. Additionally, interventions targeting specific emotion regulation strategies may be effective to reduce psychopathology in victims of child maltreatment.

Using a symptom-specific instrument to measure patient-reported daily functioning in patients with cancer

ObjectivesImproving, stable, or deteriorating patient functioning is critical to assess in cancer care and in oncology clinical trials. We evaluated the performance of the six-item interference subscale of the MD Anderson Symptom Inventory (MDASI) compared with two commonly used patient-reported measures of functioning as a reference: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and the Medical Outcomes Study Short Form 12-item health survey (SF-12). MethodsIn this secondary analysis of two databases, MDASI versus QLQ-C30 (431 multiple myeloma patients) and MDASI versus SF-12 in solid tumours (285 lung and 91 gastrointestinal cancer patients), we used Pearson correlations to test relationships of four SF-12 and five QLQ-C30 functioning subscales with MDASI total interference (MDASI-INTFER), physical (MDASI-WAW), and affective (MDASI-REM) subscales. We used area under the curve (AUC) to quantify ability to differentiate performance status levels, and Glass Delta effect size (ES) and standardised response mean to evaluate responsiveness to aggressive cancer treatment. ResultsMDASI-WAW was strongly correlated with QLQ-C30 and SF-12 physical subscales across all three cancer types (all r ≥ 0.7, P < 0.0001). The MDASI-WAW displayed AUCs that were similar to the physical functioning scales of QLQ-C30 and SF-12 (>0.7). MDASI-WAW responsiveness was equivalent to the SF-12 physical functioning subscale for chemoradiotherapy (ES = 0.72 for MDASI-WAW; 0.55 for SF-12), surgery (ES = 0.92 for MDASI-WAW; 0.97 for SF-12), and worsening of general health (ES = 1.22 for MDASI-WAW; 1.05 for SF-12). ConclusionsMDASI interference is a valid measure of symptom-related functional impairment. The three-item MDASI-WAW subscale is comparable to the SF-12 in responsiveness to functional deterioration during aggressive cancer treatment.

Perceived Transcultural Self-Efficacy of Nurses in General Hospitals in Guangzhou, China.

BackgroundConflicts arising from cultural diversity among patients and hospital staff in China have become intense. Hospitals have an urgent need to improve transcultural self-efficacy of nurses for providing effective transcultural nursing.ObjectiveThe purpose of the research was to (a) evaluate the current status of perceived transcultural self-efficacy of nurses in general hospitals in Guangzhou, China; (b) explore associations between demographic characteristics of nurses and their perceived transcultural self-efficacy; and (c) assess the reliability and validity of scores on the Chinese version of the Transcultural Self-Efficacy Tool (TSET).MethodsA cross-sectional survey of registered nurses from three general hospitals was conducted. Quota and convenience sampling were used. Participants provided demographic information and answered questions on the TSET.ResultsA total of 1,156 registered nurses took part. Most nurses had a moderate level of self-efficacy on the Cognitive (87.9%), Practical (87%), and Affective (89.2%) TSET subscales. Nurses who were older; who had more years of work experience, higher professional titles, higher incomes, and a minority background; and who were officially employed (not temporary positions) had higher perceived transcultural self-efficacy. Reliability estimated using Cronbach’s alpha was .99 for the total TSET score; reliability for the three subscales ranged from .97 to .98. Confirmatory factor analysis of TSET scores showed good fit with a three-factor model.ConclusionThe results of this study can provide insights and guidelines for hospital nursing management to facilitate design of in-service education systems to improve transcultural self-efficacy of nurses.

Diferencias en las atribuciones académicas en Lengua en base al Afecto Positivo

La finalidad de esta investigación residió en conocer si los individuos pertenecientes a población infantil española con altas puntuaciones en Afecto Positivo (AP) poseían diferencias estadísticamente significativas con los individuos con bajas puntuaciones en AP en las seis dimensiones que componen las atribuciones académicas en el área de Lengua (Éxito: capacidad, esfuerzo y causas externas; Fracaso: capacidad, esfuerzo y causas externas). La muestra estaba compuesta por 862 estudiantes, entre 8 y 11 años. Se utilizó la subescala de lengua de la Sydney Attribution Scale (SAS) y la subescala de AP del Positive And Negative Affect Schedule for Children (PANAS-C) versión reducida. La prueba t de Student reflejó que los participantes con altos niveles de AP obtuvieron medias significativamente más altas en la atribución al éxito y al fracaso en Lengua a causas externas. Por otro lado, los sujetos con bajas puntuaciones en AP obtuvieron medias significativamente más altas en la atribución del fracaso en Lengua a la capacidad y al esfuerzo. Los resultados obtenidos complementan la literatura previa existente y dejan la posibilidad a seguir ampliando el campo del conocimiento del afecto y de las atribuciones académicas.

PSYCHOMETRIC EVALUATION OF A PRE-DEATH GRIEF (PDG) SCALE FOR DEMENTIA FAMILY CAREGIVERS

Caregiver support in dementia care traditionally focuses on the emotion of stress, with emphasis on improving coping skills and reducing burden. However, the emotional experience of family caregivers can be more complex, and may be better understood with the concept of pre-death grief(PDG). PDG includes a range of emotional responses as caregivers mourn for the psychologically absent patient and anticipate impending losses. It is prevalent among dementia caregivers and is associated with negative consequences. The 50-item Marwit-Meuser Caregiver Grief Inventory(MM-CGI) is a useful measure of PDG. It has three subscales representing different losses, with the Heartfelt Sadness and Longing(HSL) subscale specifically measuring the core of PDG (that is, one’s intrapersonal reactions to lost relationship). Because MM-CGI was never validated outside of USA, we aimed to evaluate its psychometric properties in a multi-ethnic Asian population. Alternatively, we also examined whether the 15-item HSL subscale alone is sufficient as a reliable, valid and unidimensional measurement. Spouses or children of non-nursing home dementia patients were recruited from the clinics of two tertiary hospitals. They completed questionnaires containing the following scales: MM-CGI, Zarit-Burden-Interview(ZBI) and Centre-for-Epidemiologic-Studies-Depression(CES-D). 60% of participants repeated the questionnaires one week later for test-retest reliability. Internal consistency was assessed by Cronbach’s alpha; test-retest reliability by intra-class correlation(ICC); construct validity by correlation with ZBI and CES-D; and confirmatory factor analysis(CFA) by Chi-Square, Standardized-Root-Mean-Square-Residual(SRMR<0.08), Comparative-Fit-Index(CFI>0.90) and Tucker-Lewis-Index(TLI>0.90). Table 1 showed the demographic information. Cronbach’s alpha was 0.97 for MM-CGI and 0.93 for HSL. ICC was 0.94 for MM-CGI and 0.93 for HSL. MM-CGI showed convergent validity with ZBI(Pearson’s r=0.77) and CES-D(r=0.77); and divergent validity with Finance subscale of ZBI(r=0.47) and positive affect subscale of CES-D(r=0.40). HSL showed convergent validity with ZBI(r=0.64) and CES-D(r=0.69); and divergent validity with Finances subscale of ZBI(r=0.37) and Positive Affect subscale of CES-D(r=0.36). In CFA, MM-CGI showed Chi-Square p<0.001, SRMR 0.059, CFI 0.81 and TLI 0.80. HSL had better model-fit, with Chi-Square p<0.001, SRMR 0.046, CFI 0.90 and TLI 0.89. Both MM-CGI and HSL demonstrated reliability and construct validity. However, MM-CGI may require re-exploration of its factor structure. The briefer HSL subscale offers a viable alternative to measuring PDG.

Does Ramadan Fasting Affect Fatigue in Nurses?

The purpose of this study was to evaluate the effect of Ramadan fasting on fatigue in nurses. The study was conducted between June 19 and July 27, 2014, with a descriptive design. This study was completed with 99 nurses working in a public hospital in the city of Gaziantep located in the Southeastern Anatolia Region of Turkey. The data of the study were collected by using a questionnaire and the Piper Fatigue Scale. The Piper Fatigue Scale includes 4 subscale/dimensional scores and total fatigue scores. Higher scores indicate more fatigue. Statistical significance levels were set at P < .05. It was determined that the fatigue subscale and total mean scores of nurses increased in a statistically significant manner except for the affective subscale after the month of Ramadan (P < .05). In addition, it was found that the fatigue mean scores of those, who were working for 0 to 4 years, were employed in surgery units, and evaluated their health as bad, were higher (P > .05). The Ramadan fasting increased fatigue levels of nurses. Therefore, it is of vital importance to evaluate fatigue levels of nurses especially in the month of Ramadan and take the necessary precautions in terms of patient and personnel safety.

Provoked Vestibulodynia: Does Pain Intensity Correlate With Sexual Dysfunction and Dissatisfaction?

Provoked vestibulodynia (PVD) is suspected to be the most frequent cause of vulvodynia in premenopausal women. Previous research has been inconclusive as to whether higher vulvovaginal pain ratings are associated with lower sexual function and satisfaction in women with PVD. Whether pain intensity correlates with sexual impairment is an important question given its implications for treatment recommendations. To examine the associations among self-reported and objective pain measurements, sexual function, and sexual satisfaction in a large combined clinical and community sample of premenopausal women diagnosed with PVD. Ninety-eight women with PVD underwent a cotton-swab test, a vestibular friction pain measurement, and a vestibular pressure-pain threshold measurement. In addition to sociodemographics, participants completed measurements of pain, sexual function, and sexual satisfaction. Self-report measurements were the pain numerical rating scale (0-10), the McGill-Melzack Pain Questionnaire, the Female Sexual Function Index, and the Global Measure of Sexual Satisfaction. Objective measurements were pain during a cotton-swab test, pain during a vestibular friction procedure, and the vestibular pressure-pain threshold measurement. Age and relationship duration were significantly correlated with the Female Sexual Function Index total score (r=-0.31, P < .01; and r=-0.22, P < .05, respectively). When controlling for age, intercourse-related pain intensity, pain during the cotton-swab test, pain during vestibular friction, the vestibular pressure-pain threshold, and the McGill-Melzack Pain Questionnaire sensory and affective subscale scores were not significantly associated with sexual function and satisfaction in women with PVD. The findings show that in women with PVD, self-report and objective pain ratings are not associated with sexual function and satisfaction. The results support the biopsychosocial nature of PVD and underscore the importance of a patient-focused multidisciplinary treatment approach for PVD.