Total Score Correlations Research Articles

Associação entre o tempo de magistério e a autoavaliação vocal em professores universitários: estudo observacional transversal

OBJETIVO: verificar a associação entre o tempo de magistério e a autoavaliação vocal em professores universitários. MÉTODOS: participaram deste estudo 42 professores universitários, os quais responderam a um questionário para caracterização da amostra e identificação das sensações/sintomas vocais e ao Protocolo do Perfil e Participação e Atividades Vocais RESULTADOS: os participantes foram considerados jovens quanto ao tempo de magistério, pois a mediana foi de 8,5 anos, sendo que os autores não limitaram um número mínimo para participação na pesquisa, além disso, houve predomínio do gênero feminino na amostra estudada. Os sintomas vocais mais referidos pelos participantes foram sensação de secura na garganta (66,6%) e rouquidão (40,4%). A correlação entre o tempo de magistério com os domínios e o escore total do Protocolo do Perfil e Participação e Atividades Vocais não mostrou correlação significante. Os escores dos domínios: efeitos na comunicação diária (valor da correlação r= -0,08 e valor do p= 0,63), na comunicação social (valor da correlação r=-0,00 e valor do p=0,99), pontuação de restrição de participação (valor da correlação r= -0,20 e valor do p=-0,21) e o escore total (valor da correlação r= -0,01 e valor do p=-0,96) apresentaram correlação negativa, ou seja, inversas. CONCLUSÃO: embora a população estudada apresentasse queixas de sintomas vocais, isso não se reflete na limitação de suas atividades profissionais e atividades diárias. Portanto, neste estudo o tempo de uso profissional da voz ainda não compromete a qualidade de vida relacionada à voz referida pelos por professores.

Screening for Substance Use Disorder Among Incarcerated Men with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST): A Comparative Analysis of Computer-Administered and Interviewer-Administered Modalities

Substance use disorders are overrepresented in incarcerated male populations. Cost-effective screening for alcohol and substance use problems among incarcerated populations is a necessary first step forward intervention. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) holds promise because it has strong psychometric properties, requires minimal training, is easy to score, is available in the public domain but, because of complicated skip patterns, cannot be self-administered. This study tests the feasibility, reliability, and validity of using computer-administered self-interviewing (CASI) versus interviewer-administered interviewing (IAI) to screen for substance use problems among incarcerated men using the ASSIST. A 2×2 factorial design was used to randomly assign 396 incarcerated men to screening modality. Findings indicate that computer screening was feasible. Compared to IAI, CASI produced equally reliable screening information on substance use and symptom severity, with test–retest intraclass correlations for ASSIST total and substance-specific scores ranging from 0.7 to 0.9, and ASSIST substance-specific scores and a substance abuse disorder diagnosis based on the Structured Clinical Interview (SCID) were significantly correlated for IAI and CASI. These findings indicate that data on substance use and symptom severity using the ASSIST can be reliably and validly obtained from CASI technology, increasing the efficiency by which incarcerated populations can be screened for substance use problems and, those at risk, identified for treatment.

Development, reliability and validity of Traditional Chinese Medicine Health Self-Evaluation Scale (TCM-50).

To develop a health-evaluating scale from a Chinese medicine (CM) perspective and reflecting CM conception of health. The Traditional Chinese Medicine Health Self-Evaluation Scale (TCM-50) was developed by verification of dimensions, formation of item pool, verification of scoring methodology, and pilot test of scale and item analysis. TCM-50 composed of 50 items that could be classified into 4 dimensions including physiology and health, psychology and health, nature and health, and society and health. An examination of reliability and validity of TCM-50 yielded Cronbach's α coefficient of 0.927, and half coefficient of was 0.876. The intraclass correlation coefficient of total score was 0.912. After using SF-36 questionnaire to evaluate the criterion validity, the Pearson of the score of the two scales from the same participant was 0.740. TCM-50 has good reliability and validity, and can yield similar levels of efficacy as SF-36 in terms of evaluating people's overall health level. As a scale based on CM theory, TCM-50 is suitable for self-measuring the general health of Chinese patients.

Analysis of vestibular-balance symptoms according to symptom duration: dimensionality of the Vertigo Symptom Scale-short form.

BackgroundDizziness or vertigo is associated with both vestibular-balance and psychological factors. A common assessment tool is the Vertigo Symptom Scale (VSS) -short form, which has two subscales: vestibular-balance and autonomic-anxiety. Despite frequent use, the factor structure of the VSS-short form has yet to be confirmed. Here, we clarified the factor structure of the VSS-short form, and assessed the validity and reliability of the Japanese version of this tool.MethodsWe conducted a cross-sectional, multicenter, psychometric evaluation of patients with non-central dizziness or vertigo persisting for longer than 1 month. Participants completed the VSS-short form, the Dizziness Handicap Inventory, and the Hospital Anxiety and Depression Scale. They also completed the VSS-short form a second time 1–3 days later. The questionnaire was translated into Japanese and cross-culturally adapted. We conducted a confirmatory factor analysis followed by an exploratory factor analysis. Convergent and discriminant validity, internal consistency, and test-retest reliability were evaluated.ResultsThe total sample and retest sample consisted of 159 and 79 participants, respectively. Model-fitting for a two-subscale structure in a confirmatory factor analysis was poor. An exploratory factor analysis produced a three-factor structure: long-duration vestibular-balance symptoms, short-duration vestibular-balance symptoms, and autonomic-anxiety symptoms. Regarding convergent and discriminant validity, all hypotheses were clearly supported. We obtained high Cronbach’s α coefficients for the total score and subscales, ranging from 0.758 to 0.866. Total score and subscale interclass correlation coefficients for test-retest reliability were acceptable, ranging from 0.867 to 0.897.ConclusionsThe VSS-short form has a three-factor structure that was cross-culturally well-matched with previous data from the VSS-long version. Thus, it was suggested that vestibular-balance symptoms can be analyzed separately according to symptom duration, which may reflect pathophysiological factors. The VSS-short form can be used to evaluate vestibular-balance symptoms and autonomic-anxiety symptoms, as well as the duration of vestibular-balance symptoms. Further research using the VSS-short form should be required in other languages and populations.

Clinician Versus Veteran Ratings on the Mayo-Portland Participation Index in Veterans With a History of Mild Traumatic Brain Injury

The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI). To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings. A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation. Interrater reliability study. M2PI; Minnesota Multiphasic Personality Inventory-2 Symptom Validity Scale (FBS). Veterans reported greater perceived restrictions than clinicians across all M2PI items and total score. Interrater correlations ranged from rs = 0.27 (residence) to rs = 0.58 (money management) across items, with a total score correlation of rs = 0.60. When response bias was indicated, both Veterans and clinicians reported greater participation restrictions than those reported by Veterans without evidenced response bias. Low interrater correlation is consistent with previous findings. As ratings of clinicians and Veterans should not be interpreted as equivalent, documenting the rater's identity is important for interpretation. Using objective indicators of functional outcome may assist clinician raters, particularly when self-report may be biased.

Nutritional status according to the stages of Alzheimer's disease.

To assess the nutritional status of Alzheimer's disease (AD) patients with no other associated dementia, according to disease stage. Cross-sectional observational study. Neurobehavioral Diseases Outpatient Clinic, Clinical Hospital, Ribeirao Preto Medical School (University of São Paulo). The sample consisted of 36 individuals of both genders with AD diagnosis, and no other associated type of dementia, in various stages of the disease, according to the Clinical Dementia Rating (CDR 0.5-3). Nutritional status was evaluated using the Mini Nutritional Assessment (MNA) and anthropometric measurements such as weight, body mass index (BMI) and arm, waist, abdomen and hip circumferences. In addition, body composition was assessed by bioelectrical impedance analysis (BIA). The mean age of the group was 74.2±10.1years, 72.2% of them were women. The MNA showed that most of these individuals were at risk for malnutrition (55.5%) and many of them (43.7%) were underweight according to BMI. Data from BIA analysis revealed that 41.7% of these individuals had a quantity of body fat classified as malnutrition and 11.1% had a phase angle (PA) below recommended values for age group. There was a negative and significant correlation of lean mass and PA with age, and of global MNA evaluation with CDR, as well as a positive correlation of MNA total score with fat mass and BMI. Worse classifications of nutritional status obtained by MNA scores were also observed in the more severe stages of the disease, according to the CDR. Patients with AD are mostly elderly with changes in body composition that are typical of aging, with signs of peripheral malnutrition and preservation of abdominal fat. However, greater impairment of general nutritional status was observed in the more advanced stages of AD, creating a situation of greater vulnerability for these patients.

Studies on quality of orthodox teas made from anthocyanin-rich tea clones growing in Kangra valley, India

Recently anthocyanin-rich purple tea varieties have been developed. The quality of these new purple tea varieties developed in Kangra valley was assessed, and compared with the quality of tea from standard Kangra clone. Purple tea shoots (PL) recorded higher amount of polyphenols compared to standard green tea shoot (GL) while epigallocatechin gallate (EGCG) recorded higher levels in GL. Higher levels of theaflavins were recorded in orthodox black tea from purple shoots (BTP) compared to black tea (BT) made from green shoots. Both theanine and caffeine recorded higher levels in GL. Volatile flavour profiles of these teas showed qualitative and quantitative differences. Aroma extract dilution assay showed higher dilution factors in BTP than BT. Orthodox teas from purple shoots exhibited higher antioxidant activity compared to standard black tea. Strong correlation of total quality scores with aroma and infusion colour was observed. Tea from anthocyanin-rich cultivars can become specialty teas with high antioxidant activity.

Mindful Creativity Scale (MCS): Validation of a German version of the Langer Mindfulness Scale with patients with severe TBI and controls

Background: Mindfulness may have an impact on the recovery process in patients who have suffered severe traumatic brain injury (TBI). In order to make an instrument for measuring mindfulness within the German speaking clinical community available, a short, easily usable scale and a cross-cultural adaptation is needed.Objectives: To validate the Langer Mindfulness Scale (LMS) with German-speaking patients with severe TBI and their relatives (healthy controls).Research design: In a prospective cohort study of patients with severe TBI, test–re-test interviews were carried out at 6-month intervals.Sample: A total of 225 participants responded to the first survey and 230 completed the second survey.Measures: LMS, self-report questions on personality, openness and attention, as well as health and clinical evaluations (including cognitive and behavioural assessments).Results: On the basis of factor analysis, principal component analysis and item response analysis, the initial 21-items were reduced to six items. The resulting unidimensional scale showed high internal consistency (α = 0.82) and good test–re-test reliability (intra-class correlation for total score = 0.46). External validity was confirmed for the entire sample.Conclusion: It was concluded that the German short form of the original LMS (MCS) is a valid and reliable measure of mindful creativity.

Y-대학교 치위생학과 졸업생의 학교 성적과 국가시험 성적의 상관성

This study was aimed to define the predicting factor account for the Korean Dental Hygienist Licensing Examination (KDHLE) by analyzing the academic grade score and the KDHLE score. The subjects included 185 graduates (2007, 2009, 2011∼2014 graduates). The ratio of successful applicants of the subjects was 99.2%. The academic grade scores were calculated to grade point average, the KDHLE was scoring marks out of 300 (200 of written examination score and 100 of performance evaluation score) for correlation and regression analysis. The graduation grades and comprehensive examination scores correlated significantly with the KDHLE written examination scores (correlation coefficient=0.612), and KDHLE total score (correlation coefficient=0.258). First∼third grade score and comprehensive examination scores correlated significantly with KDHLE total scores (p<0.05). Especially, there are the highest correlated between second comprehensive examination scores and KDHLE total scores (correlation coefficient=0.455), the last score in time sequence is the important factors account for the KDHLE total score. But there is no correlation between academic grade score and KDHLE performance evaluation scores, therefore it is necessary to study for determine the reason. The results of multiple linear regression analysis, second grade score and the average score of comprehensive examination were the main predicting factors account for the KDHLE total score, the explanatory power was 31.6%. Our results show that KDHLE total and written examination scores are predicted by the academic grade score reliably, but not the KDHLE performance evaluation scores. Further studies are needed to determine relationship between dental hygiene education and KDHLE.

Lebanese medical students’ intention to deliver smoking cessation advice

ObjectivesObjectives of this study were to examine the constructs of the Theory of Planned Behavior and determine how they predict Lebanese medical students’ behavioral intention to advise patients to quit smoking. Study designThis was a cross-sectional study conducted among 191 medical students from six medical schools in Lebanon. MethodsThe instrument contained scales that measured attitudes toward the behavior, behavioral beliefs, subjective norms, and perceived behavioral control. Psychometric properties of the scale were examined. Item to total scale score correlations were determined and linear regression was conducted to predict the intention to advise smokers to quit. ResultsRespondents had a positive, but not very high, intention to deliver smoking cessation advice. Students reported a positive attitude toward advising patients to quit cigarette smoking and a strong belief in the physician’s obligations in smoking cessation advising. The majority reported lack of time to provide smoking cessation advice, insufficient knowledge of pharmacological aids, and the lack of openness of the patient to receive the advice. The attitude scale was the only variable that yielded a significant prediction of the intended behavior. ConclusionsThe construct of attitude toward the behavior appeared to be the most predictive of the intention to deliver advice to quit smoking among Lebanese medical students. Focusing training efforts on this construct could improve the rate of delivery of brief cessation counseling.

Measurement of External Shame: An Inside View

The aims of this study were to investigate the construct validity of the Other as Shamer scale (OAS) using confirmatory factor analysis (CFA) and to examine the psychometric properties of its Italian version in a sample of 687 nonclinical individuals. The CFA results indicated that the hypothesized hierarchical model (with 1 higher order factor and 3 first-order factors) was the best fitting solution. Cronbach's alpha indexes, as well as test–retest stability, provided satisfactory results. Correlations of the OAS total score and its subscales with the Beck Depression Inventory–II (rs = .30–.48) and the Teate Depression Inventory (rs = .32–.45) were both substantial and significant (p < .01). Receiver operating characteristic curves were constructed to indicate sensitivity and specificity of the OAS and its subscales when determining those nonclinical subjects who met clinical thresholds for depression symptoms. A series of cutoff scores for the OAS scale and its subscales was developed, with sensitivity values between .70 and .62, and specificity values between .71 and .62, indicating good to fair discrimination between the 2 groups (depressed vs. nondepressed). The theoretical and practical implications of these results were discussed.

Reproducibility and validity of the physical activity scale for the elderly (PASE) questionnaire in patients after total hip arthroplasty.

The assessment of physical activity is of concern in patients after total hip arthroplasty (THA). However, so far, no questionnaire has demonstrated adequate reproducibility and validity for assessing physical activity in these patients. The aim of this study was to evaluate the reproducibility and validity of the Physical Activity Scale for the Elderly (PASE) questionnaire in patients after THA. This was a measurement study. Fifty patients who had undergone THA (25 women, 25 men), with an average age of 68 years, were evaluated. Of these patients, 25 were assessed between 2 and 7 months after surgery (THAearly), and another 25 were assessed between 7 and 12 months after surgery (THAlate). Reproducibility of the PASE questionnaire was evaluated by administering the questionnaire on 2 different occasions. Construct validity of the PASE questionnaire was assessed by comparing the physical activity level reported by patients with that objectively recorded by a body-mounted accelerometer. Reproducibility was investigated with intraclass correlation coefficients (ICC [2,1]) for reliability and standard errors of measurement (SEM) for agreement. Validity was investigated with Pearson correlation coefficients (r). The ICC (2,1) for the PASE total score was .77 (95% confidence interval [95% CI]=.63, .86); the SEM was 23.0% (95% CI=19.2, 28.7). Validity correlation for the PASE total score was .38 (95% CI=.12, .60). No significant differences were found between THAearly and THAlate groups for reliability, agreement, and validity outcomes. Reproducibility of the PASE questionnaire may have been underestimated because the physical activity of patients was compared between 2 consecutive but different weeks. Reliability and validity analyses were underpowered. Further study with a larger sample size is necessary to obtain precise reliability and validity estimates. Nevertheless, inadequate agreement calls into question the PASE questionnaire's ability to assess the physical activity level of patients after THA surgery.

Stability of alexithymia in late adolescence: Results of a 4-year follow-up study

The aim of the present study was to assess the stability of alexithymia in adolescents and the effects of parental factors and social support thereon. The sample comprised 315 late adolescents, of whom 259 were female and 56 male. At baseline, the mean age of the subjects was 19 years (range 17–21 years). The follow-up period was 4 years (2008–2012). The 20-item Toronto Alexithymia Scale (TAS-20) was used for the assessment of alexithymia both at baseline and follow-up. The Multidimensional Scale of Perceived Social Support (MSPSS) and the Parental Bonding Instrument (PBI) were used as measures at baseline. Regarding absolute stability, the changes in the TAS-20 total scores and two subscales (DIF and EOT) were statistically significant but the effect sizes for the changes were small (Cohen׳s d 0.21–0.24). The test–retest correlations for the TAS-20 total and subscale scores were high (ρ=0.50–0.64, P<0.001), indicating relative stability. While several parental and social support variables were associated with alexithymia at baseline, low social support from friends was the only to predict higher alexithymia at follow-up. Alexithymia is a stable personality trait also in late adolescence. Low social support from friends is related to alexithymia in young adulthood.

Psychometric properties of the Stress and Crisis Inventory (SCI-93) in females with fibromyalgia and chronic widespread pain

Background: Fibromyalgia (FM) and chronic widespread pain (CWP) are commonly associated with symptoms such as fatigue, stiffness, tension, exhaustion and psychological distress. Research on biological markers of the degree of stress symptoms has been conducted for decades. However, biological markers do not offer sufficient information for clinical practice, and thus, validated rating scales are still the best assessment option. The Stress and Crisis Inventory-93 (SCI-93) was designed to assess the severity of symptoms that are primarily related to the autonomous nervous system. Objective: The purpose of this study was to evaluate the psychometric properties of the SCI-93 with regard to known-group validity, internal consistency and test–retest reliability. Methods: The study included 166 women with FM or CWP in addition to 157 age-matched healthy women. The test–retest reliability was investigated in 40 women with FM. Results: A one-factor solution was chosen, which explained 53% of the total variance; Cronbach's alpha was 0.98. The group of patients with FM and CWP showed significantly higher SCI-93 total scores than the healthy reference group (mean = 76.4 ± 24.9 vs. mean = 24.9 ± 21.3; P < 0.001), supporting known-group validity. In the test–retest reliability study, the intra class correlation for the SCI-93 total score was 0.95. Conclusions: The SCI-93 demonstrated satisfactory known-group validity and test–retest reliability. The instrument appears to reflect well the severity of autonomous symptoms.

Mo1036 Development and Validation of a Virtual Child-Turcotte-Pugh Score to Assess Liver Disease Severity in an Administrative Healthcare Database

The Child-Turcotte-Pugh (CTP) score is a widely used predictor of long-term survival in cirrhosis that has been incorporated into liver cancer staging systems such as the Barcelona Clinic Liver Cancer (BCLC) algorithm. CTP calculation requires 3 objective values: total bilirubin, serum albumin and International Normalized Ratio (INR), as well as 2 subjective variables: severity of ascites and hepatic encephalopathy. No system to quantify CTP score from administrative databases has been validated. The Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) study is a multicenter collaborative study to evaluate the outcomes and cost of hepatocellular carcinoma (HCC) in the U.S. Veterans Health Administration (VHA). In order to match cirrhotic patients with HCC to similar cirrhotic patients without HCC, we developed and validated an algorithm to extrapolate virtual CTP (vCTP) scores from data in the VHA Corporate Data Warehouse (CDW). Methods: The derivation cohort consisted of 150 subjects with ICD9 codes of 155.0 or 155.2 (HCC) randomly selected from all patients diagnosed with HCC from 2008-2010 at 7 validation sites (Boston, Bronx, Brooklyn, Philadelphia, Minneapolis, and West Haven VA Medical Centers). The validation cohort consisted of 150 subjects with ICD9 codes of 571.2, 571.5 or 571.6 (cirrhosis) in the first quarter of 2009 randomly selected from the same sites. Investigators at each site reviewed each chart and calculated actual CTP (aCTP) scores based on available data. We tested several strategies incorporating laboratory data, pharmacy data, ICD9 andCPT codes. The optimal algorithm incorporated laboratory data (albumin, bilirubin, INR) obtained proximate to the diagnosis date for the HCC cohort (and in a given quarter for the cirrhotic cohort); CPT codes for paracentesis and TIPSS; and pharmacy data for lactulose, rifaximin, furosemide, spironolactone and amiloride. Performance characteristics of each vCTP subscore and total score were evaluated. The vCTP score was tested as a predictor of survival on a cohort of 682 patients with HCC and correlated as expected in BCLC-A disease. Results: Spearman correlations among vCTP subscores and total score are shown in Table 1 for each cohort. In the derivation cohort, total vCTP matched aCTP in 54/79 (68%) cases and 76/79 (96%) were within 1 point (Spearman R=0.83, p<0.0001). In the validation cohort, total vCTP matched aCTP in 38/55 (69%) and 54/55 (98%) were within 1 point (Spearman R=0.85, p<0.0001). Conclusion: We developed and validated an algorithm to extrapolate the CTP score from data in a large administrative database with excellent correlation to actual CTP score on chart review. This algorithm may be applied to administrative healthcare databases for the purpose of stratifying cirrhotic patients by disease severity when studying any topic relevant to liver disease. Table 1. Correlations for vCTP subscores and total score

Functional Disability in Alzheimer Disease

This study aimed to determine the reliability and validity of the Turkish version of Disability Assessment for Dementia (DAD) scale in the Turkish elderly population with Alzheimer disease (AD). The DAD scale was administered to the primary caregivers of 157 patients (age 77.7 ± 6.8 years) with AD. The Turkish version of the DAD scale showed high internal consistency (Cronbach α = .942), excellent test-retest, and interrater reliability (intraclass correlation coefficient [ICC] = 0.996 and ICC = 0.994, respectively). The DAD scale was significantly correlated with activities of daily living (ADL; Modified Older Americans Research Survey ADL) and instrumental activities of daily living (IADL; Lawton and Brody IADL) scales (r = .89, P < .001 and r = .90, P < .001). Disability Assessment for Dementia had a high negative correlation with the Global Deterioration Scale (GDS; r = -.880, P < .001). Post hoc comparisons with Tukey test showed significant differences in the mean DAD scores in different GDS stages. Construct validity was estimated using total score correlation analyses between the standardized Mini-Mental State Examination (MMSE) and the DAD scale. Results revealed high and significant correlation between MMSE score and DAD scale (r = .812, P < .001). The results of multivariate analysis showed that DAD score was not correlated with gender, education, and age. The DAD total score was affected mostly by GDS, MMSE, and duration of the disease. Turkish version of the DAD scale was found to be a reliable and valid instrument to assess functional disability in Turkish elderly patients with AD. This scale assists caregivers and physicians to decide for proper interventions.

Student performance of the general physical examination in internal medicine: an observational study

BackgroundMany practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine.MethodsOne hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items.ResultsApproximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001).ConclusionsIn conclusion, performance of the general physical examination was already below expectation at the end of the internal medicine clerkship. Possible causes and suggestions for improvement are discussed.

Nocturnal journey of body and mind in Parkinson’s disease: the manifestations, risk factors and their relationship to daytime symptoms. Evidence from the NIGHT-PD study

Nocturnal manifestations of Parkinson's disease (PD) are myriad, have diverse etiologies and include motor, sleep, urinary, and neuropsychiatric symptoms which are often associated with daytime somnolence. While most patients perceive these symptoms as troublesome, the recognition of nocturnal problems related to PD is still low in clinical practice. We conducted a survey using semi-structured interviews and self-rated questionnaires of 215 consecutive patients with PD enrolled in three centers in Thailand to determine the prevalence and risk factors of nocturnal disabilities and their relationship to daytime symptoms. We found that 96.6% of patients reported the presence of nocturnal symptoms as determined by the modified version of Parkinson's Disease Sleep Scale (MPDSS). Our survey indicated that the most frequent and distressing symptom was the interruption of sleep to pass urine (56.7%, 4.4 ± 3.9). The severity of symptoms revealed in the MPDSS increased along with the disease duration (p < 0.05) and Hoehn and Yahr stages (p = 0.01). There were similar to findings of the Nocturnal Akinesia Dystonia and Cramp Score (NADCS) where patients with advanced disease had significantly higher NADCS scores than early/moderate disease (p < 0.001). There was a significant correlation of total MPDSS scores with the total scores of the 9-item Wearing-Off Questionnaire (WOQ-9); (r = -0.43, p < 0.05) [motor (r = -0.35, p < 0.05) and nonmotor subscores (r = -0.43, p < 0.05)]; total nonmotor symptoms (NMS) scores (r = -0.55, p < 0.05); Parkinson's Disease Questionnaire-8 Summary Index (PDQ-8 SI) (r = -0.52, p < 0.05); and the total NADCS (r = -0.35, p < 0.05). Multiple regression analysis identified PDQ-8 SI (β = -0.27, p = 0.005) as the most significant predictor of nocturnal manifestations of PD, followed by the nonmotor subscore of WOQ (β = -0.24, p = 0.006), and the NMS item 20 (feeling light-headed, dizzy, or weak when standing from sitting or lying) (β = -0.22, p = 0.003). Our study found that nocturnal symptoms of PD are very common and we suggest that good clinical practice should include a comprehensive review of nighttime manifestations, particularly for those patients who already experience "wearing-off" symptoms.

Correlations of interpersonal sensitivity with negative working models of the self and other: evidence for link with attachment insecurity

BackgroundIt has been suggested that interpersonal sensitivity, a personality trait associated with depression and anxiety disorders, is linked with attachment insecurity. To confirm this link, we studied the correlations of interpersonal sensitivity with working models of the self and other.MethodsThe subjects were 301 healthy Japanese. Interpersonal sensitivity and working models of the self and other were assessed by the Interpersonal Sensitivity Measure (IPSM) and the Relationship Scales Questionnaire, respectively. The correlations of the IPSM total scores with the self-model or other-model scores were analyzed by the multiple regression analysis.ResultsThe IPSM total scores were correlated negatively with the self-model scores (β = −0.48, p < 0.001) and to a lesser extent with the other-model scores (β = −0.15, p < 0.01).ConclusionsThe present study suggests that interpersonal sensitivity is correlated with negative working models of the self and other, providing evidence for its link with attachment insecurity.

Contraste de una estructura trifactorial para escala de actitudes hacia lesbianas y hombres homosexuales (ATLG)

Este artículo tiene como objetivos contrastar el modelo tridimensional de Moral y Valle (2011), para la escala ATLG y aportar pruebas de su validez. Se aplicaron las escalas ATLG (Herek, 1984), de homonegatividad internalizada (HNI-16; Moral &amp; Valle, 2013) y homofobia (HFK-10; Klamen, Grossman, &amp; Kopacz, 1999) a una muestra no probabilística de 231 estudiantes mexicanos de Ciencias de la Salud (121 mujeres y 103 hombres). Se contrastaron tres modelos por Mínimos Cuadrados Generalizados (GLS): de un factor, dos factores correlacionados y tres factores jerarquizados a uno general. Los modelos de dos factores correlacionados y de tres factores jerarquizados tuvieron una bondad de ajuste equivalente y significativamente mayor que la del modelo unidimensional. No obstante, los datos reflejaron unidimensionalidad con base en tres argumentos: 1) los valores de correlación y coeficientes de regresión de los factores de primer orden fueron muy altos; 2) el análisis paralelo de Horn indicó que el número de factores es uno, por lo que la varianza explicada por un segundo o tercer factor se debería al azar; y 3) la bondad de ajuste del modelo unidimensional fue aceptable y muy semejante a la de los otros dos modelos. Las correlaciones de la puntuación total de la ATLG con las de HNI-16 y HFK-10 fueron altas y significativas. La orientación sexual autodefinida y tener amigos homosexuales tuvieron un efecto mediano sobre la ATLG. Se concluye que la ATLG es unidimensional y posee evidencias de validez. Se sugiere una forma simplificada de 5 ítems.