Discriminant Validity Research Articles

Validation of the Patient-Reported Outcomes Measurement Information System Pain Intensity and Brief Pain Inventory During Pregnancy.

We sought to (1) validate the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a measure and Brief Pain Inventory (BPI) for assessing pain during pregnancy and (2) evaluate pain in a sample of pregnant individuals. Pregnant individuals (N = 196) were prospectively surveyed: n = 171 up to 22 weeks gestational age, n = 123 during their third trimester of pregnancy, and n = 98 both times. Additional measures included SPRINT Post-Traumatic Stress Disorder Tool, Neurological Quality of Life, Edinburgh Postnatal Depression Scale and anxiety subscale, and Adverse Childhood Experiences Questionnaire. Validity evidence examined included content validity, reliability, convergent and discriminant validity, and relevant criterion relationships. Content validity analysis suggests that the PROMIS pain measure was easy to use and interpret while the BPI provided more detail. However, BPI questions regarding medication usage and relief were unclear to some pregnant individuals. In addition, the relationships among pain ratings were stronger than relationships between pain ratings and measures intended to assess other constructs suggesting convergent and discriminant validity. Relationships with relevant criterions were presented for both the PROMIS and BPI by comparing ratings of pain intensity and severity for pregnant individuals with and without areas of pain reported on BPI. Results indicate that PROMIS and BPI provided valid information on pain intensity or severity for our perinatal sample. Depending on the research question, the PROMIS pain or BPI may be more appropriate to an individual study. Either measure could also be included in an electronic health record for accurate pain assessment in clinical settings.

Validation and assessment of the arabic psychological first aid scale among physicians, nurses, and counselors in Jordan

BackgroundPsychological first aid (PFA) involves strategies to tackle problems that occur as a result of disasters. This study aimed to validate the Arabic version of PFA scale through validity (face, content, convergent, discriminant validity, and confirmatory factor analysis) and reliability (Cronbach’s alpha). Furthermore, it aimed to assess the perceived levels of knowledge, skills, and attitudes of PFA among healthcare providers (HCPs). Moreover, it determined the differences between HCPs based on their knowledge, skills, and attitudes of PFA.MethodsA sample size of 389 HCPs (physicians = 68, nurses = 173, and counselors = 148) was conveniently selected to participate during the period of 10 December 2023 to 10 February 2024 after completing the translated PFA scale into the Arabic language. Descriptive, translation, validation process, and reliability were conducted.ResultsThe translation process was satisfied. The content validity index was 0.91, yielding proper clarity of items. Three constructs were loaded with a total variation of 63.43%, indicating a proper model fit. The goodness-of-fit indices for the PFA model revealed that relative chi-square was 1.47, comparative fit index was 0.91, Tucker-Lewis index was 0.89, and the root mean square of error approximation was 0.046. Cronbach alpha values for knowledge, skills, and attitudes of PFA were 0.90, 0.89, 0.87, respectively. We found that counselors have more knowledge (64.4%), skills (73.4%), and attitudes (73.4%) compared to physicians and nurses. There are significant differences (p < 0.001) between the selected HCP groups, particularly for the counselors’ group in terms of knowledge, skills, and attitudes of PFA.ConclusionsThe Arabic PFA scale is valid and reliable among HCPs. The results highlight the emergent need to provide knowledge, skills, and attitudes of PFA interventions among medical professionals, particularly for physicians and nurses. The Arabic version of PFA helps all HCPs in Arab countries to assess, apply, and implement PFA interventions.

The Development of a Brief Session-Level Process Measure for Emotion-Focused Couple Therapy.

Emotion-focused therapy for couples (EFT-C) has a strong tradition of delineating mechanisms of change. These change processes are typically examined using labor-intensive observational methods, which may not be practical for clinicians or researchers who aim to routinely monitor changes in therapy processes as they unfold across therapy sessions. The current study describes the EFT-C Process Measure (ECPM), a short, easily administered, eight-item questionnaire that can complement more traditional observational methods. The ECPM uses a systemic framework (assessing one's experience as well as one's perception of the partner's experience) and can be administered at the end of each session to capture the key processes of change in EFT-C (cycle understanding, accessing vulnerability, sharing vulnerabilities, responsive expression). We used data from 1033 session reports obtained from 44 couples receiving EFT-C to examine the validity of this measure. The results indicated that the ECPM evidenced convergent and discriminant validity (it was associated with reports of the therapeutic alliance), criterion validity (it was associated with reports of session evaluation and relationship satisfaction), and incremental validity for its systemic framework. Additionally, the ECPM proved sensitive in tracking change processes from session to session and capturing the expected increase in process engagement throughout the course of therapy. Although a complete validation of this tool requires a larger sample, the ECPM may be used by researchers and clinicians to obtain insights into the change process in EFT-C.

The Chinese version of Selection, Optimization, and Compensation Questionnaire: psychometric properties among adolescent students

ObjectiveThis study established the reliability and validity of the Selection, Optimization, and Compensation Questionnaire in a sample of senior secondary school students in China.MethodsThe data for this study were sourced from 1,080 students from multiple senior secondary schools using the SOC Questionnaire and the Learning Engagement Scale. This study conducted Exploratory Factor Analysis and Confirmatory Factor Analysis. The factor structure analysis of the psychometric properties of SOC Questionnaire were examined on reliability, convergent validity, concurrent criterion validity, and incremental validity.ResultsThe EFA results suggested that a three-factor solution was most appropriate for the SOC Questionnaire. The three-factor CFA model of this study calculated correlations different from what was published with an American sample of adolescents by the questionnaire developers. The reliability coefficients (Cronbach’s α, McDonald’s ω), composite reliability (rho_c), and reliability coefficient (rho_a), convergent and discriminant validity were good. Concurrent criterion validity, and incremental validity were demonstrated by the SOC Questionnaire and the LES.ConclusionThe 17-item, 3-factor SOC Questionnaire demonstrated strong reliability and validity, thus offering a new multidimensional of the SOC Questionnaire to evaluate intentional self-regulation among adolescents in schools.

Exploring the Factor Structure and Measurement Invariance of the Teacher Subjective Wellbeing Questionnaire Across Four European Countries

Teacher well-being is a psychological asset for educators, often associated with job engagement and retention. However, sophisticated measures to comprehensively assess teacher well-being are still under investigation. This study explores the factor structure and cross-country comparability of the Teacher Subjective Wellbeing Questionnaire (TSWQ) among 393 early childhood education teachers from four European countries. Exploratory and confirmatory factor analyses generally supported the TSWQ’s proposed dimensionality, identifying teaching efficacy and school connectedness as two distinct latent factors, along with indications for the existence of a general, higher-order factor. Additionally, measurement equivalence was established at all levels across the four countries. Discriminant validity analyses highlighted culturally specific nuances in the relationship between teacher well-being and burnout. The findings underscore the TSWQ’s potential to advance theoretical and methodological research on teacher well-being and broaden the instrument’s applicability across diverse educational settings.

The language use Inventory-Persian: report of the psychometric properties

BackgroundPragmatic language assessment is a necessary component of evaluation in language impairments. Some procedures are applied to assess pragmatic abilities in childhood. Parent-report questionnaires are among the most useful instruments for evaluating pragmatics in real situations. This study aimed to translate and adapt the Language Use Inventory (LUI) into Persian and examine its psychometric properties.MethodIt was a methodological and cross-sectional study. We pursued the steps of translation and adaptation of this questionnaire into Persian according to a standard guideline. Then, 348 parents/caregivers of three groups of children consisting of typically developing (TD), late-talking children, and ones with autism spectrum disorders (ASD) 18-47-month-old Persian-speaking children completed the adapted version of the LUI. The participants were recruited into study by convenience sampling. Next, different psychometric properties including item analysis, validity (content, face, and construct), and reliability (test-retest and internal consistency) were investigated.ResultsTranslation, adaptation, and item analysis led to the deletion of 7 Items. Differential validity for age revealed the noticeably different performance among different age groups (p < 0.001). Also, Given the clinical validity, TD and ASD children performed differently in this measure(p < 0.001). In addition, the evidence of the discriminant validity was confirmed by a significant difference between TD and late-talking children (p < 0.001). Concurrent validity was also established by a moderate and positive value of the correlation between total scores of the LUI-Persian and Newsha developmental scale (r = 0.54, p = 0.01). Exploratory factor analysis (EFA) indicated that the Language Use Inventory-Persian had 2 factors of verbal and nonverbal use of language. Also, the evidence for the confirmatory factor analysis (CFA) was attained (all the values of factor load were higher than 0.40). The internal consistency (α = 0.99) and test-retest reliability (r = 0.97) proved adequate values.ConclusionsThe Language Use Inventory-Persian with 173 items revealed the acceptable psychometric attributes for assessing pragmatics in 18-47-month-old Persian-speaking children; however, for screening pragmatic impairments, it may need further studies on clinical populations with a larger sample size to see whether the LUI items are appropriate or possible changes in the items are required.

Validity and reliability of the Manchester Oxford Foot Questionnaire (MOXFQ) in one-year postoperative ankle fracture patients—a validation study

BackgroundAnkle fracture patients are a heterogenous group with differences in age, sex, fracture morphology, and treatment provided. With the increased focus on patient-centered treatment, patient-reported outcome measures (PROMs) are increasingly adopted by clinicians to facilitate best clinical practice. The Manchester Oxford Foot Questionnaire (MOXFQ) has demonstrated good measurement properties when used in patients with foot or ankle disease. The PROM has three domains: (1) Pain; (2) Walking/Standing; and (3) Social Interaction. One study found sufficient content validity for the Pain and Walking/Standing domains when used in the evaluation of ankle fracture patients. Another validation study demonstrated acceptable structural validity and reliability for the MOXFQ in ankle fracture patients 12 weeks after injury. The aim of this study is to assess the structural validity and reliability of the Norwegian version of the MOXFQ in the context of an ankle fracture patients one year after surgery and provide patient acceptable symptom state (PASS) estimates.MethodsA pragmatic cross-sectional study design was used to collect the one-year MOXFQ follow-up data from patients surgically treated for an ankle fracture in the period 2017 to 2020 at (Stavanger University Hospital). The structural validity and internal consistency were assessed using confirmatory factor analysis. A separate test-retest study including patients at least one year since ankle surgery was used in the assessment of reliability and measurement error.ResultsA confirmatory factor analysis of the three-factor model of the MOXFQ had a good model fit (TLI 0.94; CFI 0.95; RMSEA 0.094; SRMR 0.039). However, the measurement model demonstrated poor discriminant validity of the three factors. A unidimensional model of the 16 items had worse model fit, while a second-order factor model demonstrated strong factor loadings for a second-order factor. A bi-factor model also revealed a strong general factor but also unique variance in the Pain and Social Interaction domain. The domains had good internal consistency (McDonald’s omega 0.80 to 0.95) and test-retest reliability (ICC 0.80 to 0.92). The standard errors of measurements for the three domains were between 6.5 and 7.5, and 5.5 for the MOXFQ-Index (scale 0 to 100). PASS estimates for the (sub)scales were: Pain 45; Walking/Standing 39; Social Interaction 19; and MOXFQ-Index 34.ConclusionThe MOXFQ with three domains demonstrated sufficient structural validity and reliability when used in the evaluation of a one-year postoperative ankle fracture population. Reporting the scores of the Pain and Walking/Standing domains was best supported.

Psychometric validation of the continuum beliefs of mental illness scale (CB-MIS) and its associations with stigma

BackgroundContinuum beliefs of mental health and illness are robustly negatively correlated with mental illness stigma. However, there is a lack of multidimensional and validated measures, not entirely relying on vignettes.MethodsTo develop such a scale, a pool of 37 items adapted from other studies on continuum beliefs, was initially examined in expert discussions and a convenience sample (N = 227, Mage=32 years, 80.6% female). Items were selected based on theoretical tenability and assigned to pre-defined facets of “State”, “Person”, and nosological “Concept” in relation to mental illness. In a second sample (N = 1375; Mage=42 years; 65.2% female), the Continuum Beliefs of Mental Illness Scale (CB-MIS) was psychometrically tested (i.e. factorial, convergent, discriminant validity).ResultsThe scale comprises three subscales with three items, and one optional vignette-based item each, rated on a 5-point Likert scale. It showed very good factorial and discriminant validity, associations with stigma were moderately negative. The scale exhibited good test-retest reliability over a period of six months.ConclusionsA validated, practical, multifaceted measure is offered to evaluate beliefs regarding the continuum of mental health and illness. Future studies should conduct subgroup-specific investigations regarding sociodemographic and illness variables, and could apply this measure to anti-stigma interventions.Trial registrationGerman Clinical Trials Register: DRKS00023557. Registered 11/12/2020. World Health Organization, Universal Trial Number: U1111–1264–9954. Registered 16/02/2021.

Validating the self-competence in death work scale for end-of-life care volunteers

There is an increasing demand for end-of-life care (EoLC) volunteers in Hong Kong’s aging population. However, there is no validated measure that assesses volunteers’ self-competence in coping with death. This is essential to optimize their services, and ensure their psychological well-being. This study aimed to validate the existing Self-Competence in Death Work Scale (SC-DWS) for EoLC volunteers. This scale has been tested previously on health professionals providing end-of-life care, and was adapted for this study with words that fitted the volunteer context.A self-administered survey collected demographic information, personal experiences, the 16-item SC-DWS, 15-item Templer Death Anxiety Scale, and the 8-item Spiritual Wellbeing Scale to examine the internal consistency, concurrent validity, and discriminative validity of this scale among EoLC volunteers. The study sample consisted of all applicants who registered for the EoLC volunteer training programme between 2019 and 2021. Applicants first underwent a systematic screening and selection procedure. They completed an online registration form which included risk assessment, followed by structured individual interviews focusing on applicants’ motivation and mental preparedness for their role. The content validity of the SC-DWS was determined using data from the 341 volunteers who were screened prior to training. Construct validity was tested using Exploratory Factor Analysis (EFA), which suggested that two-factors (subscales) offered the best combination of variables (Emotional and Existential Subscales). The new subscales and the component items differed slightly from those identified in health professional samples. Concurrent validity was demonstrated by strong correlations between the SC-DWS, and the Death Anxiety, and Spiritual Wellbeing scales. Discriminant validity was supported by strong relationships between the new subscales and participants’ personal experiences. The SC-DWS was shown not only to be reliable and valid for EoLC volunteers, but it also highlighted the unique emotional challenges they faced.

Comparison of the Beck Anxiety Inventory and the Geriatric Anxiety Scale in an Older Adult Neurology Clinic Sample.

The Beck Anxiety Inventory (BAI) is a commonly used anxiety measure, but it was not specifically designed for use among older adults. Previous research has raised concern that it may inflate anxiety ratings among older adults because of its emphasis on physical symptoms. The Geriatric Anxiety Scale (GAS) is designed for older adults but has not been examined in a neurology clinic setting. This study sought to compare the psychometric properties of the BAI and the GAS in an older adult neurology clinic sample. An exploratory aim was to determine the influence of motor symptoms on anxiety scores. Participants included 68 adults age 60+ referred for a neuropsychological evaluation in an outpatient neurology clinic. Measures included the BAI, GAS, and the Montreal Cognitive Assessment (MoCA). Psychometric properties were determined. A McNemar test compared the proportion of anxiety classifications between the BAI and GAS. Referral source (cognitive disorder versus movement-oriented teams) was used as a proxy for grouping patients who were likely to have prominent motor symptoms versus those who were not. An independent t-test compared scale performance between these groups to examine the influence of motor symptoms on anxiety ratings. Both scales had good internal consistency (GAS α = 0.93; BAI α = 0.88). Convergent validity (GAS and BAI: r = 0.81, p < .001) and discriminant validity (GAS and MoCA, r = 0.18, p = .20) were supported. The BAI detected anxiety among 40% of participants, while the GAS detected anxiety among 56%, which was a statistically significant difference (p = .002). Anxiety ratings did not differ based on referral source (t(66) = -1.59, p = .12). Both scales had good psychometric properties, though the GAS detected a higher rate of anxiety compared to the BAI despite having less focus on motor symptoms that could be attributed to age-related physical changes or movement disorders. The GAS may capture aspects of anxiety not assessed by the BAI among older adults.

The Dark Personality in a Sample of Adults: A Theoretical and Psychometric Study

This study evaluates the psychometric properties of the Dark Triad Scale within a Saudi Arabian context. A total of 205 participants were involved, with a mean age of 34.48 years (SD = 8.57). Exploratory factor analysis identified a three-factor structure corresponding to Machiavellianism, narcissism, and psychopathy, each exhibiting high internal consistency (Cronbach’s α = 0.92 for Machiavellianism, α = 0.91 for narcissism, and α = 0.89 for psychopathy). The factors demonstrated satisfactory composite reliability (CR &gt; 0.70) and acceptable convergent and discriminant validity, as indicated by an average variance extracted (AVE) greater than 0.50. Measurement invariance across gender was also established. These results suggest that the Saudi version of the Dark Triad Scale is a valid and reliable instrument for assessing the darker aspects of personality in this cultural context.

Adaptation of the Vicarious Resilience Scale to Turkish: A validity and reliability study.

The 27-item Vicarious Resilience Scale (VRS) is the first tool developed to measure vicarious resilience in mental health professionals working with trauma survivors. Given that the VRS measures the positive impact on therapists resulting from observing the healing process of trauma victims, it is especially significant to evaluate its validity and reliability in Turkish culture. This study aims to adapt the VRS to Turkish and examine its psychometric properties. VRS was adapted and administered via electronic survey to 337 mental health professionals from around the globe working with survivors of severe traumas, such as earthquake survivors. The validity of the VRS was examined using different techniques: confirmatory factor analysis (CFA) and criterion-related validity. CFA yielded seven factors that were consistent with the original form: changes in life goals and perspective, client-inspired hope, increased recognition of clients' spirituality as a therapeutic resource, increased capacity for resourcefulness, increased self-awareness and self-care practices, increased consciousness of power and privilege relative to clients' social location, and increased capacity for remaining present while listening to trauma narratives. The Cronbach's α reliability of the VRS was found to be .95; it displayed positive correlations with posttraumatic growth, psychological resilience, and quality of life, indicating convergent validity. However, it had a negative correlation with depression, anxiety, and stress, indicating discriminant validity. The VRS is a valid and reliable measurement scale by professionals working with trauma survivors to aid the recognition and cultivation of vicarious resilience in Turkish mental health professionals. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Psychological well-being, resilience, self-determination and grit: The 'novelty' role in physical education classes.

In recent years, the incorporation of novelty as a psychological need and the study of the frustration of needs have become a recurring theme in the research on psychological needs in the educational environment. Currently, there are two scales available to assess the frustration of basic psychological needs (FBN) in the context of Physical Education. The objectives of the study are (a) to analyse the factor structures of both scales to compare them with each other and (b) to analyse the effect of FBN on resilience, grit and each of the motivational regulations. The study included 1439 high school students (M = 15.03 years; SD = 1.24). The majority of participants were Caucasian 83.4%, African 9.7%, South American 6.1% and Asian 0.8%. The analyses used to examine the factor structure of the scales were exploratory and confirmatory factor analysis, reliability analysis and discriminant validity analysis. Hierarchical linear regression analysis was used to analyse the relationship of FBN. Each of the scales showed greater robustness in its factor structure and reliability (2023, Physical Education and Sport Pedagogy, 1) scale: χ2/gl = 3.62; CFI = .92; NFI = .92; RMSEA = .061; (2020, Revista de Psicología del Deporte, 29, 91) scale: χ2/gl = 2.67; CFI = .96; NFI = .96; RMSEA = .048, SRMR = .037). Additionally, FBN was positively related to less self-determined motivational regulations, while it was negatively related to grit, resilience and more self-determined motivational regulations. Finally, the results highlighted that the (2020, Revista de Psicología del Deporte, 29, 91) scale, showing greater factorial robustness, obtained greater robustness in the relationships with the variables studied.

Assessing gender essentialist beliefs towards youth athletes: Development and preliminary validation of the gender essentialist beliefs towards girls in sport scale (GEGS)

Despite evidence refuting the legitimacy of inherent and unchanging qualities and the existence of a gender sport continuum, a prevailing gender essentialist ideology persists among coaches. This ideology perpetuates the belief in a binary, hierarchical, and static structure of gender, which imparts higher cultural and social values to men's sport compared to women's and impacts girls’ development, participation, and enjoyment in sport. Some interventions have been proposed to address this issue; however, at present, no validated scale exists to assess intervention outcomes related to coaches’ gender essentialist beliefs. The aim of the current study was therefore to develop and validate the Gender Essentialist Beliefs Towards Girls in Sport Scale (GEGS), to assess gender essentialism among sport coaches. Content validity was judged by a panel of experts ( N = 4) and through interviews with coaches ( N = 5) across various sports and experience levels. Following initial item iteration, the GEGS was assessed with 633 coaches for reliability and validity. The final scale comprised 20 items and showed good reliability (internal consistency, test-retest reliability, inter-item and item-total correlations), validity (convergent validity, differentiation between known groups), and factor structure. We also found partial support for the discriminant validity of the GEGS. Overall, the GEGS provides a valuable tool for addressing gender essentialism in sport coaching and informing coach education programs. Future research should further validate the scale and explore its sensitivity to change in gender essentialist beliefs over time.

Three-Objects-Three-Places Episodic Memory Test to Screen Mild Cognitive Impairment and Mild Dementia: Validation in a Memory Clinic Population.

The Three-Objects-Three-Places (3O3P) test is a 5-minscreen for episodic memory impairment due to Alzheimer's disease, known for its briefness and easy administration, culture- and language-free nature, and the absence of specific equipment. However, no studies have validated its potential in memory clinic cohorts. The aim of this study was to test its convergent, discriminant, and known-group validities and to define thresholds for its clinical use. We included 2062 cognitively unimpaired (CU), mild cognitive impairment (MCI) and dementia patients from the Geneva Memory Center cohort who underwent the 3O3P test in the context of clinical practice. Convergent and discriminant validities were assessed using an exploratory factor analysis. The known-group validity was assessed in CU vs. MCI and dementia using the area under the curve (AUC). 3O3P test scores vs. amyloid and tau positivity, neurodegeneration, and cognition (ATNC) were assessed using the Kruskal-Wallis test. The 3O3P test cut-offs were calculated using sensitivity, specificity, PPV, NPV, and accuracy. Mean age was 72 years (SD = 11), 60% were female, mean education was 13 years (SD = 4), and mean MMSE was 25 (SD = 5). The 3O3P and Delayed Total Recall tests loaded strongly on the "memory" factor and weakly on "non-memory" factors. The 3O3P test can discriminate CU vs. MCI (AUC = 0.71) and dementia (AUC = 0.92). Higher 3O3P scores were associated with lower prevalence of ATNC (p < 0.001). A 3O3P value of 7 can detect MCI and dementia patients. The 3O3P test has demonstrated good convergent, discriminant, and known-group validity in a large memory clinic population.

Pregnancy Eating Attitudes-Questionnaire (PEA-Q): Exploratory factor analysis and psychometric performance in a pregnant community sample with body mass index ≥ 25.

Pregnancy is characterized by biopsychosocial changes that impact appetite, eating and weight. Understanding pregnant individuals' attitudes toward eating and weight can provide insight into prenatal health behavior. Accordingly, we developed and performed initial psychometric testing of a self-report measure, the Pregnancy Eating Attitudes-Questionnaire (PEA-Q), among individuals with pre-pregnancy BMI≥25. Pregnant participants with pre-pregnancy BMI≥25 (N=213), who predominantly identified as racially minoritized (51% Black/African American) and lower income (66% ≤$30,000/year), enrolled in a longitudinal study. Participants completed 25 candidate PEA-Q items and eating- and weight-related measures. We conducted exploratory factor analysis to determine PEA-Q factor structure, calculated internal consistency coefficients of the extracted factors, and assessed convergent and discriminant validity. An 11-item, three-factor solution produced excellent model fit. Factors were interpreted as Permissive Eating and Weight Attitudes (e.g., "Pregnancy is a 'free pass' to eat any type of food that I want; " α=.82), Intentional Eating Changes (e.g., "I need to eat more food each day because I am pregnant; " α=.81), and Lack of Worry about Eating and Weight (e.g., "I am not concerned about eating too much now that I am pregnant; " α=.83). Each factor showed small-to-moderate correlations with measures of gestational weight gain and/or dietary intake and was not correlated with eating pathology measures, demonstrating adequate convergent and discriminant validity, respectively. This novel self-report measure seems to adequately capture pregnancy-related attitudes toward eating and weight among pregnant individuals with BMI≥25. Further testing is required to confirm these preliminary findings and determine generalizability.

Reliability and Validity of the Consultation and Relational Empathy (CARE) Scale.

The patient's perception of physician empathy has a positive influence on patient behavior and treatment effects. The scale of Consultation and Relational Empathy (CARE) scale has been widely used to measure patients' perceptions of doctor empathy. However, the CARE scale lacks a standardized Mandarin version. In this study, we developed a Mandarin version of the CARE scale and validated its quality. There were 341 patients with hypertension and/or diabetes from four primary healthcare centers in Zhejiang Province, China participated in the primary test. Exploratory factor analysis (EFA) was conducted to explore the underlying structure of the scale. Furthermore, the test-retest reliability of the scale was evaluated during this phase. A total of 1085 patients from six primary-level clinics participated in the secondary test. Confirmatory factor analysis (CFA) was employed to confirm the underlying structure of the scale. The analysis result demonstrated that the Mandarin version of the CARE scale comprises 10 items and 3 dimensions. In the secondary test, the overall Cronbach's α of the scale was 0.91, and the CRs of the 3 dimensions were 0.90, 0.90, and 0.88, respectively, indicating acceptable Internal consistency reliability and composite reliability (CR) of the scale. The average variance extracted (AVE) ranged between 0.65 and 0.79, and all square root values of the AVE for the three dimensions were higher than their Spearman correlations, indicating the good convergent and discriminant validity. The scale could serve as an evaluation tool for patients' perceptions of doctors' empathy in primary-level medical service settings in Chinese mainland.

Reliability and validity of the Spanish version of the Breastfeeding Motivation Scale (BMS). An approach to maternal mental health through psychological factors

BackgroundThe decision to breastfeed can be complex due to the significant benefits of breastfeeding and the various barriers that mothers have to face. In this context, it is important to have adequate instruments that provide insight into a mother's motives for breastfeeding. AimGiven the absence of instruments in this language, this study focuses on translating and validating the Breastfeeding Motivation Scale (BMS) in Spanish mothers. MethodAfter cultural adaptation and an item clarity assessment with a pilot sample (n = 28), exploratory factor analysis was conducted with a preliminary sample (n = 118). The main study involved 193 Spanish primiparous mothers, aged 24-48 (M = 34.5; SD = 4.2), recruited within two months postpartum, where confirmatory factor analysis, internal consistency, group comparisons, and validity measures were explored. ResultsThe findings (χ2=358.925, df=183, p<0.001, CFI=0.971, TLI=0.967, SRMR=0.079, and RMSEA=0.071 [90% CI: 0.060-0.081]) supported the existence of four motivational factors for breastfeeding: i) external and identified, ii) intrinsic, iii) integrated, and iv) introjected motivation. The four factors of the scale showed excellent internal consistency (ωo ranging from 0.77 to 0.92), as well as good convergent and discriminant validity regarding theoretically-related variables (breastfeeding self-efficacy, positive attitude towards breastfeeding, and postpartum depression). Additionally, the scale showed incremental validity with respect to breastfeeding self-efficacy, but not regarding postpartum depression. DiscussionThe BMS evidenced good psychometric properties in Spanish primiparous mothers. The findings are discussed in the context of Ryan and Deci's self-determination theory, also reviewing the study's limitations and implications.

Altered local spontaneous activity and functional connectivity density in major depressive disorder patients with anhedonia.

The purpose of this study was to investigate the alterations of intrinsic brain function in major depressive disorder (MDD) patients with and without anhedonia based on whole-brain level by using two novel measures, four-dimensional spatial-temporal consistency of local neural activity (FOCA) and local functional connectivity density (lFCD). A total of 26 MDD patients with anhedonia (MDD-WA), 29 MDD patients without anhedonia (MDD-WoA), and 30 healthy controls (HCs) were recruited and underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning and intrinsic brain function was explored by FOCA and lFCD. A two-sample t-test was conducted to explore FOCA and lFCD differences between MDD patients and HCs, then analysis of covariance (ANCOVA) and post hoc tests were performed to obtain brain regions with significant differences among three groups. Finally, the diagnostic performance of FOCA and lFCD values with significant inter-group difference was evaluated using receiver operating characteristic (ROC) curves. Compared to HCs, MDD patients showed decreased FOCA in the right cuneus (CUN) and left postcentral gyrus (PoCG), as well as diminished lFCD in the right CUN and left calcarine fissure and surrounding cortex (CAL). Interestingly, the MDD-WA group was more likely to exhibit decreased FOCA in the left PoCG and reduced lFCD in the left CAL after consideration for the effect of anhedonia in MDD patients. The MDD-WA group further showed increased FOCA in the bilateral caudate (CAU) and right ventral anterior nucleus (VA) when comparing to HCs. Additionally, as compared with MDD-WoA group, the MDD-WA group presented decreased FOCA in the right middle occipital gyrus (MOG), which was also negatively associated with the severity of anhedonia in MDD patients. Finally, FOCA values of the right MOG exhibited excellent discriminant validity in differentiating MDD-WA from MDD-WoA, and the other individual or combined indices of FOCA or lFCD values in the aforementioned distinct brain regions presented significant utility in distinguishing between MDD or MDD-WA and HCs. The present findings suggest that aberrant intrinsic brain function in the left CAL, left PoCG, bilateral CAU, right VA, and, especially the right MOG may be associated with anhedonia in patients with MDD. Altered FOCA in the right MOG may have the potential to be a diagnostic neuroimaging biomarker for MDD patients with anhedonia.

Developing a three-dimensional convolutional neural network for full volume auto-segmentation of shoulder Dixon MRI with comparison to Goutallier classification and two-dimensional muscle quality assessment.

Preoperative intramuscular fat (IMF) is a strong predictor of tendon failure after a rotator cuff repair. Due to the contemporary labor intensive and time-dependent manual segmentation required for quantitative assessment of IMF, clinical implementation remains a challenge. The emergence of accurate three-dimensional evaluation of the rotator cuff may permit implementation with greater inter-rater reliability than common subjective scales (e.g., Goutallier classification (GC)). Here, we developed and validated convolutional neural network (CNN) model for auto-segmentation of the shoulder on Dixon MRI. Also, we aimed to assess the agreement between GC, two-dimensional (2D) and 3D IMF including their discriminatory ability for the identification of muscles above an IMF threshold shown to negatively impact surgical outcomes (i.e., GC ≥ 3). This study retrospectively obtained fat-water Dixon shoulder MRIs between March 2023 and March 2024 to develop and validate a CNN model for the segmentation of individual rotator cuff muscles and surrounding tissues. The CNN model was trained using a modified U-Net architecture (n = 80) and tested on an external dataset (n = 25). Accuracy was primarily evaluated using the Dice Similarity Coefficient (DSC) compared to manual segmentation. Reliability was evaluated by the intraclass correlation coefficient (ICC2,1) and discriminatory ability was evaluated by the area under the receiver operating characteristic curve (AUC). The model after training (37 male and 43 female, mean age = 55.8 ± 15.6 years) and testing (15 male and 10 female, mean age = 56.6 ± 19.7 years) produced DSCs of ≥ 0.89 except for teres minor (DSC = 0.86 ± 0.03). The model demonstrated excellent reliability for volume (ICC2,1 ≥ 0.93) and good to excellent reliability for IMF (ICC2,1 ≥ 0.80), with the exceptions of teres major volume (ICC2,1 = 0.82, 95% CI: 0.63 - 0.92, p < 0.001) and subscapularis IMF (ICC2,1 = 0.55, 95% CI: 0.22 - 0.77, p < 0.001). 3D IMF but not 2D IMF was associated with GC for the supraspinatus, subscapularis and infraspinatus (U ≥ 4.02, p < 0.045). The proposed CNN model's IMF outputs produced excellent discriminatory capability of muscles above the IMF threshold shown to negatively impact outcomes (AUC ≥ 0.93). The development of a CNN model allows for efficient, accurate segmentation of muscle and bone, enabling reliable evaluation of muscle quality. The model demonstrates that 2D evaluation of IMF is insufficient for differentiating between rotator cuff muscles either side of a clinically meaningful IMF threshold on the GC scheme, whereas 3D IMF shows excellent discriminant validity across all rotator cuff muscles.