Principal Component Exploratory Factor Analysis Research Articles

DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE SENSE OF BELONGING IN NURSING SCHOOL SCALE.

Background and Purpose: While sense of belonging is essential for human motivation, impaired belonging among nurses can impact the care and safety of patients. This article reports the development and psychometric testing of the Sense of Belonging in Nursing School (SBNS) scale to assess nursing students' sense of belonging in three different environments: Clinical, classroom, and among the student cohort. Method: Principal component exploratory factor analysis with varimax rotation was used to determine the construct validity on the 36-item SBNS scale with a sample of 110 undergraduate nursing students. Cronbach's alpha was used to determine the scale's internal consistency. Results: The scale was reduced to 19-items with high internal consistency (α = 0.914). Principal component analysis then identified four factors (sub-scales) with high internal consistency: Clinical staff (α = 0.904), clinical instructor (α = 0.926), classroom (α = 0.902), and classmates/cohort (α = 0.952). Conclusion: The SBNS scale is a reliable and valid tool to measure sense of belonging across three environments among nursing students. Further research is needed to determine the scale's predictive validity.

Adaptation and validation of the Latin-American Spanish version of the VHI-10 (LASVHI-10)

PurposeTo generate a cross-cultural adaptation of the Voice Handicap Index-10 (VHI-10) in the Latin-American Spanish language and to assess its psychometric properties. MethodsThis is a descriptive and prospective cross-sectional study. The Voice Handicap Index-10 (VHI-10) was translated and back-translated and then adapted to the Latin-American Spanish language (LASVHI-10). It was then applied to adult patients with clinical findings of dysphonia made by a physician. A psychometric validation consisting of a principal components exploratory factor analysis with varimax rotation, concurrent validation comparing the visual analog scale performed by the patient and two relevant questions of the Spanish version of the University of Washington Quality of Life (UWQOL) scale, known group validity assessment and test–retest reliability assessment was performed. ResultsA total of 119 patients were included. The mean score for the LASVHI-10 scale was 18.4±10.7 (median 18, range 0–40). A principal component factor analysis showed a two-factor solution with good diagnostic test results. The Cronbach's alpha value for the global scale was .92. The comparison between the LASVHI-10 and the visual analog scale demonstrated a high correlation (rho=.82), and the coefficient for test–retest was .80. ConclusionThe results of this study provide evidence of a reliable and objective instrument to be used in clinical practice and for research objectives in Spanish-speaking patients.

Values for an Undergraduate Ecotourism Management Curriculum in South Africa: A Mixed-methods Study

ABSTRACT Ecotourism is one of the fastest growing tourism niches in South Africa. Higher education institutions offering undergraduate ecotourism management programmes are tasked with producing graduates that can promote the sustainability of the sector and should therefore direct their efforts to the fostering of appropriate behaviours; values are the underlying determinants of behaviour. Employing an exploratory sequential mixed methods design, the purpose of the study was to develop a framework for a values-based undergraduate ecotourism management curriculum. Thematic analysis of the empirical materials elicited from semi-structured interviews with 12 ecotourism managers resulted in the identification of 51 values. The values were subsequently rated by managers from the wider ecotourism industry through the administration of an e-survey (n = 101). A principal components exploratory factor analysis further reduced the values into four factors – “self”, “outward”, “reciprocation” and “betterment”. This informed the framework which ultimately serves as a reference point for educational practitioners.

962. Essential Consultants’ Skills and Attitudes (Willing CONSULT): A Cross-Sectional Survey

BackgroundThere is an increasing number of studies that infectious diseases consultations improve patients’ outcomes, but few studies have investigated the quality of consultations. The aim of this study was to identify important skills and attitudes for consultants to improve the quality of consultations.MethodsWe conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and the main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke’s International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018, and current residents (2019–2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree) (Figure 1). Cronbach’s alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed. Figure 1. Skills and attitudes required in consultants according to residentsResultsThe survey included 107 individuals (61.1%, 175 potential participants). The median postgraduate years of education were four (interquartile range: 2-5), and 64.5% were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters’ needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation’s urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records appropriately and quickly) (Figure 2). ConclusionWe propose Willing CONSULT, which are important skills and attitudes for consultants.Disclosures All Authors: No reported disclosures

InterRAI Subjective Quality of Life Scale for Mental Health and Addiction Settings: A Self-Reported Measure Developed From a Multi-National Study.

Background: Measuring Quality of Life (QoL) in mental health using self-reported items is important for evaluating the quality of service and understanding the person's experience of the care received.Objective: The aim of this research was to develop and validate a self-reported QoL instrument for inpatient and community mental health settings.Methods: Data were collected from diverse research sites in Canada, Belgium, Russia, Finland, Brazil, and Hong Kong, using the 37-item interRAI Quality of Life Survey for Mental Health and Addictions. The survey was administrated to 2,218 participants from inpatient and community mental health settings, assisted living, and the general community. We randomly divided the sample into a training and a test sample (70 and 30%, respectively). We conducted principal component analysis (PCA) and exploratory factor analysis (EFA) using the training sample to identify potential factor structure. Confirmatory factor analysis (CFA) models were then fitted to finalize and externally validate the measurement model using training and test data, respectively.Results: PCA, EFA, and CFA of the training sample collectively suggested a 23-item scale measuring four latent constructs: well-being and hope (8 items), relationship (7 items), support (5 items), and activity (3 items). This model was supported by the CFA of the test sample. The goodness-of-fit statistics root mean square error, comparative fit index and Tucker-Lewis index were 0.03, 1.00, and 0.99, respectively. Estimated Cronbach's alpha based on the test data was 0.92. Raw Cronbach's alpha values for the subscales were 0.86 for well-being and hope, 0.86 for relationship, 0.69 for support, and 0.72 for activity.Conclusions: The interRAI SQoL-MHA scale is a valid instrument to measure QoL in mental health settings. The instrument will support the evaluation of the quality of care and can also be used for future research to produce SQoL-MHA values on a quality adjusted-life-year scale, facilitating the evaluation of various mental health interventions.

Essential consultants\u2019 skills and attitudes (Willing CONSULT): a cross-sectional survey

BackgroundDespite multi-professional collaboration via consultation being increasingly important given the variety of disease diagnoses and treatment, the key elements as consultants remain unclear. The study aimed to identify the skills and attitudes that are important for consultants from the residents’ perspective so that they can be targeted as priority goals in subsequent educational interventions.MethodsWe conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and a main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke’s International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018 and current residents (2019–2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree). Cronbach’s alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed.ResultsThe survey included 107 individuals (61.1 %, 175 potential participants). The median postgraduate years of education was four (interquartile range: 2–5), and 64.5 % were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters’ needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation’s urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records).ConclusionsWe propose Willing CONSULT, which are important skills and attitudes for consultants.

Psychometric properties of the Maslach Burnout Inventory - Human Services in Social Work professionals in Spain.

The burnout syndrome has traditionally been identified in the service sector professions, among which is Social Work. In order to determine this syndrome, different measuring instruments have emerged, including the Maslach Burnout Inventory. The main objective of this study was to evaluate the psychometric properties of this instrument and to find evidence of its validity (corroborating the original factorial structure and its convergent validity) and reliability (internal consistency). The Spanish adapted version of the Maslach Burnout Inventory was used. Four hundred social workers participated, randomly divided into two samples of 200 individuals (Sample 1: M=43.06, SD=9.04 and Sample 2: M=40.89, SD=8.78). We carried out principal components exploratory factor analysis with Varimax rotation. The results identified a factorial structure with four factors (Emotional Exhaustion, Depersonalization, Personal Realization, and Interpersonal Psychological Stress) (χ2 /df=1.73, CFI=0.929, NNFI=0.859, SRMR=0.069, RMSEA=0.061), different from that of the original questionnaire, which indicated three dimensions. The data also show a high internal consistency (α=0.882). The four factors were directly and moderately associated with each other (r between 0.328 and 0.534). In conclusion, this study provides new data of a valid and reliable tool for evaluating professional burnout or exhaustion.

Development of a Systemic Family Functionality Scale (SFFS)

The aim of this study is to develop a scale that measures the levels of a systemic family functionality scale that an individual perceives as a member of a family. The scale was implemented with 506 individuals. The sample consisted of 359 children (70.7%) and 147 parents (29.3%). After running necessary analyses based on the data collected, principal component analysis and exploratory factor analysis were conducted to determine the construct validity of the 36-item scale. According to principal component analysis, a six-dimensional structure of the scale was identified. The dimensions were determined to be intrafamilial support, roles, connection, rituals, communication and boundaries. The item-factor loadings ranged from .47 to .97, and the item-total correlations were between .38 and .70. The KMO coefficient was estimated as .945, and the result of the Bartlett sphericity test was significant (χ 2 = 7184.83, p < .01). As a result of confirmatory factor analysis, structural coefficients of sub-dimensions of family functioning were identified for intrafamilial connection γ1 = .64, boundaries γ1 = .75, rituals γ1 = .79, roles γ1 = .86, communication γ1 = .81 and support γ1 = .87. To determine the reliability of the scale, the Cronbach’s α score was measured and calculated to be .95.

Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms.

This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Development and validation of the Pectus Carinatum Body Image Quality of Life (PeCBI-QOL) questionnaire

IntroductionWhile body image disturbances and quality of life in persons with pectus excavatum (PE) have been well documented, very little has been done to systematically measure and document the same in patients with pectus carinatum (PC). Because of this, the current study aimed to develop and validate an instrument to assess body image related quality of life in patients with PC and their parents. MethodParticipants: Two waves of data collection took place. The development phase enrolled 78 PC patients and 76 matched parents. The validation phase enrolled 50 PC patients and 50 parents. Mean age at the initiation of treatment was 15.14 (SD = 2.54). Participants were mostly boys (85.9%) and White or Caucasian (89.7%).Instrument development, refinement, and validation: A group of 5 experts in chest wall deformities used existing measures of body image disturbances in PE, combined with the broader body image literature, to develop larger item pools for patients and their parents. Item analysis from this phase was used to remove poorly performing or statistically redundant items.In the validation phase, refined patient and parent instruments were examined using exploratory principal components factor analysis (EFA) with parallel analysis for factor retention, followed by Varimax rotation to identify a final factor solution. Results/discussionThis development and refinement process yielded a final questionnaire for patients (18 items) and parents (15 items). The patient questionnaire includes four subscales, each with good internal consistency: Body Image Disturbance; Treatment Motivation/Engagement; Physical Limitations; and Social Disadvantage. The parent questionnaire includes 3 subscales: Body Image Disturbance; Treatment Motivation/Engagement; Physical Limitations. Patient and parent scales showed moderate correlations. Among patients with measures pre- and posttreatment, there was a significant improvement in overall PeCBI-QOL score. We demonstrate, in this study, that body image and related quality of life can be reliably and validly assessed with the PeCBI-QOL, which has implications for more comprehensively documenting the negative psychological and functional consequences of pectus carinatum. Type of study/level of evidenceStudy of diagnostic test/III.

The effect of innovation practices on agribusiness performance: A structural equation modelling (SEM) approach

This study investigates how innovation practices including product, process, marketing and organizational innovation affect agribusiness performance such as innovative, production, marketing and financial performance in Ghanaian agribusiness companies. Data were collected through survey questionnaires from 1526 respondents mainly from inputs supplies, production and marketing agribusiness companies. Data were analyzed by principal component analysis (PCA), and exploratory and confirmatory factor analysis. We also employed the structural equation modelling (SEM) in determing the relationships between the variables. The results reveal the positive effects of innovation practices on agribusiness performance. Managerial implications are also discussed.

Food purchase patterns indicative of household food access insecurity, children\u2019s dietary diversity and intake, and nutritional status using a newly developed and validated tool in the Peruvian Amazon

Food security, defined as the capacity to acquire preferred food at all times, can manifest in many dimensions. Following a mixed methods approach used in India and Burkina Faso, we developed a 58-item experience-based measure in the Peruvian Amazon, based on investigator observations, relevant literature, and pre-testing with community field workers. The tool encompasses seven dimensions of food security and included measures of (1) food purchases, frequency of purchase, and location of acquisition, (2) food expenses, (3) coping mechanisms, (4) preparation of leftover food, (5) food safety (refrigerator access), (6) fishing intensity and (7) selling food. The survey was piloted among 35 randomly selected families from the Malnutrition Enteric Disease (MAL-ED) birth cohort in Santa Clara, Peru and the surrounding communities. Subsequently, based on a focus group discussion, a pile-sorting exercise, and pilot results, we reduced the survey to 36 items to be collected monthly among 203 MAL-ED households from November 2013 to January 2015. Validity and reliability were then assessed using principal component analysis and exploratory factor analysis, revealing four groups of purchase and coping strategy behaviors: (1) Sweets and sugary items, (2) Less preferred, (3) More preferred, and (4) Minimum meal. Internal consistency of the final 22-item scale had an acceptable cutoff of Cronbach’s α of 0.73. Criterion and construct validity of the factor groups revealed there were: (1) food purchase patterns that were distinctive to quality and quantity aspects of the Household Food Insecurity Access scale, (2) unique correlations of child’s intake of fats, animal source protein, fiber and other micronutrients, (3) household purchase patterns from the “more preferred” group (fish, red meat) associated with child’s weight-for-age. Food purchase and frequency, and context-specific behaviors at the household level can be used as surrogates for dietary intake patterns and nutritional status among children. Food purchase and frequency measurement is a quick, objective, non-intrusive survey method that could be used as an indicator for acute changes in household food security status with appropriate pilot testing and validation.

The revised piper fatigue scale (PFS-R) for Italian cancer patients: a validation study.

Fatigue is one of the most frequently reported symptoms by cancer patients. In recent years, much effort has been directed to designing fatigue measures which are psychometrically appropriate as well as easily administered. Among these, the Revised Piper Fatigue Scale (PFS-R) is widely used in assessing fatigue in cancer patients and other populations. Despite its large utilization in different national contexts and with different populations, its structure appears to vary across cultures, suggesting the need for its validation before use. The main aim of the present work was to verify the validity (i.e., dimensional structure and construct validity) and reliability (i.e., internal consistency) of an Italian translation of the PFS-R to reassure Italian oncology practitioners about its appropriate usage in practice and research. One-hundred ten Italian oncological inpatients were administered an Italian translation of the PFS-R together with a form for the collection of personal identification and clinical data and other fatigue and quality of life measures (POMS and EORTC QLQ-C30) already validated for Italy. Principal component exploratory factor analysis revealed a four-factor structure quite similar to (although not overlapping) the original described by Piper and colleagues; all four factors proved to be reliable and to correlate with one another and with previous validated measures of fatigue and quality of life. Preliminary descriptive statistics were also provided for data comparisons. Despite the discussed limitations, PFS-R seems a valid and reliable multidimensional fatigue measure also adequate in Italian oncological settings.

A new scale of brand lovemarks

Purpose of the paper: The current study attempts to provide a new lovemarks scale that predicts consumers ’ behavioral outcomes. This scale also bridges over some of the inconsistencies of the measurement of “brand love” that also measure “brand respect”. Methodology : In order to test the Lovemarks scale, 3 studies were conducted. Study 1 applied Exploratory Factor Analysis using Principal Component exploratory factor analysis. Study 2 used second-order confirmatory factor analysis (CFA) with a maximum likelihood fitting function of the two-component solution. Study 3 measured the nomological validity of the assessed Lovemarks scale by testing its relations with four other relevant scales. Results : Using EFA and CFA, the reliability and validity of the scale were divided into four different product categories: dairy companies, cellular network providers, banks, and fashion retail chains. The scale does have strong positive correlations with attitude, preference, price premium and recommendation. Research limitations : The main limitation of the current research is that Study 2 used CFA testing only for second-order factors and not third-order factors, which would have also enabled the testing of the antecedents of the scale ’ s items (such as intimacy or trust). Practical implications : This scale helps to predict consumer behavior and set an effective marketing strategy for the brand. It thus gives directions for product adjustments and establishes effective advertising, marketing communication strategies and brand pricing strategy. Originality of the paper : The current study is testing a new Lovemarks scale on the basis of four different product categories: dairy companies, cellular network providers, banks, and fashion retail chains.

Measuring dimensions of social climate among South African higher education students

We investigated the structure of social climate among university students to characterise the relative importance of personal and interpersonal factors. Participants were 266 students from a school of education of a large South African university (females = 66.5%; black = 53.0%, white = 25.9%; coloured = 7.5%, Asian/Indian = 6.0%; mean age = 28.71 years, SD = 10.51 years). The students completed the Experience of Social Climate Questionnaire (ESCQ). Exploratory principal component factor analysis of the data yielded a three component structure of social climate comprising of (i) Constructive interpersonal relationships, (ii) Unloving towards self, and (iii) Aggression perceptions of self. Relationships and aggression appear to define social climate in a higher education student population.

Validating the forgotten joint score-12 in patients after ACL reconstruction

BackgroundThe forgotten joint score-12 (FJS-12), used to measure postoperative joint awareness, has been extensively validated to assess outcomes after arthroplasty, however the new score has never been validated in evaluating anterior cruciate ligament (ACL) reconstruction. The purpose of our study was to validate the FJS-12 versus the knee injury and osteoarthritis outcome score (KOOS) for patients who have undergone ACL reconstruction. MethodsAll patients who had undergone ACL reconstruction with the same arthroscopic surgical technique at our institution between 2011 and 2014 (medium-term follow-up group (M-FU)) or between 2000 and 2005 (long-term follow-up group (L-FU)) were considered for inclusion in the study. To analyze unidimensionality of the FJS-12, we calculated Cronbach's alpha, item-total correlations and conducted an exploratory principal component factor analysis. To assess convergent validity, we calculated Spearman correlation coefficients for the FJS-12 and its comparable scales. ResultsWe analyzed 58 patients of the M-FU (mean follow-up 31.5 (SD13.4) months, range 12–54), and 58 patients of the L-FU (mean follow-up 139 (SD15.2) months, range 120–179). The FJS-12 showed high internal consistency (Cronbach's alpha=0.95). Ceiling effects were considerably lower for the FJS-12 (M-FU 12.1%, L-FU 15.5%) compared with the KOOS subscales (M-FU 5.2–37.9%; L-FU 13.8–55.2%) and WOMAC subscales (M-FU 37.9–62.1%; L-FU 44.8–60.3%). ConclusionsThe FJS-12 is a valid measurement tool to evaluate outcomes of ACL reconstruction. This study extends the possibilities of measuring joint awareness as a patient-reported outcome parameter from joint arthroplasty to ACL reconstruction.

Validation of the Norwegian Pain Sensitivity Questionnaire.

Background and purposeThere is a large variation in people’s reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ.MethodsConstruct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach’s alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable.ResultsThe factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach’s alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women.ConclusionThis study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain.

Toward the Identification of a Specific Psychopathology of Substance Use Disorders.

Addiction is a mental illness in which psychiatric conditions imply a prominent burden. Psychopathological symptoms in substance use disorder (SUD) patients are usually viewed as being assignable to the sphere of a personality trait or of comorbidity, leaving doubts about the presence of a specific psychopathology that could only be related to the toxicomanic process. Our research group at the University of Pisa has shed light on the possible definition of a specific psychopathological dimension in SUDs. In heroin use disorder patients, performing an exploratory principal component factor analysis (PCA) on all the 90 items included in the SCL-90 questionnaire led to a five-factor solution. The first factor accounted for a depressive “worthlessness and being trapped” dimension; the second factor picked out a “somatic symptoms” dimension; the third identified a “sensitivity–psychoticism” dimension; the fourth a “panic–anxiety” dimension; and the fifth a “violence–suicide” dimension. These same results were replicated by applying the PCA to another Italian sample of 1,195 heroin addicts entering a Therapeutic Community Treatment. Further analyses confirmed the clusters of symptoms, independently of demographic and clinical characteristics, active heroin use, lifetime psychiatric problems, kind of treatment received, and, especially, other substances used by the patient such as alcohol or cocaine. Moreover, these clusters were able to discriminate patients affected by addiction from those affected by psychiatric diseases such as major depressive disorder. Our studies seem to suggest the trait-dependent, rather than the state-dependent, nature of the introduced psychopathology dimensions of SUDs.

Association Between Women's Empowerment and Maternal and Child Nutrition in Kalalé District of Northern Benin.

Evidence on effectiveness of women's empowerment (WE) to reduce undernutrition is limited in sub-Sahara Africa, and few studies incorporate multidimensional measures of WE. To examine whether a WE status, in sum and across leadership, decision-making, mobility, economic security, male involvement in housework, and nonfamily group domains, is associated with women and their children nutritional status in Kalalé district of northern Benin. Data were obtained from the 2014 Solar Market Garden baseline study: 767 paired reproductive-age women aged 15 to 49 years and children 6 to 59 months old. Exploratory principal component (cross-validate with confirmatory) factor analysis was first conducted to identify the structure of empowerment. Then, using a new survey-based index, regression analysis was conducted to examine associations between WE measures and maternal dietary diversity score (DDS) and body mass index (BMI), as well as their child's DDS, height-for-age z score (HAZ), weight-for-height z score (WHZ), and weight-for-age z score (WAZ). Positive associations were observed between women's composite empowerment, leadership, maternal DDS and BMI, and female child's DDS. However, opposite signs were found between economic security and child's DDS. Mobility was positively associated with female children's WHZ and male children's HAZ and WAZ, while decision-making was correlated with male child's WHZ and female children's WAZ. Women's empowerment can be associated with undernutrition. Efforts to improve nutrition may benefit from empowerment initiatives that promote women's self-confidence and decision-making in Benin. However, additional qualitative and longitudinal research may enhance understanding of WE in the present area.

Performance-Based Measures Associate With Frailty in Patients With End-Stage Liver Disease.

Physical frailty, as measured by the Fried Frailty Index, is increasingly recognized as a critical determinant of outcomes in patients with cirrhosis. However, its utility is limited by the inclusion of self-reported components. We aimed to identify performance-based measures associated with frailty in patients with cirrhosis. Patients with cirrhosis, aged 50 years or older, underwent: 6-minute walk test (cardiopulmonary endurance), chair stands in 30 seconds (muscle endurance), isometric knee extension (lower extremity strength), unipedal stance time (static balance), and maximal step length (dynamic balance/coordination). Linear regression associated each physical performance test with frailty. Principal components exploratory factor analysis evaluated the interrelatedness of frailty and the 5 physical performance tests. Of 40 patients with cirrhosis, with a median age of 64 years and Model for End-stage Liver Disease (MELD) MELD of 12.10 (25%) were frail by Fried Frailty Index ≥3. Frail patients with cirrhosis had poorer performance in 6-minute walk test distance (231 vs 338 m), 30-second chair stands (7 vs 10), isometric knee extension (86 vs 122 Newton meters), and maximal step length (22 vs 27 in. (P ≤ 0.02 for each). Each physical performance test was significantly associated with frailty (P < 0.01), even after adjustment for MELD or hepatic encephalopathy. Principal component factor analysis demonstrated substantial, but unique, clustering of each physical performance test to a single factor-frailty. Frailty in cirrhosis is a multidimensional construct that is distinct from liver dysfunction and incorporates endurance, strength, and balance. Our data provide specific targets for prehabilitation interventions aimed at reducing frailty in patients with cirrhosis in preparation for liver transplantation.