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The aims of this study were to field and pilot test the Korean version of the Household Emergency Preparedness Instrument (K-HEPI) and perform psychometric testing of the instrument’s reliability and validity.
Methods
The English to Korean translation followed a symmetrical translation approach utilizing a decentered process (i.e., both the source and target languages were considered equally important) focusing on the instruments remaining loyal to the content. After translation, the K-HEPI was field tested with 30 bilingual participants who all reported that the instructions were easy to understand and the items aligned closely with the original English version. The K-HEPI was then pilot tested with 399 Korean-speaking participants in a controlled, before-after study utilizing a disaster preparedness educational intervention.
Results
Confirmatory factor analyses supported the K-HEPI retaining the factor structure of the original English version. The K-HEPI was also found to be psychometrically comparable to the original instrument.
Conclusions
The K-HEPI can validly and reliably assess the disaster preparedness of Korean-speaking populations, enabling clinicians, researchers, emergency management professionals, and policymakers to gather accurate data on disaster preparedness levels in Korean communities, identify gaps in preparedness, develop targeted interventions, and evaluate the effectiveness of disaster preparedness interventions over time.
Metabolic syndrome (MetS) is associated with an increased risk of CVD, type 2 diabetes and death from all causes. Dietary factors correlate with MetS, making diet a potential target for intervention. We used data from the 2012–2016 Korea National Health and Nutrition Examination Survey (KNHANES, n 12 122) to identify a dietary pattern (DP) using thirty-nine predefined food groups as predictors. MetS components were used as the response variable with the food groups in reduced rank regression followed by stepwise linear regression analyses. We then verified the Korean status of the DP externally in the Cardiovascular Disease Association Study (CAVAS) (n 8277) and the Health EXAminees (HEXA) study (n 48 610). The DP score, which included twenty food groups, showed significant positive associations with all MetS components and a higher prevalence ratio in KNHANES participants (P < 0·0001). Although the score was NS in CAVAS (P = 0·0913), it showed a strong positive association with MetS prevalence in HEXA (P < 0·0001). We identified and tested a DP associated with MetS in Korean populations. This DP may be a useful tool for assessing MetS risk. Although the score was linked to higher MetS risk, particularly in the predominantly urban population of the HEXA study, further validation in more diverse populations is needed.
We aimed to explore concerns and feeling of safety among quarantined and non-hospitalized COVID-19 patients.
Methods
We conducted a qualitative study of free text answers from participants of an online survey. The survey was conducted between March 2020 and June 2021. COVID-19 positive adults in home isolation and adults in quarantine were eligible for participation. 698 participants answered one or more of three open-ended questions about concerns and safety. We analyzed free-text answers using thematic analysis according to Braun and Clarke with an inductive approach.
Results
Analysis of the free-text answers from all participants identified three main themes: (1) Fear of the unknown, (2) Views on personal care and public health measures, and (3) Concern for the future of a country in crisis. Participants’ feelings revolved around health-related concerns and societal related concerns. They were concerned about their own and other’s health, and possible long-term consequences of COVID-19 infection. Some participants were satisfied with the health care system, others thought follow-ups, testing, vaccination, and information would increase their feeling of safety.
Conclusions
People quarantined and isolated due to the COVID-19 pandemic had concerns regarding personal health and societal consequences of infection control measures. Health care follow-ups and individualized information would increase participants’ feeling of safety.
To describe the design and psychometric assessment of the Adolescent Home Food Environment Questionnaire (Acronym in Portuguese: QAAD).
Design:
This was a cross-sectional study. Data were collected between August 2021 and January 2022 through self-administered questionnaires via a survey management application accessible by computer or smartphone. The instrument was subjected to analysis by a panel of experts and to a pretest that enabled the adjustment of the language and the reformulation of the questions. The psychometric evaluation included the assessment of test–retest reliability (intraclass correlation coefficient), internal consistency (composite reliability), structural validity (exploratory structural equation modelling and confirmatory factor analysis) and construct validity (Mann‒Whitney test; P< 0·05). The following food environment aspects were evaluated: family eating practices, food availability and accessibility, cooking equipment availability and parental feeding style. Moreover, the weekly frequency of fruit, bean and added sugar beverage consumption was assessed.
Setting:
A public high school in Rio de Janeiro, Brazil.
Participants:
14-to-19-year-old students (n 34 in the test‒retest reliability study; n 501 in the validation analysis).
Results:
The final version of the QAAD included thirty-two questions allowing the assessment of seven dimensions of the home food environment. The QAAD demonstrated satisfactory reliability (ICC ranging from 0·44 to 0·78), adequate internal consistency (composite reliability > 0·70) and satisfactory structural and construct validity.
Conclusions:
The careful QAAD design provided a valid, reliable and consistent instrument for characterising adolescents’ home food environments, which may provide information for tailoring and targeting healthy eating promotion actions aimed at adolescents.
To describe the development and validation of the Nova FFQ (NovaFFQ) for Brazilian adults.
Design:
The NovaFFQ is a self-administered, semi-quantitative questionnaire. The food list includes the most consumed foods and drinks based on 2017–2018 National Food Intake Survey data. We identified and differentiated foods that could be classified into multiple Nova groups. We assessed reproducibility and criterion validity using the percent energy contribution of each Nova group. Reproducibility was assessed by comparing NovaFFQ estimates on two occasions. Criterion validity was assessed by comparing the first NovaFFQ estimate against the mean of two Nova24h recalls. We estimated the intraclass correlation coefficients (ICC) for both analyses and assessed the agreement of classification into quintiles using the prevalence-and-bias-adjusted kappa coefficients for criterion validity analysis.
Setting:
Nationwide Brazilian study, the NutriNet-Brasil cohort.
Participants:
There were 243 participants in the reproducibility analysis and 376 in the criterion validity analysis.
Results:
Strong reproducibility was observed, with an ICC of 0·91 for all the Nova groups. Criterion validity showed a moderate ICC, ranging from 0·61 for processed and ultra-processed foods (UPF) to 0·65 for unprocessed and minimally processed foods. Substantial agreement in ranking individuals across quintiles was found, as indicated by the prevalence-and-bias-adjusted kappa (PABAK = 0·74, 0·72, 0·70 and 0·73 for unprocessed and minimally processed foods, culinary ingredients and processed and ultra-processed foods, respectively).
Conclusions:
The NovaFFQ is a valid instrument for assessing food consumption by processing level, especially for discriminating individuals according to the magnitude of consumption in all Nova groups.
Wishes to hasten death (WTHDs) are common in patients with serious illness. The Schedule of Attitudes Toward Hastened Death (SAHD) is a validated 20-item instrument for measuring WTHD. Two short versions have also been developed based on statistical item selection. However, all existing versions show some limitations with potential for improvement. This study aims to develop and initially validate a theory-driven and statistically sound SAHD short version based on a large multinational sample to advance the WTHD assessment in different countries and with different legislations.
Methods
A 3-step procedure was carried out including (1) theory-driven item selection, (2) exploratory, and (3) confirmatory factor analysis. We used a data set collected between 1998 and 2020 across 3 different countries (Germany, Spain, USA). Participants were N = 1156 complete cases (n = 181 German, n = 101 Spanish and n = 874 US) of severely ill adult in- and outpatients. They had to be ≥18 years and give informed consent.
Results
The exploratory factor analysis revealed that 10 of 11 items previously selected theory-driven loaded on either of 2 factors: (1) WTHD and (2) internal locus of control. These factors showed good to excellent reliability according to Cronbach’s α and McDonald’s Ω, as well as an excellent fit of our data as an overall model for the total sample.
Significance of results
The developed SAHD-10 represents a reliable and valid alternative to the SAHD and an efficient means to measure and further investigate a WTHD in cross-cultural clinical and research settings.
There are wide variations in the practices of patient involvement in health technology assessment (HTA) in Europe. The field is lacking a consensus on good practices, leading to divergent processes, methods, and evaluation of patient involvement. To identify potential good practice approaches and current gaps, a structured online survey was conducted among HTA stakeholders, including HTA practitioners, patient stakeholders, industry representatives, and others who had experienced patient involvement in HTA.
Methods
The questionnaire was co-created by HTA experts, patient stakeholders, and industry representatives and disseminated between 29 April and 14 September 2022.
Results
Responses (n = 168) were submitted from thirty-two European countries by HTA practitioners (n = 33), patient stakeholders (n = 75), industry stakeholders (n = 42), providers (n = 5), academics (n = 7), and others (n = 6). The responses indicated that “allowing access to treatments that have demonstrated value”is the principle rationale for conducting HTA. In terms of the importance of patient involvement, there was consensus across stakeholder groups that “patients have insights and information [that] no other stakeholder has” and that patient involvement is important “to inform HTA which evidence is most patient-relevant”. Shortcomings were identified in the lack of systematic and transparent processes, an unsatisfactory level of information and guidance, and minimal communication and collaboration.
Conclusions
The diverse stakeholders who responded highlighted the need for improving specific aspects of patient involvement practices, including better guidance and information, a more consistent flow of communication between the HTA body and participating patient stakeholders, and the need to develop and implement a consensus on good practices.
The primary objective of our study was to survey ENT surgeons who perform functional endoscopic sinus surgery in the UK regarding their post-sinus surgery practices.
Method
A 28-item questionnaire on post-functional endoscopic sinus surgery practices was distributed electronically to ENT UK members specialising in rhinology.
Results
Ninety (90 per cent) surgeons prescribe saline nasal irrigation post-functional endoscopic sinus surgery but administration timing and methods vary. Following functional endoscopic sinus surgery, 17.7 per cent (n = 17) of respondents routinely prescribe antibiotics, whilst about a quarter (26.0 per cent, n = 25) do not prescribe antibiotics at all. The rest of the respondents only prescribe antibiotics in specific cases. Thirty-three (34.7 per cent) respondents do not prescribe oral steroids whilst most clinicians (83.9 per cent, n = 78) prescribe intranasal corticosteroids post-operatively.
Conclusion
Our study highlights homogeneous, evidence-based practices post-functional endoscopic sinus surgery from UK-based specialists, specifically in the use of saline irrigation and intranasal corticosteroids. However, our cohort displayed significant heterogeneity regarding oral antibiotics, oral steroids, and other specific aspects of post-operative care.
This study provides researchers, practitioners, and policy makers with a profile of older adults’ travel behaviour and the older adult population that reports unmet travel needs. In addition, we quantified associations between reporting an unmet travel need and measures of health and social connectedness. Data came from the second follow-up survey of the Canadian Longitudinal Study on Aging, collected from 2018 to 2021 (n = 14,167). Nine in ten (90.2%) older adults aged 65 years and older indicated that driving is the main way they get around. Older adults with an unmet travel need were more likely to be women, have lower household incomes and education levels, and have a mobility limitation. People with an unmet travel need had 2.7 times the odds of reporting fair or poor general health (OR = 2.66, 95% CI: 2.19, 3.22) and 3.1 times the odds of feeling socially isolated (OR = 3.10, 95% CI: 2.57, 3.72) compared to those without an unmet need.
Dysphagia can lead to morbidity including weight loss and aspiration pneumonia. Effective triage of patients and streamlining of pathways to expedite diagnosis and treatment is therefore imperative.
Objectives
The goals of this research were to measure the referral to treatment time for dysphagia patients in a newly established pathway and compare with existing UK national and local referral to treatment times, and to evaluate patient feedback.
Methods
Speech and language therapy advanced clinical practitioners were trained in nasendoscopy and assessment of swallow. Referral to treatment times were measured and patient satisfaction questionnaires completed.
Results
A decrease in triage to treatment time (from 24 to 6 weeks). Patients reported high understanding of the condition and minimal discomfort during assessments. Radiation exposure was reduced (2 per cent of patients undergoing soluble contrast swallows, previously 100 per cent).
Conclusion
The new pathway expedites treatment and achieves high patient satisfaction. It empowers speech and language therapy in efficiently managing low-complexity cases and supports multidisciplinary care for dysphagia patients.
The aim of this study is to evaluate the validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) translated and adapted for use in Brazil.
Design:
Validation of the NEMS-P questionnaire. The questionnaires were applied to assess validity and reliability, based on exploratory factor analysis, Cronbach’s α coefficient and intra-class correlation, with a significance level of 95 %.
Setting:
Brazil.
Participants:
Adults over 20 years of age diagnosed with hypertension were included in the internal validity and reliability test (n 176) and intra-rater reliability (subsample n 35).
Results:
Factor analysis obtained satisfactory results. Internal consistency was acceptable for most items, with Cronbach’s α ranging from 0·6 to 0·9. The intra-rater reliability of the subsample was also valid, with intra-class correlation coefficient values ranging from 0·5 to 0·9.
Conclusion:
This work reveals the usefulness of the instrument to assess the perceived food environment in the Brazilian context, being able to measure what is proposed according to its theoretical model, and reproduces the values when applied to a sample different from its original validation. However, refinement of some questions is suggested. Finally, it demonstrates the possibility of using the entire instrument or each section independently, according to the food environments to be investigated.
The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS).
Method:
The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery was used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data.
Results:
For the eight domains of cognitive functioning identified (orientation, memory [immediate, delayed, and recognition], set shifting, attention/speed, language/fluency, and visuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where fit must be perfect and is not informative. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94).
Conclusions:
The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used to operationalize notions of neurocognitive impairment, and as a starting point for prioritizing pre-statistical harmonization and evaluating configural invariance in cross-national research.
The purpose of the study was to design, develop, and validate a newer tool on radiation emergency preparedness responses (RadEM-PREM IPE tool) to measure communication, knowledge, performance skills in multidisciplinary health science learners.
Methods:
The study design is a prospective, single centric, pilot study. Five subject experts designed, analyzed, and selected items of the instrument for relevant content and domain. Psychometrics that the tool assessed were content validity, internal consistency, test-retest reliability, and intraclass correlation coefficient. Twenty-eight participants completed test-retest reliability for validation of 21 sorted out items calculated percentage of agreement >70% I-CVI/UA (item content validity index with universal acceptability) and S-CVI/UA (scale content validity index with universal agreement method).
Results:
Items with percentage agreement >70% and I-CVI over 0.80 were kept, ranged from 0.70 to 0.78 were revised, and below 0.70 were rejected. Items with kappa values ranging from 0.04 to 0.59 were revised and ≥0.74 were retained. Internal consistency assessed using Cronbach’s alpha was 0.449. Positive correlation between attitude and communication (r = 0.448), between performance and communication (r = 0.443) were statistically significant at 0.01 level. Overall, intraclass correlation coefficient for all the measures is 0.646, which is statistically significant at 0.05 level (P < 0.05).
Conclusions:
Study concludes that the RadEM-PREM IPE tool would be a new measuring tool to assess knowledge, performance, and communication skills of interprofessional radiation emergency response team learner’s evaluation.
The objective was to characterize the progression of sleep complaints in 115 dystrophy type 1 (DM1) patients who filled out a sleep questionnaire twice at a 9-year interval. Daytime napping (22.1% vs. 34.5%, p < 0.05), early awakenings (11.4% vs 21.1%, p < 0.05), nonrestorative sleep (39.5% vs 51.8%, p < 0.05), stimulant use (7.0% vs 19.3%, p < 0.01), breathing cessation (10.7% vs 23.2%, p < 0.01), and nighttime urination (42.5% vs 54.9%, p < 0.05) increased between Time 1 and Time 2. Sleep-related complaints are prominent and augment rapidly in DM1 patients. Physicians need to better identify and treat them to help alleviate the burden they impose on patients and their caregivers.
To assess hearing rehabilitation in patients with congenital aural atresia using an active middle-ear implant (Vibrant Soundbridge).
Methods
Of a cohort of 70 microtia and atresia patients, 10 underwent Vibrant Soundbridge implantation between 2008 and 2021. Two of the 10 patients had binaural implantation, resulting in 12 ears for analysis. Pre- and post-operative audiometry data were analysed, and patient satisfaction was evaluated. Surgical issues regarding coupling sites and outcomes were analysed.
Results
Pure tone average (0.5, 1, 2 and 4 kHz) improved from a pre-operative mean (standard deviation) of 65.3 (8.7) dB HL to a post-operative mean of 26.8 (4.9) dB HL. This resulted in a mean pure tone average gain of 38.5 dB HL. The results indicate no obvious difference between stapes (n = 8) and incus (n = 4) coupling. The mean effective gain for 0.5, 1, 2 and 4 kHz was −17.8 dB HL (standard deviation = 4.3). Concerning effective gain, Vibrant Soundbridge performed best at 2 kHz. Patients reported high overall satisfaction, good sound quality and strongly improved directional hearing.
Conclusion
An active middle-ear implant (Vibrant Soundbridge) allows hearing rehabilitation in selected atretic ears, and provides long-term hearing stability in children and adults.
Measurement-based care (i.e., the systematic use of rating scales to guide clinical decision-making) has shown great promise in the treatment of major depression in clinical trials. Unfortunately, measurement-based care has not yet gained ground in clinical practice, possibly because clinician-rated scales are time-consuming and limited by the availability of trained raters. Hence, brief and valid self-rated scales (questionnaires) may serve as an alternative or supplement to clinician-rated scales. The self-rated 6-item Hamilton Depression Rating Scale (HAM-D6-SR) has shown some promise in this regard, but its validity among inpatients remains unclear.
Objectives
The objective of this study is to evaluate the criterion validity and responsiveness (sensitivity to change) of the HAM-D6-SR among inpatients using the clinician-rated 17-item Hamilton Rating Scale for Depression (HAM-D17) as gold standard reference.
Methods
Inpatients with depression will complete the HAM-D6-SR twice during admission (at least one week between the two self-ratings). At both occasions, the patients will subsequently be rated on the HAM-D17 by trained raters, who are blind to the HAM-D6-SR ratings. The agreement between the HAM-D6-SR and the HAM-D6 extracted from the HAM-D17 will be evaluated using intra-class correlation.
Results
A total of 100 inpatients will be recruited for the study. Data collection is ongoing, and the results of the study will be presented at the 2022 EPA meeting.
Conclusions
If the agreement between the HAM-D6-SR and the HAM-D6 extracted from the HAM-D17 is satisfactory, the HAM-D6-SR could inform decision-making in the treatment of depression.
Disclosure
The presenting author, PK, declares no conflict of interests. Co-author, SDØ, has received the 2020 Lundbeck Foundation Young Investigator Prize. Furthermore, SDØ owns units of mutual funds with stock tickers DKIGI, DKIDKIX, MAJGRO, NBIDE, SPVILRKL and WE
The operating theatre, as the primary learning environment for surgeons, needs to be conducive to achieve successful training. A validated 27-item questionnaire aimed at evaluating the training experience of higher surgical trainees in the operating theatre was developed.
Methods
The initial questionnaire was developed using a literature review and a focus group. Items were validated with content validity index (CVI) and Cronbach's alpha.
Results
The initial version of 33 questions was modified in the focus group into a 29-item 4-point Likert scale questionnaire covering 3 areas. Of these 29 items, 27 reached the threshold CVI of 0.87, and they achieved a Cronbach's alpha of 0.89 from 17 responses.
Conclusion
The quantitative validations in the instrument are comparable to other existing medical education evaluation tools. Aspects of non-technical skills and human factors were featured heavily and perceived to be important for learning in the operating theatre.
This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry.
Method
A population-based survey of the prevalence and causes of hearing loss among adults aged over 35 years in The Gambia was conducted. Clinical assessments included air conduction audiometry, otoscopy and clinical history. Otoscopy outcome was recorded and for those with hearing loss, a probable cause was assigned. Following otoscopy, tympanometry was completed. Otoscopy outcome was not changed as a result of tympanometry. Clinician assigned cause was compared to the results of tympanometry. The proportion of causes potentially misclassified by excluding tympanometry was determined.
Results
Among people with hearing loss, including tympanometry led to a higher proportion diagnosed with middle-ear conditions.
Conclusion
The value of adding tympanometry to population-based survey protocols is a higher estimated proportion of hearing loss being attributed to middle-ear disease rather than sensorineural causes. This can inform service needs as more people will be classified as needing medical or surgical services, and a slightly lower number will need rehabilitative services, such as hearing assistive devices. It is highly recommended that tympanometry is included in the protocol.
To assess parent or guardian satisfaction with a newly instituted day-case tonsillectomy programme at a tertiary paediatric institution.
Methods
After receiving ethical approval, an anonymous questionnaire was sent to the parent or guardian of every patient who underwent day-case tonsillectomy between July 2018 and December 2020.
Results
A total of 135 patients were included. The parent or guardian of each patient was sent a questionnaire to be filled in and returned. Ninety-two completed surveys were returned. There were high satisfaction levels, with 91.3 per cent of parents or guardians feeling comfortable bringing their child home, and 92.4 per cent of parents or guardians would recommend day-case tonsillectomy to another parent or guardian. Of the parents or guardians, 10.9 per cent needed to contact healthcare services in the 24 hours following surgery.
Conclusion
Day-case tonsillectomy has proven to be a safe, efficient service at our institution, with high satisfaction levels from patients and parents or guardians. Areas for improvement focused on communication at the time of discharge regarding follow up and analgesia.