Psychometric validation of the Columbia-Suicide Severity rating scale in Spanish-speaking adolescents / Validación psicométrica de la escala de Columbia de severidad de suicidio en adolescentes hispano-hablantes

Abstract Introduction: Adolescent suicide is a major public health issue, and early and accurate detection is of great concern. There are many reliable instruments for this purpose, such as the Columbia-Suicide severity rating scale (C-SSRS), but no validation exists for Spanish speaking Latin American adolescents. Objetive: To assess psychometric properties and cut-off scores of the C-SSRS in Spanish speaking adolescents. Methods: Exploratory assessment with principal component analysis (PCA) and Varimax rotation, and confirmatory analysis (CFA) were performed on two groups with 782 and 834 participants respectively (N=1616). Mean age was 24.8 years. A Receiver operator analysis was applied to distinguish between control and suicide-risk subgroups adolescents. Results: Promax rotation yielded two 10-items factors, for suicide ideation and behavior respectively. C-SSRS was positively correlated with other suicide risk scales, such as Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, or PHQ-9. Confirmatory factor analysis yielded a two-factor solution as the best goodness of fit model. C-SSRS showed adequate ability to detect suicide risk group with positive predictive value of 68.3%. ROC analyses showed cutoff scores of ≥ 6 and ≥ 4 for suicide ideation and behavior scales respectively Conclusion: This research offers data supporting psychometric validity and reliability of C-SSRS in nonclinical Spanish-speaking students. Added benefits are flexible scoring and management easiness. This questionnaire yields data on distinct aspects of suicidality, being more parsimonious than separate administration of a bunch of questionnaires.

Resumen Introducción: Suicidio adolescente es un problema de salud pública y su detección temprana es de gran interés. Hay numerosos instrumentos confiables para este objetivo, como la escala Columbia para la detección del riesgo de suicidio, pero no ha sido validada para población adolescente de habla hispana en Latinoamérica. Objetivo: Validar psicométricamente y explorar los puntos de corte para la escala Columbia en adolescentes de habla hispana. Métodos: Analisis exploratorio con extracción de componentes principales y rotación Varimax así como análisis confirmatorio fueron llevados a cabo sobre 782 y 834 participantes respectivamente (N=1616). La edad media fue de 24.8 años. El análisis ROC distinguió entre controles y adolescentes en riesgo de suicidio. Resultados: La rotación Promax arrojó dos factores de 10 ítems, para ideación y comportamiento suicida respectivamente. La C-SSRS correlaciono positivamente con otras escalas de detección de riesgo de suicidio como Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, o el PHQ-9. El análisis factorial confirmatorio ofreció una solución de 2 factores como el modelo con mejor ajuste. El análisis ROC tuvo puntos de corte ≥ 6 y ≥ 4 para las escalas de ideación y comportamiento suicida respectivamente Conclusión: Esta investigación ofrece datos que apoyan la validez psicométrica y confiabilidad de la C-SSRS en población de estudiantes adolescentes hispano-hablantes latinoamericanos. Beneficios adicionales son un sistema de puntaje flexible y facilidad de administración. Este cuestionario ofrece datos sobre distintos aspectos de suicidalidad siendo más robusto que la administración separada de varios cuestionarios diferentes.

Cetoacidosis diabética asociada al consumo agudo de metilona en un paciente masculino de 21 años / Diabetic ketoacidosis associated with acute methylone consumption in a 21 years old male patient

El uso de metilona se ha visto incrementado últimamente, comercializada como sustituto legal de las drogas clásicas e imitando sus efectos. Actualmente ha sido prohibida en los mercados europeo y americano. Se describe el caso de una cetoacidosis diabética complicada por el consumo agudo de metilona en un joven caucásico de 21 años dependiente de insulina. Luego de ingerir tres cápsulas durante una fiesta, se presenta durante la madrugada del 18 de enero de 2012 al departamento de emergencias de un nosocomio del conurbano bonaerense, partido de General Sarmiento (Argentina). Refiere haber experimentado mareos, vómitos y somnolencia, con aliento cetónico, deshidratación, taquicardia, taquipnea, hipertensión arterial e hipertermia. El laboratorio mostró acidosis metabólica y en el análisis toxicológico se encontró un nivel de metilona de 0.09 mg/dl. Se trató en una unidad de cuidados intensivos con reposición de volumen, insulina y potasio. Remitió luego de 48 horas. Como mecanismos se postulan sus efectos serotoninérgicos y noradrenérgicos y la secreción de hormona antidiurética, que producen deshidratación, lipólisis y aumento de cuerpos cetónicos con acidosis mayor de la esperable por la hiperglicemia. Conclusiones En este caso se demuestra la asociación entre consumo agudo de metilona y cetoacidosis diabética. Se sugiere la vigilancia epidemiológica y educación sobre los riesgos potenciales del uso de metilona en gente joven especialmente aquellos predispuestos a desarrollar cetoacidosis diabética.

Use of methylone has risen recently, traded as a legal substitute of classic drugs, mimicking its effects. Actually it has been banned in European and American markets. The case of ketoacydotic diabetes complicated with the acute consumption of methylone is described in a 21 years' caucasic insulin dependent male. After the ingestion of 3 capsules during a party, he presents during the dawn of January, 18th of 2012, to a Buenos Aires State suburban Hospital emergency department (Argentina). He refers having experienced dizziness, vomiting and somnolence, with ketotic breath, dehydration, high heart and breath rates and hypertermia. Lab exams showed metabolic acidosis and on the toxicologic analysis methylone level of 0.09 mg/dl was found. Patient was treated in an ICU with fluid reposition, volume restriction, insulin and potassium. Remission occurred after 48 hours. Mechanisms of action suggested include serotoninergic and noradrenergic effects and antidiuretic hormone release, which in term produce dehydration, lypolisis and ketotic bodies raise with acidosis greater than expected for hyperglicemia. Conclusions In this case an association between acute use of methylone and ketoacidotic diabetes was found. Epidemiologic surveillance and education about potential risks of methylone use in young people are suggested, especially those who are predisposed to developing ketoacydotic diabetes.

Traducción, adaptación al español y validación de la Escala de Bienestar Mental de Warwick-Edinburgh en una muestra de adultos mayores argentinos / Translation, Spanish adaptation and validation of the Warwick-Edinburgh well-being scale in a sample of Argentine older adults / Tradução, adaptação ao espanhol e validação da escala de bem-estar mental de Warwick-Edinburgh em uma mostra de adultos maiores argentinos

El estudio analiza las propiedades psicométricas y la estructura factorial de la Escala de Bienestar Mental de Warwick- Edinburgh luego de realizar la traducción directa y revertida y su adaptación al español. Se validó la escala mediante su aplicación a una muestra de 910 adultos mayores argentinos, con edades comprendidas entre 71 y 96 años (media 81.4 años; DE 10.9 años). Se obtuvieron los siguientes indicadores: distribución de respuestas, consistencia interna, confiabilidad test-retest, validez de constructo, y se realizó un análisis factorial exploratorio y confirmatorio. En cuatro de los ítems se debieron modificar los términos para mantener la equivalencia conceptual con el original. El índice de confiabilidad alfa de Cronbach (0.89), la correlación ítem-escala total (0.41-0.78), el índice test-retest medido mediante el coeficiente de correlación intra-clase (CCI) (0.91) mostraron un nivel satisfactorio. El análisis factorial confirmatorio mostró un RMSEA de 0.054, considerado aceptable; un valor CFI igual a 0.963, un valor de NNFI 0.925 (levemente inferior al deseado) y un GFI con un valor de 0.991. Se obtuvo una solución de dos factores, por lo cual no se pudo sostener la hipótesis de uni-dimensionalidad de la escala original. Se concluye que la escala traducida y adaptada al español para una muestra de adultos mayores no institucionalizados tiene un ajuste adecuado, con alta consistencia interna y buena confiabilidad test-retest, con iguales valores de constructo que el instrumento original, lo que permitiría su uso en la población adulta mayor.

The study assesses psychometric properties and factorial structure of the Warwick-Edinburgh mental well-being scale after forward and backward translations and Spanish adaptation. The scale was validated by applying it to a sample of 910 Argentine elders, with ages ranging from 71 and 96 years (media 81.4 years; SD 10.9 years). The following measures were obtained: response distributions, internal consistency, test-retest reliability, construct validity and exploratory and confirmatory factor analysis. In four of the original items, phrasing was modified to keep conceptual equivalence with the original instrument. Reliability (Cronbach's alpha 0.89), item-total scale (0.41-0.78) and test-retest measured by intra-class correlation coefficient (ICC) (0.91) were deemed appropriate. Confirmatory factorial analysis showed a RMSEA = 0.054, considered acceptable, a CFI = 0.963, a NNFI = 0.925 (slightly below the accepted value) and a GFI = 0.991. A two factor solution was obtained so it was not possible to hold the single dimensional hypothesis as in the original scale. The translated and adapted scale shows an appropriate level of adjustment, high internal consistency and good test-retest reliability, with the same construct validity as the original instrument which allows its use among the elderly population.

O estudo analisa as propriedades psicométricas e a estrutura fatorial da Escala de Bem-estar Mental de Warwick-Edinburgh depois de realizar a tradução direta e revertida e sua adaptação ao espanhol. Validou-se a escala mediante sua aplicação a uma mostra de 910 adultos maiores argentinos, com idades compreendidas entre 71 e 96 anos (média 81.4 anos; DE 10.9 anos). Obtiveram-se os seguintes indicadores: distribuição de respostas, consistência interna, confiabilidade teste-reteste, validade de constructo, e realizou-se uma análise fatorial exploratória e confirmatória. Em quatro dos itens tiveram que ser modificados os termos para manter a equivalência conceitual com o original. O índice de confiabilidade alfa de Cronbach (0.89), a correlação item-escala total (0.41-0.78), o índice teste-reteste medido mediante o coeficiente de correlação intra-classe (CCI) (0.91) mostraram um nível satisfatório. A análise fatorial confirmatória mostrou um RMSEA de 0.054, considerado aceitável; um valor CFI igual a 0.963, um valor de NNFI 0.925 (levemente inferior ao desejado) e um GFI com um valor de 0.991. Obteve-se uma solução de dois fatores, pelo qual não de pôde sustentar a hipótese de uni-dimensionalidade da escala original. Concluise que a escala traduzida e adaptada ao espanhol para uma mostra de adultos maiores não institucionalizados tem um ajuste adequado, com alta consistência interna e boa confiabilidade teste-reteste, com iguais valores de constructo que o instrumento original, o que permitiria seu uso na população adulta maior.

Elders Health Empowerment Scale. Spanish adaptation and psychometric analysis / Escala de Empoderamiento sobre la Salud para Adultos Mayores. Adaptación al español y análisis psicométrico

Introduction: Empowerment refers to patient skills that allow them to become primary decision-makers in control of daily self-management of health problems. As important the concept as it is, particularly for elders with chronic diseases, few available instruments have been validated for use with Spanish speaking people. Objective: Translate and adapt the Health Empowerment Scale (HES) for a Spanish-speaking older adults sample and perform its psychometric validation. Methods: The HES was adapted based on the Diabetes Empowerment Scale-Short Form. Where "diabetes" was mentioned in the original tool, it was replaced with "health" terms to cover all kinds of conditions that could affect health empowerment. Statistical and Psychometric Analyses were conducted on 648 urban-dwelling seniors. Results: The HES had an acceptable internal consistency with a Cronbach's α of 0.89. The convergent validity was supported by significant Pearson's Coefficient correlations between the HES total and item scores and the General Self Efficacy Scale (r= 0.77), Swedish Rheumatic Disease Empowerment Scale (r= 0.69) and Making Decisions Empowerment Scale (r= 0.70). Construct validity was evaluated using item analysis, half-split test and corrected item to total correlation coefficients; with good internal consistency (α> 0.8). The content validity was supported by Scale and Item Content Validity Index of 0.98 and 1.0, respectively. Conclusions: HES had acceptable face validity and reliability coefficients; which added to its ease administration and users' unbiased comprehension, could set it as a suitable tool in evaluating elder's outpatient empowerment-based medical education programs.

Introducción: Empoderamiento se refiere a las habilidades que le permiten al paciente convertirse en responsable de tomar las decisiones para el control diario de sus problemas de salud. A pesar de ser un concepto tan importante, particularmente para adultos mayores con problemas crónicos de salud, hay pocos instrumentos accesibles que hayan sido validados para su uso en hispano-hablantes. Objetivo: Traducir y adaptar la Escala de Empoderamiento sobre la Salud (EES) para una muestra de adultos mayores hispano-hablantes y llevar a cabo su validación psicométrica. Métodos: La EES se adaptó basándose en la Escala de Empoderamiento de la Diabetes versión corta. Donde se mencionaba "diabetes" en el instrumento original, se reemplazó con el término "salud" para cubrir todos los tipos de condiciones que podrían afectar el Empoderamiento sobre la salud. Se realizaron análisis estadísticos y psicométricos sobre 648 adultos mayores residentes urbanos. Resultados: La EES tuvo una consistencia interna aceptable con un α de Cronbach de 0.89. la validez convergente se apoyó en un coeficiente de correlación de Pearson significativo entre la EES total y por ítems y la Escala General de Auto-eficacia (r= 0.77), la Escala de Empoderamiento para la Enfermedad Reumática versión Sueca (r= 0.69) y la Escala de Empoderamiento Tomando Decisiones (r= 0.70). La validez de Constructo se evaluó mediante análisis de ítem, test de las dos mitades y coeficiente de correlación ítem corregido total (α >0.8). La validez de contenido se apoyó por los Índices de Validez de Contenido para la Escala y para los ítems de 0.98 y 1.0, respectivamente. Conclusiones: La EES tuvo una validez y confiabilidad aceptables, que sumados a su facilidad de administración y comprensión simple y sin sesgos podría constituirse en una herramienta confiable para evaluar programas educativos médicos basados en el Empoderamiento de pacientes mayores ambulatorios.

A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease: a randomized controlled trial / Intervenção com um programa de reminiscência para melhorar qualidade de vida de residentes com Alzheimer com cuidados prolongados: ensaio controlado randomizado

OBJECTIVE: A single-blinded, parallel-groups (intervention, active and passive control groups) randomized controlled trial (RCT) was chosen to investigate whether a specific reminiscence program is associated with higher levels of quality of life in nursing home residents with dementia. METHODS: The intervention used a life-story approach, while the control groups participated in casual discussions. The Social Engagement Scale (SES) and Self Reported Quality of Life Scale (SRQoL) were used as the outcome measures, which were examined at baseline (T0), 12 weeks (T1), and six months (T2) after the intervention. The final sample had 135 subjects (active control group = 45; passive control group = 45; intervention group = 45). RESULTS: The Wilcoxon test showed significant differences in the intervention group between T2 and T0, and between T1 and T0 in the SES, and there were significant differences between T0 and T1 (intervention effect size = 0.267) and T1 and T2 (intervention effect size = 0.450) in the SRQoL. The univariate logistic regression scores showed that predictors of change in the SRQoL were associated with fewer baseline anxiety symptoms and lower depression scores. CONCLUSIONS: The intervention led to significant differences between the three groups over time, showing a significant improvement in the quality of life and engagement of the residents in the intervention group.

OBJETIVO: Elegeu-se um ensaio randomizado controlado simples cego, com grupos paralelos (intervenção, comparação e controle) para pesquisar se um programa específico de reminiscência associa-se com maiores níveis de qualidade de vida em residentes com demência com cuidados prolongados. MÉTODO: No grupo de intervenção usou-se o enfoque da história de vida, enquanto o grupo controle recebeu conversas amistosas. A Escala de Compromisso Social (SES) e a escala auto-referida de qualidade de vida (SRQoL) foram as medidas de resultados, examinados na linha de base, doze semanas, e seis meses após a intervenção. A mostra final teve 135 sujeitos (controle n = 45; comparação n = 45; intervenção n = 45). RESULTADOS: Wilcoxon test no grupo intervencional comparando os resultados entre T1 e T0, T2 e T1, e T2 e T0 mostraram diferenças significativas entre T2 e T0 (tamanho do efeito de intervenção = 0,460) e T1 e T0 (tamanho do efeito de intervenção = 0,486) em o SES; e entre T0 e T1 (tamanho do efeito de intervenção = 0,267) e T1 e T2 (tamanho do efeito de intervenção = 0,450) em o SRQoL no grupo de intervenção. As pontuações de regressão logística univariada mostraram que os predictores de mudança estavam associados com menores níveis de ansiedade basal e menores níveis de depresión. CONCLUSÕES: A intervenção produziu diferenças significativas entre os três grupos ao longo do tempo, mostrando uma melhoria significativa na qualidade de vida e compromisso dos residentes no grupo de intervenção.

Disociación entre atribución de discapacidad explícita e implícita hacia adultos mayores en estudiantes de psicología / Dissociation between psychology student's implicit and explicit disability atribution to elders

Los adultos mayores son objeto de estereotipos negativos que pueden explorarse por medidas explícitas e implícitas. Dado que existen discrepancias entre ambas, es conveniente combinarlas. Son escasos los estudios sobre atribución de discapacidad hacia adultos mayores por parte de jóvenes en el ámbito educativo. El objetivo del estudio que se informa fue evaluar si existe una disociación entre las medidas implícitas y explícitas de atribución de discapacidad hacia adultos mayores en una cohorte de estudiantes de la Carrera de Psicología. Las actitudes explícitas se estudiaron con el Test de Evaluación de Actitudes hacia Adultos Mayores (EVAAM) y las implícitas, con un test de asociación implícita (TAI) en relación con categorías de capacidad / discapacidad, en combinaciones congruentes e incongruentes. Se correlacionaron ambas pruebas para verificar el grado de disociación entre ellos. Como resultado se observó que en el TAI, la combinación incongruente (capacidad + vejez) tuvo mayor tamaño de efecto implícito que la congruente (capacidad + juventud), demostrando la existencia de una atribución automática de discapacidad hacia adultos mayores. Los valores para la escala explícita fueron mejores y no correlacionaron con el TAI. Así se concluye que los adultos mayores reciben una atribución automática de discapacidad por parte de los estudiantes de Psicología, que no coincide con su preferencia explícita. Esto podría deberse a la intención de agradabilidad de los jóvenes, a la falta de introspección sobre representaciones implícitas o a una independencia de las representaciones explícitas e implícitas. Queda por considerar si las atribuciones implícitas y explícitas forman diferentes constructos, o son parte de uno solo, con valores positivos en el polo voluntario y negativos en el involuntario.

Negative attributions toward elders are a paramount feature creating an unfavorable trait which manifests itself as stereotypes and discriminatory behaviors. This turns to be more critical when those misattributions are covertly distributed in the general population. Negative attributions toward elders are greater than younger when comparing both groups, and are dependent on several factors such as amount of information provided, coherence of the data, age and even the year when the search was carried on, as recent studies show less differences between elders and young attributions compared with older ones, particularly on explicit measures. Probably this reflects the more acceptability and tolerance exhibited by new cohorts toward different social groups in such areas as ethnics, religion or sexuality. It is obvious that elders stereotypes must be explored using not only explicit but also implicit measures, which reveal more clearly automatic associations and attributions toward key social groups. As there are sound differences between both kinds of assessments, combination is highly recommended. There are few studies that have accomplished the investigation of disability attribution toward elders by young subjects in the field of Education using Implicit Association Tests (IAT). This may prove useful as ageism exists in the Psychology Career Programs, being studies about elders under-represented in the programs contents. Objectives: To evaluate whether dissociation between implicit and explicit disability attribution measures exists in a cohort of young university psychology students. Methods and instruments: 210 subjects were included in the study (121 female and 89 men), who were recruited from students attending regular courses at the Faculty of Psychology on the city of Rosario (Argentina), aged from 24 to 29-year-old. Implicit attributions were assessed with the IAT that measures automatic association's strength between two core concepts (in the present study abilities /disabilities) and the two poles of an evaluative dimension (elderhood / youth). Stimulus are displayed on a computer screen and the subject has to associate core concept and attribute dimension faster when both are of equal valence (shorter latency). Subjects holding strong association between disability and elderhood have faster responses when those share the same key that has to be pressed to accomplish a valid answer. Latency spread between congruent (ability / youth) and incongruent (ability / elderhood) associations is accounted for the automatic strength of the implicit effect. Explicit attitudes were studied with the Attitudes toward Elders Evaluation Test and implicit ones using the Implicit Association Test with ability / disability categories in congruent and incongruent combinations. Both tests were correlated to disclose any dissociation between them. Dependent variable to measure implicit attitudes was the value of d which represents the size of the implicit effect between congruent and incongruent condition. A 2 (cate gories) x 2 (attributes) x 2 (dimensions) matrix was used, and independent variables were rotated between participants. Valence of attributes ranged from positive to negative and were associated with categories using as control factor the order of task congruence (block 3 congruent and block 6 incongruent). Dependent variable for explicit attitudes was the overall mean answers of the EVAAM (Adult Evaluation Scale). Results: In the IAT, the incongruent combination (ability old age) had a greater implicit size effect than the congruent one (ability youth), showing the existence of an automatic disability attribution toward elders. Results in the explicit scale were better and didn't correlate with IAT. Conclusions: Elders receive a Psychology student's automatic disability attribution, which doesn't match their explicit preference. This may be due to young students' agreeability intention, lack of introspection on implicit representations, or explicit and implicit representations independence. It remains to be investigated whether explicit and implicit attributions belong to different constructs or to only one, with positive values in the voluntary pole and negative values in the involuntary pole.