Psychometric validation of an empowerment scale for Spanish-speaking patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) knowledge has been constructed with studies performed in Caucasians patients; Latin American patients present unique characteristics. Empowerment is a social multidimensional construct that has been associated to better health-related quality of life in RA. There is no validated instrument for use with Spanish-speaking patients. The objective of the study was to adapt the Spanish version of the Health Empowerment Scale (S-HES), which was selected for its psychometric properties and suitability for low-literacy populations, for RA Hispanic patients (RAEH), and to perform its psychometric validation. METHODS: RAEH adaptation, pilot testing, and psychometric validation were performed. Three convenience samples of RA outpatients from a national tertiary care level center were used. For RAEH adaptation, the word "health" was substituted with "RA" in the original S-HES, integrated by 8 items. Pilot testing (in 50 patients) assessed feasibility. Psychometric validation included content validity (nine experts rated item convenience, clarity, and cultural semantic accuracy), internal consistency (in 200 patients, Cronbach's alpha) and test-retest (in a subsample of 50 patients, ICC and 95% CI), construct validity (factor analysis), and face validity (in 20 patients, % of agreement). Patients gave written informed consent. RESULTS: Patients were primarily middle-aged females and had typical long-standing disease, although early disease was represented. In the psychometric validation sample, the majority of the outpatients had autoantibodies; meanwhile, half of them had no evidence of disease activity, with acute reactants phase determinations within normal range. Patients with comorbidities and joint replacement were also included. Experts agreed upon the attributes of content validity: 83-100% considered the item was essential, 100% agreed on the item's clarity and 80-100% on the cultural semantic accuracy. In the pilot sample, ≥ 80% of the patients agreed with the item's clarity and format. In the psychometric validation sample, mean RAEH was 34 (maximum possible score: 40 = highest score). RAEH had a good internal consistency, Cronbach's α = 0.86, and moderately good reliability (ICC [95% CI] test-retest: 0.79 [0.62-0.88]). Factor analysis for construct validity showed a single factor explaining 52% of the variance. Patients agreed with each item content validity (85-100%) and clarity (75-100%). CONCLUSIONS: RAEH was valid and reliable to evaluate empowerment in Spanish-speaking RA patients.

Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation.

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7-9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.

Infecciones cutáneas en pacientes sometidos a transplante y en pacientes con infección por HIV: estudio comparativo y revisión bibliográfica / Cutaneous infections in transplants patients recipients and HIV positive patients: comparative study and biblyographic review

Estudio compativo entre grupos de pacientes. El primero estaba constituido por pacientes sometidosa transplantes de diferentes órganos y el segundo, por portadores de HIV; ambos con alteracións immunitarias. Efectuamos también un estudio sobre la frecuencia de las infecciones cutáneas, así como de los gérmenes más comunes. Se revisó pormenorizadamente la bibliografia existente sobre estas patologias

Infant temperament and cardiac vagal tone: assessments at twelve weeks of age.

Sixty 12-week-old infants participated in a laboratory study to explore the relations between temperament and cardiac vagal tone. Temperament was evaluated via laboratory observations and maternal ratings. Cardiac vagal tone, measured as the amplitude of respiratory sinus arrhythmia, was quantified from beat-to-beat heart period data collected during a resting baseline period and during the laboratory assessment of temperament. Specific hypotheses were investigated relating temperament to both basal cardiac vagal tone and changes in cardiac vagal tone during social/attention challenges. Infants with higher baseline cardiac vagal tone were rated in the laboratory as showing fewer negative behaviors and were less disrupted by the experimental procedure. Infants who decreased cardiac vagal tone during the laboratory assessment were rated on maternal report temperament scales as having longer attention spans, and being more easily soothed.

Prenatal maternal reactivity to infant cries predicts postnatal perceptions of infant temperament and marriage appraisal.

In a sample of 60 primiparous women, cardiac response and ratings of subjective aversiveness to recordings of unfamiliar infant cries were studied at 32 weeks' gestation. Regression analyses were used to examine relations between cardiac acceleration and subjective aversiveness and 3 groups of postnatal dependent variables: perception of infant temperament, the mother's emotional state, and her appraisal of her marriage. Mothers who prenatally rated the cry recordings as more aversive postnatally described their 3-month-old infants as more fussy/difficult and unpredictable. With statistical control for prenatal variation on the emotional state and marital outcome measures, cardiac acceleration predicted later marital quality. Women who showed greater cardiac acceleration to the cries described their postnatal marital relationships more negatively.

Epilogue: bridging the gap between research on attachment and psychopathology.

Clinicians and researchers are beginning to acknowledge the importance of integrating a developmental perspective into the understanding of clinical disorders. The application of findings from basic attachment research to this understanding of psychopathology is a prototype for interdisciplinary research. However, major gaps continue to exist between basic research on attachment processes and clinical issues of assessment, classification, and treatment of mental disorders from infancy through adolescence. This epilogue highlights the importance of more integrative research. As a reflection of growth in this direction, National Institute of Mental Health funding patterns are reviewed, and promising areas for future research are suggested. The field is well positioned for conceptual advancement if more integrative approaches are used.