Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo / Diagnostic accuracy and predictive validity of associated use of Fototest and Mini-Cog in cognitive impairment

Introducción: El Fototest y el Mini-Cog incluyen todos los dominios que debieran formar parte de una evaluación cognitiva. Nuestro objetivo es evaluar la utilidad diagnóstica del uso conjunto de ambos instrumentos para el diagnóstico de deterioro cognitivo (DC). Métodos: Estudio fase iii de evaluación de pruebas diagnósticas con 2 muestras independientes, estudio (448 sujetos), dividida aleatoriamente en 2 dataset (Base 80%, Test 20%), y Externa (61 sujetos). Prueba index: Fototest y Mini-Cog aplicados consecutivamente; prueba de referencia: evaluación cognitiva formal. Se evalúa la UD del uso combinado y escalonado de los modelos simple (Comb-Simple), regresión logística (Comb-RL) y árbol aleatorio (Comb-AA) para identificar DC (GDS ≥ 3). Se realiza un análisis exploratorio en Base seleccionando los criterios que maximizan la exactitud; la evaluación se realiza en las muestras Test y externa mediante un análisis preespecificado con los criterios seleccionados. Resultados: La UD de los modelos combinados en Base (Comb-Simple 88,3 [(88,5-91,4] [exactitud, LI95%-LS95%], Comb-RL 91.6 [88,2-94,3] y Comb-AA 95,2 [92,5-97,2])) es significativamente superior a la de Mini-Cog y Fototest (81,6 [77,1-85,4] y 84,9 [80,8-88,5], respectivamente); estos resultados son replicados en Test (Comb-Simple 88,9 [exactitud], Comb-RL 95,6 y Comb-AA 92,2) y externa (Comb-Simple 91,8, Comb-RL 90,2 y Comb-AA 88,5). La aplicación escalonada mantiene la misma UD pero requiere menos tiempo (197,3 ± 56,7 vs. 233,9 ± 45,2, p < 0,0001). Conclusiones: El uso conjunto del Fototest y el Mini-Cog requiere menos de 4 min y mejora la UD de ambos instrumentos. El uso escalonado es más eficiente porque manteniendo la misma UD requiere menos tiempo de aplicación.(AU)

Introduction: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. Methods: We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. Results: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001). Conclusions: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less...(AU)

Diagnostic accuracy and predictive validity of combined use of Fototest and Mini-Cog in cognitive impairment.

INTRODUCTION: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS: We performed a phase III diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs 233.9 s [45.2]; P < .0001). CONCLUSIONS: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.

Validez Predictiva e Igualdad de Trato de la “Oposición” como Método de Selección para Inspectores de Hacienda y Técnicos de Hacienda del Estado / Predictive Validity and Equal Treatment of “Competition” as a Selection Method for State Treasury Inspectors and Treasury Technicians

La “oposición” es el método de selección de personal para los cuerpos superiores de la función pública española y cientos de miles de candidatos participan en las oposiciones cada año. A pesar de ello, permanece sin haberse estudiado su validez predictiva y sus potenciales efectos sobre la igualdad de trato para hombres y mujeres. Este artículo presenta dos estudios independientes dedicados establecer la validez predictiva y el grado de igualdad de trato de la “oposición”. En el primero se examinó con candidatos al Cuerpo de Técnicos de Hacienda. Los resultados indicaron una validez operativa ρ = .54 (N = 392) y un valor d de Cohen promedio de .14 para la igualdad de trato favorable a los hombres. El segundo estudio se realizó con candidatos al Cuerpo Superior de Inspectores de Hacienda y la validez operativa fue de ρ = .50 (N =.70) y la d de Cohen de .33 favorable a las mujeres. Los resultados indican que la “oposición” muestra una validez semejante o superior a la de los mejores instrumentos de selección de personal. Finalmente, se discuten las implicaciones para la práctica y se hacen recomendaciones para mejorar este sistema de acceso a la función pública.(AU)

The "competition” (“oposición” in Spanish) is the method of personnel selection for the higher Corps of the Spanish civil service, and hundreds of thousands of candidates participate in the competitive examinations each year. Despite this, its predictive validity and its potential effects on equal treatment for men and women remain unknown. This article presents two independent studies devoted to establishing the predictive validity and the degree of equal treatment of the "competition". In the first one, the validity was examined with candidates for the Corps of Treasury Technicians. The results indicated an operational validity ρ = .54 (N = 392) and an average Cohen's d value of .14 for equal treatment favorable to men. The second study was conducted with candidates for the Corps of Senior Treasury Inspectorate and the operational validity was ρ = .50 (N =.70) and Cohen's d of .33 favorable to women. The results indicate that the "competition" shows similar or superior validity to that of the best personnel selection instruments. Finally, implications for practice are discussed and recommendations are made to improve this system of access to the civil service.(AU)

Cambios en el control postural y la marcha en pacientes con ictus en fase subaguda tras recibir rehabilitación interdisciplinar y factores relacionados: estudio retrospectivo / Postural control and gait changes in subacute stroke patients after receiving interdisciplinary rehabilitation and related factors: a retrospective study

Introducción: La rehabilitación precoz tras el ictus resulta fundamental para optimizar la recuperación, pero sus efectos y los factores pronósticos están aún en discusión. Objetivo: Evaluar los cambios en el control postural y la marcha en los pacientes con ictus que reciben rehabilitación interdisciplinar en fase subaguda y valorar los posibles factores relacionados. Pacientes y métodos: Estudio observacional retrospectivo que analizó datos sociodemográficos y clínicos, incluyendo el control postural y la capacidad de marcha, mediante las escalas Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke (PASS), Functional Ambulation Categories (FAC) y de Tinetti, tanto en el inicio como a los dos meses de rehabilitación. Resultados: Se recogieron datos de 63 pacientes con ictus en fase subaguda. La rehabilitación interdisciplinar tuvo un impacto clínico moderado (p < 0,01; d > 0,5) y relevante sobre el control postural y la marcha. Los factores asociados moderadamente (p < 0,05; d > 0,5) a una mayor evolución en el control postural evaluado con la TIS y la PASS fueron la rehabilitación ambulatoria, la ausencia de medicación psicótropa y la ausencia de dislipidemia. La TIS en el inicio se asoció significativamente (p < 0,05) con los valores de todas las escalas tras dos meses de rehabilitación, excepto con la PASS movilidad. Conclusiones: La rehabilitación interdisciplinar favorece cambios moderados y clínicamente relevantes en la recuperación del control postural y la marcha de pacientes con ictus subagudo tras dos meses de tratamiento. La rehabilitación ambulatoria y la ausencia de dislipidemia y de medicación psicótropa se asocian con la evolución, pero son necesarios más estudios para confirmar su influencia en muestras mayores.(AU)

Introduction: Although early post-stroke rehabilitation is essential to optimize recovery, its effects and prognostic factors are yet under discussion. Objective: To assess postural control and gait changes in post-stroke patients who underwent interdisciplinary rehabilitation in subacute phase and evaluate potential associated factors. Patients and methods: An observational retrospective study that analyzed sociodemographic and clinical data, including Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke (PASS), Functional Ambulatory Categories (FAC) and Tinetti scale, at admission and two months after rehabilitation. Results: Data were collected from 63 patients with stroke in subacute phase. Interdisciplinary rehabilitation had a moderate and relevant clinical impact (p < 0,01; d > 0,5) in postural control and gait. Ambulatory rehabilitation, psychotropic medication absence and dislipemia absence were moderate associated factors (p < 0,05; d > 0,5) with a greater evolution in postural control measured with TIS and PASS. TIS at admission showed significant association with all scales’ results at two months after rehabilitation, except with PASS changing posture subscale. Conclusions: Interdisciplinary rehabilitation promotes moderate and clinically relevant changes in postural control and gait recovery in subacute stroke patients, after two-month rehabilitation period. Ambulatory rehabilitation, dyslipidemia absence and psychotropic medication absence were associated with patients’ evolution, but further research is required to confirm their actual influence in larger samples.(AU)

Validez de la Wisconsin Gait Scale para predecir el riesgo de caídas en pacientes con ictus / Validity of the Wisconsin Gait Scale to predict the risk of falls in stroke patients

Introducción: Aproximadamente, la mitad de las personas que han sufrido un ictus sufre una caída durante el primer año tras la lesión, lo que afecta a su funcionalidad. Las escalas de evaluación de la marcha podrían utilizarse para predecir el riesgo de caídas. Objetivo: Estudiar la capacidad de la Wisconsin Gait Scale (WGS) para predecir el riesgo de caídas en pacientes con ictus. Pacientes y métodos: Estudio observacional retrospectivo que incluyó a pacientes con ictus entre mayo de 2010 y octubre de 2016. Se recopilaron datos de la WGS y de la Berg Balance Scale (BBS) tras la hospitalización (fase aguda), a los tres meses (fase subaguda) y a los seis y 12 meses (fases crónicas). Se empleó la BBS como variable de resultado para determinar la capacidad de la WGS para predecir el riesgo de caídas. El cálculo de la validez predictiva se llevó a cabo mediante las curvas receiver operating characteristics y el análisis del área bajo la curva (AUC). Resultados: Se recopilaron datos de 61 pacientes que cumplieron los criterios de inclusión (tras la admisión: 61; a los tres meses: 61; a los seis meses: 58; a los 12 meses: 42). En todas las mediciones, el AUC fue mayor de 0,9, por lo que la WGS distingue a los pacientes con ictus con riesgo moderado de sufrir caídas de los de riesgo bajo. Conclusiones: La WGS es un instrumento válido para predecir el riesgo de caídas en pacientes con un ictus en relación con los puntos de corte establecidos en la BBS.(AU)

Introduction: Approximately, half of the stroke patients suffered a fall during the first year after the injury, affecting its functionality. Gait evaluation scales could evaluate to predict the risk of falls. Objective: To study the ability of the Wisconsin Gait Scale (WGS) to predict the risk of falls in stroke subjects. Patients and methods. Retrospective observational study that included stroke patients between May 2010 and October 2016. Data from the WGS and the Berg Balance Scale (BBS) were collected after hospitalization (acute phase), at 3 months (subacute phase) and at 6 and 12 months (chronic phases). BBS was used as the outcome variable to determine the ability of the WGS to predict the risk of falls. The calculation of the predictive validity was carried out using the ROC (Receiver Operating Characteristics) curves and the analysis of the area under the curve (AUC, area under the curve). Results: Data were collected from 61 patients who met the inclusion criteria (after admission: 61; 3 months: 61; 6 months: 58; 12 months: 42). In all measurements, the AUC was greater than 0.9, so the WGS distinguishes stroke patients with moderate risk of falling from those with low risk. Conclusions: The WGS scale is a valid instrument to predict the risk of falls in patients with a criterion in relation to the cut-off points established in the BBS.(AU)

Diagnostic accuracy and predictive validity of associated use of Fototest and Mini-Cog in cognitive impairment. / Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo.

INTRODUCTION: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS: We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001). CONCLUSIONS: Combined application of the Fototest and Mini-Cog takes less than 4minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.

[Connection between subjective sexual arousal and genital response: differences between men and women]. / Relación entre la excitación sexual subjetiva y la respuesta genital: diferencias entre hombres y mujeres.

OBJECTIVE: The level of agreement between subjective and objective measures of sexual arousal is referred as sexual concordance. Sex is one of the principal moderators and there is a higher level of correspondence in men than in women. The aim of this study is to evaluate the predictive validity of the scales Ratings of Sexual Arousal (RSA) and Ratings of Genital Sensations (RGS), relating their scores with the genital response to visual sexual stimuli in men and women. MATERIAL AND METHOD: A sample of 159 young heterosexuals was used (69 men and 90 women) which completed, firstly, a sociodemographic and sexual story questionnaire, the Sexual Inhibition/Sexual Excitation Scales Short-Form and the SOS-6. At the laboratory, they were exposed to a neutral film and to an explicit sexual content film. The subjective sexual arousal was evaluated with the RSA and RGS scales and the genital response was registered through a plethysmography (men) and a photo-plethysmography (women). RESULTS: Significant correlations were obtained between subjective and objective sexual arousal only in men. The RGS scale has the capacity to predict the erection response toward sexual stimuli. CONCLUSIONS: The theory of differences in sexual concordance between men and women was endorsed. Modest evidence about the predictive validity of the subjective sexual arousal evaluation scale was found only in men. It arises the need for subjective and objective assessment of sexual arousal, in clinical settings and research area.

Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. / Validez predictiva y fiabilidad de la escala de Braden para valoración del riesgo de úlceras por presión en una unidad de cuidados intensivos.

OBJECTIVE: Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. DESIGN: An analytical, observational, longitudinal prospective study was carried out. SETTING: Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). PATIENTS: Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. INTERVENTIONS: None. VARIABLES OF INTEREST: The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. RESULTS: The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. CONCLUSIONS: The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios.

Un estudio preliminar de una prueba de autodetección a distancia. Riesgo en trastornos alimentarios / A preliminary study of an online self-detection test. Risk in eating disorders

El objetivo de este estudio fue evaluar la utilidad de una prueba de autodetección de riesgo en trastornos alimentarios a distancia (PARTAD), desde una perspectiva cuantitativa, determinando su validez predictiva y poder de clasificación y una cualitativa, analizando el contenido de las opiniones y sugerencias de las usuarias. De la muestra total (n = 3,501) 3,059 eran adolescentes (13-19 años) y jóvenes (20-35 años); 394 mujeres adultas (36-50 años); y 48 adultas maduras (51-60 años). Se construyó un instrumento de 30 ítems dicotómicos y de opción múltiple y se agregaron 2 preguntas abiertas con propósitos de retroalimentación para mejorarlo y para la evaluación cualitativa. El análisis discriminante arrojó una función con fuerte poder discriminatorio entre grupos, con alto y bajo riesgo en trastornos alimentarios, que explica hasta el 88% de la varianza y el 100% de clasificación correcta. También se obtuvo un 23% de comentarios (706), el análisis y clasificación de sus contenidos mostraron los efectos esperados. Los resultados permiten responder afirmativamente en relación con la utilidad del PARTAD.

The aim of this study was to evaluate the usefulness of an Online Test of Self-Detection in Risk for Eating Disorder (OTSDRED) from a quantitative perspective (determining its predictive validity and classification power) and from a qualitative one (analyzing the opinions and suggestions of users). From the total sample (N = 3501) of women, 3059 were adolescents (13- 19 years), youth (20-35 years); 394 adult (36-50 years); and 48 mature adult (51-60 years). An instrument of 30 dichotomous items and multiple choice was built. Two open questions with feedback for improvement purposes and for the qualitative assessment were added. The Discriminant Analysis yielded strong discriminatory power function between groups with high and low risk for eating disorders, explaining up to 88% of the variance and 100% of correct classification. With regard to the qualitative perspective a 23% of comments (706) were obtained; the analysis and classification of its contents showed the expected effects. The results from the quantitative and qualitative analysis allowed affirmative answer regarding the usefulness of OTSDRED.

Validez predictiva del instrumento Evaluación de Riesgos y Recursos (FER-R) para la intervención en adolescentes infractores de ley: estudio preliminar / Predictive Validity at the Instrument Risk and Resources (FER-R) for Intervention Assessment with Young Offenders: Preliminary Study

Se estudió la validez predictiva del instrumento Ficha de Evaluación de Riesgos y Recursos (FER-R) para adolescentes infractores de ley, en un lapso de dos años (2009-2011). La FER-R consta de 60 ítems y permite el registro de 10 dominios, riesgos criminogénicos, recursos y el registro de un índice de escalada delictiva. La muestra estuvo conformada por 101 adolescentes varones, entre 14 y 19 años de edad, judicializados y derivados a programas de intervención en medio libre. Los principales resultados muestran que el índice general de riesgo medido por la FER-R, presenta un 68.3 % de aciertos, con un área bajo la curva ROC = 0.73, indicando una magnitud predictiva fuerte de la escala total para predecir reincidencia en los adolescentes infractores chilenos.

The present study examined the recidivism predictive validity of an at risk and resources instrument for young offenders (FER-R) along a two-year span (2009-2011). This instrument has 60 items and it allows the recording of behavior in 10 different domains, grouped in three indices: criminogenic risk, resources, and an index of escalating crime rate. The sample consisted of 101 male young offenders (14 and 19 years), sent over to take part on free medium intervention programs. The main results showed that the overall predictive coefficient of the FER-R was a 68.3% correct, with an area under the curve, AUCs = 0.73, indicating a predictive capacity moderate to strong of recidivism of the instrument for Chilean juvenile offenders.