Evaluación funcional para personas no ambulantes afectas de atrofia muscular espinal y distrofia muscular de Duchenne. Traducción y validación de la escala Egen Klassifikation 2 para la población española / Functional assessment for people unable to walk due to spinal muscular atrophy and Duchenne muscular dystrophy. Translation and validation of the Egen Klassifikation 2 scale for the Spanish population

Introducción. La escala Egen Klassifikation 2 (EK2), ampliación de la escala EK, evalúa la capacidad funcional de personas con atrofia muscular espinal (AME) y distrofia muscular de Duchenne (DMD) que están en fase de silla de ruedas. Esta versión es más específica para la AME que su antecesora. Objetivo. Analizar la validez y fiabilidad de la versión española de dicha escala como instrumento de medición de la capacidad funcional en pacientes afectos de AME y DMD que están en silla de ruedas. Pacientes y métodos. Primeramente se realizó una traducción-retrotraducción al español de la versión en inglés de la EK2 y, posteriormente, se estudió la fiabilidad de la versión traducida. Para ello, se seleccionaron 39 pacientes, de edades comprendidas entre 4 y 60 años, que fueron valorados por dos observadores. Para evaluar la concordancia intraobservador se realizaron dos evaluaciones por un mismo observador, y para la interobservador, se realizó una tercera evaluación por un segundo observador. Resultados. Los valores obtenidos referidos a la puntuación total de los ítems de la escala (suma EK2) reflejan una fiabilidad intra e interobservador excelente, de 0,993 y 0,988, respectivamente. Asimismo, para cada uno de los ítems, la fiabilidad fue excelente, a excepción de un ítem, en el que fue buena. Conclusiones. La versión española de la escala EK2 es un instrumento válido y fiable para la población española como herramienta de medición de la capacidad funcional en pacientes con AME y DMD que están en silla de ruedas (AU)

Introduction. The Egen Klassifikation 2 Scale (EK2), expansion of the EK scale, assesses the functional capacity of people with spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD) that are in wheelchair phase. This version is more specific for SMA than its EK predecessor. Aim. To examine the validity and reliability of the Spanish version of the scale as a tool for measuring the functional capacity in patients with DMD and SMA who are in wheelchairs. Patients and methods. First, a translation-back-translation into Spanish of the English version of the EK2 was performed; later, we studied the reliability of the translated version. For this, 39 patients, aged between 4 and 60, who were evaluated by two observers, were recruited. To evaluate the intra-observer consistency, two assessments by the same observer were performed, and the inter-observer third assessment was performed by a second observer. Results. The obtained values based on the total score of the scale items (sum EK2) reflect excellent intra- and inter-observer reliability, 0.993 and 0.988 respectively. Also, for each of the items, reliability was excellent except for one item in which it was good. Conclusions. The Spanish version of the EK2 scale is a valid and reliable instrument for the Spanish population as a tool for measuring the functional capacity in patients with SMA and DMD who are in wheelchairs (AU)

A house divided: deinstitutionalization, medicare and the Canadian Mental Health Association in Saskatchewan, 1944-1964.

Defined as a set of distinct processes that included the declining use of large psychiatric institutions and the increasing use of outpatient services and general hospitals, deinstitutionalization occurred earlier in Saskatchewan than other provinces in Canada. It was led by a CCF government dedicated to major change across a number of sectors including mental health, assisted by one of the most influential and well-organized social movement organizations of the 1950s, the Saskatchewan Division of the Canadian Mental Health Association (SCMHA). However, by the late 1950s and early 1960s, the SCMHA opposed the CCF government's policy priority on medicare which it felt came at the expense of mental health care, in particular the implementation of a regional psychiatric hospital system called the Saskatchewan Plan. As a consequence, the SCMHA, once such a powerful ally of the CCF government in health reform, formed a strategic and temporary coalition with the anti-medicare forces in the province. Given the fact that a number of medical staff within the government's department of public health were prominent members of the SCMHA, the CCF government found that it occupied an increasingly divided house at the very time it was struggling to introduce medicare in the midst of civil unrest and a doctors' strike.