Validação da Escala de Depressão Geriátrica numa Amostra de Idosos Institucionalizados da População Portuguesa

Objetivo: O objetivo desta investigação prendeu-se com a validação da Escala de Depressão Geriátrica (GDS) numa amostra de pessoas idosas institucionalizadas em estruturas residenciais de longa duração. Método: A amostra foi constituída por 493 pessoas idosas institucionalizadas com idades iguais ou superiores a 60 anos de idade, avaliada através da GDS, da Entrevista Neuropsicológica Internacional Mini (M.I.N.I.), do Inventário de Ansiedade Geriátrica (GAI), da Lista dos Afetos Positivos (AP) e Negativos (AN) e da Escala de Satisfação com a Vida (SWLS). A fidedignidade teste-reteste foi avaliada administrando a GDS a uma subamostra de 85 pessoas. Resultados: A análise estatística para validação da GDS, levou a uma versão final de 8 itens. A versão com 8 itens apresentou um valor de alfa de Cronbach de 0,87 com um único fator, no que respeita à análise fatorial. As correlações (p < 0,01) atestaram a sua validade concorrente (GAI: r = 0,76; AP: r = -0,22; AN: r = 0,62; SWLS: r = -0,32). A fidedignidade teste-reteste com cerca de 1,44 meses de intervalo mostrou-se adequada (r = 0,55). A análise ROC revelou uma AUC de 0,82, sensibilidade e especificidade de 80% e 77%, respetivamente, e um ponto de corte de 5/6 para o diagnóstico de depressão. Conclusão: Os resultados obtidos apoiam a validade e a capacidade de rastreio da versão reduzida da GDS no contexto de institucionalização de pessoas idosas. / Purpose: The objective of the present investigation was the validation of the Geriatric Depression Scale (GDS), in a sample of institutionalized older people in long term care centers. Method: The data was collected in a sample of 493 institutionalized older people with ages equal or above of 60 years old, through the GDS, Mini-International Neuropsychological Interview (M.I.N.I.), Geriatric Anxiety Inventory (GAI), Positive Affect (PA) and Negative Affect (NA) Schedule and Satisfaction With Life Scale (SWLS). The trustworthiness of the test-retest was evaluated by administrating GDS once more to a sub population of 85 people. Results: The statistic analysis to validate GDS prompted a final version with eight items. About the internal consistency, 8-item GDS presented a Cronbach alpha of 0,87 and a single factor when reported to factorial analysis. The correlations (p < 0,01) helped with the concurrent validation (GAI: r = 0,76; PA: r = -0,22; AN: r = 0,62; SWLS: r = -0,32). The fidelity of the test-retest with around 1,44 months in between each application showed to be appropriate (r = 0,55). ROC analysis showed an AUC of 0,82, with sensibility and specificity of 80% and 77%, accordingly, with a cutoff of 5/6 for the diagnosis of depression. Conclusion: The results support the validity and the applicability of the scale when addressing the institutionalized older population

Validity and reliability of a shorter version of the Geriatric Depression Scale in institutionalized older Portuguese adults

Objectives: Depressive symptoms are common in older adults in institutional contexts; however, there is a lack of validated measures for these settings. Identifying depressive symptoms can help clinicians to manage them and to prevent or delay their complications. This study aimed to validate the Geriatric Depression Scale (GDS) in an institutionalized sample of older adults.Method: 493 institutionalized older people (73% women) aged 60 or over were evaluated through the GDS, the Mini International Neuropsychiatric Interview (MINI) (depression vs. no depression = 11% vs. 89%), the Geriatric Anxiety Inventory (GAI), the Positive Affect (PA) and Negative Affect (NA) Schedule, and the Satisfaction with Life Scale (SWLS). Test-retest reliability was assessed with 57 older adults.Results: An 8-item version presented a Cronbach's alpha value of .87 with a single factor explaining its variance. The correlations (p < .01) attested the concurrent validity (GAI: r = .76; PA: r = -.22; AN: r = .62; SWLS: r = -.32). Test-retest reliability (6.51 months) was adequate (r = .52). ROC analysis (AUC = .82; sensitivity = 80%; specificity = 77%) and Youden index revealed a cutoff of 5/6 for the diagnosis of depression.Conclusion: Results support the validity and the screening capacity of a short version of GDS in institutional contexts. Short screening instruments for depressive symptoms may facilitate their identification, allowing for timely clinical interventions in institutional settings

Validação da PANAS numa amostra portuguesa de pessoas idosas em resposta social

Background: Positive and negative affect are two psychobiological dimensions of subjective wellbeing (BES) relevant to the way institutional support is experienced in the lives of many older people.&nbsp;Aim: The study aimed to validate, in the context of institutional support, a brief version of the Positive and Negative Affect Schedule (PANAS), a questionnaire that allows us to evaluate positive and negative affect.&nbsp;Methods: A sample of 389 old adults (61 – 100 years; M&nbsp;= 80.89; SD&nbsp;= 7.48 years) was assessed with the PANAS, Satisfaction With Life Scale, and Geriatric Depression Scale-8. In this sample, the psychometric properties of the PANAS were tested, and an exploratory factor analysis was performed. In the second sample of 383 subjects (60 – 99 years; M&nbsp;= 80.27; SD&nbsp;= 7.87 years), confirmatory factor analysis was executed.&nbsp;Results: A reduced version of PANAS was obtained, with 14 items, a two-dimensional structure, adequate internal consistency, convergent, and divergent validity for the Positive Affect/PA and Negative Affect/NA. Temporal stability (interval = 1.44 months) was equally adequate for PA and NA (p&nbsp;&lt; 0.001). Confirmatory factor analysis revealed an adequate adjustment for the two-dimensional structure of PANAS-14 (AGFI&nbsp;= 0.91; CFI&nbsp;= 0.93; SRMR&nbsp;= 0.05; RMSEA&nbsp;= 0.06; PCLOSE&nbsp;= 0.12).&nbsp;Conclusion: The PANAS-14 is a brief psychometrically suitable tool for the assessment of PA and NA in institutionalized older adults supported by social institutions.Introdução: O afeto positivo e negativo são duas dimensões psicobiológicas do bem-estar subjetivo (BES) relevantes para a forma como é experienciada a circunstância da recurso a apoio institucional na vida de muitas pessoas idosas.&nbsp;Objetivo: O objetivo do estudo foi validar, no contexto de resposta social, uma versão breve da Positive and Negative Affect Schedule&nbsp;(PANAS), um questionário que permite avaliar o afeto positivo e negativo.&nbsp;Métodos: Numa amostra de 389 idosos (61 – 100 anos; M&nbsp;= 80,89; DP&nbsp;= 7,48 anos), avaliados através da PANAS, da Satisfaction With Life Scalee da Geriatric Depression Scale-8, testaram-se as propriedades psicométricas e realizou-se uma análise fatorial exploratória da PANAS. Numa segunda amostra de 383 sujeitos&nbsp; (60 – 99 anos; M&nbsp;= 80,27; DP&nbsp;= 7,87 anos) efetuou-se uma análise fatorial confirmatória.&nbsp;Resultados: Obteve-se uma versão reduzida da PANAS, com 14 itens, estrutura bidimensional, adequadas consistências internas, validade convergente e divergente para o Afeto Positivo/AP e Afeto Negativo/AN. A estabilidade temporal (intervalo = 1,44 meses) foi igualmente adequada para o AP&nbsp; e para o AN (p&nbsp;&lt; 0,001). A análise fatorial confirmatóriarevelou um ajustamento adequado para a estrutura bidimensional da PANAS-14 (AGFI&nbsp;= 0,91; CFI&nbsp;= 0,93; SRMR&nbsp;= 0,05; RMSEA&nbsp;= 0,06; PCLOSE&nbsp;= 0,12).&nbsp;Conclusão: A PANAS-14 é um instrumento breve psicometricamente adequado para a avaliação do PA e do NA em pessoas idosas em resposta social

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

The Other as Shamer Scale – 2: Development and validation of a short version of a measure of external shame

External shame arises from the perception of negative judgements about the self in the mind of others and is currently measured by Other As Shamer Scale (OAS). This scale has been used in numerous studies. This study sought to develop a valid and reliable shorter form of the scale, called OAS2, in an adult sample of 690 participants, using experts’ item ratings and Confirmatory Factor Analysis. The OAS2 consisted of 8 items, which replicated the unidimensional structure of the OAS (Matos et al., 2011) and revealed a good fit. The OAS2 had good internal consistency (.82), similar to the longer version. The OAS2 has good concurrent and divergent validity, being highly correlated with the OAS (r = .91). The OAS and OAS2 have very similar significant correlations with measures of internal shame, psychopathology and anger, with no significant difference between them. Our results, suggest that the OAS2 is an economic, valid and reliable measure of external shame.N/

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt