Editorial: Measurement Tools for Clinical Assessment, Characterization and Neurorehabilitation of Parkinson's Disease

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Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study

Background: Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors. Objective: This study aims to analyze the psychometric properties of the COVID-19-specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population. Methods: This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19-related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated. Results: The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; χ25=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ 224=42.025, P=.01, PSI=.642), unidimensionality (binomial 95% CI -.005 to .045), and item local independency. Conclusions: Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic.The research was funded by the Carlos III Health Institute. The funder had no role in the study design; collection, analysis, and interpretation of data; writing of the paper; or decision to submit for publication.S

Social relations and health in older people in Spain using SHARE survey data

Introduction: Social relationships (SR) are an important aspect in the healthy ageing process. The study aimed to describe SR in over-50s in Spain and analyse their association with physical/emotional, functional and cognitive/sensory health variables. Methods: The study sample was formed by 5583 people representing the Spanish population aged 50 and over, who participated in the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The variables were divided into socio-demographic aspects and economic, health and SR aspects represented by the number of friends, family members and satisfaction with social network and the Revised UCLA loneliness scale. The health variables were grouped using a main component analysis. Multiple linear regressions were performed between the health components with socio-demographic and SR variables. Results: 67.26% of respondents said they did not feel lonely. The feeling of loneliness was the variable most closely related to the physical and emotional, functional and cognitive and sensory health components. The main SR variable associated to health components was the Revised UCLA Loneliness Scale (standardised beta, p < 0.001; p < 0.001; and p < 0.001, respectively). The number of family members in social network SR variable was also associated with the physical/emotional health (β = 0.09, p < 0.001) and cognitive/sensory ability (β = 0.10, p = 0.001) components. Conclusions: The main SR aspect that impacts health status was loneliness. The results of this study suggest the importance of developing public health policies oriented to promoting action on the SR characteristics that enhance older people’s health.This study was funded by the Institute of Health Carlos III through the QASP (PI18CIII/00046), and partially funded by REDISSEC (RD16/0005/0002 and RD16/0001/0005, co-funded by European Regional Development Fund/European Social Fund “A way to make Europe”/“Investing in your future”) projects, and the ENCAGEN-CM project (H2019/HUM-5698) funded by the Community of Madrid and co-funded by the European Regional Development Fund.S

Validação da escala breve do comportamento resiliente (BRCS) uma amostra multiétnica de idosos chilenos

[EN] The aim of this study was to analyze the psychometric properties of the Brief Resilient Coping Scale (BRCS) for a multiethnic sample of Chilean older people (800). This sample has the particular feature of including non-indigenous (231) and indigenous Aymara (201) and Mapuche (368) people resident in native rural areas. It is a cross-sectional study. Descriptive statistics were calculated for socio-demographic and outcome data, covering mean, standard deviation, frequencies and percentages. For the BRCS, psychometric properties were analyzed according to the principles of Classical Test Theory. The analysis of the psychometric properties of the BRCS for three ethnic groups of older Chilean people shows that this rating scale is acceptable, reliable and valid, although the differences between groups highlight the need for culturally adapted geriatric assessment scales. The BRCS showed satisfactory psychometric characteristics for the studied samples. It is important for medical and social sciences to have ethnically sensitive instruments for the evaluation of psychosocial resources that promote successful aging. [ES] El objetivo de este estudio fue analizar las propiedades psicométricas de la Escala Breve de Afrontamiento Resiliente (BRCS) para una muestra multiétnica de 800 personas mayores chilenas. Esta muestra tiene la particularidad de incluir personas no indígenas (231) e indígenas aymaras (201) y mapuche (368) residentes en áreas rurales nativas. Se llevó a cabo un estudio transversal. Se realizaron análisis descriptivos para las variables sociodemográficos, tales como media, desviación estándar (DE), frecuencias y porcentajes. Para BRCS, las propiedades psicométricas se analizaron de acuerdo con los principios de la Teoría Clásica de las Pruebas. Los análisis de las propiedades psicométricas de BRCS para los tres grupos étnicos de personas mayores chilenas muestran que esta escala es aceptable, confiable y válida, aunque las diferencias entre los grupos resaltan la necesidad de que las escalas de evaluación geriátrica sean adaptadas culturalmente. BRCS mostró características psicométricas satisfactorias para las muestras estudiadas. Es importante para las ciencias médicas y sociales contar con instrumentos étnicamente sensibles para la evaluación de los recursos psicosociales que promueven un envejecimiento exitoso. [PT] O objetivo deste estudo foi analisar as propriedades psicométricas da Escala Breve do Comportamento Resiliente (BRCS) para uma amostra multiétnica de 800 idosos chilenos. Esta amostra tem a particularidade de incluir pessoas não indígenas (231), Aimarás (201) e Mapuche (368) residentes em áreas rurais nativas. Foi realizado um estudo transversal. Foram realizadas análises descritivas para as variáveis sociodemográficas, como média, desvio padrão (DP), frequências e percentuais. Para a BRCS, as propriedades psicométricas foram analisadas segundo os princípios da Teoria Clássica dos Testes. As análises das propriedades psicométricas da BRCS para os três grupos étnicos de idosos chilenos mostram que esta escala é aceitável, confiável e válida, embora as diferenças entre os grupos destacam a necessidade de adaptação cultural das escalas de avaliação geriátrica. BRCS mostrou características psicométricas satisfatórias para as amostras estudadas. É importante para as ciências médicas e sociais contar com instrumentos etnicamente sensíveis para a avaliação dos recursos psicossociais que promovem o envelhecimento bem- -sucedido.This work was supported by the Government of Chile (Proyecto FONDECYT 1170493) and University of Tarapacá (Proyecto UTA MAYOR 3768-20) and the Research Program of the Madrid Autonomous Community, Spain (ENCAGENCN, Ref: H2019/HUM-5698).S

Comparison of scaling methods for activities of daily living in older people.

[ES] Comparar las propiedades psicométricas de escalas de medición de las actividades de la vida diaria según distintos métodos y comprobar si los más complejos tienen más capacidad discriminatoria. Muestra de personas mayores de la Encuesta sobre discapacidad, autonomía personal y situaciones de dependencia. Se utilizaron 14 ítems que medían actividades de la vida diaria. Cinco métodos de escalamiento: Suma y Rasch (los dos con ítems en forma dicotómica o politómica) y Guttman (forma dicotómica). Se evaluaron su capacidad discriminatoria (precisión relativa [PR]) y el área bajo la curva (AUC). Todos los métodos mostraron altas correlaciones de Pearson entre ellos (0,765-0,993). Tenían similar poder discriminatorio al comparar categorías extremas de individuos no limitados respecto a gravemente limitados (PR: 0,93-1,00). El procedimiento Suma politómico mostró la mayor AUC (0,934; intervalo de confianza del 95% [IC95%]: 0,928-0,939) y el Guttman la menor (0,853; IC95%: 0,845-0,861). Se observa una mayor fiabilidad en ítems politómicos que dicotómicos. Los métodos sencillos (Suma) y los complejos (Rasch) son opciones igualmente válidas. El método Guttman presentó peor capacidad discriminatoria. [EN] To compare the psychometric properties of scales top measure activities of daily living, constructed with different scaling methods, and to check whether the most complex scales have higher discriminatory capacity. Sample of elderly people from the Spanish Survey on Disability, Personal Autonomy and Dependency We used 14 items that measured activities of daily living. Five scaling methods were applied: Sum and Rasch (both for dichotomous and polytomous items) and Guttman (dichotomous). We evaluated the discriminatory capacity (relative precision [RP]) and area under the curve (AUC). All methods showed high Pearson correlations among them (0.765-0.993). They had similar discriminatory power when comparing extreme categories of individuals with no disability with severely limited (RP: 0.93-1.00). The polytomous Sum procedure showed the highest AUC (0.934; 95% confidence interval [95%CI]: 0.928-0.939) and Guttman the lowest (0.853; 95%CI: 0.845-0.861). Polytomous items have greater reliability than the dichotomous ones. Simplest methods (Sum) and most complex (Rasch) are equally valid. Guttman method presented worse discriminatory capacity.El estudio fue parcialmente financiado por ENVACES, Plan Nacional I + D + I, Ref. CSO2015-64115-R, y el Programa Envejecimiento Activo, Calidad de Vida y Género, Comunidad de Madrid (ENCAGE-CM), Ref: S2015/HUM-3367.S

Measuring COVID-19 health literacy: validation of the COVID-19 HL questionnaire in Spain

Background: The COVID-19 pandemic has highlighted the importance of health literacy to make informed preventive decisions. A specifc COVID-19 health literacy questionnaire (CHL-Q) is included in the COVID-19 Snapshot Monitoring WHO initiative to conduct behavioral insights studies related to COVID-19. The objective was to assess the psychometric properties of a Spanish version of the COVID-19 Health Literacy Questionnaire (CHL-Q). Methods: Data quality, acceptability, internal consistency, and construct and structural validity were analyzed. A Rasch analysis was also performed. This cross-sectional, observational study was conducted on the Spanish general population after the frst wave of the pandemic and after the end of the general lockdown by an online survey agency. 1033 participants (inclusion criteria were being 18 years or older and living in Spain), was extracted from a panel of approximately 982,000 participants. The sampling was stratifed matching the Spanish general population in terms of age, gender, and area of residence. The CHL-Q includes 9 items and assesses people’s knowledge, motivation and competencies to access, understand, evaluate, and apply information about COVID-19 in order to make informed decisions. Results: CHL-Q index presented a mean of 33.89 (SD=9.4), and good ft to the Rasch model (χ2(32)=34.672, p=0.342, person separation index=0.77), with ordered thresholds, unidimensionality, item local independence, and no item bias by sex, age or education level. The CHL-Q showed signifcant diferent scores by level of education, experience of infection, confusion related to COVID-19 information and adherence to preventive measures. We found a statistically signifcant correlation between the CHL-Q index and the total number of preventive measures adopted, COVID-19 knowledge, and information seeking behaviour. The Cronbach´s alpha was 0.87 and the item total corrected correlation, 0.49–0.68. Conclusions: The Spanish version of CHL-Q is a short, adequate, and reliable instrument to measure COVID-19 related health literacy in the Spanish general population. Measuring the CHL in the population can be useful to evaluate whether public authorities, media and the medical and scientifc community have been able to reach the population to ofer the information in the terms they need it.This work was supported by Carlos III Health Institute.S

Compliance with the main preventive measures of COVID-19 in Spain: The role of knowledge, attitudes, practices, and risk perception

In epidemics such as COVID-19, major changes need to be made to the population's behavior to prevent infection and stop disease transmission. The three most recommended preventive measures are wearing a mask, washing hands with soap or hydroalcoholic gel, and watching an interpersonal distance of at least two meters (3W) from other people. This study aimed to assess adherence to these COVID-19-related three preventive measures and its association with knowledge, attitudes, risk perception, and practices in Spain. The COSMO-Spain survey, based on the WHO Behavioral Insights questionnaire on COVID-19, was conducted in the general Spanish population using an online questionnaire (n = 1,033). Sociodemographic, knowledge, attitudes, practices, and risk perception variables were included. A multivariable logistic regression model was carried out to evaluate the factors associated with compliance with the three preventive measures. Half of the respondents (49.8%) were women with a median age of 45 (Inter-quartile Range, IR = 21) years. In the logistic regression, the factors associated with 3W compliance were being over 45 years; knowing about how COVID-19 spreads and wearing masks properly; appropriate attitudes towards COVID-19 (greater agreement with mandatory mask use); high risk perception (feeling that the coronavirus is spreading rapidly, being concerned about non-mask wearers), and adherence to other preventive measures against COVID-19, such as staying at home. Adequate knowledge, attitudes and risk perception are determinants of 3W compliance. Developing effective health education programs and frequent communication strategies are necessary, particularly for those who adhere less to preventive measures.S

Living with Chronic Illness Scale: International validation through the classic test theory and Rasch analysis among Spanish-speaking populations with long-term conditions

Background: The Living with Chronic Illness (LW-CI) Scale is a comprehensive patient-reported outcome measure that evaluates the complex process of living with long-term conditions. Objective: This study aimed to analyse the psychometric properties of the LW-CI scale according to the classic test theory and the Rasch model among individuals living with different long-term conditions. Design: This was an observational, international and cross-sectional study. Methods: A total of 2753 people from six Spanish-speaking countries living with type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, Parkinson's disease, hypertension and osteoarthritis were included. The acceptability, internal consistency and validity of the LW-CI scale were analysed using the classical test theory, and fit to the model, unidimensionality, person separation index, item local independency and differential item functioning were analysed using the Rasch model. Results: Cronbach's α for the LW-CI scale was .91, and correlation values for all domains of the LW-CI scale ranged from .62 to .68, except for Domain 1, which showed correlation coefficients less than .30. The LW-CI domains showed a good fit to the Rasch model, with unidimensionality, item local independency and moderate reliability providing scores in a true interval scale. Except for two items, the LW-CI scale was free from bias by long-term condition type. Discussion: After some adjustments, the LW-CI scale is a reliable and valid measure showing a good fit to the Rasch model and is ready for use in research and clinical practice. Future implementation studies are suggested. Patient and Public Contribution: Patient and public involvement was conducted before this validation study - in the pilot study phase.Ministry of Science, Innovation and University, Spanish Government; FEDER/ Ministerio de Ciencia, Innovación y Universidades – Agencia Estatal de Investigación/ Proyecto, Grant/Award Number: CSO2017–82691‐RS

The Personal Wellbeing among Community-Dwelling Older Adults in Spain and Associated Factors

Objective: The conceptual framework of Quality of Life (QoL) allows approaching the knowledge of the living conditions of people in order to help establishing policies for QoL improvement. This study is aimed at examining the assessment made by older adults on their personal wellbeing and the satisfaction with life and the associated factors. A summary of the psychometric properties of the measurement instrument was also presented. Method: The data came from the Ageing in Spain Longitudinal Study, Pilot Survey (ELES-PS), carried out in 2011 among people 50 years old or more living in family housing in Spain. The Personal Wellbeing Index (PWI), as a multidimensional measure of QoL, was used to evaluate the subjective wellbeing. Personal, social and residential characteristics were considered as independent variables. Descriptive statistical analysis, ANOVA, correlation, factor and regression analyses were applied. Results and conclusions: The PWI had good psychometric properties and showed the convergent validity with satisfaction with life as a whole (SWLW). Unidimensional structure of the scale was also demonstrated. PWI and SWLW total scores reached 74.5%SM and 77.1%SM, respectively. The best rated life domains were the satisfaction with relationships, safety and feeling part of the community. The SWLW observed significant differences in gender categories while PWI within age and social status. Both scales were associated with marital status, educational level, household size, current activity status and social status. The regression model of the PWI explained 34.2% of the variance through factors on socio-demographic and economic resources, psychosocial, health/functioning, family and social networks, leisure and residential environment. Based on these results, it would be desirable to deepen on this line from a longitudinal perspective to detect the influence of the changing conditions of the aged people in their personal well-being and life satisfaction.This research was funded by the Spanish Ministry of Science and Innovation (National R&D&I Plan: ref. CSO2009-08645-E/SOCI, CSO2009-06638-E/SOCI, CSO2009-06637-E/SOCI), by the Fundación Obra Social Cajamadrid and by the Basque Government, and supported by the Ageing Process Research Unit INGEMA-CSIC, for carrying out the ELES Project Pilot Survey. Another grant from the Spanish Ministry of Science and Innovation (National R&D&I Plan: ref. CSO2011-30210-C02-01) was endorsed for the analysis. Authors would like to thank the editor and the anonymous reviewer/s for their helpful comments during the development of this paper

ICF-Based Disability Survey in a Rural Population of Adults and Older Adults Living in Cinco Villas, Northeastern Spain: Design, Methods and Population Characteristics

Background: This article describes the methods of a door-to-door screening survey exploring the distribution of disability and its major determinants in northeastern Spain. This study will set the basis for the development of disability-related services for the rural elderly in northeastern Spain. Methods: The probabilistic sample was composed of 1,354 de facto residents from a population of 12,784 Social Security card holders (age: 6 50 years). Cognitive and disability screenings were conducted (period: June 2008-June 2009). Screening instruments were the MMSE and the World Health Organization Disability Assessment Schedule. Participants screened positive for disability underwent an assessment protocol focusing on primary care diagnoses, disability, lifestyle, and social and health service usage. Participants screened positive for cognitive functioning went through in-depth neurological evaluation. Results: The study sample is described. Usable data were available for 1,216 participants. A total of 625 individuals (51.4%) scored within the positive range in the disability screening, while 135 (11.1%) scored within the positive range of the cognitive screening. The proportion of positively screened individuals was higher for women and increased with age. Conclusions: Screening surveys represent a feasible design for examining the distribution of disability and its determinants among the elderly. Data quality may benefit from methodological developments tailored to rural populations with a low education level. Copyright (C) 2010 S. Karger AG, Base