Validez y fiabilidad de un instrumento para la valoración de la entrevista clínica en médicos residentes de medicina de familia: el cuestionario GATHA-RES

ObjetivoComprobar la validez de contenido, la consistencia interna y la fiabilidad intraobservador de un cuestionario para la evaluación de la comunicación médico-paciente de los residentes de medicina de familia.DiseñoEstudio observacional, de validación de un instrumento de medida.EmplazamientoNivel de atención primaria. Unidades docentes de medicina de familia y comunitaria.Población de estudioPara el análisis de validez, 25 médicos residentes de medicina familiar y comunitaria. Para el análisis de fiabilidad, 48 médicos de la misma especialidad.Mediciones e intervencionesPara la construcción del cuestionario, se partió de una versión (GATHA-BASE), compuesta por 42 ítems seleccionados por un panel compuesto por 60 médicos de familia. Para la validez de contenido, se utilizaron 68 encuentros clínicos con pacientes simulados, que fueron videograbados y evaluados. La validez de contenido del cuestionario se estudió mediante un análisis factorial, y para medir su consistencia interna se calcularon los coeficientes alfa de Cronbach. La fiabilidad intraobservador de la versión GATHA-RES fue evaluada mediante los índices kappa y los coeficientes de correlación intraclase.ResultadosObtuvimos una versión del GATHA-RES con 27 ítems. El análisis factorial reveló la existencia de 9 factores: «empatía», «anamnesis», «bidireccionalidad», «negociación», «información», «miscelánea 1», «miscelánea 2» y «centrado en el paciente», que mostraron una buena correlación con los contenidos teóricos y formales del cuestionario original (inicialmente agrupados en 3 secciones: actitudes, tareas comunicacionales y habilidades). Todos los coeficientes de correlación intraclase presentaron cifras ≥ 0,90.ConclusionesEl cuestionario GATHA-RES es un instrumento válido y fiable que puede ser usado para la evaluación de las habilidades comunicacionales de los médicos de familia en formación.ObjectiveTo check the validity of content, the internal consistency and the intra-observer reliability of a questionnaire to evaluate the doctor-patient communication of family medicine residents.DesignObservation study, to validate a measurement instrument.SettingPrimary care. Family and community medicine teaching units.Study populationFor the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality.Measurements and interventionsThe questionnaire was constructed on the basis of a version (GATHABASE) composed of 42 items selected by a panel of 60 general practitioners. For content validity, 68 clinical encounters with simulated patients, video-recorded and evaluated, were used. The questionnaire's validity content was studied through a factorial analysis. To measure its internal consistency, Cronbach's alpha coefficients were calculated. Intra-observer reliability of the GATHA-RES version was evaluated through the kappa indexes and the intra-class correlation coefficients.ResultsWe obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors («empathy», «anamnesis», «two-way communication», «negotiation», «information», «miscellaneous 1», «miscellaneous 2» and «patient-focused») which showed close correlation with the theoretical and formal contents of the original questionnaire (originally grouped in three sections: attitudes, communication tasks and skills). All the intraclass correlation coefficients had figures ≥ 0.90.ConclusionsThe GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training

Determinants of Fatigue after First-Ever Ischemic Stroke during Acute Phase

© 2014 The Authors. Published by PLOS. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1371/journal.pone.0110037 A correction to the article was made on 19/12/2012: https://doi.org/10.1371/journal.pone.011646

Psychosocial and Sociodemographic predictors of attrition in a longitudinal study to predict on set of episodes of major depression in primary care: The Predicted- Spain Study

Few data exist on the psychosocial factors associated with attrition in longitudinal surveys. This study was undertaken to determine psychosocial and sociodemographic predictors of attrition from a longitudinal study of the onset and persistence of episodes of major depression in primary care. A systematic random sample of general practice attendees was recruited in seven Spanish provinces between October 2005 and February 2006. Major depression was diagnosed using the Composite International Diagnostic Interview and a set of 39 individual and environmental risk factors for depression were assessed at baseline and after 6 and 12 months of follow-up

Predicting onset of major depression in general practice attendees in Europe: extending the application of the predictD risk algorithm from 12 to 24 months.

BACKGROUND: PredictD is a risk algorithm that was developed to predict risk of onset of major depression over 12 months in general practice attendees in Europe and validated in a similar population in Chile. It was the first risk algorithm to be developed in the field of mental disorders. Our objective was to extend predictD as an algorithm to detect people at risk of major depression over 24 months. Method Participants were 4190 adult attendees to general practices in the UK, Spain, Slovenia and Portugal, who were not depressed at baseline and were followed up for 24 months. The original predictD risk algorithm for onset of DSM-IV major depression had already been developed in data arising from the first 12 months of follow-up. In this analysis we fitted predictD to the longer period of follow-up, first by examining only the second year (12-24 months) and then the whole period of follow-up (0-24 months). RESULTS: The instrument performed well for prediction of major depression from 12 to 24 months [c-index 0.728, 95% confidence interval (CI) 0.675-0.781], or over the whole 24 months (c-index 0.783, 95% CI 0.757-0.809). CONCLUSIONS: The predictD risk algorithm for major depression is accurate over 24 months, extending it current use of prediction over 12 months. This strengthens its use in prevention efforts in general medical settings

Spiritual and religious beliefs as risk factors for the onset of major depression:an international cohort study

<p>Background. Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the USA, limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.</p><p>Method. Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.</p><p>Results. The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p</p><p>Conclusions. These results do not support the notion that religious and spiritual life views enhance psychological well-being.</p>