Dutch translation and cross-cultural validation of the Adult Social Care Outcomes Toolkit (ASCOT)

Background: The Adult Social Care Outcomes Toolkit was developed to measure outcomes of social care in England. In this study, we translated the four level self-completion version (SCT-4) of the ASCOT for use in the Netherlands and performed a cross-cultural validation. Methods: The ASCOT SCT-4 was translated into Dutch following international guidelines, including two forward and back translations. The resulting version was pilot tested among frail older adults using think-aloud interviews. Furthermore, using a subsample of the Dutch ACT-study, we investigated test-retest reliability and construct validity and compared response distributions with data from a comparable English study. Results: The pilot tests showed that translated items were in general understood as intended, that most items were reliable, and that the response distributions of the Dutch translation and associations with other measures were comparable to the original English version. Based on the results of the pilot tests, some small modifications and a revision of the Dignity items were proposed for the final translation, which were approved by the ASCOT development team. The complete original English version and the final Dutch translation can be obtained after registration on the ASCOT website (http://www.pssru.ac.uk/ascot). Conclusions: This study provides preliminary evidence that the Dutch translation of the ASCOT is valid, reliable and comparable to the original English version. We recommend further research to confirm the validity of the modified Dutch ASCOT translation

Arteriolar constriction in mild-to-moderate essential hypertension:An old concept requiring reconsideration?

Objective To investigate differences between in-vivo properties of a vascular bed in hypertensive patients and normotensive controls, Design Despite the controversy about the origin of essential hypertension and its accompanying vascular changes, it is generally assumed that the characteristic increase in peripheral resistance when hypertension progresses is caused by arteriolar constriction. Yet, there is little experimental evidence that this assumption generally holds in vivo. Methods A non-invasive technique was used for studying properties of the complete vascular bed of an upper arm segment under an occluding cuff in 23 previously untreated hypertensive patients and their matched normotensive controls. The method used the segment's electrical impedance to assess the volumes of extravascular fluid and of arterial and venous blood under varying arterial transmural pressures. Results Compared with that of matched normotensive controls, the compliance of the large arteries of the vascular bed was on average 50.9% lower (P <0.001) in the hypertensive patients, The compliance of the complete arterial bed at the operating blood pressure level was also lower (40.0%, P <0.01), but appeared to be significantly higher (45.9%, P <0.05) at the normotensive blood pressure level, On the venous side, the patients had a higher blood volume (60.0%, P <0.01) and an increased myogenic response (68.5%, P <0.05). Conclusions The increase in vascular resistance in the hypertensive patients is due primarily to changes in the large and small vessels of the arterial bed, We found no evidence for a generally increased arteriolar constriction

“Who Am I to Judge These Things”: Intersectional Dimensions of Self-Silencing of People with a Neuromuscular Disease in a Clinical Trial

Ethical guidelines protecting medical research participants have been criticized for stripping the sociocultural contexts of research. This critique is urgent considering ongoing calls to account for participant diversity in recruitment and inclusion procedures. Our intersectional analysis of illness narratives explores how sociostructural factors might play a role in participants’ exposure to research-related harm in clinical trials. Although widening participation does respond to generalizability concerns, we argue that gendered, classed, and ableist processes of self-silencing could simultaneously enhance risk of harm for participants with multiple oppressed identities. To prevent this, researchers might actively involve participants when designing trials