Validation and cross-cultural adaptation of the depression Patient's Health Questionnaire - 9 in the Romanian population of patients with Type 2 Diabetes Mellitus

Beyond the Digital Competencies of Medical Students: Concerns over Integrating Data Science Basics into the Medical Curriculum

Introduction. Data science is becoming increasingly prominent in the medical profession, in the face of the COVID-19 pandemic, presenting additional challenges and opportunities for medical education. We retrospectively appraised the existing biomedical informatics (BMI) and biostatistics courses taught to students enrolled in a six-year medical program. Methods. An anonymous cross-sectional survey was conducted among 121 students in their fourth year, with regard to the courses they previously attended, in contrast with the ongoing emergency medicine (EM) course during the first semester of the academic year 2020−2021, when all activities went online. The questionnaire included opinion items about courses and self-assessed knowledge, and questions probing into the respondents’ familiarity with the basics of data science. Results. Appreciation of the EM course was high, with a median (IQR) score of 9 (7−10) on a scale from 1 to 10. The overall scores for the BMI and biostatistics were 7 (5−9) and 8 (5−9), respectively. These latter scores were strongly correlated (Spearman correlation coefficient R = 0.869, p < 0.001). We found no correlation between measured and self-assessed knowledge of data science (R = 0.107, p = 0.246), but the latter was fairly and significantly correlated with the perceived usefulness of the courses. Conclusions. The keystone of this different perception of EM versus data science was the courses’ apparent value to the medical profession. The following conclusions could be drawn: (a) objective assessments of residual knowledge of the basics of data science do not necessarily correlate with the students’ subjective appraisal and opinion of the field or courses; (b) medical students need to see the explicit connection between interdisciplinary or complementary courses and the medical profession; and (c) courses on information technology and data science would better suit a distributed approach across the medical curriculum.

Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review

Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .

Translation, Linguistic Validation, and Readability of the Spanish Version of the VISA-H Scale in Elite Athletes

BACKGROUND

Data regarding the diagnosis of Proximal Hamstring Tendinopathy (PHT) is limited. There is a need for a standardized, valid, and reliable instrument for evaluating PHT among Spanish population. The purpose of this study was to linguistically validate and cross-culturally adapt the Spanish version of the VISA-H for Spanish population and to assess its readability, initial feasibility, appropriateness and acceptability.

METHODS

Cross-cultural adaptation was done according to established guidelines. Process included 5 steps: independent translations, synthesis of the translations, back-translations, expert committee, and pre-test. The linguistic validation of the questionnaire followed a standard methodology that included comprehension test interviews to assess the relevance, understanding and acceptability of the VISA-H. Comprehension was analyzed with cognitive interviews of 18 Spanish Professional basketball and soccer players (n = 8 male, n = 10 female end-users, healthy individuals at risk), using think-aloud and probing techniques.

RESULTS

All subjects (18/18) reported that the items were clear and did not cause upset. Additionally, every respondent had no difficulty in completing the form and found it fairly easy. No difficulties with the instructions were reported. Readability score resulted in adequate levels of understanding (Fernandez-Huerta score of 67.5), showing high level of acceptability.

CONCLUSION

The results of the linguistic and semantic validation conducted with health risky population enable the identification that the Sp-VISA-H was well accepted and easily understood by the participants. Further testing on PHT patients is needed to corroborate these preliminary data.

"A Romanian Version of the Experiences in Close Relationship Scale – Short Form (ECR-S) Measure of Adult Attachment"

The present research objective is to adapt the 12-item Experiences in Close Relationship Scale – Short Form (ECR-S) on the Romanian population. This self-report scale is used to assess adult attachment, by two dimensions: Anxiety and Avoidance. The psychometric properties of the instrument were assessed in a cross-sectional approach, by examining the reliability (in terms of internal consistency, as well as test-retest reliability), factor structure, convergent and predictive validity, in a sample from general population. A total number of 440 participants, aged 18 to 71 years-old, filled out a socio-demographics data sheet, the ECR-S and the Patient Health Questionnaire-9 (PHQ-9). The incomplete questionnaires were removed, resulting in a final number of 421 participants for the analysis. Results indicated good internal consistency (Cronbach`s alpha coefficients 0.79, 0.73, McDonald`s omega coefficients 0.80, 0.74) and good test-retest reliability over 2-weeks period (Spearman coefficients 0.86, 0.74) for both subscales (Anxiety and Avoidance). The confirmatory analysis revealed a bifactorial structure, with 11 items. Results confirmed convergent and predictive validity. Influence of socio-demographic variables was also assessed. The results indicate that the Romanian version of ECR-S has good psychometric properties, being a suitable instrument for assessing adult attachment.

Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review

BACKGROUND

The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs.

OBJECTIVE

Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed.

METHODS

This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines.

RESULTS

A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use.

CONCLUSIONS

This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.

Burnout Toll on Empathy Would Mediate the Missing Professional Support in the COVID-19 Outbreak

Purpose

The year 2020 was marked by the COVID-19 pandemic, massively disruptive at the general population level and for healthcare systems. We aimed to evaluate the psychological distress associated with work-related experiences among medical professionals and supporting staff during the pandemic outbreak.

Patients and Methods

A cross-sectional survey was conducted between April and May 2020, employing a self-administered on-line questionnaire that included the collection of socio-demographic and professional status information, Hamilton Anxiety Rating Scale, nine-item Patient Health Questionnaire (PHQ-9), Maslach Burnout Inventory - General Survey, Connor-Davidson Resilience Scale, and a subscale of the International Personality Item Pool (IPIP) for empathy. A total of 364 professionals of the county-coordinated area responded. Descriptive statistics summarized the findings and a mediation model was analyzed, applying the causal step strategy. The specific direct and causal mediation effects were estimated with the bias-corrected and accelerated bootstrap sampling method.

Results

Anxiety, burnout, stress, resilience, and empathy proved to be significantly associated with both the professional category (ie, consultant, specialty doctor, trainee doctor, senior nurse, trainee nurse or other) and the perceived professional support (the nonparametric multivariate permutation test resulted in p=0.048 and p<0.001, respectively). When controlling for the marital and professional status, the female gender had an OR=2.26, 95% CI (1.21; 4.22) toward a high level of empathy compared to males. The causal mediation effect of the perceived lack of professional support on empathy through burnout-depersonalization was highly significant (p<0.001) with an average of 0.0599, 95% CI (0.0238; 0.10), while the direct effect was non-significant (p=0.536) with an average of 0.0295, 95% CI (-0.0774; 0.15).

Conclusion

We highlighted the impact of the lack of professional support on healthcare workers' empathy through burnout-depersonalization in a context of a high workload, time pressure, job stress beyond previous training, and inherently limited organizational support, which are potentially modifiable factors in the mid-term.

Angiotensin-Ⅱ and angiotensin-(1-7) imbalance affects comorbidity of depression and coronary heart disease

A large body of evidence suggests a relationship between depression and coronary heart disease (CHD). Angiotensin-Ⅱ (Ang-Ⅱ) and angiotensin-(1-7) [Ang-(1-7)] are considered to exert biological effects in both conditions. Here, we aimed to determine the role of Ang-Ⅱ and Ang-(1-7) in the occurrence of comorbid depression in patients with CHD. Our study included 214 CHD patients and 100 matched healthy controls. Serum Ang-Ⅱ and Ang-(1-7) levels were assessed by ELISA, and the depression symptoms were evaluated by the nine-item Patient Health Questionnaire (PHQ-9). Linear regression and correlation analyses were used to estimate the associations between PHQ-9 scores and Ang-Ⅱ and Ang-(1-7) serum levels. Six single-nucleotide polymorphisms (SNPs) spanning the angiotensin converting enzyme 2 (ACE2) and MAS1 genes were genotyped. The associations between SNPs and depression risk in CHD patients were examined using logistic regression analysis with adjustment for age and gender. Decreased Ang-(1-7) (P < 0.05) and an elevated Ang-Ⅱ/Ang-(1-7) ratio (P < 0.01) were observed in CHD patients with depression compared to CHD patients without depression. PHQ-9 scores were negatively correlated with Ang-(1-7) level (r=-0.44, P < 0.01) and positively correlated with the Ang-Ⅱ/Ang-(1-7) ratio (r = 0.33, P < 0.05). Furthermore, carriers of risk allele T for CHD with depression had significantly higher PHQ-9 scores (P < 0.05), lower Ang-(1-7) level (P < 0.01), and higher Ang-Ⅱ/Ang-(1-7) ratio (P < 0.05) than those CC carriers. Collectively, our results firstly showed that Ang-(1-7) serum level in CHD patients may protect against comorbid depression. Moreover, the imbalance between Ang-Ⅱ and Ang-(1-7) may contribute to depression in CHD patients.

Relationship Between Debt and Depression, Anxiety, Stress, or Suicide Ideation in Asia: A Systematic Review

Background: This article aims to review research manuscripts in the past 5 years that focus on the effects of debt on depression, anxiety, stress, or suicide ideation in Asian countries. Methods: A search for literature based on the PRISMA guidelines was conducted on Medline, PubMed, Web of Science, Scopus, and ScienceDirect, resulting in nine manuscripts meeting inclusion criteria. The studies were conducted in Thailand, Korea, Singapore, Pakistan, India, Cambodia, and China. Results: The findings of the studies show that there is evidence to support that being in debt is related to Asian participants experiencing depression, anxiety, stress, or suicide ideation. However, the studies are limited to quantitative studies only. The definition of debt is also unclear in most manuscripts. Few manuscripts also examined how other factors influence the relationship between debt and mental illness. Conclusion: There are limited studies on the psychological effects of debt on the Asian population. Future studies should focus on the relationship between debt and psychological well-being among this population.