Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population

OBJECTIVES

To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population.

METHODS

Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated.

RESULTS

The model tested was considered an adequate fit to the data (comparative fit index [CFI] = 0.947, Tucker-Lewis index [TLI] = 0.927, and root-mean-square error of approximation [RMSEA] = 0.051) and its internal consistency was good, with a Cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total QIDS-SR16 score and the total scores of the Patient Health Questionnaire (PHQ-9) instruments (r = 0.67, p < 0.001), the Posttraumatic Symptoms Checklist (PCL-5) (r = 0.61, p < 0.001), and the Patient-Reported Outcomes Measurement Information System (PROMIS) (r = 0.60, p < 0.001) indicate good concurrent and convergent validity.

CONCLUSION

The QIDS-SR16 has robust psychometric properties in terms of its internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of the QIDS-SR16 is an adequate instrument for assessment of depressive symptoms in the context of an online survey.

Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the DSM-IV criteria that assesses the severity of depression symptoms, in the Brazilian population.

METHOD

Participants were 4.400 Brazilians over 15 years old recruited from an online survey assessing depressive symptoms during the early phase of COVID-19 pandemic in Brazil. Internal consistency, construct validity and convergent and discriminant validity of the QIDS-SR16 were evaluated.

RESULTS

The tested model was considered adequate to the data (CFI = 0.947, TLI = 0.927 and RMSEA = 0.051) and its internal consistency was good, with a cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total score of the QIDS-SR16 and the total scores of the PHQ-9 instruments (r = 0.67, p < 0.001), PCL-5 (r = 0.61, p < 0.001) and PROMIS (r = 0.60, p < 0.001) demonstrate good indicators of concurrent and convergent validity.

CONCLUSION

The psychometric properties of the QIDS-SR16 proved to be strong in terms of internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of QIDS-SR16 is an adequate instrument to assess depressive symptoms in the context of an online survey.

Correlation Between Subjective and Objective Severity of Oral and Ocular Dryness in Primary Sjögren Syndrome

OBJECTIVE

Sjögren syndrome (SS) is a common autoimmune disease primarily affecting the eyes and mouth. With no single gold standard test for its diagnosis, accurate identification of patients with SS continues to be challenging. We aimed to assess the correlation of ocular and oral symptoms of dryness with objective measures in order to evaluate reliability in the screening of primary SS (pSS) in clinical practice.

METHODS

We conducted a cross-sectional analysis of pre-screened pSS and sicca control patients assessed in the Multidisciplinary Sjögren's Clinic at the University Health Network in Toronto. The signs, symptoms, and objective measure of oral and ocular dryness and damage of each patient were prospectively recorded using a standardized protocol.

RESULTS

Subjective measures of severity for xerophthalmia and xerostomia correlated in general with objective severity. Oral symptoms tend to have a stronger correlation with objective findings than ocular symptoms. Many patients with few or insignificant eye symptoms had profound ocular dryness and damage. Similarly, some patients with few or no symptoms of oral dryness had profound objective salivary hypofunction. The absence of symptoms does not rule out profound eye and mouth dryness or damage.

CONCLUSION

Although objective measures of xerostomia may not be practical for general population screening, it is crucial that practicing specialists perform objective testing of all patients suspected of pSS, instead of relying on symptoms. Without objective testing, the physician cannot ensure the diagnosis of pSS and that the existence of significant damage is not overlooked and left untreated.

Negative symptoms in schizophrenia: correlation with clinical and genetic factors

Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT, DRD2, MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (β = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.

Evaluation of the 6-item Identify Chronic Migraine screener in a large medical group

Objective

To evaluate the sensitivity and specificity of the 6‐item Identify Chronic Migraine screener (ID‐CM[6]), designed to improve the detection of chronic migraine (CM).

Background

CM is often undertreated and underdiagnosed. Survey‐based studies have found that approximately 75–80% of people meeting criteria for CM do not report having received an accurate diagnosis.

Methods

This study used claims data of patients enrolled in a large medical group who had at least one medical claim with an International Classification of Diseases 9th/10th revision diagnostic code for migraine in the 12‐month prescreening period. The Identify Chronic Migraine survey was administered by e‐mail, in‐person, or over the telephone to all enrolled patients. A Semi‐Structured Diagnostic Interview (SSDI) was administered by telephone by a trained physician. The ID‐CM(6) and SSDI classifications of CM status were compared to evaluate sensitivity and specificity of the ID‐CM(6) screening tool.

Results

The analysis of the ID‐CM(6) screening tool included 109 patients, with 65/109 (59.6%) positive for CM based on the SSDI. The mean (standard deviation) age of the patient sample was 49 (15) years and 100/109 (91.7%) were female. Using the SSDI as the diagnostic gold standard, the ID‐CM(6) had a sensitivity of 70.8% (46/65) and a specificity of 93.2% (41/44).

Conclusion

The ID‐CM(6) demonstrated acceptable sensitivity and good specificity in determining CM status. The results of this analysis support the real‐world utility of the ID‐CM(6) as a simple and useful tool to identify patients with CM.

[Clinical observation of herb-separated moxibustion combining western medication on allergic rhinitis of kidney-yang deficiency type and correlation with infrared thermal imagining]

OBJECTIVE

To observe the therapeutic effect of herb-separated moxibustion combined with budesonide nasal spray (rhinocort) on moderate to severe persistent allergic rhinitis (AR) of kidney-yang deficiency type, and to explore the correlation between nasal temperature and condition of allergic rhinitis.

METHODS

A total of 70 patients with moderate to severe persistent AR were randomized into an observation group (35 cases) and a control group (35 cases, 3 cases dropped off). Both groups were treated with rhinocort, one spray on each side of the nostril (approximately 64 μg each spray), once in the morning and once in the evening, for 4 weeks. On the basis of the above treatment, the observation group was treated with herb-separated moxibustion at Shenshu (BL 23), Feishu (BL 13), Zhiyang (GV 9), Dazhui (GV 14), 3 moxibustions per acupoint, a single treatment lasting about 30 min. This treatment was given once every other day, 3 times every week, and totally continuous 4 weeks. The changes of AR symptom visual analogue scale (VAS) scores were observed before and after treatment and at 3 months follow-up after treatment. The heat variation (temperature, range) on projection areas of the nose, lungs, large intestine and kidneys of the two groups' patients before and after treatment were detected by the infrared thermal imaging diagnostic system, and the correlation between the VAS scores and nasal temperature before and after treatment was analyzed. The clinical effects of both groups were evaluated according to the VAS score.

RESULTS

The total effective rate in the observation group after treatment was 85.7% (30/35), which was higher than 71.9% in the control group (23/32, P<0.05). After treatment and at follow-up, the VAS scores of both groups were lower than those before treatment (P<0.05), and the VAS score of the observation group was lower than that of the control group at follow-up (P<0.05). After treatment, the nasal temperature, pulmonary range, large intestinal range and renal range of the observation group were all lower than those before treatment (P<0.05), the nasal temperature and nasal range of the control group were lower than before treatment (P<0.05), and the reduction of nasal temperature, nasal range and renal range in the observation group was greater than that of the control group (P<0.05). Before and after treatment, there was a correlation between VAS score and nasal temperature (P<0.05).

CONCLUSION

The herb-separated moxibustion combining western medication has a better effect and long-term effect than western medication alone for moderate to severe persistent AR, which can improve heat variation on projected areas of the nose, lung, large intestine and kidney of patients. In addition, nasal temperature can reflect the severity of the symptoms of patients with moderate to severe persistent AR, or it can be used as a secondary indicator to evaluate condition of AR.

Symptom Burden Clustering in Chronic Kidney Disease Stage 5

Patients with chronic kidney disease (CKD) Stage 5, experience multiple symptoms that negatively affect the health-related quality of life (HRQoL). This study examined the cluster of symptoms and their association with disease severity and comorbidities. The study sample included 123 patients with CKD Stage 5; 60 patients were in the dialysis group and 63 patients in the Conservative Kidney Management group. Symptom data were collected using the Spanish modified version of Palliative Care Outcome Scale-Symptoms (POS-S) Renal, a validated questionnaire to assess symptoms in this population. More than half of the patients described weakness, difficulty sleeping, and feeling depressed. Two symptom clusters were identified. There was no significant statistical correlation between disease severity and symptoms and between comorbidities and symptoms. The tendency of these symptoms to occur together has implications for improving symptom management in this population. Routine symptom assessment can be useful in clinical and research settings.

Medication therapy management and complex patients with disability: a randomized controlled trial

BACKGROUND

Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities.

OBJECTIVE

To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations.

METHODS

Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice.

INTERVENTIONS

8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module.

PRIMARY OUTCOME

mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs.

ANALYSIS

general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes).

RESULTS

Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time.

CONCLUSION

Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.