Reliability and Validity of the Spanish Language Measures of the NIH Toolbox Cognition Battery

Objective

The NIH Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) was developed under contract from the National Institutes of Health to create a set of easy-to-administer neuropsychological measures, for use across the lifespan (ages 3-85). The NIHTB Cognition Battery (NIHTB-CB) includes two language measures that were developed, calibrated, and normed separately in English and Spanish. This analysis presents the test-retest reliability and construct validity of the Spanish-language picture vocabulary test (S-PVT) and oral reading recognition test (S-ORRT) among adults.

Participants and Method

Participants were adults age 18-85 who took part in the NIHTB norming study in Spanish (N = 408, Age: M = 44.1, SD = 16.7; Education: M = 10.7, SD = 4.3; 65.0% female). Of these, 48 repeated the battery 1 week later. Both the S-PVT and the S-ORRT were administered using computer adaptive testing and scored using item response theory. Spearman’s correlations were used to evaluate test-retest reliability. Convergent validity was evaluated by correlating S-PVT scores with scores on the Batería-III Woodcock-Muñoz Vocabulario Sobre Dibujos, and by correlating S-ORRT scores with scores on a 48-item version of the Word Accentuation Test. Adjusted Spearman’s correlations and general linear models related scores to age, education, and sex.

Results

Both the S-PVT (ρ = 0.87, p < .001) and the S-ORRT (ρ = 0.88, p < .001) demonstrated good test-retest reliability. Good convergent validity was found for both the S-PVT (ρ = 0.76, p < .001) and the S-ORRT (ρ = 0.65, p < .001). Scores on the S-PVT were positively related to education (ρ = 0.38, p < .001), and scores on the S-ORRT were negatively related to age (ρ = -0.18, p < .01) and positively related to education (ρ = 0.30, p < .001).

Conclusions

The Spanish language measures of the NIHTB-CB demonstrated acceptable reliability and validity, suggesting they can be used to measure language ability among Spanish-speaking adults in the United States.

Validation of the NIH Toolbox in Individuals with Neurologic Disorders

OBJECTIVE

Individuals with spinal cord injury (SCI), traumatic brain injury (TBI), and stroke experience a variety of neurologically related deficits across multiple domains of function. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) examines motor, sensation, cognition, and emotional functioning. The purpose of this paper is to establish the validity of the NIHTB in individuals with neurologic conditions.

METHODS

Community-dwelling individuals with SCI (n = 209), TBI (n = 184), or stroke (n = 211) completed the NIHTB. Relative risks for impaired performance were examined relative to a matched control groups.

RESULTS

The largest group differences were observed on the Motor domain and for the Fluid Cognition measures. All groups were at increased risk for motor impairment relative to normative standards and matched controls. Fluid cognitive abilities varied across groups such that individuals with stroke and TBI performed more poorly than individuals with SCI; increased relative risks for impaired fluid cognition were seen for individuals in the stroke and TBI groups, but not for those in the SCI group. All three neurologic groups performed normally on most measures in the Sensation Battery, although TBI participants evidenced increased risk for impaired odor identification and the stroke group showed more vision difficulties. On the Emotion Battery, participants in all three groups showed comparably poor psychological well-being, social satisfaction, and self-efficacy, whereas the TBI group also evidenced slightly increased negative affect.

CONCLUSIONS

Data provide support for the validity of the NIHTB in individuals with neurologic conditions.

Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology

OBJECTIVE

To address the need for brief, reliable, valid, and standardized quality of life (QOL) assessment applicable across neurologic conditions.

METHODS

Drawing from larger calibrated item banks, we developed short measures (8-9 items each) of 13 different QOL domains across physical, mental, and social health and evaluated their validity and reliability. Three samples were utilized during short form development: general population (Internet-based, n = 2,113); clinical panel (Internet-based, n = 553); and clinical outpatient (clinic-based, n = 581). All short forms are expressed as T scores with a mean of 50 and SD of 10.

RESULTS

Internal consistency (Cronbach α) of the 13 short forms ranged from 0.85 to 0.97. Correlations between short form and full-length item bank scores ranged from 0.88 to 0.99 (0.82-0.96 after removing common items from banks). Online respondents were asked whether they had any of 19 different chronic health conditions, and whether or not those reported conditions interfered with ability to function normally. All short forms, across physical, mental, and social health, were able to separate people who reported no health condition from those who reported 1-2 or 3 or more. In addition, scores on all 13 domains were worse for people who acknowledged being limited by the health conditions they reported, compared to those who reported conditions but were not limited by them.

CONCLUSION

These 13 brief measures of self-reported QOL are reliable and show preliminary evidence of concurrent validity inasmuch as they differentiate people based upon number of reported health conditions and whether those reported conditions impede normal function.

CAT administration of language placement examinations

This article describes the development of a computerized adaptive test for Cegep de Jonquiere, a community college located in Quebec, Canada. Computerized language proficiency testing allows the simultaneous presentation of sound stimuli as the question is being presented to the test-taker. With a properly calibrated bank of items, the language proficiency test can be offered in an adaptive framework. By adapting the test to the test-taker's level of ability, an assessment can be made with significantly fewer items. We also describe our initial attempt to detect instances in which "cheating low" is occurring. In the "cheating low" situation, test-takers deliberately answer questions incorrectly, questions that they are fully capable of answering correctly had they been taking the test honestly.

The risk of acquiring hepatitis B or C among public safety workers: a systematic review

CONTEXT

Determination of the occupational risk of hepatitis B and C to public safety workers is important in identifying prevention opportunities and has significant legal and policy implications.

OBJECTIVES

Characterize the risk of occupationally acquired infection: (1) risk of exposure to blood and body fluids, (2) seroprevalence of hepatitis B and C in the source population, and (3) risk of infection after exposure.

DATA SOURCES

Electronic search of MEDLINE (1991-1999), HealthStar (1982-1999), and CINAHL (1975-1999) supplemented by selected reference citations and correspondence with authors of relevant articles.

STUDY SELECTION

Peer-reviewed journal articles (N=702) that addressed the transmission of hepatitis B and C in law enforcement, correctional, fire, emergency medical services, and healthcare personnel were identified. One hundred five (15.0%) articles were selected for full-text retrieval; 72 (68.6%) were selected for inclusion.

DATA ABSTRACTION

Articles selected for inclusion were abstracted by two reviewers and checked by a third reviewer, using a standard reporting form.

DATA SYNTHESIS

Evidence tables were constructed, using the standardized abstracts. The tables were designed to summarize data for the key elements of the risk analysis.

CONCLUSIONS

Data suggest that emergency medical service (EMS) providers are at increased risk of contracting hepatitis B, but data have failed to show an increased prevalence of hepatitis C. EMS providers have exposure risks similar to those of hospital-based healthcare workers. Other public safety workers appear to have lower rates of exposure. Urban areas have much higher prevalence of disease, and public safety workers in those areas are likely to experience a higher incidence of exposure events.

Testing the reliability and validity of a measure of safety climate

The lack of compliance with universal precautions (UP) is well documented across a wide variety of healthcare professions and has been reported both before and after the enactment of the Occupational Safety and Health Administration's Bloodborne Pathogens Standard. Gershon, Karkashian, and Felknor (1994) found that several factors correlated significantly with healthcare workers' lack of compliance with UP, including a measure of organizational safety climate (e.g., the employees' perception of their organizational culture and practices regarding safety). We conducted a secondary analysis using data from a cross-sectional survey of a convenience sample of 1,746 healthcare workers at risk of occupational exposure to bloodborne pathogens to assess the validity and reliability of Gershon's measure of safety climate. Findings revealed no relationship between safety climate and employees' gender, age, education, tenure in position, profession, hours worked per day, perceived risk, attitude toward risk, and training. An association was demonstrated between safety climate and (1) healthcare worker compliance with UP and (2) the availability of personal protective equipment, providing support for the construct validity of this measure of safety climate. These findings could be used by occupational health professionals to assess employees' perceptions of the safety culture and practices in the workplace and to guide the institution's risk management efforts in association with U.P.

Methodologic issues in intervention research--health care

To better understand the methodological challenges faced by intervention research in health care, workshops reviewed two intervention studies to reduce back injuries among nursing home staff and two studies on the use of precautions to prevent occupational transmission of bloodborne pathogens. These studies adapted rigorous designs to real-world settings and made good use of multiple measures to detect effects and communicate this information to policy makers. The studies grappled with issues about implementation integrity and would benefit from better theory of administrative practices associated with a safety-conscious work environment.

Facilitator report: bloodborne pathogens exposure among health care workers

Several psychosocial and organizational factors have been identified as important correlates of compliance with safe work practices among health care workers. In particular, compliance with "universal precautions"--a set of work practices which were designed to minimize exposure to bloodborne pathogens--has been found to be associated with several potentially modifiable factors. The development of interventional strategies designed specifically to target these factors (e.g., HIV/AIDS attitudes, safety climate) are important objectives in the overall risk management approach to occupational exposure to bloodborne pathogens.

Microenvironmental immunoregulation: possible role of contrasuppressor cells in maintaining immune responses in gut-associated lymphoid tissues

The addition of Peyer's patch T cells from most strains of mice to spleen cells in primary Mishell-Dutton cultures either has no effect or augments the spleen cells' response to sheep erythrocytes. However, if the Peyer's patch T cells are treated with an anti-I-J antiserum and complement to remove contrasuppressor-inducer cells, the remaining Ly-2 cells (T cells that express Ly-2 but not Ly-1) are highly suppressive. This "latent" suppressor cell activity also can be revealed by removing contrasuppressor-acceptor (transducer) cells from the splenic assay population with either an anti-I-J or anti-Ly-2 antiserum. These findings, taken together with previous work showing that orally administered antigen leads to systemic tolerance, give experimental support to the notion that contrasuppression may be important in allowing microenvironmental immune responses (in this case the gut-associated lymphoid tissue) to take place while systemic immunity is suppressed.

Suppressor cells in vitro: differential effects of indomethacin and related compounds

In vitro immune response systems known to involve suppressor cell regulation were examined for effects produced by the drug indomethacin and other compounds known to inhibit the cyclooxygenase pathway of arachidonic acid metabolism. In all cases tested where suppressor T cell activity is known to be the dominant inhibitory mechanism, suppression was not blocked by drug addition and was sometimes more pronounced. In the cases tested where suppression could be attributed to a non-T cell, most likely a macrophage-like cell (M0), suppression could be abolished by drug treatment. Indomethacin and related compounds may be useful analytical tools for separation of T cell vs. non-T cell mediated suppression.