The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico

This article illustrates a comprehensive cross-cultural adaptation model used to translate into Spanish and to culturally adapt the Diagnostic Interview Schedule for Children (DISC). The process strived to identify similar phenomena to those identified by the original English version in a dissimilar context. To attain cross-cultural equaivalency five important dimensions were addressed: semantic, technical, content, criterion and conceptual. To meet this challenge various steps were taken, including bilingual committee, back-translation, reliability and validity testing. The result is an instrument which could be used, not only in Puerto Rico, but also in other Spanishspeaking child and adolescent populations after appropriate cultural adaptations.     

Ataques de nervios in the Puerto Rican diagnostic interview schedule: The impact of cultural categories on psychiatric epidemiology

This paper examines the effect of the cultural category ataques de nervios on responses to the Puerto Rican Diagnostic Interview Schedule (DIS), a Spanish version of structured psychiatric diagnostic interview developed for the NIHM Epidemiologic Catchment Area study. An ataque de nervios scale was created from the Somatization items of the DIS to explore the effect of this culturally meaningful category of distress on responses to a standard psychiatric interview. Analysis of 1,513 cases from a representative sample of the island of Puerto Rico indicated that people reporting ataque symptoms fit the social characteristics described for ataques sufferers in the ethnographic literature. Qualitative data indicated that Puerto Ricans were reporting ataques de nervios in the panic section of the DIS. Questions are raised about the validity of the somatization and panic sections of the DIS in cross-cultural research with Hispanics.     

Cross-cultural adaptation of instruments assessing breastfeeding determinants: a multi-step approach

Background

Cross-cultural adaptation is a necessary process to effectively use existing instruments in other cultural and language settings. The process of cross-culturally adapting, including translation, of existing instruments is considered a critical set to establishing a meaningful instrument for use in another setting. Using a multi-step approach is considered best practice in achieving cultural and semantic equivalence of the adapted version. We aimed to ensure the content validity of our instruments in the cultural context of KwaZulu-Natal, South Africa.

Methods

The Iowa Infant Feeding Attitudes Scale, Breastfeeding Self-Efficacy Scale-Short Form and additional items comprise our consolidated instrument, which was cross-culturally adapted utilizing a multi-step approach during August 2012. Cross-cultural adaptation was achieved through steps to maintain content validity and attain semantic equivalence in the target version. Specifically, Lynn’s recommendation to apply an item-level content validity index score was followed. The revised instrument was translated and back-translated. To ensure semantic equivalence, Brislin’s back-translation approach was utilized followed by the committee review to address any discrepancies that emerged from translation.

Results

Our consolidated instrument was adapted to be culturally relevant and translated to yield more reliable and valid results for use in our larger research study to measure infant feeding determinants effectively in our target cultural context.

Conclusions

Undertaking rigorous steps to effectively ensure cross-cultural adaptation increases our confidence that the conclusions we make based on our self-report instrument(s) will be stronger. In this way, our aim to achieve strong cross-cultural adaptation of our consolidated instruments was achieved while also providing a clear framework for other researchers choosing to utilize existing instruments for work in other cultural, geographic and population settings.

     

Translation And Cultural Adaptation Of A Mental Health Outcome Measure: The Basis-R©

Culturally and linguistically appropriate outcome measures are needed to address the needs of Latino consumers of mental health services. The revised Behavior and Symptom Identification Scale (BASIS-R(c)) is an English-language consumer self-report measure designed to assess outcome of behavioral health or substance abuse treatment. This study sought to develop a culturally and linguistically appropriate version of the BASIS-R(c) for Spanish-speaking Latinos. To achieve this goal, the English instrument was translated and adapted into Spanish by an international bilingual committee and tested in four focus groups and 45 cognitive interviews with Puerto Ricans, Dominicans, and Mexicans living in the United States and Puerto Rico. Focus groups and cognitive interviews provided qualitative and quantitative information about the instrument's content and format, and respondents' understanding of the instructions, questionnaire items, time frame, and response options. Respondents' ratings of the clarity and importance of each item were also obtained. Analyses of focus group and cognitive interview data identified items that were confusing or difficult for participants. Findings suggest that the Spanish version of the BASIS-R(c) incorporated the cultural diversity of the three groups of Latinos in this study without compromising the validity of the English version of the BASIS.     

Cultural Adaptation of a Survey to Assess Medical Providers’ Knowledge of and Attitudes towards HIV/AIDS in Albania

Though the HIV/AIDS epidemic in Southeastern Europe is one of low reported prevalence, numerous studies have described the pervasiveness of medical providers’ lack of knowledge of HIV/AIDS in the Balkans. This study sought to culturally adapt an instrument to assess medical providers’ knowledge of and attitudes towards HIV/AIDS in Albania. Cultural adaptation was completed through development of a survey from previously validated instruments, translation of the survey into Albanian, blinded back translation, expert committee review of the draft instrument, focus group pre-testing with community- and University Hospital Center of Tirana-based physicians and nurses, and test-retest reliability testing. Blinded back translation of the instrument supported the initial translation with slight changes to the idiomatic and conceptual equivalences. Focus group pre-testing generally supported the instrument, yet some experiential and idiomatic changes were implemented. Based on unweighted kappa and/or prevalence adjusted bias adjusted kappa (PABAK), 20 of the 43 questions were deemed statistically significant at kappa and/or PABAK ≥0.5, while 12 others did not cross zero on the 95% confidence interval for kappa, indicating their probable significance. Subsequently, an instrument to assess medical providers’ knowledge of and attitudes toward HIV/AIDS for an Albanian population was developed which can be expanded within Albania and potentially to other countries within the Balkans, which have an Albanian-speaking population.     

Ethnicity,region and nation: Valencian identity and the Spanish nation-state

In the exploration of the relationships between ethnicity, national identity, and symbolic building of the region, this article deals with a key issue: the achievements and limitations of the assimilation of culturally heterogeneous populations by European nation-states. The modern Spanish national identity (at times shown as purely political) has included and still includes cultural elements (above all, the spread of the Spanish language). This meant that the ethnicity of the Valencians (a population with autonomous political structures until their violent destruction in 1707) had to be redefined as a regional identity in order to avoid coming into conflict with national identity. This re-working excluded the Catalan language, spoken by most of the inhabitants of the region, from the political sphere. In the long term, this cultural characteristic became stigmatized, which favoured its undercommunication to the extent that a process of language shift was initiated. This case study highlights the historical analysis of ethnic identity and the instability of its integration into national structures.     

Cultural Specificity and Comparison in Psychiatric Epidemiology: Walking the Tightrope in American Indian Research

Increasingly, the mental health needs of populations are measured using large-sample surveys with standardized measures and methods. Such efforts, however, rarely include sufficient number of smaller, culturally defined populations to draw defensible conclusions about their needs. Furthermore, without some adaptation, the standardized methods and measures may yield invalid results in such populations. Using a recently completed psychiatric epidemiology and services study with American Indian populations as a case example, this paper outlines issues facing epidemiologists working in such culturally diverse contexts. The issues discussed include the following: (1) persuading the scientific community and potential sponsors that work with distinct or culturally defined populations is important; (2) framing research questions and activities to meet the needs of communities; (3) defining a population of inference; (4) balancing the needs for comparability and cultural specificity; (5) maximizing scientific validity in light of the challenges in sample acquisition; and (6) developing and implementing data collection methods that uphold scientific standards but are also realistic given the context. The authors draw on their experiences—most recently in the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP)—to illustrate these issues and suggest ways to address each. A goal of this paper is to challenge those invested in conducting culturally valid epidemiologic work in such populations to better articulate the nature of these efforts.     

Evaluación de las características operativas de la versión 2.2018 del instrumento de evaluación del malestar emocional de la National Comprehensive Cancer Network en pacientes atendidos en el Instituto Nacional de Cancerología,Bogotá

Introduction:

Cancer patients have significant levels of emotional distress. The National Comprehensive Cancer Network (NCCN) developed the distress management tool to quickly assess significant distress in oncological patients who require intervention. For its use in Colombia, we made its cross-cultural adaptation and validation.

Objective:

To determine the operative characteristics of the distress management tool, version 2.2018, in patients seen at the Instituto Nacional de Cancerología (INC) in Colombia.

Materials and methods:

Counting with the authorization from the NCCN, we translated, made the cross-cultural adaptation, and evaluated the operational characteristics of the tool. We included 343 cancer patients seen at the INC, who filled out the cross-culturally adapted instrument. A diagnostic test study was carried out with a semi-structured interview as a reference.

Results:

The patients had an average age of 49.7 years (SD=15) and the majority were women (67%). The instrument had an area under the ROC curve of 0.81 (95% CI: 0.77 - 0.86); its optimal cut-off point was 3.5 approached to 4 when using integers on the scale; its sensitivity was 0.81 (95% CI: 0.76 - 0.85), and its specificity, 0.69 (95% CI: 0.64 - 0.74). The agreement percentage between the result of the interview and the instrument was 73% (kappa = 0.64; p< 0.001).

Conclusions:

The distress management tool allowed for the detection of moderate to severe distress requiring intervention and management. This instrument was adapted and validated in cancer patients in Colombia keeping the cutoff point at ≥ 4 as in the original version.     

ADHD-Type Behavior and Harmful Dysfunction in Childhood: A Cross-Cultural Model

Cross-cultural studies of psychiatric phenomena allow testing of assumptions of biological consistency and improved understanding of how disorders are culturally formulated. We used a comparative approach to test for population variation in degrees of harmful academic and social dysfunction associated with children's display of behaviors considered symptomatic of Attention Deficit Hyperactivity Disorder (ADHD). Teacher ratings on psychometric scales described behavior and functioning in population-representative samples of Colombian and United States schoolchildren. Mean levels of the behaviors were similar across populations, including a constant gender difference. A multiple regression model showed remarkably consistent relationships of hyperactivity and inattention to harmful dysfunction across populations and genders. Increasing inattention was associated with increasing harmful dysfunction. Increased hyperactivity was associated with improved functioning to a uniform threshold, beyond which more hyperactivity was associated with greater harmful dysfunction. Patterns of relationships between ADHD-associated behaviors and their consequences may prove useful as a basis for cross-cultural investigation of ADHD. The idea of ADHD as psychiatric disease concept or construct with some cross-cultural (external) validity is supported by these data, [cross-cultural psychology, ADHD (Attention deficit hyperactivity disorder), child behavioral disorders, Colombia]     

The longer you stay, the bigger you get: length of time and language use in the U.S. are associated with obesity in Puerto Rican women

This cross-sectional study examined whether length of time in the U.S., language use, and birthplace (proxy measures of acculturation) were associated with body mass index (BMI) and obesity in a sample of 174 low-income Puerto Rican women from Hartford, Connecticut. The mean BMI for the total sample (N = 174) was 27.39 (S.D. = 5.07), and nearly 34% of the sample was considered obese (BMI > or = 30). There was a statistically significant increase in BMI with length of time in the U.S. (P = 0.012) and these differences were even greater among women born in Puerto Rico (P = 0.003). Moreover, obesity prevalence was highest among women who had been in the U.S. for 10 years or more (40%), as compared to those who had been in the U.S. less than 1 year (29%; P = 0.045). There were no statistically significant associations between language and BMI for the total sample. However, among bilingual speakers born in Puerto Rico, there were significant differences in BMI according to their level of English fluency. Those who spoke fluent or very good English had a significantly higher BMI (mean = 29.72; SD = 4.12) than women whose English was good to not-so-good (mean = 26.8; SD = 5.24; P = 0.016). The findings from this study point to the need for more research on the acculturation process and obesity, in order to design culturally tailored obesity prevention programs.     

Arabic translation and cross-cultural adaptation of the Sport Concussion Assessment Tool 5 (SCAT5)

The aim was to create a Modern Standard Arabic SCAT5 version for different Arabic dialects. This translation and cross-cultural adaptation was performed in eight stages: initial translations, reconciliation of translations and cultural adaptation, back translation, appraisal of back translations, validation of the translation, review and adjustment by reconciliation committee, pretesting in 12 football players and document finalisation. As an alternative to the problematic Months In Reverse Order Test (MIROT) in Arabic, the Serial 3s test (32 Arabic and 30 English participants), the Days of the Week Backwards test (DWBT), and the ‘Adding Serial 3s’ test were tested (30 English and 30 Arabic participants) for accuracy, difficulty and time of completion. The Arabic SCAT5 was similar and comparable to the original English version (7-point Likert scales =< 2). Testing of the pre-final version of the Arabic SCAT5 took 20.4 (SD 3.4) and 17.7 (SD 3.0) minutes respectively to complete and was found acceptable in terms of clarity, understandability, grammatical correctness and coherence. The Arabic Serial 3s test (subtraction version) was unsuitable due to high completion time, low pass rate and high difficulty perception [time = 47.2 (SD 28.0) s; accuracy = 55.2%; difficulty = 3.2 (SD 1.1)]. The Arabic DWBT was too fast and undemanding for concentration testing [time = 4.6 (SD 1.5) s; accuracy = 90%; difficulty = 1.1 (SD 0.3)]. The Adding Serial 3s tests produced similar completion times [18.4 (SD 6.8) vs. 21.1 (SD 5.3), p = 0.088], accuracy (100%) and self-rated difficulty [English = 2.0 (SD 0.7) vs. Arabic-speaking participants = 2.1 (SD 0.8), p = 0.512] and was therefore adopted to replace the MIROT. This culturally adapted Arabic-SCAT5 questionnaire is the first concussion assessment tool available for Arabic-speaking healthcare providers and athletes. Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport. 2021;38(1):129–144.     

Validation of the Diagnostic Interview for Genetic Studies (DIGS) in Colombia

An interview tool, Diagnostic Interview for Genetic Studies (DIGS 3.0), was translated into Spanish for application in studies of psychiatric disorders in Colombia. Two Spanish translations of the original English version of DIGS were prepared and back-translated into English. A review committee verified the linguistic and cultural equivalence of the translations. The evaluator and test-retest reliability were assessed calculating Cohen's kappa for samples of 65 and 91 patients respectively. DIGS proved valid in both appearance and content. The confidence interval (C.I.) was excellent for schizophrenia (kappa = 0.81, C.I. 95% = 0.68-0.93), bipolar disorder (kappa = 0.87, C.I. 95% = 0.75-0.99), major depressive disorder (kappa = 0.86, C.I. 95% = 0.70-1.00), and for a normal diagnosis (kappa = 0.65, C.I. 95% = 0.41-0.89); it was good for other psychiatric diagnosis (kappa = 0.65, C.I. 95% = 0.41-0.89) and poor for schizoaffective disorder (kappa = 0.37, C.I. 95% = -0.02-0.76). Test-retest reliability was excellent for all diagnoses (kappa > 0.8), except for "other psychiatric diagnoses" (kappa = 0.64, C.I. 95% = 0.31-0.96). The Spanish translation of the DIGS was comprehensible, with face and content validity, and good test-retest and evaluator reliability. This translation will be a useful tool for genetic studies of psychiatric disorders in Latin America, particularly where schizophrenia and affective disorders are involved.     

Limits to adaptation in asexual populations

In asexual populations, the rate of adaptation is basically limited by the frequency and properties of spontaneous beneficial mutations. Hence, knowledge of these mutational properties and how they are affected by particular evolutionary conditions is a precondition for understanding the process of adaptation. Here, we address how the rate of adaptation of asexual populations is limited by its population size and mutation rate, as well as by two factors affecting the fraction of mutations that confer a benefit, i.e. the initial adaptedness of the population and the variability of the environment. These factors both influence which mutations are likely to occur, as well as the probability that they will ultimately contribute to adaptation. We attempt to separate the consequences of these basic population features in terms of their effect on the rate of adaptation by using results from evolution experiments with microorganisms.     

“Chronicity,” “Nervios,” and community care: A case study of Puerto Rican psychiatric patients in New York City

The role of ethnicity, community structure, and folk concepts of mental illness in facilitating the adaptation of long term psychiatric patients to community living has received little attention. This article examines the cultural concepts of mental illness and the community involvement of 30 Puerto Rican psychiatric patients participating in a New York City treatment program. It is shown that many of the attributes usually associated with chronic mental illness do not apply to this population. It is argued that the folk concept of nervios helps to foster the integration of these patients in a wide range of community networks. The impact of gentrification on these patients' community integration is also discussed.     

Short RNAs in environmental adaptation

Non-coding small RNAs (19-24 nucleotide long) have recently been recognized as the important regulator of gene expression in both plants and animals. Several classes of endogenous short RNAs have partial or near perfect complementarity to mRNAs and a protein complex is guided by short RNAs to target mRNAs. The targeted mRNA is either cleaved or its translation is suppressed. Initially, short RNAs were believed to primarily regulate the normal development of plants and animals, but recent advances implicate short RNAs in environmental adaptation.     

Cross-cultural adaptation and preliminary validation of a zygosity determination questionnaire for twins in Sri Lanka.

We report the process of adaptation into Sinhala of a questionnaire given to mothers of twins to determine zygosity. Adaptation and validation was carried out in three stages. Firstly, we used a nominal group to translate the English version and to assess the extent of agreement (consensus measurement) on the appropriateness of the translation and resolve disagreement (consensus development). Secondly we used a qualitative interview with 25 mothers of twins. The three main stems of the translated questionnaire were used as a semi-structured interview, and the responses noted verbatim. These were categorised and analysed, and the translated full questionnaire was then presented as closed questions with fixed choice responses. The categorised responses generated during the qualitative interview were compared with the responses to the fixed choices in the full questionnaire. The third stage was the appraisal of the questionnaire by 17 bilingual parents of twins. The source and translated version of the questionnaire were given to them at least 3 days apart. The responses were rated and the total scores were computed to determine the zygosity. This step was carried out to measure the validity and reliability of the Sinhala version. A perfect correlation between the original and adapted version was obtained, with a kappa of 1. The results suggest that the Sinhala version of the questionnaire is conceptually equivalent to the original questionnaire. Comparison of the zygosity determination by using this adapted questionnaire with results from analysis of genetic markers on Sri Lankan twins is needed for final validation of the translated questionnaire.     

The possible mechanisms of the adaptation of microbial populations to low positive temperatures

Biologically low temperature was studied for its effect on the survival of populations and their biochemical and molecular-genetical state. The research was carried out on Yersinia pseudotuberculosis and Shigella sonnei models. It is established that the process of low-temperature adaptation of the populations may occur either at the level of the whole population with participation of inducible cold isoenzymes or at the level of a part of population, the temperature being a selection factor of the adapted cells.     

The effects of prenatal and postnatal environmental interaction: Prenatal environmental adaptation hypothesis

Adverse antenatal maternal environments during pregnancy influence fetal development that consequently increases risks of mental health problems including psychiatric disorders in offspring. Therefore, behavioral and brain alterations caused by adverse prenatal environmental conditions are generally considered as deficits. In this article, we propose a novel hypothesis, along with summarizing a body of literatures supporting it, that fetal neurodevelopmental alterations, particularly synaptic network changes occurring in the prefrontal cortex, associated with adverse prenatal environmental conditions may be adaptation to cope with expected severe postnatal environments, and therefore, psychiatric disorders may be able to be understood as adaptive strategies against severe environmental conditions through evolution. It is hoped that the hypothesis presented in this article stimulates and opens a new venue on research toward understanding of biological mechanisms and therapeutic treatments of psychiatric disorders.     

Psychiatric care in relation to the development of the contemporary state: The case of Catalonia

Over the past two centuries, extensive mental health care systems have come to be a feature of all Western societies. However, the theoretical model generally invoked to account for this process has only limited applicability to Spain, where the growth of capitalism and the liberal state followed an atypical and uneven course. Political power and economic power, usually coterminous, were divided in Spain between center and periphery, so that, until the 1960s, Spain's economic center of gravity was localized in Catalonia, the most culturally and linguistically distinct region. Here we are dealing with a paradox: on the one hand, the failure of the incompletely centralized and economically underdeveloped Spanish state to develop a system of psychiatric care comparable to those of other European states; and on the other hand, the success of the Catalan bourgeoisie, though lacking a state of its own, in creating such a system through private initiative.Translated by Susan DiGiacorno     

La transición hacia el retiro: adaptación en una muestra de prejubilados españoles de la escala Retirement Satisfaction Inventory

Objectives

This study provides psychometric data for the Spanish adaptation of the scale of Retirement Satisfaction Inventory (RSI). We explore the factor structure and psychometric properties a sample of Spanish early retirees. RSI measures the motivation to retirement, satisfaction with life in retirement and leisure activities.

Material and methods

The RSI scale (Floyd et al, 1992) was applied to a sample of 638 Spanish early-pensioners with a mean age of 61.28 (SD: 5.77) years and a mean age at early retirement of 53.89 years (SD: 2.71). An exploratory factorial analysis was performed using the SPSS statistics package, and a confirmatory factorial using the AMOS 6.0 module. The data collection process was carried out by means of the questionnaires by post method.

Results

The adaptation of the RSI to Spanish showed a three-scale structure:: the reasons for retirement, satisfaction with life in retirement, and leisure activities. These scales showed a structure with four, two and three main factors, respectively, which differ slightly from those reported in the original instrument.The confirmatory factorial analysis demonstrated the optimum fit of the model for the three scales.

Conclusions

The RSI adaptation to Spanish provides a tool that could asses the motivation towards retirement during the leaving work process, satisfaction with retirement life, and the leisure sources in the Spanish early retired population.