Purpose To determine the factorial validity, internal consistency, criterion-related and concurrent validity of the Perception of Quality of Rehabilitation Services - Montreal (PQRS-Montreal) questionnaire for persons receiving traumatic brain injury (TBI) rehabilitation services. Design Cross-sectional study. Setting Seventeen facilities providing acute care and intensive inpatient and outpatient TBI adult rehabilitation. Participants Five-hundred thirty adults (GCS=3-15; mean age =41.5 +/- 16.9 years) who received rehabilitation were administered the questionnaire during an interview near time of discharge. Subjects responded to the 61 PQRS-Montreal items (five-point scale of agreement) and to the Client Satisfaction Question (CSQ8). Results Exploratory and confirmatory factor analyses identified three potential subscales (one- and two-factor solutions) explaining 26.1-41% of the variance (ecological approach, quality of team, service organization). The subscales' internal structures were interpretable and their internal consistency varied from 0.51 to 0.90 (Cronbach's alpha). Rehabilitation phase significantly and positively impacted factor scores and all factor scores were significantly and moderately correlated with CSQ8 scores. Conclusions The PQRS-Montreal possesses adequate psychometric properties supporting its use as a valid tool to measure patients' perception of the quality of TBI rehabilitation services. This tool could help guide the development and monitoring of TBI rehabilitation service delivery.

Objective:The purpose of this study was to assess the relationship between stigmatizing attitudes towards people living with HIV (PLHIV) and HIV testing.Methods: A cross-sectional population study was conducted in the province of Quebec, Canada.A representative sample of 1,500 for the province Quebec randomly selected individuals aged 15 to 64 years and able to speak French or English was surveyed.Participants were interviewed by telephone from March to April 2010.Bivariate analyses and multiple sequential logistic regression analyses were performed to assess the relationship between stigmatizing attitudes and HIV testing while controlling for variables known to be associated with testing.Results: Only 45% of the participants had ever been tested for HIV.Of these, 25% had been tested in the past 12 months and 55% in the past 5 years.Compared with never-tested participants, tested participants were more likely to be women, aged less than 50 years, born outside Canada, more educated, have engaged in risky behaviors, and have known at least one PLWHA.The mean stigmatizing attitude score was statistically nonsignificant in the multivariate model.However, considered separately, one attitudinal dimension showed significance.After adjusting for demographics and individual variables, being less concerned about occasional encounters with PLHIV significantly increased the odds for HIV testing (OR= 1.31; 95% CI: 1.06-1.61). Conclusion:People expressing less concern about occasional encounters with PLHIV were more likely to have had HIV testing.This finding suggests a deleterious effect of stigmatization on HIV testing, and that this concern may be a critical consideration in designing awareness campaigns to encourage HIV testing.

The Interdisciplinary Study of Inequalities in Smoking (ISIS) is a cohort study investigating the joint effects of residents' socio-demographic characteristics and neighbourhood attributes on the social distribution of smoking in a young adult population. Smoking is a behaviour with an increasingly steep social class gradient; smoking prevalence among young adults is no longer declining at the same rate as among the rest of the population, and there is evidence of growing place-based disparities in smoking. ISIS was established to examine these pressing concerns. The ISIS sample comprises non-institutionalized individuals aged 18-25 years, who are proficient in English and/or French and who had been living at their current address in Montréal, Canada, for at least 1 year at time of first contact. Two waves of data have been collected: baseline data were collected November 2011-September 2012 (n = 2093), and a second wave of data was collected January-June 2014 (n = 1457). Data were collected from respondents using a self-administered questionnaire, developed by the research team based on sociological theory, which includes questions concerning social, economic, cultural and biological capital, and activity space as well as smoking behaviour. Data are available upon request from [katherine.frohlich@umontreal.ca].

Background: Although stigmatization has long been recognized as a major obstacle to HIV prevention. The lack of a valid and reliable measurement tool for stigmatization is a major gap in the research. This study aimed to: 1) develop a scale of stigmatizing attitudes towards people living with HIV (SAT-PLWHA-S) and 2) demonstrate its reliability and validity.Methods: French and English-speaking experts (n = 21) from different professional communities (academics, practitioners) assessed the clarity and relevance of the proposed items. The psychometric properties of the SAT-PLWHA-S were assessed with a random digit dial population based telephone survey (n = 1,500) of respondents in Quebec, Canada. Analyses included exploratory and confirmatory factor analyses, correlations, multiple linear regressions, t-tests, hypothesis testing of factorial structure invariance, and Cronbach's alpha.Results: Confirmatory factor analysis (CFA) supported a 27-item structure with seven factors: 1) concerns about occasional encounters; 2) avoidance of personal contact; 3) responsibility and blame, 4) liberalism, 5) non-discrimination, 6) confidentiality of seropositive status, and 7) criminalization of HIV transmission. Cronbach's alphas indicate satisfactory internal consistency. An assessment of concurrent validity using Pearson's correlation and multiple linear regression shows that homophobia and HIV transmission knowledge are significant determinants of stigmatizing attitudes toward PLHIV. Discriminant validity (t-test) results suggest that the SAT-PLWHA-S can differentiate attitudes between different groups and indicates invariant factor structure across language.Conclusions: The results of this study suggest that the SAT-PLWHA-S is a reliable and valid tool for measuring stigmatizing attitudes toward PLHIV and that it can contribute to a deeper understanding of HIV stigma.

People living with HIV (PWHIV) face negative attitudes that isolate and discourage them from accessing services. Understanding negative attitudes and the social environment can lead to more effective health promotion strategies and programs. However, a scale to measure attitudes has been lacking. We developed and validated attitudes toward PWHIV Scale to examine trends in attitudes toward PWHIV in Quebec in 1996, 2002, and 2010. We also examined the relationship between negative attitudes toward PWHIV, homophobia, and knowledge about HIV transmission. The scale included 16 items and had a five-factor structure: F1 (fear of being infected), F2 (fear of contact with PWHIV), F3 (prejudicial beliefs toward groups at high risk of HIV), F4 (tolerance regarding sexual mores and behaviors), and F5 (social support for PWHIV). The validity and reliability of the scale were assessed and found to be high. Overall, Quebecers had positive attitudes toward PWHIV, with more negative attitudes observed in subgroups defined as male,≥50 years of age,<14 years of education, higher levels of homophobia, and below-average knowledge about HIV transmission. Scores were stable between 1996 and 2002, and increased in 2010. Negative attitudes were correlated with higher levels of homophobia and lesser knowledge about HIV transmission. The lowest scores for each factor were observed in the same subgroups that had low overall scores on the Attitudes Scale. The findings from this study can be used to intensify interventions that promote compassion for PWHIV, address attitudes toward homosexuality, and encourage greater knowledge about the transmission of HIV in these subgroups.

Systematic observation is increasingly used as a method to measure neighbourhood characteristics thought to influence health inequalities. This article reports on the theory-driven development of a new observation tool composed of reflective indicators of neighbourhood characteristics believed to influence inequalities in smoking. We also report the results of generalisability analyses conducted to estimate the reliability (inter-rater reliability and temporal stability) of the observation tool. We use the reliability results to reflect on the quality of the measures and on the theoretical anchors of the tool. We conclude by making recommendations to improve measures collected through systematic observation.

Objective: To examine the reliability of a new measure of independence in everyday activities based on executive functions, the Instrumental Activities of Daily Living (IADL) Profile, when administered to individuals with a moderate or severe traumatic brain injury (TBI). Design: Generalizability theory was used to estimate generalizability and dependability coefficients as well as the relative contribution of identified sources of measurement error to total measurement error. Decision studies were used to enable the investigators to determine the optimal measurement design. Setting: The IADL Profile was administered in subjects' homes and community environments. Participants: A convenience sample of 30 adults aged 16 to 65 with a moderate or severe TBI. Interventions: Not applicable. Main Outcome Measures: IADL Profile scores include 6 factor scores (going to the grocery store/shopping for groceries, having a meal with guests/cleaning up, putting on outdoor clothing, obtaining information, making a budget, and preparing a hot meal) and 1 total score. Task analysis is based on 4 operations related to executive functions: formulating a goal, planning, carrying out the task, and verifying attainment of the goal. Results: Generalizability coefficients of factor scores indicated acceptable to excellent reliability. 2 main sources of measurement error were identified: raters and items. Analyses of dependability coefficients confirmed that 1 evaluator can reliably score the tool on a single occasion after having received a 3-day training workshop. Conclusions: The IADL Profile administered to individuals with a moderate or severe TBI provides occupational therapists with a reliable set of measures of IADL independence capable of both capturing and analyzing the complex interactions between personal and environmental factors.

Background. Occupational therapists are frequently asked to document the interplay between individuals' neuropsychological deficits and the requirements of their daily lives. Purpose. The present study was designed to develop and validate a measure of independence in everyday functioning that considers recent advances in research regarding the ecological assessment of executive functions. Method. Experts (n=8) judged the IADL Profile's content validity and the tool was pilot tested with the target population (n=8). To document the tool's reliability, 30 patients aged 16 to 65 with moderate or severe TBI were recruited. A trained examiner administered the IADL Profile, and three trained judges rated video recordings on two occasions. Results. An eight-task (29-item) test was developed. Comparing ratings of four raters, 95 percent of kappa coefficients indicated moderate to almost perfect agreement, and 94% showed almost perfect intrarater agreement. Implications. The IADL Profile provides occupational therapists with a set of measures of IADL independence with strong preliminary evidence of reliability.

Bottari C, Dassa C, Rainville C, Dutil É. A generalizability study of the Instrumental Activities of Daily Living Profile.

L’auteur présente une nouvelle méthode1 d’analyse des données longitudinales qui pallie les lacunes des techniques et des modèles existants. À partir des caractéristiques propres au changement dans le domaine éducatif et plus particulièrement à ses aspects cognitifs et affectifs, l’importance d’une information portant aussi bien sur la structure globale des données que sur les profils individuels est mise en évidence. La famille de modèles proposée répond à ce besoin en intégrant le domaine des courbes de développement au domaine de l’analyse factorielle. 1. Cette étude a fait l’objet d’une communication au Congrès International de l’A.S.U. à Nancy (France), le 3 juin 1981.

Primary objective: To examine relationships between classical measures of executive functions (EF) and indices of traumatic brain injury (TBI) severity with the IADL Profile, a new performance-based measure of independence in instrumental activities of daily living (IADL) based on EF. This study hypothesized the presence of correlations between classical tests of EF and the IADL Profile, as the latter aims to establish whether the subject's main difficulties pertain to goal formulation, planning, carrying out the task and/or attaining the initial task goal; all important components of EF. Methods and procedures: One hundred subjects with a moderate/severe TBI aged 16-65 years (convenience sample) were recruited. Subjects were tested with the IADL Profile and three measures of EF within their home environment. Data was analysed using Pearson correlations, t-tests and multiple stepwise regressions. Results: Post-traumatic amnesia and working memory emerged as the major determinants of IADL Profile scores. Together, indices of injury severity, measures of EF, education, age and environmental factors accounted for 12-28% of the variance in IADL Profile scores. Conclusions: This study has shown that the IADL Profile's non-structured approach permits the observation of a broad range of behaviours related to EF deficits and thus provides a closer approximation of the person's independence in IADL. Further study is required to demonstrate the IADL Profile's ability to inform more targeted treatment interventions.

Background Mothers who give birth to preterm infants are at increased risk of mortality from coronary heart disease and stroke, but the biological pathways underlying these associations have not been explored.Methods We carried out a case-control study nested in a large (n = 5337) prospective, multicentre cohort. All cohort women had an interview, examination and venipuncture at 24-26 weeks. Frozen plasma samples in spontaneous preterm births (n = 207) and 444 term controls were analysed for plasma homocysteine, folate, cholesterol ( total, low-density lipoprotein and high-density lipoprotein) and thrombin-antithrombin ( TAT) complexes. DNA was extracted and analysed for seven gene polymorphisms involved in thrombophilia or folate or homocysteine metabolism. Fresh placentas were fixed, stained and blindly assessed for histologic evidence of infarction and decidual vasculopathy.Results High ( above the median) plasma homocysteine and HDL cholesterol were significantly and independently associated with the risk of spontaneous preterm birth [ adjusted odds ratios (OR)s = 1.9 (95% 1.1-3.3) and 0.5 (0.3-0.9), respectively]. A higher proportion of women with high homocysteine concentrations had decidual vasculopathy [(13.0 vs 6.8%; OR = 1.9 (1.1-3.5)], although the positive association between decidual vasculopathy and preterm birth did not achieve statistical significance [OR = 1.5 (0.9-2.7)]. No significant associations were observed with the DNA polymorphisms or with plasma TAT or folate levels.Conclusions Similar vasculopathic risk factors may underlie preterm birth and adult coronary heart disease and stroke.

Selective study participation can theoretically lead to selection bias. We explored this issue in the context of a multicentre cohort study of socio-economic disparities in preterm birth. Women with singleton pregnancies were recruited from four large Montreal maternity hospitals and invited to return for an interview, vaginal examination and venepuncture at 24-26 weeks of gestation. We compared the observed preterm birth rate (ultrasound confirmed) among the 5146 cohort women to that expected based on all 108 724 Montreal Census Metropolitan Area (CMA) singleton births for 1998-2000. The observed preterm birth rate in the study cohort was 5.1%, compared with 6.3% in the CMA (P < 0.001) (unadjusted morbidity ratio [95% CI] = 0.80 [0.71, 0.90]). Within each stratum of maternal education and neighbourhood income (the latter based on postal code matched links to the 2001 Canadian census), cohort women had substantially lower rates of preterm birth than women from the CMA. No significant association between socio-economic status (SES) and preterm birth was observed in the study cohort, except among 'indicated' (non-spontaneous) cases. The association between neighbourhood income and preterm birth was biased to the null in the study cohort, with adjusted odds ratios in the poorest vs. richest quintiles of 1.01 [0.63, 1.64] in the cohort vs. 1.28 [1.18, 1.39] in the CMA, although no such bias was observed for the association with maternal education assessed at the individual level. We speculate that the lower-than-expected preterm birth rate and attenuated association between neighbourhood income and preterm birth may be related to selective participation by women more psychologically invested in their pregnancies. Investigators should consider the potential for biased associations in pregnancy/birth cohort studies, especially associations based on SES or race/ethnicity, and carry out sensitivity analyses to gauge their effects.

BACKGROUND:Neither macro- nor micronutrient supplements have been clearly demonstrated to reduce the risk of preterm birth. However, there has been little attention to carotenoids, tocopherols, and long-chain fatty acids other than n-3 polyunsaturates.METHODS:We conducted a case-control study nested in a large (n = 5337) prospective, multicenter cohort. All cohort women had an interview, examination, and venipuncture at 24-26 weeks' gestation. Frozen plasma samples in spontaneous preterm births (n = 207) and approximately 2-term controls per case (n = 443) were analyzed for carotenoids, retinol, tocopherols, and long-chain fatty acids. Fresh placentas were fixed, stained, and assessed (without knowledge of pregnancy outcome) for histologic evidence of infection or inflammation, decidual vasculopathy, and infarction.RESULTS:High (above the median) plasma concentrations of alpha- and beta-carotene, alpha- and beta-cryptoxanthin, and lycopene were all associated with reductions in risk of spontaneous preterm birth, with evidence of dose-response effects across quartiles. Modest increases in risk were observed with elevated total monounsaturated, total polyunsaturated, and total n-6 polyunsaturated long-chain fatty acids concentrations. Paradoxically, a high gamma-tocopherol concentration was associated with increased preterm birth risk (adjusted odds ratio = 1.8 [95% confidence interval = 1.2-2.6]). Only one of the studied micronutrients (lutein) was independently associated with a reduced risk of decidual vasculopathy (0.5 [0.3-0.9]).CONCLUSIONS:Carotenoids and long-chain fatty acids warrant further investigation in in vitro, animal, and human studies of preterm birth.

Abstract: This study examines the usefulness of the Montreal Service Concept framework of service quality measurement, when it was used as a predefined set of codes in content analysis of patients’ responses. As well, the study quantifies the interrater agreement of coded data. Two raters independently reviewed each of the responses from a mail survey of ambulatory patients about the quality of care and recorded whether or not a patient expressed each concern. Interrater agreement was measured in three ways: the percent crude agreement, Cohen’s kappa, and the coefficient of the generalizability theory. We found all levels of interrater code-specific agreement to be over 96%. All kappa values were above 0.80, except four codes associated with rarely observed characteristics. A coefficient of generalizability equal to 0.93 was obtained. All indices consistently revealed substantial agreement. We empirically showed that the content categories of the Montreal Service Concept were exhaustive and reliable in a well-defined content-analysis procedure.

Les liens existant entre la théorie de l’échantillonnage et la validité externe des recherches en sciences humaines, et plus particulièrement en éducation, sont exposés. Une étude sur la nature et la qualité de la généralisation des conclusions présentées dans des thèses de doctorat et des mémoires de maîtrise en psychologie et en sciences de l’éducation de deux universités québécoises sert à illustrer les problèmes d’échantillonnage rencontrés en pratique. L’ampleur et l’importance des lacunes mises en évidence servent de toile de fond à quelques suggestions de correctifs.

Après avoir établi que la méthode classique de construction des tests, basée sur les principes psychométriques, postule la distribution normale des traits mesurés, la possibilité de démontrer que la normalité des traits psychologiques constitue une constante naturelle est écartée. Ensuite, après avoir contesté l’utilisation du postulat de normalité pour certaines formes d’évaluation en éducation, des distinctions sont établies entre principes « édumétriques » et principes psychométriques, entre tests critériés et tests normatifs, entre différences inter-individuelles et différences intra-individuelles. Ces distinctions permettent de voir qu’un instrument élaboré selon les principes psychométriques classiques, postulant la normalité, servira à amplifier les différences inter-individuelles et ne pourra pas être qualifié d’instrument basé sur une erreur scientifique. Toutefois, il est reconnu que certaines utilisations des principes psychométriques en éducation sont inacceptables et que les principes édumétriques sont généralement mieux adaptés aux besoins de l’enseignement et de l’apprentissage.