Addressing confounding errors when using non-experimental, observational data to make causal claims

In their recent book, Is Inequality Bad for Our Health?, Daniels, Kennedy, and Kawachi claim that to “act justly in health policy, we must have knowledge about the causal pathways through which socioeconomic (and other) inequalities work to produce differential health outcomes.” One of the central problems with this approach is its dependency on “knowledge about the causal pathways.” A widely held belief is that the randomized clinical trial (RCT) is, and ought to be the “gold standard” of evaluating the causal efficacy of interventions. However, often the only data available are non-experimental, observational data. For such data, the necessary randomization is missing. Because the randomization is missing, it seems to follow that it is not possible to make epistemically warranted claims about the causal pathways. Although we are not sanguine about the difficulty in using observational data to make warranted causal claims, we are not as pessimistic as those who believe that the only warranted causal claims are claims based on data from (idealized) RCTs. We argue that careful, thoughtful study design, informed by expert knowledge, that incorporates propensity score matching methods in conjunction with instrumental variable analyses, provides the possibility of warranted causal claims using observational data.     

The dark side of Instagram: Predictor model of dysmorphic concerns

Background/ObjectiveDysmorphic concern are excessive preoccupation about one or several physical characteristics perceived as defects, usually unnoticeable by others. This study was intended to explore the relationship between Instagram use and dysmorphic concerns through appearance-related comparisons, ideas of reference and problems with emotion regulation, and find out whether this relationship is moderated by gender. Method: The sample was comprised of 796 participants (M_age = 22.49; SD = 3.56; 54% women). Results: The results showed a non-significant direct effect between Instagram use and dysmorphic concerns. However, the relationship between these variables was statistically significant through appearance-related comparisons, ideas of reference about “laughing, commenting” and difficulties in emotion regulation. Gender did not moderate any relationship. Conclusions: Men and women who made the most use of Instagram were equally vulnerable to dysmorphic concerns when they tended to compare their appearance with other users, had problems regulating their emotions, and showed interpretative biases related to the belief that others could make comments about them or laugh at them because of their imperfections. The implications of the study are discussed.     

Assessment of Person-Centered Care in Gerontology Services: A new tool for healthcare professionals

Background/Objective: Retirement homes and other gerontology services are frequently criticized due to their lack of flexibility and tailored attention, leading to homogeneous treatment which compromises patients’ control of their lives. This study aims to develop and validate the first Spanish instrument for healthcare professionals to assess the degree of person-centered attention delivered by senior care centers. Method: A total of 844 healthcare professionals (mean age = 39.94 years old; SD = 10.56) with a mean of 6.56 years (SD = 6.15) of work experience participated in the study. The psychometric properties of the questionnaire developed were analyzed using both classical test theory and item response theory models. Results: The internal structure was unidimensional with an explained variance of 55.23%. Reliability was outstanding: internal consistency (α = .96, ω = .96) and test-retest (r = .88; ICC = .93). The total score was significantly correlated with two similar questionnaires, with associated variance of 58.83% and 55.20% respectively. Conclusions: The new instrument allows healthcare professionals to assess the level of person-centered care provided by gerontology centers with excellent reliability and validity.     

Development of the Spanish short version of Negative Attitudes Toward Masturbation Inventory

Background/Objective: Masturbation has historically been a sexual behaviour associated with negative connotations, as a consequence of traditional orthodox positions, despite its positive impact on health. The instruments developed to measure the attitude towards masturbation are scarce, and none of them have been validated in the Spanish adult population. This study aims to propose a short version of the Negative Attitudes Toward Masturbation Inventory (NATMI) and examine their psychometric properties (reliability and evidence of validity) in the Spanish adult population. Method: A total of 4,116 heterosexual adults aged 18-83 years (M = 40.58; SD = 12.24; 54.64% women) participated in the study. In addition to the NATMI, they answered other scales to assess sexual attitudes, sexual desire, propensity to become sexually excited/inhibited and sexual functioning. Results: Analysis of the construct validity of the NATMI resulted in a reduced version of ten items grouped into a single factor explaining 66% of the variance (ordinal alpha = .95). The evidence of validity is clear, as subjects with negative and positive attitude towards masturbation differed in religiousness, frequency of masturbation, erotophilia, positive attitude towards sexual fantasies, sexual inhibition and sexual functioning. Conclusions: The Spanish short version of NATMI provides reliable and valid measures in the Spanish adult population.     

Was that (cyber)bullying? Investigating the operational definitions of bullying and cyberbullying from adolescents’ perspective

Background/Objective: Despite the great interest that bullying and cyberbullying have received during the last decades, the problem of defining these phenomena is still debated. Recently, this discussion has also been articulated in terms of how young people who are directly involved in bullying and cyberbullying understand these notions. This study aimed at investigating the operational definitions of both bullying and cyberbullying provided by adolescent victims and perpetrators, by inquiring the weight of traditional criteria (i.e., frequency, deliberateness, imbalance of power, and harm) as well as dominance in the perception of these phenomena. Method: A total of 899 students aged between 11 and 16 years filled out the Student Aggression and Victimisation Questionnaire. Results: Common traits and differences between the operational definition of bullying and cyberbullying and between the perspectives of victims and perpetrators of aggression were found. The most relevant criterion for the perception of both these phenomena was clearly the presence of dominance. By contrast, the imbalance of power showed no significant relationship with the perception of being bullied or bullying others both offline and online. Conclusions: Findings emphasise that young people conceptualise bullying with a clear reference to relational and group processes, rather than to individual differences.     

Satisfaction of Health Science teachers with the convergence process of the European Higher Education Area

The European Higher Education Area (EHEA) has implied a major transformation of university studies in European countries. The aim of this study was to assess the satisfaction of university teachers in the area of Health Sciences with the convergence process to determine positive and negative aspects in their practices. The sample was composed of 1,361 teachers of Spanish public universities. They all participated in an ad hoc survey that included questions pertaining to the following issues: a) personal and professional information, b) general and institutional aspects, c) aspects related to teaching, research, and administrative work, d) methodology and the teaching-learning process, e) assessment of students, f) training of teachers, and g) coordination, organization, and resources at the school. Results reveal that teachers are not totally satisfied with the way the EHEA is being established. In conclusion, certain changes would be necessary to achieve real convergence between countries.     

Development and validation of the Granada Burnout Questionnaire in Spanish police

The goal of the present study is to develop a questionnaire, with proper psychometric properties and current norms, to evaluate the burnout syndrome in Spain. The operative definition of burnout proposed by Maslach and Jackson is used to define three dimensions (Emotional exhaustion, Depersonalization and Personal accomplishment). A total of 2,403 national Spanish police participated. Evidence of construct validity was checked through cross validation (showing a good fit of the three factors model to the data). Using the MBI, NEO-FII and CECAD evidence of convergent validity and criteria validity were developed (showing that the relations are similar to the ones that appear in other research). The discrimination, mean, standard deviation, and typical error of the average of the items composing the various dimensions were analyzed. Both the Cronbach's alpha coefficient and the conditional standard error of measurement (CSEM) were calculated for each of the dimensions. The results showed good internal consistency (all α values > .85). Finally, the questionnaire was scaled using T scores. The psychometrical properties reported here support the use of this new questionnaire for the burnout evaluation in Spanish police.     

Q-Coh: A tool to screen the methodological quality of cohort studies in systematic reviews and meta-analyses

The evaluation of the methodological quality of primary studies in a systematic review is a key process to enhance the likelihood of achieving valid results. When considering non-randomized designs as cohort studies, this process becomes even more critical, since these designs are more susceptible to bias than randomized controlled trials are. Taking this into account, a tool, named Q-Coh, was designed with the aim to screen the methodological quality of the primary studies with a cohort design priming specificity over sensitivity in a reasonable application time. After applying it to 21 prospective cohort studies by three raters, all domains had a moderate to good agreement, with all except one of them having statistically significant kappa values. Despite there is no gold standard for the methodological quality, arguments supporting its validity are given. Future research should assess the psychometric properties of Q-Coh in the context of real meta-analyses, evaluate the influence of the raters’ substantive and methodological expertise on these properties, and explore different ways of including the domains-based ratings of the quality provided by Q-Coh into meta-analyses.     

Using online social media,Facebook, in screening for major depressive disorder among college students

This study explored the feasibility of using Internet social networking media in an online program for Major Depressive Disorder (MDD) screening and psychoeducation targeting college students. A Facebook advertisement targeted students at five colleges in the United States to complete a mental health research survey that screened for MDD using the Patient Health Questionnaire-9 (PHQ-9). Students who screened positive for MDD were offered an eightweek follow-up survey. Of the 259 students who consented to participate in the study, 26.7% screened positive for MDD, while only 14.2% were receiving treatment. The use of Facebook to advertise for online screening for MDD required very little start-up time, and the average cost was $11.45 per subject recruited. It is feasible to use online, commercially available social networking media such as Facebook for online screening for MDD among college students. However, conducting online screening and offering treatment resources alone did not increase treatment rate in this population.     

Rats learn to eat more to avoid hunger

Several recent experiments have provided evidence that the ingestion of a distinctive food by rats can be a learnt instrumental act as well as an associatively conditioned reaction. In the previous work, maintenance food was withheld for shorter and longer durations on different days following access to the training food. Extra eating before the longer fast was interpreted as avoidance of hunger. This interpretation was based on the evidence showing that extra eating as a result of classical conditioning comes from pairing food stimuli with the presence of little or no hunger because of repletion with energy nutrients. The theory that the extra eating arose from a response-depletion contingency was tested in the present experiment by training rats on only a long fast or only a short fast. Greater increase in intake was seen before the longer fast. The results also replicated previously seen cycles of increase, decrease, and renewed increase in putative deficit-avoidant eating over about three trials, indicating that the extra eating reduces the response-reinforcing hunger and that the consequent part-extinction restores reinforcement. The shape of the learning curve was consistent with these cycles occurring from the start of training, further supporting the view that the increase in food intake before a long delay in refeeding is hunger-reinforced instrumental behaviour.