[pt] O Ages e Stages Questionnaire Terceira Edição na tradução para o português-BR (ASQ3-BR) é um teste de rastreio usado para avaliar o desenvolvimento de crianças na idade pré-escolar (8 a 60 meses) em cinco áreas do desenvolvimento: Comunicação Coordenação Motora Ampla, Coordenação Motora Fina, Resolução de Problemas e Pessoal e Social, tendo sido aplicado pela Secretaria de Educação do Rio de Janeiro em 124.292 crianças de 468 creches públicas do município do Rio de Janeiro, nos anos de 2010, 2011 e 2012. Foi realizada uma análise estatística dos escores obtidos de cada criança para identificação dos dados normativos de interpretação através das médias e desvios padrão bem como os percentis de 5 porcento e 10 porcento. Esses resultados foram comparados com os valores normativos estabelecidos pelo instrumento original americano, para se confirmar suas propriedades psicométricas e identificar diferenças dos resultados obtidos. Numa segunda abordagem, os escores foram avaliados na sua consistência interna através dos coeficientes de Alfa de Cronbach e da Correlação Item-Total para identificação de possíveis discrepâncias do instrumento com o reflexo na sua fidedignidade quando aplicado em ambiente de creche. Os resultados comprovaram que embora o ASQ3-BR seja um bom instrumento tendo as mesmas propriedades psicométricas da versão original em inglês, é passível de ter sua fidedignidade aumentada quando aplicado em ambiente de creches pela adaptação de alguns itens que possam levar em consideração os procedimentos operacionais específicos dessas creches. / [en] The Ages and Stages Questionnaire Third Edition in translation to Portuguese-BR (ASQ3-BR) is a screening test used to evaluate the development of children in pre-school age (8-60 months) in five areas of development: Communication Coordination Wide motor, coordination motor Fine, Troubleshooting and Personal and Social and applied by the Secretariat of the Rio de Janeiro Education 124,292 children in 468 public kindergartens in the city of Rio de Janeiro, in the years 2010, 2011 and 2012. A statistical analysis of the scores was carry on of each child in order to identify the normative interpretation through the means and standard deviations as well as 5 percent and 10 percent percentiles. These results were compared with normative values of American original instrument, to confirm its psychometric properties and identify differences between results. In a second approach, the scores were assessed on their internal consistency using the coefficients of Cronbach s Alpha and Correlation Item-Total to identify possible instrument s discrepancies with the reflection in its reliability when applied in day care environment. The results showed that although the ASQ3-BR is a good instrument with same psychometric properties of the original English version, is likely to have increased their reliability when applied in day care environment by adapting some items that can take into account the day care specific operational procedures.

Background: Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease characterized by the loss of motor neurons. Preference-based measures (PBMs) of health-related quality of life (HRQL) can be utilized for cost-effectiveness analyses of interventions in individuals with ALS. However, current measures are generic (GPBMs) and the psychometric properties of these measures have not yet been evaluated in ALS. Purpose: The purpose of this thesis was to evaluate the psychometric properties of GPBMs in ALS by 1) conducting a systematic review of the psychometric properties of GPBMs, and 2) assessing the content and convergent validity of GPBMs in ALS. Methods: Two studies were conducted. First, a systematic review was performed, and four databases were searched to identify studies that used and reported on the psychometric properties of GPBMs in ALS. Second, participants were recruited from three clinical sites across Canada and outcome measures were administered through an online or hardcopy survey. Areas of importance to the HRQL of individuals with ALS were identified using the Patient Generated Index (PGI), mapped against GPBMs to determine their coverage and scores were compared to determine convergent validity. Results: For the first study, the EQ-5D-3L was found to be the most commonly used GPBMs in ALS. It demonstrated convergent and known-groups validity however, significant floor effects were observed. For the second study, results indicated that the majority of GPBMs identified approximately half of the areas impacted by ALS. In addition, there were several domains not identified by GPBMs. Conclusion: This thesis highlights the importance of complete psychometric evaluation of measures in ALS. There is the need for the development of an ALS specific preference-based measures that reflects the health concerns of individuals with ALS; as GPBMs used in ALS were evaluated and deemed to be lacking in support for their usage in ALS. / Thesis / Master of Science Rehabilitation Science (MSc) / Amyotrophic Lateral Sclerosis (ALS) is a fatal disease that causes individuals to lose their strength and eventually the ability to speak, eat, move and breathe. Questionnaires can be used to understand the health-related quality of life (HRQL) of individuals with ALS however these measures do not always reflect the experiences of these individuals. The goal of this dissertation was to identify whether measures truly capture areas important to individuals with ALS. In our studies, we found that there is little proof in the accuracy of measures used. In addition, the measures do not fully capture the areas of life important to individuals with ALS. This is important to help researchers and health care professionals understand the effects of ALS on HRQL. These results will help them determine which treatments are worthwhile and the best to use in practice and provide recommendations for future research.

Yes / Objective: To examine score validity and reliability of a Child version of the 21-item Three-Factor Eating Questionnaire (CTFEQ-R21) in a sample of Canadian children and adolescents and its relationship with body mass index (BMI) z-scores and food/taste preferences. Design: Cross-sectional study. Setting: School-based. Subjects: 158 children, 63 boys (11.5±1.6 years) and 95 girls (11.9±1.9 years). Results: The exploratory factor analysis revealed that the CTFEQ-R21 was best represented by four factors with item 17 removed (CFFEQ-R20) representing Cognitive Restraint (CR), Cognitive Uncontrolled Eating (UE 1), External Uncontrolled Eating (UE 2), and Emotional Eating (EE) and accounted for 41.2% of the total common variance, with good scale reliability. ANOVAs revealed that younger children reported higher UE 1 scores and CR scores compared to older children, and boys who reported high UE 1 scores had significantly higher BMI Z-scores. Children with high UE 1 scores reported a greater preference for high protein and fat foods, and high-fat savoury (HFSA) and high-fat sweet (HFSW) foods. Higher preference for high protein, fat, and carbohydrate foods, and HFSA, HFSW, and low-fat savoury foods was found in children with high UE 2 scores. Conclusions: This study suggests that the CFFEQ-R20 can be used to measure eating behaviour traits and associations with BMI z-scores and food/taste preferences in Canadian children and adolescents. Future research is needed to examine the validity of the questionnaire in larger samples and in other geographical locations, as well as the inclusion of extraneous variables such as parental eating or socio-economic status.

[pt] Introdução: Transtornos de ansiedade representam uma das mais comuns e debilitantes formas de psicopatologia na infância e adolescência. O desenvolvimento de instrumentos psicométricos voltados para a identificação de sintomas ansiosos precocemente pode se configurar em um interessante investimento na prevenção de prognósticos desfavoráveis ao longo do tempo. Objetivo: Avaliar o nível de ansiedade em crianças e adolescentes do Rio de Janeiro. Método: A escala MASC-VB foi aplicada juntamente com a escala RCMAS e o CDI em uma amostra composta por 317 sujeitos, com idades entre 8 e 16 anos, sendo 48 pacientes ambulatoriais e 269 estudantes, moradores da Rocinha e de outras localidades. Resultados: A escala mostrou características satisfatórias de consistência interna, validade discriminante, validade convergente e validade de critério. Os resultados apresentados são compatíveis com os obtidos no estudo de validação da escala no Brasil e com os estudos realizados com a versão original. Foram observados escores elevados de ansiedade em crianças e adolescentes moradores da Rocinha, compatíveis ou superiores aos encontrados na amostra de pacientes ambulatórias. Conclusão: A MASC é uma das escalas mais difundidas mundialmente para avaliar a presença de sintomas de ansiedade em crianças e adolescentes. Os dados obtidos com este estudo confirmam o bom desempenho psicométrico da escala para uso na população brasileira. Novos estudos se fazem necessários para melhor explicar os níveis elevados de ansiedade identificados na população geral, em especial na amostra extraída da Rocinha. / [en] Anxiety disorders represent one of the most common and debilitating forms of psychopathology in children and adolescents. A way to prevent from a bad prognosis is to develop assessment tools that are able to identify the anxious phenomenon as soon as possible, at any time or culture. Objective: To evaluate the anxiety levels in children and adolescents from Rio de Janeiro. Method: Using a clinical sample of 48 outpatients and a community sample of 269 children and adolescent (8-16 years old) who lived in Rocinha and other localities, the MASC-BV and other psychometric tools were completed. Results: The MASCBV exhibited strong internal reliability, demonstrated good discriminative validity, good convergent validity and good criterion validity. The results are comparable to those presented in the validation study of the MASC in Brazil and to the first studies of the scale. As expected, high levels of anxiety symptoms were found in girls. Not expected, the higher scores in MASC-VB in the sample from Rocinha. Conclusion: The MASC is one of the most world-wide used scale to measure anxiety in children and adolescents. The results indicate good psychometric properties that shows it can be a useful measure to Brazilian population. New studies are necessary to better understand the high levels of anxiety in the community sample, specially in the Rocinha group.

Recent political and social changes in South Africa have created the need for culture-fair tests for cross-cultural measurement of cognitive ability. This need has been highlighted by the professional, legal and research communities. For cognitive assessment, dynamic assessment is more equitable because it involves a test-train-retest procedure, which shows what performance levels individuals are able to attain when relevant training is provided. Following Binet’s thinking, dynamic assessment aims to identify those individuals who are likely to benefit from additional training. The theoretical basis for learning potential assessment is Vygotsky’s concept of the zone of proximal development. This thesis describes the development, standardisation and evaluation of the Learning Potential Computerised Adaptive Test (LPCAT), for measuring learning potential in the culturally diverse South African population by means of nonverbal figural items. In accordance with Vygotsky’s view, learning potential is defined as a combination of present performance and the extent to which performance is increased after relevant training. This definition allows for comparison of individuals at different levels of initial performance and with different measures of improvement. Computerised adaptive testing based on item response theory, as used in the LPCAT, is uniquely suitable for increasing both measurement accuracy and testing efficiency of dynamic testing, two aspects that have been identified as problematic. The LPCAT pretest and the post-test are two separate adaptive tests, hence eliminating the role of memory in post-test performance. Several multicultural groups were used for item analysis and test validation. The results support the LPCAT as a culture-fair measure of learning potential in the nonverbal general reasoning domain. For examinees with a wide range of ability levels, LPCAT scores correlate strongly with academic performance. For African examinees, poor proficiency in English (the language of teaching) hampers academic performance. The LPCAT ensures the equitable measurement of learning potential, independent of language proficiency and prior scholastic learning and can be used to help select candidates for further training or developmental opportunities. / Psychology / D. Litt. et Phil. (Psychology)

Recent political and social changes in South Africa have created the need for culture-fair tests for cross-cultural measurement of cognitive ability. This need has been highlighted by the professional, legal and research communities. For cognitive assessment, dynamic assessment is more equitable because it involves a test-train-retest procedure, which shows what performance levels individuals are able to attain when relevant training is provided. Following Binet’s thinking, dynamic assessment aims to identify those individuals who are likely to benefit from additional training. The theoretical basis for learning potential assessment is Vygotsky’s concept of the zone of proximal development. This thesis describes the development, standardisation and evaluation of the Learning Potential Computerised Adaptive Test (LPCAT), for measuring learning potential in the culturally diverse South African population by means of nonverbal figural items. In accordance with Vygotsky’s view, learning potential is defined as a combination of present performance and the extent to which performance is increased after relevant training. This definition allows for comparison of individuals at different levels of initial performance and with different measures of improvement. Computerised adaptive testing based on item response theory, as used in the LPCAT, is uniquely suitable for increasing both measurement accuracy and testing efficiency of dynamic testing, two aspects that have been identified as problematic. The LPCAT pretest and the post-test are two separate adaptive tests, hence eliminating the role of memory in post-test performance. Several multicultural groups were used for item analysis and test validation. The results support the LPCAT as a culture-fair measure of learning potential in the nonverbal general reasoning domain. For examinees with a wide range of ability levels, LPCAT scores correlate strongly with academic performance. For African examinees, poor proficiency in English (the language of teaching) hampers academic performance. The LPCAT ensures the equitable measurement of learning potential, independent of language proficiency and prior scholastic learning and can be used to help select candidates for further training or developmental opportunities. / Psychology / D. Litt. et Phil. (Psychology)

Assessment in patients with NMD consists principally of measures of motor impairment since they are well known by clinicians and their measures do not require much equipment. The conventional treatments in patients with NMD are above-all focused on the diminution of motor impairments by maintaining or improving joint mobility, muscle strength and endurance. Nevertheless, a reduction of motor impairments does not directly lead to a higher ability in performing daily activities. Therefore, activity limitations should be measured specifically. A new scale of activity limitations was first developed in children and adults with NMD. The use of the Rasch model provided a scale to assess the fundamental psychometric qualities. Secondly, relationships between motor impairments and activity limitations were investigated to verify the assumption that reduced motor impairments do not necessarily lead to higher activity levels. Finally, to complete the investigation of psychometric qualities, a longitudinal study of the developed questionnaire was carried out to evaluate its sensitivity to change. Chapter 1 presents the development of ACTIVLIM, a Rasch-built measure of activity limitations and its validation in children and adults with NMD. ACTIVLIM is a self-reported questionnaire that assesses the difficulties adult patients and parents of affected children perceive when they or their children perform daily activities. This questionnaire originally included 126 daily activities and was submitted to 369 patients. The Rasch model selected 22 daily activities to define a linear and unidimensional measure of activity limitations in patients with NMD. The validity and the reproducibility of the results were also studied. A second section of Chapter 1 demonstrates why the measure of activity limitations in children with NMD as assessed using the ACTIVLIM questionnaire is based upon the perception of their parents. A third section of Chapter 1 compares the difficulties self-perceived by the patients with the difficulties observed by external examiners. The agreement between both measures is very good, indicating that the use of ACTIVLIM as a self-reporting questionnaire is a valid method to assess activity limitations in patients with NMD. Chapter 2 investigates the relationships between motor impairments and activity limitations as measured with the ACTIVLIM questionnaire. As the anatomical basis and pathophysiology are different from one NMD to another, the relationships between impairments and activity limitations were investigated in six main diagnostic groups and in the whole sample without diagnostic distinction. Gait speed and muscle weakness in proximal and flexor muscle groups were significantly but moderately correlated to the activity limitations, indicating that the latter cannot simply be inferred from motor impairments but should be independently measured and treated. Chapter 3 investigates the sensitivity to change of the ACTIVLIM questionnaire. As NMD are progressive disorders, it is important that the ACTIVLIM questionnaire be able to assess the change over time in the activity level of patients with NMD in order to characterize the disease course and to quantify the effects of new treatments on activity limitations in these patients. Finally, the last section discusses the results of the different chapters and presents perspectives for future research.

Introduction : L’évaluation des apprentissages a une importance indéniable en pédagogie des sciences de la santé et l’utilisation d’examens écrits est omniprésente, notamment en médecine. Toutefois, l’élaboration d’évaluations de haute qualité est souvent un défi pour les rédacteurs et les programmes. Il est donc important d’identifier des stratégies qui pourraient faciliter le travail des rédacteurs tout en ayant un impact positif sur la qualité des questions écrites, notamment l’utilisation de consignes lors de la rédaction. Méthodologie : Nous avons élaboré une liste de consignes de rédaction de questions d’examens par un processus itératif et rigoureux. 14 consignes discriminantes ont été retenues. À l’aide d’une étude de cas multiples, nous avons exploré l’utilisation de ces consignes de rédaction de questions auprès de quatre rédacteurs pour des examens d’un programme préclinique de médecine. Un questionnaire et une entrevue individuelle semi-dirigée ont été effectués pré et post utilisation des consignes. Les unités d’analyses et de comparaison étaient : la qualité et les propriétés psychométriques des questions pré et post utilisation des consignes, l’acceptabilité et l’utilisation de celles-ci. Résultats : Pour tous les participants, les questions rédigées respectaient majoritairement les consignes de rédaction. Quoique non statistiquement significative, nous avons observé une légère augmentation du coefficient de discrimination chez les rédacteurs (2 sur 4) qui utilisaient les consignes de manière active. Nos résultats suggèrent que l’appropriation que font les rédacteurs des consignes semble influencer leur perception de l’utilité et de l’acceptabilité des consignes. Conclusion : Les résultats obtenus semblent suggérer que l’utilisation d’une liste circonscrite de consignes de rédaction offre une bonne stratégie à adopter pour améliorer la qualité des questions. Les rédacteurs de questions qui sont mieux outillés et qui semblent adopter pleinement l'utilisation des consignes de rédaction y voient les impacts positifs sur la qualité de leurs questions. / Abstract : Introduction : The assessment of learners has an undeniable importance in health professions education and the use of written exams is omnipresent, notably in medicine. However, developing high-quality assessment is often a challenge for administrators and exam developers. It is therefore important to identify strategies that could facilitate their work while having a positive impact on the quality of the written exam questions, including the use of guidelines when developing exams. Methodology : We created a list of item-writing guidelines through a rigorous and systematic process. We identified 14 discriminant guidelines. Using a multiple case study, we explored the use of those questions writing guidelines with four exam developers at the preclinical phase of an undergraduate medicine program. A questionnaire was completed and a semi-directed individual interview was carried out before and after the use of guidelines. The units of analysis and comparison were: the quality and psychometric properties of questions pre- and post-use of the guidelines, the acceptability and the use of these guidelines. Results : For all the participants, the written questions respected mostly the instructions of drafting. Although not statistically significant, we observed a slight increase in the coefficient of discrimination among editors who actively used the instructions. Our results suggest that participants’ appropriation of the item-writing guidelines seemed to influence their perception of the usefulness and acceptability of instructions. Conclusion : The results seem to suggest that the use of a narrow list of writting guidelines provides a good strategy for improving the quality of the questions. Exam developers that are better equipped and seem to fully adopt the use of drafting guidelines see the positive impacts on the quality of their questions.

<b>Introduction:</b> Health-related websites have developed to be much more than information sites: they are used to exchange experiences and find support as well as information and advice. It is important that health professionals and website developers understand how content may impact users. This thesis documents the development and application of a tool to measure the impact of using health-related websites which contain experiential and/or factual information. <b>Methods:</b> A multi-method study with five stages. Stage 1: Questionnaire items based upon themes relating to the impact of using health-related websites were constructed following qualitative secondary analysis of 93 interviews relating to patient and carer experiences of health and a recent literature review. Items were assessed by an expert panel. Stage 2: Cognitive interviews were carried out to confirm acceptability of items. Stage 3: Item reduction steps were used to reduce the number of items. Stage 4: The validity and reliability of the remaining items were tested using traditional and modern psychometric methods. Stage 5: The new questionnaire was piloted in a randomised controlled trial. <b>Results:</b> Eighty-two items were constructed according to the key themes identified in Stage 1. Following expert and patient refinement, two independent item pools entered psychometric testing. The first item pool related to general views of using the internet in relation to health and the second item pool related to the impact of using a specific health-related website. Sub-scales and summary scores were found to have high construct validity, internal consistency and test-retest reliability. The questionnaire showed high completion rates and low counts of missing data in a trial setting. <b>Conclusion:</b> Analysis confirmed good psychometric properties in the eHIQ-Part 1 (11 items) and the eHIQ-Part 2 (26 items). Preliminary findings of trial data demonstrate the acceptability and feasibility of including the eHIQ in randomised controlled trials. This tool will enable the measurement of the impact of health-related websites containing various styles of information and support across a range conditions and facilitate their accurate evaluation in clinical trials.

The study’s aim was to obtain evidence of validity of the Learning Self-Regulation Questionnaire (LSRQ) internal structure and to verify metric invariance compared with a previous research study. The participants were 237 university students from the first three academic semesters of a private university in three Peruvian cities (two in the North of Peru, and one in Lima). The analysis was performed by a semi-confirmatory factor analysis, specifying as comparison matrix: a) the configuration derived from a previous study, and b) the free estimation loadings factors. The results indicate that two dimensions represent the instrument structure satisfactorily; but the metric invariance compared to a previous study was not satisfactory. The re-specification of the model, by removing two items with factorial complexity problems and the free estimation of the items, was successful. These results are discussed so as to the interpretation of their scores and the lack of metric invariance. / El objetivo del estudio fue obtener evidencias de validez de la estructura interna del Cuestionario de Autorregulación del Aprendizaje (Learning Self-Regulation Questionnaire; LSRQ) y verificar la invarianza métrica comparada con un estudio previo. Los participantes fueron 237 estudiantes universitarios de los tres primeros ciclos académicos de una universidad privada, procedentes de tres ciudades del Perú (dos del norte y una de Lima). El análisis se realizó mediante un análisis factorial semiconfirmatorio, especificando como matriz de comparación (a) la configuración derivada de un estudio previo, y (b) la estimación libre de las cargas factoriales. Los resultados indican que dos dimensiones representan satisfactoriamente la estructura del instrumento; pero la invarianza métrica respecto a un estudio previo no fue satisfactoria. La reespecificación del modelo, mediante la eliminación de dos ítems con problemas de complejidad factorial y la estimación libre de los ítems, obtuvieron resultados satisfactorios. Se discuten estos resultados en el marco de la interpretación de sus puntajes y la falta de invarianza métrica.