Wille (1996) proposed an item selection strategy which may be used to maximise, first, the internal consistency and, next, the convergent and discriminant validity of items in multi-dimensional Likert-type questionnaires or scales. In terms of his strategy, the latter aspects of validity are maximised by means of exploratory factor analyses. In this article, it is done by means of Tateneni, Mels, Cudeck and Browne’s (2001) Comprehensive Exploratory Factor Analysis (CEFA) program which implements exploratory factor analysis, but provides the advantages of standard confirmatory factor analysis (e.g., the computation of the standard errors of the rotated factor loadings and measures of “model" fit). The benefits that accrue by using this incremental approach are demonstrated in terms of Allport and Ross’ (1967) Religious Orientation Scale, a widely-used psychological instrument.<p> <strong>Opsomming</strong> <br>Wille (1996) het ’n itemseleksiestrategie voorgestel om eerstens die interne konsekwentheid, en tweedens die konvergente en divergente geldigheid van items in multidimensionele Likert-tipe vraelyste of skale te maksimeer. Volgens sy strategie word laasgenoemde aspekte van geldigheid deur middel van eksploratiewe faktorontledings gemaksimeer. In hierdie artikel, sal dit gedoen word deur Tateneni, Mels, Cudeck en Browne (2001) se program vir Omvattende Eksploratiewe Faktorontleding (CEFA) te gebruik, wat eksploratiewe faktorontleding aanwend, maar ook die voordele van gewone, bevestigende faktorontleding (bv., die berekening van die standaardfoute van die geroteerde faktorbeladings en indekse van modelpassing) bied. Die voordele wat spruit uit die toepassing van hierdie inkrementele benadering word gedemonstreer aan die hand van Allport en Ross (1967) se Religious Orientation Scale, ’n gewilde sielkundige meetintrument

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Acute kidney injury (AKI) following snakebite is common in developing countries and Bothrops genus is the main group of snakes in Latin America. To evaluate the pathogenic mechanisms associated with Bothrops venom nephrotoxicity, we assessed urinary and blood samples of patients after hospital admission resulting from Bothrops snakebite in a prospective cohort study in Northeast Brazil. Urinary and blood samples were evaluated during hospital stay in 63 consenting patients, divided into AKI and No-AKI groups according to the KDIGO criteria. The AKI group showed higher levels of urinary MCP-1 (Urinary monocyte chemotactic protein-1) (median 547.5 vs. 274.1 pg/mgCr; p = 0.02) and urinary NGAL (Neutrophil gelatinase-associated lipocalin) (median 21.28 vs. 12.73 ng/mgCr; p = 0.03). Risk factors for AKI included lower serum sodium and hemoglobin levels, proteinuria and aPTT (Activated Partial Thromboplastin Time) on admission and disclosed lower serum sodium (p = 0.01, OR = 0.73, 95% CI: 0.57–0.94) and aPTT (p = 0.031, OR = 26.27, 95% CI: 1.34–512.11) levels as independent factors associated with AKI. Proteinuria showed a positive correlation with uMCP-1 (r = 0.70, p < 0.0001) and uNGAL (r = 0.47, p = 0.001). FENa (Fractional Excretion of sodium) correlated with uMCP-1 (r = 0.47, P = 0.001) and uNGAL (r = 0.56, p < 0.0001). sCr (serum Creatinine) showed a better performance to predict AKI (AUC = 0.85) in comparison with new biomarkers. FEK showed fair accuracy in predicting AKI (AUC = 0.92). Coagulation abnormality was strongly associated with Bothrops venom-related AKI. Urinary NGAL and MCP-1 were good biomarkers in predicting AKI; however, sCr remained the best biomarker. FEK (Fractional Excretion of potassium) emerged as another diagnostic tool to predict early AKI. Positive correlations between uNGAL and uMCP-1 with proteinuria and FENa may signal glomerular and tubular injury. Defects in urinary concentrations highlighted asymptomatic abnormalities, which deserve further study.

Background: Burnout is prevalent among medical personnel and affects their work environment. This study investigated the level of burnout among registrars and medical officers at public healthcare facilities in Bloemfontein. Methods: An analytical cross-sectional study included registrars and medical officers at four public healthcare facilities in Bloemfontein. Socio-demographic information was collected and participants completed the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalisation and personal accomplishment. Results: Of the 300 potential participants, 205 were included in the result. Only 3.4% of the participants showed no burnout on all three subscales and 28.3% had only low to moderate levels of burnout on all three subscales. A quarter (26.3%) of the participants showed high burnout on one subscale, but not the others. Furthermore, 26.3% showed a high level of burnout on any combination of two of the three subscales. A high degree of burnout on all three subscales was found in 15.6% of the participants. Conclusion: Burnout is a major problem among registrars and medical officers working in public hospitals in Bloemfontein. An action plan needs to be put in place in partnership with the Departments of Health and Higher Education to prevent burnout among an important working cadre.

Background Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the underreporting of registries using the capture-recapture method. Methods This study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and health information management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patientsc haracteristics. Results Totally, 76.24% of SSIs were detected post-discharge. Staphylococcus.aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95% and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552-695) and under-reporting percentage was 63.32%. Conclusions To recognize the trends of SSIs mortality and morbidity in national level, it is signi cant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection prevention and control (IPC) programs and providing updated protocols is recommended.

Aims We aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs. Methods This descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug‐associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF. Results There were 444 drug‐related deaths and 21,296 overdoses during the study period. FTI and CF were well correlated (Spearman's rho 0.64, P < .001). Of the classes of interest, opioids had the highest FTI (40.3 95% confidence interval [CI] 35.2–45.4 deaths per 100 years of use at the defined daily dose or deaths/DDD/100 years) and CF (12.4% 95%CI 11.0–13.9). Fentanyl, methadone and morphine had the highest relative fatal toxicity within this class. Tricyclic antidepressants had the highest relative fatal toxicity of all antidepressants (FTI 14.5 95%CI 9.7–19.3 deaths/DDD/100 years and CF 7.1% [95%CI 4.8–9.3]) and benzodiazepines appeared to be more associated with multiple agent deaths than single. Of the illicit drugs, heroin had the highest CF (26.4%, 95%CI 19.1–33.7). Conclusion Knowledge of relative lethal toxicity is useful to prescribers and medicines and public health policy makers in restricting access to more toxic drugs and may also assist coroners in determining cause of death.

ASI intervention at an early age enhances the developmental progress of premature infants.

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