The theory of Planned Behaviour is one of the models most frequently used in the literature to explore pro-environmental behaviour including recycling, travel mode choice, energy consumption, water conservation, food choice, and ethical investment (Stern, 2000; Staats, 2003). Armitage and Conner (2001) identified its application in 154 different contexts. The Theory of Planned Behaviour (Ajzen, 1988) assumes that the best prediction of behaviour is given by asking people if they are intending to behave in a certain way. Here we note that the intention will not express itself in behaviour if it is physically impossible to perform the behaviour or if unexpected barriers stand in the way. Assuming intention can explain behaviour, how can intention be explained?. According to Azjen, three determinants explain behavioural intention: 1. The attitude (opinions of oneself about the behaviour); 2. The subjective norm (opinions of others about the behaviour); 3. The perceived behavioural control (self-efficacy towards the behaviour).

The Theory of Planned Behaviour

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

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2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.

Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations

Measuring Health: A Guide to Rating Scales and Questionnaires

An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.

Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale

The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88); six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by test-retest correlations of 0.87 (graduate students) and 0.81 (dialysis patients) and Cronbach's alphas of 0.93 (graduate students) and 0.90 (dialysis patients).

Quality of life index: development and psychometric properties.

The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88); six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by test-retest correlations of 0.87 (graduate students) and 0.81 (dialysis patients and Cronbach's alphas of 0.93 (graduate students) and 0.90 (dialysis patients.

[Quality of life index: development and psychometric properties].

The purpose of this study was to examine the psychometric properties of the Quality of Life Index (QLI) (Ferrans & Powers, 1985a). The sample consisted of 349 patients selected randomly from the adult, in-unit hemodialysis patient population of Illinois. Factor analysis was used to examine the underlying factor structure. A four-factors solution best fit the data, indicating that there were four dimensions underlying the QLI: health and functioning, socioeconomic, psychological/spiritual, and family. Factor analysis of the four primary factors revealed one higher order factor, representing quality of life. Construct validity also was supported by the contrasted groups approach. As predicted, it was found that those who had higher incomes had significantly higher quality of life scores on the social and economic subscale. Support for convergent validity was provided by a strong correlation (r = .77) between scores from the QLI and an assessment of life satisfaction. Findings supported the internal consistency reliability of the entire QLI (alpha = .93) and the four subscales (alphas = .87, .82, .90, .77).

Psychometric assessment of the Quality of Life Index.

Purpose: To revise the Wilson and Cleary model of health-related quality of life (HRQoL), with suggestions for applying each of the components, and to facilitate the use of HRQoL in nursing and health care.

Organizing Construct: HRQoL, based on relevant literature over the past 20 years.

Methods: The original model was revised in three substantive ways: (a) indicating that biological function is influenced by characteristics of both individuals and environments; (b) deleting nonmedical factors; and (c) deleting the labels on the arrows that tend to restrict characterization of the relationships.

Findings: Theoretical background is provided for each of the major components of the model, and examples of instruments to measure them, were added.

Conclusions: In quality-of-life research, the current challenge is to devise models to clarify the elements of health-related quality of life (HRQOL) and the causal relationships among them. This revision of Wilson and Cleary's model includes a taxonomy of the variables that often have been used to measure HRQoL. This revision should be useful in research and clinical practice.

Carol Estwing Ferrans

Papers

Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale

Quality of life index: development and psychometric properties.

[Quality of life index: development and psychometric properties].

Psychometric assessment of the Quality of Life Index.

Conceptual Model of Health-Related Quality of Life