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It is shown how to overcome a new missing data problem in survival analysis. Iterative nonparametric techniques are utilized and the missing data information is both estimated and used for further estimation in each iterative step. Theory is developed and a good finite sample performance is illustrated by simulations. The main motivation is an application to French data on the temporal development of the number of hospitalized Covid-19 patients.

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Introduction: The Transgression-Related Interpersonal Motivations Inventory (TRIM-18) is an instrument that assesses episodic forgiveness composed of three subscales: avoidance, revenge and benevolence. In the present study we examined the dimensionality of the Spanish version of the TRIM-18 (TRIM-18-S). We provided evidences of estimated reliability and construct validity of the interpretation of the scores. Method: A total of 943 participants completed the TRIM-18-S. A subset of 94 participants completed the measure again to allow computation of two-week estimated temporal stability, and 277 participants completed additional measures of empathy, anger, and information regarding the relation with the offender to allow computations supporting construct validity. Results: The TRIM-18-S showed good psychometric properties. Confirmatory factor analysis revealed a three-factor structure. Alphas ranged from .80 to .90. Two week estimated test-retest correlations ranged from .74 to .84. Construct validity was supported by correlations with a single-item measuring forgiveness and with empathy, state anger, and closeness and type of relationship. Conclusions: The scale presents adequate psychometric properties for its potential use in Spanish population (AU)

Introducción: La escala Transgression-Related Interpersonal Motivations (TRIM-18) es un instrumento diseñado para evaluar perdón específico compuesto por tres subescalas: evitación, venganza y benevolencia. En el presente estudio se examina la dimensionalidad de la versión española del TRIM-18 (TRIM-18-S). Se presentan evidencias de fiabilidad y de validez de constructo de la interpretación de las puntuaciones. Método: Un total de 943 sujetos completaron el TRIM-18-S. Una submuestra de 94 participantes completaron la escala otra vez dos semanas después para el cálculo de la estabilidad temporal, y 277 participantes completaron medidas adicionales de empatía, ira e información relacionada con el tipo de ofensor para el cálculo de la validez de constructo. Resultados: El TRIM-18-S mostró buenas propiedades psicométricas. El análisis factorial confirmatorio reveló una estructura tridimensional. Los valores del alfa de Cronbach variaron entre .80 y .90. Los valores obtenidos para la fiabilidad test-retest variaron entre.74 y .84. Se hallaron evidencias de validez de constructo a partir de las correlaciones con el ítem único de medida de perdón y con empatía, ira, cercanía con el ofensor y tipo de relación. Conclusiones: La escala presenta propiedades psicométricas adecuadas para su uso en población español (AU)

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PURPOSE: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: This is a prospective case series. SETTING: The study was set at an outpatient clinic in a general hospital. PATIENTS: Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the video-oculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver. INTERVENTION: Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent. MAIN OUTCOME MEASURES: The main outcome measure is the number of patients without pDBN at 30 and 180 days. RESULTS: Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers. CONCLUSIONS: Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation.

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CONCLUSION: Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. OBJECTIVE: To analyse the video-oculographic findings of positional tests in patients with BPPV. MATERIAL AND METHODS: Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix-Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. RESULTS: Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix-Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.

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A prospective cohort study was designed to evaluate the long-term outcome and health-related quality of life (HRQoL) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) treated by the particle repositioning maneuver (PRM) in the outpatient clinic of a general community hospital. Fifty individuals with PC-BPPV were included, and 45 (90%) completed the study. The diagnosis was based on the history of short episodes of vertigo and a positional nystagmus during the Dix-Hallpike test (DHT). All patients were treated by a single PRM, and relapses were evaluated by DHT at 30, 180 and 360 days post-treatment; a new PRM was performed if the DHT was positive. The main outcome measures were: percentage of patients with a negative DHT after treatment, scores obtained on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) before and 30, 180 and 360 days post-treatment. The DHT was found negative in 80% (40/50) of individuals at 30 days. Ten, seven and five patients presented a positive DHT at 30, 180 and 360 days, respectively. Persistent BPPV was observed in 5% (2/50) of patients at 360 days, despite repeated PRM. Relapses (DH+ after successful PRM) were observed in 7.5% (3/50) at 180 days and 360 days. Both questionnaires showed a reliability Cronbach's alpha >0.7. The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for all scales except for vitality. After PRM, patients improved their scores with both instruments, indicating a restoration of HRQoL at 30 days. Physical dimension scores of the SF-36 improved from day 30 to 360. DHI-S scores were statistically better after PRM (P < 0.001). Our results show that the effectiveness of PRM is 88% after 1 year of follow-up. Patients with BPPV experienced a decrease in HRQoL, which was restored after PRM. Although relapses were observed in 7.5% of individuals, they did not affect HRQoL.

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BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness within the geriatric population causing disability. The diagnosis is established by the position-induced rotatory nystagmus, related to the involved ear, demonstrated by the Dix-Hallpike test (DHT). Although the Epley's modified manoeuvre, or particle respositioning manoeuvre (PRM), is an effective treatment for this disorder, its impact on health outcome in patients over 60 years old is unknown. OBJECTIVE: To assess BPPV health-related quality of life in elderly individuals using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S). METHODS: A prospective study including new cases of BPPV in patients older than 60 years was carried out. The diagnosis was based on the history of recurrent sudden crises of vertigo and a typical positional-induced nystagmus during the DHT. All patients were treated by a single PRM and relapses were investigated a the 30th post-treatment day. RESULTS: DHT was found negative in 82% (23/28) individuals at 30 days. The eight scales of the SF-36 have a good internal consistency reliability in patients with BPPV (Cronbach's alpha > 0.7). The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for role physical, body pain, social function, role emotional and mental health. After PRM, patients restored scores to norms, showing a significant increase in role physical (p < 0.05), body pain (p < 0.04), vitality (p < 0.02), social function (p < 0.003) and mental health scores (p < 0.005). DHI-S total score significantly decreased from 17.19 +/- 9.06 (mean +/- SD) at the first day to 9.70 +/- 10.13 at 30 days (p < 0.001). CONCLUSIONS: BPPV has a significant impact on health-related quality of life in elderly patients on their emotional and physical states compared to those unaffected. The PRM can restore health-related quality of life in elderly patients with BPPV.

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OBJECTIVE: To determine the impact of the particle repositioning maneuver on posterior canal benign paroxysmal positional vertigo-related quality of life using the Medical Outcomes Study 36-Item Short Form Health Survey and the Dizziness Handicap Inventory Short Form. STUDY DESIGN: Prospective, consecutive new cases of posterior canal benign paroxysmal positional vertigo. SETTING: Ambulatory, primary referral hospital. PATIENTS: Forty individuals with posterior canal benign paroxysmal positional vertigo were investigated. The diagnosis was made on the basis of the history of recurrent sudden crisis of vertigo and positional-induced nystagmus during the Dix-Hallpike test. INTERVENTIONS: All patients were treated by a single particle repositioning maneuver, and relapses were investigated at Days 7 and 30 posttreatment. MAIN OUTCOME MEASURES: Percentage of patients with negative Dix-Hallpike test after treatment, scores obtained on the 36-Item Short Form Health Survey and Dizziness Handicap Inventory Short Form before and 30 days after treatment. RESULTS: DHT was found negative in 76% (28 of 37) individuals at 30 days. The eight scales of the 36-Item Short Form Health Survey had a good internal consistency reliability (Cronbach's alpha > 0.7) in patients with posterior canal benign paroxysmal positional vertigo. The average standardized score for each 36-Item Short Form Health Survey scale was compared with the reference population normative data, showing differences with norms for all scales, except for Vitality. After particle repositioning maneuver, patients scored closer to norms, and Social Function and Mental Health scores were significantly higher than the scores obtained before the particle repositioning maneuver (p < 0.05). Dizziness Handicap Inventory Short Form total score significantly decreased from 18.05 +/- 9.91 (mean +/- standard deviation) at the first day to 9.54 +/- 9.94 at 30 days (p < 0.001). All 36-Item Short Form Health Survey scale scores were correlated significantly with Dizziness Handicap Inventory Short Form total scores at 30 days after treatment. CONCLUSIONS: Posterior canal benign paroxysmal positional vertigo has a significant impact on health-related quality of life, and patients experienced a decrease in quality of life as compared with norms. The particle repositioning maneuver improves health-related quality of life in posterior canal benign paroxysmal positional vertigo.

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PURPOSE: To determine if position during bedrest is related to the canal affected in posterior canal benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS: Fifty-five individuals with posterior canal BPPV were investigated. Diagnosis was established if a consistent clinical history was found with vertigo and induced positional nystagmus elicited on the Dix-Hallpike test (DHT). Preference for left or right position during bed rest was determined before performing the DHT. All patients were treated by a single particle repositioning procedure, and relapses were investigated at the seventh and 30 days posttreatment. RESULTS: Forty-five individuals always slept on the same side (29 on the right, 16 on the left side), and 10 patients preferred to change sides during bed rest. Among those patients able to maintain a constant position during bed rest, 27 and 18 presented a positive DHT on the right and left sides, respectively. The canal affected was found to be significantly associated with side during bed rest (relative risk = 2.75; P = 0.01, Fisher exact test). DHT was negative in 86% of patients at 30 days. No differences were found between individuals who presented a constant position in bed and those who changed positions. CONCLUSIONS: Lateral supine position during bed rest is associated with the canal affected in BPPV. We speculate that gravity might facilitate the deposition of particulate material on the posterior semicircular near the ampulla canal during bed rest.

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