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Purpose: Education on medical Spanish, defined as the use of Spanish by clinicians for communication with patients, has proliferated rapidly since the first guidelines were published in 2008. This study aims to characterize the scope of the field, identify gaps, and propose emerging questions for future study. Method: The authors conducted a narrative review of the medical Spanish education literature published from 2000 to 2023. First, a comprehensive search algorithm was developed across three databases (Medline, Scopus, and Web of Science Core Collection) and conducted on August 2, 2023. Two reviewers then independently assessed articles for inclusion/exclusion and subsequent categorization of included articles. Results: The search identified 1,303 articles, and authors added ten articles from other sources. A total of 138 individual articles were included in the final categorization and sub-analysis. There has been an upward trend in the number of articles published yearly since 2000. Most publications were educational interventions (67/138, 49%), followed by commentaries/perspectives (27/138, 20%), proficiency testing (17/138, 13%), needs assessments (16/138, 12%), reviews (6/138, 4%), and vocabulary analyses (5/138, 4%). Slightly over half of publications (72/138, 52%) were centered on physicians or physicians-in-training, with 23 (17%) articles applicable across health professions, and a few focused on pharmacists, nurses, physical therapists, psychologists, physician assistants, and genetic counselors. The vast majority (119/138, 86%) were published in medical/scientific journals and 19 (14%) in language/humanities journals. All but two first authors were affiliated with United States institutions, representing 30 states and Puerto Rico. Conclusions: Over the past two decades, many medical Spanish educational interventions have been published, and several assessment tools have been developed and validated. Gaps remain in evaluation data to demonstrate course effectiveness, the use of pedagogical frameworks to guide curricula, faculty development opportunities, and the role of heritage Spanish learners. Future work should address medical Spanish gaps in health professions and medical specialties, explore patient-engaged approaches to research, and evaluate longitudinal outcomes.

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Despite increasing attention to the importance of examining factors that impact housing instability and homelessness, the field lacks a validated scale of housing instability. The current study examined the reliability and validity of a seven-item scale that measures housing instability. Data were taken from a larger study which implemented the Domestic Violence Housing First model across five domestic violence agencies in the Pacific Northwest. A total of 406 participants were interviewed every six months over a period of two years. A Spanish version of the scale was administered to Spanish-speaking participants. Results provide an overview of the psychometric functioning of the scale and support its utility in assessing housing instability and homelessness. Specifically, the scale demonstrated concurrent and predictive validity, and showed evidence of scalar equivalence over time and across both language and locality. The current scale is therefore a succinct and psychometrically sound measure of housing instability which can be used moving forward to track housing instability in English and Spanish speakers, as well as in urban and rural settings.

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PURPOSE: The objective of this study is to identify the beliefs, values, perceptions, and experiences of medical oncology, radiation oncology, and clinical haematology professionals about the advance care planning process. METHODS: Qualitative exploratory study. There were four focus groups with 14 nurses and 12 physicians (eight medical oncology, one radiation oncology, three haematology). A reflexive thematic analysis of the data obtained was performed. RESULTS: We identified 20 thematic categories, which we grouped into four themes: lack of knowledge about advance care planning; perception of the advance care planning process: knowledge acquired from practice; barriers and facilitators for the implementation of advance care planning; and communication as a key aspect of advance care planning. CONCLUSIONS: The participants valued advance care planning as an early intervention tool that promotes autonomy. They perceived difficulties in approaching planning due to lack of knowledge, training, and time. They identified the therapeutic relationship with the person, the participation of the person's loved ones, teamwork, and communication skills as essential to ensuring the quality of the process. Finally, they recognised that palliative care professionals provide added value in supporting planning processes.

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Fluoride hesitancy is a growing public health challenge and interventions to address it may need to be tailored for minoritized subgroups to address oral health inequities. The goals of this qualitative study were to investigate the extent to which an existing conceptual model on topical fluoride hesitancy is applicable to Latino parents and whether applicability differed between Spanish-speaking Latino (SL) and English-speaking Latino (EL) parents. We conducted semi-structured one-on-one interviews with non-Latino English-speaking parents (N = 50), SL parents (n = 8), and EL parents (n = 8). We coded the transcripts deductively and compared our findings both qualitatively and quantitatively to an existing model on topical fluoride hesitancy comprising 21 categories classified into six domains. We compared frequencies across model domains and categories for Latino versus non-Latino parents as well as for SL versus EL parents. Latino parents were represented across all six domains and 21 categories of the conceptual model. Comparing Latino and non-Latino parents, representation was similar across Domains 1 to 3 (necessity, chemicals, and harm); Latino parents were more highly represented in Domains 4 to 6 (uncertainty, pressure, and choice) compared with non-Latino parents. A larger proportion of EL parents thought a healthy diet was more important than fluoride (Category 1d) and a larger proportion of SL parents felt they did not know enough about fluoride (Category 4a). An existing conceptual model on topical fluoride hesitancy was generally a good fit for SL and EL parents. However, differential representation across model categories suggests that fluoride-related communication and intervention approaches may need to be tailored to Latino parents based on language preference.

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BACKGROUND: While there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic. METHODS: The WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint. DISCUSSION: The use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.

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INTRODUCTION: Laryngeal dystonia (LD) is a focal dystonia affecting the intrinsic laryngeal muscles. Clinical diagnosis requires subjective evaluation by experienced clinicians and is primarily based on auditory-perceptual assessment. Several speech tasks are widely accepted to elicit diagnosis specific auditory-perceptual symptoms of glottal stops in adductor LD or breathy breaks in abductor LD in spoken English. With the growing Spanish speaking population in the US and lack of Spanish speech tasks to assist in identifying LD in Spanish speaking subjects, assessing the reliability of phonemically loaded sentences in Spanish for use by non-Spanish speaking providers is critical. The first aim of this study was to develop and assess the reliability of a set of Spanish language phonemically loaded sentences designed to elicit signs and symptoms of LD. The second aim was to determine the effectiveness of non-Spanish speaking speech-language pathologists (SLPs) in identifying LD in Spanish speaking subjects using these stimuli. METHODS: Phonemically loaded sentences were developed for this study following current guidelines for assessment of LD. Voice samples were obtained from native Spanish speaking individuals. Participant-speakers included 20 people with LD and 20 people without LD who served as controls. All participant-speakers were assessed by a Spanish-speaking laryngologist. Audio samples were presented to non-Spanish speaking SLPs with expertise in working with people with LD who served as raters and classified the samples as either presence or absence of LD. Kappa and the intra-class correlation coefficient were calculated and mixed effects logistic regression was used for prediction. RESULTS: The inter and intra-rater reliability indicated statistically significant agreement. Sensitivity, specificity, and predictive values for the diagnosis of LD by the raters were overall strong. CONCLUSIONS: Findings demonstrate that non-Spanish speaking SLPs with expertise in the assessment and treatment of LD can reliably identify the presence of LD using Spanish language stimuli in Spanish-speaking individuals. This study supports the use of newly developed Spanish language phonemically loaded voiced and voiceless sentences by English speaking clinicians as an effective tool for identifying LD in Spanish speakers, perhaps mitigating diagnostic delays experienced by patients with LD.

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OBJECTIVE: To assess the association between language proficiency and absolute dominance on language versus visual-perceptual formatted and executive versus delayed memory neuropsychological measures in bilingual adults. METHODS: Data from 55 bilingual, conversationally fluent, neurologically intact, Mexican American, consecutive, adults tested in separate sessions in Spanish and English in a counterbalanced order were analyzed. Age, years of education, self-reported language proficiency, Woodcock-Muñoz Language Survey-Revised (WMLS-R) picture vocabulary measures of language proficiency, and dominance (absolute Spanish-English WMLS-R difference scores) were correlated with 11 measures from La Batería Neuropsicólogica en Español and its original English language tests. RESULTS: Self-reported and WMLS-R measures of language proficiency were significantly correlated in each language. Absolute language dominance was not significantly associated with any Spanish or English neuropsychological raw score. The WMLS-R language proficiency, but not age or years of education, was significantly correlated with language-formatted neuropsychological measures of California Verbal Learning Test delayed free recall number of words (both languages), letter fluency (both languages), delayed story memory (in English), and Stroop interference (Spanish). Linear regression models using age, years of education, and WMLS-R picture vocabulary scores as predictors were significant for all these measures excepting the last. The WMLS-R language proficiency was not significantly associated with raw scores on any visual-perceptual formatted measure. CONCLUSIONS: Monolingual neuropsychological test norms for language-formatted tests likely overestimate bilingual Mexican Americans' performance.

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Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.

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Cannabis and health research continue to largely ignore the usage patterns, perceptions, and medically related use in Spanish-speaking communities. The primary aim of this study was to collect data among Spanish-speaking communities on cannabis use that specifically characterizes granular demographic information, medically motivated and recreational use patterns including potency of products, medical motivations for use, and what perceptions are held as to risks and benefits. Secondarily, exploratory analyses were made to investigate potential effects of location or acculturation status. Five hundred forty-nine individuals completed the survey, including 294 residing in the United States (US) (Mage =31.8, SD=9.72; 154 women, 137 men, 3 non-binary and self-described individuals), 174 residing outside of the US (International) (Mage =26.6, SD=8.75; 77 women, 96 men, 1 non-binary and self-described individuals), and 81 who did not report country of residence (Unknown location) (Mage =26.7, SD=7.37; 17 women, 61 men, 3 non-binary and self-described individuals). Overall use was mostly recreational, while the US group was significantly more motivated by medical or combined medical and recreational reasons than the other two groups (p=0.02). The most common reason for medical use was anxiety or depression (14% of sample). The US group also smoked or vaporized significantly more often than the other two groups and was more likely to include daily users (p<0.001). The sample generally viewed the effects of cannabis use more favorably than negatively, but there were significant differences in these views between users and non-users. The rich heterogeneity suggested by these data belies the importance of taking an equity focused approach to cannabis research and will help to improve representation in the field.

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Integrated behavioral health (IBH) embeds behavioral health clinicians in primary care settings to improve access and quality of care. This study investigates whether co-located IBH impacts knowledge and experiences of behavioral healthcare, particularly for individuals with limited English proficiency (LEP). 330 patients were recruited from the waiting rooms of a federally qualified health center to answer multiple-choice and Likert scale questions about behavioral healthcare. English-speaking patients were more confident in their knowledge of IBH (X2(1) = 4.79, p = .03) and external behavioral healthcare (X2(1) = 28.75, p < .001). On average, the 77 patients who accessed IBH believed that IBH appointments had a positive impact (Likert scale mean = 3.90, SD = .10). Despite satisfaction with IBH across demographic groups and similar or higher interest in behavioral health services among patients with LEP, they were found to have less knowledge about IBH than English-speaking patients.

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Este trabajo surge de mi ponencia en el Congreso Anual de la Asociación de Lenguas Modernasde los Estados Unidos (MLA) el 9 de enero del 2019, en Chicago, Illinois. Aborda la función didácticade dichos y refranes como auténticas cápsulas culturales en el contexto del español médico,campo de primera necesidad en los Estados Unidos. El papel protagonístico de la lengua en lacultura (y viceversa) —condensado en máximas que hacen eco de una conciencia colectiva—, amenudo transmite altas dosis de machismo que, abierta o solapadamente, alimenta el engranajeinstitucionalizado de la violencia contra la mujer y contra el colectivo LGTBIQ+. Por ello, este breverecorrido por tonos disonantes nos hablará de creencias culturales opresivas que aún repercutenen la salud y en el bienestar de la mujer y de otras personas también históricamente vulneradas.El objetivo de esta experiencia de aprendizaje (mía y nuestra) es que la voz que escuchemosnos llame a examinar junto con nuestro alumnado ideas heredadas que —lejos de dar vida yesperanza— enferman y matan. Así posibilitaremos el cambio individual y social en pro de la salud y de los derechos humanos. (AU)

Part of this work was presented by the author on January 9, 2019, at the MLA (ModernLanguage Association) Annual Convention in Chicago, Illinois. It addresses the didactic role ofSpanish sayings and proverbs as authentic cultural capsules in the context of medical Spanish,a necessary field in the United States. The leading role of language in culture (and vice versa),synthesized within maxims echoing a collective consciousness, frequently conveys high levels ofsexism. It is male chauvinism that, openly or covertly, feeds the institutionalized mechanism ofviolence against women and against the LGBTQIA+ community. Thus, this short journey throughdissonant tones will talk to us about oppressive cultural beliefs that still impact women’s healthand the health of others whose rights have also been historically violated. The objective of thislearning experience (mine and yours) is that the voice that we hear will call us and our studentsto examine inherited ideas so remote from life and hope, that they sicken and kill. In so doing,we will be empowering individual and social change towards improved health and the defense of human rights. (AU)

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BACKGROUND: Acculturation to the United States has been previously studied in Spanish-speaking populations, but little is known about the potential relationship between acculturation and type 2 diabetes mellitus (T2DM). OBJECTIVE: The purpose of this review was to explore the relationship between acculturation and T2DM in Spanish-speaking populations in the United States. METHODS: Selected studies collected from a review of literature were analyzed by population, ethnicity, acculturation scale, and significance. RESULTS: Thirty-two eligible articles showed conflicting data between the effects of acculturation on T2DM. CONCLUSION: Overall, studies yielded inconclusive results on the significance of the relationship between acculturation and diabetes in Spanish-speaking populations, which merit further investigation.

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ABSTRACTA study was conducted to examine the factor structure of the Neurobehavioral Symptom Inventory (NSI) among a large community sample of 729 Spanish-speakers from the Continental United States (n = 174, 23.9%), Latin America (n = 465, 63.8%), and Spain (n = 90, 12.3%) The sample was 62.1% female, had at least 10 years of formal education, and ranged in age from 18 to 65 years (M = 36.7, SD = 12.5). The sample was randomly split into two groups with comparable demographics for a sequential analysis that consisted of an exploratory factor analysis on the first subsample followed by a confirmatory factor analysis within a second validation subsample. Results demonstrated a high internal consistency reliability for the Spanish version of the NSI, and a three-factor solution was supported with somatic, affective, and cognitive factors. Findings were comparable to prior studies with the English version of the NSI providing preliminary support for the construct validity of this measure among a large sample of Spanish-speakers. Further study is needed to determine the criterion-related validity of the individual factors as separate subscales and to examine the appropriateness of this measure for individuals with lower levels of education.

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INTRODUCTION: The Voice Handicap Index 10 (VHI-10) has been translated to many languages. There are substantial differences between the translation methods. Translated questionnaires without appropriate linguistic validation may not capture cultural differences or be understood by the participants in the manner intended by the original developers. This also holds true between dialects within a language. There are two versions of the VHI-10 in Spanish, both translated in Spain. Considering the cultural and dialectical differences amongst Spanish speakers, it is hypothesized that these translations may not be applicable globally. The purpose of this study was to determine the linguistic relevance and applicability of the currently available versions of the VHI-10 in Spanish amongst Spanish speakers outside of Spain. METHODS: This study used mixed methods qualitative and quantitative procedures consisting of semi-structured interviews and quantitative analysis of data. Sixty-nine participants met the inclusion criteria. Participants with and without a diagnosis of dysphonia were included. Demographic data collected included age, gender, cultural/dialectical background, level of education, and number of years residing in Southern California. Participants were provided the currently available translated versions of the VHI-10 in Spanish (V1 and V2). After reading both questionnaires, a semi-structured interview was conducted by a bilingual SLP. Semi-structured interview responses were coded to determine patterns of words marked as problematic/not understood or non-representative of the Spanish dialect spoken by the participants. RESULTS: The majority of participants marked at least one word in both versions as problematic/not understood or non-representative of the Spanish dialect spoken (60/69, 87.0% for V1 and 63/69, 92.3%, for V2). The two words most frequently marked as problematic/not understood or non-representative of the Spanish dialect spoken were "hándicap" (marked by 51/69 participants, 73.9%) and "minusvalía" (marked by 52/69 participants, 75.4%). CONCLUSIONS: Data analysis demonstrates that the majority of participants marked words as not understood/non-representative of their dialect on either V1 or V2. One question not understood or not answered could have an impact on how we interpret this patient-reported outcome measure in clinical practice. Use of currently available Spanish translations of the VHI-10 may yield unreliable results when used amongst Spanish speakers outside Spain due to dialectal and cultural differences. Future work will include validation of a voice patient-reported outcome measure that is culturally and linguistically appropriate for Spanish speakers outside Spain.

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Abstract Introduction and objective: Workers contend with many threats while performing their daily routine that could undermine their dignity, such as denigrating comments from supervisors or co-workers. Denying workers' dignity constitutes a direct threat towards their well-being. The aim of this paper is to adapt and validate the Spanish version of the Workplace Dignity Scale (WDS). Method: An instrumental design was executed in order to adapt the scale to Spanish with a Mexican population (N = 588). Following back-translation, three studies were conducted in which confirmatory factor analysis, correlations, regressions, and invariance analysis were applied. Results: The results showed that the Spanish adaptation conforms to the six-factor structure of the original scale and that organisational dehumanisation and workers' self-objectification predicted dignity at work; with workers' self-objectification being the variable that most strongly predicted workers' dignity. Finally, we also evaluated measurement invariance comparing our data with the results of the original scale. In general, results indicated that even when the Spanish version of the WDS presented an adequate factor structure, its measurement presented different factor loadings and slopes compared with the measurement of the original scale. Conclusions: In general, we have an instrument adapted to the Mexican context that allows us to evaluate workers' sense of dignity in the workplace.

Resumen Introducción y objetivo: Los trabajadores pueden enfrentar muchas amenazas mientras realizan su rutina diaria que podrían socavar su dignidad, como comentarios denigrantes de supervisores o compañeros de trabajo. Negar la dignidad de los trabajadores constituye una amenaza directa para su bienestar. El objetivo de este artículo fue adaptar y validar la versión en español de la Workplace Dignity Scale (WDS). Método: Se realizó un diseño instrumental con el fin de adaptar la escala al español con población mexicana (N = 588). Después de realizar una traducción inversa, se realizaron tres estudios donde se aplicaron análisis factoriales confirmatorios, correlaciones, regresiones y un análisis de invarianza. Resultados: Los resultados mostraron que la adaptación al español se ajusta a la estructura de seis factores de la escala original y que la deshumanización organizacional y la auto-objetivación de los trabajadores predecían la dignidad en el trabajo; siendo la auto-objetivación de los trabajadores la variable que predecía en mayor medida la dignidad de los trabajadores. Finalmente, también se evaluó la invariancia de medición comparando nuestros datos con los resultados de la escala original. En general, los resultados indicaron que aun cuando la versión en español de la WDS presentaba una estructura factorial adecuada, su medición presentaba cargas factoriales y pendientes diferentes en comparación con la medición de la escala original. Conclusiones: En general, contamos con un instrumento adaptado al contexto mexicano que nos permite evaluar el sentido de dignidad de los trabajadores en el lugar de trabajo.

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This study investigates self-perceptions of voice-related handicap as a function of facemask use in the general working population during the COVID19 outbreak, using the Voice Handicap Index (VHI). Each VHI item was answered twice in a row; the first answer referred to the condition of not wearing a facemask (henceforth, the Without condition) and the second to the condition of using a facemask (henceforth, the With condition). VHI scores were collected via Google Forms (Google, Mountain View, California), targeting 2 groups of speakers of different nationalities, Portuguese (n = 261) and Spanish (n = 297). A Wilcoxon test was carried out to compare VHI scores between With and Without conditions for each group of speakers; a Mann-Whitney U test was used to compare groups within each condition. Results suggested that VHI overall scores and scores for all dimensions were higher for the With condition, for both Portuguese and Spanish speakers. When comparing groups of speakers, Spanish speakers presented higher scores for functional and emotional dimensions, for both With and Without conditions. In addition, the overall score for the Without condition was higher for Spanish speakers. No differences between groups were found for the total VHI score for the With condition. When comparing overall VHIdiff between speakers, that is, the difference in the VHI total score between With and Without conditions, no significant differences could be found. Thus, a multiple regression analysis was carried out between the VHIdiff and the independent variables of interest: age, sex, smoking habits, professional occupation, nationality, facemask type and its hours of use. The resulting model providing the highest association suggested that 2.5% of the variation in overall VHIdiff total score could be associated with sex, smoking habits, and professional level. Female smokers who use their voices during prolonged hours at work (e.g., teachers, lawyers, sales people) presented a higher VHI total score when wearing a mask. Future voice-related health interventions should address preventive strategies towards speaking behaviors leading to vocal fatigue and vocal effort as a consequence of compulsory facemask use, especially with respect to female professional voice users who smoke.

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Resumen De la población mundial 7.8% es hispanohablante, esto representa 567 millones de personas y se calcula que para 2050 esta cifra se elevará, además, el español es el segundo idioma de comunicación a nivel internacional; con este contexto y a casi cuatro décadas de la aparición formal de la Bulimia Nerviosa (BN), es necesario conocer cuáles y cómo son los instrumentos para evaluar los síntomas de la BN en este tipo de población. Por tanto, el objetivo de la presente investigación fue describir los cuestionarios para evaluar en población de habla hispana los síntomas de BN. Se encontró que México, cuenta con seis instrumentos; España con cinco; Colombia tiene tres instrumentos; Puerto Rico y Cuba cuentan con dos; Argentina, Costa Rica, Bolivia, El Salvador, Venezuela y República Dominicana, cuentan con uno. Estos pueden ser para el tamizaje de síntomas de la BN; o para evaluar los síntomas de la BN como parte de la evaluación de diversas dimensiones; o para evaluar a los familiares/cuidadores en el proceso de tratamiento de la BN. Se concluye que, es alentador que la población de habla hispana cuente con diversos cuestionarios adaptados y validados en su lengua para evaluar los síntomas de la BN.

Abstract Of the world population 7.8% is Spanish-speaking, this represents 567 million people and it is estimated that by 2050 this figure will rise, in addition, Spanish is the second language of communication at the international level; With this context and almost four decades after the formal publication of Bulimia Nervosa (BN), it is necessary to know which and how are the instruments to evaluate the symptoms of BN in this type of population. Therefore, the objective of the present investigation was to describe the questionnaires to evaluate the symptoms of BN in the Spanish-speaking population. It was found that Mexico has six instruments; Spain has five; Colombia has three instruments; Puerto Rico and Cuba have two; Argentina, Costa Rica, Bolivia, El Salvador, Venezuela and the Dominican Republic have just one. These can be for the screening of BN symptoms; or to evaluate the symptoms of BN as part of the evaluation of some dimensions; or to evaluate family members /caregivers in the BN treatment process. It is concluded that it is encouraging that the Spanish-speaking population has several questionnaires adapted and validated in their language to evaluate the symptoms of BN.

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STUDY OBJECTIVES: Family caregivers of people with dementia frequently report sleep problems that are linked to depressive and anxious symptoms. However, data are needed regarding the psychometric properties of specific measures of sleep problems in caregiving populations. The aim of this study is to analyse the psychometric properties of the Insomnia Severity Index (ISI; Morin, 1993) in a Spanish dementia caregiver sample. METHODS: 271 participants took part in face-to face interviews where, along with sociodemographic variables, caregivers' sleep problems, depressive and anxious symptoms were measured. The psychometric properties of the ISI were analysed through Confirmatory Factor Analysis (CFA) and analysis of the internal consistency and convergent and criterion validity. RESULTS: The Spanish version of the Insomnia Severity Index showed adequate indices of internal consistency (Cronbach's alpha = 0.78) in our sample of family caregivers of people with dementia. A one-factor structure provided a better fit to the data than two- and three-factor structures. The ISI was significantly associated with lower sleep quality, less average sleep time per day and lower self-perception of vitality, as well as with higher depressive and anxious symptoms. Differences in ISI scores were found between people with and without depressive and anxious symptoms. Statistically significant gender-based differences in sleep problems were also found, with female caregivers showing higher sleep problems. CONCLUSIONS: The ISI is a reliable and valid instrument to assess the subjective severity of sleep problems in the family dementia caregiver population and may be a useful instrument in intervention and research settings. Additional evidence was also provided of the importance of considering sleep problems in the studied population.

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OBJECTIVE: The Paced Auditory Serial Addition Test (PASAT) and Wechsler Adult Intelligence Scale Letter Number Sequencing subtest (LNS) are two commonly used measures of working memory. Demographic variables (age, education, ethnicity, etc.) can impact performance on these measures, underscoring the need for demographically adjusted norms. We aimed to develop normative data for the PASAT and LNS for Spanish-speaking adults living in the U.S.-Mexico border region as part of a larger normative effort. METHOD: Participants were native Spanish-speakers from the Neuropsychological Norms for the U.S. Mexico Border Region in Spanish (NP-NUMBRS) project. Two hundred and forty-nine participants completed the PASAT and 202 participants completed LNS. Ages ranged from 19 to 60 and education from 0 to 20 years. RESULTS: Older age was associated with lower scores on LNS (p < .01) but not PASAT. Lower education was associated with lower scores on both tests (ps < .001). Women obtained lower raw scores than men on PASAT (ps < .003), and there were no significant main effects of gender on LNS raw scores. Raw-to-scaled score conversions were calculated, and fractional polynomial equations were developed to calculate demographically-adjusted T-scores accounting for age, education, and gender. Published norms for English-speaking non-Hispanic Whites substantially overestimated rates of impairment (defined as T-score < 40) on both the PASAT and LNS. CONCLUSIONS: The use of the population-specific normative data may improve detection of working memory dysfunction in U.S. Spanish-speaking adults and contribute to improved diagnostic accuracy and treatment planning in this population. Whether the norms generalize to U.S. Spanish-speakers from other countries remains to be determined.

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