Cultural scale adaptation and validation of the Spanish version of the BRCA Self-Concept Scale in women carriers at high risk for hereditary breast and ovarian cancer

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Sumalla, Esther Darder, Silvia Iglesias, Cristian Ochoa, Ignacio Blanco" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Vanessa" "apellidos" => "Castejón" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Tatiana" "apellidos" => "Rovira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Enric C." "apellidos" => "Sumalla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Esther" "apellidos" => "Darder" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Silvia" "apellidos" => "Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Cristian" "apellidos" => "Ochoa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:4 [ "nombre" => "Ignacio" "apellidos" => "Blanco" "email" => array:1 [ 0 => "iblanco.germanstrias@gencat.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Programa de Cáncer Hereditario Institut d’Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d’Oncologia-Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Programa de Cáncer Hereditario, Institut Català d’Oncologia-Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta, Unidad de Consejo Genético, Hospital Universitario Dr. Josep Trueta, Girona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Psico-Oncología, Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Programa de Asesoramiento y Genética Clínica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adaptación cultural y validación de la versión española de la Escala de Autoconcepto en BRCA en mujeres portadoras con alto riesgo de cáncer de mama y ovario hereditario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1565 "Ancho" => 2940 "Tamanyo" => 311368 ] ] "descripcion" => array:1 [ "en" => "Confirmatory factor analysis of 3 first-order factors from the Spanish version of the BRCA Self-Concept Scale (Model 2)." ] ] ] "textoCompleto" => "IntroductionBetween 5% and 10% of breast cancer (BC) diagnoses are due to mutations in the germ line of high-penetrance genes BRCA1/2 that are transmitted with an autosomal dominant inheritance, responsible for the hereditary breast and ovarian cancer (HBOC) syndrome. Carriers of mutations of these genes have a high risk of developing cumulative HBOC throughout life, ranging from 47% to 52% for BC and 8% to 22% for ovarian cancer (OC),<a class="elsevierStyleCrossRef" href="#bib0155">1</a> and a probability of 50% of transmitting this susceptibility to their offspring. Being a carrier of a genetic condition that predisposes a potentially life-threatening disease like cancer poses a threat to one ‘s health and can be considered a highly stressful life event.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> Knowledge of this increased risk is for life, and affects not only the individual but their family, who must make a number of complex decisions based on this probabilistic information. The individuals and families susceptible to this hereditary predisposition to cancer are referred to genetic counselling (GC) units, where an individualised assessment of the risk of occurrence and/or recurrence of the disease is made, and strategies for early prevention and detection are offered, according to their individual risk. These units have proved to be effective in reducing incidence and mortality rates. The aim of GC is to help those individuals learn and adapt to the medical, psychological and family implications of the genetic contribution to the disease.<a class="elsevierStyleCrossRef" href="#bib0165">3</a>Fostering a psychological adaptation to their condition as carrier is one of the objectives of the GC, its evaluation is important. Adapting to a hereditary disease or the risk of having one is dynamic and multidimensional; in order to demonstrate the effectiveness of GC, indicators are needed both for the process and its outcome.<a class="elsevierStyleCrossRefs" href="#bib0170">4–6</a> To assess psychological adaptation in the context of GC standardised questionnaires are almost exclusively used for symptoms of anxiety and depression, which are measures of adaptation failure–specifically the results–and not observable measures of how the process is developing. Likewise, the lack of sensitivity of these questionnaires to specific and relevant needs of the GC have been noted.<a class="elsevierStyleCrossRefs" href="#bib0160">2,4,7</a> In this sense, a study of women diagnosed with BC or OC who underwent genetic tests found that the desire to receive psychological support responds to other needs that are not detected by the usual indicators focused on psychopathology, and only a third of those who express these needs eventually receive psychological support.<a class="elsevierStyleCrossRef" href="#bib0190">8</a> In short, instruments that are sensitive to the specific needs of GC, adequately validated in this context, are needed and they must have multidimensional measures that consider all the relevant aspects of the adaptation process to hereditary diseases.<a class="elsevierStyleCrossRefs" href="#bib0160">2,4–7</a>In this context the BRCA Self-Concept Scale<a class="elsevierStyleCrossRef" href="#bib0160">2</a> has been developed and validated in English, which assesses the impact on the individual's self-concept of knowing that they carry a genetic alteration that predisposes them to HBOC, and has its equivalent in other hereditary cancer syndromes.<a class="elsevierStyleCrossRefs" href="#bib0195">9,10</a> Self-concept, based on Self-concept Scheme Models, is defined as a complex cognitive, multidimensional, active and dynamic structure that integrates and synthesises thoughts, feelings and experiences about oneself<a class="elsevierStyleCrossRef" href="#bib0205">11</a> and is considered the organising framework that gives meaning, shape and direction to these experiences.<a class="elsevierStyleCrossRef" href="#bib0210">12</a> In chronic diseases, a new or restored self-concept is indicative of adaptation to the condition or disease insomuch that it reflects an emotional acceptance and internalisation of oneself as a person with a certain condition.<a class="elsevierStyleCrossRef" href="#bib0215">13</a> In oncology, self-concept is an important variable, as its alteration may involve greater emotional distress and negatively impact adherence to health behaviours. Alternatively, the ability to build new schemes of oneself can facilitate recovery after an adverse event, thus establishing a bi-directional, self-concept-disease relationship.<a class="elsevierStyleCrossRef" href="#bib0220">14</a>The BRCA Self-Concept Scale assesses the impact of being a carrier on the different dimensions of self-concept, considering both negative and positive changes. The analysis of the main components carried out for its development and validation generates a 3-factor solution that evidences its multidimensionality: Stigma, which in the original version represents 38.7% of the total variance explained (Cronbach α=0.86), assesses to what extent the person feels isolated and different from others, or whether they have a damaged identity after undergoing the genetic test; Vulnerability (8.5% of the total variance explained in the original version, α=0.76) assesses the fragility and uncertainty about the body itself and its health; Control (6.5% of the total variance explained in the original version, α=0.68) evaluates self-efficacy, resilience and hope.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> Studies to date have not reported the existence of a second-order factor, focusing attention on the involvement of the specific dimensions of self-concept and its association with other relevant GC variables. Thus, integrating high-risk conditions to develop HBOC in self-concept in terms of control is associated with lower levels of emotional distress; however, doing so in terms of Stigma and/or Vulnerability is associated with higher levels. Also, it has been shown that open communication with the partner and children is associated with less Stigma in self-concept, which reverts to lower levels of general malaise.<a class="elsevierStyleCrossRefs" href="#bib0225">15–17</a>This study aims to culturally adapt the BRCA Self-Concept Scale to Spanish, confirm its original factorial structure, evaluate its internal consistency and analyse its convergence with the Escala de Preocupación por el Cáncer [Cancer Concern Scale (CCS)], the only instrument validated in Spanish in the context of hereditary BC<a class="elsevierStyleCrossRef" href="#bib0240">18</a> that has shown an association with adherence to preventive behaviours.<a class="elsevierStyleCrossRef" href="#bib0245">19</a>Materials and methodParticipantsIn order to obtain a sample similar to the original instrument, women carrying pathogenic mutations in their BRCA1/2 genes were identified, both healthy and affected women who were undergoing medical monitoring because of their high risk of BC and OC. The inclusion criteria were the following: being a carrier of the mutation in BRCA1/2, be of legal age, literate in Spanish, and at least 6 months must have passed from receiving the result of the genetic test. Exclusion criteria were: to have a cognitive impairment and/or a disabling psychiatric diagnosis. Of the 329 candidates invited to participate, 165 (50.15%) returned completed questionnaires, with no significant differences in age or medical variables between those who agreed to participate and those who were rejected (data not reported, available only upon request). The final sample size meets the subject ratio criteria: item 5:1–10:1, suitable for applying a confirmatory factor analysis (CFA).<a class="elsevierStyleCrossRef" href="#bib0250">20</a> The average age was 47.73 years (SD=13.38), and 76 (46.1%) women had not developed any cancer at the time of answering the questionnaire, being considered healthy carriers. Descriptive of the final sample shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Measurement instrumentsBRCA Self-Concept Scale<a class="elsevierStyleCrossRef" href="#bib0160">2</a>: assesses the impact of being a carrier of the mutation in BRCA1/2 on the self-concept. It consists of 17 items with Likert response format with 8 categories, the score ranges from one (strongly disagree) to 7 (strongly agree) in ascending order. Score 8 corresponds to the not applicable (NA) category. The Stigma factor contains items 5, 8, 9, 10, 12, 13, 16 and 17. The Vulnerability factor includes items 3, 4, 7, 11 and 14. The Control factor includes items 1, 2, 6 and 15. Higher scores on Stigma and Vulnerability imply negative changes in self-concept; in Control they imply positive changes.CCS<a class="elsevierStyleCrossRef" href="#bib0240">18</a>: 6-item self-report questionnaire that assesses the respondents’ concern for developing cancer, with a score ranging from one (no concern) to 4 (maximum concern); α in this study=0.896.Sociodemographic variables: age, education level, marital status, children.Medical variables: oncological status, time since genetic diagnosis, time since oncological diagnosis and prophylactic surgeries.Data collectionThe study was conducted in the Institut Català d’Oncologia GC units located in the Duran i Reynals, Germans Trias i Pujol and Josep Trueta hospitals, following the hospitals’ clinical research ethics committees review and approval of the study. The sample was obtained between July 2012 and May 2014, following established protocols for accessing and processing data from medical records and ensuring their confidentiality. An explanation of the study with the questionnaires, an informed consent and a postage paid return envelope was sent by post. All participants were informed of the confidentiality of their answers and agreed to answer the questionnaires.Adaptation of the scaleThe author authorised the cultural adaptation and validation of the scale to Spanish, which was done through two complementary procedures: translation-back translation, following the guidelines of the International Tests Commission,<a class="elsevierStyleCrossRef" href="#bib0255">21</a> and expert testing to collect proof of the translated items content validity regarding their adherence to the subscales. The English version of the instrument was translated by 2 bilingual people (a linguist and a psychologist) and back-translated by 2 other people with the same profile, all familiar with both cultures. The 2 translations in Spanish were reviewed by the research team and the translators, and a first version of the Self-Concept Scale in BRCA was generated, which was later sent for back-translation into English. The resulting version of the scale was assessed using the recommended levels of equivalence and a consensus was reached that our version was faithful to the original. Finally, the clarity, understanding, time of completion, relevance and acceptability was assessed through a pilot scale procedure given to a sub-sample of 10 patients. For the expert testing, 5 health psychologists assessed on a dichotomous “yes/no” scale the adequacy level of each item for each sub-scale, considering the author's definition. In addition, they indicated the degree of safety of each judgement issued, on a scale from 0 to 100. To assess the suitability of each item to its security sub-scale, the judgement was divided by 100, and the result was multiplied by −1 when the dichotomous scale response was ‘no’ (result from judging the item as belonging to that sub-scale). For each item 3 ratings were obtained, one per sub-scale from −1 to +1. For each of these resulting values a contrast hypothesis non-parametric test (Kolmogorov-Smirnov) was carried out with a test value of 0 to determine its significance, using a criterion corrected to 3 comparisons for each item where p<0.017. The results indicate that only items 10 (“I think a lot about the result of my genetic test”), and 13 (“I feel overwhelmed with this information”), considered Stigma in the original instrument, show no belonging to their sub-scale (zk-s=0.80, ns; and zk-s=0.87, ns, respectively), and if they do, it is to, according to the judges, the Vulnerability scale (zk-s=1.70; p=0.006 and zk-s=1.62; p=0.01, respectively). It was therefore decided to test, in addition to the author's original model (Model 1), the model in which items 10 and 13 become part of the Vulnerability sub-scale (Model 2).AnalysisTo evaluate the psychometric properties of the 2 models tested the following was conducted: (a) descriptive analysis of the items; (b) AFC through the firm weighted least squares estimator for categorical data, and without imputation of lost values due to presenting random patterns that allow response tendencies to be ruled out<a class="elsevierStyleCrossRef" href="#bib0260">22</a>; (c) analysis of the internal consistency of the sub-scales of both models, using the Cronbach α coefficient and (d) evidence of convergent validity of the sub-scales of both models with an equivalent measure of psychological adaptation in the context of GC (CCS) through the Spearman correlation to confirm the positive and moderate relationships with the sub-scales Stigma and Vulnerability and negative and moderate with the sub-scales Control.In the AFC, in addition to testing the original Model 1, a re-specification model is tested with the covariance of error (uniqueness) of items 4 (“I feel like a walking time-bomb”) and 5 (“I feel different to people my age”) as they are correlative, start with the same words and present modification indices (MI) that support this configuration.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> This re-specification is maintained in the case of Model 2. The goodness of fit of the 3 models is assessed through the normal indices, χ2 comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA) and weighted root mean square residual, considering the following cutoffs: RMSEA<0.05 and TLI and CFI>0.95 indicating a good fit, and RMSEA<0.08 and TLI and CFI>0.90 as reasonable fit.<a class="elsevierStyleCrossRefs" href="#bib0250">20,24</a> The internal consistency is adequate from a Cronbach α of at least 0.70.<a class="elsevierStyleCrossRef" href="#bib0275">25</a> For the convergent validity, due to the average size of the sample, a |R|≥0.030 is considered a good effect size.<a class="elsevierStyleCrossRef" href="#bib0280">26</a> The AFC has been conducted using Mplus v. 7 and the others, with SPSS v. 21.ResultsThe descriptive statistics of the items are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. All items corresponding to the sub-scale Stigma of the original version show a marked ground effect, without a ceiling effect, resulting in positively skewed distributions. Items 3, 4 and 14 from Vulnerability also have a low representation of highest scoring categories, while items 7 and 11 have indices of asymmetry in the opposite direction to the rest of the items in the sub-scale. Items from the Control scale, whose semantic content is positive valence compared to the remaining items of the scale, have a negative asymmetry. Because of the distribution of the items, the data are analysed as categorical. There are a total of 102 lost values (3.64% of total values from the sample). 77.45% of the missing data are from the category NA, and 22.55% not answered values (NAn). For all items, both the number of NAn on one hand and the NA on the other, represent values below 5% of subjects who did not answer, and considered together, only items 3, 14 and 16 slightly exceed 5%, thus the majority correspond to NA. Upon analysing the set of lost values, up to 36 different patterns are found.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the fit indices for the models analysed. Model 1, original structure of 3 first-order factors obtains fit indices that do not fully meet the recommended standards, especially for the RMSEA value 0.083 (90% CI 0.068–0.097). The correlation between Stigma and Vulnerability is 0.952, indicating an overlap between the two factors. Model 1 re-specified (releasing error covariance of items 4 and 5), least restrictive, obtains more appropriate fit indices (CFI 0.969, TLI 0.963 and RMSEA 0.072 [90% CI 0.057–0.087]), while maintaining a high correlation between factors Stigma and Vulnerability of 0.929. Model 2 is tested, in which according to the expert testing results, items 10 and 13 become indicators Vulnerability and in which the error covariance parameter between items 4 and 5 remain released (¿45). Model 2 (items 10 and 13 are indicators of Vulnerability, and releasing the parameter ¿45) obtains appropriate fit indices: CFI 0.973; TLI 0.968; RMSEA 0.067 (90% CI 0.051–0.082). The items were good indicators of the latent factors, with standardised factor loadings, all significant (between 0.698 and 0.879 for Stigma, 0.590 and 0.885 for Vulnerability, and 0.420 and 0.762 for Control). The correlations between factors, all significant and the sign according to the content of the sub-scales were, 0.89 between Vulnerability and Stigma, −0.589 between Control and Stigma, and −0.553 between Control and Vulnerability.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The internal consistency of the BRCA self-concept scales and their correlation with CCS can be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. Stigma reliability is supported in both models with values of 0.859 and 0.835; and Vulnerability moves from a value of 0.788 in Model 1 to 0.843 in Model 2, while the scale Control receives a value of 0.614. Finally, the elimination of any items did not report any improvements in the internal consistency of the sub-scales, thus it was decided to keep them intact. As for the convergent correlation of the BRCA self-concept (Model 2) with CCS, Stigma and vulnerability show high positive significant association with CCS, with values of 0.631 and 0.683, respectively, while Control showed a significant negative moderate association of 0.363.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionOne of the objectives of GC in HBOC is to facilitate patients’ adaptation to having a significantly higher risk than the rest of the general population of developing the disease and transmitting this susceptibility to cancer to offspring.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> As carriers of an inherited predisposition, integrating their condition as persons at high risk of developing cancer into their self-concept is indicative of psychological adaptation to it.<a class="elsevierStyleCrossRefs" href="#bib0215">13,14</a> The availability of a scale to assess the impact of being a carrier on the individual's self-concept responds to the need for sensitive and specific instruments that have been properly validated in the context of GC.<a class="elsevierStyleCrossRefs" href="#bib0175">5,6</a> This study is the first to adapt and validate the BRCA Sel-Concept Scale in our sociocultural environment, which, used with psychopathological symptoms, has been shown to be sensitive and specific to GC's relevant needs,<a class="elsevierStyleCrossRef" href="#bib0160">2</a> and stands as an integrator of both the process and the result of the individual's adaptation to their condition of carrier or high-risk.<a class="elsevierStyleCrossRefs" href="#bib0160">2,13,14</a> For the cross-cultural adaptation and validation a translation-back translation protocol process was followed, complemented by expert testing; it is the first study to verify the structure of the scale using an AFC. The Model 2 results allow maintaining the solution of 3 first-order factors, Stigma, Vulnerability and Control, with appropriate indices of fit. In addition, after finding evidence that items 10 and 13 are better indicators of the factor Vulnerability than Stigma, the reliability for these sub-scales not only remains high, but increases at midpoint for Vulnerability compared to the original version. Likewise, evidence in favour of the convergent validity of the 3 sub-scales in regard to CCS were reported.The number of factors, the relationships of the items with them and the relationship between factors are guided by previous theoretical and empirical evidence.<a class="elsevierStyleCrossRefs" href="#bib0160">2,16,17</a> Self-concept is dynamic, and changes to it do not happen with the same intensity and the same rhythm in all countries around the world.<a class="elsevierStyleCrossRefs" href="#bib0160">2,11</a> The variability of time since the genetic diagnosis in the sample, an average of 4 years in this study, could explain the asymmetric bias of the sampling distribution of the items, with a more marked ground effect in the Stigma items, and a ceiling effect on Control items. Although some studies have not found time effects from the genetic diagnosis in the dimensions of self-concept,<a class="elsevierStyleCrossRef" href="#bib0225">15</a> others describe curvilinear trajectories of the psychological impact of the BRCA1/2 test, where the greatest impact is the first 6 months following the test.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> In this study, the results can be interpreted as catergorisations of adaptation to GC, and as reflecting the integration (result) of being a BRCA1/2 carrier in the individual's self-concept in terms of low Stigma, low Vulnerability and high Control in a sample that already adheres to the monitoring offered by GC units. Longitudinal studies that allow us to know the effect of time on each of the specific areas of self-concept are recommended. Alternatively, if this effect continues to be observed in further studies with homogeneous samples in regard to the time elapsed since genetic diagnosis, the wording of the items, the number of categories included in the response, or the dimension of the number of issues including in each of the sub-scales should be reconsidered. As for the Model 1 that underwent testing, considering that for small samples a value of RMSEA of 0.08 has been established as admissible, the configuration rates of Model 1 could support the original structure of the scale. However, it has been agreed that the value of the upper limit of the confidence interval and covariance between error of items 4 and 5 shown by IM do not permit accepting the model as valid. One possible explanation is that for validation of the original instrument an ACP was conducted which, unlike the factor analysis (FA), does not distinguish between common variance and variance error, being the total variance that which is sought to be reproduced. The AF, in contrast, is based on the principle that the variables have error measurement and tries to reproduce only the common variance. In this sense, items 4 and 5 are correlative and begin with the same words, raising the possibility of an effect method. It is usual for typical performance questionnaires to contain redundant items, and in the AF the errors between redundant items cannot be considered to be independent. Therefore it tests a less restrictive model.<a class="elsevierStyleCrossRef" href="#bib0250">20</a>On the other hand, the high correlation between factors Stigma and Vulnerability points to a possible incorrect designation of relations between indicators and latent factors, or even that it could be one sole factor. We can already see in the instrument's original development and validation study significant weightings in more than one factor.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> Upon carrying out the expert testing, we found that items 10 (“I think a lot about my genetic test”) and 13 (“I feel overwhelmed with this information”), initially belonging to Stigma are identified as indicators of the factor Vulnerability, a finding that does not contradict the original version of the instrument, where these items had weightings of 0.36 in that factor.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> From a theoretical perspective, both items have a clear ruminative and/or intrusive thought component arising from the traumatic response to stressful life events; in this case, the impact of being a carrier is the loss of identity as a healthy person<a class="elsevierStyleCrossRef" href="#bib0170">4</a> and the high risk of developing HBOC stands out as a potential threat to the individual's, even family members’, integrity and health, breaking a belief as basic as invulnerability. In the particular case of hereditary cancer, the attribution processes established by a cause-effect relationship between genetic alteration and disease could install feelings of guilt and shame with significant implications for identity, further encouraged by a cultural environment that symbolises genes as the true inner nature and essence of our ancestors and descendants.<a class="elsevierStyleCrossRef" href="#bib0290">28</a> In the context of hereditary diseases, it seems difficult to separate a self-concept of vulnerability from a self-concept of stigma, as this increased risk of vulnerability, using GC's own discourse, is due to a genetic alteration or pathogenic mutation, a language that can easily be understood in stigmatising terms.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> In the particular case of Lynch syndrome, a disease of inherited predisposition to colorectal cancer, the corresponding scale of impact on self-concept contemplates the dimensions of stigma and vulnerability in a single factor.<a class="elsevierStyleCrossRef" href="#bib0200">10</a> In our study, preliminary tests with 2 factors showed that the model does not fit a bifactor model, and even assuming an overlap between the two factors, we believe keeping them separate is convenient because in the HBOC they are predicted and are related to different specific needs.<a class="elsevierStyleCrossRefs" href="#bib0230">16,17</a> In addition, both sub-scales get adequate indices of reliability and adequate convergent validity with the CCS. In any case, this high correlation should be considered as a potential source of collinearity in subsequent studies.Regarding internal consistency, the Stigma subscale has an Cronbach α greater than 0.80 in all the models analysed, similar to the original version; and Vulnerability, after incorporating items 10 and 13, increased half a point to 0.843. The reliability of the sub-scale Control, as occurs in the original version, does not reach the desired standard. The definition of the sub-scale Control, proposed in the original instrument–self-efficacy, resilience and hope–highlights its heterogeneity, which contrasts with the low number of items it contains, only 4, of which 2 had low, although significant, factorial weightings. Despite these limitations, expert testing concluded that the 4 items measure Control, and that the original version of the instrument has adequate measures with convergent, divergent and criterion validity.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> Moreover, their usefulness has been established in recent empirical studies, which has associated it with low levels of emotional distress.<a class="elsevierStyleCrossRefs" href="#bib0225">15–17</a> Self-efficacy, resilience and hope play an important role in the individual's psychological adaptation to potentially traumatic events, so despite the justified need to complete the reliability and validity of the sub-scale, we consider it necessary to maintain it. Alternatively, the sub-scale can be complimented with brief instruments that are already used in GC, such as the personal perception of control.<a class="elsevierStyleCrossRef" href="#bib0180">6</a>The BRCA Self-Concept Scale has potential uses for both care and research. This scale allows us to explore how specific impacts of the genetic test in self-concept are associated with psychological well-being, medical adherence, decision-making in prophylactic surgery and habits of health, promising lines to be developed that can assist in identifying more specific targets on which to focus psychological intervention, offering more tailored clinical care to the needs of this population. From a health care perspective, assessing and detecting whether the result of genetic testing is having a positive or negative impact on self-concept has clear clinical implications and would allow to individualise the process of GC by responding to the specific needs of each patient; at the same time, it would also identify those patients who have difficulties in adapting to their condition as high-risk candidates for a more extensive and specific psychological support. Thus, for example, in stigmatised carriers, opening channels of communication with their nuclear family, especially their partner, can help reduce malaise.<a class="elsevierStyleCrossRef" href="#bib0235">17</a> Vulnerability, such as concerns about cancer, can increase anxiety and interfere with medical adherence, while greater control and empowerment can foster health behaviours,<a class="elsevierStyleCrossRef" href="#bib0160">2</a> such that encouraging a self-concept based on Control can have clear therapeutic benefits. Indeed, one of the scale's appeals is that it includes both positive and negative impacts; the positive psychological responses and the benefits associated with GC being an emerging and encouraging area of study that responds to the promising results that can already be seen in BC interventions from the Positive Psychology based on facilitating post-traumatic growth in women with BC.<a class="elsevierStyleCrossRefs" href="#bib0295">29,30</a>FinanceThis study has been made possible by the PI10/00748 and PI13/00189Health Research Fund support, and the Spanish Association Against Cancer Board of Barcelona. VC has received a predoctoral fellowship from the Bellvitge Institute of Biomedical Research.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres672918" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec679265" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres672919" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec679264" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and method" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Measurement instruments" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Adaptation of the scale" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Finance" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack227154" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-28" "fechaAceptado" => "2015-09-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec679265" "palabras" => array:4 [ 0 => "Self-concept" 1 => "Hereditary breast and ovarian cancer syndrome" 2 => "Psychological adjustment" 3 => "Validation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec679264" "palabras" => array:4 [ 0 => "Autoconcepto" 1 => "Cáncer de mama y ovario hereditario" 2 => "Adaptación psicológica" 3 => "Estudio de validación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveHaving an inherited predisposition to cancer may have a psychological impact, and one goal of genetic counselling is to promote psychological adjustment to the new situation. Thus, in the genetic context, validated measures of adjustment are required. Given that self-concept is a good indicator of adjustment to the disease or to the risk for it, and a relevant variable in oncology, the goal of the study is to culturally adapt and validate the BRCA Self-Concept Scale. Material and methodOne hundred and sixty-five BRCA carriers’ women answered to the questionnaire, previously adapted through a process of forward/back-translation, and to the Cancer Worry Scale (CWS) as a measure of convergent validity. Theoretical structure of BRCA Self-Concept Scale was assessed by expert judges, and submitted to a confirmatory factor analysis (CFA). Cronbach's α was calculated for each subscale (Stigma, Vulnerability and Control), and correlations with CWS were performed. ResultsExpert judges’ structure and CFA do not support the original structure of the questionnaire. The respecificity model (with items 10 and 13 loading on Vulnerability factor) show a better fit: comparative fit index 0.973; Tucker-Lewis index 0.968; root mean square error of approximation 0.067. The Cronbach's α is 0.83 for Stigma, 0.84 for Vulnerability, and 0.61 for Control. Evidence of convergent validity with CWS has been obtained (Spearman's rho 0.631 for Stigma, 0.683 for Vulnerability, and −0.363 for Control; p<0.001). ConclusionsResults support the validity of the modified Spanish BRCA Self-Concept Scale, which is a potentially useful measure for the study of psychological adjustment to high risk for hereditary breast and ovarian cancer." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Fundamento y objetivoTener una predisposición hereditaria al cáncer puede asociarse a un impacto psicológico. Uno de los objetivos del consejo genético es favorecer la adaptación psicológica a la nueva situación, siendo necesarios instrumentos validados en este contexto. Por ser el autoconcepto un buen indicador de adaptación a la enfermedad o al riesgo de tenerla, y una variable relevante en oncología, el objetivo es adaptar culturalmente al castellano y validar la BRCA Self-Concept Scale. Material y métodoCiento sesenta y cinco portadoras de mutación en los genes BRCA respondieron al cuestionario previamente sometido a un proceso de traducción-retrotraducción, y a la Escala de Preocupación por el Cáncer (EPC) como medida de validez convergente. Se valoró la estructura del cuestionario mediante una prueba de expertos y un análisis factorial confirmatorio (AFC), se calculó el α de Cronbach de las 3 subescalas (Estigma, Vulnerabilidad y Control), y se correlacionaron con la EPC. ResultadosLa prueba de expertos y el AFC no confirman la estructura original del cuestionario. El modelo reespecificado (con los ítems 10 y 13 en Vulnerabilidad) muestra mejor ajuste: comparative fit index 0,973; Tucker-Lewis index 0,968; root mean square error of approximation 0,067. El α de Cronbach es de 0,83 para Estigma, de 0,84 para Vulnerabilidad, y de 0,61 para Control. Se encuentra evidencia de validez convergente con la EPC (rho de Spearman 0,631 para Estigma, 0,683 para Vulnerabilidad, y −0,363 para Control; p<0,001). ConclusionesLos resultados apoyan la validez de la escala modificada de autoconcepto BRCA, siendo una medida potencialmente útil para valorar la adaptación a tener una alta predisposición hereditaria al cáncer." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Castejón V, Rovira T, Sumalla EC, Darder E, Iglesias S, Ochoa C, Blanco I. Adaptación cultural y validación de la versión española de la Escala de Autoconcepto en BRCA en mujeres portadoras con alto riesgo de cáncer de mama y ovario hereditario. Med Clin (Barc). 2016;146:148–154." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1565 "Ancho" => 2940 "Tamanyo" => 311368 ] ] "descripcion" => array:1 [ "en" => "Confirmatory factor analysis of 3 first-order factors from the Spanish version of the BRCA Self-Concept Scale (Model 2)." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Hospital of origin, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duran i Reynals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (57.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Germans Trias i Pujol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Josep Trueta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (29.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age in years, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.73 (13.38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Studies completed, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No qualifications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (39.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (33.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Higher \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Marital status, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Single \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Married/cohabiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (78.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Separated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (7.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Widowed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Has children, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130 (78.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Months since genetic diagnosis, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.02 (37.11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Oncological status, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (46.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Affected \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (53.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">First oncological diagnosis of those affected (n=89), n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (84.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ovarian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (13.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Years since the first oncological diagnosis, mean (DE) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.55 (8.71) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Prophylactic surgery, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (53.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bilateral mastectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Salpingo-oophorectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (39.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bilateral Mastectomy+salpingo-oophorectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1103541.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General characteristics of the sample (n=165)." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "C: Control; SD: standard deviation; S: Stigma; SE: standard error; It. Original factor: item number, brief description and factor it belongs to in the original version (full description in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>); NA: not applicable; NAn: not answered; V: vulnerability." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">It._Original factor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asymmetry SE=0.192 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kurtosis SE=0.383 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ground effect, % \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ceiling effect, % \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NAn \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lost (NA+ NAn), % \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1: hopeful_C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.471 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.899 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.030 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2: able to handle results_C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.615 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.347 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.181 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3: betrayed by my body_V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.673 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.894 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4: time-bomb_V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.913 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.972 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.488 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5: different from my age_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.204 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.753 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6: I know my body well_C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.639 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.069 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.447 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7: guilty transmission to children_V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.346 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.513 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8: isolated_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.110 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.632 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.241 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9: loss of privacy_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.782 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.343 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.533 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10: think of the results_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.892 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.448 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11: concern about cancer_V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.081 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.915 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.499 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12: labelled_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.060 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.419 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13: overwhelmed_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.740 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.935 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.332 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14: I do not trust my body_V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.927 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.797 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.648 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15: I am in control_C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.897 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.081 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.061 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16: it affects who I am_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.766 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.156 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17: reserved_S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.793 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.460 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.934 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1103539.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Descriptions of the items in the BRCA Self-Concept Scale (n=165)." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CFI: comparative fit index; CI: confidence interval; Model 1: 3 first-order factors, original version; Model 1 parameter release it 4–5: 3 factors from the original version, release error covariance of items 4 and 5; Model 2: judges, with items 10 and 13 as indicators of vulnerability, and release error covariance of items 4 and 5; RMSEA: root mean square error of approximation; TLI: Tucker-Lewis index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Models \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">χ2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">df \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CFI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TLI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RMSEA (90% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Model 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">246.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.959 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.952 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.083 (0.068–0.097) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Model 1 parameter release it 4–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">213.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.969 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.963 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.072 (0.057–0.087) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Model 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200.008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.973 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.968 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.067 (0.051–0.082) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1103538.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Indices of fit of the models tested in the confirmatory factor analysis with firm weighted least squares estimator for categorical data." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "CCS: Cancer Concern Scale.Reliability calculated by Cronbach α.Spearman's Rho." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stigma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vulnerability \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">α Model 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.859 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.788 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.614 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">α Model 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.835 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.843 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.614 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Correlations sub-scales Model 2 and CCS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.631<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.683<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.363<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1103540.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Correlation is significant at level 0.01 (bilateral)." ] ] ] "descripcion" => array:1 [ "en" => "Reliability of BRCA Self-Concept sub-scales and convergence with Cancer Concern Scale." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The average cumulative risks of breast and ovarian cancer for carriers of mutations in BRCA1 and BRCA2 attending genetic counseling units in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.L. 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Original article

Cultural scale adaptation and validation of the Spanish version of the BRCA Self-Concept Scale in women carriers at high risk for hereditary breast and ovarian cancer

Adaptación cultural y validación de la versión española de la Escala de Autoconcepto en BRCA en mujeres portadoras con alto riesgo de cáncer de mama y ovario hereditario

Vanessa Castejóna,b, Tatiana Rovirab, Enric C. Sumallaa, Esther Darderc, Silvia Iglesiasa, Cristian Ochoad,e, Ignacio Blancoa,f,

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iblanco.germanstrias@gencat.cat

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a Programa de Cáncer Hereditario Institut d’Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d’Oncologia-Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, Spain

b Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, Spain

c Programa de Cáncer Hereditario, Institut Català d’Oncologia-Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta, Unidad de Consejo Genético, Hospital Universitario Dr. Josep Trueta, Girona, Spain

d Unidad de Psico-Oncología, Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, Spain

e Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain

f Programa de Asesoramiento y Genética Clínica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Between 5&#37; and 10&#37; of breast cancer &#40;BC&#41; diagnoses are due to mutations in the germ line of high-penetrance genes <span class="elsevierStyleItalic">BRCA1&#47;2</span> that are transmitted with an autosomal dominant inheritance&#44; responsible for the hereditary breast and ovarian cancer &#40;HBOC&#41; syndrome&#46; Carriers of mutations of these genes have a high risk of developing cumulative HBOC throughout life&#44; ranging from 47&#37; to 52&#37; for BC and 8&#37; to 22&#37; for ovarian cancer &#40;OC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> and a probability of 50&#37; of transmitting this susceptibility to their offspring&#46; Being a carrier of a genetic condition that predisposes a potentially life-threatening disease like cancer poses a threat to one &#8216;s health and can be considered a highly stressful life event&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Knowledge of this increased risk is for life&#44; and affects not only the individual but their family&#44; who must make a number of complex decisions based on this probabilistic information&#46; The individuals and families susceptible to this hereditary predisposition to cancer are referred to genetic counselling &#40;GC&#41; units&#44; where an individualised assessment of the risk of occurrence and&#47;or recurrence of the disease is made&#44; and strategies for early prevention and detection are offered&#44; according to their individual risk&#46; These units have proved to be effective in reducing incidence and mortality rates&#46; The aim of GC is to help those individuals learn and adapt to the medical&#44; psychological and family implications of the genetic contribution to the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Fostering a psychological adaptation to their condition as carrier is one of the objectives of the GC&#44; its evaluation is important&#46; Adapting to a hereditary disease or the risk of having one is dynamic and multidimensional&#59; in order to demonstrate the effectiveness of GC&#44; indicators are needed both for the process and its outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;6</span></a> To assess psychological adaptation in the context of GC standardised questionnaires are almost exclusively used for symptoms of anxiety and depression&#44; which are measures of adaptation failure&#8211;specifically the results&#8211;and not observable measures of how the process is developing&#46; Likewise&#44; the lack of sensitivity of these questionnaires to specific and relevant needs of the GC have been noted&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;4&#44;7</span></a> In this sense&#44; a study of women diagnosed with BC or OC who underwent genetic tests found that the desire to receive psychological support responds to other needs that are not detected by the usual indicators focused on psychopathology&#44; and only a third of those who express these needs eventually receive psychological support&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> In short&#44; instruments that are sensitive to the specific needs of GC&#44; adequately validated in this context&#44; are needed and they must have multidimensional measures that consider all the relevant aspects of the adaptation process to hereditary diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;4&#8211;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this context the <span class="elsevierStyleItalic">BRCA Self-Concept Scale</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> has been developed and validated in English&#44; which assesses the impact on the individual&#39;s self-concept of knowing that they carry a genetic alteration that predisposes them to HBOC&#44; and has its equivalent in other hereditary cancer syndromes&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a> Self-concept&#44; based on Self-concept Scheme Models&#44; is defined as a complex cognitive&#44; multidimensional&#44; active and dynamic structure that integrates and synthesises thoughts&#44; feelings and experiences about oneself<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> and is considered the organising framework that gives meaning&#44; shape and direction to these experiences&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> In chronic diseases&#44; a new or restored self-concept is indicative of adaptation to the condition or disease insomuch that it reflects an emotional acceptance and internalisation of oneself as a person with a certain condition&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> In oncology&#44; self-concept is an important variable&#44; as its alteration may involve greater emotional distress and negatively impact adherence to health behaviours&#46; Alternatively&#44; the ability to build new schemes of oneself can facilitate recovery after an adverse event&#44; thus establishing a bi-directional&#44; self-concept-disease relationship&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">BRCA Self-Concept Scale</span> assesses the impact of being a carrier on the different dimensions of self-concept&#44; considering both negative and positive changes&#46; The analysis of the main components carried out for its development and validation generates a 3-factor solution that evidences its multidimensionality&#58; Stigma&#44; which in the original version represents 38&#46;7&#37; of the total variance explained &#40;Cronbach <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;86&#41;&#44; assesses to what extent the person feels isolated and different from others&#44; or whether they have a damaged identity after undergoing the genetic test&#59; Vulnerability &#40;8&#46;5&#37; of the total variance explained in the original version&#44; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;76&#41; assesses the fragility and uncertainty about the body itself and its health&#59; Control &#40;6&#46;5&#37; of the total variance explained in the original version&#44; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;68&#41; evaluates self-efficacy&#44; resilience and hope&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Studies to date have not reported the existence of a second-order factor&#44; focusing attention on the involvement of the specific dimensions of self-concept and its association with other relevant GC variables&#46; Thus&#44; integrating high-risk conditions to develop HBOC in self-concept in terms of control is associated with lower levels of emotional distress&#59; however&#44; doing so in terms of Stigma and&#47;or Vulnerability is associated with higher levels&#46; Also&#44; it has been shown that open communication with the partner and children is associated with less Stigma in self-concept&#44; which reverts to lower levels of general malaise&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This study aims to culturally adapt the <span class="elsevierStyleItalic">BRCA Self-Concept Scale</span> to Spanish&#44; confirm its original factorial structure&#44; evaluate its internal consistency and analyse its convergence with the Escala de Preocupaci&#243;n por el C&#225;ncer &#91;Cancer Concern Scale &#40;CCS&#41;&#93;&#44; the only instrument validated in Spanish in the context of hereditary BC<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> that has shown an association with adherence to preventive behaviours&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0030" class="elsevierStylePara elsevierViewall">In order to obtain a sample similar to the original instrument&#44; women carrying pathogenic mutations in their <span class="elsevierStyleItalic">BRCA1&#47;2</span> genes were identified&#44; both healthy and affected women who were undergoing medical monitoring because of their high risk of BC and OC&#46; The inclusion criteria were the following&#58; being a carrier of the mutation in <span class="elsevierStyleItalic">BRCA1&#47;2</span>&#44; be of legal age&#44; literate in Spanish&#44; and at least 6 months must have passed from receiving the result of the genetic test&#46; Exclusion criteria were&#58; to have a cognitive impairment and&#47;or a disabling psychiatric diagnosis&#46; Of the 329 candidates invited to participate&#44; 165 &#40;50&#46;15&#37;&#41; returned completed questionnaires&#44; with no significant differences in age or medical variables between those who agreed to participate and those who were rejected &#40;data not reported&#44; available only upon request&#41;&#46; The final sample size meets the subject ratio criteria&#58; item 5&#58;1&#8211;10&#58;1&#44; suitable for applying a confirmatory factor analysis &#40;CFA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> The average age was 47&#46;73 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#46;38&#41;&#44; and 76 &#40;46&#46;1&#37;&#41; women had not developed any cancer at the time of answering the questionnaire&#44; being considered healthy carriers&#46; Descriptive of the final sample shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Measurement instruments</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">BRCA Self-Concept Scale</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#58; assesses the impact of being a carrier of the mutation in <span class="elsevierStyleItalic">BRCA1&#47;2</span> on the self-concept&#46; It consists of 17 items with Likert response format with 8 categories&#44; the score ranges from one &#40;strongly disagree&#41; to 7 &#40;strongly agree&#41; in ascending order&#46; Score 8 corresponds to the not applicable &#40;NA&#41; category&#46; The Stigma factor contains items 5&#44; 8&#44; 9&#44; 10&#44; 12&#44; 13&#44; 16 and 17&#46; The Vulnerability factor includes items 3&#44; 4&#44; 7&#44; 11 and 14&#46; The Control factor includes items 1&#44; 2&#44; 6 and 15&#46; Higher scores on Stigma and Vulnerability imply negative changes in self-concept&#59; in Control they imply positive changes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">CCS</span><a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#58; 6-item self-report questionnaire that assesses the respondents&#8217; concern for developing cancer&#44; with a score ranging from one &#40;no concern&#41; to 4 &#40;maximum concern&#41;&#59; <span class="elsevierStyleItalic">&#945;</span> in this study<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;896&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sociodemographic variables&#58;</span> age&#44; education level&#44; marital status&#44; children&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Medical variables&#58;</span> oncological status&#44; time since genetic diagnosis&#44; time since oncological diagnosis and prophylactic surgeries&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study was conducted in the <span class="elsevierStyleItalic">Institut Catal&#224; d&#8217;Oncologia</span> GC units located in the <span class="elsevierStyleItalic">Duran i Reynals&#44; Germans Trias i Pujol</span> and <span class="elsevierStyleItalic">Josep Trueta</span> hospitals&#44; following the hospitals&#8217; clinical research ethics committees review and approval of the study&#46; The sample was obtained between July 2012 and May 2014&#44; following established protocols for accessing and processing data from medical records and ensuring their confidentiality&#46; An explanation of the study with the questionnaires&#44; an informed consent and a postage paid return envelope was sent by post&#46; All participants were informed of the confidentiality of their answers and agreed to answer the questionnaires&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Adaptation of the scale</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author authorised the cultural adaptation and validation of the scale to Spanish&#44; which was done through two complementary procedures&#58; translation-back translation&#44; following the guidelines of the International Tests Commission&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> and expert testing to collect proof of the translated items content validity regarding their adherence to the subscales&#46; The English version of the instrument was translated by 2 bilingual people &#40;a linguist and a psychologist&#41; and back-translated by 2 other people with the same profile&#44; all familiar with both cultures&#46; The 2 translations in Spanish were reviewed by the research team and the translators&#44; and a first version of the Self-Concept Scale in <span class="elsevierStyleItalic">BRCA</span> was generated&#44; which was later sent for back-translation into English&#46; The resulting version of the scale was assessed using the recommended levels of equivalence and a consensus was reached that our version was faithful to the original&#46; Finally&#44; the clarity&#44; understanding&#44; time of completion&#44; relevance and acceptability was assessed through a pilot scale procedure given to a sub-sample of 10 patients&#46; For the expert testing&#44; 5 health psychologists assessed on a dichotomous &#8220;yes&#47;no&#8221; scale the adequacy level of each item for each sub-scale&#44; considering the author&#39;s definition&#46; In addition&#44; they indicated the degree of safety of each judgement issued&#44; on a scale from 0 to 100&#46; To assess the suitability of each item to its security sub-scale&#44; the judgement was divided by 100&#44; and the result was multiplied by &#8722;1 when the dichotomous scale response was &#8216;no&#8217; &#40;result from judging the item as belonging to that sub-scale&#41;&#46; For each item 3 ratings were obtained&#44; one per sub-scale from &#8722;1 to &#43;1&#46; For each of these resulting values a contrast hypothesis non-parametric test &#40;Kolmogorov-Smirnov&#41; was carried out with a test value of 0 to determine its significance&#44; using a criterion corrected to 3 comparisons for each item where <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#46; The results indicate that only items 10 &#40;&#8220;I think a lot about the result of my genetic test&#8221;&#41;&#44; and 13 &#40;&#8220;I feel overwhelmed with this information&#8221;&#41;&#44; considered Stigma in the original instrument&#44; show no belonging to their sub-scale &#40;<span class="elsevierStyleItalic">z</span><span class="elsevierStyleInf">k-s</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#44; ns&#59; and <span class="elsevierStyleItalic">z</span><span class="elsevierStyleInf">k-s</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;87&#44; ns&#44; respectively&#41;&#44; and if they do&#44; it is to&#44; according to the judges&#44; the Vulnerability scale &#40;<span class="elsevierStyleItalic">z</span><span class="elsevierStyleInf">k-s</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;70&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006 and <span class="elsevierStyleItalic">z</span><span class="elsevierStyleInf">k-s</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; respectively&#41;&#46; It was therefore decided to test&#44; in addition to the author&#39;s original model &#40;Model 1&#41;&#44; the model in which items 10 and 13 become part of the Vulnerability sub-scale &#40;Model 2&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">To evaluate the psychometric properties of the 2 models tested the following was conducted&#58; &#40;a&#41; descriptive analysis of the items&#59; &#40;b&#41; AFC through the firm weighted least squares estimator for categorical data&#44; and without imputation of lost values due to presenting random patterns that allow response tendencies to be ruled out<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&#59; &#40;c&#41; analysis of the internal consistency of the sub-scales of both models&#44; using the Cronbach <span class="elsevierStyleItalic">&#945;</span> coefficient and &#40;d&#41; evidence of convergent validity of the sub-scales of both models with an equivalent measure of psychological adaptation in the context of GC &#40;CCS&#41; through the Spearman correlation to confirm the positive and moderate relationships with the sub-scales Stigma and Vulnerability and negative and moderate with the sub-scales Control&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the AFC&#44; in addition to testing the original Model 1&#44; a re-specification model is tested with the covariance of error <span class="elsevierStyleItalic">&#40;uniqueness&#41;</span> of items 4 &#40;&#8220;I feel like a walking time-bomb&#8221;&#41; and 5 &#40;&#8220;I feel different to people my age&#8221;&#41; as they are correlative&#44; start with the same words and present modification indices &#40;MI&#41; that support this configuration&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> This re-specification is maintained in the case of Model 2&#46; The goodness of fit of the 3 models is assessed through the normal indices&#44; <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> comparative fit index &#40;CFI&#41;&#44; Tucker-Lewis index &#40;TLI&#41;&#44; root mean square error of approximation &#40;RMSEA&#41; and weighted root mean square residual&#44; considering the following cutoffs&#58; RMSEA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 and TLI and CFI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;95 indicating a good fit&#44; and RMSEA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;08 and TLI and CFI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;90 as reasonable fit&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;24</span></a> The internal consistency is adequate from a Cronbach <span class="elsevierStyleItalic">&#945;</span> of at least 0&#46;70&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> For the convergent validity&#44; due to the average size of the sample&#44; a &#124;<span class="elsevierStyleItalic">R</span>&#124;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;030 is considered a good effect size&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> The AFC has been conducted using Mplus v&#46; 7 and the others&#44; with SPSS v&#46; 21&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The descriptive statistics of the items are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; All items corresponding to the sub-scale Stigma of the original version show a marked ground effect&#44; without a ceiling effect&#44; resulting in positively skewed distributions&#46; Items 3&#44; 4 and 14 from Vulnerability also have a low representation of highest scoring categories&#44; while items 7 and 11 have indices of asymmetry in the opposite direction to the rest of the items in the sub-scale&#46; Items from the Control scale&#44; whose semantic content is positive valence compared to the remaining items of the scale&#44; have a negative asymmetry&#46; Because of the distribution of the items&#44; the data are analysed as categorical&#46; There are a total of 102 lost values &#40;3&#46;64&#37; of total values from the sample&#41;&#46; 77&#46;45&#37; of the missing data are from the category NA&#44; and 22&#46;55&#37; not answered values &#40;NAn&#41;&#46; For all items&#44; both the number of NAn on one hand and the NA on the other&#44; represent values below 5&#37; of subjects who did not answer&#44; and considered together&#44; only items 3&#44; 14 and 16 slightly exceed 5&#37;&#44; thus the majority correspond to NA&#46; Upon analysing the set of lost values&#44; up to 36 different patterns are found&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the fit indices for the models analysed&#46; <span class="elsevierStyleItalic">Model 1</span>&#44; original structure of 3 first-order factors obtains fit indices that do not fully meet the recommended standards&#44; especially for the RMSEA value 0&#46;083 &#40;90&#37; CI 0&#46;068&#8211;0&#46;097&#41;&#46; The correlation between Stigma and Vulnerability is 0&#46;952&#44; indicating an overlap between the two factors&#46; <span class="elsevierStyleItalic">Model 1 re-specified</span> &#40;releasing error covariance of items 4 and 5&#41;&#44; least restrictive&#44; obtains more appropriate fit indices &#40;CFI 0&#46;969&#44; TLI 0&#46;963 and RMSEA 0&#46;072 &#91;90&#37; CI 0&#46;057&#8211;0&#46;087&#93;&#41;&#44; while maintaining a high correlation between factors Stigma and Vulnerability of 0&#46;929&#46; Model 2 is tested&#44; in which according to the expert testing results&#44; items 10 and 13 become indicators Vulnerability and in which the error covariance parameter between items 4 and 5 remain released &#40;<span class="elsevierStyleItalic">¿</span><span class="elsevierStyleSup">45</span>&#41;&#46; <span class="elsevierStyleItalic">Model 2</span> &#40;items 10 and 13 are indicators of Vulnerability&#44; and releasing the parameter <span class="elsevierStyleItalic">¿</span><span class="elsevierStyleSup">45</span>&#41; obtains appropriate fit indices&#58; CFI 0&#46;973&#59; TLI 0&#46;968&#59; RMSEA 0&#46;067 &#40;90&#37; CI 0&#46;051&#8211;0&#46;082&#41;&#46; The items were good indicators of the latent factors&#44; with standardised factor loadings&#44; all significant &#40;between 0&#46;698 and 0&#46;879 for Stigma&#44; 0&#46;590 and 0&#46;885 for Vulnerability&#44; and 0&#46;420 and 0&#46;762 for Control&#41;&#46; The correlations between factors&#44; all significant and the sign according to the content of the sub-scales were&#44; 0&#46;89 between Vulnerability and Stigma&#44; &#8722;0&#46;589 between Control and Stigma&#44; and &#8722;0&#46;553 between Control and Vulnerability&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The internal consistency of the BRCA self-concept scales and their correlation with CCS can be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; Stigma reliability is supported in both models with values of 0&#46;859 and 0&#46;835&#59; and Vulnerability moves from a value of 0&#46;788 in Model 1 to 0&#46;843 in Model 2&#44; while the scale Control receives a value of 0&#46;614&#46; Finally&#44; the elimination of any items did not report any improvements in the internal consistency of the sub-scales&#44; thus it was decided to keep them intact&#46; As for the convergent correlation of the BRCA self-concept &#40;Model 2&#41; with CCS&#44; Stigma and vulnerability show high positive significant association with CCS&#44; with values of 0&#46;631 and 0&#46;683&#44; respectively&#44; while Control showed a significant negative moderate association of 0&#46;363&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">One of the objectives of GC in HBOC is to facilitate patients&#8217; adaptation to having a significantly higher risk than the rest of the general population of developing the disease and transmitting this susceptibility to cancer to offspring&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> As carriers of an inherited predisposition&#44; integrating their condition as persons at high risk of developing cancer into their self-concept is indicative of psychological adaptation to it&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a> The availability of a scale to assess the impact of being a carrier on the individual&#39;s self-concept responds to the need for sensitive and specific instruments that have been properly validated in the context of GC&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> This study is the first to adapt and validate the BRCA Sel-Concept Scale in our sociocultural environment&#44; which&#44; used with psychopathological symptoms&#44; has been shown to be sensitive and specific to GC&#39;s relevant needs&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> and stands as an integrator of both the process and the result of the individual&#39;s adaptation to their condition of carrier or high-risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;13&#44;14</span></a> For the cross-cultural adaptation and validation a translation-back translation protocol process was followed&#44; complemented by expert testing&#59; it is the first study to verify the structure of the scale using an AFC&#46; The Model 2 results allow maintaining the solution of 3 first-order factors&#44; Stigma&#44; Vulnerability and Control&#44; with appropriate indices of fit&#46; In addition&#44; after finding evidence that items 10 and 13 are better indicators of the factor Vulnerability than Stigma&#44; the reliability for these sub-scales not only remains high&#44; but increases at midpoint for Vulnerability compared to the original version&#46; Likewise&#44; evidence in favour of the convergent validity of the 3 sub-scales in regard to CCS were reported&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The number of factors&#44; the relationships of the items with them and the relationship between factors are guided by previous theoretical and empirical evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;16&#44;17</span></a> Self-concept is dynamic&#44; and changes to it do not happen with the same intensity and the same rhythm in all countries around the world&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;11</span></a> The variability of time since the genetic diagnosis in the sample&#44; an average of 4 years in this study&#44; could explain the asymmetric bias of the sampling distribution of the items&#44; with a more marked ground effect in the Stigma items&#44; and a ceiling effect on Control items&#46; Although some studies have not found time effects from the genetic diagnosis in the dimensions of self-concept&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> others describe curvilinear trajectories of the psychological impact of the <span class="elsevierStyleItalic">BRCA1&#47;2 test</span>&#44; where the greatest impact is the first 6 months following the test&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> In this study&#44; the results can be interpreted as catergorisations of adaptation to GC&#44; and as reflecting the integration &#40;result&#41; of being a <span class="elsevierStyleItalic">BRCA1&#47;2</span> carrier in the individual&#39;s self-concept in terms of low Stigma&#44; low Vulnerability and high Control in a sample that already adheres to the monitoring offered by GC units&#46; Longitudinal studies that allow us to know the effect of time on each of the specific areas of self-concept are recommended&#46; Alternatively&#44; if this effect continues to be observed in further studies with homogeneous samples in regard to the time elapsed since genetic diagnosis&#44; the wording of the items&#44; the number of categories included in the response&#44; or the dimension of the number of issues including in each of the sub-scales should be reconsidered&#46; As for the Model 1 that underwent testing&#44; considering that for small samples a value of RMSEA of 0&#46;08 has been established as admissible&#44; the configuration rates of Model 1 could support the original structure of the scale&#46; However&#44; it has been agreed that the value of the upper limit of the confidence interval and covariance between error of items 4 and 5 shown by IM do not permit accepting the model as valid&#46; One possible explanation is that for validation of the original instrument an ACP was conducted which&#44; unlike the factor analysis &#40;FA&#41;&#44; does not distinguish between common variance and variance error&#44; being the total variance that which is sought to be reproduced&#46; The AF&#44; in contrast&#44; is based on the principle that the variables have error measurement and tries to reproduce only the common variance&#46; In this sense&#44; items 4 and 5 are correlative and begin with the same words&#44; raising the possibility of an effect method&#46; It is usual for typical performance questionnaires to contain redundant items&#44; and in the AF the errors between redundant items cannot be considered to be independent&#46; Therefore it tests a less restrictive model&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">On the other hand&#44; the high correlation between factors Stigma and Vulnerability points to a possible incorrect designation of relations between indicators and latent factors&#44; or even that it could be one sole factor&#46; We can already see in the instrument&#39;s original development and validation study significant weightings in more than one factor&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Upon carrying out the expert testing&#44; we found that items 10 &#40;&#8220;I think a lot about my genetic test&#8221;&#41; and 13 &#40;&#8220;I feel overwhelmed with this information&#8221;&#41;&#44; initially belonging to Stigma are identified as indicators of the factor Vulnerability&#44; a finding that does not contradict the original version of the instrument&#44; where these items had weightings of 0&#46;36 in that factor&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> From a theoretical perspective&#44; both items have a clear ruminative and&#47;or intrusive thought component arising from the traumatic response to stressful life events&#59; in this case&#44; the impact of being a carrier is the loss of identity as a healthy person<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> and the high risk of developing HBOC stands out as a potential threat to the individual&#39;s&#44; even family members&#8217;&#44; integrity and health&#44; breaking a belief as basic as invulnerability&#46; In the particular case of hereditary cancer&#44; the attribution processes established by a cause-effect relationship between genetic alteration and disease could install feelings of guilt and shame with significant implications for identity&#44; further encouraged by a cultural environment that symbolises genes as the true inner nature and essence of our ancestors and descendants&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> In the context of hereditary diseases&#44; it seems difficult to separate a self-concept of vulnerability from a self-concept of stigma&#44; as this increased risk of vulnerability&#44; using GC&#39;s own discourse&#44; is due to a genetic alteration or pathogenic mutation&#44; a language that can easily be understood in stigmatising terms&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> In the particular case of Lynch syndrome&#44; a disease of inherited predisposition to colorectal cancer&#44; the corresponding scale of impact on self-concept contemplates the dimensions of stigma and vulnerability in a single factor&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> In our study&#44; preliminary tests with 2 factors showed that the model does not fit a bifactor model&#44; and even assuming an overlap between the two factors&#44; we believe keeping them separate is convenient because in the HBOC they are predicted and are related to different specific needs&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a> In addition&#44; both sub-scales get adequate indices of reliability and adequate convergent validity with the CCS&#46; In any case&#44; this high correlation should be considered as a potential source of collinearity in subsequent studies&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding internal consistency&#44; the Stigma subscale has an Cronbach <span class="elsevierStyleItalic">&#945;</span> greater than 0&#46;80 in all the models analysed&#44; similar to the original version&#59; and Vulnerability&#44; after incorporating items 10 and 13&#44; increased half a point to 0&#46;843&#46; The reliability of the sub-scale Control&#44; as occurs in the original version&#44; does not reach the desired standard&#46; The definition of the sub-scale Control&#44; proposed in the original instrument&#8211;self-efficacy&#44; resilience and hope&#8211;highlights its heterogeneity&#44; which contrasts with the low number of items it contains&#44; only 4&#44; of which 2 had low&#44; although significant&#44; factorial weightings&#46; Despite these limitations&#44; expert testing concluded that the 4 items measure Control&#44; and that the original version of the instrument has adequate measures with convergent&#44; divergent and criterion validity&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Moreover&#44; their usefulness has been established in recent empirical studies&#44; which has associated it with low levels of emotional distress&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#8211;17</span></a> Self-efficacy&#44; resilience and hope play an important role in the individual&#39;s psychological adaptation to potentially traumatic events&#44; so despite the justified need to complete the reliability and validity of the sub-scale&#44; we consider it necessary to maintain it&#46; Alternatively&#44; the sub-scale can be complimented with brief instruments that are already used in GC&#44; such as the personal perception of control&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The BRCA Self-Concept Scale has potential uses for both care and research&#46; This scale allows us to explore how specific impacts of the genetic test in self-concept are associated with psychological well-being&#44; medical adherence&#44; decision-making in prophylactic surgery and habits of health&#44; promising lines to be developed that can assist in identifying more specific targets on which to focus psychological intervention&#44; offering more tailored clinical care to the needs of this population&#46; From a health care perspective&#44; assessing and detecting whether the result of genetic testing is having a positive or negative impact on self-concept has clear clinical implications and would allow to individualise the process of GC by responding to the specific needs of each patient&#59; at the same time&#44; it would also identify those patients who have difficulties in adapting to their condition as high-risk candidates for a more extensive and specific psychological support&#46; Thus&#44; for example&#44; in stigmatised carriers&#44; opening channels of communication with their nuclear family&#44; especially their partner&#44; can help reduce malaise&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Vulnerability&#44; such as concerns about cancer&#44; can increase anxiety and interfere with medical adherence&#44; while greater control and empowerment can foster health behaviours&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> such that encouraging a self-concept based on Control can have clear therapeutic benefits&#46; Indeed&#44; one of the scale&#39;s appeals is that it includes both positive and negative impacts&#59; the positive psychological responses and the benefits associated with GC being an emerging and encouraging area of study that responds to the promising results that can already be seen in BC interventions from the Positive Psychology based on facilitating post-traumatic growth in women with BC&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Finance</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study has been made possible by the <span class="elsevierStyleGrantNumber" refid="gs1">PI10&#47;00748 and PI13&#47;00189</span><span class="elsevierStyleGrantSponsor" id="gs1">Health Research Fund</span> support&#44; and the <span class="elsevierStyleGrantSponsor" id="gs2">Spanish Association Against Cancer Board of Barcelona</span>&#46; VC has received a predoctoral fellowship from the <span class="elsevierStyleGrantSponsor" id="gs3">Bellvitge Institute of Biomedical Research</span>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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            0 => "Self-concept"
            1 => "Hereditary breast and ovarian cancer syndrome"
            2 => "Psychological adjustment"
            3 => "Validation"
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            0 => "Autoconcepto"
            1 => "C&#225;ncer de mama y ovario hereditario"
            2 => "Adaptaci&#243;n psicol&#243;gica"
            3 => "Estudio de validaci&#243;n"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Having an inherited predisposition to cancer may have a psychological impact&#44; and one goal of genetic counselling is to promote psychological adjustment to the new situation&#46; Thus&#44; in the genetic context&#44; validated measures of adjustment are required&#46; Given that self-concept is a good indicator of adjustment to the disease or to the risk for it&#44; and a relevant variable in oncology&#44; the goal of the study is to culturally adapt and validate the BRCA Self-Concept Scale&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">One hundred and sixty-five BRCA carriers&#8217; women answered to the questionnaire&#44; previously adapted through a process of forward&#47;back-translation&#44; and to the Cancer Worry Scale &#40;CWS&#41; as a measure of convergent validity&#46; Theoretical structure of BRCA Self-Concept Scale was assessed by expert judges&#44; and submitted to a confirmatory factor analysis &#40;CFA&#41;&#46; Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> was calculated for each subscale &#40;Stigma&#44; Vulnerability and Control&#41;&#44; and correlations with CWS were performed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Expert judges&#8217; structure and CFA do not support the original structure of the questionnaire&#46; The respecificity model &#40;with items 10 and 13 loading on Vulnerability factor&#41; show a better fit&#58; comparative fit index 0&#46;973&#59; Tucker-Lewis index 0&#46;968&#59; root mean square error of approximation 0&#46;067&#46; The Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> is 0&#46;83 for Stigma&#44; 0&#46;84 for Vulnerability&#44; and 0&#46;61 for Control&#46; Evidence of convergent validity with CWS has been obtained &#40;Spearman&#39;s rho 0&#46;631 for Stigma&#44; 0&#46;683 for Vulnerability&#44; and &#8722;0&#46;363 for Control&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Results support the validity of the modified Spanish BRCA Self-Concept Scale&#44; which is a potentially useful measure for the study of psychological adjustment to high risk for hereditary breast and ovarian cancer&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tener una predisposici&#243;n hereditaria al c&#225;ncer puede asociarse a un impacto psicol&#243;gico&#46; Uno de los objetivos del consejo gen&#233;tico es favorecer la adaptaci&#243;n psicol&#243;gica a la nueva situaci&#243;n&#44; siendo necesarios instrumentos validados en este contexto&#46; Por ser el autoconcepto un buen indicador de adaptaci&#243;n a la enfermedad o al riesgo de tenerla&#44; y una variable relevante en oncolog&#237;a&#44; el objetivo es adaptar culturalmente al castellano y validar la <span class="elsevierStyleItalic">BRCA Self-Concept Scale</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Ciento sesenta y cinco portadoras de mutaci&#243;n en los genes <span class="elsevierStyleItalic">BRCA</span> respondieron al cuestionario previamente sometido a un proceso de traducci&#243;n-retrotraducci&#243;n&#44; y a la Escala de Preocupaci&#243;n por el C&#225;ncer &#40;EPC&#41; como medida de validez convergente&#46; Se valor&#243; la estructura del cuestionario mediante una prueba de expertos y un an&#225;lisis factorial confirmatorio &#40;AFC&#41;&#44; se calcul&#243; el &#945; de Cronbach de las 3 subescalas &#40;Estigma&#44; Vulnerabilidad y Control&#41;&#44; y se correlacionaron con la EPC&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La prueba de expertos y el AFC no confirman la estructura original del cuestionario&#46; El modelo reespecificado &#40;con los &#237;tems 10 y 13 en Vulnerabilidad&#41; muestra mejor ajuste&#58; <span class="elsevierStyleItalic">comparative fit index</span> 0&#44;973&#59; <span class="elsevierStyleItalic">Tucker-Lewis index</span> 0&#44;968&#59; <span class="elsevierStyleItalic">root mean square error of approximation</span> 0&#44;067&#46; El &#945; de Cronbach es de 0&#44;83 para Estigma&#44; de 0&#44;84 para Vulnerabilidad&#44; y de 0&#44;61 para Control&#46; Se encuentra evidencia de validez convergente con la EPC &#40;rho de Spearman 0&#44;631 para Estigma&#44; 0&#44;683 para Vulnerabilidad&#44; y &#8722;0&#44;363 para Control&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los resultados apoyan la validez de la escala modificada de autoconcepto BRCA&#44; siendo una medida potencialmente &#250;til para valorar la adaptaci&#243;n a tener una alta predisposici&#243;n hereditaria al c&#225;ncer&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Castej&#243;n V&#44; Rovira T&#44; Sumalla EC&#44; Darder E&#44; Iglesias S&#44; Ochoa C&#44; Blanco I&#46; Adaptaci&#243;n cultural y validaci&#243;n de la versi&#243;n espa&#241;ola de la Escala de Autoconcepto en <span class="elsevierStyleItalic">BRCA</span> en mujeres portadoras con alto riesgo de c&#225;ncer de mama y ovario hereditario&#46; Med Clin &#40;Barc&#41;&#46; 2016&#59;146&#58;148&#8211;154&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Confirmatory factor analysis of 3 first-order factors from the Spanish version of the <span class="elsevierStyleItalic">BRCA</span> Self-Concept Scale &#40;Model 2&#41;&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;57&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Germans Trias i Pujol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Josep Trueta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Widowed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Has children&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130 &#40;78&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Months since genetic diagnosis&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;02 &#40;37&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Oncological status&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;46&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Affected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">First oncological diagnosis of those affected &#40;n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">89&#41;&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;84&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ovarian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Years since the first oncological diagnosis&#44; mean &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;55 &#40;8&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Prophylactic surgery&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral mastectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Salpingo-oophorectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;39&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral Mastectomy<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>salpingo-oophorectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">General characteristics of the sample &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">C&#58; Control&#59; SD&#58; standard deviation&#59; S&#58; Stigma&#59; SE&#58; standard error&#59; It&#46; Original factor&#58; item number&#44; brief description and factor it belongs to in the original version &#40;full description in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; NA&#58; not applicable&#59; NAn&#58; not answered&#59; V&#58; vulnerability&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">It&#46;&#95;Original factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asymmetry SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kurtosis SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ground effect&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ceiling effect&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NAn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lost &#40;NA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span> NAn&#41;&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#58; hopeful&#95;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;471&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;899&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#58; able to handle results&#95;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#58; betrayed by my body&#95;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;673&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;894&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#58; time-bomb&#95;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#58; different from my age&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;753&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#58; I know my body well&#95;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;639&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;447&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#58; guilty transmission to children&#95;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;346&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;513&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#58; isolated&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;632&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#58; loss of privacy&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#58; think of the results&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;892&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#58; concern about cancer&#95;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;915&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#58; labelled&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;419&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#58; overwhelmed&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;740&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;935&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#58; I do not trust my body&#95;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;927&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;797&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;648&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#58; I am in control&#95;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;897&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#58; it affects who I am&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;766&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#58; reserved&#95;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;460&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;934&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Descriptions of the items in the <span class="elsevierStyleItalic">BRCA</span> Self-Concept Scale &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CFI&#58; comparative fit index&#59; CI&#58; confidence interval&#59; Model 1&#58; 3 first-order factors&#44; original version&#59; Model 1 parameter release it <span class="elsevierStyleItalic">4&#8211;5&#58;</span> 3 factors from the original version&#44; release error covariance of items 4 and 5&#59; Model 2&#58; judges&#44; with items 10 and 13 as indicators of vulnerability&#44; and release error covariance of items 4 and 5&#59; RMSEA&#58; root mean square error of approximation&#59; TLI&#58; <span class="elsevierStyleItalic">Tucker-Lewis index&#46;</span></p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Models&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">246&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;959&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;083 &#40;0&#46;068&#8211;0&#46;097&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Model 1 parameter release it <span class="elsevierStyleItalic">4&#8211;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;963&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;072 &#40;0&#46;057&#8211;0&#46;087&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Model 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;973&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;968&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;067 &#40;0&#46;051&#8211;0&#46;082&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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