Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016.

OBJECTIVE: To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. METHODS: This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. RESULTS: In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. CONCLUSION: The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.

[Brazilian validation of the item banks on Sleep Disturbance and Wake Disturbance in the Patient-Reported Outcomes Measurement Information System (PROMIS)]. / Validação brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS).

This study aimed to validate the Brazilian version of the item banks for Sleep Disturbance and Wake Disturbance from the Patient-Reported Outcomes Measurement Information System (PROMIS). Validation of these item banks used classical test theory, item response theory, calibrations of items according to the gradual response model proposed by Samejima, and analysis of Differential Item Functioning (DIF), with a sample consisting of 627 participants over 18 years of age. As for data quality, there were no missing data, five items from the Sleep Disturbance bank and four items from the WE bank showed a floor effect, and none of the banks showed a ceiling effect. The two banks displayed excellent reliability with homogeneous scale and good temporal stability. With confirmatory factor analysis, using absolute and incremental goodness-of-fit indices, both banks displayed good fit, showing that the instruments are valid and sufficiently unidimensional. The calibration showed that the items' psychometric properties were satisfactory with good coverage of the sleep-wake construct. As for DIF, both the Sleep Disturbance and Wake Disturbance banks proved to be homogeneous for the different test groups. In conclusion, the version in Brazilian Portuguese for the item banks on Sleep Disturbance and Wake Disturbance in the PROMIS proved to be a reliable, precise, and valid instrument with robust psychometric analyses.

O objetivo deste estudo foi validar a versão brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS). A validação desses bancos de itens foi feita por meio da Teoria Clássica dos Testes, Teoria de Resposta ao Item, calibração dos itens conforme o modelo de resposta gradual proposto por Samejima e análise do Funcionamento Diferencial do Item (DIF), sendo a amostra constituída por 627 participantes com mais de 18 anos. Em relação à qualidade dos dados, observou-se que não houve dados perdidos, e cinco itens do banco Distúrbio do Sono e quatro itens do banco Distúrbio da Vigília tiveram efeito piso, e nenhum dos bancos apresentou efeito teto. Os dois bancos mostraram excelente confiabilidade com uma escala homogênea e boa estabilidade temporal. Com a Análise Fatorial Confirmatória, através dos índices de qualidade de ajuste absoluto e incremental, verificou-se um bom ajuste para os dois bancos, o que revela que os instrumentos são válidos e suficientemente unidimensionais. A calibração evidenciou que as propriedades psicométricas dos itens foram satisfatórias com boa cobertura do construto sono-vigília. No tocante ao DIF, tanto o banco Distúrbio do Sono quanto o banco Distúrbio da Vigília mostraram ser homogêneos para os diferentes grupos testados. Pode-se concluir que a versão para a língua portuguesa falada no Brasil dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do PROMIS demonstrou ser uma medida confiável, precisa e válida, com análises psicométricas robustas.

El objetivo de este estudio fue validar la versión brasileña de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del Patient-Reported Outcomes Measurement Information System (PROMIS). La validación de esos bancos de ítems se realizó mediante teoría clásica de los tests, teoría de respuesta al ítem, calibración de los ítems, según el modelo de respuesta gradual propuesto por Samejima, así como el análisis del Funcionamiento Diferencial del Ítem (DIF), estando la muestra constituida por 627 participantes con más de 18 años. En relación con la calidad de los datos, se observó que no hubo dados perdidos y cinco ítems del banco Disturbio del Sueño y cuatro ítems del banco Disturbio de la Vigilia tuvieron efecto suelo, además ninguno de los bancos presentó un efecto techo. Los dos bancos mostraron excelente confiabilidad con una escala homogénea y buena estabilidad temporal. Con el análisis factorial confirmatorio, usándose los índices de calidad de ajuste absoluto e incremental, se verificó un buen ajuste para los dos bancos, lo que revela que los instrumentos son válidos y suficientemente unidimensionales. La calibración evidenció que las propiedades psicométricas de los ítems fueron satisfactorias con una buena cobertura del constructo sueño-vigilia. En lo que se refiere al DIF, tanto el banco Disturbio del Sueño como el Disturbio de la Vigilia mostraron ser homogéneos para los diferentes grupos testados. Se puede concluir que la versión para la lengua portuguesa hablada en Brasil de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del PROMIS demostró ser una medida confiable, precisa y válida, con análisis psicométricos robustos.

Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016 / Análise de sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016

ABSTRACT Objective To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. Methods This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. Results In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. Conclusion The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.

RESUMO Objetivo Analisar a sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016. Métodos Estudo de coorte retrospectivo com dados do Ministério da Previdência Social. O evento de interesse foi o óbito, e as funções de sobrevida foram estimadas pelos métodos Kaplan-Meier e de regressão de Cox. Resultados No período "início da doença até o óbito", o sexo feminino (HR=0,54; IC95% 0,43-0,53) e recebimento de benefícios previdenciários (HR=0,13; IC95% 0,11-0,23) foram associados a maior sobrevida. A menor sobrevida esteve associada à forma cardíaca da doença (HR=2,64; IC95% 2,23-3,12), residência em zona rural (HR=1,23; IC95% 1,14-1,21) e manifestação da doença entre os anos de 2000 e 2016 (HR=5,32; IC95% 4,74-5,93). Da mesma forma, no período "incapacidade laboral até o óbito", o sexo feminino (HR=0,51; IC95% 0,41-0,52) e o recebimento de benefícios previdenciários (HR=0,24; IC95% 0,14-0,45) foram associados a maior sobrevida, assim como forma cardíaca da doença (HR=1,95; IC95% 1,83-2,13), residência em zona rural (HR=1,31; IC95% 1,21-1,54) e manifestação da doença entre os anos de 2000 e 2016 (HR=1,53; IC95% 1,33-1,71) associaram-se a menor sobrevida. Conclusão Os principais preditores de mortalidade e sobrevida de portadores de doença de Chagas que recebem benefícios previdenciários e assistenciais no Brasil foram apresentados. Estes achados podem nortear a definição de prioridades de ações de acompanhamento pela atenção primária à saúde, preconizada atualmente para o manejo longitudinal da doença.

Cross-cultural adaptation of the Four Habits Coding Scheme (4HCS) for teaching and assessing patient-centered communication skills in Brazil.

Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians' communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as "Engage in small talk", "Expansion of concerns", "Elicit full agenda", "Use patient's frame of reference", and "Explore plan acceptability". They also had difficulty in reaching consensus on the translation of the word "clinician", which was first translated as "physician". Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.

[Cross-cultural adaptation and validation of the PROMIS Global Health scale in the Portuguese language]. / Adaptação transcultural e validação da escala de Saúde Global do PROMIS para a língua portuguesa.

This study aimed to perform the cross-cultural adaptation and validation of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale in the Portuguese language. The ten Global Health items were cross-culturally adapted by the method proposed in the Functional Assessment of Chronic Illness Therapy (FACIT). The instrument's final version in Portuguese was self-administered by 1,010 participants in Brazil. The scale's precision was verified by floor and ceiling effects analysis, reliability of internal consistency, and test-retest reliability. Exploratory and confirmatory factor analyses were used to assess the construct's validity and instrument's dimensionality. Calibration of the items used the Gradual Response Model proposed by Samejima. Four global items required adjustments after the pretest. Analysis of the psychometric properties showed that the Global Health scale has good reliability, with Cronbach's alpha of 0.83 and intra-class correlation of 0.89. Exploratory and confirmatory factor analyses showed good fit in the previously established two-dimensional model. The Global Physical Health and Global Mental Health scale showed good latent trait coverage according to the Gradual Response Model. The PROMIS Global Health items showed equivalence in Portuguese compared to the original version and satisfactory psychometric properties for application in clinical practice and research in the Brazilian population.

Esperança, Medo e Qualidade de vida Relacionada à Saúde na Percepção de Mulheres com Câncer de Mama / Hope, Fear, and Health-Related Quality of Life Perceived by Women with Breast Cancer / Esperanza, Miedo y Calidad de Vida Relacionada a la Percepción de Mujeres con Cáncer de Mama

Introdução: O período de diagnóstico e tratamento do câncer de mama é difícil, permeado de incertezas e associado a uma alta taxa de morbimortalidade. Objetivo: Conhecer o significado que as mulheres com câncer de mama em tratamento em um hospital universitário atribuíram à sua experiência de medo mascarado pelo sentimento de esperança, bem como investigar a percepção da qualidade de vida no enfrentamento da doença. Método: Estudo quanti-qualitativo com 78 mulheres. Para a avaliação quantitativa, avaliaram-se os escores do Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey (SF-36) e da Escala de Esperança de Herth. Para a análise qualitativa, conduziram-se narrativas com dez dessas mulheres que foram analisadas por meio de métodos fenomenológicos de investigação. Resultados: Foram detectados escores reduzidos nos domínios capacidade funcional e saúde mental do SF-36 que implicam em impacto negativo na qualidade de vida e alto índice nos escores de esperança, o que é um fator positivo. Três classes centrais emergiram de 243 segmentos das narrativas por meio de declarações significativas e unidades de significado correspondentes. Conclusão: A experiência do período de diagnóstico e tratamento inclui enfrentamento, conhecimento da doença, assistência clínica (médicos, equipes), exaltação ao desespero e o paradoxo entre o medo e a esperança. Foi discutida a essência da experiência vivenciada e compartilhada pelas participantes à luz da teoria da doença, como uma ruptura da narrativa biográfica. O estudo destaca implicações para a equipe de médicos, coordenadores do Sistema Único de Saúde e outros profissionais da saúde

Introduction: The period of diagnosis and treatment of breast cancer is tough, full of uncertainties, and associated with a high morbidity and mortality rate. Objective: To understand the meaning that women with breast cancer under treatment in a university hospital attribute to their experience of fear masked by the feeling of hope and investigate the participants' perception of quality of life while coping with the disease. Method: Quantitative, qualitative study conducted with 78 women. For the quantitative evaluation, the scores of the Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey(SF-36) and the Herth Hope Scale were evaluated. For the qualitative analysis, narratives were conducted with 10 of these women who were analyzed using phenomenological investigation methods. Results: Low scores were detected in the functional capacity and mental health domains of SF-36, which imply in a negative impact on the quality of life and a high index of hope scores, which is a positive factor. Three central classes emerged from 243 segments of the participants' narratives, through meaningful statements and their corresponding meaning units. Conclusion: The experience of the diagnosis and treatment period includes coping, cognizance of the disease, clinical consultation (doctors, teams), from exaltation to despair, and the paradox between fear and hope. It was discussed the essence of the experience the participants lived and shared in light of the theory of the disease as a rupture of the biographic narrative. The study highlights implications for the teams of physicians, SUS ­ National Health System coordinators, and other healthcare professionals.Key words: Breast Neoplasms/psychology; Quality of Life; Hope; Emotions; Fear

Introducción: El período de diagnóstico y tratamiento del cáncer de mama es difícil, puesto que presenta muchas incertidumbres y está asociado con una alta taza de morbilidad. Objetivo: Conocer el significado que las mujeres con cáncer de mama en tratamiento en un hospital universitario le atribuyeron a su experiencia de temor enmascarado por el sentimiento de esperanza, así como investigar la percepción de la calidad de vida al enfrentar la enfermedad. Método: Estudio cuantitativo y cualitativo con 78 mujeres. Para la evaluación cuantitativa, evaluamos las puntuaciones del Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey (SF-36) y la Escala de Esperanza de Herth. Para el análisis cualitativo, se realizaron narrativas con 10 de estas mujeres que fueron analizadas utilizando métodos de investigación fenomenológica. Resultados: Se detectó que la capacidad funcional y de salud mental del SF-36 se redujeron, y al mismo tiempo se presentó un alto índice de Esperanza lo que implica un impacto negativo en la calidad de vida y un alto índice de puntajes de esperanza, lo cual es un factor positivo. Surgieron tres clases centrales de entre los 243 segmentos de las entrevistas a través de declaraciones significativas y sus respectivas unidades de significado. Conclusión: El experimento, durante el periodo de diagnóstico y tratamiento, incluye el enfrentamiento, el conocimiento de la enfermedad, la asistencia clínica (médicos, equipos), la exaltación a la desesperación y una paradoja entre el miedo y la esperanza. Se discutió la esencia de la experiencia vivida y compartida por las participantes a la luz de la teoría de la enfermedad, como una ruptura de la narrativa biográfica. El estudio destaca las implicaciones para el equipo de médicos, coordinadores del Sistema Único de Salud de Brasil y otros profesionales de la salud

Boosting nonverbal physician-patient communication in medical education / Impulsionando a comunicação não verbal na educação médica

Abstract: Introduction: Nonverbal communication is an important part of the medical interview. However, nonverbal skills are still underestimated in medical education and instruments for their teaching and assessing in medical schools are scarce. Objective: We aimed to translate and culturally adapt the Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) to Brazilian Portuguese. Methods: We translated the RCS-O in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through the Delphi technique, review by a language coordinator, and pre-test. We used video recordings of four medical consultations performed by medical students and residents to pre-test the instrument. During this phase, three independent observers assessed the medical students and residents' performance in real health care scenarios through the use of the recordings. Results: Most of the difficulties regarding the translation and cultural adaptation were related to the polysemic meaning of some items. Words and expressions such as "stimulating", "warmth", "desire", "relaxed", "conversation to a deeper level", "deeper relationship", "casual", and "intensely" required adaptation in order to remove the potential sexual connotation that could arise from overintimacy in the physician-patient relationship. Conclusion: The Brazilian version of the RCS-O is a culturally, conceptually, semantically and operationally valid instrument. It may represent an important advance for the strengthening of learning and assessing nonverbal communication in medical education. We hope this study may encourage health educators to invest in the teaching and assessment of nonverbal communication skills in other countries.

Resumo: Introdução: A comunicação não verbal corresponde a importante parte da entrevista médica. No entanto, as habilidades não verbais ainda são subestimadas na educação, e os instrumentos para ensino e avaliação nas escolas de saúde são escassos. Objetivo: Nosso objetivo foi traduzir e adaptar culturalmente a Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) para o português do Brasil. Método: Traduzimos a RCS-O em sete etapas: tradução inicial, reconciliação, retrotradução, revisão pelo autor, revisão independente, consenso pela técnica Delphi, revisão por um coordenador de linguagem e pré-teste. Utilizamos gravações de quatro consultas médicas realizadas por estudantes de Medicina e residentes para pré-testar o instrumento. Durante essa fase, três observadores independentes avaliaram o desempenho de estudantes de Medicina e residentes em cenários reais de assistência médica por meio do uso das gravações. Resultados: A maioria das dificuldades de tradução e adaptação cultural foi relacionada ao significado polissêmico de alguns itens. Palavras e expressões como "stimulating", "warmth", "desire", "relaxed", "conversation to a deeper level", "deeper relationship", "casual", and "intensely" precisaram ser adaptadas para remover a conotação sexual que poderia surgir da intimidade presente na relação médico-paciente. Conclusão: A versão brasileira da RCS-O é cultural, conceitual, semântica e operacionalmente válida. Representa um avanço importante para o ensino e a avaliação da comunicação não verbal na educação médica. Esperamos que este estudo possa incentivar educadores de saúde a investir no ensino e na avaliação dessas habilidades nas escolas médicas.

Cross-cultural adaptation to Portuguese of a measure of satisfaction with participation of the Patient-Reported Outcomes Measurement Information System (PROMIS(r)).

BACKGROUND: Mental disorders often impair functioning in several areas of life and lead to unhappiness and suffering that may affect health-related quality of life (HRQoL). Satisfaction with participation is an indicator of HRQoL, and its measurement by patients reflects the impact of disease on their social, emotional and professional life. The Patient-Reported Outcomes Measurement Information System (PROMIS(r)) offers an item bank based on item response theory. This system provides efficient, reliable and valid self-report instruments of satisfaction with participation, a measure that is both scarce and useful in the assessment of mental disorder outcomes. OBJECTIVE: To cross-culturally adapt the PROMIS(r) satisfaction with participation item bank to Portuguese. METHODS: Cross-cultural adaptation followed the Functional Assessment of Chronic Illness Therapy (FACIT) multilingual translation method and was achieved through steps of forward and backward translations, review by bilingual experts (one of them a native of Portugal) and pretesting in a group of 11 adult native Brazilians. Instrument adaptation followed a universal approach to translation, with harmonization across languages. RESULTS: Equivalence of meaning was achieved. As two of the 26 translated items, which asked about leisure and social activities, were not understood by less educated participants, an explanation in parentheses was added to each item, and the problem was solved. All items were appropriate and did not cause embarrassment to the participants. CONCLUSIONS: The satisfaction with participation item bank is culturally and linguistically suitable to be used in Brazil. After the pretest is applied in Portugal and in other Portuguese-speaking countries, the same instrument will be ready to be used in multinational studies.

Validação brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS) / Brazilian validation of the item banks on Sleep Disturbance and Wake Disturbance in the Patient-Reported Outcomes Measurement Information System (PROMIS) / Validación brasileña de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia en el Patient-Reported Outcomes Measurement Information System (PROMIS)

O objetivo deste estudo foi validar a versão brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS). A validação desses bancos de itens foi feita por meio da Teoria Clássica dos Testes, Teoria de Resposta ao Item, calibração dos itens conforme o modelo de resposta gradual proposto por Samejima e análise do Funcionamento Diferencial do Item (DIF), sendo a amostra constituída por 627 participantes com mais de 18 anos. Em relação à qualidade dos dados, observou-se que não houve dados perdidos, e cinco itens do banco Distúrbio do Sono e quatro itens do banco Distúrbio da Vigília tiveram efeito piso, e nenhum dos bancos apresentou efeito teto. Os dois bancos mostraram excelente confiabilidade com uma escala homogênea e boa estabilidade temporal. Com a Análise Fatorial Confirmatória, através dos índices de qualidade de ajuste absoluto e incremental, verificou-se um bom ajuste para os dois bancos, o que revela que os instrumentos são válidos e suficientemente unidimensionais. A calibração evidenciou que as propriedades psicométricas dos itens foram satisfatórias com boa cobertura do construto sono-vigília. No tocante ao DIF, tanto o banco Distúrbio do Sono quanto o banco Distúrbio da Vigília mostraram ser homogêneos para os diferentes grupos testados. Pode-se concluir que a versão para a língua portuguesa falada no Brasil dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do PROMIS demonstrou ser uma medida confiável, precisa e válida, com análises psicométricas robustas.

This study aimed to validate the Brazilian version of the item banks for Sleep Disturbance and Wake Disturbance from the Patient-Reported Outcomes Measurement Information System (PROMIS). Validation of these item banks used classical test theory, item response theory, calibrations of items according to the gradual response model proposed by Samejima, and analysis of Differential Item Functioning (DIF), with a sample consisting of 627 participants over 18 years of age. As for data quality, there were no missing data, five items from the Sleep Disturbance bank and four items from the WE bank showed a floor effect, and none of the banks showed a ceiling effect. The two banks displayed excellent reliability with homogeneous scale and good temporal stability. With confirmatory factor analysis, using absolute and incremental goodness-of-fit indices, both banks displayed good fit, showing that the instruments are valid and sufficiently unidimensional. The calibration showed that the items' psychometric properties were satisfactory with good coverage of the sleep-wake construct. As for DIF, both the Sleep Disturbance and Wake Disturbance banks proved to be homogeneous for the different test groups. In conclusion, the version in Brazilian Portuguese for the item banks on Sleep Disturbance and Wake Disturbance in the PROMIS proved to be a reliable, precise, and valid instrument with robust psychometric analyses.

El objetivo de este estudio fue validar la versión brasileña de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del Patient-Reported Outcomes Measurement Information System (PROMIS). La validación de esos bancos de ítems se realizó mediante teoría clásica de los tests, teoría de respuesta al ítem, calibración de los ítems, según el modelo de respuesta gradual propuesto por Samejima, así como el análisis del Funcionamiento Diferencial del Ítem (DIF), estando la muestra constituida por 627 participantes con más de 18 años. En relación con la calidad de los datos, se observó que no hubo dados perdidos y cinco ítems del banco Disturbio del Sueño y cuatro ítems del banco Disturbio de la Vigilia tuvieron efecto suelo, además ninguno de los bancos presentó un efecto techo. Los dos bancos mostraron excelente confiabilidad con una escala homogénea y buena estabilidad temporal. Con el análisis factorial confirmatorio, usándose los índices de calidad de ajuste absoluto e incremental, se verificó un buen ajuste para los dos bancos, lo que revela que los instrumentos son válidos y suficientemente unidimensionales. La calibración evidenció que las propiedades psicométricas de los ítems fueron satisfactorias con una buena cobertura del constructo sueño-vigilia. En lo que se refiere al DIF, tanto el banco Disturbio del Sueño como el Disturbio de la Vigilia mostraron ser homogéneos para los diferentes grupos testados. Se puede concluir que la versión para la lengua portuguesa hablada en Brasil de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del PROMIS demostró ser una medida confiable, precisa y válida, con análisis psicométricos robustos.

Versão Brasileira do Tool for Assessing Cultural Competence Training (TACCT): uma Matriz de Competência Cultural / Brazilian Version of the Tool for Assessing Cultural Competence Training (TACCT): a Cultural Competence Model

Resumo: Introdução: Este estudo teve como objetivos traduzir, adaptar e avaliar as propriedades psicométricas do Tool for Assessing Cultural Competence Training (TACCT) para o português falado no Brasil. Métodos: Os itens do TACCT foram adaptados transculturalmente por meio das etapas de tradução, reconciliação, retrotradução, revisão da retrotradução, revisores independentes, etapa Delphi, pré-teste e incorporação dos resultados do pré-teste no processo de tradução. A versão final do instrumento para a língua portuguesa foi autoaplicada em 320 estudantes de uma escola médica. Para verificar a precisão da escala, adotou-se a análise de confiabilidade. Utilizamos a análise fatorial confirmatória para avaliação da validade de construto e dimensionalidade do instrumento. Resultado: A versão final do TACCT mostrou-se adequada e teve sua validade e confiabilidade confirmadas. Conclusão: A versão brasileira do TACCT é válida e confiável e tem potencial para ser utilizada no processo de implantação, revisão ou aprimoramento de currículos de escolas médicas brasileiras.

Abstract: Introduction: To translate, adapt and evaluate the psychometric properties of the Tool for Assessing Cultural Competence Training (TACCT) to Brazilian Portuguese. Methods: The TACCT items were transculturally adapted through several stages, namely: translation, reconciliation, backtranslation, revision of backtranslation, independent reviews, Delphi stage, pretest, and incorporation of the pretest results into the translation process. The final Portuguese version of the instrument was self-applied by 320 medical students. The scale accuracy was verified using reliability analysis. We employed confirmatory factor analysis to assess the construct validity and instrument dimensionality. Results: The final version of the TACCT was adequate, and its validity and reliability were confirmed. Conclusion: The Brazilian Portuguese version of the TACCT is valid and reliable, and it can be used to implement, review, and improve new curriculum content of Brazilian medical schools.

[Portuguese-language cultural adaptation of the Items Banks of Anxiety and Depression of the Patient-Reported Outcomes Measurement Information System (PROMIS)]. / Adaptação transcultural dos Bancos de Itens de Ansiedade e Depressão do Patient-Reported Outcomes Measurement Information System (PROMIS) para língua portuguesa.

The Patient-Reported Outcome Measurement Information System (PROMIS), structured in Itens Banks, provides a new tool for evaluating results that apply to various chronic diseases through advanced statistical techniques (TRI) and computerized adaptive testing (CAT). The aim of this study was to culturally adapt the Items Banks of Anxiety and Depression of PROMIS to the Portuguese language. The process followed the recommendations of PROMIS through the advanced translation, reconciliation, back-translation, FACIT review, independent review, finalization, pre-test, and incorporation of the results from the pre-test. The translated version was pre-tested in ten patients, and items 3, 46, and 53 of the Bank of Anxiety and item 46 of the bank of Depression had to be changed. Changes affected equivalence of meaning, and the final version was consistent with the Brazilian population's linguistic and cultural skills. In conclusion, for the Brazilian population the translated version proved semantically and conceptually equivalent to the original.

[Brazilian-Portuguese translation and cultural adaptation of the sleep and wake disturbances domains of the Patient-Reported-Outcomes Measurement Information System (PROMIS)]. / Tradução e adaptação cultural para a língua portuguesa dos domínios Distúrbios do Sono e Distúrbios da Vigília do Patient-Reported-Outcomes Measurement Information System (PROMIS).

Altered sleep and wakefulness affect individuals' mood, memory, and psychomotor performance and thus directly impact their quality of life. Tools to analyze the quality of these factors should be available for clinical evaluation. This study aimed to translate into Brazilian Portuguese and culturally adapt the Patient-Reported Outcomes Measurement Information System (PROMIS), specifically the sleep and wake disturbances domains. The translation and cultural adaptation processes followed the guidelines proposed by the Functional Assessment of Chronic Illness Therapy (FACIT) organization. The methodology included translation, reconciliation, back-translation, review by PROMIS, review by independent reviewers, pretest, and incorporation of the results into the final version. The Portuguese version of the sleep and wake disturbances domains presents semantic, idiomatic, cultural, and conceptual equivalence with the items in the source language.

Cross-cultural adaptation of the Four Habits Coding Scheme (4HCS) for teaching and assessing patient-centered communication skills in Brazil / Adaptação transcultural do Four Habits Coding Scheme (4HCS) para o ensino e avaliação de habilidades de comunicação centradas no paciente no Brasil / Adaptación transcultural del Four Habits Coding Scheme (4HCS) para la enseñanza y evaluación de habilidades de comunicación centradas en el paciente en Brasil

Abstract: Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians' communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as "Engage in small talk", "Expansion of concerns", "Elicit full agenda", "Use patient's frame of reference", and "Explore plan acceptability". They also had difficulty in reaching consensus on the translation of the word "clinician", which was first translated as "physician". Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.

Resumo: As diretrizes brasileiras para a educação enfatizam as habilidades de comunicação centradas no paciente enquanto importante competência para os estudantes de medicina. O Four Habits Coding Scheme (4HCS) é um instrumento utilizado no ensino e avaliação das habilidades de comunicação do clínico em uma abordagem de cuidado centrado na pessoa. O nosso objetivo foi traduzir e realizar a adaptação transcultural do 4HCS para o português do Brasil. O processo de tradução foi realizado em sete estágios: tradução independente, reconciliação, retro-tradução, revisão pelo autor, revisão independente - consenso através da técnica Delphi -, revisão por um coordenador linguístico e pré-teste. Durante o pré-teste, três observadores independentes avaliaram quatro consultas médicas realizadas por estudantes e residentes de medicina que foram gravadas em um cenário de atendimento real. Os revisores tiveram dificuldade em chegar a um consenso sobre expressões referentes à compreensão da pessoa como um todo, tais como "engage in small talk", "expansion of concerns", "elicit full agenda", "use patient's frame of reference" e "explore plan acceptability". Também tiveram dificuldade em chegar a um consenso sobre a tradução da palavra "clinician", que fora traduzida primeiro como "médico". Questões históricas e culturais na relação médico-paciente podem ter influenciado o resultado. A versão brasileira do 4HCS é um instrumento válido no sentido cultural, conceitual, semântico e operacional. Pode representar um avanço importante no fortalecimento do modelo de cuidado centrado no paciente no Brasil.

Resumen: Las directrices brasileñas para la educación enfatizan las habilidades de comunicación centradas al paciente, por considerarla una importante competencia para los estudiantes de medicina. El Four Habits Coding Scheme (4HCS) es un instrumento utilizado en la enseñanza y evaluación de las habilidades de comunicación dentro del ámbito clínico, desde una perspectiva de cuidado centrado en la persona. El objetivo fue traducir y realizar la adaptación transcultural del 4HCS al portugués de Brasil. El proceso de traducción se realizó en siete fases: traducción independiente, conciliación, retro-traducción, revisión por parte del autor, revisión independiente -consenso a través de la técnica Delphi-, revisión por parte de un coordinador lingüístico y prueba previa. Durante la prueba previa, tres observadores independientes evaluaron cuatro consultas médicas, que fueron realizadas por estudiantes y residentes de medicina que se grabaron en un escenario de atención real. Los revisores tuvieron dificultades para llegar a un consenso sobre expresiones referidas a la comprensión de la persona como un todo, tales como "engage in small talk", "expansion of concerns", "elicit full agenda", "use patient's frame of reference" y "explore plan acceptability". También tuvieron dificultades para llegar a un consenso sobre la traducción de la palabra "clinician", que se tradujo en primera instancia como "médico". Las cuestiones históricas y culturales en la relación médico-paciente pueden haber influenciado el resultado. La versión brasileña del 4HCS es un instrumento válido, en el sentido cultural, conceptual, semántico y operacional. Puede representar un avance importante en el fortalecimiento del modelo de cuidado centrado en el paciente en Brasil.

Adaptação transcultural e validação da escala de Saúde Global do PROMIS para a língua portuguesa / Cross-cultural adaptation and validation of the PROMIS Global Health scale in the Portuguese language / Adaptación transcultural y validación de la escala de Salud Global del PROMIS a la lengua portuguesa

Resumo: O objetivo deste estudo foi realizar a adaptação transcultural da escala de Saúde Global do Patient-Reported Outcomes Measurement Information System (PROMIS) para a língua portuguesa. Os dez itens sobre Saúde Global foram adaptados transculturalmente por meio do método proposto pelo Functional Assessment of Chronic Illness Therapy (FACIT). A versão final do instrumento para a língua portuguesa foi autoadministrada em 1.010 participantes no Brasil. A precisão da escala foi verificada usando-se a análise dos efeitos piso e teto, confiabilidade da consistência interna e confiabilidade teste-reteste. Utilizou-se a análise fatorial exploratória e confirmatória para avaliação da validade de construto e dimensionalidade do instrumento. A calibração dos itens foi realizada por meio do Modelo de Resposta Gradual proposto por Samejima. Quatro itens globais necessitaram de ajustes após a realização do pré-teste. A análise das propriedades psicométricas demonstrou que a escala de Saúde Global tem boa confiabilidade, com coeficiente alfa de Cronbach de 0,83 e coeficiente de correlação intraclasse de 0,89. As análises fatorial exploratória e confirmatória revelaram um bom ajuste ao modelo previamente estabelecido de duas dimensões. As escalas de Saúde Física Global e Saúde Mental Global apresentaram uma boa cobertura do traço latente, de acordo com o Modelo de Resposta Gradual. Os itens Saúde Global do PROMIS para a língua portuguesa apresentaram equivalência em relação à versão original e propriedades psicométricas satisfatórias para a aplicação direcionada à população brasileira na prática clínica e em pesquisas.

Abstract: This study aimed to perform the cross-cultural adaptation and validation of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale in the Portuguese language. The ten Global Health items were cross-culturally adapted by the method proposed in the Functional Assessment of Chronic Illness Therapy (FACIT). The instrument's final version in Portuguese was self-administered by 1,010 participants in Brazil. The scale's precision was verified by floor and ceiling effects analysis, reliability of internal consistency, and test-retest reliability. Exploratory and confirmatory factor analyses were used to assess the construct's validity and instrument's dimensionality. Calibration of the items used the Gradual Response Model proposed by Samejima. Four global items required adjustments after the pretest. Analysis of the psychometric properties showed that the Global Health scale has good reliability, with Cronbach's alpha of 0.83 and intra-class correlation of 0.89. Exploratory and confirmatory factor analyses showed good fit in the previously established two-dimensional model. The Global Physical Health and Global Mental Health scale showed good latent trait coverage according to the Gradual Response Model. The PROMIS Global Health items showed equivalence in Portuguese compared to the original version and satisfactory psychometric properties for application in clinical practice and research in the Brazilian population.

Resumen: El objetivo de este estudio fue realizar la adaptación transcultural de la escala de Salud Global del Patient-Reported Outcomes Measurement Information System (PROMIS) a la lengua portuguesa. Los diez ítems sobre Salud Global se adaptaron transculturalmente mediante el método propuesto por el Functional Assessment of Chronic Illness Therapy (FACIT). La versión final del instrumento en lengua portuguesa fue autoadministrada en 1.010 participantes en Brasil. La precisión de la escala fue verificada usándose el análisis de los efectos suelo y techo, confiabilidad de la consistencia interna y confiabilidad test-retest. Se utilizó el análisis factorial exploratorio y confirmatorio para la evaluación de la validez del constructo y dimensionalidad del instrumento. La calibración de los ítems se realizó mediante el Modelo de Respuesta Gradual, propuesto por Samejima. Cuatro ítems globales necesitaron ajustes tras la realización del pre-test. El análisis de las propiedades psicométricas demostró que la escala de Salud Global tiene una buena confiabilidad, con el coeficiente alfa Cronbach de 0,83 y el coeficiente de correlación intraclase de 0,89. Los análisis factoriales exploratorio y confirmatorio revelaron un buen ajuste al modelo previamente establecido de dos dimensiones. Las escalas de Salud Física Global y Salud Mental Global presentaron una buena cobertura del trazo latente, de acuerdo con el Modelo de Respuesta Gradual. Los ítems Salud Global del PROMIS adaptados a la lengua portuguesa presentaron equivalencia, respecto a la versión original y propiedades psicométricas satisfactorias para la aplicación dirigida a la población brasileña en la práctica clínica y en investigaciones.

Tradução e adaptação cultural para a língua portuguesa dos domínios Distúrbios do Sono e Distúrbios da Vigília do Patient-Reported-Outcomes Measurement Information System (PROMIS) / Brazilian-Portuguese translation and cultural adaptation of the sleep and wake disturbances domains of the Patient-Reported-Outcomes Measurement Information System (PROMIS) / Traducción y adaptación cultural para la lengua portuguesa de los dominios Transtornos del Sueño y Transtornos de la Vigilia del Patient-Reported-Outcomes Measurement Information System (PROMIS)

Alterações no sono e na vigília repercutem negativamente no estado de humor, na memória e no desempenho psicomotor do indivíduo, refletindo diretamente em sua qualidade de vida. Instrumentos de avaliação da qualidade desses fatores devem estar disponíveis para a avaliação clínica. O objetivo deste trabalho foi traduzir e adaptar culturalmente os domínios Distúrbios do Sono e Distúrbios da Vigília do instrumento de medida Patient-Reported Outcomes Measurement Information System (PROMIS) para a língua portuguesa. O processo de tradução e adaptação transcultural seguiu as orientações da organização Functional Assessment of Chronic Illness Therapy (FACIT). Essa metodologia compreende: tradução, reconciliação, retrotradução, revisão dos autores e dos revisores independentes, pré- teste e obtenção da versão final em português. A versão para a língua portuguesa dos domínios Distúrbios do Sono e Distúrbios da Vigília do PROMIS apresentou boa equivalência semântica, idiomática, cultural e conceitual dos itens.

Altered sleep and wakefulness affect individuals’ mood, memory, and psychomotor performance and thus directly impact their quality of life. Tools to analyze the quality of these factors should be available for clinical evaluation. This study aimed to translate into Brazilian Portuguese and culturally adapt the Patient-Reported Outcomes Measurement Information System (PROMIS), specifically the sleep and wake disturbances domains. The translation and cultural adaptation processes followed the guidelines proposed by the Functional Assessment of Chronic Illness Therapy (FACIT) organization. The methodology included translation, reconciliation, back-translation, review by PROMIS, review by independent reviewers, pretest, and incorporation of the results into the final version. The Portuguese version of the sleep and wake disturbances domains presents semantic, idiomatic, cultural, and conceptual equivalence with the items in the source language.

Las alteraciones en el sueño y en la vigilia afectan negativamente el estado de ánimo, la memoria y el rendimiento psicomotor del individuo, reflejándose directamente en su calidad de vida. Los instrumentos de evaluación de la calidad de esos factores deben estar disponibles para su evaluación clínica. Así, este estudio tuvo como objetivo traducir y adaptar culturalmente los dominios Trastornos del Sueño y Trastornos de la Vigilia del instrumento de medición Patient- Reported Outcomes Measurement Information System (PROMIS) a la lengua portuguesa. El proceso de traducción y adaptación cultural adoptó las directrices de la organización Functional Assessment of Chronic Illness Therapy (FACIT), cuya metodología incluye: la traducción, síntesis, retrotraducción, evaluación por un comité de expertos y evaluación externa, test previo y, por fin, la obtención de una versión final en portugués. La versión en portugués de los dominios Trastornos del Sueño y Trastornos de la Vigilia del PROMIS presentó una buena equivalencia semántica, idiomática, cultural y conceptual.

Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric.

OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric) has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 +/- 7.12 years), 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36) at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric) has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years), 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36) at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.