Psychometric validation of the Portuguese version of the Neuropathic Pain Symptoms Inventory.

BACKGROUND: It has been shown that different symptoms or symptom combinations of neuropathic pain (NeP) may correspond to different mechanistic backgrounds and respond differently to treatment. The Neuropathic Pain Symptom Inventory (NPSI) is able to detect distinct clusters of symptoms (i.e. dimensions) with a putative common mechanistic background. The present study described the psychometric validation of the Portuguese version (PV) of the NPSI. METHODS: Patients were seen in two consecutive visits, three to four weeks apart. They were asked to: (i) rate their mean pain intensity in the last 24 hours on an 11-point (0-10) numerical scale; (ii) complete the PV-NPSI; (iii) provide the list of pain medications and doses currently in use. VAS and Global Impression of Change (GIC) were filled out in the second visit. RESULTS: PV-NPSI underwent test-retest reliability, factor analysis, analysis of sensitivity to changes between both visits. The PV-NPSI was reliable in this setting, with a good intra-class correlation for all items. The factorial analysis showed that the PV-NPSI inventory assessed different components of neuropathic pain. Five different factors were found. The PV-NPSI was adequate to evaluate patients with neuropathic pain and to detect clusters of NeP symptoms. CONCLUSIONS: The psychometric properties of the PV-NPSI rendered it adequate to evaluate patients with both central and peripheral neuropathic pain syndromes and to detect clusters of NeP symptoms.

Impact of cancer-related symptom synergisms on health-related quality of life and performance status.

To identify the impact of multiple symptoms and their co-occurrence on health-related quality of life (HRQOL) dimensions and performance status (PS), 115 outpatients with cancer, who were not receiving active cancer treatment and were recruited from a university hospital in Sao Paulo, Brazil completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, the Beck Depression Inventory, and the Brief Pain Inventory. Karnofsky Performance Status scores also were completed. Application of TwoStep Cluster analysis resulted in two distinct patient subgroups based on 113 patient experiences with pain, depression, fatigue, insomnia, constipation, lack of appetite, dyspnea, nausea, vomiting, and diarrhea. One group had multiple and severe symptom subgroup and another had less symptoms and with lower severity. Multiple and severe symptoms had worse PS, role functioning, and physical, emotional, cognitive, social, and overall HRQOL. Multiple and severe symptom subgroup was also six times as likely as lower severity to have poor role functioning; five times more likely to have poor emotional; four times more likely to have poor PS, physical, and overall HRQOL; and three times as likely to have poor cognitive and social HRQOL, independent of gender, age, level of education, and economic condition. Classification and Regression Tree analyses were undertaken to identify which co-occurring symptoms would best determine reduction in HRQOL and PS. Pain and fatigue were identified as indicators of reduction on physical HRQOL and PS. Fatigue and insomnia were associated with reduction in cognitive; depression and pain in social; and fatigue and constipation in role functioning. Only depression was associated with reduction in overall HRQOL. These data demonstrate that there is a synergic effect among distinct cancer symptoms that result in reduction in HRQOL dimensions and PS.

Indicadores materno-infantis na adolescência e juventude: sociodemográfico, pré-natal, parto e nascido-vivos / Maternal-infantile indicators in adolescence and youth: socio-demographic, prenatal, delivery and newborns

Objetivo: conhecer características e associações entre idade materna e aspectos da gestação, parto e nascidos vivos de adolescentes e adultas jovens em Feira de Santana, Bahia. Métodos: estudo epidemiólogico de corte transversal com nascidos vivos e mães adolescentes (10-16-19 anos) e adultas jovens (20-24 anos), através de Informações de Nascidos Vivos (SINASC-1998), totalizando 5.279 nascimentos. As variáveis foram classificados em sociodemográficas (idade, escolaridade e sexo do recém-nascido) e relacionadas a gestação, parto e condições dos recém-nascidos. Os dados processados usando a razão de prevelência e a análise multivariada. A regressão logística foi usada para controlar fatores de confusão (pré-natal e idade gestacional) e associar idade materna e peso de nascimento. Resultados: em 1998, 21,6 por cento dos nascidos vivos no município foram de adolescentes; a escolaridade de 51,2 por cento das mães era 1§ grau incompleto; e a razão de risco ajustada apontaram maior prevalência de analfabetismo, não realização do pré-natal, peso insuficiente ao nascer e menor prevalência de peso adequado, na faixa de 10 a 16 anos, comparada às demais faixas estudadas. A agressão logística mostrou associação positiva entre idade materna e peso insuficiente, bem como associação negativa com peso adequado ao nascer. Verificou-se significativa falta de registros em alguns itens do SINASC. Conclusões: o resultados apontaram entre adolescentes alta prevalência de nascidos vivos e baixo nível de escolaridade, além do risco aumentado para analfabetismo, não realização de pré-natal, baixo peso e peso insuficiente do RN, principalmente na faixa de 10 a 16 anos, em comparação com as outras faixas estudadas