Satisfaction With Appearance Scale-SWAP: Adaptation and validation for Brazilian burn victims.

AIM: Methodological study that aimed to adapt the Satisfaction with Appearance Scale (SWAP) into Brazilian Portuguese language and to assess the validity, the reliability and the dimensionality of the adapted version in a sample of Brazilian burn victims. METHODS: We carried out the adaptation process according to the international literature. Construct validity was assessed by correlating the adapted version of SWAP scores with depression (Beck Depression Index), self-esteem (Rosenberg Self-Esteem Scale), health-related quality of Life (Short Form Health Survey-36) and health status of burn victims (Burn Specific Health Scale-Revised), and with gender, total body surface area burned, and visibility of the scars. We tested dimensionality using Exploratory Factor Analysis (EFA) and the reliability by means of Cronbach's alpha. RESULTS: Participants were 106 adult burned patients. The correlations between the Brazilian version of the SWAP scores and the correlated construct measures varied from moderate to strong (r=.30-.77). The participants who perceived their burn sequelae was visible reported being more dissatisfied with their body image than the participants who answered that their scars would not be visible (p<.001). Cronbach's alpha for the adapted version was 0.88 and the item-total correlation varied from moderate to strong (r=.35-.73). The EFA resulted in three factors with a total explained variance percentage of 63.2%. CONCLUSION: The Brazilian version of the SWAP was valid and reliable for use with Brazilian burn victims.

A randomized controlled trial of an educational programme to improve self-care in Brazilian patients following percutaneous coronary intervention.

AIMS: To test an educational programme with telephone follow-up to improve self-care in Brazilian patients who underwent percutaneous coronary intervention. BACKGROUND: Percutaneous coronary intervention has been established as a treatment for coronary disease. However, additional intervention is needed to improve self-care for individuals who undergo this procedure to reduce further disease. Telephone follow-up is one strategy that has been used to improve chronic disease self-care. DESIGN: Randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01341093. METHODS: Sixty patients who were preparing for their first percutaneous coronary intervention between 2011-2012 were randomly allocated to an educational programme with telephone follow-up (N = 30) or a control group (N = 30). Perceived health status was assessed with the Medical Outcomes Study 36-Item Short Form. Self-efficacy, symptoms of anxiety and depression and medication adherence were also assessed. Measures were collected before intervention (baseline) and 6 months later. RESULTS: Both groups improved from baseline to 6 months in the 'Physical Component Summary' and in the domains of 'Physical Functioning', 'Role-Emotional' and 'Role-Physical'. The educational programme group showed a reduction in anxiety from baseline to 6-month follow-up, while the control group showed a slight increase. No differences in symptoms in depression and self-efficacy were found and both groups reported high levels of medication adherence. CONCLUSION: The educational programme with telephone follow-up is a promising intervention as it led to reduction in anxiety for those receiving the educational programme. Further improvements in timing and focus of the educational programme, such as targeting emotional and social lifestyle changes, might be warranted.

Reliability of the Cardiac Patients Learning Needs Inventory (CPLNI) for use in Portugal.

AIMS AND OBJECTIVES: To perform the semantic validation and to evaluate the reliability and the presence of ceiling and floor effects of the Cardiac Patients Learning Needs Inventory in Portuguese patients with coronary artery disease. BACKGROUND: Information should be selected based on what patients know and need to learn, which means that the teaching process should be based on each person's needs. The Cardiac Patients Learning Needs Inventory is aimed at identifying the cardiac patients' individual learning needs. DESIGN: Methodological research design. METHODS: Two hundred patients hospitalised at the coronary intensive care unit or at the cardiothoracic surgery unit of a public hospital in Lisbon answered the adapted version of the Cardiac Patients Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. Scores above 0·50 were considered acceptable. Stability was measured through test-retest and calculated using student's t test. Significance was set at 0·05. RESULTS: Patients' mean age was 65 years (SD = 11·8), and most were men (152; 76%). Cronbach's alpha for the total scale was high in the first and second measurement (0·91), and for seven domains, it was acceptable in the first and second measurement (range from 0·50-0·89). No statistically significant difference was found between mean scores on the first and second measurement. Lower diversity was observed in the answers, most of which ranged between important and very important (ceiling-effect). CONCLUSION: The adapted version for use in Portugal maintained the conceptual, semantic and idiomatic equivalences of the original version and showed adequate reliability. RELEVANCE TO CLINICAL PRACTICES: Owing to the lack of validated instruments translated into Portuguese, to measure cardiac patients' learning needs, this study entails important clinical and theoretical implications.

Assessment of the health status in Brazilian burn victims five to seven months after hospital discharge.

PURPOSE: To evaluate health status, impact of event, anxiety, and depression in burn victims at five-to-seven months after hospital discharge, and to explore the association between those variables with age, body surface area burn (BSA), sex, and marital status. METHODS: Cross-sectional study involving 73 adults who were interviewed for general health status (BSHS-R), impact of event (IES), and anxiety and depression (HADS). RESULTS: Participants were mostly men (68.5%), with mean age 38.4 years (SD = 14.5), and mean hospital length of stay (LOS) 24.5 days (SD = 25.3). Mean scores were: 128.1 (SD = 18.9) for BSHS-R, 62.1(SD = 35.8) for IES, 5.5 (SD = 4.1) for anxiety, and 3.9 (SD = 3.9) for depression. Health status was highly and inversely correlated with impact of event, depression, anxiety, LOS, number of surgeries, and BSA. Men and women differed in the BSHS-R affect and body image domains, and depression. Individuals with larger BSA reported worse scores for BSHS-R (work domain). CONCLUSION: Burn victims reported good health status on average, which was negatively correlated with reported depression, anxiety, impact of event, LOS, number of operations, and BSA. These findings suggest that general health might be improved by interventions that target modifiable behavioral factors, such as support groups and cognitive behavioral therapies.

Original research: telephone follow-up for patients after myocardial revascularization: a systematic review.

OBJECTIVE: To identify studies of telephone follow-up conducted with patients who had undergone myocardial revascularization, and to assess and synthesize the results. DESIGN AND METHODS: This is a systematic review; the literature search was conducted in six electronic databases. Controlled descriptors were health education, teaching, myocardial revascularization, coronary artery bypass, angioplasty, telenursing, telephone, and hotlines; the noncontrolled descriptor was needs information. Of 170 identified studies, seven met the inclusion criteria and were selected for analysis. The Jadad scale, which ranges from 0 to 5, was used to assess the methodological quality of studies, with scores of 3 to 5 indicative of higher quality. FINDINGS: Five of the seven studies found statistically significant positive changes in the outcome measures of health-related quality of life, pain, physical functioning, mood symptoms, anxiety, knowledge about self-care measures, medication compliance, and the lipid profile. Four of these five studies had a Jadad score of 3 and were of higher quality. CONCLUSIONS: This review provides nurses and other clinicians with a synthesis of research on telephone follow-up in patients after myocardial revascularization. Of the seven studies analyzed, five showed evidence of some benefit from telephone follow-up. Their findings support the use of telephone follow-up to periodically assess patient knowledge, discuss patient concerns and offer ways to address them, monitor mood symptoms and anxiety levels, and encourage behavioral and lifestyle changes. Although any telephone follow-up intervention must be adapted according to each patient's needs, the lack of similarity among and specific information about the interventions described in the analyzed studies made it difficult to evaluate specific elements. More research is needed to identify optimal content and frequency, number, and duration of calls.

Cultural adaptation and psychometric properties of the family questionnaire in a Brazilian sample of relatives of schizophrenia outpatients.

AIMS AND OBJECTIVES: To evaluate the internal reliability and validity of the Brazilian Portuguese version of the Family Questionnaire among families of schizophrenia outpatients. BACKGROUND: The main studies about the family environment of schizophrenia patients are related to the concept of Expressed Emotion. There is currently no instrument to evaluate this concept in Brazil that is easily applicable and comparable with studies from other countries. DESIGN: Methodological and cross-sectional research design. METHOD: A convenience sample of 130 relatives of schizophrenia outpatients was selected. The translation and cultural adaptation of the instrument involved experts in mental health and experts in the German language and included back translation, semantic evaluation of items and pretesting of the instrument with 30 relatives of schizophrenia outpatients. The psychometric properties of the instrument were studied with another 100 relatives, which fulfilled the requirements for the Brazilian Portuguese version of the instrument. The psychometric properties of the instrument were assessed by construct validity (using an analysis of its key components, comparisons between distinct groups-convergent validity with the Antonovsky's Sense of Coherence Scale) and reliability (checking the internal consistency of its items and its test-retest reproducibility). RESULTS: The analysis of main components confirmed dimensionality patterns that were comparable between the original and adapted versions. In two domains of the instrument, critical comments and emotional over-involvement had moderate and significant correlations, respectively, with Antonovsky's Sense of Coherence Scale, appropriate values of Cronbach's alpha and strong and significant correlations, respectively, in test-retest reproducibility. We observed significant differences between distinct groups of parents in the category of emotional over-involvement. CONCLUSION: We conclude that the Portuguese-adapted version of the Family Questionnaire is valid and reliable for the study sample. RELEVANCE TO CLINICAL PRACTICE: This study provided evidence that the Family Questionnaire is a reliable and valid instrument for assessing expressed emotion. It is easy and practical to use and is acceptable for use in a Brazilian cultural population.

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Duke Anticoagulation Satisfaction Scale.

AIM: The aim of this study was to evaluate the internal reliability and validity of the Brazilian-Portuguese version of Duke Anticoagulation Satisfaction Scale (DASS) among cardiovascular patients. BACKGROUND: Oral anticoagulation is widely used to prevent and treat thromboembolic events in several conditions, especially in cardiovascular diseases; however, this therapy can induce dissatisfaction and reduce the quality of life. DESIGN: Methodological and cross-sectional research design. METHODS: The cultural adaptation of the DASS included the translation and back-translation, discussions with healthcare professionals and patients to ensure conceptual equivalence, semantic evaluation and instrument pretest. The Brazilian-Portuguese version of the DASS was tested among subjects followed in a university hospital anticoagulation outpatient clinic. The psychometric properties were assessed by construct validity (convergent, known groups and dimensionality) and internal consistency/reliability (Cronbach's alpha). RESULTS: A total of 180 subjects under oral anticoagulation formed the baseline validation population. DASS total score and SF-36 domain correlations were moderate for General health (r=-0.47, p<0.01), Vitality (r=-0.44, p<0.01) and Mental health (r=-0.42, p<0.01) (convergent). Age and length on oral anticoagulation therapy (in years) were weakly correlated with total DASS score and most of the subscales, except Limitation (r=-0.375, p<0.01) (Known groups). The Cronbach's alpha coefficient was 0.79 for the total scale, and it ranged from 0.76 (hassles and burdens)-0.46 (psychological impact) among the domains, confirming the internal consistency reliability. CONCLUSIONS: The Brazilian-Portuguese version of the DASS has shown levels of reliability and validity comparable with the original English version. RELEVANCE TO CLINICAL PRACTICE: Healthcare practitioners and researchers need internationally validated measurement tools to compare outcomes of interventions in clinical management and research tools in oral anticoagulation therapy.

Reliability and validity of the Impact of Event Scale (IES): version for Brazilian burn victims.

AIMS: The aims of this study were to assess the internal reliability (internal consistency), construct validity, sensitivity and ceiling and floor effects of the Brazilian-Portuguese version of the Impact of Event Scale (IES). DESIGN: Methodological research design. METHOD: The Brazilian-Portuguese version of the IES was applied to a group of 91 burned patients at three times: the first week after the burn injury (time one), between the fourth and the sixth months (time two) and between the ninth and the 12th months (time three). The internal consistency, construct validity (convergent and dimensionality), sensitivity and ceiling and floor effects were tested. RESULTS: Cronbach's alpha coefficients showed high internal consistency for the total scale (0·87) and for the domains intrusive thoughts (0·87) and avoidance responses (0·76). During the hospitalisation (time one), the scale showed low and positive correlations with pain measures immediately before (r=0·22; p<0·05) and immediately after baths and dressings (r=0·21; p<0·05). After the discharge, we found strong and negative correlations with self-esteem (r=-0·52; p<0·01), strong and positive with depression (r=0·63; p<0·01) and low and negative with the Bodily pain (r=-0·24; p<0·05), Social functioning (r=-0·34; p<0·01) and Mental health (r=-0·27; p<0·05) domains of the SF-36 at time two. Regarding the sensitivity, no statistically significant differences were observed between mean scale scores according to burned body surface (p=0·21). The floor effect was observed in most of the IES items. CONCLUSION: The adapted version of the scale showed to be reliable and valid to assess postburn reactions on the impact of the event in the group of patients under analysis. RELEVANCE TO CLINICAL PRACTICE: The Impact of Event Scale can be used in research and clinical practice to assess nursing interventions aimed at decreasing stress during rehabilitation.