[Measure of disease impact: instrument construct validity in patients with coronary artery disease]. / Medida do impacto da doença: validade de constructo de instrumento entre coronariopatas.

This study estimated the known groups construct validity for the Instrument to Measure the Impact of Coronary Disease on Patient's Everyday Life (IDCV) related to signs and symptoms, ventricular systolic function, left ventricular ejection fraction (LVEF) and health-related quality of life (HRQoL) in 153 outpatients with coronary artery disease. Data was obtained through application of IDCV and Brazilian versions of the instruments The Medical Study 36-item Short Form Health Survey - SF-36 and the MacNew Heart Disease Health-related Quality of Life Questionnaire . Mann-Whitney test was used to verify the ability of IDCV in discriminating impact of signs and symptoms, LVEF and ventricular systolic dysfunction. Also, the Kruskal-Wallis test was used to verify the discrimination power of the IDCV in relation to HRQoL. It was observed that the IDCV discriminated the impact between variables scored in HRQOL quartiles (≤Q1, Q1-Q3, ≥Q3). The study findings contribute for improvement of IDCV in measurement of disease impact in coronary artery disease patients.

Relationship between beliefs regarding a low salt diet in chronic renal failure patients on dialysis.

OBJECTIVE: The aim of this study was to investigate the relationship between beliefs regarding a low salt diet and the nutritional behavior of sodium consumption as well their relation with sociodemographic and clinical variables among chronic renal failure (CRF) patients on dialysis. DESIGN AND METHODS: This cross-sectional study enrolled a sample of 117 patients who answered the Brazilian version of the Beliefs about Dietary Compliance Scale (BDCS), the sodium frequency food questionnaire, and the use of discretionary salt/day. RESULTS: The average of total salt consumption was 10.6 g/day (±6.3) and it was positively correlated with the interdialytic weight gain (r = 0.20 P = .032) and negatively correlated with the education level (r = -0.19 P = .044). The Benefits beliefs were discriminatory of the higher and lower salt consumers, and proportionally related to monthly income (r = 0.22 P = .017). The Barriers beliefs were positively correlated only to time on dialysis (r = 0.25 P = .008). Subjects with lower schooling and those of older age tended to consume more discretionary salt (r = -0.27, P = .005; r = 0.23, P = .016, respectively); however, they reported a lower consumption of foods with high salt content (r = 0.25 P = .006; r = -0.27 P = .004). CONCLUSIONS: Educational interventions aimed at reducing salt consumption for this group must include interventions targeted at different behaviors related to overall salt consumption, the specificities of age, and level of schooling of the patients.

Social structure, social cognition, and physical activity: a test of four models.

OBJECTIVE: This study investigated the combined influence of social structural factors (e.g. income) and cognitions in predicting changes in physical activity. Four models were tested: (a) direct effects (social structural factors influence behaviour controlling for cognitions), (b) mediation (cognitions mediate social structural influence), (c) moderation (social structural factors moderate cognition-behaviour relations), and (d) mediated moderation (cognitions mediate the moderating effects of social structural position). DESIGN: Baseline and 3-month follow-up surveys. METHODS: A random sample of 1,483 adults completed self-report measures of physical activity at baseline and 3-month follow-up. Measures of age, gender, education, income, material and social deprivation, intention, perceived behavioural control (PBC), and intention stability also were taken. RESULTS: Apart from age, social structural factors exhibited very small or marginal effects on behaviour change, and only education moderated the intention-behaviour relation. In contrast, the magnitude of direct effects of the social cognition variables was comparatively large and intention stability mediated the moderating effect of education. CONCLUSIONS: Stable intentions and PBC are the key predictors of changes in physical activity. Consequently, our findings would suggest the value of focusing on cognitions rather than social structural variables when modelling the determinants of physical activity.

Quality of life, dyspnea and ventricular function in patients with hypertension.

AIM: This paper is a report of an investigation of the relationship between health-related quality of life and left ventricular function among patients with hypertension who did not fulfil the criteria for heart failure. BACKGROUND: Heart failure is a common consequence of hypertension, with Doppler echocardiography being the gold-standard tool to evaluate left ventricular function, mainly hypertension-induced left ventricular damage. Echocardiographic data indicating poorer ventricular function have been related to lower levels of health-related quality of life in patients with systolic and/or diastolic heart failure. However, data are still lacking regarding the correlation between health-related quality of life and left ventricular function and structure in patients with hypertension who do not fulfil the criteria for heart failure. METHOD: Between September 2005 and February 2007, 98 patients with hypertension without systolic or diastolic heart failure were evaluated. Health-related quality of life was assessed using the Medical Outcomes Study Short Form-36. Left ventricular function was evaluated through Tissue Doppler echocardiography. RESULTS: Statistically significant but weak correlations (varying from r = -0.22 to 0.35) were observed between some of the Short Form-36 domains and echo data. To consider the potential effect of dyspnoea in this relationship, patients were split according to the presence or absence of the symptom. In the subgroup without dyspnoea, similar patterns of correlation were observed (varying from r = 0.26 to 0.32). In the subgroup with dyspnoea, however, more and stronger correlations were observed between echo data and health-related quality of life domains, varying from r = -0.40 to 0.50. CONCLUSION: Nurses should be aware of the relevance of evaluating the functional echocardiographic data of patients who not fulfil heart failure criteria, but who experience dyspnoea in order to implement appropriate action plans.

Effect of implementation intentions to change behaviour: moderation by intention stability.

The aim of this study was to assess the effects of implementation intentions on leisure-time physical activity, taking into account the stability of intention. At baseline (T0), 349 participants completed a psychosocial questionnaire and were randomly assigned to implementation intention or control condition. Three months after baseline assessment (T1), participants in the experimental group were asked to plan where, when, and how they would exercise. Leisure-time physical activity was assessed 3 mo. later (i.e., at 6-mo. follow-up; T2). The intervention had no significant effect on physical activity at 6-mo. follow-up. However, a significant interaction of group and intention stability was observed, with the effect of the intervention on behaviour statistically significant only among those with unstable intention. Intention stability thus moderated the effect of the intervention, i.e., the intervention was more successful among individuals who needed support to change (unstable intenders).

Association between Taste Sensitivity and Self-Reported and Objective Measures of Salt Intake among Hypertensive and Normotensive Individuals.

This study investigated the gustatory threshold for salt and its relationship with dietary salt intake among hypertensive (n = 54) and normotensive (n = 54) subjects. Salt intake was evaluated through 24-hour urinary sodium excretion and self-reported measures (discretionary salt, Sodium- Food Frequence Questionnaire (Na-FFQ), and 24-hour recall). Detection and recognition thresholds were higher among hypertensive subjects, as well as the total sodium intake. Detection and recognition thresholds were positively related to discretionary salt and total intake of the group as whole. Hypertensive and normotensive subjects presented positive correlations between taste sensitivity and the different measures of salt intake. To conclude, a positive correlation exists between taste threshold and salt intake and both seem to be higher among hypertensive subjects. The combined use of methods of self-report and assessment of taste thresholds can be useful in health promotion and rehabilitation programs, by screening subjects at higher risk of elevated salt intake and the critical dietary behaviors to be targeted as well to evaluate the result of targeted interventions.

Medida do impacto da doença: validade de constructo de instrumento entre coronariopatas / Medicion del impacto de la enfermedad: la validez de constructo de un instrumento entre pacientes con enfermedad coronaria / Measure of disease impact: instrument construct validity in patients with coronary artery disease

Este estudo estimou a validade de constructo pelo teste de grupos conhecidos do Instrumento para Mensuração do Impacto da Doença no Cotidiano do Valvopata (IDCV) quanto a sinais e sintomas, função ventricular sistólica, fração de ejeção do ventrículo esquerdo (FEVE) e qualidade de vida relacionada à saúde (QVRS) em 153 coronariopatas em seguimento ambulatorial. Os dados foram obtidos pela aplicação do IDCV e das versões brasileiras do The Medical Study 36-item Short Form Health Survey – SF-36 e MacNew Heart Disease Health-related Quality of Life Questionnair e. Foi utilizado o teste de Mann-Whitney para verificar a capacidade do IDCV em discriminar o impacto quanto a sinais e sintomas, FEVE e disfunção sistólica ventricular, bem como o teste de Kruskal-Wallis para verificar seu poder de discriminação em relação à QVRS. Constatou-se que o IDCV discriminou o impacto entre aqueles que pontuaram nos quartis (≤Q1, Q1-Q3, ≥Q3) de QVRS. Os achados deste estudo contribuem para o refinamento do IDCV na mensuração do impacto da doença entre coronariopatas.

Este estudio tuvo como objetivo estimar la validez de constructo por medio de pruebas en grupos conocidos del Instrumento para Medición del Impacto de la Enfermedad en la vida diaria del paciente con valvulopatía, relacionado a la búsqueda de signos y síntomas, función ventricular sistólica, fracción de eyección ventricular izquierda (FEVI) y la calidad de vida relacionada con la salud (CVRS). Fue ejecutado en 153 pacientes con enfermedad coronaria que realizaban control regular en los consultorios externos. La recolección de los datos fue a través de la aplicación del instrumento específico y de las versiones brasileñas del The Medical Study 36-item Short Form Health Survey – SF-36 y MacNew Heart Disease Health-related Quality of Life Questionnair e. Fue utilizado la prueba de Mann-Whitney para verificar la capacidad del Instrumento para Medición del Impacto de la Enfermedad en la vida diaria del paciente con valvulopatía y discriminar el impacto en relación con los signos y síntomas, la fracción de eyección ventricular izquierda (FEVI) y la disfunción sistólica ventricular izquierda; así como la prueba de Kruskal-Wallis para comprobar el poder de discriminación en relación con la CVRS. Fue constatado que el IDCV fue capaz de discriminar el impacto entre los sujetos que puntuaron en los cuartiles (≤Q1, Q1-Q3, ≥Q3) de la CVRS. Los resultados del estudio contribuyen para el perfeccionamiento del IDCV en la medición del impacto de la enfermedad en pacientes con enfermedad coronaria.

This study estimated the known groups construct validity for the Instrument to Measure the Impact of Coronary Disease on Patient’s Everyday Life (IDCV) related to signs and symptoms, ventricular systolic function, left ventricular ejection fraction (LVEF) and health-related quality of life (HRQoL) in 153 outpatients with coronary artery disease. Data was obtained through application of IDCV and Brazilian versions of the instruments The Medical Study 36-item Short Form Health Survey – SF-36 and the MacNew Heart Disease Health-related Quality of Life Questionnaire . Mann-Whitney test was used to verify the ability of IDCV in discriminating impact of signs and symptoms, LVEF and ventricular systolic dysfunction. Also, the Kruskal-Wallis test was used to verify the discrimination power of the IDCV in relation to HRQoL. It was observed that the IDCV discriminated the impact between variables scored in HRQOL quartiles (≤Q1, Q1-Q3, ≥Q3). The study findings contribute for improvement of IDCV in measurement of disease impact in coronary artery disease patients.

Psychometric properties of the Minnesota Living with Heart Failure--Brazilian version--in the elderly.

BACKGROUND: Heart failure (HF) has implications for the quality of life for any age range, more so for the elderly who simultaneously present other limitations imposed by multiple co-morbidities. Although there are several instruments to measure Health Related Quality of Life (HRQL), none is specific to the elderly with HF. Among disease-specific instruments, Minnesota Living with Heart Failure(LHFQ) has not been studied extensively among the elderly with respect to its psychometric properties. OBJECTIVE: The purpose of this study was to evaluate the convergent, divergent and discriminative validity of the Brazilian version of LHFQ applied to elderly HF patients. METHOD: One hundred and seventy (170) elderly were interviewed. LHFQ capacity to discriminate subjects among New York Heart Association (NYHA) Classes I, II and III/IV was analyzed. Convergent and divergent validity was evaluated through the correlation between the domains of LHFQ and the generic instrument, Medical Outcomes Study (MOS) 36-item Short-Form Health Survey (SF-36). RESULTS: The LHFQ total score and physical dimension sub-scale discriminated between the three sub-groups of NYHA Classes I, II and III/IV (P < .0001). The emotional dimension discriminated NYHA Classes I and III/IV (P = .0034). The physical and emotional dimensions of the LHFQ and SF-36 were significantly correlated (coefficients from .46 to .70 for physical dimension and from .31 to .65 for emotional dimension). However, contrary to expectations, the divergent validity was not totally confirmed as there was no difference in the magnitude of the correlations between the LHFQ emotional and physical dimensions and the SF-36 role physical, social functioning and role emotional. Thus, the results suggest that LHFQ seems to be a valid tool to measure HRQL in the elderly, but new studies remain necessary to gain a better understanding of its discriminative validity for more advanced NYHA functional classes and for its divergent validity.