Are Perineal Massage and Instrument-Assisted Perineal Stretching With Short Protocol Effective for Increasing Pelvic Floor Muscle Extensibility? A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare (1) the effects of the instrument-assisted perineal stretching technique with different application protocols in combination with perineal massage and (2) the effects of the isolated techniques on the extensibility and strength of the pelvic floor muscles (PFMs). METHODS: A randomized controlled clinical trial with parallel randomization, assessor blinding, and concealed allocation was conducted in the Campus Physical Education at the Federal University of Uberlândia in Brazil. Ninety-six pregnant women (18-40 years of age) were allocated into 4 groups: perineal massage (PnM) group (PnM protocol for 10 minutes); instrument-assisted perineal stretching with a long static protocol for 15 minutes [IStrLS group]); PnM + IStrLS group (both techniques applied in the 2 previous groups); and PnM + IStrSR group (the same techniques as used in the PnM + IStrLS group but with a short repeated protocol; 4 sets lasting 30 seconds each). Eight interventions were performed in all 4 groups twice weekly (beginning at the 34th gestational week). The primary outcome was PFM extensibility, assessed using vaginal dilator circumference, and the secondary outcome was PFM strength, assessed using vaginal manometry. RESULTS: For the PFM extensibility variable, a significant main effect of time (F2,88 = 87.951) and group (F3,88 = 7.193) was found. Tukey post hoc test results showed that the PnM + IStrSR group presented greater extensibility than the PnM and IStrLS groups. The PnM group showed increased PFM strength after 8 sessions compared with the other groups. CONCLUSIONS: Women who were pregnant and received the combination of perineal massage and instrument-assisted perineal stretching with short repeated application had a greater increase in PFM extensibility than perineal massage and instrument-assisted perineal stretching alone. IMPACT: The combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol led to better PFM extensibility results than the application of the techniques alone in women who were pregnant. LAY SUMMARY: Pregnant women can benefit from intervention using the combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol.

Effects of the addition of transcutaneous electrical stimulation to non-pharmacological measures in labor pain: study protocol for a randomized controlled trial.

BACKGROUND: Labor, although natural and physiological, is a period that can be marked by stress, pain, anxiety, suffering, fear, and anguish for a woman. Thus, non-pharmacological methods that reduce pain during labor are important to allow a better experience without the use of medications. Therefore, the aim of this study is to evaluate the effects of non-pharmacological pain relief methods, added or not to the application of transcutaneous electrical stimulation (TENS), on pain, satisfaction with the childbirth, duration of labor, and newborn conditions. METHODS: This is a randomized controlled clinical trial, with a non-probabilistic convenience sample, composed of women in the first active stage of labor, admitted to a public institution. The parturients will be divided into 3 groups: group 1 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball and receiving back massage for 30 min; group 2 (n = 36) composed of parturients who will also have continuous support and will be encouraged to walk, adopt different positions using the Swiss ball, and will receive the application of TENS for 30 min; and group 3 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball, and will receive placebo TENS application for 30 min. The outcomes evaluated in the study will be pain intensity assessed by the visual analog scale of pain applied before, immediately after, and 30 min and 1 h after the interventions; Experience and Satisfaction with Childbirth Questionnaire (QESP) applied 12 to 24 h after delivery; and data regarding delivery (type of delivery, total duration of labor, and possible obstetric complications) and neonate (weight, height, possible complications, Apgar score in the first and fifth minutes). DISCUSSION: With this research, it is expected to understand the effects of the intervention through TENS electrostimulation added to other non-pharmacological methods for pain management during labor. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) RBR-68kh6j . Registered on March 17, 2020.

Effects of tibial and parasacral nerve electrostimulation techniques on women with poststroke overactive bladder: study protocol for a randomized controlled trial.

BACKGROUND: Neurogenic bladder (NB) can affect people after stroke episodes. NB features changes in the normal voiding pattern at the bladder filling and emptying phases. Overactive NB is characterized by urgency symptoms, with or without urinary incontinence, caused by NB. This disorder affects many domains of life (physical, social, psychological, domestic, sexual) that limit personal autonomy and degrade the quality of life. Among the several treatments available, the conservative physical therapy intervention through tibial nerve electrostimulation (TNES) and parasacral electrostimulation (PSES) can help improve patient conditions with a smaller number of collateral effects than those of interventions based on medication. The aim of the present study is to compare the effects of TNES and PSES techniques in women with overactive NB after stroke episodes to assess the impact of urinary incontinence in these women, on their number of incontinence episodes, daytime and nocturnal urinary frequency, and quality of life. METHODS: This is a prospective clinical study to compare two randomized groups based on parallel and blind conditions. Forty-four women who have had a stroke episode at least 30 days before the trial and who have developed overactive NB will be recruited for the trial. All patients will be subjected to initial evaluation and randomly divided into two groups, TNES and PSES. Subsequently, the two groups will be subjected to a 12-session intervention protocol, twice a week. A new evaluation will be performed after the intervention. DISCUSSION: The results of this study will contribute to the physiotherapeutic treatment of women with NB after a stroke episode since such results will add information about the benefits of this treatment, urinary control, and the improvements in the quality of life of these women. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) RBR-2bn2z4 . Registered on December 11, 2018.

[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.

Esophageal manometry in systemic sclerosis: findings and association with clinical manifestations.

INTRODUCTION: Systemic sclerosis (SSC) is an autoimmune disorder that affects several organs of unknown etiology, characterized by vascular damage and fibrosis of the skin and organs. Among the organs involved are the esophagus and the lung. OBJECTIVES: To relate the profile of changes in esophageal electromanometry (EM), the profile of skin involvement, interstitial pneumopathy (ILD), and esophageal symptoms in SSC patients. METHODS: This is an observational, cross-sectional study carried out at the SSC outpatient clinic of the Hospital de Clínicas of the Federal University of Uberlândia. After approval by the Ethics Committee and signed the terms of consent, 50 patients were initially enrolled, from 04/12/2014 to 06/25/2015. They were submitted to the usual investigations according to the clinical picture. The statistical analysis was descriptive in percentage, means, and standard deviation. The Chi-square test was used to evaluate the relationship between EM, high-resolution tomography, and esophageal symptoms. RESULTS: 91.9% of the patients had some manometric alterations. 37.8% had involvement of the esophageal body and lower esophageal sphincter. 37.8% had ILD. 24.3% presented the diffuse form of SSC. No association was found between manometric changes and clinical manifestations (cutaneous, pulmonary, and gastrointestinal symptoms). CONCLUSION: The present study confirms that esophageal motility alterations detected by EM are frequent in SSC patients, but may not be related to cutaneous extension involvement, the presence of ILD, or the gastrointestinal complaints of patients.

Esophageal manometry in systemic sclerosis: findings and association with clinical manifestations

SUMMARY INTRODUCTION Systemic sclerosis (SSC) is an autoimmune disorder that affects several organs of unknown etiology, characterized by vascular damage and fibrosis of the skin and organs. Among the organs involved are the esophagus and the lung. OBJECTIVES To relate the profile of changes in esophageal electromanometry (EM), the profile of skin involvement, interstitial pneumopathy (ILD), and esophageal symptoms in SSC patients. METHODS This is an observational, cross-sectional study carried out at the SSC outpatient clinic of the Hospital de Clínicas of the Federal University of Uberlândia. After approval by the Ethics Committee and signed the terms of consent, 50 patients were initially enrolled, from 04/12/2014 to 06/25/2015. They were submitted to the usual investigations according to the clinical picture. The statistical analysis was descriptive in percentage, means, and standard deviation. The Chi-square test was used to evaluate the relationship between EM, high-resolution tomography, and esophageal symptoms. RESULTS 91.9% of the patients had some manometric alterations. 37.8% had involvement of the esophageal body and lower esophageal sphincter. 37.8% had ILD. 24.3% presented the diffuse form of SSC. No association was found between manometric changes and clinical manifestations (cutaneous, pulmonary, and gastrointestinal symptoms). CONCLUSION The present study confirms that esophageal motility alterations detected by EM are frequent in SSC patients, but may not be related to cutaneous extension involvement, the presence of ILD, or the gastrointestinal complaints of patients.

RESUMO INTRODUÇÃO A esclerose sistêmica (ES) é uma doença autoimune que afeta vários órgãos de etiologia desconhecida, caracterizada por dano vascular e fibrose da pele e órgãos. Entre os órgãos envolvidos estão o esôfago e o pulmão. OBJETIVOS Relacionar o perfil das alterações na eletromanometria (ME), o perfil de acometimento da pele, a pneumopatia intersticial (PI) e os sintomas esofágicos em pacientes com ES. MÉTODO Trata-se de um estudo observacional, transversal, realizado no ambulatório de SSC do Hospital das Clínicas da Universidade Federal de Uberlândia. Após aprovação pelo Comitê de Ética e assinatura dos termos de consentimento, 50 pacientes foram inicialmente convidados, de 04/12/2014 a 25/06/2015. Eles foram submetidos às investigações usuais de acordo com o quadro clínico. A análise estatística foi descritiva em porcentagem, média e desvio padrão. O teste Qui-quadrado foi utilizado para avaliar a relação entre ME, tomografia de alta resolução e sintomas esofágicos. RESULTADOS 91,9% dos pacientes apresentaram alterações manométricas. 37,8% tinham envolvimento do corpo esofágico e do esfíncter esofágico inferior. 37,8% tinham IP. 24,3% apresentaram a forma difusa da ES. Não há associação entre alterações manométricas e manifestações clínicas (sintomas cutâneos, pulmonares e gastrointestinais). CONCLUSÃO O presente estudo confirma que as alterações da motilidade esofágica detectadas pela EM são frequentes em pacientes com SSC, mas podem não estar relacionadas ao envolvimento cutâneo, à de DPI ou às queixas gastrointestinais dos pacientes.

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.

Perception of health professionals from a city in the interior of Brazil on the vulnerability of older adults to HIV infection / Percepção de profissionais de saúde de um município no interior do Brasil sobre a vulnerabilidade de idosos a infecção por HIV

Introduction: Discussing the AIDS/Older adult theme is a challenging task, as it contradicts the common association of old age with "asexuality", added to the difficulty in early diagnosis when considering other common comorbidities in this age group. Objective: To know the perception of health professionals regarding the possibility of HIV/AIDS infection in older patients. Methods: This cross-sectional observational study received a favorable opinion (19072313.9.0000.5152) from the Human Research Ethics Committee (Universidade Federal de Uberlândia ­ UFU). Dentists, nurses, and physicians from the Primary Care Network participated. We applied Questionnaire 1 to 15 professionals and analyzed the content to elaborate Questionnaire 2, applied to 220 professionals. Results: In the χ2 test of independence, the professionals presented a response pattern similar to that expected for most items, indicating that the profession does not determine the Yes or No answer. The exploratory factor analysis identified dimensions and allowed us to eliminate items that did not contribute to the formation of these dimensions. After three attempts, we found five factors and kept only highly correlated items (r>0.5) in the antiimage matrix. Nine of the 25 items were excluded. We performed a multivariate mixed general linear model (professions x factors). An interaction effect between factors and profession was found for factors 2 (Lack of professional engagement), 3 (Lack of engagement of public management), and 5 (Stigma). Discussion: The results suggest similarities and differences in the responses given by health professionals, showing the influence of both common and specific training base of these professionals. Conclusion: Older adults are vulnerable due to the non-use of condoms, a practice known to most health professionals. AIDS in old age is not the focus of care in public health services, given the low participation of some professions in the public system and their lack of knowledge, considering the old curricula in educational institutions, which do not offer disciplines to expand the training of this professional.

Introdução: A temática AIDS/Idosos é uma tarefa desafiadora, pois contraria a associação comum da velhice à "assexualidade", acrescentado da dificuldade no diagnóstico precoce com outras comorbidades comuns na velhice. Objetivo: Conhecer a visão de profissionais de saúde diante da possibilidade de infecção por HIV/AIDS no paciente idoso. Métodos: Este estudo é observacional transversal. Participaram dentistas, enfermeiros e médicos da Rede de Atenção Primária. Aplicou-se o Questionário 1 a 15 profissionais e realizou-se análise de conteúdo com o objetivo de elaboração do Questionário 2, aplicado a 220 profissionais. Resultados: No χ2 de independência, os profissionais apresentaram padrão de resposta semelhante ao esperado para a maioria dos itens, indicando que não é a profissão que determina o Sim e o Não. A análise fatorial exploratória identificou dimensões e permitiu eliminar os itens que não contribuem para a formação dessas dimensões. Após três tentativas, foram encontrados cinco fatores, mantendo somente itens com correlação elevada (r>0,5) na matriz de anti-imagem. Entre esses itens, 9 dos 25 foram excluídos. Executamos o Modelo Linear Geral Multivariado Misto (profissões x fatores). Observou-se o efeito de interação entre fatores e profissão para os fatores 2 (Desconhecimento pelo profissional), 3 (Falta de engajamento da gestão pública) e 5 (Estigmas). Discussão: Os resultados sugerem que há semelhanças e diferenças nas respostas oferecidas pelos profissionais de saúde, mostrando tanto a influência da base comum da formação desses profissionais quanto da base específica da formação. Conclusão: Os idosos são vulneráveis em virtude do não uso do preservativo, sendo essa prática de conhecimento da maioria dos profissionais de saúde. A AIDS na Terceira Idade não é alvo de atenção pelos serviços públicos de saúde, resultado da pouca participação de algumas profissões no sistema público e falta de conhecimentos, considerando os currículos antigos nas instituições de ensino, que não oferecem disciplinas para a formação mais ampla desse profissional.

Semantic and psychometric validation of the Brazilian Portuguese version (PASE-P) of the Psoriatic Arthritis Screening and Evaluation questionnaire.

PASE (Psoriatic Arthritis Screening and Evaluation) was developed in the English language to screen for inflammatory arthritis among patients with psoriasis. It is 15 item self administered questionnaire with a score from 15 to 75. A higher score indicates a greater risk for inflammatory joint disease. The purpose of this study was to translate, adapt and validate this questionnaire into Brazilian Portuguese (PASE-P). METHODS: 465 patients diagnosed with psoriasis (158 with psoriatic arthritis confirmed by a rheumatologist according to the CASPAR criteria and 307 without) were evaluated in dermatology clinics. We performed the analysis of semantic equivalence in eight steps. For psychometric equivalence, we evaluated the data quality, reliability, construct validity, well-known groups and discriminant characteristics of the items, as well as a ROC curve to determine optimal PASE-P cutoff points in case identification and their sensitivity / specificity. The final version presented excellent reproducibility (CCI = 0.97) and reliability (Cronbach's alpha> 0.9). A cut-off point of 25 distinguished between patients with and without psoriatic arthritis, with sensitivity of 69.5 and specificity of 86.8. PASE-P proved to be culturally valid and reliable to screen for psoriatic arthritis in Brazilian patients with psoriasis.

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis.

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. ETHICS AND DISSEMINATION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42018083465).

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators.

Epicardial adipose tissue and carotid artery disease: Protocol for systematic review and meta-analysis.

BACKGROUND: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Epicardial adipose tissue (EAT) is a metabolically active fat depot, abundant in proinflammatory cytokines, and has been correlated with the extent and severity of carotid artery disease (CD). The locations most frequently affected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between EAT and CD. The aim of this study is to examine this association of EAT with CD in different ages and sex. METHODS: This systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that (1) examined the association between EAT and CD, (2) focus on cohort, case-control and cross-sectional studies, (3) will conducted among in adults aged 40 to 70 years, (4) provided sufficient data for calculating ORs or relative risk with a 95% CI, (5) will published as original articles written in English or other languages, and (6) have been published until January 2018 will be included. Study selection, data collection, quality assessment and statistical syntheses will be conducted based on discussions among investigators. RESULTS: We propose the current protocol to evaluate the evaluation of EAT with ED. CONCLUSION: This systematic review will not need ethical approval, because it does not involve human beings. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. ETHICS AND DISSEMINATION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42018083458).

Epicardial adipose tissue and metabolic syndrome: An update protocol for systematic review and meta-analysis.

BACKGROUND: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia, and an increased risk of cardiovascular events. However, there are no systematic analyses, or well-conducted meta-analyses to evaluate the relationship between epicardial adipose tissue (EAT) and (MetS). The aim of this study is to examine this association of EAT with MetS in different ages and sex. METHODS: The update systematic review, and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that firstly, examined the association between EAT and MetS, secondly, focus on cohort, case-control, and cross-sectional studies, thirdly, were conducted among in adults aged between 40 and 70 years, fourth, provided sufficient data for calculating ORs or relative risk with a 95% CI, fifth, were published as original articles written in English or other languages, and sixth, have been published until January year 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. RESULTS: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. This study will provide a high quality synthesis on the association of EAT and MetS. CONCLUSION: This systematic review will provide evidence to assess whether there is a strong association of EAT and MetS, and its components.

Epicardial adipose tissue and metabolic syndrome An update protocol for systematic review and meta-analysis

BACKGROUND: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia, and an increased risk of cardiovascular events. However, there are no systematic analyses, or well conducted meta-analyses to evaluate the relationship between epicardial adipose tissue (EAT) and (MetS). The aim of this study is to examine this association of EAT with MetS in different ages and sex. METHODS: The update systematic review, and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that firstly, examined the association between EAT and MetS, secondly, focus on cohort, case-control, and cross-sectional studies, thirdly, were conducted among in adults aged between 40 and 70 years, fourth, provided sufficient data for calculating ORs or relative risk with a 95% CI, fifth, were published as original articles written in English or other languages, and sixth, have been published until January year 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. RESULTS: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. This study will provide a high quality synthesis on the association of EAT and MetS. CONCLUSION: This systematic review will provide evidence to assess whether there is a strong association of EAT and MetS, and its components.

Epicardial adipose tissue and carotid artery disease Protocol for systematic review and meta-analysis

BACKGROUND: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Epicardial adipose tissue (EAT) is a metabolically active fat depot, abundant in proinflammatory cytokines, and has been correlated with the extent and severity of carotid artery disease (CD). The locations most frequently affected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between EAT and CD. The aim of this study is to examine this association of EAT with CD in different ages and sex. METHODS: This systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that (1) examined the association between EAT and CD, (2) focus on cohort, case-control and cross-sectional studies, (3) will conducted among in adults aged 40 to 70 years, (4) provided sufficient data for calculating ORs or relative risk with a 95% CI, (5) will published as original articles written in English or other languages, and (6) have been published until January 2018 will be included. Study selection, data collection, quality assessment and statistical syntheses will be conducted based on discussions among investigators. Results: We propose the current protocol to evaluate the evaluation of EAT with ED. CONCLUSION: This systematic review will not need ethical approval, because it does not involve human beings. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal.

[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.

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.

EFEITO DO EXERCÍCIO FÍSICO SOBRE A SAÚDE E SOBRECARGA DE MÃES DE CRIANÇAS E ADOLESCENTES COM PARALISIA CEREBRAL / EFFECT OF EXERCISE ON HEALTH AND BURDEN OF MOTHERS OF CHILDREN AND ADOLESCENTS WITH CEREBRAL PALSY / EFECTO DEL EJERCICIO SOBRE LA SALUD Y SOBRECARGA DE LAS MADRES DE NIÑOS Y ADOLESCENTES CON PARÁLISIS CEREBRAL

RESUMO Introdução: A paralisia cerebral (PC) é considerada a incapacidade física mais comum na infância. Essa doença afeta profundamente a saúde e o bem-estar dos indivíduos acometidos e também pode influenciar múltiplos aspectos da vida de seus cuidadores, especialmente as mães. Objetivo: Avaliar o efeito de um programa de exercício resistido sobre a qualidade de vida relacionada à saúde (QVRS) de mães de crianças e adolescentes com PC. Método: Vinte e duas mães sedentárias cuidadoras de crianças e adolescentes com PC, aptas à prática de exercício resistido, participaram de um programa de exercício resistido de intensidade moderada, em 2 sessões semanais durante 12 semanas. Todos os participantes responderam ao questionário de QVRS, Short Form Questionnaire (SF-36), à escala de sobrecarga Caregiver Burden Scale (CBS) e ao Inventário de Depressão de Beck (BDI) antes e após o programa de intervenção. Os escores dos questionários pré e pós-intervenção foram comparados pelo teste de Wilcoxon e a magnitude das diferenças foi medida pelo tamanho do efeito. Resultados: A mediana de idade das mães foi de 41 anos e variou de 18 a 58 anos. A mediana da idade das crianças/adolescentes foi de 14 anos, variando 3 a 21 anos. Após a intervenção foram encontrados aumentos significativos nos escores do SF-36 (p < 0,05), exceto nos domínios aspectos físicos e aspectos emocionais, que já obtiveram pontuação máxima pré-intervenção. Os escores do CBS e do BDI tiveram redução significativa pós-intervenção (p < 0,05). Conclusão: A prática regular de exercícios resistidos tem impacto positivo sobre a QVRS, a percepção de sobrecarga e a intensidade de sintomas depressivos de mães cuidadoras de crianças e adolescentes com PC.

ABSTRACT Introduction: Cerebral palsy (CP) is considered the most common physical disability in childhood. This disease profoundly affects the health and well-being of affected individuals and can influence multiple aspects of the life of their caregivers, especially mothers. Objective: To evaluate the effect of a resistance training program on health-related quality of life (HRQoL) of mothers of children and adolescents with CP. Methods: Twenty-four sedentary mothers caregivers of children and adolescents with CP, able to practice resistance training, participated in a resistance training program of moderate intensity of 2 sessions per week for 12 weeks. All participants answered to HRQoL questionnaire, SF-36, Caregiver Burden Scale (CBS) and Beck Depression Inventory (BDI) before and after the intervention program. The scores of the questionnaires before and after the intervention were compared using the Wilcoxon test and the magnitude of the differences was measured by effect size. Results: The median age of the mothers was 41 years, ranging from 18 to 58 years. The median age of children and adolescents was 14 years, ranging from 3 to 21 years. The SF-36 scores were significantly higher after the intervention (p<0.05), except in the domains physical aspects and emotional aspects, which already scored the highest value before the intervention. CBS and BDI scores were significantly reduced after intervention (p<0.05). Conclusion: The regular practice of resistance training has a positive impact on HRQoL, burden perception and intensity of depressive symptoms of mothers caregivers of children and adolescents with CP.

RESUMEN Introducción: La parálisis cerebral (PC) es considerada la discapacidad física más común en la infancia. Esta enfermedad afecta profundamente la salud y el bienestar de los individuos afectados y también puede influir en muchos aspectos de la vida de sus cuidadores, especialmente las madres. Objetivo: Evaluar el efecto de un programa de ejercicios de resistencia en la calidad de vida relacionada con la salud (CVRS) de las madres de niños y adolescentes con parálisis cerebral. Método: Veinte y dos madres sedentarias cuidadoras de niños y adolescentes con PC, aptas para la práctica de ejercicios de resistencia, participaron en un programa de ejercicios de resistencia de intensidad moderada, de 2 sesiones por semana durante 12 semanas. Todos los participantes respondieron el cuestionario CVRS, el Short Form Questionnaire (SF-36), la escala de sobrecarga del cuidador Caregiver Burden Scale (CBS) y el Inventario de Depresión de Beck (BDI) antes y después de la intervención. Las puntuaciones de los cuestionarios antes y después de la intervención se compararon mediante la prueba de Wilcoxon y la magnitud de las diferencias fue medida por el tamaño del efecto. Resultados: La edad mediana de las madres fue de 41 años, con un rango de 18 a 58 años. La mediana de edad de los niños/adolescentes fue de 14 años, con rango 3 a 21 años. Después de la intervención se encontró un aumento significativo en los resultados de SF-36 (p < 0,05), excepto en los dominios aspectos físicos y aspectos emocionales, que han obtenido la máxima puntuación antes de la intervención. Las puntuaciones de la CBS y la BDI tuvieron una reducción significativa después de la intervención (p < 0,05). Conclusión: La práctica regular de ejercicios de resistencia tiene un impacto positivo en la CVRS, la percepción de la sobrecarga y la intensidad de los síntomas depresivos de las madres cuidadoras de niños y adolescentes con PC.

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.