Psychometric properties of a Spanish version of the McGill Pain Questionnaire in several Spanish-speaking countries.

OBJECTIVE: Versions of the McGill Pain Questionnaire are available in a several languages and are used in clinical studies and sociocultural or ethnic comparisons of pain issues. However, there is a lack of studies that compare the validity and reliability of the instrument in the countries where it is used. The current study investigates the psychometric properties of a Spanish version of the McGill Pain Questionnaire in five Spanish-speaking countries. DESIGN: The authors conducted a multicenter and transnational study with one investigator in each center. Patients were evaluated once with a Spanish version of the McGill Pain Questionnaire, a visual analog scale, and a verbal rating scale. SETTING: The study was performed in pain clinics and acute pain units of four Latin American countries (Argentina, Costa Rica, Mexico, and Panama) and Spain. PATIENTS: The study included 205 patients (84 with acute pain, 121 with chronic pain) from Latin America. Their data were compared with those of 282 Spanish patients. INTERVENTIONS: The McGill Pain Questionnaire, visual analog scale, and verbal rating scale were administered once to all patients. The McGill Pain Questionnaire was administered again to patients from Latin America countries to ascertain descriptor comprehension. OUTCOME MEASURES: Demographic data, McGill Pain Questionnaire parameters, and visual analog scale and a verbal rating scale scores were obtained from patients with chronic and acute pain. Psychometric properties of the Spanish version of the McGill Pain Questionnaire were established for each country by calculating the ordinal consistency by means of rank-scale correlation (Spearman test), intercategory correlation, and interparameter correlation (Pearson test). Concurrent validity was also calculated by comparing scores from the visual analog scale (Pearson test) and verbal rating scale (Spearman test) with questionnaire parameters (qualitative-to-quantitative comparisons). RESULTS: The Spanish version of the McGill Pain Questionnaire maintained a high internal validity when tested in different countries. Ordinal consistency, intercategory, interparameter, and qualitative-to-quantitative parameter correlations were similar in all countries. Few descriptors were considered to be inappropriate or difficult to understand. CONCLUSIONS: The psychometric properties of the Spanish version of the McGill Pain Questionnaire assessed in different Latin-American countries suggest that the questionnaire may be used to evaluate Spanish-speaking patients. The validity of this test should be extended with reliability studies to further establish its usefulness in the evaluation of pain.

Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis.

The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.

Opioid availability in Latin America: the declaration of Florianopolis.

Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.

Argentina's WHO Cancer Pain Relief Program: a patient care model.

We treat cancer pain patients at their homes, in collaboration with their relatives and primary physician. Assistance is free. Our team is monodisciplinary and trained volunteers are the liaison between team and patients. In 118 patients treated with our model between October 1987 and December 1988, we assessed the symptoms that moved them to seek assistance, their previous therapies, and the effectiveness of our intervention. The data obtained suggest that (a) in our country, the majority of cancer patients do not obtain effective pain and symptom control; (b) our model yields satisfactory pain control and improvement in quality of life; and (c) there is a need for centers that teach and practice terminal care; our model may be useful as a working outline for such centers.

Group-specific component (Gc) alleles among Haitian immigrants.

Gc allele frequencies were determined in Haitian immigrants, a group at high risk for AIDS. Gc2, an allele associated with disease resistance, is infrequent in this group; Gc1f is frequent.

Infusión subcutánea intermitente de morfina para el tratamiento del dolor en pacientes con cancer / Intermittent subcutaneous morphine infusion for treatment of pain in patients with cancer

Se describe el tratamiento de 12 pacientes con dolor por cáncer por medio de infusiones subcutáneas intermitentes de clorhidrato de morfina. Once (11) de los pacientes fueron tratados en sus domicilios y obtuvieron analgesia satisfactoria hasta el momento de sus muertes, sin complicaciones atribuibles al método ni efectos indiseables distintos de los observados en los tratamientos crónicos con analgésicos opioides. La duración promedio de las infusiones fue de 11.5 ñ 7.82 (ds) días

Infusión subcutánea intermitente de morfina para el tratamiento del dolor en pacientes con cancer / Intermittent subcutaneous morphine infusion for treatment of pain in patients with cancer

Se describe el tratamiento de 12 pacientes con dolor por cáncer por medio de infusiones subcutáneas intermitentes de clorhidrato de morfina. Once (11) de los pacientes fueron tratados en sus domicilios y obtuvieron analgesia satisfactoria hasta el momento de sus muertes, sin complicaciones atribuibles al método ni efectos indiseables distintos de los observados en los tratamientos crónicos con analgésicos opioides. La duración promedio de las infusiones fue de 11.5 ñ 7.82 (ds) días (AU)

HLA in kinship determinations among Haitian immigrants.

Immunogenetic study of alleged first-degree relatives was undertaken among 258 prospective United States immigrants from Haiti. Methods involved serotyping red cells for ABO, Rh, and MN antigens and typing leukocytes for HLA, A, B, and C locus antigens. Kinship was definitely excluded in a relatively low 4.2% of cases involving putative parents and children. Among cases involving alleged siblings, estimates of fraud appeared slightly higher, but the method is suspect because even in true sibships, there may be an absence of obligatory gene markers. Data suggests that some cases involved half-siblings rather than fraud. Of demonstrated exclusions of parent or child, HLA detected the lack of kinship in 87.4% versus 16.9% by red cell typing. However, there were cases in which exclusions were found by red cell methods alone; furthermore, red cell plus HLA typing allows for a calculation of probability of kinship that is analogous to calculations in paternity studies. Together, the red cell and leukocyte systems offer a prior probability of exclusion of parent-child relationships in 91.3%.