Cross-cultural adaptation and validation of a Brazilian version of an instrument to assess impairments related to oral functioning of people with Down syndrome.

BACKGROUND: An instrument was developed in Canada to assess impairments related to oral functioning of individuals with four years of age or older with Down syndrome (DS). The present study attempted to carry out the cross-cultural adaptation and validation of the instrument for the Brazilian Portuguese language and to test its reliability and validity. FINDINGS: After translation and cross-cultural adaptation, the instrument was tested on caregivers of people with DS. Clinical examination for malocclusion was carried out in people with DS by two calibrated examiners. Inter and Intra examiner agreement was assessed by Intraclass Correlation Coefficient (ICC) and ranged from 0.92 to 0.97 respectively. Total of 157 people with DS and their caregivers were able to compose the sample. They were selected from eight institutions for people with DS in five cities of southeastern Brazil. The mean age of people with DS was 20.7 [±13.1] and for caregivers was 53.1 [±13.7]. The mean instrument score was 18.6 [±9.0]. Internal reliability ranged from 0.49 to 0.80 and external reliability ranged from 0.78 to 0.88. Construct validity was verified by significant correlations identified between malocclusion and the total instrument; and caregivers' educational level and the instrument (p<0.05). Discriminant validity was proved as the instrument presented different mean comparing people with DS and non-DS (p<0.05). CONCLUSIONS: Initial validity tests indicated that the instrument related to the oral health for people with DS may be a valid instrument to this segment of the population in Brazil.

An investigation of the role of sense of coherence in predicting survival among Brazilians with head and neck cancer.

To test the hypothesis that people with head and neck (H&N) cancer with higher sense of coherence (SOC) have longer survival than those with lower SOC. A hospital-based prospective study of 162 subjects with newly diagnosed H&N cancer was conducted. Sense of coherence (SOC) was evaluated at baseline using the 13-item "Orientation to Life" questionnaire. Out of 162 subjects recruited at baseline, 152 were followed for up to 39 months from cancer diagnosis. One-year survival status was obtained for 140 subjects. No association was found between SOC and either 1-year survival status or survival length. The results of this study indicate that a high SOC, compared to lower SOC, does not seem to improve 1-year survival or survival length among this sample of Brazilians with H&N cancer.

An investigation of the correlates of sense of coherence in a sample of Brazilians with head and neck cancer.

The aim of this study was to investigate the correlates of Sense of Coherence (SOC) in Head and Neck (H&N) cancer patients during the initial months following their diagnosis. A sample of 162 subjects with newly diagnosed H&N cancer was recruited from a Brazilian hospital. SOC was evaluated using a validated instrument, and these data plus socio-demographic, behavioural and clinical data were collected using interviews. Correlates of SOC in the sample were analysed using multiple linear regression. The mean SOC score was 63.8 and the mean age was 57.7 years. Most of the subjects were male, had a partner and had low levels of education. The cancers were mainly in the oral cavity and diagnosed at a late stage. Analyses demonstrated that subjects who were men, who had a partner, who were working and those with an opportunity to talk openly had higher (i.e. stronger) SOC. No statistically significant association was observed between SOC and clinical variables or tobacco and alcohol consumption. These results suggest an association between SOC and socio-demographic and psychosocial covariates only in this sample of Brazilian H&N cancer patients.

Measuring parental-caregiver perceptions of child oral health-related quality of life: psychometric properties of the Brazilian version of the P-CPQ.

The Parental-Caregiver Perceptions Questionnaire (P-CPQ) is an instrument that assesses a parent's or a caregiver's perceptions regarding the impact of children's oral health status on quality of life. The aim of this study was to evaluate the psychometric properties of the Brazilian version of the P-CPQ. Following translation and cross-cultural adaptation, the P-CPQ was tested on 123 parents and caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents/caregivers were recruited at dental clinics of the Federal University of Minas Gerais, where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. The mean P-CPQ score was 13.01 (SD=12.14) for the dental caries group and 16.57 (SD=13.13) for the malocclusion group. Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.84. Test-retest reliability revealed satisfactory reproducibility (ICC=0.83). Construct validity was satisfactory, demonstrating significant correlations between global indicators and the total scale. The P-CPQ score was able to discriminate between different parental/caregiver perceptions of oral conditions in their children (dental caries and malocclusion). The results for the Brazilian version of the P-CPQ confirm that this questionnaire is a reliable and valid instrument to assess parental perceptions on the impact that oral health status has on children's life quality.

Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - short forms.

BACKGROUND: The need to evaluate the impact of oral health has led to the development of instruments for measuring oral health-related quality of life (OHQoL). One such instrument is the Child Perceptions Questionnaire (CPQ(11-14)), developed specifically for 11-to-14-year-old children. As this questionnaire was considered long (37 items), shorter forms were developed with 8 (Impact Short Form: 8--ISF:8) and 16 items (Impact Short Form: 16--ISF:16) to facilitate use in the clinical setting and population-based health surveys. The aim of the present study was to translate and cross-culturally adapt these CPQ(11-14) short forms for Brazilian Portuguese and evaluate the measurement properties of these versions for use on Brazilian children. METHODS: Following translation and cross-cultural adaptation, the ISF:8 and ISF:16 were tested on 136 children from 11 to 14 years of age in the city of Belo Horizonte, Brazil. The instrument was administered by a trained researcher who also performed clinical examinations. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability, test-retest reliability) were determined. Discriminant validity was tested between groups, which were divided into children with no cavities and no malocclusion; children with cavities and without malocclusion; and children with malocclusion and without cavities. RESULTS: The mean total score was 6.8 [standard deviation (SD) 4.2] for the ISF:8 and 11.9 (SD 7.6) for the ISF:16 (p < 0.001). Statistically significant associations were found between oral abnormalities and the subscales of the ISF:8 and ISF:16 (p < 0.05). Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (ICC) (ISF:8 = 0.98 and ISF:16 = 0.97) and Cronbach's alpha (ISF:8 = 0.70 and ISF:16 = 0.84) proved to be adequate. Construct validity was confirmed from the correlation between the short form scores and oral health and overall well-being ratings. The score on the short forms of the CPQ(11-14) was able to discriminate between different oral conditions. Criterion validity was satisfactory (p < 0.05). CONCLUSION: The Brazilian versions of CPQ(11-14) ISF:8 and ISF:16 have satisfactory psychometric properties, similar to those of the original instrument.

Measuring parental-caregiver perceptions of child oral health-related quality of life

The Parental-Caregiver Perceptions Questionnaire (P-CPQ) is an instrument that assesses a parent's or a caregiver's perceptions regarding the impact of children's oral health status on quality of life. The aim of this study was to evaluate the psychometric properties of the Brazilian version of the P-CPQ. Following translation and cross-cultural adaptation, the P-CPQ was tested on 123 parents and caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents/caregivers were recruited at dental clinics of the Federal University of Minas Gerais, where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. The mean P-CPQ score was 13.01 (SD=12.14) for the dental caries group and 16.57 (SD=13.13) for the malocclusion group. Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.84. Test-retest reliability revealed satisfactory reproducibility (ICC=0.83). Construct validity was satisfactory, demonstrating significant correlations between global indicators and the total scale. The P-CPQ score was able to discriminate between different parental/caregiver perceptions of oral conditions in their children (dental caries and malocclusion). The results for the Brazilian version of the P-CPQ confirm that this questionnaire is a reliable and valid instrument to assess parental perceptions on the impact that oral health status has on children's life quality.

O Parental-Caregiver Perceptions Questionnaire (P-CPQ) é um instrumento que avalia a percepção do pai/responsável a respeito do impacto da saúde bucal da sua criança na qualidade de vida da mesma. O objetivo do estudo foi avaliar as propriedades psicométricas da versão brasileira do P-CPQ. Após a tradução e adaptação transcultural, o P-CPQ foi testado em uma amostra de 123 pais/responsáveis de crianças com idade entre 11-14 anos com cárie dentária e maloclusão. Os pais/responsáveis foram selecionados das clínicas dentárias da Universidade Federal de Minas Gerais, onde as crianças recebiam atendimento odontológico. As propriedades psicométricas foram avaliadas através da consistência interna, confiabilidade teste-reteste, validade de constructo e validade discriminante. O escore médio do P-CPQ foi 13,01 (dp=12,14) para o grupo com cárie dentária e 16,57 (dp=13,13) para o grupo com maloclusão. A consistência interna foi confirmada pelo coeficiente alfa de Cronbach de 0,84. A confiabilidade teste-reteste revelou satisfatória reprodutibilidade (ICC=0,83). A validade de constructo foi satisfatória, demonstrando correlações significativas entre os indicadores globais e a escala total. O escore do P-CPQ foi capaz de discriminar diferentes percepções dos pais/responsáveis sobre as condições bucais de suas crianças (cárie dentária e maloclusão). Os resultados da versão brasileira do P-CPQ confirmam ser este um questionário válido e confiável.

The pediatric quality of life inventory (PedsQL) family impact module: reliability and validity of the Brazilian version.

BACKGROUND: Pediatric health-related quality of life (HRQOL) has emerged as an important health outcome in clinical trials and healthcare research, for which HRQOL assessment instruments have played an important role. However, these instruments are not available in all countries or all languages. The Pediatric Quality of Life Inventory (PedsQL) Family Impact Module is a multidimensional instrument developed to assess the impact of chronic medical conditions on the HRQOL of parents and family functioning. The objective of the present study was to evaluate the psychometric properties of the PedsQL Family Impact Module cross-culturally adapted for use in Brazil. METHODS: The PedsQL Family Impact Module was administered to 95 parents/guardians of children with cancer in active therapy from 2 to 18 years of age of both genders. Subjects were recruited by means of convenience samples from the Pediatric Hematology/Oncology Centers at two public hospitals. The 'in-patient' sample was defined as individuals who were hospitalized for the administration of chemotherapy. The 'out-patient' sample was defined as individuals who were receiving chemotherapy and were not hospitalized. RESULTS: Test-retest reliability exhibited correlation values ranging from 0.81 to 0.96 for all subscales. Internal consistency reliability was demonstrated for the PedsQL Family Impact Module: Total Scale Score (alpha = 0.89), Parent Health-Related Quality of Life Summary Score (alpha = 0.83) and Family Summary Score (alpha = 0.73). The Total Impact Score for the in-patient and out-patient samples was 67.60 and 56.43, respectively (p < 0.01). The construct validity demonstrated that the PedsQL Family Impact Module proved capable of distinguishing between families whose children/adolescents were hospitalized and families of children/adolescents who are being taken care of at home. CONCLUSION: The Brazilian version of the PedsQL Family Impact Module was considered reliable and valid for assessing the impact of a chronic pediatric health condition on the HRQOL of parents and family functioning. The instrument should be field tested on other chronic pediatric illnesses.

Cross-cultural adaptation of the Child Perceptions Questionnaire 11-14 (CPQ11-14) for the Brazilian Portuguese language.

BACKGROUND: Oral-Health-Related Quality of Life (OHRQoL) instruments are being used with increasing frequency in oral health surveys. However, these instruments are not available in all countries or all languages. The availability of cross-culturally valid, multi-lingual versions of instruments is important for epidemiological research. The Child Perceptions Questionnaire 11-14 (CPQ11-14) is an OHRQoL instrument that assesses the impact of oral conditions on the quality of life of children and adolescents. The objective of the current study was to carry out the cross-cultural adaptation of CPQ11-14 for the Brazilian Portuguese language. METHODS: After translation and cross-cultural adaptation, the CPQ 11-14 was tested on 160 11-to-14-year-old children who were clinically and radiographically examined for the presence or absence of dental caries. The children were receiving dental care at the Pediatric Dental and Orthodontic clinics of the Federal University of Minas Gerais, Brazil. To test the quality of the translation, 17 children answered the questionnaire. The internal consistency of the instrument was assessed by Cronbach's Alpha Coefficient and the test-retest reliability by Intraclass Correlation Coefficient (ICC). RESULTS: The mean CPQ11-14 score were 24.5 [standard deviation (SD) 18.27] in the group with caries and 12.89 [SD 10.95] in the group without caries. Median scores were 20 and 10 in the groups with and without caries, respectively (p < 0.001). Significant associations were identified between caries status and all CPQ domains (p < 0.05). Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.86. Test-retest reliability revealed satisfactory reproducibility (ICC = 0.85). The questionnaire proved to be a valid instrument. Construct validity was satisfactory, demonstrating highly significant correlations with global indicators for the total scale and subscales. The CPQ11-14 score was able to discriminate between different oral conditions (groups without and with untreated caries). CONCLUSION: The present study demonstrated that the CPQ11-14 is applicable to children in Brazil. It has satisfactory psychometric properties, but further research is required to evaluate these properties in a population study.

Measurement properties of the Brazilian version of the Pediatric Quality of Life Inventory (PedsQL) cancer module scale.

BACKGROUND: The use of health-related quality of life (HRQOL) measurements has been increased progressively in health surveys. These measurements document the functional and psychosocial outcomes of health conditions and complement clinical indicators to provide a comprehensive description of individuals and populations' health. The Pediatric Quality of Life Inventory (PedsQL) is a promising instrument with age-appropriate versions. The objective of the current paper was to evaluate the psychometric properties of the PedsQL 3.0 Cancer Module cross-culturally adapted for use in Brazil. METHODS: A cross-sectional study was developed with 190 Brazilian families of individuals from 2 to 18 years of age, of both genders, with cancer in various phases of treatment or control. Subjects were recruited by means of convenience samples from the Pediatric Hematology/Oncology Centers at two public hospitals. 'In-treatment' status was defined as individuals who were receiving medical care to induce remission. 'Off-treatment' status was defined as individuals for whom all therapy was completed for a period of at least one month. Reliability was determined through test-retest reliability and internal consistency. The validity of the Cancer Module was determined through discriminant and convergent validity. Correlations between the scores obtained by the children/adolescents with cancer and their guardians were assessed. RESULTS: Test-retest reliability demonstrated good correlation (0.69-0.90 for children/adolescents; 0.71-0.93 for guardians) and adequate agreement of the items (0.26-0.85 for children/adolescents; 0.25-0.87 for guardians). Internal consistency demonstrated adequate indices in comparisons between groups (alpha = 0.78-0.80 for children and adolescents; 0.68-0.88 for guardians). The 'pain and hurt', 'nausea', 'procedural anxiety' and 'treatment anxiety' subscales proved capable of distinguishing the groups of children in treatment and off treatment (p < 0.05). Positive significant correlations were observed between the scores of the PedsQL 3.0 Cancer Module and the PedsQL 4.0 Generic Core scales. Weak correlations were found between the reports of the children and those of the guardians. CONCLUSION: The Brazilian version of the PedsQL 3.0 Cancer Module exhibited good measurement properties regarding reproducibility and construct validity.