Reliability and validity of the Brazilian version of the world health organization disability assessment schedule (WHODAS 2.0) questionnaire for women with urinary incontinence.

PURPOSE: To analyze the reliability and validity of the WHODAS 2.0 instrument for women with urinary incontinence (UI). METHODS: This is a methodological study with Brazilian women with complaints of urge, stress or mixed UI, over 18 years old, without cognitive disorders. The WHODAS 2.0 (36-item version) and the auxiliary instruments were applied through face-to-face and telephone interviews after 7-14 d. The psychometric properties evaluated were: Cronbach's alpha for internal consistency, intraclass correlation coefficient (ICC) for intra-rater test-retest, Spearman's correlation coefficient (rho) for construct validity of WHODAS 2.0 with auxiliary instruments; and ANOVA for discriminative validity with UI severity. RESULTS: 101 women with UI with a mean age of 50.71 ± 10.39 were included. WHODAS 2.0 showed good reliability in all domains and excellent reliability in the total score (>0.80). The intra-evaluator test-retest showed ICC values between 0.59 and 0.87 (p < 0.001). We observed a positive correlation between the WHODAS 2.0 domains and the instruments recommended by International Continence Society (ICS), with greater emphasis on moderate correlation with the Urinary Impact Questionnaire (IUQ-7) subscale (rho = 0.730 p < 0.001). CONCLUSION: The WHODAS 2.0 instrument is a reliable and valid questionnaire for investigating the functioning and disability of women with UI.

The WHODAS 2.0 is a valid and reliable tool for future functioning research with women with urinary incontinence.The WHODAS 2.0 can be used in clinical practice to assess disabilities in women with urinary incontinence.The validation of WHODAS 2.0 reinforces the need for rehabilitation based on the functioning needs of each patient with urinary incontinence.The WHODAS 2.0 assesses functioning based on the biopsychosocial model, supported by the ICF (International Classification of Functioning, Disability and Health).

The Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) is reliable and valid for chronic stroke survivors.

BACKGROUND: Stroke is the leading cause of disability worldwide. Assessing stroke's impact on patients' daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population. OBJECTIVES: This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke. METHODS: Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity. RESULTS: The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76-0.91) except for the "getting along" domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale. CONCLUSIONS: The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals.

Comparison of disability level between Early and Late Onset Parkinson's Disease using WHODAS 2.

Background: Parkinson's disease (PD) is a degenerative neurological disorder that usually affects people over the age of 60. However, 10%-20% of patients have an early onset of PD (EOPD). Objectives: To compare disability levels according to the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2) between people with EOPD and those with late-onset PD (LOPD). Methods: We conducted a cross-sectional study with 95 EOPD patients (mean-age 44.51 ± 4.63, H&Y 1.93 ± 0.93) and 255 LOPD patients (mean-age 63.01 ± 7.99, H&Y 2.02 ± 0.95). Demographic information, clinical characteristics, cognitive evaluation by Telephone-Montreal-Cognitive-Assessment (T-MoCA), functionality self-evaluation by WHODAS-2 and the Unified-Parkinson's-Disease-Rating-Scale (MDS-UPDRS), parts I and II, were documented for each patient by an individual remote interview. Results: Analysis showed a statistically significant difference between EOPD and LOPD in two domains of WHODAS-2 only: cognition (Z-adjusted = 2.60; p-value adjusted <0.009) and activities of daily living related to work/school (Z-adjusted = 2.34; p-value adjusted <0.01). T-MoCA scores confirmed more impaired cognition capacity in LOPD (Z-adjusted = 2.42; p-value adjusted <0.01). The two groups had no significant differences in levodopa daily dosage, Hoehn and Yahr (H&Y) stages, disease time duration, and MDS-UPDRS I and II scores. Conclusion: People living with EOPD face similar disability levels as those with LOPD, except for cognition, where LOPD patients exhibited higher levels of disability than EOPD and for work activities where the EOPD exhibited higher levels of disability than LODP. These results highlight the challenges faced by people with EOPD in interacting with society and living with the disease for a longer time. The WHODAS-2 can be a useful tool to assess disability and tailor interventions for people with PD of different age groups.

Giving women WOICE postpartum: prevalence of maternal morbidity in high-risk pregnancies using the WHO-WOICE instrument.

BACKGROUND: There are no accurate estimates of the prevalence of non-severe maternal morbidities. Given the lack of instruments to fully assess these morbidities, the World Health Organization (WHO) developed an instrument called WOICE. We aimed to evaluate the prevalence of non-severe maternal morbidities in puerperal women and factors associated to impaired clinical, social and mental health conditions. METHOD: A cross-sectional study with postpartum women at a high-risk outpatient clinic in southeast Brazil, from November 2017 to December 2018. The WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; the second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. Data collection was supported by Tablets with REDCAP software. Initially, a descriptive analysis was performed, with general prevalence of all variables contained in the WOICE, including scales on anxiety and depression (GAD-7 and PHQ-9- impaired if ≥10), functionality (WHODAS- high disability scores when ≥37.4) and data on violence and substance use. Subsequently, an evaluation of cases with positive findings was performed, with a Poisson regression to investigate factors associated to impaired non-clinical and clinical conditions. RESULTS: Five hundred seventeen women were included, majority (54.3%) multiparous, between 20 and 34 years (65.4%) and with a partner (75,6%). Over a quarter had (26.2%) preterm birth. Around a third (30.2%) reported health problems informed by the physician, although more than 80% considered having good or very good health. About 10% reported any substance use and 5.9% reported exposure to violence. Anxiety was identified in 19.8% of cases, depression in 36.9% and impaired functioning in 4.4% of women. Poisson regression identified that poor overall health rating was associated to increased anxiety/depression and impaired functioning. Having a partner reduced perception of women on the presence of clinical morbidities. CONCLUSION: During postpartum care of a high-risk population, over one third of the considered women presented anxiety and depression; 10% reported substance use and around 6% exposure to violence. These aspects of women's health need further evaluation and specific interventions to improve quality of care.

Measurement of maternal functioning during pregnancy and postpartum: findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi.

BACKGROUND: The World Health Organization's definition of maternal morbidity refers to "a negative impact on the woman's wellbeing and/or functioning". Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. METHODS: A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015-2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship between functioning and health conditions. RESULTS: Women attending antenatal care had a lower level of functioning than those attending postpartum care. Women with a health condition or associated demographic risk factor were more likely to have a lower level of functioning than those with no health condition. However, the absolute difference in functioning scores typically remained modest. CONCLUSIONS: Functioning is an important concept which integrates a woman-centered approach to examining how a health condition affects her life, and ultimately her return to functioning after delivery. However, the WHODAS-12 may not be the optimal tool for use in this population and additional components to capture pregnancy-specific issues may be needed. Challenges remain in how to integrate functioning outcomes into routine maternal healthcare at-scale and across diverse settings.

Self-reported disability in women with fibromyalgia from a tertiary care center.

BACKGROUND: The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. METHODS: One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. RESULTS: Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire. CONCLUSIONS: Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

Self-reported disability in women with fibromyalgia from a tertiary care center

Abstract Background: The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. Methods: One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. Results: Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire. Conclusions: Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

Evaluation of the quality of recovery and the postoperative health status after elective surgery / Avaliação da qualidade da recuperação e do estado de saúde no pós-operatório de cirurgias eletivas

Abstract Purpose: Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. Methods: This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. Results: Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. Conclusions: Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

Resumo Objetivo: A recuperação pós-operatória é um processo complexo com dimensões fisiológicas, funcionais e psicológicas. A qualidade da recuperação pós-operatória é considerada um resultado crucial após cirurgia e anestesia. O objetivo deste estudo foi avaliar e comparar a qualidade da recuperação pós-operatória e o estado de saúde antes e depois da cirurgia em pacientes submetidos à cirurgia eletiva. Métodos: Este estudo observacional prospectivo foi feito com pacientes agendados para cirurgia eletiva. A avaliação da recuperação pós-operatória foi feita com a Escala de Qualidade da Recuperação Pós-Operatória (Postoperative Quality of Recovery Scale) e o estado de saúde foi avaliado com a aplicação do EuroQol, que analisa problemas em cinco dimensões (mobilidade, cuidados pessoais, atividades habituais, dor/desconforto e ansiedade/depressão) e a ferramenta para medida de incapacidade desenvolvida pela Organização Mundial da Saúde (World Health Organization Disability Assessment Schedule 2.0). Má qualidade de recuperação foi definida como uma recuperação em menos de dois domínios da Escala de Qualidade da Recuperação Pós-Operatória no primeiro dia (D1) de pós-operatório. Resultados: Antes da cirurgia (D0), os pacientes com má qualidade de recuperação apresentaram escores medianos na escala visual analógica semelhantes aos dos pacientes sem má qualidade de recuperação, mas apresentaram mais problemas nas dimensões mobilidade, atividades habituais, dor/desconforto e ansiedade/depressão. No terceiro mês após a cirurgia, os pacientes com má qualidade de recuperação apresentaram escores na escala visual analógica medianos no EuroQol semelhantes aos dos pacientes sem má qualidade de recuperação, mas apresentaram mais problemas na dimensão dor/desconforto. Os escores World Health Organization Disability Assessment Schedule 2.0 dos pacientes com má qualidade de recuperação foram significativamente maiores no início do estudo, embora os resultados tenham sido semelhantes no terceiro mês. Conclusões: Os pacientes com má qualidade de recuperação apresentaram o pior estado de saúde no D0. A avaliação no terceiro mês indicou taxas semelhantes de problemas no EuroQol (exceto dor/desconforto) e escores semelhantes no World Health Organization Disability Assessment Schedule 2.0.

[Evaluation of the quality of recovery and the postoperative health status after elective surgery]. / Avaliação da qualidade da recuperação e do estado de saúde no pós­operatório de cirurgias eletivas.

PURPOSE: Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. METHODS: This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. RESULTS: Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. CONCLUSIONS: Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

Análisis de discapacidad utilizando WHODAS 2. 0 versión de 12 preguntas a pacientes de Instituto Teletón Santiago dos años después de su alta institucional / Analisis of disability using WHODAS 2. 0 among patients from Santiago Teleton Institute two years after discharge

Introducción: El Instituto Teletón Santiago es una organización sin fines de lucro dedicada a proporcionar rehabilitación integral a niños con discapacidades físicas hasta que cumplen 20 años de edad. Objetivo: Evaluar el nivel de discapacidad en sujetos del Instituto Teletón Santiago 2 años después del alta. Método: La versión de 12 ítems del cuestionario de Evaluación de la Discapacidad de la Organización Mundial de la Salud (12-Whodas) se aplicó a través de entrevista telefónica a pacientes o a su representante del Instituto Teletón Santiago 2 años después de su alta. Resultados: La puntuación mediana global de 12-Whodas fue de 17,0 puntos. La dificultad de desempeño es moderada o severa en todos los dominios en más del 40% de los pacientes y varía entre el 55,4% en movilidad y 42,6% en cuidado personal. El tener una actividad laboral independiente y educación universitaria fue asociado a una discapacidad leve (OR: 0,06 y 0,26, respectivamente), mientras que una mayor edad y el estar desempleados por razones de salud fue asociado a una discapacidad severa (OR: 1,15 y 2,80, respectivamen-te). Conclusiones: Hubo un nivel clínicamente significativo de discapacidad en todos los dominios descritos en 12-Whodas. Confirmamos los datos internacionales de que ser autónomo laboralmente y tener estudios universitarios está asociado con un menor nivel de discapacidad. Destaca la falta de educación inclusiva para estas personas. La adaptación y validación del instrumento 12-Whodas en individuos con enfermedades neuromusculo-esqueléticas es necesaria para proporcionar datos normativos específicos que permitan comparaciones internacionales.

Introduction: Chile Teletón Institute is a not-for-profit organization dedicated to providing comprehensive rehabilitation to children with physical disabilities until they reach 20 years of age. Method: The 12-item version of the World Health Organiza-tion Disability Assessment Schedule (12-Whodas) survey was applied by phone interview to patients or representatives from Santiago Teletón Institute, 2 years after discharge. Results: The 12-Whodas global median score was 17 points. The perfor-mance difficulty is moderate or severe in all domains in more than 40% of the patients, and varies between 55.4% in mobility and 42.6% in personal care. Being self-employed and having a college education were associated with a lower level of disabi-lity (OR: 0.06 and 0.26, respectively), whereas being older and unemployed for health reasons were associated with a higher likelihood of severe disability (OR: 1.15 and 2.80, respectively). Conclusions: There was a clinically significant level of disabi-lity in all the domains described in 12-Whodas. We confirm international data reporting that being self-employed and co-llege-educated are associated with a lower level of disability. A lack of inclusive education for this population stands out. Adaptation and validation of the 12-Whodas in individuals with neuromusculoskeletal disorders is needed to provide specific normative data allowing international comparisons.

Reference ranges of the WHO Disability Assessment Schedule (WHODAS 2.0) score and diagnostic validity of its 12-item version in identifying altered functioning in healthy postpartum women.

OBJECTIVES: To compare scores on the 36-item WHO Disability Assessment Schedule 2.0 tool (WHODAS-36) for postpartum women across a continuum of morbidity and to validate the 12-item version (WHODAS-12). METHODS: This is a secondary analysis of the Brazilian retrospective cohort study on long-term repercussions of severe maternal morbidity. We determined mean, median, and percentile values for WHODAS-36 total score and for each domain, and percentile values for WHODAS-12 total score in postpartum women divided into three groups: "no," "nonsevere," and "severe" morbidities. RESULTS: The WHODAS-36 mean total scores were 11.58, 18.31, and 19.19, respectively for no, nonsevere, and severe morbidity. There was a dose-dependent effect on scores for each domain of WHODAS-36 according to the presence and severity of morbidity. The diagnostic validity of WHODAS-12 was determined by comparing it with WHODAS-36 as a "gold standard." The best cut-off point for diagnosing dysfunctionality was the 95th percentile. CONCLUSION: The upward trend of WHODAS-36 total mean value scores of women with no morbidity compared with those with morbidity along a severity continuum may reflect the impact of morbidity on postpartum functioning.

The impact of hypertension, hemorrhage, and other maternal morbidities on functioning in the postpartum period as assessed by the WHODAS 2.0 36-item tool.

OBJECTIVE: To assess the scores of postpartum women using the WHO Disability Assessment Schedule 2.0 36-item tool (WHODAS-36), considering different morbidities. METHODS: Secondary analysis of a retrospective cohort of women who delivered at a referral maternity in Brazil and were classified with and without severe maternal morbidity (SMM). WHODAS-36 was used to assess functioning in postpartum women. Percentile distribution of total WHODAS score was compared across three groups: Percentile (P)<10, 1090. Cases of SMM were categorized and WHODAS-36 score was assessed according to hypertension, hemorrhage, or other conditions. RESULTS: A total of 638 women were enrolled: 64 had mean scores below P<10 (1.09) and 66 were above P>90 (41.3). Of women scoring above P>90, those with morbidity had a higher mean score than those without (44.6% vs 36.8%, P=0.879). Women with higher WHODAS-36 scores presented more complications during pregnancy, especially hypertension (47.0% vs 37.5%, P=0.09). Mean scores among women with any complication were higher than those with no morbidity (19.0 vs 14.2, P=0.01). WHODAS-36 scores were higher among women with hypertensive complications (19.9 vs 16.0, P=0.004), but lower among those with hemorrhagic complications (13.8 vs 17.7, P=0.09). CONCLUSIONS: Complications during pregnancy, childbirth, and the puerperium increase long-term WHODAS-36 scores, demonstrating a persistent impact on functioning among women, up to 5 years postpartum.

WHODAS and the evaluation of disability among people with mental disorders with and without psychotic symptoms / El WHODAS y la evaluación de discapacidad en personas con trastornos mentales con y sin síntomas psicóticos

Abstract Introduction Valid and feasible measures to properly assess the most impaired areas of functioning in various groups of patients with mental disorders would allow the development and evaluation of interventions designed to modify the specific environmental barriers that contribute to patients´ disability. Objective This article seeks to evaluate the internal consistency and construct and convergent validity of the Spanish version of the World Health Organization's Disability Assessment Schedule WHODAS 2.0, as well as its relationship with sociodemographic variables and symptomatic severity in Mexican patients with and without psychotic symptoms. Method The WHODAS 2.0 and the Social and Occupational Functioning Assessment Scale SOFAS were administered to 153 patients with any of the following diagnoses: affective disorders, anxiety disorders, stress-related disorders, and psychotic disorders. Results The WHODAS 2.0 showed high internal consistency in patients with psychotic symptoms (Cronbach's alpha = .92) and without psychotic symptoms (Cronbach's alpha = .89). Nevertheless, only in patients without psychotic symptoms, was a significant negative correlation between WHODAS (disability) and SOFAS (functioning) total scores observed, together with significant differences in WHODAS scores between those with mild and severe symptomatology. Discussion and conclusion The WHODAS 2.0 is an adequate measure of disability in patients without psychotic symptoms. It could be used as a complementary measure of disability in those with psychotic symptoms. Further studies are required to determine other psychometric properties of the WHODAS 2.0, particularly those related to temporal stability and sensitivity to change.

Resumen Introducción Disponer de medidas válidas y confiables para evaluar las áreas de funcionamiento más comprometidas en los diferentes grupos de pacientes con trastornos mentales permitiría el desarrollo y la evaluación de intervenciones dirigidas a modificar barreras específicas del contexto que contribuyen a su deterioro funcional. Objetivo Evaluar la consistencia interna y la validez de constructo y convergente de la versión en español del cuestionario para la evaluación de discapacidad de la Organización Mundial de la Salud WHODAS 2.0, así como su relación con variables demográficas y la gravedad sintomática en pacientes mexicanos con y sin síntomas psicóticos. Método El WHODAS y la escala de evaluación del funcionamiento social y ocupacional SOFAS se aplicaron a una muestra de 153 pacientes con algún diagnóstico de trastorno afectivo, de ansiedad, relacionado con el estrés o psicótico. Resultados El WHODAS mostró alta consistencia interna en pacientes con síntomas psicóticos (alpha de Cronbach = .92) y en aquellos sin síntomas psicóticos (alpha de Cronbach = .89). Sin embargo, sólo en los pacientes sin síntomas psicóticos se observó una correlación negativa entre las puntuaciones del WHODAS 2.0 (discapacidad) y el SOFAS (funcionalidad) así como diferencias significativas en las puntuaciones WHODAS de aquellos con sintomática leve y grave. Discusión y conclusión La escala WHODAS 2.0 es adecuada para medir discapacidad en pacientes sin síntomas psicóticos. En aquellos con síntomas psicóticos, podría servir más bien con fines complementarios. Se sugieren estudios para determinar otras propiedades psicométricas del WHODAS, especialmente las relacionadas con su estabilidad temporal y sensibilidad al cambio.

Multicentric study of epidemiological and clinical characteristics of persons injured in motor vehicle accidents in Medellín, Colombia, 2009-2010 / Estudio multicéntrico de las características epidemiológicas y clínicas de las personas lesionadas en accidentes de tránsito en Medellín, Colombia, 2009-2010

Introduction: Traffic accidents (TA) cause 1.23 million deaths each year worldwide while between 20 and 50 million persons are injured each year. In 2011 in Medellin, Colombia, there were 307 traffic deaths and 23,835 injured with 411 accidents for each 10,000 vehicles. Objective: The purpose of the study was to describe the epidemiologic and clinical characteristics, as well as the quality of life and disability outcomes for those injured in traffic accidents in Medellin. Methods: This prospective, descriptive, cross-sectional study collected data from 834 patients that were classified with the New Injury Severity Score (NISS) , the WHO-DAS-II (Disability Assessment) Scale and the SF-36 Health Survey. Results: Three-fourths (75.8%) of the patients were male. Eighty-one percent (81.0%) of patients were involved in motorcycle accidents, with 45.6% suffering moderate trauma, and 32.6% experiencing severe trauma. Of the patients with severe trauma, 8.5% were not wearing helmets. Half of the sample (49.7%) injured their extremities. The WHODAS-II domains most affected were: Activities outside the home (62.0%), Housework (54.3%) and Moving in one's environment (45.2%). Quality of life areas affected were: Physical role (20.3%), Body pain (37.3%), Emotional role (44.1%), Physical functioning (52.6%). Conclusions: Patients with more severe injuries had higher levels of disability and a worse quality of life. Motorcycles made up a large proportion of traffic accidents in this city and mitigation strategies to reduce this public health problem should particularly focus on this high-risk group.

Antecedentes: Los accidentes de tránsito (AT) causan 1.23 millones de muertes en el mundo, y entre 20 y 50 millones sufren lesiones no fatales. En Medellín (Colombia) en el 2011 hubo 307 muertos en AT y 23.835 heridos, con 411 accidentes por cada 10.000 vehículos. Objetivo: Describir las características epidemiológicas, clínicas, de calidad de vida y discapacidad de los pacientes luego de un AT en Medellín. Métodos: Estudio descriptivo trasversal prospectivo del estado inicial de una cohorte de 834 pacientes, clasificados de acuerdo a la gravedad de trauma (NISS) y las escalas WHO-DAS II y SF-36. Resultados: En el 81% de los AT estuvieron involucradas motos, con lesiones moderadas en el 45.6 %, y graves en el 32.6% de ellos. No utilizaban casco el 8.5% de los pacientes con NISS grave. En el 49.7% se afectaron los miembros inferiores. Los dominios del WHO-DAS II más afectados fueron: actividades fuera del hogar (62.0%) actividades domésticas (54.3%) y moverse en el entorno (45.2%). La calidad de vida comprometió los dominios de desempeño físico (20.3%), dolor corporal (37.3%), desempeño emocional (44.1%) y funcionamiento físico (52.6%). Conclusiones: Los pacientes con lesiones más graves tuvieron mayor compromiso en la discapacidad y en la calidad de vida. Esta carga de enfermedad la producen principalmente los AT en los que están involucradas las motos.

Factores relacionados con la carga de discapacidad en personas con intento de suicidio, atendidas en la red pública de servicios de salud de Santiago de Cali / Factors related to the disability burden in people with suicidal attempts attended in the public health care service network of Santiago de Cali

Introducción: Según la Organización Mundial de la Salud, las secuelas del intento de suicidio constituyen la sexta causa de mala salud y discapacidad en el mundo. Objetivo: Establecer los grados de discapacidad y sus factores relacionados, en términos de restricciones en la participación y limitaciones en la actividad, en personas con intento de suicidio entre septiembre del 2009 y junio del 2010, atendidas en la Red Pública de Servicios de Salud de Santiago de Cali. Método: Estudio observacional de corte transversal en 126 personas con intento de suicidio, con edades entre 15 y 65 años. Se empleó la versión en español de la Escala de Evaluación de Discapacidad de la Organización Mundial de la Salud. Resultados: Se calcularon 30 años de vida ajustados en función de la discapacidad (AVAD), se estimó una prevalencia del 95,3 % de discapacidad. El 4,6 % de la muestra no presenta discapacidad; el 41,27 %, discapacidad leve; el 38,1 %, discapacidad moderada, y el 15,87 %, discapacidad severa. Los factores relacionados con discapacidad fueron: edad, ocupación, presencia de enfermedad mental, presencia de síntomas depresivos actuales, métodos fatales, consumo de medicamentos psiquiátricos, limitaciones en la actividad, restricciones en la participación y no práctica religiosa. Conclusiones: La prevalencia de discapacidad en personas con intento de suicidio atendidas en la Red Pública de Servicios de Salud de Santiago de Cali fue del 95,3 %. Los resultados son acordes con el estudio de carga mundial de enfermedad que establece una alta carga para trastornos mentales asociados a intento de suicidio. La presencia de una deficiencia posterior al intento de suicidio incrementa la carga de discapacidad.

Introduction: According to the World Health Organization (WHO), the aftermaths of suicide attempts are the sixth leading cause of poor health and disability in the world. Object: Establish the level of disability and related factors in terms of restrictions regarding participation and activity limitations in cases of suicidal attempts attended by the Public Service Network Health of Santiago de Cali, from September 2009 to June 2010. Methodology: A cross-section, observational study was applied to 126 people between 15 and 65 who had attempted suicide and were treated at the Public Health Service in Santiago de Cali. A Spanish version of the Disability Assessment Scale of the World Health Organization Results: 30 disability-adjusted life years (DALYs) were calculated together with a disability prevalence of 95.3%. 4.6% of the sample did not show disability while 41.27% had mild disability, 38.1%, moderate disability, and 15.87%, severe disability. Factors related with disability were: Age, occupation, presence of mental illness, current depressive symptoms, lethal methods, use of psychiatric drugs, activity limitations, participation restrictions and lack of religious practice. Conclusions: The prevalence of disability in people who have committed suicidal attempts treated at the public health services in Santiago de Cali, was 95.3%. The results are consistent with the study of global burden of disease that establishes a high score for mental disorders in suicidal attempts. The presence of a deficiency after the suicide attempt increases the burden of disability.

[Factors Related to the Disability Burden in People with Suicidal Attempts Attended in the Public Health Care Service Network of Santiago de Cali]. / Factores relacionados con la carga de discapacidad en personas con intento de suicidio, atendidas en la red pública de servicios de salud de Santiago de Cali.

INTRODUCTION: According to the World Health Organization (WHO), the aftermaths of suicide attempts are the sixth leading cause of poor health and disability in the world. OBJECT: Establish the level of disability and related factors in terms of restrictions regarding participation and activity limitations in cases of suicidal attempts attended by the Public Service Network Health of Santiago de Cali, from September 2009 to June 2010. METHODOLOGY: A cross-section, observational study was applied to 126 people between 15 and 65 who had attempted suicide and were treated at the Public Health Service in Santiago de Cali. A Spanish version of the Disability Assessment Scale of the World Health Organization RESULTS: 30 disability-adjusted life years (DALYs) were calculated together with a disability prevalence of 95.3%. 4.6% of the sample did not show disability while 41.27% had mild disability, 38.1%, moderate disability, and 15.87%, severe disability. Factors related with disability were: Age, occupation, presence of mental illness, current depressive symptoms, lethal methods, use of psychiatric drugs, activity limitations, participation restrictions and lack of religious practice. CONCLUSIONS: The prevalence of disability in people who have committed suicidal attempts treated at the public health services in Santiago de Cali, was 95.3%. The results are consistent with the study of global burden of disease that establishes a high score for mental disorders in suicidal attempts. The presence of a deficiency after the suicide attempt increases the burden of disability.

Multicentric study of epidemiological and clinical characteristics of persons injured in motor vehicle accidents in Medellín, Colombia, 2009-2010.

INTRODUCTION: Traffic accidents (TA) cause 1.23 million deaths each year worldwide while between 20 and 50 million persons are injured each year. In 2011 in Medellin, Colombia, there were 307 traffic deaths and 23.835 injured with 411 accidents for each 10.000 vehicles. OBJECTIVE: The purpose of the study was to describe the epidemiologic and clinical characteristics, as well as the quality of life and disability outcomes for those injured in traffic accidents in Medellin. METHODS: This prospective, descriptive, cross-sectional study collected data from 834 patients that were classified with the New Injury Severity Score (NISS) , the WHO-DAS-II (Disability Assessment) Scale and the SF-36 Health Survey. RESULTS: Three-fourths (75.8%) of the patients were male. Eighty-one percent (81.0%) of patients were involved in motorcycle accidents, with 45.6% suffering moderate trauma, and 32.6% experiencing severe trauma. Of the patients with severe trauma, 8.5% were not wearing helmets. Half of the sample (49.7%) injured their extremities. The WHODAS-II domains most affected were: Activities outside the home (62.0%), Housework (54.3%) and Moving in one's environment (45.2%). Quality of life areas affected were: Physical role (20.3%), Body pain (37.3%), Emotional role (44.1%), Physical functioning (52.6%). CONCLUSIONS: Patients with more severe injuries had higher levels of disability and a worse quality of life. Motorcycles made up a large proportion of traffic accidents in this city and mitigation strategies to reduce this public health problem should particularly focus on this high-risk group.

ANTECEDENTES: Los accidentes de tránsito (AT) causan 1.23 millones de muertes en el mundo, y entre 20 y 50 millones sufren lesiones no fatales. En Medellín (Colombia) en el 2011 hubo 307 muertos en AT y 23.835 heridos, con 411 accidentes por cada 10.000 vehículos. OBJETIVO: Describir las características epidemiológicas, clínicas, de calidad de vida y discapacidad de los pacientes luego de un AT en Medellín. MÉTODOS: Estudio descriptivo trasversal prospectivo del estado inicial de una cohorte de 834 pacientes, clasificados de acuerdo a la gravedad de trauma (NISS) y las escalas WHO-DAS II y SF-36. RESULTADOS: En el 81% de los AT estuvieron involucradas motos, con lesiones moderadas en el 45.6 %, y graves en el 32.6% de ellos. No utilizaban casco el 8.5% de los pacientes con NISS grave. En el 49.7% se afectaron los miembros inferiores. Los dominios del WHO-DAS II más afectados fueron: actividades fuera del hogar (62.0%) actividades domésticas (54.3%) y moverse en el entorno (45.2%). La calidad de vida comprometió los dominios de desempeño físico (20.3%), dolor corporal (37.3%), desempeño emocional (44.1%) y funcionamiento físico (52.6%). CONCLUSIONES: Los pacientes con lesiones más graves tuvieron mayor compromiso en la discapacidad y en la calidad de vida. Esta carga de enfermedad la producen principalmente los AT en los que están involucradas las motos.