Cross-cultural adaptation and validation of the universal Portuguese-version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F) / Adaptação transcultural e validação da versão portuguesa universal da Escala Avaliação Funcional Pediátrica de Terapia de Doença Crônica - Fadiga (pedsFACIT-F)

Abstract Objective: To cross-culturally adapt and validate the universal Portuguese version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F). Method: The universal Portuguese version of the pedsFACIT-F was cross-culturally adapted and validated in 323 children and adolescents aged 8-18 years, 173 healthy individuals, and 150 with chronic diseases (cancer, juvenile idiopathic arthritis, and diabetes). Reliability (internal consistency and test-retest reliability) was assessed. Item response theory model assumptions were evaluated using confirmatory and exploratory factor analyses. Items were calibrated using a graded response model. Differential item functioning was assessed regarding age, gender, and clinical condition (healthy vs. chronic diseases). Results: No major cultural adaptations were needed. Internal consistency (Cronbach's alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.92) were good. CFA (CFI = 0.92, TLI = 0.90, RMSEA = 0.097) and CFE analysis confirmed sufficient unidimensionality. The data also fit the GRM and demonstrated good coverage of the fatigue construct (threshold parameters range: -1.42 to 4.56). No items demonstrated significant differential item functioning. Conclusion: The universal Portuguese version of the pedsFACIT-F provides a reliable, precise, and valid measure after being assessed by robust psychometric properties. Stability of the measurement properties of the pedsFACIT-F scale allows its use to assess fatigue in clinical research in Portuguese-speaking children and adolescents.

Resumo Objetivo: Adaptar transculturalmente e validar a versão portuguesa universal da escala Avaliação Funcional Pediátrica de Terapia de Doença Crônica - Fadiga (pedsFACIT-F). Método: A versão traduzida para o português universal e adaptada transculturalmente da escala pedsFACIT-F foi validada em 323 crianças (entre 8 e 18 anos), 173 saudáveis e 150 com doenças crônicas (câncer, artrite idiopática juvenil e diabetes). A confiabilidade foi avaliada pela consistência interna e confiabilidade teste-reteste. Os pressupostos do modelo da teoria da resposta ao item foram avaliados por meio da análise fatorial confirmatória e exploratória. Os itens foram calibrados segundo modelo de resposta gradual. O funcionamento diferencial do item foi examinado com respeito à idade, ao gênero e à condição de saúde (saudáveis versus doenças crônicas). Resultados: A adaptação cultural não apresentou dificuldades substantivas. A confiabilidade da consistência interna (alfa-Cronbach = 0,84) e do teste-reteste (correlação intraclasse = 0,92) foram adequadas. As análises da AFC (CFI = 0,92, TLI = 0,90, RMSEA = 0,097) e AFE confirmaram suficiente unidimensionalidade. O estudo de calibração demostrou bom ajuste do MRG e boa cobertura do construto fadiga (variação dos limiares das categorias de resposta: -1,42 a 4,56). Não foi verificada presença de funcionamento diferencial do item significante. Conclusão: A versão portuguesa universal da escala pedsFACIT-F é uma medida confiável, precisa e válida, verificada após análises de propriedades psicométricas robustas. A estabilidade das propriedades de medida da escala permite seu uso para avaliação de fadiga em estudos clínicos com crianças e adolescentes em países lusófonos.

Cross-cultural adaptation and validation of the universal Portuguese-version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F).

OBJECTIVE: To cross-culturally adapt and validate the universal Portuguese version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F). METHOD: The universal Portuguese version of the pedsFACIT-F was cross-culturally adapted and validated in 323 children and adolescents aged 8-18 years, 173 healthy individuals, and 150 with chronic diseases (cancer, juvenile idiopathic arthritis, and diabetes). Reliability (internal consistency and test-retest reliability) was assessed. Item response theory model assumptions were evaluated using confirmatory and exploratory factor analyses. Items were calibrated using a graded response model. Differential item functioning was assessed regarding age, gender, and clinical condition (healthy vs. chronic diseases). RESULTS: No major cultural adaptations were needed. Internal consistency (Cronbach's alpha=0.84) and test-retest reliability (intraclass correlation coefficient=0.92) were good. CFA (CFI=0.92, TLI=0.90, RMSEA=0.097) and CFE analysis confirmed sufficient unidimensionality. The data also fit the GRM and demonstrated good coverage of the fatigue construct (threshold parameters range: -1.42 to 4.56). No items demonstrated significant differential item functioning. CONCLUSION: The universal Portuguese version of the pedsFACIT-F provides a reliable, precise, and valid measure after being assessed by robust psychometric properties. Stability of the measurement properties of the pedsFACIT-F scale allows its use to assess fatigue in clinical research in Portuguese-speaking children and adolescents.

Quality of life in children and adolescents with allergic rhinitis.

UNLABELLED: Allergic rhinitis (AR) remains a significant pediatric health problem because of the burden of uncontrolled symptoms on daily activities and on general well being. AIM: to assess the impact of AR on health-related quality of life (HRQL) of children and adolescents using a generic instrument, the Child Health Questionnaire (CHQ - PF50). METHODS: Between January and November 2004, parents or caregivers of 23 children and adolescents with AR without comorbidities and with positive prick tests for at least one air allergen were invited to participate of a cross-sectional study and asked to answer the self-administered CHQ-PF50. The scores were compared to those of healthy children and adolescents. RESULTS: Patient scores were lower (p<0.05) than healthy subsets in both the physical and psychosocial summaries and in most of the CHQ-PF50 scales (p<0,05), except for the 'change in health' scale. The size effect was higher in the physical score compared to the psychosocial summary score. CONCLUSIONS: allergic rhinitis has a global negative impact on the HRQL of children and adolescents, with major repercussions in physical function; AR also negatively affects family relations.

Local cytokines and clinical symptoms in children with allergic rhinitis after different treatments.

BACKGROUND: Therapy for allergic rhinitis aims to control symptoms and improve the quality of life. The treatment of allergic rhinitis includes allergen avoidance, environmental controls, pharmacologic treatment, and specific immunotherapy. OBJECTIVES: The aim of this study is to evaluate the clinical changes and the levels of interferon-gamma (IFN-gamma) and interleukin-5 (IL-5) in nasal lavage fluid from children with allergic rhinitis after different types of pharmacologic treatment (mometasone, montelukast, or desloratadine). METHODS: Twenty-four children aged from six to 12 years with moderate persistent allergic rhinitis were randomized into three groups receiving monotherapy treatment over four weeks: nasal corticosteroid (mometasone), leukotriene modifier (montelukast), or antihistamine (desloratadine). The perception of symptom improvement during the medication use was evaluated at the end of the treatment. Samples of nasal lavage fluid were collected before and after treatment for measuring IFN-gamma and IL-5 cytokines by ELISA. RESULTS: All parents perceived an improvement in symptoms. Significant enhancement was seen in the mometasone group compared to those with montelukast (P = 0.01) and desloratadine (P = 0.02). No significant differences were found among the three groups in the levels of IL-5 and IFN-gamma in nasal fluid at baseline or after treatment. Only the group treated with mometasone showed a slight but significant reduction in IL-5 levels after the treatment period as compared with levels before the treatment (P = 0.0469). CONCLUSION: The group treated with mometasone showed better improvement of clinical symptoms and a slight reduction in IL-5 levels in the nasal fluid. This may indirectly reflect the relative immunomodulatory effects of the drugs tested.

Deficiência de anticorpos anti-polissacarídicos: relato de casos / Impaired polysaccharide responsiveness: cases report

Introdução: A deficiência de anticorpos antipolissacaride ou deficiência parcial de anticorpos é considerada uma dasquatro imunodeficiências mais comuns da infância e sua principal manifestação são as infecções bacterianas repetitivas das vias aéreas.Descrição: São relatados casos de três pacientes com historta de infecções de repetição de diferentes evoluções cujaavaliação imunológica demonstrou uma produção alterada de anticorpos ao Streptococcus pneumoniae após imunização para os sorotipos testados, embora apresentasse níveis normais deimunoglobulinas, cuja instalação de um tratamento adequado promoveu a redução nas infecções bem como da qualidade de vida desses pacientes.Comentários: A grande maioria dos pacientes com deficiência de anticorpos antipolissacaride necessita de tratamento antibiótico agressivo nas infecções, cursos de antibióticos profiláticos, e em alguns casos, de terapia de reposição de imuneglobulinas.Alguns pacientes podem se beneficiar da vacinação heptavalente conjugada para o S.pneumoniae. É necessárioampliar a informação médica com relação ao diagnóstico apresentadonessa série, bem como, melhorar a rede laboratorial de propedêutica diagnóstica para permitir a identificação dessa patologia.

Introduction: Impaired polysaccharide responsiveness or partial antibodies defect is considered one of the four mostcommon immunodeficiencies in pediatric patients and is characterized by recurrent bacterial respiratory infectlons.Description: Three cases are related with a recurrent infections history with different evaluations, which immunological evaluations showed impaired antibodies response againstStreptococcus pneumoniae after immunization for tested serotypes,although presented normal leveis of immunoglobulin. The adequate treatment reduced the number and severity of infections and improved the patient's quality of life.Comments: The majority of patients with impaired polysaccharide responsiveness require aggressive antibiotic treatmentduring infections, serres of prophylactic antibiotics, and, rarely, IgG replacement. Some patients may clinicai benefit from írnmunization with the conjugate vaccine to S.pneumoniae. It'simportant to improve the medical information about the presenteddiagnosis, in addition to amplify the number of practiced laboratories to better identification of this disease.

Quality of life in children and adolescents with allergic rhinitis / Qualidade de vida em crianças e adolescentes com rinite alérgica

Allergic rhinitis (AR) remains a significant pediatric health problem because of the burden of uncontrolled symptoms on daily activities and on general well being. AIM: to assess the impact of AR on health-related quality of life (HRQL) of children and adolescents using a generic instrument, the Child Health Questionnaire (CHQ - PF50). METHODS: Between January and November 2004, parents or caregivers of 23 children and adolescents with AR without comorbidities and with positive prick tests for at least one air allergen were invited to participate of a cross-sectional study and asked to answer the self-administered CHQ-PF50. The scores were compared to those of healthy children and adolescents. RESULTS: Patient scores were lower (p<0.05) than healthy subsets in both the physical and psychosocial summaries and in most of the CHQ-PF50 scales (p<0,05), except for the "change in health" scale. The size effect was higher in the physical score compared to the psychosocial summary score. CONCLUSIONS: allergic rhinitis has a global negative impact on the HRQL of children and adolescents, with major repercussions in physical function; AR also negatively affects family relations.

A rinite alérgica (RA) representa importante problema de saúde pública, compromete as atividades diárias e pode repercutir no bem estar dos pacientes. OBJETIVO: Avaliar o impacto da RA na qualidade de vida relacionada à saúde (QVRS) de crianças e adolescentes por meio do questionário genérico Child Health Questionnaire (CHQ-PF50). CASUÍSTICA E MÉTODOS: Entre janeiro e novembro de 2004 pais ou responsáveis de 23 crianças e adolescentes com RA sem comorbidades e teste cutâneo de hipersensibilidade imediata positivo para pelo menos um aeroalérgeno foram convidados a participar de um estudo transversal e solicitados a responder o CHQ-PF50. Os escores obtidos foram comparados com os de crianças e adolescentes saudáveis. RESULTADOS: Os escores obtidos pelos pacientes foram menores (p<0,05) que os do grupo controle nos sumários físico e psicossocial e na maioria das escalas, com exceção na escala "alteração na saúde". O tamanho do efeito foi maior no escore sumário físico que no psicossocial. CONCLUSÕES: A RA causa impacto negativo global na QVRS de crianças e adolescentes com maior repercussão na função física, e afeta negativamente a dinâmica familiar.

Deficiência auditiva neurossensorial associada à doença de Kawasaki / Sensorineural hearing loss associated with Kawasaki disease

Objetivo: a doença de Kawasaki (DK) é uma vasculite sistêmica idiopática, autolimitada, de pequenos e médios vasos. Foram descritos na literaura treze casos de deficiência auditiva neurossensorial, durante a evolução dessa doença. Descreve-se o caso de um lactente com doença de Kawasaki com evolução, durante a fase aguda, para deficiência auditiva neurossensorial. A descrição do caso justifica-se por ilustrar uma complicação grave da DK, pouco mencionada na literatura, que reforça a recomendação de cautela na avaliação global destes pacientes. Descrição: menino hígido de 1 ano e sete meses de idade apresentou-se com febre diária persistente, iniciada havia sete dias, associada à irritabilidade,conjutivite bilateral não-exsudativa, reitema máculo-papular em tronco. Evoluiu com artrite em punhos, cotovelos, joelhos e tornozelos e edema e descamação de mãos e pés, que impossibilitava a deambulação. O diagnóstico de doença de Kawasaki foi estabelecido de acordo com os critérios da American Heart Association (AHA), e a criança foi tratada de forma convencional. Houve regressão das manifestações clínicas três dias após o inicio do tratamento. Contudo, um mês após o início dos sintomas, os familiares notaram resposta insatisfatória a estímulos sonoros. A avaliação da acuidade auditiva através do BERA (Brainstem Evoked Responses Audiometry - Audiometria de Potenciais Evocados de Tronco Cerebral) disgnosticou perda auditiva neurossensorial bilateral, grau severo a profundo. Comentários: é possível que o exame rotineiro de acuidade auditiva em crianças com doença de Kawasaki possa identificar precocemente a deficiência auditiva neurossensorial

[Sensorineural hearing loss associated to Kawasaki Disease] / Deficiência auditiva neurossensorial associada à doença de Kawasaki.

OBJECTIVE: Kawasaki disease is a systemic idiopathic self-limited vasculitis of small and medium-sized vessels. Thirteen cases of sensorineural hearing loss during the evolution of this disease have been described in the literature. We describe a case of an infant with Kawasaki disease who developed sensorineural hearing loss during the acute phase. This case report shows a complication of Kawasaki disease, with few citations in literature, enhancing the importance of careful evaluation of these patients. DESCRIPTION: Nineteen-month-old-boy, formerly healthy, with persistent daily fever seven days before admission, associated with irritability, bilateral nonexudative conjunctivitis and maculopapular erythema on his trunk. There was later development of arthritis on wrists, elbows, knees, and ankles, and swelling associated with desquamation of hands and feet, which prevented him from walking. The diagnosis of Kawasaki disease was established according to the American Heart Associations criteria, and the child was conventionally treated. There was regression of clinical manifestations three days after the beginning of treatment. However, one month after the onset of symptoms, the family noticed an unsatisfactory response to sound stimuli. The evaluation of auditory acuity through BERA (Brainstem Evoked Responses Audiometry) revealed severe bilateral sensorineural hearing loss. COMMENTS: Routine examination of auditory acuity in children with Kawasaki disease may help identify sensorineural hearing loss at an early stage.