Perspectivas metodológicas del análisis del discurso aplicadas al estudio de los sistemas de salud / Methodological perspectives of discourse analysis applied to the study of health systems

Introducción: El análisis del discurso es un abordaje alternativo de investigación de sistemas de salud. Objetivo: Describir la producción científica que investiga los sistemas de salud utilizando el análisis del discurso como perspectiva teórico-metodológica. Métodos: Revisión sistemática exploratoria de literatura, que incluyó la búsqueda de textos en inglés y español en cinco bases de datos (SciELO, MEDLINE, PubMed, EBSCO y ScienceDirect). Se utilizaron los descriptores "sistema OR salud" AND "análisis OR discurso" y sus traducciones al inglés. Se incluyeron artículos originales con metodología cualitativa, revisiones sistemáticas exploratorias de la literatura, ensayos y tesis doctorales, cuya metodología o tema de revisión fuese expresamente descrita como análisis de discurso de sistemas de salud, de sus funciones o estructura organizativa, publicados en el periodo entre enero de 1994 a diciembre de 2019; se excluyeron textos con metodología cuantitativa, estudios mixtos y metaanálisis. Resultados: Se incluyó un total de 27 textos en la revisión, se describió en cuatro categorías la forma como el análisis del discurso puede ser utilizado en el estudio de los sistemas de salud: el concepto del proceso salud enfermedad, la autonomía del sujeto, los discursos de gestión y los sistemas de salud como política pública. Discusión: Los sistemas de salud son campos para el ejercicio de las relaciones de poder que construyen sujetos, configuran la autonomía del sujeto y determinan las intervenciones del proceso salud-enfermedad. Conclusiones: Esta revisión identificó que el discurso es utilizado como dispositivo de poder que configura sujetos y la forma como se interviene el proceso salud-enfermedad.

Introduction: An alternative approach to health systems research is discourse analysis. Objective: To describe the scientific production that investigates health systems using discourse analysis as a theoretical-methodological perspective. Methodology: Systematic review. The search was conducted in five databases (SciELO, MEDLINE, PubMed, EBSCO and Science Direct), in both Spanish and English. The descriptors used were "sistema OR salud" AND "análisis OR discurso", and their English equivalents. Qualitative studies, scoping reviews, essays and PhD theses, published between January 1994 and December 2019, were included; in all cases their subject was described clearly as discourse analysis of health systems, their functions or organizative structure. Results: A total of 27 texts were included in the revision; four categories describe how discourse analysis can be used in the study of health systems as well, the concept of the health-disease process, subject autonomy, management discourses, and health systems as public policy. Discussion: Health systems are fields for the exercise of power relations that construct subjects, configure the autonomy of the subject, and determine the interventions of the health-disease process. Conclusions: This review identifies that discourse is used as a device of power that configures subjects and the way in which the health-disease process is intervened.

Vivências de trabalho precoce de adolescentes em medida socioeducativa / Experience of child labor of adolescents complying with a social-educational measure / Vivencias de trabajo infantil de adolescentes en medidas socioeducativas

Este artigo tem como objetivo analisar a vivência de trabalho precoce de adolescentes e jovens em cumprimento de medida socioeducativa, no estado da Paraíba. Os instrumentos utilizados foram um Questionário Mosquito Diagnóstico e uma Entrevista Semiestruturada. A análise foi realizada com o software Iramuteq, (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), através da Análise Hierárquica Descendente, que gerou seis classes: significado do trabalho; infância e escola; condições objetivas de vida; trabalho, drogas e ato infracional; consequências do trabalho infantil; e trabalho infantojuvenil. A perspectiva teórica utilizada foi a psicologia histórico-cultural e os dados discutidos a partir do conceito de vivência. Conclui-se que as vivências e situações sociais de desenvolvimento foram caracterizadas pelo trabalho precoce que oportunizou o envolvimento com atos infracionais e as instituições responsáveis pela garantia de direitos em vez de garantir a proteção social, criminalizaram por meio de medidas socioeducativas.(AU)

This article aims to analyze the experience of child labor of adolescents and youngsters that are complying a social-educational measure, in the State of Paraíba. The instruments utilized were a Questionnaire Mosquito Diagnóstico and a Semi-Structured Interview. The analysis was performed by using the Iramuteq software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), by using Descending Hierarchical Analysis, which generated six classes: meaning of labor; childhood and school; objective conditions of life; labor, drugs, and act of infraction; consequences of child labor; and child labor. The theoretical perspective used was historical-cultural psychology and the data were discussed from the concept of experience. It was concluded that the experiences and social situations of development were characterized by child labor, which enabled the involvement with acts of infraction; and the institutions responsible for guaranteeing rights, instead of guaranteeing social protection, criminalized by using social-educational measures.(AU)

Este artículo tiene como objetivo analizar la vivencia precoz de adolescentes y jóvenes que cumplen medidas socioeducativas en el estado de Paraíba (Brasil). Los instrumentos utilizados fueron un Cuestionario Mosquito Diagnóstico y una entrevista semiestructurada. El análisis se realizó con el software Iramuteq (Interface de R pour les Multidimensionnelles Analyzes de Textes et de Questionnaires), mediante análisis jerárquico descendente, que generó seis clases: Significado del trabajo; Infancia y escuela; Condiciones objetivas de vida; Trabajo, drogas y acto de infracción; Consecuencias del trabajo infantil; y Trabajo infantojuvenil. La perspectiva teórica que se utilizó fue la psicología histórico-cultural, y los datos se discutieron desde el concepto de vivencia. Se concluye que las vivencias y situaciones sociales de desarrollo se caracterizaron por trabajo infantil que permitió la participación en infracciones y que las instituciones responsables de garantizar los derechos en lugar de la protección social los criminalizaron mediante medidas socioeducativas.(AU)

Case-Finding tool for COPD in LMIC (COLA) - translation and cross-cultural adaptation into Brazilian Portuguese language

ABSTRACT OBJECTIVE To translate and cross-culturally adapt the COPD in Low- and middle-income countries (LMICs) Assessment (COLA) questionnaire into Brazilian Portuguese, a case-finding instrument for chronic obstructive pulmonary disease (COPD). METHODS Translation and cross-cultural adaptation were completed in six steps: the original version was translated into Brazilian Portuguese by two native speakers of the target language; the translated versions were synthesized; back-translation was performed by two native speakers of the original language; the back-translation and the Brazilian Portuguese version of the COLA were reviewed and harmonized by an expert committee of specialists; and, then, the pre-final version was tested by 30 health professionals who were asked if the items were clear to understand. The acceptability, clarity, and understandability of the translated version were evaluated. A final review of the questionnaire was produced by the authors and approved by the author of the original questionnaire. RESULTS Some idiomatic, semantic, and experiential inconsistencies were identified and properly adjusted. Item 3 was considered the most unclear item (23,3%). Items 7, 8, and 9 presented clarity above 80% (93%, 90%, and 90%, respectively). Suggestions were discussed and incorporated into the tool and COLA was found to be clear and easy to understand. CONCLUSIONS The Brazilian version of the COLA was easily understood by healthcare professionals and adapted to Brazilian culture. Translation and cultural adaptation of the COLA instrument into Brazilian Portuguese can be an important case-finding instrument for chronic obstructive pulmonary disease in Brazil.

Phonetic-phonological performance of typical younger and aged adults from Brazils capital city / Desempenho fonético-fonológico de adultos jovens e idosos típicos da capital do Brasil

ABSTRACT. Given the sociodemographic diversity in Brazil, it is fundamental to understand the speech performance of a sample from the Brazilian capital. The repetition task can assess phonological and motor-phonetic planning. Previous studies found phonological-phonetic performance of speakers to be associated with education, age, and other demographic factors. Objectives: To compare the phonetic-phonological performance for speech of younger and aged adults in the capital of Brazil, Federal District (FD); to compare FD performance against national normative means based on São Paulo; to determine the association of phonetic-phonological agility with sociodemographic, cognitive, and neuropsychiatric variables for the sample. Methods: Cross-sectional study. A total of 60 volunteers from the FD, comprising 30 older adults and 30 younger ones, were stratified by education into two subgroups: 2‒7 years and ≥8 years of education. Data on age, educational level, and socioeconomic status were collected. The Verbal Agility subtest of the Boston Diagnostic Aphasia Examination was applied to assess phonetic-phonological performance. Results: No statistically significant difference in performance for verbal agility was found between aged and younger adults from the FD. There was a statistically significant difference in the phonetic-phonological performance of the FD sample compared with the Brazilian normative mean values. Cognitive and socioeconomic variables were associated with verbal agility. Conclusions: In the capital of Brazil, economic status, age, education, and cognitive variables were associated with verbal agility performance, despite there being no difference in phonetic-phonological performance between younger and aged adult groups. Regional differences in phonetic-phonological performance were also evident.

RESUMO. Diante da diversidade sociodemográfica do Brasil, é fundamental compreender o desempenho de fala de uma amostra da capital do país. O teste de repetição pode avaliar o planejamento fonológico e fonético-motor. Estudos prévios mostram que o desempenho fonético-fonológico de falantes foi associado à escolaridade, à idade e a outras variáveis demográficas. Objetivos: Comparar o desempenho fonético-fonológico da fala de idosos e adultos jovens da capital do Brasil, Distrito Federal (DF); comparar o desempenho da amostra do DF com as médias normativas nacionais, obtidas em São Paulo; e verificar a associação da agilidade fonético-fonológica da nossa amostra com as variáveis sociodemográficas, cognitivas e neuropsiquiátricas. Métodos: Estudo transversal. Foram selecionados 60 voluntários do DF, 30 idosos e 30 adultos jovens, subdivididos em dois grupos conforme a escolaridade, de 2 a 7 anos e de 8 anos ou mais de estudo. As características etárias, de escolaridade e de classe econômica foram coletadas. O subteste de agilidade verbal do Teste de Boston para Diagnóstico das Afasias foi aplicado para avaliação do desempenho fonético-fonológico. Resultados: O desempenho de agilidade verbal dos idosos não apresentou diferença estatisticamente significante em relação aos adultos jovens do DF. Houve diferença estatisticamente significante ao se comparar o desempenho fonético-fonológico da amostra do DF com as médias normativas brasileiras. As variáveis cognitivas e socioeconômicas estiveram associadas à agilidade verbal. Conclusões: Na capital do Brasil, as variáveis econômicas, etárias, de escolaridade e cognitivas estiveram associadas à agilidade verbal, apesar da ausência de diferença do desempenho fonético-fonológico entre adultos jovens e idosos. Houve diferenças de desempenho fonético-fonológico conforme a região do país.

Cross-cultural adaptation, validity and reproducibility of the Back Beliefs Questionnaire among older Brazilians with acute low back pain. A cross-sectional study

ABSTRACT BACKGROUND: Low back pain (LBP) has emerging as an epidemic, multifactorial and multidimensional condition in older age. Assessment of attitudes and beliefs of patients with back pain is necessary for understanding the impact of psychosocial factors on pain perception and management. OBJECTIVES: To cross-culturally adapt and examine the validity and reproducibility (intra and interrater reliability and agreement) of the Back Beliefs Questionnaire (BBQ) in older Brazilians with acute LBP. DESIGN AND SETTING: Cross-sectional methodological report conducted at the Department of Physical Therapy of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. METHODS: The present study was conducted for translating, adapting, and examining the psychometric properties of a questionnaire. Participants aged ≥ 60 years experiencing an acute episode of LBP were recruited. Coefficients of internal consistency, reliability and agreement were obtained using Cronbach's α, intraclass correlations, and standard error of measurement and the smallest detectable change, respectively. RESULTS: Twenty-six participants aged between 60-84 years and reporting a mean of 9.8 (4.3) years of schooling completed the study. The Brazilian Portuguese-language version of the BBQ (BBQ-Brazil) was proposed and presented with adequate conceptual, semantic, operational, and measurement equivalence from the original version. Intra and interrater evaluations showed moderate (0.74) and excellent (0.91) intraclass correlation coefficients, respectively, with small standard error of measurement for both evaluations. Internal consistency was considered adequate (0.70). CONCLUSION: BBQ-Brazil had consistent measurements of validity and reproducibility, and proved to be a valuable tool in clinical practice for addressing attitudes and beliefs of older patients with acute LBP.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis / Adaptação transcultural do instrumento Thirst Distress Scale (TDS) para o português brasileiro e propriedades psicométricas em pacientes em hemodiálise

Abstract Objective: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). Methods: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). Results: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). Conclusion: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Resumo Objetivo: Realizar a adaptação transcultural da escala Thirst Distress Scale (TDS) para o português brasileiro e estudar suas propriedades psicométricas em pacientes em hemodiálise (HD). Métodos: Foram realizadas traduções, retrotraduções, discussão com especialistas e avaliação psicométrica, com aplicação da versão final em 126 pacientes em HD e reteste em 70 pacientes da amostra inicial. A consistência interna do instrumento foi obtida pelo alfa de Cronbach. Para analisar a concordância com a intensidade de sede, avaliada pela Escala Visual Analógica (EVA), foi utilizado o teste Kappa e a estratégia gráfica de Bland-Altman. Para avaliar a reprodutibilidade, foi realizado teste de correlação intraclasse (CCI). Resultados: Para obtenção da versão final da escala TDS em português brasileiro, intitulada TDS-BR, foi necessária adaptação de vocabulário em três itens e mudança de tempo verbal em seis itens. Houve boa compreensão da escala pelos pacientes em HD, consistência interna satisfatória (0,84, p<0,001), concordância moderada com a Escala Visual Analógica (EVA) (kappa=0,44; p<0,001) e reprodutibilidade quase perfeita (CCI=0,87; p<0,001). Conclusão: Os resultados obtidos indicam a aplicabilidade e confiabilidade do instrumento na língua portuguesa (Brasil). A ferramenta, por ser de fácil compreensão e baixo custo, além de ter boa aceitação, pode ser um instrumento relevante no manejo da sede de pacientes em HD.

Artículos de Revisión / Review Articles

This paper summarizes the main features of review articles in medical topics. Articles can be classified as narrative reviews, systematic reviews or meta-analysis. Narrative reviews are appropriate to update etiology, pathophysiology or clinical aspects of diseases, and advances in basic and preclinical sciences. In systematic reviews the authors define its purpose, limit its scope, describe the literature search, define the inclusion and exclusion criteria adopted to select primary studies, and the criteria applied to assess the quality of their results and conclusions. Meta-analysis are quantitative, statistically analysed systematic reviews that consider mainly primary studies conducted prospectively with simultaneous randomized controls, pooling the data obtained from each of these primary studies in order to get a single estimate of effect. Systematic analysis and meta-analysis are important to evaluate new diagnostic and therapeutic tools, and they are most relevant to evidence-based medicine, mainly for the design of clinical guidelines and the adoption of new health care policies. Review articles published in Revista Médica de Chile were compared in one or two-year periods separated by ten years in between: in the "2001 period" 26 reviews were all narrative; in the "2010 period" 30 reviews were narrative and another 4 were systematic reviews; in the "2019 period" 14 reviews were narrative and another 7 were systematic reviews. No meta-analysis had been published in these periods, in this journal. Meta-analysis including primary studies performed in Chile by Chilean investigators have been published in English language in other medical journals. The educational and professional role of review articles is recognised, with a word of caution on a strict adherence to ethical rules adopted by scientific and clinical publications, mainly with respect to authorship and potential conflicts of interest.

Psychometric properties of the WHOQOL-SRPB BREF, Brazilian Portuguese version

Objective: To test the reliability and the discriminant and convergent validity of the abbreviated Brazilian Portuguese World Health Organization's Quality of Life Instrument - Spirituality, Religion, and Personal Beliefs module (WHOQOL-SRPB BREF). Methods: In a sample of 404 individuals, we applied a general questionnaire, the WHOQOL-BREF, the long-form SRPB, the Brief Religious-Spiritual Coping Scale (RCOPE), and the Beck Depression Inventory (BDI). Priority was given to the 9-item SRPB assessment: its unidimensionality was tested through confirmatory factor analysis and Rasch analysis. Results: Confirmatory factor analysis of the 9-item SRPB assessment indicated an adjusted model with acceptable fit to data. In the Rasch analysis, general fit measures showed adequate performance. The 9-item SRPB assessment showed good internal consistency (alpha = 0.85), and could differentiate (discriminant validity) between religious and atheist/agnostic respondents (mean = 74.7±14.1 and 56.8±15.5, respectively; t = 6.37; degrees of freedom [df] = 402; p < 0.01) and between non-depressed and depressed respondents (mean = 76.5±12.9 and 67.1±16.5; t = 5.57; df = 190.5; p < 0.01). Correlations (convergent validity) were significant with the positive-RCOPE subscale (r = 0.58, p < 0.01) and the WHOQOL-BREF domains (Pearson coefficient ranging between 0.24 and 0.49; p < 0.01), but were in the negative direction with the negative-RCOPE subscale (r = -0.10, p < 0.05). Correlation with the long-form SRPB domain (r = 0.934) was almost perfect. Conclusion: The Brazilian Portuguese 9-item SRPB has good psychometric properties and confirmed the findings of the long-form Brazilian Portuguese version and the abbreviated English version.

Práticas discursivas e produção de sentidos: análise da aplicação em Saúde Mental no Brasil / Discursive practices and production of meanings: analysis of the application in Mental Health in Brazil / Prácticas discursivas y producción de sentidos: análisis de la aplicación en Salud Mental en Brasil

Este estudo analisou a aplicação das práticas discursivas e produção de sentidos na descrição e interpretação dos sentidos dados a diferentes fenômenos em saúde mental no Brasil. Trata-se de uma revisão bibliográfica baseada na literatura especializada, a partir da consulta a estudos científicos selecionados utilizando a Biblioteca Virtual em Saúde (BVS) com as palavras-chave 'práticas discursivas' e 'produção de sentidos', no título, resumo ou assunto, resultando na seleção de 21 estudos, dada sua relação com a saúde mental. A aplicação desta teoria se deu na abordagem profissional e usuário, assistência terapêutica, formação profissional, maternidade, paternidade, adoção e percepção pessoal de fenômenos como crise, vulnerabilidade social, doença, cuidado, self, exclusão social e violência. Compreender esses fenômenos possibilita a reflexão sobre a práxis de profissionais de saúde mental e afins, contribuindo com estratégias de acolhimento e formação de vínculo na relação entre profissional e usuário a partir da interpretação dos sentidos.

This study has analyzed the application of discursive practices and production of meanings in the description and interpretation of the meanings given to different phenomena in mental health in Brazil. This is a bibliographical review based on specialized literature from the inquiry to selected scientific studies employing the Virtual Health Library (VHL) with the following keywords: 'discursive practices' and 'production of meanings', in the title, abstract or subject, resulting in the selection of 21 studies, given their relation to the mental health. The application of this theory is on the professional approach and user, therapeutic assistance, professional training, maternity, paternity, adoption and personal perception of phenomena such as crisis, social vulnerability, illness, care, self, social exclusion and violence. Understanding these phenomena enables the reflection about the praxis of mental health professionals and the like, contributing with strategies of integration and formation of links in the relationship between the professional and the user from the interpretation of the meanings.

Este estudio analizó la aplicación de las prácticas discursivas y producción de los sentidos en la descripción e interpretación de los sentidos dados a diferentes fenómenos en salud mental en Brasil. Se trata de una revisión bibliográfica basada en la literatura especializada, a partir de la consulta a estudios científicos utilizando la Biblioteca Virtual en Salud (BVS) con las palabras clave: 'prácticas discursivas' y 'producción de sentidos', en el título, resumen o asunto, resultando en la selección de 21 estudios, dada su relación con la salud mental. La aplicación de esta teoría se dio en el enfoque profesional y usuario, asistencia terapéutica, formación profesional, maternidad, paternidad, adopción, y percepción personal de fenómenos como crisis, vulnerabilidad social, enfermedad, cuidado, self, exclusión social y violencia. Comprender estos fenómenos posibilita la reflexión sobre la praxis de profesionales de salud mental y afines, contribuyendo con estrategias de acogida y formación de vinculo en la relación entre profesional y usuario a partir de los sentidos.

Barriers and innovative interventions for early detection of cervical cancer / Barreras e intervenciones innovadoras para la detección temprana del cáncer cervicouterino

Abstract: Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.

Resumen: El cáncer cervicouterino ha disminuido significativamente en los últimos 30 años, pero sigue siendo una de las principales causas de muerte entre mujeres de bajos recursos y minorías raciales/étnicas. Las tecnologías preventivas del cáncer cervicouterino no están siempre disponibles y los laboratorios no están siempre bien equipados para utilizarlas. La información sobre el VPH no ha sido difundida ampliamente. La OMS y datos de EEUU y Latinoamérica ofrecen estrategias para reducir el cáncer cervicouterino. El entendimiento de las barreras sistémicas, personales y culturales, dentro de un marco de toma de decisiones, y mensajes innovadores puede reducir las barreras asociadas con el cáncer cervicouterino en las Américas.

Assessment of the quality of life of Egyptian and Tunisian autoimmune bullous diseases' patients using an Arabic version of the autoimmune bullous disease quality of life and the treatment of autoimmune bullous disease quality of life questionnaires

Abstract: Background: The Autoimmune Bullous Disease Quality of Life (ABQOL) and the Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaires proved to be reliable tools that measure the disease and treatment burden. Objectives: We aimed to assess the ABQOL and TABQOL in the Arabic population. Methods: The English questionnaires were translated into the Arabic language by a certified translation agency. Eighty autoimmune bullous disease (AIBD) patients were included in this study. Patients were asked to answer 2 questionnaires. After 1 week the same patients were asked to answer the same questionnaires again. Results: The age of the patients ranged from 19 to 81 years (mean=46), 19 males, 61 females. The ABQOL ranged from 0-37 (mean=16.4±9.2). The TABQOL ranged from 2-43 (mean=21.5±9.4). Test-retest reliability was acceptable, Cronbach's alpha was 0.76 for ABQOL and 0.74 for TABQOL. There was no significant correlation between the age of the patients and ABQOL, r =-0.2, p value was 0.183. There was a significant negative correlation between the age of the patients and the TABQOL, r=-0.2, p value was 0.039. There was a significant negative correlation between the education of the patients and the TABQOL, r=-0.3, p value was 0.007. Study limitations: Small sample size of some AIBDs and patients with severe disease. Conclusion: Objective and valuable measurements such as ABQOL and TABQOL are now available to help physicians understand their patient's distress and should be used in every patient with AIBD. Younger and less educated patients appear to have more effects on their QOL from the treatments.

Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for brazilian portuguese

ABSTRACT Objective: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian Portuguese, in patients with spinal cord injury and multiple sclerosis. Materials and Methods: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. Results: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach α of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coefficient of 0.86 [0.76 - 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p <0.0001). Conclusions: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.

Cultural adaptation and validation of the Geriatric Oral Health Assessment Index - GOHAI - Colombian version / Adaptación cultural y validación del Geriatric Oral Health Assessment Index - GOHAI - versión Colombia

Abstract Objective: This study aims to carry out the cultural adaptation and the validation of the GOHAI scale for the Colombian population. Methods: Translation process, cultural adaptation, and content and face validity were carried out with a sample of 63 participants as a pretest. The validation counted with a sample of 7,200 subjects, divided into two groups: a work sample (WS) with 3,628 subjects and a confirmatory sample (CS) with 3,572 subjects. Construct, criterion validity and internal consistency were performed for both samples. Test-retest reliability was assessed with a sub-sample of 75 participants Results: The GOHAI showed an appropriate face and content validity, the pre-test revealed an understandable questionnaire, the scale showed a unidimensional factorial structure and a Cronbach's Alpha of 0.8. Convergent validity with a self-perception on general health scale pointed to a significant correlation (p= 0.0001), while discriminant validity showed significant differences regarding groups according to age group, skin color, educational level, socio-economic level, healthcare affiliation and self-perception about need of dental prostheses. Gender groups did not show significant differences among groups within either sample. The CS showed similar results, differences existed among factorial structures of 2 and 3 factors, and for discriminant validity, the CS showed statistically significant differences for the Area variable not in the WS. Kendall's test-retest analysis's correlation is 0.85 (p= 0.0000). Conclusions: The GOHAI scale is valid and reliable enough to be used as a measure of Oral-Health-Related Quality of Life in the Colombian elderly population, also could be applied for other Latin-American populations.

Resumen Objetivo: Adaptar culturalmente y validar la escala de autopercepción de salud bucal - Geriatric Oral Health Assessment Index (GOHAI) para la población mayor colombiana. Métodos: El proceso de traducción, adaptación cultural, contenido y validez aparente se llevaron a cabo en el pre-test con una muestra de 63 participantes. La validación contó con una muestra de 7,200 sujetos, divididos en dos grupos: una muestra de trabajo (WS) con 3,628 sujetos y una muestra confirmatoria (CS) con 3,572 sujetos. Se realizó validez de constructo, criterio y consistencia interna para ambas muestras. La confiabilidad test-re-test se evaluó con una submuestra de 75 participantes. Resultados: La escala GOHAI mostró condiciones adecuadas de apariencia y contenido, El pre-test mostro un cuestionario entendible y adecuado, la escala arrojo una estructura factorial única y una consistencia interna Alfa de Cronbach de 0,8. La validez convergente con la variable autopercepción en salud general mostró diferencia significativa entre grupos (p= 0.0001), la validez discriminante mostro diferencias significativas con las variables grupo de edad, color de piel, nivel educativo, estrato socio-económico, regímenes de salud y autopercepción de necesidad de prótesis dental; la variable Área mostró diferencia significativa en la MC, no en la muestra MT. El análisis test-retest mostro una correlación de Kendall de 0.85 (p= 0.0000). Conclusión: El instrumento GOHAI es válido y confiable y puede ser usado como una medida de Calidad de Vida relacionada con Salud Bucal en personas mayores en Colombia y puede ser aplicado en otras poblaciones de habla hispana de América Latina.

Validation of the Brazilian Version of CADE-Q II to Assess Knowledge of Coronary Artery Disease Patients / Validação da Versão Brasileira em Português do CADE-Q II para Avaliar o Conhecimento de Pacientes com Doença Arterial Coronariana

Abstract Background: The Coronary Artery Disease Education Questionnaire (CADE-Q), an instrument aimed at assessing patients' knowledge about coronary artery disease (CAD), was originally developed and psychometrically validated in Brazil. It was later translated, cross-culturally adapted, and validated to English. Although both versions demonstrated good reliability and validity, new studies in the area have pointed out the need of implementing the CADE-Q with other components of cardiac rehabilitation (CR) programs, such as psychologic factors, which had not been considered in previous version and were added in the subsequent, adapted version. Thus, a second version of CADE-Q was developed in English, the CADE-Q II. Objective: to translate, culturally adapt and psychometrically validate the CADE-Q II in Brazilian Portuguese. Methods: After translation and review by a Committee of specialists in CR, a version in Brazilian Portuguese was generated and tested in 307 patients in CR. Test-retest reliability was assessed by intraclass correlation coefficient (ICC) in 49 patients; internal consistency was assessed using Cronbach's alpha (α); and, criterion validity was assessed regarding patients' educational level and family income. The level of significance adopted for all tests was 5%. Results: After the ICC analysis, 4 items were excluded. The questionnaire was considered internally consistent (α > 0.7). Associations were found between the mean total scores and the variables schooling (p < 0.001) and income (p < 0.001). Median total score was 53 (14) points corresponding to 65.4% of the total possible score. Conclusion: The Portuguese version of the CADE-Q II showed sufficient reliability, consistency and validity, supporting its use in future studies.

Resumo Fundamento: O questionário para avaliar o conhecimento de pacientes com doença arterial coronariana (CADE-Q) foi originalmente desenvolvido e validado no Brasil. Mais tarde foi traduzido, adaptado culturalmente e validado para o inglês. Embora ambas as versões possuam boa confiabilidade e validade, com o avanço dos estudos da área observou-se a necessidade de implementar o CADE-Q com outros componentes envolvidos em programas de reabilitação cardíaca (RC), como fatores psicológicos, que não tinham sido abordados na versão anterior e foram adicionados nesta versão. Devido a isso, uma segunda versão foi desenvolvida em inglês, o CADE-Q II. Objetivo: Traduzir, adaptar culturalmente e validar psicometricamente para o português o questionário CADE-Q II. Métodos: A versão em português foi gerada (após tradução e revisão por um comitê de especialistas em RC) e testada em 307 pacientes em programas de RC. A confiabilidade teste e reteste foi avaliada por meio do coeficiente de correlação intraclasse (CCI) em 49 pacientes, a consistência interna foi avaliada pelo alfa de Cronbach (α), e a validade de critério foi avaliada em relação à escolaridade e renda familiar mensal dos pacientes. O nível de significância adotado para todos os testes foi de 5%. Resultados: Após a análise do CCI, quatro itens foram excluídos da versão em português. O questionário foi considerado internamente consistente (α > 0,7). Foram encontradas associações entre os escores totais médios e as variáveis escolaridade (p < 0,001) e renda (p < 0,001). A mediana da pontuação total foi de 53 (14) pontos correspondendo a 65,4% do escore total possível. Conclusão: A versão em português do CADE-Q II apresentou confiabilidade, consistência e validade suficientes, apoiando a sua utilização em estudos futuros.

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Quality of Prenatal Care Questionnaire (QPCQ)

ABSTRACT OBJECTIVE To translate and to observe the psychometric measures of the Brazilian version of the Quality of Prenatal Care Questionnaire. METHODS The translation protocol followed the standards of the International Society for Pharmacoeconomics and Outcomes Research. Descriptive statistics were performed to identify characteristics of 280 literate postpartum women in a public hospital. We examined the internal consistency using Cronbach's alfa. To determine the test-retest reproducibility and the instrument's stability, we performed the intraclass correlation coefficient and Bland and Altman plot between two applications. We investigated the item's properties using the item response theory. RESULTS The overall Cronbach's alpha index was 0.975. The intraclass correlation coefficient was 0.995 (95%CI 0.993-0.996) and a uniform distribution was visualized at the Bland and Altman plot. The item response theory identified the discriminatory power and the difficulty level of the instrument and of each item. The instrument showed acute angulation of the expected total score, and good concentrate information and good standard error curves, preserving the latent construct and its original items. CONCLUSIONS This analysis concluded that the Brazilian version of the Quality of Prenatal Care Questionnaire is a high-quality, reliable and valid questionnaire to determine the quality of prenatal care among Brazilian women. The questionnaire is suitable for the cultural context represented.

Translation and cultural adaptation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module for quality of life assessment in patients with lung cancer in Brazil / Tradução e adaptação cultural do Quality of Life Questionnaire-Lung Cancer Module da European Organisation for Research and Treatment of Cancer para avaliação da qualidade de vida relacionada à saúde em pacientes com câncer de pulmão no Brasil

ABSTRACT Objective: To translate the European Organisation for Research and Treatment of Cancer (EORTC) 29-item Quality of Life Questionnaire-Lung Cancer Module (QLQ-LC29, developed for the assessment of quality of life in patients with lung cancer) to Portuguese, conducting a pilot study of the Portuguese-language version and adapting it for use in Brazil. Methods: For the translation, cultural adaptation, and pilot testing of the QLQ-LC29, we followed the guidelines established by the EORTC. The translation (English → Portuguese) and back-translation (Portuguese → English) were both carried out by translators, working independently, who were native speakers of one language and fluent in the other. After review, a draft version was created for pilot testing in lung cancer patients in Brazil. Results: A total of 15 patients diagnosed with lung cancer completed the Portuguese-language version of the questionnaire. At the end of the process, we conducted a structured interview to identify any patient difficulty in understanding any of the questions. The final versions were sent to the EORTC and were approved. Conclusions: The Portuguese-language version of the EORTC QLQ-LC29 appears to be a useful, important, reliable questionnaire that is a valid tool for assessing quality of life in patients with lung cancer in Brazil.

RESUMO Objetivo: O objetivo deste estudo foi traduzir, adaptar culturalmente e realizar um ensaio piloto para criar a versão em português do Brasil do questionário da European Organisation for Research and Treatment of Cancer (EORTC) denominado Quality of Life Questionnaire-Lung Cancer (QLQ-LC29, lung module), desenvolvido para a avaliação da qualidade de vida em doentes com câncer de pulmão. Métodos: Foram seguidas as orientações da EORTC para a tradução, a adaptação cultural e a realização de um ensaio piloto do QLQ-LC29. Foi realizado o processo de tradução (inglês → português) e tradução reversa (português → inglês) por tradutores independentes nativos em um dos idiomas e fluentes no outro idioma. Após revisão, uma versão preliminar for criada para o ensaio piloto com pacientes no Brasil. Resultados: No total, 15 pacientes com diagnóstico de câncer de pulmão preencheram a versão em português do Brasil do questionário. No final, foi conduzida uma entrevista estruturada para identificar qualquer dificuldade em alguma das perguntas. As versões finais foram enviadas para a EORTC e aprovadas. Conclusões: A versão em português do Brasil do EORTC QLQ-LC29 (lung module) é uma ferramenta útil, importante, fidedigna e válida para a aferição da qualidade de vida relacionada à saúde em pacientes com neoplasia pulmonar.

Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia / Adaptación transcultural de la escala Cambridge Pulmonary Hypertension Outcome Review en pacientes con hipertensión pulmonar en Colombia

ABSTRACT Objective: To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. Methods: The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. Results: A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. Conclusions: The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.

RESUMEN Objetivo: Realizar la adaptación transcultural del cuestionario Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) como instrumento para evaluar la percepción de síntomas, la limitación funcional y la calidad de vida relacionada con la salud (CVRS) en una población colombiana de sujetos con diagnóstico de hipertensión arterial pulmonar (HAP) e hipertensión pulmonar tromboembólica crónica (HPTEC). Métodos: Estudio de validación de pruebas de determinación de precisión y propiedades psicométricas desarrollado en 3 fases: traducción con adaptación cultural mediante panel bilingüe, aplicación inicial y general para la evaluación de características psicométricas en una cohorte de pacientes > 18 años, con diagnóstico de HAP e HPTEC, en seguimiento por consulta externa de programas de hipertensión pulmonar del Hospital Universitario San Ignacio, Fundación Clínica Shaio y Clínicos IPS. Resultados: Se obtuvo una versión en castellano de la escala CAMPHOR. La consistencia interna observada para los dominios de síntomas, actividades y calidad de vida (valores del coeficiente alfa de Cronbach de 0,92, 0,87 y 0,93 respectivamente) fue adecuada. La confiabilidad prueba-reprueba estuvo por encima de 0,70 y la evaluación de la validez convergente y de grupos conocidos de las subescalas confirmó las correlaciones moderadas y fuertes con constructos relacionados del SF36v2, así como la capacidad discriminatoria según la severidad de la enfermedad. Conclusiones: La versión en castellano de la escala CAMPHOR presentó un proceso de traducción lingüística y adaptación cultural que permite considerarla equivalente a la versión original, demostrando adecuadas propiedades psicométricas en la muestra estudiada. Por ello se recomienda su utilización tanto en la investigación como en la práctica clínica, con el fin de evaluar el impacto de las intervenciones en la CVRS.

Translation and cultural adaptation of the King's Brief Interstitial Lung Disease health status questionnaire for use in Brazil / Tradução e adaptação cultural do King's Brief Interstitial Lung Disease health status questionnaire

ABSTRACT Objective: To translate the King's Brief Interstitial Lung Disease (K-BILD) questionnaire to Portuguese and culturally adapt it for use in Brazil. The K-BILD quantifies the health status of patients with ILD. Methods: The process involved the following steps: authorization from the author of the original (English-language) questionnaire; translation of the questionnaire to Portuguese by three translators, working independently; merging of the translations by a committee of specialists; back-translation of the questionnaire to English; revision and readjustment of the back-translation by the committee of specialists; evaluation by the original author; revision of the back-translation; cognitive debriefing (verification of the clarity and acceptability of the Portuguese-language version in the target population-i.e., patients with ILD); and finalization of the Portuguese-language version. Results: In the cognitive debriefing step, 20 patients with ILD were interviewed. After the interviews, the clarity and acceptability index of each question was ≥ 0.8, which is considered acceptable. Conclusions: The Portuguese-language version of K-BILD appears to be easily administered to and understood by patients with ILD in Brazil. To our knowledge, this is the only instrument in Brazilian Portuguese that is designed to evaluate the impact that ILD has on the various aspects of the lives of those it affects.

RESUMO Objetivo: Traduzir e adaptar culturalmente o King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire, utilizado para mensurar o estado de saúde em pacientes com doença pulmonar intersticial (DPI), para a língua portuguesa falada no Brasil. Métodos: As seguintes etapas foram realizadas: autorização do autor do instrumento original; preparação; tradução do K-BILD da língua inglesa para a língua portuguesa falada no Brasil por três tradutores independentes; unificação das traduções por um comitê de especialistas; retradução do português para o inglês; revisão e readequação da retradução pelo comitê de especialistas; avaliação do autor do original; revisão da versão em inglês; desdobramento cognitivo (observação da clareza e aceitabilidade do questionário traduzido na população-alvo); e elaboração da versão final em português. Resultados: Na etapa de desdobramento cognitivo foram entrevistados 20 pacientes com DPI. Após todas as entrevistas, o índice de clareza e aceitabilidade das questões foi igual ou maior que 0,8, indicando um índice de clareza aceitável para todas as questões. Conclusões: A versão do K-BILD mostrou ser compreensível e de fácil aplicação. Até onde sabemos, esse é atualmente o único instrumento disponível em português falado no Brasil dirigido à avaliação do impacto da DPI em vários aspectos da vida desses pacientes.