Diseño y Validación de una Aplicación Móvil, para el Diagnóstico de Anemia en Pre-Escolares. Estudio de Precisión Diagnóstica / Design and Validation of a Mobile Application for the Diagnosis of Anemia in Preschoolers. Diagnostic Accuracy Study

La anemia afecta a miles de niños. Para el diagnóstico se cuantifica la hemoglobina (Hb); técnica que no se encuentra al alcance de toda la población. Contar con un instrumento validado de fácil aplicación, puede ayudar al diagnóstico. El objetivo de este estudio fue validar una aplicación móvil (APP) para diagnosticar anemia en niños de 2 a 5 años, aplicable por padres o tutores. Estudio de validación de escalas. Mediante búsqueda bibliografía se recopilaron ítems y dominios relacionados con anemia en niños. Una vez reducidos, se construyó un cuestionario para pilotaje, con tres hematólogos pediatras. El resultado de este fue posteriormente validado por 22 expertos mediante aplicación de escalas tipo Likert. Los ítems validados, se contrastaron con la Hb de niños de 267 niños de 2 a 5 años de los andes ecuatorianos (2.560 msnm). Se determinó asociación de los ítems con Hb y con los resultados obtenidos y se construyó la APP. 14 ítems fueron analizados. Todos ellos puntuaron sobre la mediana de la distribución (35,5 puntos) y fueron valorados por, al menos el 50 % de los expertos. Se seleccionaron palidez palmar, astenia y sueño en horas no habituales. Todos mostraron asociación significativa con anemia (p<0,05), y fueron aplicados como preguntas a padres o tutores y contrastados con el valor de Hb. Sensibilidad y especificidad para palidez fue: 85,1 % y 85,0 %; astenia: 72,3 % y 87,7 %; sueño en horas no habituales: 68,1 % y 87,7 %; palidez más astenia o sueño: 95,7 % y 74,6 %; y debilidad más sueño: 92,5 % y 76,8 %. Se desarrolló y validó una APP para diagnóstico de anemia en niños de 2 a 5 años aplicable por padres o tutores.

SUMMARY: Anemia affects thousands of children, and to reach a diagnosis, hemoglobin (Hb) is quantified. This technique however, is not always accessible to the general population. Therefore, the availability of a validated instrument can be useful in the diagnosis. The aim of this study was to validate a mobile application (APP), to diagnose anemia in children from 2 to 5 years old, applicable by parents or guardians. Scale validation study. Through a bibliographic search, items and domains related to anemia in children were collected. Once reduced, a pilot questionnaire was constructed with three pediatric hematologists. The result was later validated by 22 experts through the application of the Likert-type scales. The validated items were contrasted with the Hb of children of 267 children from 2 to 5 years of age from the Ecuadorian Andes (2,560 meters above sea level). The association of the items with Hb and with the results obtained was determined, and the APP was constructed. 14 items were analyzed. All of them scored above the median of the distribution (35.5 points) and were valued by at least 50 % of the experts. Palmar pallor, asthenia, and sleep at unusual hours were selected. All showed a significant association with anemia (p<0.05) and were applied as questions to parents or guardians and contrasted with the Hb value. Sensitivity and specificity for pallor was: 85.1 % and 85.0 %; asthenia: 72.3 % and 87.7 %; sleep at unusual hours: 68.1 % and 87.7 %; paleness plus fatigue or sleepiness: 95.7 % and 74.6 %; and weakness plus sleep: 92.5 % and 76.8 %. An APP for the diagnosis of anemia in children from 2 to 5 years old applicable by parents or guardians was developed and validated.

A validated instrument to assess dentists' knowledge about diabetes: the dental - diabetes questionnaire

Aim: To elaborate and validate an instrument for Brazilian Portuguese speakers, to assess dentists' knowledge about care of patients with diabetes mellitus (Dental-Diabetes). Methods: Methodological study comprising four stages: a) Elaboration of instrument; b) Content validation (computing Content Validity Index - CVI) based on Expert Committee assessment; c) Pre-test with 30 dentists, followed by assessment of suggestions by Expert Committee; d) Psychometric validation through instrument application in a sample of 127 dentists by means of the web tool e-Surv. Cronbach's alpha and intraclass correlation coefficients were used to evaluate, respectively, internal consistency and reproducibility. Results: The final version of the instrument consists of 22 questions (7 on sociodemographic data and 15 querying dentists' knowledge) and those submitted for validation attained a CVI of 0.95 [95% CI 0.916-0,981], showing satisfactory internal consistency, with 0.794 Cronbach's alpha [95% CI 0.741-0.842] and an intraclass correlation coefficient of 0.799 [95% CI: 0.746-0.846] between the test and retest scores. Conclusions: Dental-Diabetes is a comprehensive instrument, culturally adequate and validated to assess dentists' knowledge about care of patients with diabetes

Validation of the Brazilian version of the child pain catastrophizing scale and its relationship with a marker of central sensitization

Abstract Objectives The Pain Catastrophizing Scale-Child version (PCS-C) allows to identify children who are prone to catastrophic thinking. We aimed to adapt the Brazilian version of PCS-C (BPCS-C) to examine scale psychometric properties and factorial structure in children with and without chronic pain. Also, we assessed its correlation with salivary levels of Brain-Derived Neurotrophic factor (BDNF). Methods The Brazilian version of PCS-C was modified to adjust it for 7-12 years old children. To assess psychometric properties, 100 children (44 with chronic pain from a tertiary hospital and 56 healthy children from a public school) answered the BPCS-C, the visual analogue pain scale, and questions about pain interference in daily activities. We also collected a salivary sample to measure BDNF. Results We observed good internal consistency (Cronbach's value = 0.81). Parallel analysis retained 2 factors. Confirmatory factor analysis of our 2-factor model revealed consistent goodness-of-fit (IFI = 0.946) when compared to other models. There was no correlation between visual analogue pain scale and the total BPCS-C score; however, there was an association between pain catastrophizing and difficulty in doing physical activities in school (p= 0.01). BPCS-C total scores were not different between groups. We found a marginal association with BPCS-C (r= 0.27, p= 0.01) and salivary BDNF levels. Discussion BPCS-C is a valid instrument with consistent psychometric properties. The revised 2-dimension proposed can be used for this population. Children catastrophism is well correlated with physical limitation, but the absence of BPCS-C score differences between groups highlights the necessity of a better understanding about catastrophic thinking in children.

Validity evidences of the brazilian version of the demands of illness inventory / Pruebas de validez de la versión brasileña del demands of illness inventory / Evidências de validade da versão brasileira do demands of illness inventory

ABSTRACT Objective: to translate and localize the Demands of Illness Inventory into Brazilian Portuguese, analyzing evidences for its validity and reliability. Method: methodological study carried out in six stages: translation, synthesis, back translation, specialist committee, pre-test, and evaluation of the author of the original instrument. The specialist committee was formed by eight professionals with different specialties. The agreement of these specialists was evaluated using the Content Validity Index and Kappa coefficient. The pre-test was carried out with 31 patients. The reliability was assessed using Cronbach's alpha. Results: all cultural adaptation stages showed adequate results. The Content Validity Index and the Kappa coefficient were above 0.83 and 0.81 respectively. The reliability was 0.95 for the instrument as a whole. Conclusion: this instrument is culturally adapted for cancer patients in the Brazilian context with satisfactory evidence of the psychometric properties evaluated, good acceptability and is acceptably easy to understand.

RESUMEN Objetivo: traducir, adaptar culturalmente y analizar las pruebas de validez y fiabilidad del Demands of Illness Inventory al portugués brasileño. Método: estudio metodológico realizado en seis etapas: traducción, síntesis, retro-traducción, comité de especialistas, pre-ensayo y evaluación del autor del instrumento original. El comité de expertos estaba compuesto por ocho profesionales multidisciplinares. El acuerdo de los expertos se evaluó mediante el índice de validez del contenido y el coeficiente Kappa. La prueba previa se realizó en 31 pacientes. La fiabilidad se comprobó mediante el alfa de Cronbach. Resultados: todas las etapas de la adaptación cultural se realizaron satisfactoriamente. El índice de validez del Contenido y el coeficiente Kappa mostraron valores superiores a 0,83 y 0,81, respectivamente. La fiabilidad fue de 0,95 para el instrumento total. Conclusión: este instrumento se ha adaptado culturalmente a los pacientes oncológicos en el contexto brasileño, con evidencia satisfactoria de las propiedades psicométricas evaluadas, buena aceptabilidad y comprensión.

RESUMO Objetivo: realizar a tradução, adaptação cultural, análise de evidências de validade e confiabilidade do Demands of Illness Inventory para o português brasileiro. Método: estudo metodológico realizado em seis etapas: tradução, síntese, retrotradução, comitê de especialistas, pré-teste e avaliação do autor do instrumento original. O comitê de especialistas foi formado por oito profissionais multidisciplinares. A concordância dos especialistas foi avaliada pelo Índice de Validade de Conteúdo e o coeficiente Kappa. O pré-teste foi realizado em 31 pacientes. A confiabilidade foi verificada mediante o alfa de cronbach. Resultados: todas as etapas de adaptação cultural foram realizadas satisfatoriamente. O Índice de Validade de Conteúdo e o coeficiente Kappa apresentaram valores acima de 0,83 e 0,81, respectivamente. A confiabilidade foi de 0,95 para o instrumento total. Conclusão: este instrumento se mostrou culturalmente adaptado para pacientes oncológicos no contexto brasileiro, com evidência satisfatória das propriedades psicométricas avaliadas, boa aceitabilidade e compreensão.

Validez y confiabilidad de dos instrumentos para evaluar la adherencia al tratamiento en pacientes quemados / Validity and reliability of two instruments to assess adherence to treatment in burn patients

RESUMEN Introducción: La adherencia terapéutica constituye uno de los principales problemas de las intervenciones en salud. Una de las poblaciones en las que se evidencian dificultades en la adherencia al tratamiento es en los pacientes quemados. Objetivo: Determinar la validez y confiabilidad de dos instrumentos para la evaluación de la adherencia al tratamiento y sus dimensiones influyentes en pacientes quemados hospitalizados. Métodos: Desde el enfoque cuantitativo se realizó un estudio transversal, en el periodo comprendido de enero de 2017 a diciembre de 2019. Se establecieron como variables de la investigación la adherencia al tratamiento y los factores influyentes en la adherencia al tratamiento. Se utilizó el criterio de expertos, la prueba piloto y por último se aplicaron los dos cuestionarios a 90 pacientes quemados. Resultados: Ambos instrumentos demostraron tener validez de contenido. La fiabilidad test-retest del instrumento para evaluar la adherencia terapéutica fue considerable y significativa, mientras que la consistencia interna fue aceptable. En el instrumento que evalúa las dimensiones influyentes en la adherencia terapéutica la fiabilidad fue muy fuerte y la consistencia buena. Conclusiones: Los dos instrumentos elaborados para la evaluación de la adherencia terapéutica en pacientes quemados hospitalizados, presentaron validez de contenido y confiabilidad.

ABSTRACT Introduction: Therapeutic adherence constitutesone of tema in problems of health interventions. One of the populations in which difficulties in adherence to treatment are evidence disburn patients. Objective: To determine the validity and reliability of two instruments for the evaluation of adherence to treatment and the irinfluential dimensions in hospitalized burn patients. Methods: From the quantitative approach, a cross-sectional study was conducted, in the period from January 2017 to December 2019. Adherence to treatment and influencing adherence to treat ment were established as research variables. Expert judgment wasused, the pilot test and finally the two question naireswere applied to 90 burn patients. Results: Both instruments proved to have content validity. The test-retestreliability of the instrument to evaluate therapeuticad herence was considerable and significant, whilethe internal consistency was acceptable. Reliability was very strong and consistency good in the instrument that evaluates the influencing dimensions in therapeutic adherence. Conclusions: The two instruments developed forthe evaluation of therapeutic adherence in hospitalized burn patients present content validity and reliability.

Translation, cross-cultural adaptation to the Portuguese language and validation of the Undergraduate Clinical Education Environment Measure Instrument (Uceem) / Tradução, adaptação transcultural para a língua portuguesa e validação do instrumento Undergraduate Clinical Education Environment Measure (Uceem)

Abstract: Introduction: The educational environment for the clinical teaching of undergraduate medical and nursing students influences the students' perception of significant aspects of satisfaction in the clinical learning environment. Objective: To transculturally adapt, with the concept, content and construct validity, the instrument "Undergraduate Clinical Education Environment Measure - UCEEM" into the Brazilian Portuguese language and validate the translated and adapted version; involving medical and nursing students, while experiencing clinical teaching during their undergraduate course. Method: This is a methodology study aimed at the translation, adaptation and transcultural validation process, which is divided into six steps, as proposed by Beaton. The steps consisted in the translation, translation synthesis, back-translation, proofreading by the experts committee, pre-testing and submission of the final version of the instrument to the author. Five bilingual translators participated in this process (three for the translation and two for the back-translation), as well as eight expert professionals who work as academic faculty and have Master's and Doctoral degrees. The validation was carried out at two moments: the first one by using semantic, idiomatic, cultural and conceptual equivalence (pre-test), involving 30 medical and nursing students going through clinical teaching; and the second moment, the validation and assessment of the psychometric properties with 161 students from these same courses. Result: The transcultural adaptation carried out by eight expert professionals in this area was performed based on the experts' considerations, in addition to the analysis and considerations of the researcher and author of the original instrument. The result of this phase led to the final version of this instrument in Brazilian Portuguese, which shows 26 items divided into two dimensions and four subscales that were maintained according to its original form. Following the filling out of the instrument by the nursing and medical students, the analysis of the Theory of Response revealed to be reliable, as determined by a Cronbach's alpha of 0.917. According to Spearman's correlation test, the results indicate a positive correlation between the questions. Conclusions: The Portuguese version of the UCEEM instrument showed to be adequate and useful to evaluate the satisfaction with the educational environment in clinical teaching according to the perception of medical and nursing students.

Resumo: Introdução: O ambiente/clima educacional para o ensino clínico destinado a estudantes de Medicina e Enfermagem influencia a percepção deles sobre os aspectos significativos de satisfação no ambiente clínico de aprendizagem. Objetivo: Este estudo teve como objetivos adaptar transculturalmente com validade de face, conteúdo e constructo o instrumento Undergraduate Clinical Education Environment Measure (UCEEM) para o português do Brasil e validar a versão traduzida e adaptada com estudantes de Enfermagem e Medicina que vivenciam o ensino clínico durante a formação. Método: Trata-se de um estudo metodológico para tradução, adaptação e validação transcultural, processo dividido em seis fases propostas por Beaton. As etapas consistiram em tradução, síntese das traduções, retrotradução, revisão pelo comitê de experts, pré-teste e envio da versão final do instrumento adaptado à autora do instrumento. Participaram do processo cinco tradutores bilíngues (três para tradução e dois para retrotradução) e oito profissionais experts que atuam como docentes e possuem título de mestre e/ou doutor. A validação foi realizada em dois momentos. No primeiro, realizaram-se as equivalências semântica, idiomática, cultural e conceitual (pré-teste) com 30 estudantes de Enfermagem e Medicina vivenciando o ensino clínico. No segundo, efetuou-se a validação com avaliação das propriedades psicométricas de 161 estudantes desses mesmos cursos. Resultado: A adaptação transcultural foi realizada por oito profissionais experts da área, além contar com a análise e as considerações da pesquisadora e autora do instrumento original. O resultado dessa etapa conduziu à versão final do instrumento em português, que apresenta 26 itens divididos em duas dimensões e quatro subescalas, as quais foram mantidas conforme original. Após o preenchimento do instrumento por estudantes de Medicina e Enfermagem, a análise de Teoria de Resposta ao Item revelou confiabilidade, determinada pelo alfa de Cronbach, de 0,917. No teste de correlação de Spearman, os resultados apontaram a existência de correlação positiva entre as questões. Conclusão: A versão em português do instrumento UCEEM mostrou-se adequada e útil para avaliar a satisfação com o ambiente educacional no ensino clínico pela percepção dos estudantes de Medicina e Enfermagem.

Factor analysis of the cross-cultural adaptation of the multidimensional attitudes scale towards deaf persons in Chilean dental students

There are various instruments to measure attitudes toward persons with disabilities (PwD). The Multidimensional Attitudes Scale (MAS) toward PwD is a three-dimension scale with good psychometric properties; the Spanish version has been validated with a four-factor structure. Aim: To examine the factor structure of a cross-cultural adapted version of the Spanish MAS towards deaf persons in a sample of Chilean dental students. Methods: This cross-sectional study involved five Chilean public health experts that reviewed the scale for obtaining a preliminary version of a 30-item modified MAS towards deaf persons; a pilot with 15 dental students was performed, and a final sample composed of 311 students was included. For the exploratory factor analysis (EFA), maximum likelihood estimation (ML) for determining the number of factors and parallel analysis (PA) was used, with Oblimin for the rotation method. Cronbach's alpha was used to assess reliability. The root mean square error of approximation (RMSEA), comparative fit index (CFI), incremental fit index (IFI), goodness of fit index (GFI), Tucker-Lewis fit index (TLI-NNF) and root mean square of residuals (RMSR) were used to assess model fit. Results: All items had a normal distribution with the exception of items 7 and 10. The four-factor structure without item 10 in this EFA presented an adequate Cronbach's alpha (>0.83), suggesting acceptable reliability. RMSEA, TLI-NNFI, RMSR, GFI and CFI indices suggested a good fit of the model and were consistent with the literature. Conclusion: The Spanish modified version of the MAS towards deaf persons has a four-factor structure, which in consistent with a previous version of the MAS

What, what for and how? Developing measurement instruments in epidemiology / O quê, para quê e como? Desenvolvendo instrumentos de aferição em epidemiologia

ABSTRACT The development and cross-cultural adaptation of measurement instruments have received less attention in methodological discussions, even though it is essential for epidemiological research. At the same time, the quality of epidemiological measurements is often below ideal standards for the construction of solid knowledge on the health-disease process. The scarcity of systematizations in the field about what, what for, and how to adequately measure intangible constructs contributes to this scenario. In this review, we propose a procedural model divided into phases and stages aimed at measuring constructs at acceptable levels of validity, reliability, and comparability. Underlying our proposal is the idea that not only some but several connected studies should be conducted to obtain appropriate measurement instruments. Implementing the model may contribute to broadening the interest in measurement instruments and, especially, addressing key epidemiological problems.

RESUMO Embora fundamental para a pesquisa epidemiológica, o desenvolvimento e a adaptação transcultural de instrumentos de aferição têm recebido menos destaque nas discussões metodológicas que permeiam o campo. Em paralelo, a qualidade das mensurações realizadas em muitos estudos epidemiológicos está frequentemente aquém do desejado para a construção de conhecimento sólido sobre o processo saúde-doença. A escassez de sistematizações sobre o que, para que e como aferir na área provavelmente contribui para esse cenário. Nesta revisão, propomos um modelo processual composto por uma sequência de etapas voltadas à mensuração de construtos em níveis aceitáveis de validade, confiabilidade e, por extensão, comparabilidade. Subjaz à proposta a ideia de que não apenas alguns, mas diversos estudos concatenados entre si e sucessivamente mais aprofundados devem ser conduzidos para obter aferições adequadas. A implementação do modelo poderá contribuir para alargar o interesse sobre instrumentos de aferição e, especialmente, para enfrentar os problemas investigados em epidemiologia.

Validación del instrumento de recogida de información para evaluar la percepción de riesgo en hipertensos / Validation of a data collection instrument to assess risk perception in hypertensive patients

RESUMEN Introducción: en el municipio de Remedios, Villa Clara, se desarrolla una estrategia para promover la adherencia terapéutica en pacientes hipertensos, que asume la percepción de riesgo como ente modulador; en este marco, se hizo necesaria la construcción y validación de un instrumento para su medición. Objetivo: presentar el proceso de construcción del cuestionario, así como la validación de contenido, criterio, constructo, y la evaluación de su confiabilidad. Métodos: la muestra empleada fue de 444 hipertensos esenciales, de las tres áreas de Remedios. La validación de contenido se realizó según expertos; la de criterio por la correlación de Spearman y la de constructo por análisis de componentes principales. La confiabilidad se calculó por el coeficiente Alfa de Cronbach. Resultados: el coeficiente de concordancia entre expertos fue de 0,80 para los criterios: razonable, comprensible y sensible a variación. Esto demostró que las categorías incluidas en el instrumento son apropiadas. El estadígrafo Rho de Spearman fue de 0,77 con significación bilateral en el nivel de 0,01, para la correlación entre adherencia terapéutica y percepción de riesgo. El análisis multivariado por componentes principales sugirió la presencia de tres dimensiones: cognitivo-valorativa, afectivo-motivacional, e intencional-conductual. El Alfa de Cronbach fue de 0,82, lo que confirmó la confiabilidad del cuestionario. Conclusiones: los resultados mostrados a través de las pruebas de validez y confiabilidad demostraron que el cuestionario es un instrumento apto para su uso y aplicación, según los objetivos perseguidos en su construcción, tanto para la investigación como para el trabajo del médico de la atención primaria.

ABSTRACT Introduction: a strategy is being developed to promote therapeutic adherence in hypertensive patients in Remedios municipality, Villa Clara which assumes risk perception as a modulating entity; within this framework, it became necessary to build and validate an instrument to measure it. Objective: to present the process of the questionnaire construction, as well as the validation of content, criteria, construct, and evaluation of its reliability. Methods: the sample used was 444 essential hypertensives from three areas of Remedios. Content validation was done according to experts; criteria validation by Spearman's correlation and construct validation by principal component analysis. Reliability was calculated by Cronbach's Alpha coefficient. Results: coefficient of agreement among experts was 0.80 for the criteria: reasonable, understandable and sensitive to variation. This showed that the categories included in the instrument are appropriate. Spearman's Rho statistician was 0.77 with bilateral significance at the level of 0.01, for correlation between therapeutic adherence and risk perception. Multivariate analysis by main components suggested the presence of three dimensions: cognitive-valuable, affective-motivational, and intentional-behavioral. Cronbach's Alpha was 0.82, which confirmed the reliability of the questionnaire. Conclusions: the results shown through the validity and reliability tests demonstrated that the questionnaire is an instrument suitable for use and application, according to the objectives pursued in its construction, both for research and for the work of the primary care physician.

Adaptación y datos psicométricos de la versión chilena del Protocolo de Exploración de Habilidades Metalingüísticas Naturales en Afasia (MetAphAs) / Adaptation and psychometric data of the Exploration of Natural Metalinguistic Skills in Aphasia Protocol (MetAphAs) - Chilean version

RESUMEN Objetivo: El objetivo de este estudio fue adaptar transculturalmente el Protocolo de Exploración de Habilidades Metalingüísticas Naturales en Afasia (MetAphAs), contribuyendo a la aplicación futura del instrumento en la población afásica chilena. Método: la muestra corresponde a 72 individuos sanos de la región de Valparaíso, de 50 a 85 años. El Protocolo MetAphAs mide las habilidades metalingüísticas naturales y presenta los elementos básicos en los que debe basarse una exploración de la dimensión metacognitiva involucrada en el comportamiento verbal. La validez se verificó mediante el coeficiente alfa de Cronbach, incluidos los valores de cada una de las 6 secciones; las correlaciones entre las variables fueron analizadas por el coeficiente de Pearson. Resultados: el 64% de la muestra correspondió a mujeres y el 36% a hombres, con el mayor grupo de edad de participación de 61 a 70 años; se verifica una correlación adecuada entre las variables según el coeficiente de Pearson y los valores altamente positivos según el alfa de Cronbach. Conclusión: el uso del protocolo fue factible y relevante, con datos que demostraron una alta confiabilidad. Los resultados obtenidos y las ventajas indicadas alientan el uso de este tipo de instrumento como una opción viable para la validación en afásicos chilenos.

ABSTRACT Purpose: This study aimed to cross culturally adapt the Protocol for the Exploration of Natural Metalinguistic Skills in Aphasia (MetAphAs), contributing to the future application in the aphasic Chilean population. Method: The sample corresponds to 72 healthy subjects in the region of Valparaíso, between the ages of 50 to 85. The MetAphAs measures natural metalinguistic skills and presents the basic elements on which to base the exploration of the metacognitive dimensions involved in verbal behavior. The validity was ascertained by means of Cronbach's Alpha Coefficient, including the values of each of the 6 sections; the correlations between variables were analyzed by the Pearson coefficient. Results: We observed that 64% of the sample corresponded to the female and 36% to the male gender, with predominant age ranging from 61 to 70 years. We verified adequate correlation between the variables according to the Pearson coefficient, and highly positive values according to Cronbach's Alpha. Conclusion: The use of the protocol is viable, with data demonstrating high reliability. The results evidenced high liability, which encourages the continuation process of its validation with Chilean aphasic population.

DISABKIDS® in Brazil: advances and future perspectives for the production of scientific knowledge / DISABKIDS® no Brasil: avanços e perspectivas futuras na produção do conhecimento científico / DISABKIDS® en Brasil: avances y perspectivas futuras en la producción del conocimiento científico

Objective: to map the Brazilian scientific production related to the stages of the methodological process for the use of DISABKIDS® instruments and/or forms adapted to Brazil. Method: scoping review, with searches conducted on10 electronic databases, plus Google Scholar and contacts with researchers, without restriction of period or language. Results: the mapping identified 90 scientific studies involving 46 instruments. Of these, 11 (23.9%) included the elaboration and/or cultural adaptation of the DISABKIDS® instruments to measure the Quality of Life of children or adolescents with chronic conditions and 35 (76.1%) used the Generic Measures and/or Specific Modules for the semantic validation of other instruments. Conclusion: this scoping review allowed a comprehensive evaluation of the use of the DISABKIDS® instrument and forms, in relation to the validation of the instrument adapted to Brazil, presenting a positive advance in the scenario with the development of academic/scientific projects in the country, incorporating the method recommended by the literature for the elaboration, cultural adaptation and validation of instruments and for the systematized and standardized recording of the perception and understanding of the target population about the measure of interest, using DISABKIDS® forms adapted for this purpose.

Objetivo: mapear a produção científica brasileira que versa sobre as fases do processo metodológico para a utilização dos instrumentos e/ou formulários DISABKIDS® adaptados para o Brasil. Método: scoping review realizada através da busca em 10 bases de dados eletrônicas, no Google Scholar e por meio de consulta à pesquisadores, sem restrição de período ou idioma. Resultados: o mapeamento identificou 90 estudos científicos que envolveram 46 instrumentos, dos quais 11 (23,9%) foram realizados os processos de elaboração e/ou adaptação cultural dos instrumentos DISABKIDS® para mensuração da Qualidade de Vida de crianças ou adolescentes com condições crônicas e em 35 (76,1%) foram utilizados o Formulários de Impressões Gerais e/ou Folhas Específicas para realizar a validação semântica de outros instrumentos. Conclusão: constatou-se que essa scoping review permitiu avaliação abrangente do uso do instrumento e dos documentos DISABKIDS®. Em relação à validação do instrumento adaptado ao Brasil apresenta avanço positivo do cenário junto ao desenvolvimento de projetos acadêmicos/científicos no país, a partir da incorporação ao método preconizado pela literatura para elaboração, adaptação cultural e validação de instrumentos, do registro sistematizado e padronizado da percepção, bem como do entendimento da população alvo sobre a medida de interesse, ao lançar mão de formulários DISABKIDS® adaptados para esse fim.

Objetivo: mapear la producción científica que se ocupa de las etapas del proceso metodológico para el uso de los instrumentos y/o formularios adaptados DISABKIDS® a Brasil. Método: scoping review, búsqueda realizada en 10 bases de datos electrónicas, en el Google Scholar y por intermedio de consulta a investigadores, sin restricción de período o idioma. Resultados: el mapeo identificó 90 estudios científicos que involucraron 46 instrumentos, de los cuales 11 (23,9%) la elaboración y/o adaptación cultural de los instrumentos DISABKIDS® se realizaron para medir la Calidad de Vida de niños o adolescentes con afecciones crónicas y en 35 (76,1%) utilizaron los Formularios de Impresiones Generales y/o Hojas Específicas para realizar la validación semántica de otros instrumentos. Conclusión: se encontró que esta revisión de alcance permitió una evaluación exhaustiva del uso del instrumento y los documentos DISABKIDS®. En cuanto a la validación del instrumento adaptado a Brasil presenta un avance positivo del escenario en conjunto al desarrollo de proyectos académicos/científicos en el país, desde la incorporación al método recomendado por la literatura para la elaboración, adaptación cultural y validación de instrumentos, desde el registro sistematizado y estandarizado de la percepción, así como la comprensión de la población objetivo sobre la medida de interés mediante el uso de formularios DISABKIDS® adaptados con esta finalidad.

SIGMA-VB: Validity and reliability of the Brazilian Portuguese version of the Montgomery-Åsberg Depression Rating Scale using the Structured Interview Guide for the MADRS

Objective: The Montgomery-Åsberg Depression Rating Scale (MADRS) is widely used to assess depression severity. The Structured Interview Guide for the MADRS (SIGMA) was created to standardize MADRS assessment. The objective of this study was to translate and validate the original SIGMA into a Brazilian Portuguese version (SIGMA-VB). Methods: We translated and cross-culturally validated the original SIGMA into the SIGMA-VB, and assessed its psychometric properties using data from 93 adult outpatients enrolled in the Integral Assessment in Unipolar Depression (AIUNI) trial. Participants were assessed by two raters on five visits over 8 weeks. We calculated multiple interrater reliability indexes for the SIGMA-VB and used the Hamilton Depression Hating Scale (HAM-D) for validation purposes. Results: According to the SIGMA-VB, participants had moderate depression at baseline followed by mild depression at 8 weeks. We found over 90% of correlation between scores attributed by different raters using the SIGMA-VB. Correlations between the SIGMA-VB and the HAM-D were above 66%. Conclusion: Our findings confirm that the SIGMA-VB is a valid and reliable instrument to assess depression severity in clinical research and practice. Its interrater reliability was similar to that of a previously published Japanese version of the SIGMA.

Construcción y validación del cuestionario Satisfacción de los usuarios en servicios de Estomatología. Cienfuegos, 2018 / Construction and validation of the questionnaire Satisfaction of users in Dentistry services. Cienfuegos, 2018

RESUMEN Fundamento: Actualmente los usuarios de los servicios estomatológicos tienen expectativas diferentes y son más exigentes respecto a la calidad de atención. Medir el grado de satisfacción de los usuarios, es una tarea compleja que requiere de instrumentos válidos y confiables. Objetivo: validar un instrumento que permita evaluar el nivel de satisfacción de los usuarios del servicio de Estomatología General Integral. Métodos: estudio de innovación tecnológica, en el sub-sistema de atención estomatológica en la especialidad de Estomatología General Integral, en Cienfuegos. A través del criterio de expertos y según la metodología propuesta por Moriyama se realizó la construcción del cuestionario. Para determinar la confiabilidad se utilizó el método de text-retext, y se calculó el coeficiente de correlación de Spearman. La consistencia interna fue analizada mediante el coeficiente alfa de Cronbach. El contenido fue validado mediante la consulta a un segundo grupo de expertos. Para realizar la validación de construcción se utilizó el método de grupos extremos y se aplicó una prueba de comparación de medias en muestras independientes, con un intervalo de confianza de 0,05. Resultados: el cuestionario quedó definido como unidimensional, con cuatro categorías y diez ítems seleccionados. Los resultados de las pruebas de confiabilidad y validez fueron satisfactorios. Conclusión: el cuestionario Satisfacción de los usuarios en servicios de Estomatología es un instrumento adecuado y con criterios apropiados para el uso en el terreno investigativo, así como en la práctica de dichos servicios, ya que permite obtener datos sobre la satisfacción de los usuarios.

ABSTRACT Foundation: Currently, users of dental services have different expectations about dental services and are more demanding in relation to the quality of the service. To measure the level of satisfaction of users is a complex task which requires valid and reliable instruments. Objective: to validate an instrument that allows the assessment of the level of users´ satisfaction of the Comprehensive General Dentistry service. Methods: Study of technological Innovation, in the sub-system of dental service in the Comprehensive General Dentistry Specialty. The construction of this questionnaire was done by means of expert criteria and the methodology proposed by Moriyama. Its reliability was determined by the use of text-retext method, and Spearmen coefficient was calculated. Internal consistency was analyzed by alpha coefficient of Cronbach. The content was validated by consulting a second group of experts. For the validation of this construction the method of extreme groups was used and the test of measurement comparison of independent samples was used with an confidence interval of 0,05. Results: the questionnaire was defined as unidimensional with four categories and 10 selected items. The results of the reliability test and validity were satisfactory. Conclusion: the satisfaction questionnaire in Dentistry services is an adequate instrument and with appropriate criteria for its use in the research field, so as in the practice of these services, since it allows to obtain data about users' satisfaction.

Adequação das atividades da intervenção "administração de hemoderivados" da classificação das intervenções de enfermagem para pacientes adultos / Adequacy of the activities in "blood products administration", of the nursing interventions classification, for adult patients / Adecuación de las actividades de la intervención "administración de hemoderivados" de la clasificación de intervenciones de enfermería para pacientes adultos

Introdução: a prevenção e/ou identificação precoce de reações transfusionais dependem de vigilância e cuidados diretos realizados pelos enfermeiros de forma segura e baseada em evidências. A Administração de Hemoderivados, uma intervenção na Classificação de Intervenções de Enfermagem, compreende 27 atividades que não foram validadas anteriormente. Objetivo: avaliar a adequação das atividades da intervenção da Classificação das Intervenções de Enfermagem Administração de Hemoderivados para pacientes adultos. Métodos: a adequação das atividades da Administração de Hemoderivados para pacientes adultos foi avaliada por 73 enfermeiros intensivistas de um hospital particular no Brasil. Atividades com médias ponderadas <0,80 e >0,50 foram classificadas como secundárias. Atividades com médias ponderadas ≥0,80 foram classificadas como principais. Atividades com razões ponderadas <0,50 foram consideradas não essenciais. Além disso, as atividades, dentro de suas classificações como principais ou secundárias, foram tipificadas pelos pesquisadores em seis subgrupos: cuidado basal; cuidado durante transfusão; cuidado após transfusão; cuidados durante e após transfusão; cuidados basal, durante e após transfusão; e cuidado após reação. Resultados: 22 atividades foram classificadas como principais, quatro foram classificadas como secundárias (dois cuidados basais, um cuidado durante e um cuidado após transfusão) e uma foi considerada não essencial (obter amostra do sangue e amostra da primeira urina após a reação à transfusão). Conclusões: na opinião dos enfermeiros intensivistas, a adequação da maioria das atividades da intervenção NIC Administração de Hemoderivados foi apoiada. Algumas mudanças na redação de algumas atividades podem melhorar a clareza e a precisão. Nossos resultados podem contribuir para futuros estudos de validação de conteúdo com maiores amostras de enfermeiros de diferentes especialidades que realizam transfusões rotineiramente, como enfermeiros oncologistas.(AU)

Introduction: prevention and/or early identification of transfusion-associated reactions rely on safe, evidence-based vigilance and direct care by nurses. Blood Products Administration, an intervention in the Nursing Interventions classification (NIC), comprises 27 activities that have not been previously validated. Objective: to evaluate the adequacy of the activities in the NIC intervention Blood Products Administration for adult patients. Methods: the adequacy of Blood Products Administration activities for adult patients was evaluated by 73 critical care nurses of a private hospital. Activities with weighted ratios (WR) <0.80 but >0.50 were labeled as minor. Activities with WR ≥0.80 were classified as major. Activities with WR <0.50 were discarded. Additionally, the activities within their classifications as major or minor were typified by the researchers in six subgroups: Baseline care; Care throughout transfusion; Care...(AU)

Introducción: la prevención y / o identificación temprana de las reacciones a la transfusión dependen de la vigilancia y de la atención segura de enfermería, en base a evidecias. La administración de hemoderivados, una intervención en la Clasificación de intervenciones de enfermería, comprende 27 actividades que no han sido validadas antes. Objetivo: evaluar la idoneidad de las actividades de intervención de la Clasificación de Intervenciones de Enfermería Administración de Hemoderivados para pacientes adultos. Métodos: 73 enfermeras de cuidados intensivos de un hospital privado de Brasil evaluaron la idoneidad de las actividades de administración de hemoderivados para pacientes adultos. Las actividades con promedios ponderados <0,80 y> 0,50 se clasificaron como secundarias. Las actividades con promedios ponderados ≥0,80 se clasificaron como principales. Las actividades con relaciones ponderadas <0,50 se consideraron no esenciales. Además, las actividades dentro de sus clasificaciones como principales o secundarias fueron tipificadas por los investigadores en seis subgrupos: atención basal; precaución durante la transfusión; cuidado después de la transfusión; cuidado durante y después de la transfusión; cuidado basal durante y después de la transfusión; y cuidado después de la reacción. Resultados: 22 actividades se clasificaron como principales, cuatro se clasificaron como secundarias (dos cuidados iniciales, uno durante y uno después de la transfusión) y uno se consideró no esencial (obtención de muestra de sangre y muestra de la primera orina después de la reacción a la transfusión). Conclusiones: los enfermeros de cuidados intensivos apoyan la idoneidad de la mayoría de las actividades de intervención NIC Administración de hemoderivados. Ciertas alteraciones en la redacción de algunas actividades podrían mejorar la claridad y la precisión. Nuestros hallazgos podrían contribuir a futuros estudios de validación de contenido con muestras más amplias de enfermeros de diferentes especialidades que realizan transfusiones de forma rutinaria, tales como los enfermeros oncológicos. (AU)

Application of closed negative pressure drainage technique in repair of wound of hand trauma infection / 中国基层医药

Objective@#To explore the application value of closed negative pressure drainage technique in wound healing of hand trauma.@*Methods@#From August 2013 to October 2017, 80 patients with hand trauma in the Traditional Chinese Medicine Hospital of Cixi were divided into two groups according to the random principle, with 40 cases in each group.The control group was treated with conventional wound repair, and the observation group was treated with closed negative pressure drainage.The repair effect, healing, secondary operation, antibiotic use, hospitalization, histopathological score and patients' satisfaction were observed.@*Results@#The total effective rate of the observation group (97.50%) was obviously higher than that of the control group(80.00%)(χ2=6.13, P<0.05). The time of healing, length of hospital stay and the use time of antimicrobial agents in the observation group were (15.11±2.43)d, (16.27±1.79)d and (6.06±0.65)d, respectively, which were all lower than those in the control group(t=14.43, 13.31, 23.29, all P<0.05). The second operation rate of the observation group (5.00%) was lower than that of the control group(P<0.05), and the histopathological score in the observation group (7.11±0.53) was higher than that in the control group(P<0.05). The satisfaction rate of the observation group (100.00%) was obviously higher than that of the control group(χ2=6.49, P<0.05).@*Conclusion@#In the treatment of wound healing of hand trauma, the application of closed negative pressure drainage technology is better, which can effectively control the disease and is worthy of further promotion and use.

Application of closed negative pressure drainage technique in repair of wound of hand trauma infection / 中国基层医药

Objective To explore the application value of closed negative pressure drainage technique in wound healing of hand trauma.Methods From August 2013 to October 2017,80 patients with hand trauma in the Traditional Chinese Medicine Hospital of Cixi were divided into two groups according to the random principle,with 40 cases in each group.The control group was treated with conventional wound repair,and the observation group was treated with closed negative pressure drainage.The repair effect,healing,secondary operation,antibiotic use,hospitalization,histopathological score and patients'satisfaction were observed.Results The total effective rate of the observation group (97.50％) was obviously higher than that of the comrol group(80.00％) (x2 =6.13,P ＜ 0.05).The time of healing,length of hospital stay and the use time of antimicrobial agents in the observation group were (15.11 ±2.43) d,(16.27 ± 1.79) d and (6.06 ± 0.65) d,respectively,which were all lower than those in the control group (t =14.43,13.31,23.29,all P ＜ 0.05).The second operation rate of the observation group (5.00％) was lower than that of the control group(P ＜ 0.05),and the histopathological score in the observation group (7.11 ± 0.53) was higher than that in the control group (P ＜ 0.05).The satisfaction rate of the observation group (100.00％) was obviously higher than that of the control group(x2 =6.49,P ＜ 0.05).Conclusion In the treatment of wound healing of hand trauma,the application of closed negative pressure drainage technology is better,which can effectively control the disease and is worthy of further promotion and use.

Desenvolvimento de escala para avaliar a qualidade de vida de pessoas vivendo com HIV: parte 2 / Development of a quality of life scale for assessment of people living with HIV: part 2

A presente investigação teve como objetivo realizar a parte dois do desenvolvimento da Escala QUALI-HIV, destinada a avaliar a qualidade de vida de pessoas vivendo com HIV. O método desenvolvido caracteriza-se por um estudo metodológico, que contemplou as seguintes fases: Entrevistas com a população para compreender o significado de qualidade de vida para as pessoas vivendo com HIV; Validação de face e conteúdo 2 realizada por meio do comitê de juízes; Avaliação das propriedades psicométricas: análise fatorial exploratória; e, Análise Multitraço Multimétodo. A coleta de dados foi realizada nos Serviços de Atenção Especializada do município de Ribeirão Preto, Estado de São Paulo, Brasil. A amostra foi composta por pessoas que vivem com HIV, maiores de 18 anos, que estavam em acompanhamento nos serviços especializados, e por especialistas na temática do HIV. Para a coleta de dados, utilizou-se um instrumento de acordo com a fase em desenvolvimento. Os dados qualitativos foram analisados pelo software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, e os dados quantitativos, pelos softwares Statistical Package for Social Science versão 20 e Multitrait Analysis Program. Nas entrevistas, participaram 26 pessoas vivendo com HIV e emergiram quatro classes principais sobre a percepção de qualidade de vida: Classe 1 - Peculiaridades enfrentadas no tratamento; Classe 2 - Estigma e diminuição da autoestima; Classe 3 - Saúde como centro da Qualidade de vida; Classe 4 - Viver com expectativas. Na Validação de face e conteúdo 2, participaram cinco especialistas na temática. Os itens da Escala foram avaliados por meio do índice de validade de conteúdo, que apresentou a média de concordância IVC=0,97. A Análise fatorial exploratória contemplou 357 pessoas vivendo com HIV, e a análise das propriedades psicométricas resultou em dados satisfatórios em que foram extraídos quatro fatores, correspondendo à variância explicada de 39,98. O Fator 1, denominado "Impacto da infecção pelo HIV na qualidade de vida", contempla 26 itens; o Fator 2, "Bem estar", abarca 11 itens; o Fator 3, com três itens, está relacionado à "Atividade física"; e o Fator 4, de cinco itens, compreende a "Revelação diagnóstica ". Na Multitraço Multimétodo, participaram 103 pessoas vivendo com HIV. A análise resultou na maioria dos itens com valores aceitáveis de correlação para a validade convergente, e em relação à validade divergente, a Escala QUALI-HIV apresentou resultados satisfatórios, com ajuste de 96,6% da escala como um todo. Diante dos dados resultantes desta pesquisa, conclui-se que a escala desenvolvida apresenta propriedades psicométricas preliminares satisfatórias. A aplicabilidade desta escala poderá atuar como instrumento integrante no cuidar de pessoas vivendo com HIV, exercendo influência no direcionamento da atenção efetiva, de acordo com as necessidades individuais dessas pessoas

The objective of this study was to carry out part 2 of the development of the QUALI-HIV scale, aimed at assessing the quality of life of people living with HIV. The developed method is characterized by a methodological study, which included the following stages stages: Creation of the scale items: Interviews with the population to understand the meaning of quality of life for people living with HIV; Face and content validation 2 performed through the expert committee; Evaluation of psychometric properties: exploratory factor analysis; and Multitrait Multimethod Analysis. Data were collected in specialized care services of the city of Ribeirão Preto, in the state of São Paulo, Brazil. The sample was made up of people living with HIV, over 18 years of age, and who were being followed up in these specialized services and by HIV specialists. An instrument designed according to the development stage was applied for data collection. Qualitative data were analyzed using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRaMuTeQ) software, and quantitative data were analyzed with the Statistical Package for the Social Sciences version 20 and the Multitrait Analysis Program. In the interviews 26 people living with HIV participated and four main classes emerged on the perception of quality of life: Class 1 - Singularities faced during treatment; Class 2 - Stigma and decreased self-esteem; Class 3 - Health at the center of quality of life; Class 4 - Living with expectations. Five experts on the theme participated in Face and content validation 2. The scale items were assessed by means of the content validity index, which provided the mean of agreement CVI=0.97. The Exploratory factor analysis included 357 people living with HIV, and the analysis of psychometric properties resulted in satisfactory data in which four factors were extracted, corresponding to the explained variance of 39.98. Factor 1, named "Impact of the HIV infection on quality of life", has 26 items; Factor 2, "Well-being", presents 11 items; Factor 3, with three items, regards "Physical activity"; and Factor 4, with five items, addresses the "Diagnosis revelation". In Multitrait Multimethod, a total of 103 people living with HIV participated. The analysis resulted in most of the items presented acceptable values of correlation to the converging validity, the QUALI-HIV scale presented satisfactory results, with a total adjustment of 96.6% of the scale. Given the data resulting from this research, it is concluded that the developed scale presents satisfactory preliminary psychometric properties. This applicability of this scale can serve as a tool in the care of people living with HIV, influencing the orientation of effective care, according to the individual needs of this population

Verificación del cumplimiento de la minuta patrón sin eliminación de la muestra en servicios de alimentación escolar: diseño y validación de una metodología / Verification of standard menu compliance without disposing the sample in school feeding services: design and validation of a methodology

RESUMEN Objetivo Tradicionalmente la verificación de la minuta patrón implica la eliminación de la muestra evaluada debido al grado de manipulación a la que es sometida. Se propone una nueva metodología sin eliminación de la muestra en el proceso de evaluación de la minuta patrón, en comparación con la metodología convencional con descarte, y validar su uso en un grupo de comedores escolares en la ciudad de Bogotá. Materiales y Métodos Se llevó a cabo una prueba piloto en nueve comedores, para seleccionar la metodología de implementación más factible, considerando los aspectos de medición de peso y volumen, tiempos de ejecución, temperaturas y riesgo microbio-lógico para componentes sólidos y líquidos. Para el componente líquido se desarrolló una fórmula que establece la relación entre peso y volumen de las bebidas ofrecidas. Resultados Los resultados muestran que no existen diferencias estadísticamente significativas entre las mediciones de peso y volumen obtenidos con la metodología propuesta "Medición por componente en plato tarado" en comparación con la habitual de "Medición por plato completo y descarte de muestra". Conclusión Es necesaria la implementación de una nueva metodología de verificación de la minuta patrón en servicios de alimentación que no implique la eliminación de las muestras y propenda por la disminución de los desperdicios y el ahorro de recursos económicos para las instituciones.(AU)

ABSTRACT Objective Standard menu compliance requires disposing of the sample evaluated due to the high degree of manipulation to which it is subjected. A new methodology is proposed to preserve the sample used during the evaluation process of the standard serving size, compared with the conventional methodology that disposes of it, and to validate its use in a group of school canteens in the city of Bogotá. Materials and Methods A pilot test was carried out in nine canteens to select the most feasible implementation methodology, considering aspects such as weight and volume measurement, execution times, temperatures and microbiological risk for solid and liquid items. Regarding liquid items, a formula was developed to establish the relationship between weight and volume of the beverages offered. Results The results show that there are no statistically significant differences between the weight and volume measurements obtained with the proposed methodology "Measurement by item in tared plate" compared to the usual "Measurement by complete plate and sample disposal". Conclusion It is necessary to implement a new methodology for verifying standard menu compliance in food services that does not imply disposing of samples and encourages waste reduction and savings for schools.(AU)

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation / Construção e Validação Psicométrica do HIPER-Q para Avaliar o Conhecimento de Pacientes Hipertensos em Reabilitação Cardíaca

Abstract Background: The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. Objective: To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. Methods: A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis. Results: The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. Conclusion: The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Resumo Fundamento: A ausência de instrumentos capazes de mensurar o nível de conhecimento de pacientes hipertensos em programas de reabilitação cardíaca sobre sua doença reflete a carência de recomendações específicas para esses pacientes. Objetivo: Construir e validar um questionário para avaliar o conhecimento de hipertensos em programas de reabilitação cardíaca sobre sua doença. Métodos: foram avaliados 184 hipertensos, com média de idade de 60,5±10 anos, 66,8% homens. A reprodutibilidade foi avaliada pelo cálculo do coeficiente de correlação intraclasse, utilizando-se as situações do método de teste-reteste. A consistência interna foi avaliada pelo alfa de Cronbach, e a validade do construto pela análise fatorial exploratória. Resultados: A versão final do instrumento apresentou 17 questões dispostas em áreas de importância para a educação do paciente. O instrumento proposto apresentou um índice de clareza de 8,7 (0,25). O valor do coeficiente de correlação intraclasse foi de 0,804 e do alfa de Cronbach 0,648. A análise fatorial revelou cinco fatores associados às áreas de conhecimento. No que diz respeito à validade de critério, os pacientes com maior escolaridade e maior renda familiar apresentaram maior conhecimento sobre a hipertensão. Conclusão: O instrumento possui índice de clareza satisfatório e validade adequada, podendo ser utilizado para avaliar o conhecimento de hipertensos participantes de programas de reabilitação cardíaca.

Development of a clinical protocol for detection of cervical cancer precursor lesions / Desenvolvimento de protocolo clínico para detecção de lesões precursoras do câncer de colo uterino / Desarrollo de protocolo clínico para detección de lesiones precursoras del cáncer de cuello uterino

ABSTRACT Objective: to develop and validate the content of a clinical protocol aimed at prevention of cervical cancer in primary care. Method: technological research according to the steps: (1) submission of the project to the research ethics committee; (2) bibliographic survey; (3) elaboration of the clinical protocol; and (4) content validation. In the third step, the information was collected through bibliographic research and gynecology specialists were consulted. For the final step, four judges were selected to evaluate the clinical protocol according to AGREE 2. Domains that reached the minimum level of agreement of 75% in the scores were considered validated. Results: the scores obtained in each domain of the instrument were as follows: domain 1 (scope and purpose) = 87.5%; domain 2 (stakeholder involvement) = 83.3%; domain 3 (development rigor) = 79.7%; domain 4 (clarity of presentation) = 76.3%; domain 5 (applicability) = 78.1%; and domain 6 (editorial independence) = 85.4. Conclusion: the clinical protocol proved to be a validated material with scores above the minimum required. The protocol obtained positive recommendations with modifications and went through adjustments in order to make it more effective.

RESUMO Objetivos: desenvolver e validar o conteúdo de um protocolo clínico direcionado à prevenção do câncer cervical na atenção primária. Método: Trata-se de uma pesquisa de desenvolvimento tecnológico em saúde(8) realizada em quatro etapas: (1) submissão do projeto ao comitê de ética em pesquisa; (2) levantamento bibliográfico; (3) elaboração do protocolo clínico; e (4) validação de conteúdo. Na terceira etapa, as informações foram levantadas mediante pesquisa bibliográfica e consultados especialistas em ginecologia. Para a etapa final, foram selecionados quatro juízes que avaliaram o protocolo clínico segundo o AGREE 2. Foram considerados validados os domínios que obtiveram nível de concordância mínimo de 75% nas pontuações. Resultados: as pontuações obtidas, em cada domínio do instrumento, foram as seguintes: domínio 1 (escopo e finalidade)=87,5%; domínio 2 (envolvimento das partes interessadas)=83,3%; domínio 3 (rigor do desenvolvimento)=79,7%; domínio 4 (clareza da apresentação)=76,3%; domínio 5 (aplicabilidade)=78,1%; e domínio 6 (independência editorial)=85,4. Conclusão: o protocolo clínico mostrou-se um material validado com pontuações superiores ao mínimo exigido. Obteve recomendações positivas com modificações e passou por ajustes a fim de torná-lo mais efetivo.

RESUMEN Objetivos: desarrollar y validar el contenido de un protocolo clínico dirigido a la prevención del cáncer cervical en atención primaria. Método: investigación tecnológica conforme a las etapas: (1) sujeción del proyecto al comité de ética en investigación; (2) levantamiento bibliográfico; (3) elaboración del protocolo clínico; y (4) validación de contenido. En la tercera etapa, las informaciones fueron levantadas mediante investigación bibliográfica y consultados especialistas en ginecología. Para la etapa final, fueron seleccionados cuatro jueces que evaluaron el protocolo clínico según el AGREE 2. Fueron considerados válidos los dominios que obtuvieron nivel de concordancia mínimo de 75% en las puntuaciones. Resultados: las puntuaciones obtenidas, en cada dominio del instrumento, fueron las siguientes: dominio 1 (alcance y finalidad) = 87,5%; dominio 2 (implicación de las partes interesadas) - 83,3%; dominio 3 (rigor del desarrollo) = 79,7%; dominio 4 (claridad de la presentación) = 76,3%; dominio 5 (aplicabilidad) = 78,1% y dominio 6 (independencia editorial) = 85,4. Conclusión: el protocolo clínico se mostró como un material válido con puntuaciones superiores al mínimo exigido. Obtuvo recomendaciones positivas con modificaciones y pasó por ajustes a fin de hacerlo más efectivo.