Exploración del discurso de los enfermos crónicos sobre la legalización de la muerte asistida / Exploring the Discourse of Chronically-Ill Patients about the Legalization of Medically-Assisted Death / Exploração do discurso dos doentes crônicos sobre a legalização da morte medicamente assistida

Introducción: las enfermedades crónicas van en aumento e implican múltiples consecuencias que, en un determinado momento, con el paso de los años, pueden llegar a un estado terminal de la enfermedad. El objetivo de este estudio fue analizar el discurso de enfermos crónicos sobre la muerte digna, la eutanasia y el suicidio médicamente asistido para visibilizar la necesidad de la regulación de la muerte digna. Materiales y métodos: se llevó a cabo una investigación cualitativa que se inserta dentro del paradigma del construccionismo social, mediante entrevistas a enfermos crónicos de la Ciudad de México, utilizando una guía semiestructurada. Se empleó el análisis del discurso para encontrar convergencias y diferencias en los discursos. Resultados: se entrevistaron siete personas vía telefónica de enero a marzo del 2022. Las principales enfermedades fueron: lupus, cáncer, artritis, diabetes y ovarios poliquísticos. Los discursos convergen hacia una muerte digna sin dolor, sufrimiento, tranquila y en casa. Coinciden sus discursos en legalizar la eutanasia y el suicidio médicamente asistido; sin embargo, hay divergencias en cuanto a solicitarlas. Conclusiones: la experiencia de la enfermedad crónica es un factor importante para aceptar en un futuro la muerte médicamente asistida, sin ser una carga para otros y evitar el dolor y sufrimiento al final de la vida. La religión influye en las decisiones, pero se puede observar una mayor apertura para aceptar la legalización de la muerte médicamente asistida.

Introduction: Chronic diseases are increasing in frequency and entail multiple consequences that can eventually lead to death. The study aim was to analyze the discourse of chronically-ill patients on death with dignity, euthanasia, and medically-assisted suicide to highlight the need for regulation of death with dignity. Materials and Methods: A qualitative study was conducted within the paradigm of social constructionism. A semi-structured guide was used to conduct interviews with chronically-ill patients in Mexico City. Discourse analysis was performed to identify convergences and differences in the discourses. Results: Seven interviews were conducted by telephone from January to March 2022. The main diseases of the interviewees were lupus, cancer, arthritis, diabetes, and polycystic ovaries. The discourses converged toward a preference for dignified death without pain or suffering that was calm, and occurred at home. The discourses included the topics of legalizing euthanasia and medically-assisted suicide, but the patients differed on whether or not these should be requested. Conclusions: The experience of chronic illness was an important factor in accepting medically-assisted death for the patients, who did not wish to be a burden on others and wanted to avoid pain and suffering at the end of their lives. Religion influenced the patients' decisions, but there was openness to accepting legalization of medically-assisted death.

Introdução: a incidência das doenças crônicas vem aumentando, e têm múltiplas consequências que num determinado momento, ao longo dos anos, podem chegar a um estado terminal da doença. O objetivo deste estudo foi analisar o discurso de pessoas com doenças crônicas sobre morte digna, eutanásia e suicídio medicamente assistido para tornar visível a necessidade de regulamentar a morte digna. Materiais e métodos: foi realizada uma pesquisa qualitativa que se insere no paradigma do construcionismo social. Entrevistas com pacientes crônicos na Cidade do México foram realizadas usando um guia semiestruturado. A análise do discurso foi utilizada para encontrar convergências e divergências nos discursos. Resultados: foram realizadas sete entrevistas por telefone no período de janeiro a março de 2022. As principais doenças foram lúpus, câncer, artrite, diabetes e ovários policísticos. Os discursos convergem para uma morte digna sem dor, sofrimento, tranquila e em casa. Seus discursos coincidem na legalização da eutanásia e do suicídio medicamente assistido; entretanto, há divergências quanto à sua solicitação. Conclusões: a experiência da doença crônica é um fator importante para aceitar a morte medicamente assistida no futuro, sem ser um fardo para os outros e evitando a dor e o sofrimento no final da vida. A religião influencia nas decisões, mas observase uma maior abertura para aceitar a legalização da morte medicamente assistida.

Assessment of depression, anxiety, and stress in COVID-19-positive patients with chronic illness – A comparative study

Background: The physical, social, and emotional difficulties posed by chronic illnesses can result in depression, anxiety, and stress, which are common mental health conditions. The severe acute respiratory syndrome-CoV-2 virus, which causes the novel respiratory illness COVID-19, has had a significant impact on the global population, especially those who already have underlying chronic illnesses. In this study, we tried to evaluate the psychological stress, depression, and anxiety experienced by COVID-positive patients with and without chronic health conditions, while they are quarantined as a result of the COVID-19 pandemic. Aim and Objectives: The objectives of this study were to assess the prevalence of depression, anxiety, and stress among COVID-positive patients and to compare the prevalence of depression, anxiety, and stress among COVID-positive patients with and without chronic illness in a district in North Kerala. Materials and Methods: This observational and cross-sectional study was carried out in a district in the northern state of Kerala, India. A study population of 251 individuals who had positive COVID tests participated in the study. Out of this group, 117 people had chronic health problems such as high blood pressure, diabetes, and heart disease, while the remaining 134 people were without any chronic illness. An online questionnaire including sociodemographics and depression, anxiety, and stress scale -21 was used to evaluate depression, anxiety, and stress among the participants. Results: COVID patients with chronic illnesses experienced severe depression at a rate of 77.8% compared to 20.1% in those without any chronic illness. Patients with chronic illnesses who tested positive for COVID-19 also experienced severe anxiety in 77.8% of cases, compared to the 23.8% of really severe cases of anxiety among COVID patients who do not have any chronic illnesses. Moderate stress levels were observed in 76.06% of COVID patients with chronic illness when compared to 22.4% in those with no comorbidities. Conclusion: According to the study’s findings, people with chronic illnesses experience higher levels of stress, anxiety, and depression than those who do not have those conditions. The existence of such a high prevalence and severity of psychological issues among quarantined patients with COVID-19 underscores the need for serious attention to the mental health status of these patients.

Psicologia na atenção básica: cuidado aos idosos com doenças crônicas não transmissíveis / Psychology in primary care: healthcare for the elderly diagnosed with noncommunicable diseases / Psicología en atención primaria: atención a la salud de los adultos mayores con enfermedades crónicas no transmisibles

OBJETIVO: Este trabalho tem por objetivo compreender como os Determinantes Sociais da Saúde estão presentes nas práticas de cuidado à população idosa com hipertensão arterial sistêmica e diabetes mellitus ofertadas pelas psicólogas da Atenção Básica. MÉTODO: Foi realizada uma pesquisa descritiva e de abordagem qualitativa, a partir de entrevistas semiestruturadas, com 7 psicólogas atuantes em Unidade Básica de Saúde (UBS) e/ou Unidade de Saúde da Família (USF) de Salvador (BA), que atendem o público idoso, tendo ocorrido em plataforma digital. A análise de dados ocorreu através do método hermenêutico-dialético e teve a Psicologia Social Crítica como base teórica. RESULTADOS: Verificou-se que a atuação das psicólogas na Atenção Básica à população idosa com Hipertensão Arterial Sistêmica e Diabetes Mellitus, em sua maioria, é orientada por práticas de promoção da saúde, prevenção à doença e políticas públicas em saúde. Identificou-se, de modo geral, a compreensão dos Determinantes Sociais da Saúde como produtores de iniquidades em saúde nos relatos das psicólogas, tendo sido mapeado somente 2 psicólogas que demonstraram não compreender a categoria 'raça' como um Determinante Social indissociável dos demais. CONCLUSÃO: Observou-se que o campo de atuação da psicologia no contexto da Atenção Básica, guiada pela Psicologia Social Crítica e pela Saúde Coletiva, promovem contribuições teóricas para todos os campos da psicologia.

OBJECTIVE: The study aims to identify the major role of psychologists in the promotion of health and disease prevention of elderly people diagnosed with Systemic Arterial Hypertension and Diabetes Mellitus quality of life. METHOD: A descriptive research with a qualitative approach was carried out, based on semi-structured interviews, with 7 psychologists working in a Basic Health Unit (Unidade Básica de Saúde - UBS) and/or Family Health Unit (Unidade de Saúde da Família - USF) in Salvador (BA), which serve the elderly, having taken place on a digital platform. Data analysis was carried out using the hermeneutic-dialectic method and Critical Social Psychology as a theoretical basis. RESULTS: It was found that the role of psychologists in Primary Care for elderly with Systemic Arterial Hypertension and Diabetes Mellitus is mostly guided by health promotion practices, disease prevention and public health policies. In general, the understanding of the Social Determinants of Health as producers of health inequities was identified in the psychologists' reports, with only 2 psychologists demonstrating that they did not understand the category 'ethnicity' as a Social Determinant inseparable from the others. CONCLUSION: It was identified that the field of action of psychology in the context of Primary Care guided by Critical Social Psychology and Public Health promotes theoretical contributions to all fields of psychology.

OBJETIVO: Este trabajo tiene como objetivo comprender cómo los Determinantes Sociales de la Salud están presentes en las prácticas de atención a la población anciana con hipertensión arterial sistémica y diabetes mellitus ofrecidas por psicólogos de Atención Primaria. MÉTODO: Se realizó una investigación descriptiva con enfoque cualitativo, basada en entrevistas semiestructuradas, con 7 psicólogos que actúan en una Unidad Básica de Salud (Unidade Básica de Saúde - UBS) y/o Unidad de Salud de la Familia (Unidade de Saúde da Família - USF) en Salvador (BA), que atienden al público mayor, teniendo lugar en una plataforma digital. El análisis de los datos se realizó a través del método hermenéutico-dialéctico y tuvo como base teórica la Psicología Social Crítica. RESULTADOS: Se constató que el trabajo de los psicólogos en la Atención Básica para ancianos con Hipertensión Arterial Sistémica y Diabetes Mellitus, en su mayoría, está orientado por prácticas de promoción de la salud, prevención de enfermedades y políticas públicas de salud. En general, la comprensión de los Determinantes Sociales de la Salud como productores de inequidades en salud fue identificada en los informes de los psicólogos, siendo mapeados solo 2 psicólogas que demostraron no entender la categoría raza como un Determinante Social inseparable de los demás. CONCLUSIÓN: Se observó que el campo de la psicología en el contexto de la Atención Primaria orientado por la Psicología Social Crítica y la Salud Colectiva promueve aportes teóricos para todos los campos de la psicología.

Morbidities, Self-reported Health, Purpose, and Satisfaction with Life in Older Adults / Morbidades, Autoavaliação de Saúde, Propósito e Satisfação com a Vida em Idosos / Morbilidades, Autoevaluación de Salud, Propósito y Satisfacción con la Vida en Adultos Mayores

Abstract This study aims to estimate the prevalence of overall satisfaction with life regarding sense of purpose in life, morbidities, and self-reported health, and to identify their direct and indirect associations among the domains in community-dwelling older adults. The research has a cross-sectional design, and we evaluated 419 older adults. Morbidities were assessed using a dichotomous question; self-reported health and satisfaction with life were assessed using a 5-point Likert scale; and sense of purpose was assessed using the Ryff and Keyes 10-item scale. An analysis of structural equations was conducted using Path Analysis. The relationship between morbidities and overall satisfaction with life was mediated by self-reported health; purpose in life mediated the relationship between self-reported health and overall satisfaction with life. Beyond managing chronic illnesses, subjective assessments of health and well-being are key to successful aging.

Resumo Este estudo teve como objetivo estimar a prevalência de satisfação global com a vida e referenciada a domínios, propósito de vida, morbidades e autoavaliação de saúde e identificar associações diretas e indiretas de morbidades, autoavaliação geral de saúde e propósito de vida com satisfação global com a vida em idosos comunitários. Trata-se de um delineamento transversal que avaliou 419 idosos. Morbidades foram avaliadas por questão dicotômica, autoavaliação de saúde e satisfação com a vida por escala tipo Likert de 5 pontos, e propósito pela escala de 10 itens de Ryff e Keyes. Utilizou-se análise de equações estruturais via análise de caminhos. A relação entre morbidades e satisfação global com a vida foi mediada pela autoavaliação de saúde; propósito de vida mediou a relação entre autoavaliação de saúde e satisfação global com a vida. Além do tratamento de doenças crônicas, avaliações subjetivas da saúde e bem-estar são essenciais para o envelhecimento bem-sucedido.

Resumen Este estudio tuvo como objetivo estimar la prevalencia de satisfacción global con la vida y referenciada a los dominios propósito de vida, morbilidades y salud autoevaluada, e identificar asociaciones directas e indirectas de morbilidades, autoevaluación general de salud y propósito con la satisfacción general con la vida en adultos mayores comunitarios. Es un diseño transversal que evaluó a 419 adultos mayores. Las morbilidades se evaluaron mediante una pregunta dicotómica, la autoevaluación de salud y la satisfacción con la vida por la escala Likert de 5 puntos, y el propósito mediante la escala de 10 ítems de Ryff y Keyes. Se utilizó análisis de ecuaciones estructurales vía análisis de trayectoria. La relación entre morbilidades y satisfacción general con la vida estuvo mediada por autoevaluación de la salud; el propósito de vida medió la relación entre autoevaluación de salud y satisfacción general con la vida. Más allá del manejo de enfermedades crónicas, las evaluaciones subjetivas de salud y bienestar son clave para un envejecimiento exitoso.

Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas / Care models at the second level: Experience of the Medical Specialties Unit

Resumen Objetivo: Reportar la implementación y los beneficios del Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas, su utilidad en el manejo y seguimiento de los pacientes con enfermedades crónicas. Material y métodos: Se lograron implementar 9 consultorios de atención médica de la siguiente forma, 2 de Endocrinología, 3 consultorios de Clínica de Enfermedades Crónicas, uno de educación en diabetes e hipertensión, así como 3 de apoyo nutricional. Se midió valores absolutos del número de consultas durante los años 2017, 2018, 2019 y parte del 2020. Así mismo se buscó identificar las patologías más prevalentes con la idea en tener un mejor control y seguimiento de los pacientes, con una mejor organización de personal de atención médico y de enfermería. Resultados y discusión: Se lograron incrementar los números de consulta, con un control y seguimiento más estricto de los pacientes, además de los beneficios en cuanto a la formación y capacitación de médicos residentes, generales tanto militares como profesionales de la salud civiles para enfrentar estos padecimientos prevalentes en nuestro país.

Abstract Objective: To report the implementation as well as the benefits of the Comprehensive Care Model at the second level: Experience of the Medical Specialties Unit, and assess its usefulness in the management and monitoring of patients with chronic diseases. Material and methods: 9 medical care clinics were implemented as follows, 2 for Endocrinology, 3 Clinics for Chronic Diseases, one for education in diabetes and hypertension, as well as 3 for nutritional support. Absolute values of the number of consultations were measured during the years 2017, 2018, 2019 and part of 2020. Likewise, it was sought to identify the most prevalent pathologies with the idea of having a better control and monitoring of patients, with a better organization of medical and nursing care personnel. Results and discussion: It was possible to increase the consultation numbers, with a stricter control and monitoring of patients, in addition to the benefits in terms of training and training of resident doctors, both military generals and civilian health professionals to face these prevalent conditions in our country.

Effectiveness of an Intervention Package on Life Skill Education among Children with Speci c Chronic Illness

Life skill education develops young people'#39;s capacity o engage in positive behaviours that nurture their own well-being, set personal goals, and grow successfully as self-suf cient adults. The life skills education of children helps develop a concept of oneself as a person of worth and dignity. In the present study 28 Government high school children of 8 and 9 standard of both genders in the age group 13-15 with asthma and epilepsy were selected for the study. Once the children and parents expressed the interest in taking part in the study, home visit and school visits were conducted to collect information from the parents. In-depth interview and FGD (Focus Group Discussion) were conducted for children, parents and teachers to obtain the information as complete as possible on the participants'#39; past and current illness and its management. The results were classi ed under four themes '#39;perception on children with chronic illnesses'#39;, '#39; rst aid management in the school'#39;, '#39;Safety and security during rst aid management'#39; and '#39;Peer group support'#39;. FGD with parents arrived with three themes were '#39;Perception on children with speci c chronic illness'#39;, '#39;First aid management in the school'#39; and '#39;Peer group support'#39;. In-depth interview with class teacher: 50 percent teachers were ready to give care for children but 50 percent of the teachers stated that they have no time to give special care besides some risky involved in providing care. There was no special system of education for the children with chronic illness.

Características y experiencias de los cuidadores familiares en el contexto de la salud mental / Characteristics and experiences of family caregivers in the mental health setting

RESUMEN Objetivo. Describir las características y experiencias de los cuidadores familiares de personas con trastorno mental, atendidos en una institución de alta complejidad. Materiales y métodos. Estudio de método mixto, explicativo, con una secuencia inicial cuantitativa y luego cualitativa. La fase cuantitativa se realizó mediante instrumentos validados: ficha de caracterización de la díada persona con enfermedad crónica-cuidador familiar; el inventario de habilidad de cuidado (CAI) de Nkongho, y la escala de sobrecarga de Zarit. La fase cualitativa se realizó con un enfoque fenomenológico hermenéutico, la información se recolectó mediante entrevistas en profundidad para comprender las necesidades de los cuidadores. Resultados. Los cuidadores fueron, en su mayoría, mujeres, principalmente madres e hijas, con educación básica primaria, ocupación hogar y dedicados al trabajo independiente, nivel socioeconómico bajo, nivel de habilidad de cuidado bajo y un importante número de cuidadores perciben algún grado de sobrecarga. Los temas identificados en el análisis de las entrevistas fueron: sintiendo miedo ante la enfermedad; la experiencia del cansancio del cuidador; perder el trabajo: otro costo de la enfermedad; el temor de delegar el cuidado; el amor: un soporte para el cuidador; necesitando apoyo para cuidar. Conclusiones. El cuidador experimenta una situación compleja asociada con la gran demanda de cuidados, y condiciones en que progresa la alteración de la salud mental.

ABSTRACT Objective. To describe the characteristics and experiences of family caregivers of persons with mental disorders in a highly complex institution. Materials and methods. Mixed method, explanatory study, with an initial quantitative and then qualitative sequence. The quantitative phase was carried out using validated instruments: characterization sheet of the person with chronic illness-family caregiver dyad; the Nkongho Caregiving Ability Inventory (CAI), and the Zarit burden scale. The qualitative phase was conducted with a hermeneutic phenomenological approach; the information was collected through in-depth interviews to understand the needs of the caregivers. Results. The caregivers were mostly women, mainly mothers and daughters, home-occupied and self-employed, with basic primary education, low socioeconomic level and low caregiving skill level; a significant number of caregivers perceived some degree of overload. The themes identified in the analysis of the interviews were: feeling fear before the disease; the experience of caregiver fatigue; losing one's job: another cost of the disease; fear of delegating care; love: a support for the caregiver; needing support to care. Conclusions. The caregiver experiences a complex situation associated with the high demand for care, and conditions under which mental health impairment progresses.

Incidence of multimorbidity and associated factors during the COVID-19 pandemic in Brazil: a cohort study

ABSTRACT BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, access to healthcare services may have become difficult, which may have led to an increase in chronic diseases and multimorbidity. OBJECTIVES: To assess the incidence of multimorbidity and its associated factors among adults living in the state of Rio Grande do Sul, Brazil. DESIGN AND SETTING: Cohort study conducted in Rio Grande do Sul, Brazil. METHODS: We included data from the two waves of the Prospective Study About Mental and Physical Health (PAMPA). Data were collected via online questionnaires between June and July 2020 (wave 1) and between December 2020 and January 2021 (wave 2). Multimorbidity was defined as the presence of two or more diagnosed medical conditions. RESULTS: In total, 516 individuals were included, among whom 27.1% (95% confidence interval, CI: 23.5-31.1) developed multimorbidity from wave 1 to 2. In adjusted regression models, female sex (hazard ratio, HR: 1.97; 95% CI: 1.19-3.24), middle-aged adults (31-59 years) (HR: 1.78; 95% CI: 1.18-2.70) and older adults (60 or over) (HR: 2.41; 95% CI: 1.25-4.61) showed higher risk of multimorbidity. Back pain (19.4%), high cholesterol (13.3%) and depression (12.2%) were the medical conditions with the highest proportions reported by the participants during wave 2. CONCLUSION: The incidence of multimorbidity during a six-month period during the COVID-19 pandemic was 27.1% in the state of Rio Grande do Sul, Brazil.

Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study

ABSTRACT BACKGROUND: Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed. OBJECTIVE: To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults. DESIGN AND SETTING: Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district. METHODS: The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age. RESULTS: Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001). CONCLUSIONS: To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.

Manejo familiar no cuidado à criança em condição crônica egressa da Unidade de Terapia Intensiva Neonatal: um estudo de métodos mistos / Family management in the care of chronic children leaving from the neonatal intensive care unit: a mixed methods study

A condição crônica na infância exige da família a continuidade do cuidado ao longo do tempo, com ações que contemplem a vigilância e monitoramento das diferentes necessidades e demandas das crianças. Este estudo teve como objetivo analisar o manejo familiar no cuidado à criança com condição crônica egressa de UTIN (Unidade de Terapia Intensiva Neonatal) sob a perspectiva dos familiares. Trata-se de um estudo misto do tipo paralelo convergente (QUAN+QUAL), tendo o Modelo de Estilo de Manejo Familiar como quadro teórico. Participaram familiares de crianças com condições crônicas egressas de Unidade de Terapia Intensiva Neonatal do sudeste do Brasil. No momento da entrevista as crianças estavam na faixa etária de 2 anos a 2 anos 11 meses e 29 dias. Para a coleta de dados quantitativos foi utilizado o instrumento Medida de Manejo Familiar (Family Management Measure ­ FaMM) e um questionário de caracterização sociodemográfica. Os dados quantitativos foram analisados por meio do programa estatístico Stata 15. Os dados qualitativos foram produzidos por meio de entrevista semiestruturada e submetidos à Análise de Conteúdo Dirigida. O projeto foi aprovado pelo Comitê de Ética em Pesquisa (CEP) da Universidade Federal de Minas Gerais com parecer favorável 3.508.414 e parecer 4.103.704; e do Comitê de Ética do Hospital Sofia Feldman/ Fundação de Assistencial Integral à Saúde com parecer favorável 3.550.836 e parecer 4.112.532. Obteve-se a participação de 53 famílias de crianças com condições crônicas egressas da UTIN, 34 crianças egressas do Hospital Filantrópico (64,15%) e 19 crianças egressas do Hospital Federal (35,85%). A maioria das crianças era do sexo masculino (66,04%), com média de idades (em anos) de 2,73 anos. Com base nas convergências e divergências dos dados qualitativos e quantitativos tem-se que as famílias focam na perspectiva da normalidade da criança com condição crônica, para minimizar os impactos advindos do cuidar dela no domicílio. A condição crônica ainda precisa ser aceita por parte dos familiares e, sendo parte da visão que possuem do impacto da condição, pode ser um dificultador para o manejo familiar. O apoio e parceria do casal estão presentes no compartilhamento das ações de cuidado. A maioria das famílias apresentou maior facilidade para atender às necessidades de cuidado do filho com condição crônica no domicílio. Condições sociais e econômicas favoráveis contribuíram para a capacidade da família em cuidar da criança com condição crônica. Diante da necessidade do cuidado prolongado no domicílio fez com que muitas mães tidas como cuidadoras principais, deixassem seus serviços para dedicarem integralmente o cuidado ao filho. Conclui-se que as famílias possuem uma visão positiva da situação de cuidar das crianças com condições crônicas egressas da UTIN no domicílio. Embora cada família seja única, elas percebem o cuidado à criança com condição crônica de forma similar, normalizando a sua condição. Existe relação entre o contexto de vida das famílias e a habilidade de manejo da criança em condição crônica. Poder contar com o companheiro ou outros membros da família pode melhorar o manejo dessas famílias. Dessa forma, faz-se necessário que a enfermagem esteja presente no contexto familiar como fonte de apoio e promovendo intervenções necessárias para manter o funcionamento da unidade familiar.

The chronic condition in childhood requires continuity of care from the family over time, with actions that include surveillance and monitoring of the different needs and demands of children. This study aimed to analyze family management in the care of children with a chronic condition discharged from the NICU (Neonatal Intensive Care Unit) from the perspective of family members, in the light of the Family Management Style Framework. It is a mixed study of the convergent parallel type (QUAN-QUAL), having the Family Management Style as a theoretical framework. Family members of children with chronic conditions from a Neonatal Intensive Care Unit in southeastern Brazil participated. At the time of the interview, the children were aged between 2 years and 2 years 11 months and 29 days. For the collection of quantitative data, the instrument Family Management Measure ­ FaMM and a questionnaire of sociodemographic characterization were used. Quantitative data were analyzed using the statistical program Stata 15. Qualitative data were produced through semi-structured interviews and submitted to Directed Content Analysis. The project was approved by the Research Ethics Committee (CEP) of the Federal University of Minas Gerais with a favorable opinion 3,508,414 and opinion 4,103,704; and the Ethics Committee of Hospital Sofia Feldman/ Integral Health Assistance Foundation with favorable opinion 3,550,836 and opinion 4,112,532. The participation of 53 families of children with chronic conditions from the NICU, 34 children from the Philantropic Hospital (64.15%) and 19 children from the Federal Hospital (35.85%) participated. Most children were male (66.04%), with a mean age (in years) of 2.73 years. Based on the convergences and divergences of qualitative and quantitative data, families focus on the perspective of the normality of the child with a chronic condition, to minimize the impacts arising from caring for the child at home. The chronic condition still needs to be accepted by family members and, as part of their view of the impact of the condition, it can be a hindrance to family management. The couple's support and partnership are present in the sharing of care actions. Most families found it easier to meet the care needs of a child with a chronic condition at home. Favorable social and economic conditions contributed to the family's ability to care for a child with a chronic condition. Faced with the need for long-term care at home, many mothers, considered the main caregivers, left their services to fully dedicate the care to the child. It is concluded that families have a positive view of the situation of caring for children with chronic conditions who leave the NICU at home. Although each family is unique, they perceive care for children with a chronic condition in a similar way, normalizing their condition. There is a relationship between the family's life context and the ability to manage a child with a chronic condition. Being able to count on a partner or other family members can improve the management of these families. Thus, it is necessary for nursing to be present in the family context as a source of support and promoting necessary interventions to maintain the functioning of the family unit.

Factores asociados a la salud autoevaluada en personas costarricenses: resultados para la cohorte de jubilación de CRELES / Factors associated with self-rated health in Costa Ricans: results for the CRELES retirement cohort

Resumen Introducción: La salud autoevaluada se ha considerado como una medida subjetiva del estado de salud general. El objetivo de este estudio consistió en identificar factores asociados a la salud autoevaluada en personas adultas costarricenses. Métodos: la muestra provino de un estudio de corte transversal que incluyó 992 hombres y 1570 mujeres participantes de una nueva corte de jubilación del proyecto Costa Rica: Estudio de Longevidad y Envejecimiento Saludable, referido como CRELES-RC. La salud autoevaluada se midió a través de una sola pregunta sobre la valoración del estado de salud, con cinco opciones de respuesta: excelente, muy buena, buena, regular y mala. Se calcularon odds ratios (OR) para cuantificar la contribución de las enfermedades crónicas y otros factores con una mala salud autoevaluada. Resultados: por un lado, los modelos de regresión logística determinaron que la salud autoevaluada se asocia con la zona de residencia, el nivel educativo, la percepción de la situación económica, la actividad física, el apoyo emocional y la presencia de enfermedad crónica. Por otro lado, las personas con alguna enfermedad crónica, excepto cáncer, evidenciaron una peor salud autoevaluada; la relación más fuerte se presentó con la artritis, la enfermedad pulmonar y la diabetes. Conclusiones: el estudio identificó que la zona de residencia, la actividad física, el nivel educativo, el apoyo emocional y la enfermedad crónica podrían afectar la salud de las personas.

Abstract Introduction: Self-rated health has been considered a subjective measure of general health status. We aim was identified factors associated with self-rated health in the Costa Ricans adult population. Methods: a population cross-sectional study with a total of 992 men and 1570 women representing a new retirement cohort participating in the project Costa Rica: Longevity and Healthy Aging Study and referred to as CRELES-RC. Self-rated health was measured through a single question on the assessment of health status that considers five options: excellent, very good, good, fair and poor. Odds ratios (OR) were calculated to quantify the contribution of chronic diseases and other factors to poor self-rated health. Results: The logistic regression models determined that self-rated health is associated with the area of residence, educational level, perception of the economic situation, physical activity, emotional support and the presence of chronic disease. People with a chronic disease, except cancer, indicate poorer self-rated health. The strongest relationship was with arthritis, lung disease, and diabetes. Conclusions: the study allowed to identify that the area of residence, education, physical activity, emotional support and chronic illness could affect people's health.

Physical activity and sedentary behavior as multimorbidity discriminators among elderly Brazilians: a cross-sectional study

ABSTRACT BACKGROUND: Associations between behaviors and individual chronic diseases have been demonstrated. However, the relationship between time spent on sedentary behavior and multimorbidity remains less clear. OBJECTIVE: To identify the predictive power of various intensities of physical activity versus sedentary behavior, as discriminatory factors for cardiometabolic multimorbidity (cardiovascular diseases and diabetes) in the elderly. DESIGN AND SETTING: Cross-sectional study in different residential census tracts and residential households in Florianópolis (SC). METHODS: The participants were 425 elderly people (65% women) from the EpiFloripa Aging study in 2014. Sociodemographic variables and self-reported incidence of cardiovascular diseases and diabetes were obtained via a questionnaire. Light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) were measured using accelerometers. The analyses were stratified according to sex and included a diagnosis for interpretation. Behaviors were taken into consideration if their predictive power in terms of area under the receiver operating characteristic (ROC) curve was greater than 0.50. The time cutoff point was defined from sensitivity and specificity. RESULTS: For older adult men with diabetes, the predictive value of MVPA for absence of multi-morbidity was an area of 0.75 (95% confidence interval, CI: 0.538-0.962), and a cutoff of 17 minutes per day. Older adult women with diabetes had an area of 0.71 (95% CI: 0.524-0.866) and a cutoff of 10 minutes per day. LPA and SB did not present predictive values. CONCLUSION: The time spent on MVPA is a predictor of absence of multimorbidity in elderly people with diabetes, for both sexes.

Prevalencia del deterioro cognitivo en personas mayores de 60 años, en un consultorio médico de la región de Altahabana (Cuba), perteneciente al Municipio Boyeros. Año 2020 / Prevalence of cognitive impairment in people over 60 years old at a medical office in the region of Altahabana (Cuba), belonging to the Boyeros Municipality. Year 2020

El deterioro cognitivo es un problema de salud a nivel mundial, el cual se ha convertido en uno de las mayores demandas de atención médica en las personas mayores. Con el objetivo de determinar la prevalencia del deterioro cognitivo en las personas mayores de 60 años, se realizó un estudio descriptivo, con carácter retrospectivo de corte transversal a 323 adultos mayores en el Consultorio Médico de la Familia # 20, ubicado en la región de Altahabana, perteneciente al Policlínico Universitario "Federico Capdevila" del Municipio Boyeros (Cuba). El estudio se realizó entre enero y diciembre de 2020. Se encontró que el 31% de las personas mayores, pertenecen al grupo de edades de 65 a 69 años, con un predominio del género femenino en un 61%. El nivel de escolaridad universitario estuvo presente en un 57,5%. El deterioro cognitivo de las personas mayores prevaleció en un 14%; la hipertensión arterial, en un 64,8% fue la enfermedad crónica no transmisible que más se asoció al deterioro cognitivo.

Cognitive impairment is a global health problem, which has become one of the greatest demands for medical care in older people. In order to determine the prevalence of cognitive impairment in people over 60 years of age, a descriptive, retrospective, cross-sectional study was carried out on 323 older adults in the Family Medical Clinic # 20, located in the Altahabana region, belonging to the "Federico Capdevila" University Polyclinic of the Boyeros Municipality (Cuba). The study was carried out between January and December 2020. It was found that 31% of the elderly belong to the 65 to 69 age group, with a 61% predominance of the female gender. The level of university education was present in 57.5%. Cognitive impairment in the elderly prevailed in 14%; arterial hypertension, in 64.8%, was the chronic non-communicable disease that was most associated with cognitive deterioration.

El consumo de medicamentos en pacientes de la tercera edad / The consumption of medicines in elderly patients

Introducción: Los adultos mayores generalmente presentan diferentes patologías, lo que implica un alto consumo de medicamentos, con lo cual, este grupo poblacional constituye uno de los que mayor cantidad de errores pueden cometer en el uso de fármacos. Objetivo: Evaluar el comportamiento del consumo de fármacos en una población perteneciente a la tercera edad. Métodos: Se realizó un estudio descriptivo de corte transversal en un consultorio médico del municipio Arroyo Naranjo de La Habana en el período entre octubre de 2018 y mayo de 2019. La población estuvo conformada por 365 pacientes geriátricos con diagnóstico de enfermedad crónica no transmisible (ECNT). Se realizó un muestreo al azar para un total de 67 pacientes seleccionados. Las variables analizadas fueron: edad, sexo, ECNT asociada y medicamentos consumidos. Los datos fueron obtenidos mediante revisión de historias clínicas y entrevistas realizadas. Se realizó un análisis porcentual para determinar prevalencia en cada variable analizada. Resultados: Los medicamentos que más destacaron en la muestra fueron los antihipertensivos e hipoglucemiantes. El consumo de medicamentos fue superior en los pacientes de 75 años en adelante y fundamentalmente en las mujeres. Los hombres, por su parte, constituyeron los más irresponsables en la adherencia al tratamiento. Conclusiones: Existió correspondencia entre los tratamientos y las patologías en la mayoría de los casos con excepción de algunos pacientes en los que la relación beneficio-riesgo del tratamiento no se cumplió totalmente. Sin embargo, de manera global, se considera que no existe un adecuado uso de los medicamentos en la muestra(AU)

Introduction: Aged adults generally have different pathologies, which implies high consumption of drugs, with which, this population group is one of those that can make the higher number of errors when using medication drugs. Objective: To evaluate the behavior of drug use in an elderly population. Methods: A descriptive cross-sectional study was carried out in a medical office in Arroyo Naranjo municipality, Havana, from October 2018 to May 2019. 365 geriatric patients made up the population they had diagnosis of chronic non-communicable disease (NCD). A random sampling was carried out for a total of 67 selected patients. The variables analyzed were age, sex, associated NCD, and medications used. The data were obtained by studying medical records and interviews. A percentage analysis was carried out to determine prevalence in each variable analyzed. Results: The drugs that stood out the most in the sample were antihypertensive and hypoglycemic drugs. The consumption of drugs was higher in patients aging 75 years and older and mainly in women. Men were the most irresponsible in adherence to treatment. Conclusions: There was correspondence between the treatments and the pathologies in most cases with the exception of some patients in whom the benefit-risk ratio of the treatment was not fully met. However, generally, it is considered that there is no adequate use of the drugs in the sample(AU)

Epidemiologia, complicações e fatores associados à doença crítica crônica em pacientes hospitalizados por trauma em unidade de terapia intensiva / Epidemiology, complications, and factors associated with chronic critical illness in patients hospitalized by trauma in an intensive care unit

A doença crítica crônica (DCC) descreve pacientes que sobreviveram ao episódio inicial de doença crítica, mas que permanecem dependentes da unidade de terapia intensiva (UTI) por períodos prolongados ou pelo resto de suas vidas. O presente estudo objetivou caracterizar pacientes traumatizados e hospitalizados na Unidade de Terapia Intensiva com Doença Crítica Crônica. Foram coletados dados de internações por trauma UTI no interior do Paraná de 2013 a 2016, dessa maneira, foi traçado o perfil epidemiológico e realizado associações e comparação dos grupos analisados (total de pacientes traumatizados hospitalizados em UTI em comparação com os pacientes traumatizados que desenvolveram DCC). Notou-se que dos 417 indivíduos traumatizados investigados, 41 (9,8%) foram classificados com DCC. Além disso, o sexo masculino, menor índice de comorbidades, maior gravidade do trauma e ferimentos contusos estiveram relacionados ao desenvolvimento da DCC. Os pacientes com DCC apresentaram complicações cirúrgicas (87,8%), e 41,5% evoluíram a óbito. Portanto, os pacientes com DCC permanecem por longo período na UTI (com uma média de 19,88 dias), os quais necessitam de cuidados intensivos de enfermagem e da equipe multiprofissional.(AU)

Chronic critical illness (CCI) describes patients who survived the initial episode of critical illness, but who remain dependent of the intensive care unit (ICU) for extended periods or for the rest of their lives. This study aimed at characterizing traumatized patients hospitalized in the Intensive Care Unit with Chronic Critical Illness. Data from ICU trauma hospitalizations in the interior of the state of Paraná were collected from 2013 to 2016, and with them, the epidemiological profile was drawn up, associations were made, and the analyzed groups were compared (total traumatized patients hospitalized in the ICU compared to traumatized patients who developed CCI). It was observed that from the 417 traumatized individuals investigated, 41 (9.8%) were classified as having CCI. In addition, it was observed that gender (male), a lower rate of comorbidities, greater severity of trauma, and blunt injuries were related to the development of CCI. Patients with CCI had surgical complications (87.8%), and 41.5% died. Therefore, CCI remain in the ICU for a long period (with an average of 19.88 days), which require intensive nursing care and the use of a multidisciplinary team.(AU)

Praxiologia do cuidado de saúde homens que convivem com a Diabetes e a Hipertensão Arterial / Health care praxiology men living with diabetes and hypertension / Hombres de praxiología de la salud que viven con diabetes e hipertensión

Objetivo: Aprender as práticas de cuidado de saúde exercitadas por homens em situação de adoecimento crônico. Método: Estudo qualitativo realizado com 38 homens idosos que conviviam com a Diabetes e a Hipertensão Arterial Sistêmica em um município da Bahia, Brasil. Realizamos entrevista individual submetida à análise pelo método do Discurso do Sujeito Coletivo, suportado pela Teoria das Transições. Resultados: A praxiologia do cuidado de saúde dos homens esteve configurada pelo desenvolvimento de aprendizados e aquisições de habilidades específicas sobre a doença crônica; reeducação familiar; adesão às terapêuticas tradicionais face a utilização dos fitoterápicos, de saberes ancestrais e populares; a promoção de atividade física e repouso; o controle de modificações nos órgãos e no corpo e a promoção do bem-estar psicológico e a superação do sofrimento. Conclusão: As práticas de cuidado estão constituídas a partir das vivências masculinas na experiência do adoecimento crônico pela Diabetes Mellitus e a Hipertensão Arterial, que ao seu modo, implicam em mobilizações das masculinidades ao encontro de atos, atitudes, ações direcionadas à convivência com a doença, o seu enfrentamento e a significação a partir das oportunidades e dos acessos que estão disponíveis no território.

Objective: Objective: To learn the health care practices exercised by men in a situation of chronic illness. Method: Qualitative study carried out with 38 elderly men who lived with Diabetes and Systemic Arterial Hypertension in a city in Bahia, Brazil. We conducted an individual interview submitted to analysis using the Collective Subject Discourse method, supported by the Transition Theory. Results: The praxiology of men's health care was shaped by the development of learning and the acquisition of specific skills about chronic disease; family reeducation; adherence to traditional therapies in view of the use of herbal medicines, ancestral and popular knowledge; the promotion of physical activity and rest; the control of changes in organs and body and the promotion of psychological well-being and the overcoming of suffering. Conclusion: Care practices are constituted from male experiences in the experience of chronic illness due to Diabetes Mellitus and Arterial Hypertension, which, in their own way, imply mobilizations of masculinities to meet acts, attitudes, actions directed to living with the disease, its confrontation and the significance from the opportunities and accesses that are available in the territory.

Objetivo: Conocer las prácticas asistenciales que ejercen los hombres en situación de enfermedad crónica. Método: Estudio cualitativo realizado con 38 hombres mayores que vivían con Diabetes e Hipertensión Arterial Sistémica en una ciudad de Bahía, Brasil. Realizamos una entrevista individual sometida a análisis utilizando el método del Discurso Colectivo del Sujeto, apoyado en la Teoría de la Transición. Resultados: La praxiología del cuidado de la salud de los hombres fue moldeada por el desarrollo del aprendizaje y la adquisición de habilidades específicas sobre enfermedades crónicas; reeducación familiar; adherencia a las terapias tradicionales en vista del uso de hierbas medicinales, conocimientos ancestrales y populares; la promoción de la actividad física y el descanso; el control de los cambios en los órganos y el cuerpo y la promoción del bienestar psicológico y la superación del sufrimiento. Conclusión: Las prácticas de cuidado se constituyen a partir de vivencias masculinas en la vivencia de enfermedad crónica por Diabetes Mellitus e Hipertensión Arterial, que, a su manera, implican movilizaciones de masculinidades para enfrentar actos, actitudes, acciones encaminadas a convivir con la enfermedad. , su enfrentamiento y la trascendencia de las oportunidades y accesos que se encuentran disponibles en el territorio.

Patient Assessment of Chronic Illness Care (PACIC) of diabetes in the out-patient department of a private hospital

Background@#Patient-centered outcomes in chronic care assessed through Quality of Health Care can be measured by its congruence to the Chronic Care Model (CCM) using Patient Assessment of Chronic Illness Care (PACIC). Behavioral and quality measures that influence the patient’s perception of the quality of care remain unknown.@*Objective@#This study aimed to assess the quality of chronic illness care among diabetic patients using PACIC and its relationship to socio-demographic factors.@*Methods@#A cross-sectional study involving diabetic patients of the Out-Patient Department of a private hospital were enrolled through non-probability sampling. Overall score from the PACIC questionnaire, its subscale scores and its relationship with the socio-demographic factors were determined using descriptive statistics.@*Results@#All participants were married and living with their families. Median age was 58. The over- all PACIC score was 3.53 + 0.72 SD. Problem solving/Contextual subscale presented the highest score while follow up/coordination had the least. Those who have college degrees had significantly lower mean scores than high school graduates (p-value = 0.032).@*Conclusion@#PACIC scores indicate a moderate to high quality of care. PACIC is a practical instrument that can be used in quality assessment and improvement programs.

Disability and socio-occupational functioning in persons with schizophrenia

Background: Schizophrenia is a chronic mental illness which severely affects the functioning of individuals in their daily life. Functional disability in chronic illness is one of the major concerns for mental health professionals. The study aims to assess the disability of persons with schizophrenia and its relationship with age of onset, total duration of illness, and socio-occupational functioning. Methods and materials: The present study is a descriptive cross-sectional study. Sixty persons with schizophrenia were selected using simple random sampling from the outpatient department (OPD). Written informed consent was taken from the participants who fulfilled the inclusion and exclusion criteria. Clarifications were made regarding the basic purpose of the study before administration of tools. The study was undertaken with the permission of the Scientific Advisory and Institute Ethics committees. Sociodemographic datasheet, the revised Kuppuswamy scale, the Brief Psychiatric Rating Scale (BPRS), the Indian Disability Evaluation and Assessment Scale (IDEAS), and the Social Occupational Functioning Scale (SOFS) were administered. Collected data were analysed using the software (Statistical Package for the Social Sciences [SPSS] 25.0) using the statistical methods of mean, standard deviation, frequency, percentage, and Pearson correlation. Results: The findings showed that most of the respondents (71.7%) were having moderate level of disability and moderate impairment (40%) in socio-occupational functioning. The global score of disability has a significant positive correlation with total duration of illness (r=0.255, p<0.05) and negative correlation with age of onset of illness (r=-0.075), and there is significant positive correlation (r=0.829, p<0.01) between socio-occupational functioning and global disability. Conclusion: Disability has an impact on socio-occupational functioning in persons with schizophrenia. A higher level of disability can lead to higher level of impairment.

Translation and Validation of Patient Activation Measure (PAM R-13) in Kannada Language

In a country like India with a large population, with diverse culture, socioeconomic status and educational levels, there is a need to translate a Patient Activation Scale Measure (PAM®13) into a regional language which will reduce the language barrier, increases the understanding of patient’s disease condition, and improves their self-management skills. Hence, a reliable and validated instrument ‘Patient Activation Measure (PAM®13)’ is used for evaluating patient’s awareness, skills, and trust in self-management of disease. We wanted to translate and validate the PAM®-13 questionnaire in Kannada language and assess activation levels in diabetes mellitus patients. METHODSA cross-sectional analysis done among 200 adults with diabetes mellitus who speak Kannada. Patients of diabetes mellitus, aged 18 - 85 years from both sexes were included in the study. The PAM®-13 – was translated as recommended by World Health Organisation’s procedure for cross-cultural validation and adaptation of self- report measures. This involved forward translation, synthesis, backward translation, pre-testing and the final version which was performed by the professionals of Kannada and English language. Data was analysed using SPSS ver. 24.0 for mean, median, standard deviation, Pearson’s correlation and Spearman’s correlation. Stata 14 was used to analyse internal consistency using Cronbach’s Alpha, inter-item, inter-rest, inter-test correlation. RESULTSWe found that the mean of the Kannada version of the PAM®-13 was 55.68. The level of internal consistency was good (α=0.8357). CONCLUSIONSPAM® -13 in Kannada language has been demonstrated to be a valid and reliable measure of patient activation in the diabetic population and the present study suggests good psychometric properties.

Evaluación de conocimientos y autonomía para la transición de adolescentes hacia la atención de adultos / Assessment of knowledge and autonomy for the transition from adolescent toward adult care

INTRODUCCIÓN: Cada vez más niños con enfermedades complejas logran sobrevivir requiriendo el paso de una atención pediátrica a una de adultos. Es fundamental contar con herramientas que permitan conocer el grado de preparación del paciente para este traslado. OBJETIVO: Crear un cuestionario local para medir el estado de preparación para la transición de adolescentes con enfermedad crónica y someterlo a pruebas de validación. PACIENTES Y MÉTODO: Basado en cuestionarios internacionales se diseñó un instrumento de auto-reporte que se sometió a validez de contenido por expertos, y luego a pruebas de comprensión y factibilidad en grupo piloto. Posteriormente se realizó validación de constructo y fiabilidad utilizando análisis factorial tras ser aplicado en adolescentes con enfermedad crónica. RESULTADOS: Tras el análisis por 11 expertos y piloto de 8 pacientes se obtuvo un instrumento que fue respondido en forma completa por 168 adolescentes. Edad promedio 14,4 años. Tras la validación de constructo se genera un instrumento de 24 ítems de alta relevancia clínica, con 9 ítems con resultados psicométricos aceptables, los que se destacan en el cuestionario final. CONCLUSIÓN: Se presenta un cuestionario de auto-reporte para medir el estado de preparación de los adolescentes para la transición a servicios de adultos. Las propiedades psicométricas del instrumento resultaron insuficientes para su validación, ya que sólo se comprueba la validez de constructo y confiabilidad para 9 de los 24 ítems.

INTRODUCTION: In the last decades more and more children survive with complex health conditions, requiring a transition from pediatric to adult care. It is essential to have instruments that provide information on the level of preparation of patients for this process. OBJECTIVE: To create and validate a questionnaire to measure the readiness status of adolescent patients with chronic diseases in the transition process. PATIENTS AND METHOD: Based on international questionnaires, a self-report instrument was designed which was subjected to content validity by experts, and then to comprehension and feasibility tests in a pilot group. Subsequently, construct and reliability validation were performed through a factorial analysis after applied it to adolescents living with a chronic illness. RESULTS: After the analysis made by 11 experts and the pilot group with 8 patients, we obtained an instrument that was fully answered by 168 teenagers (Average age 14.4 years). After construct validation, a 24-items instrument of high clinical relevance was developed, with 9 items with acceptable psychometric properties, which were highlighted in the final questionnaire. CONCLUSION: a self-report instrument aimed to measure the readiness of adolescents during the transition process to adult care is presented. The reported psycho metric properties of the instrument were insufficient to consider it validated since the construct vali dity and reliability were only checked for 9 of the 24 items.