[Development of a questionnaire to measure asthmatic patients' knowledge of their disease]. / Desarrollo de un cuestionario para medir los conocimientos del paciente asmático en relación con su enfermedad.

OBJECTIVE: To develop a valid, reliable, and sensitive self-administered questionnaire in Spanish to measure the knowledge asthmatic patients have of their disease. PATIENTS AND METHODS: The face and content validity of the questions was established by consensus among expert pulmonologists. To determine the importance of the questions, they were put to 100 participating asthmatic patients. The number of questions was reduced by consensus taking into account the importance given to each question by these patients. A further 25 patients participated in the assessment of reliability and sensitivity. The questionnaire was administered 5 times: twice before and 3 times after an educational intervention. The direct and indirect external consistency (kappa statistic) and the overall kappa value were determined. Sensitivity was assessed from the number of correct answers before and after the intervention (Wilcoxon test; P< .05) and from the percentage change (>40% was clinically significant). RESULTS: Fifty-nine questions were drawn up and the final version included 20. The test-retest consistency was between 0.81 and 1 in 76% of the cases before the intervention and in 92% after it. The kappa statistic before the intervention was between 0.41 and 1 in 96% of the cases, and between 0.81 and 1 in 88% afterwards. The overall kappa values before and after the intervention were 0.12 and 0.43, respectively. The median sensitivity, measured as percentage change, was 67% and 10 patients showed an improvement between 81% and 233%. CONCLUSIONS: The questionnaire is reliable, has face and content validity, and is very sensitive to change. In view of these results, this instrument is useful for measuring the knowledge that asthmatic patients have of their disease in clinical practice and investigation.

Desarrollo de un cuestionario para medir los conocimientos del paciente asmático en relación con su enfermedad / Development of a questionnaire to measure asthmatic patients' knowledge of their disease

Objetivo: Desarrollar un cuestionario en español, autoadministrado, que mida los conocimientos del paciente asmático en relación con su enfermedad y que sea válido, fiable y sensible. Pacientes y métodos: La validez de apariencia y contenido de las preguntas redactadas se estableció por consenso de neumólogos expertos. Para la calificación de la importancia de las preguntas participaron 100 pacientes asmáticos. La reducción del número de preguntas para la versión final del cuestionario se realizó por consenso y tomando en consideración la escala de importancia determinada por los mismos pacientes. Para evaluar la fiabilidad y sensibilidad participaron otros 25 pacientes. El cuestionario se aplicó en 5 ocasiones diferentes: 2 previas y 3 posteriores a la intervención educativa. Se midió la consistencia externa directa e indirecta (índice kappa) y la kappa global. La sensibilidad se determinó con el número de aciertos antes y después de la intervención (prueba de Wilcoxon; p 40%, clínicamente significativo). Resultados: Se redactaron 59 preguntas y la versión final del cuestionario consta de 20. La consistencia directa antes y después de la intervención fue de 0,81-1 en el 76 y el 92% de los casos, respectivamente. El índice kappa antes de la intervención se situó entre 0,41 y 1 en el 96% de los casos, y después fue de 0,81-1 en el 88%. La kappa global antes y después de la intervención fue de 0,12 y 0,43, respectivamente. La mediana de la sensibilidad, medida en porcentaje de cambio, fue del 67% y 10 pacientes mostraron una mejora entre el 81 y el 233%. Conclusiones: El cuestionario es fiable, reúne los criterios de validez de contenido y apariencia y es muy sensible al cambio. En virtud de la magnitud de los resultados, es un instrumento útil para medir los conocimientos del paciente asmático en la práctica clínica o la investigación

Objective: To develop a valid, reliable, and sensitive self-administered questionnaire in Spanish to measure the knowledge asthmatic patients have of their disease. Patients and methods: The face and content validity of the questions was established by consensus among expert pulmonologists. To determine the importance of the questions, they were put to 100 participating asthmatic patients. The number of questions was reduced by consensus taking into account the importance given to each question by these patients. A further 25 patients participated in the assessment of reliability and sensitivity. The questionnaire was administered 5 times: twice before and 3 times after an educational intervention. The direct and indirect external consistency (k statistic) and the overall k value were determined. Sensitivity was assessed from the number of correct answers before and after the intervention (Wilcoxon test; P40% was clinically significant). Results: Fifty-nine questions were drawn up and the final version included 20. The test-retest consistency was between 0.81 and 1 in 76% of the cases before the intervention and in 92% after it. The k statistic before the intervention was between 0.41 and 1 in 96% of the cases, and between 0.81 and 1 in 88% afterwards. The overall k values before and after the intervention were 0.12 and 0.43, respectively. The median sensitivity, measured as percentage change, was 67% and 10 patients showed an improveme between 81% and 233%. Conclusions: The questionnaire is reliable, has face and content validity, and is very sensitive to change. In view of these results, this instrument is useful for measuring the knowledge that asthmatic patients have of their disease in clinical practice and investigation

[Epidemiology of Tuberculosis in Mexico, 1981-1998. Inconsistencies between reports of the WHO and the Ministry of health]. / Discrepancias entre los datos ofrecidos por la Secretaría de Salud y la Organización Mundial de la Salud sobre tuberculosis en México, 1981-1998.

OBJECTIVE: To describe the tuberculosis morbidity and mortality trends in Mexico, by comparing the data reported by the Ministry of Health (MH) and the World Health Organization (WHO) between 1981 and 1998. MATERIAL AND METHODS: The number of cases notified in the past few years, their rates, and the trends of the disease in Mexico were analyzed. The incidence of smear-positive pulmonary tuberculosis was estimated for 1997 and 1998 with the annual tuberculosis infection risk (ATIR), to estimate the percentage of bacilliferous cases in 1997-1998. RESULTS: WHO reported more tuberculosis cases for Mexico than the MH. However, this difference has decreased throughout the years. The notification of smear-positive cases remained stable during 1993-1998. The estimated percentages of detection were 66% for 1997 and 26% for 1998 (based on ATIR of 0.5%). Tuberculosis mortality decreased gradually (6.7% per year) between 1990 and 1998, whereas the number of new cases increased, suggesting the persistence of disease transmission in the population. CONCLUSIONS: Inconsistencies between case notifications from national data and WHO were considerable, but decreased progressively during the study period. According to ATIR estimations, a considerable number of infectious tuberculosis cases are not detected. The English version of this paper is available at: http://www.insp.mx/salud/index.html.