The Richards-Campbell Sleep Questionnaire and Sleep in the Intensive Care Unit Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil.

OBJECTIVE: To translate the Richards-Campbell Sleep Questionnaire (RCSQ) and Sleep in the Intensive Care Unit Questionnaire (SICUQ) to Portuguese, making the appropriate cross-cultural adaptations for their use in Brazil, as well as to determine the interobserver reliability of the instruments. METHODS: In this study, we evaluated medical and surgical patients admitted to the adult ICU of the Federal University of Paraná Hospital de Clínicas, in the city of Curitiba, Brazil, between June of 2017 and January of 2018. The translation and cross-cultural adaptation of the questionnaires involved the following steps: translation, synthesis, back-translation, revision by an expert panel, approval of the back-translation by the original authors, pretesting, and creation of the final versions. Two researchers applied the Portuguese-language versions in the evaluation of critically ill patients. Interobserver reliability was assessed by calculating the intraclass correlation coefficient (ICC) and 95% CI. RESULTS: The sample comprised 50 patients, of whom 27 (54%) were women. The mean age was 47.7 ± 17.5 years. The main reason for ICU admission, in 10 patients (20%), was cancer. The interobserver reliability of the questionnaires ranged from good to excellent. For the RCSQ, the ICC was 0.84 (95% CI: 0.71-0.90). For SICUQ domains 1-5 (sleep quality and daytime sleepiness), the ICC was 0.75 (95% CI: 0.55-0.86), whereas it was 0.86 (95% CI: 0.76-0.92) for SICUQ domains 6 and 7 (causes of sleep disruption). CONCLUSIONS: The cross-culturally adapted, Portuguese-language versions of the RCSQ and SICUQ appear to have good interobserver reliability.

Effectiveness and Safety of Supervised Home-Based Physical Training in Patients With COPD on Long-term Home Oxygen Therapy: A Randomized Trial.

BACKGROUND: Patients with COPD in advanced stages who need long-term home oxygen therapy (LTHOT) have difficulty participating in outpatient pulmonary rehabilitation (PR) programs. This difficulty is due to the severity of their disease, limitations involving transportation and mobility, high costs, and issues related to patients' safety and individual needs. Unsupervised home-based physical training (PT) is frequently used. RESEARCH QUESTION: The main objective of this study was to investigate the effectiveness of a supervised home-based PT program on exercise capacity and other outcomes in patients with COPD receiving LTHOT. STUDY DESIGN AND METHODS: In a randomized clinical trial, patients with COPD who were on LTHOT were allocated into two groups: the supervised physical training (PT) group, consisting of patients who received home-based supervised muscle strength and endurance training in twice-weekly 60-min sessions for 12 weeks; and the unsupervised activity booklet group, consisting of patients who received a booklet advising them to perform exercise twice a week for 12 weeks. All participants were assessed prior to and following the intervention in terms of exercise capacity (6-min step-test and the 1-min sit-to-stand test); dyspnea (Medical Research Council scale); fatigue (Brazilian Portuguese version of the Fatigue Severity Scale); and health status (COPD Assessment Test). RESULTS: A total of 44 patients were assessed (mean age, 70 ± 8 years; FEV1, 33 ± 14% predicted) (PT group, n = 22; booklet group, n = 22). Only the PT group patients presented significant improvement in the 6-min step-test (21 ± 9 vs 14 ± 11; P = .001), Medical Research Council scale (3.3 ± 1.0 vs 3.9 ± 0.9; P = .013), Brazilian Portuguese version of the Fatigue Severity Scale (5.0 ± 1.4 vs 5.2 ± 1.3; P = .015), and COPD Assessment Test (21 ± 8 vs 26 ± 6; P = .001). No adverse effects were observed. INTERPRETATION: Supervised home-based PT was effective and safe in improving exercise capacity, dyspnea, fatigue, and health status in patients with COPD on LTHOT. CLINICAL TRIAL REGISTRATION: Brazilian Registry of Clinical Trials; No.: RBR-535smn; URL: http://www.ensaiosclinicos.gov.br.

The Richards-Campbell Sleep Questionnaire and Sleep in the Intensive Care Unit Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil / Tradução e adaptação transcultural para a língua portuguesa usada no Brasil de Richards-Campbell Sleep Questionnaire e Sleep in the Intensive Care Unit Questionnaire

ABSTRACT Objective: To translate the Richards-Campbell Sleep Questionnaire (RCSQ) and Sleep in the Intensive Care Unit Questionnaire (SICUQ) to Portuguese, making the appropriate cross-cultural adaptations for their use in Brazil, as well as to determine the interobserver reliability of the instruments. Methods: In this study, we evaluated medical and surgical patients admitted to the adult ICU of the Federal University of Paraná Hospital de Clínicas, in the city of Curitiba, Brazil, between June of 2017 and January of 2018. The translation and cross-cultural adaptation of the questionnaires involved the following steps: translation, synthesis, back-translation, revision by an expert panel, approval of the back-translation by the original authors, pretesting, and creation of the final versions. Two researchers applied the Portuguese-language versions in the evaluation of critically ill patients. Interobserver reliability was assessed by calculating the intraclass correlation coefficient (ICC) and 95% CI. Results: The sample comprised 50 patients, of whom 27 (54%) were women. The mean age was 47.7 ± 17.5 years. The main reason for ICU admission, in 10 patients (20%), was cancer. The interobserver reliability of the questionnaires ranged from good to excellent. For the RCSQ, the ICC was 0.84 (95% CI: 0.71-0.90). For SICUQ domains 1-5 (sleep quality and daytime sleepiness), the ICC was 0.75 (95% CI: 0.55-0.86), whereas it was 0.86 (95% CI: 0.76-0.92) for SICUQ domains 6 and 7 (causes of sleep disruption). Conclusions: The cross-culturally adapted, Portuguese-language versions of the RCSQ and SICUQ appear to have good interobserver reliability.

RESUMO Objetivo: Traduzir e adaptar transculturalmente o Richards-Campbell Sleep Questionnaire, designado Questionário de Sono Richards-Campbell (QSRC), e Sleep in the Intensive Care Unit Questionnaire, designado Questionário de Sono em UTI (QS-UTI), para a língua portuguesa do Brasil e determinar a confiabilidade interobservador dos instrumentos. Métodos: O estudo incluiu pacientes clínicos e cirúrgicos da UTI Adulto do Hospital de Clínicas da Universidade Federal do Paraná, localizado em Curitiba (PR) entre junho de 2017 e janeiro de 2018. A tradução e a adaptação transcultural seguiram as seguintes etapas: tradução, síntese das versões, tradução reversa, revisão pelo comitê de especialistas, aprovação dos autores originais, pré-teste e versão final dos questionários. As versões na língua portuguesa foram utilizadas por dois pesquisadores na avaliação dos pacientes críticos. A confiabilidade interobservador foi avaliada pelo coeficiente de correlação intraclasse (CCI) e IC95%. Resultados: A amostra foi composta por 50 pacientes, sendo a maioria mulheres (n = 27; 54%). A média de idade foi de 47,7 ± 17,5 anos. O principal motivo de internação foram doenças oncológicas (n = 10; 20%). Os questionários demonstraram de boa a alta confiabilidade interobservador. Para o QSRC, observou-se um CCI = 0,84 (IC95%: 0,71-0,90); para o QS-UTI, observou-se, para os domínios de 1 a 5, um CCI = 0,75 (IC95%: 0,55-0,86) e, para os domínios 6 e 7, um CCI = 0,86 (IC95%: 0,76-0,92). Conclusões: Os resultados de confiabilidade interobservador permitem que as versões traduzidas e adaptadas transculturalmente para o português do Brasil dos questionários QSRC e do QS-UTI sejam utilizadas como importantes ferramentas de avaliação do sono nas UTIs de adultos no Brasil.

Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy.

Chronic obstructive pulmonary disease (COPD) has systemic consequences that lead to reduced physical activity in daily life (PADL). Little is known about PADL and its associations in individuals with COPD on home-based long-term oxygen therapy (LTOT). The objective of the study was to determine whether there is an association between severe physical inactivity and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on home-based LTOT using electric oxygen concentrators and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV1: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale - FSS), dyspnea (Medical Research Council - MRC scale), functional status (London Chest ADL scale [LCADL] and Timed Up and Go [TUG] test) and functional exercise capacity (Six-Minute Step test [6MST] and Sit-to-Stand test [STST]). PADL was markedly low (1444 ± 1203 steps/day) and associated with daily duration of LTOT (r = -0.50), fatigue (r = -0.36), LCADL (r = -0.41), 6MST (r = 0.48), and STST (r = 0.53) (p < .05 for all). Multiple linear regression revealed that daily duration of LTOT and STST explained 39% of the variability of PADL. Longer daily duration of LTOT, fatigue, worse functional status and exercise capacity were all associated with physical inactivity in individuals with COPD on LTOT, whereas daily duration of LTOT and the STST were determinants of reduced physical activity.

EXPERIMENTAL PARACOCCIDIOIDOMYCOSIS IN PREGNANT RATS.

Paracoccidioidomycosis (PCM), caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb), is the most prevalent systemic mycosis in Latin America. There are few reports in the literature about the disease damages during pregnancy and the consequences to the fetuses and breeding. This study evaluated the implications of PCM during pregnancy on offspring and mothers in Wistar rats. Groups of rats were submitted to systemic Pb infection, by intraperitoneal infusion, and mated 30 days after the infection date. Immediately after birth, rats and neonates were sacrificed to obtain organs for standard histological examination, morphometric analysis, fungi recovery by plating (CFU) and dosing of anti-Pb antibodies by ELISA. There were no stillbirths or miscarriages, however, the fetuses from infected pregnant rats had lower body and organ weight but the fertility rate was 100%. The largest number of CFU was recovered from the organ of pregnant rats, the pathological examination revealed more severe infection in the same group, further on the largest number of granulomas and fungal field. It can be concluded that the PCM was more severe in the group of pregnant rats, with implications to the weight of offspring.

Dose response effect of Paracoccidioides brasiliensis in an experimental model of arthritis.

Paracoccidioidomycosis (PCM) is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb) and corresponds to prevalent systemic mycosis in Latin America. The aim of the present work was to evaluate the dose response effect of the fungal yeast phase for the standardization of an experimental model of septic arthritis. The experiments were performed with groups of 14 rats that received doses of 103, 104 or 105 P. brasiliensis (Pb18) cells. The fungi were injected in 50 µL of phosphate-buffered saline (PBS) directly into the knee joints of the animals. The following parameters were analyzed in this work: the formation of swelling in knees infused with yeast cells and the radiological and anatomopathological alterations, besides antibody titer by ELISA. After 15 days of infection, signs of inflammation were evident. At 45 days, some features of damage and necrosis were observed in the articular cartilage. The systemic dissemination of the fungus was observed in 11% of the inoculated animals, and it was concluded that the experimental model is able to mimic articular PCM in humans and that the dose of 105 yeast cells can be used as standard in this model.

DOSE RESPONSE EFFECT OF Paracoccidioides brasiliensis IN AN EXPERIMENTAL MODEL OF ARTHRITIS / Efeito da dose resposta de Paracoccidioides brasiliensis no modelo experimental de artrite

Paracoccidioidomycosis (PCM) is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb) and corresponds to prevalent systemic mycosis in Latin America. The aim of the present work was to evaluate the dose response effect of the fungal yeast phase for the standardization of an experimental model of septic arthritis. The experiments were performed with groups of 14 rats that received doses of 103, 104 or 105 P. brasiliensis (Pb18) cells. The fungi were injected in 50 µL of phosphate-buffered saline (PBS) directly into the knee joints of the animals. The following parameters were analyzed in this work: the formation of swelling in knees infused with yeast cells and the radiological and anatomopathological alterations, besides antibody titer by ELISA. After 15 days of infection, signs of inflammation were evident. At 45 days, some features of damage and necrosis were observed in the articular cartilage. The systemic dissemination of the fungus was observed in 11% of the inoculated animals, and it was concluded that the experimental model is able to mimic articular PCM in humans and that the dose of 105 yeast cells can be used as standard in this model.

A paracoccidioidomicose (PCM) é causada pelo fungo dimórfico Paracoccidioides brasiliensis (Pb) e corresponde à micose sistêmica de maior prevalência na América Latina. O objetivo do presente trabalho foi avaliar a dose resposta de leveduras do fungo para padronização do modelo experimental de artrite séptica. Os experimentos foram realizados com grupos de 14 ratos que receberam doses de 103, 104 ou 105 células de P. brasiliensis (Pb18). Os fungos foram injetados em 50 µL de solução salina em tampão fosfatado (PBS) diretamente na articulação do joelho dos animais. Os seguintes parâmetros foram analisados neste trabalho: a formação de edema nos joelhos infundidos com as células das leveduras e alterações radiológicas, anatopalógicas além de titulação de anticorpos por Elisa. Após 15 dias de infecção, os sinais de inflamação foram evidentes. Aos 45 dias, algumas características de dano e necrose foram observadas na cartilagem articular. A disseminação sistêmica do fungo foi observada em 11% dos animais inoculados, concluiu-se que o modelo experimental é capaz de mimetizar a PCM articular em humanos e que a dose de 105 leveduras representa a dose padrão para o desenvolvimento do modelo.