Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016.

OBJECTIVE: To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. METHODS: This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. RESULTS: In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. CONCLUSION: The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.

Fully angularly resolved 3D microrheology with optical tweezers.

Microrheology with optical tweezers (MOT) is an all-optical technique that allows the user to investigate a materials' viscoelastic properties at microscopic scales, and is particularly useful for those materials that feature complex microstructures, such as biological samples. MOT is increasingly being employed alongside 3D imaging systems and particle tracking methods to generate maps showing not only how properties may vary between different points in a sample but also how at a single point the viscoelastic properties may vary with direction. However, due to the diffraction limited shape of focussed beams, optical traps are inherently anisotropic in 3D. This can result in a significant overestimation of the fluids' viscosity in certain directions. As such, the rheological properties can only be accurately probed along directions parallel or perpendicular to the axis of trap beam propagation. In this work, a new analytical method is demonstrated to overcome this potential artefact. This is achieved by performing principal component analysis on 3D MOT data to characterise the trap, and then identify the frequency range over which trap anisotropy influences the data. This approach is initially applied to simulated data for a Newtonian fluid where the trap anisotropy induced maximum error in viscosity is reduced from ~ 150% to less than 6%. The effectiveness of the method is corroborated by experimental MOT measurements performed with water and gelatine solutions, thus confirming that the microrheology of a fluid can be extracted reliably across a wide frequency range and in any arbitrary direction. This work opens the door to fully spatially and angularly resolved 3D mapping of the rheological properties of soft materials over a broad frequency range.

Ophthalmic artery Doppler in the complementary diagnosis of preeclampsia: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the accuracy of different parameters of the ophthalmic artery Doppler (OAD) in the complementary diagnosis of preeclampsia (PE). METHODS: This meta-analysis adhered to the PRISMA guidelines. To investigate the mean difference in OAD values, peak systolic velocity (PSV), end-diastolic velocity (EDV), second systolic velocity peak (P2), resistance index (RI), pulsatility index (PI), and peak ratio (PR), between PE cases (overall and according to severity) and controls, random-effects meta-analyses were conducted for each Doppler parameter, with overall PE and mild and severe PE subgroups. Diagnostic performance and heterogeneity were evaluated with summary receiver operating characteristic (sROC) curves and 95% confidence intervals obtained with bivariate models. RESULTS: Eight studies stratified the results into mild and severe or late and early PE, involving 1,425 pregnant women. PR and P2 had better diagnostic performance than the other indexes, with the PR of AUsROC at 0.885, the sensitivity of 84%, and specificity of 92%, with a low false-positive rate of 0.08 and the P2 with AUsROC of 0.926, the sensitivity of 85% and specificity of 88%. RI, PI, and EDV showed good performance and consistency across studies but lower AUsROC values of 0.833, 0.794, and 0.772, respectively. CONCLUSION: Ophthalmic artery Doppler is a complementary tool with good performance for the diagnosis of overall and severe preeclampsia, with high and best sensitivity and specificity when using PR and P2 parameters.

OptoRheo: Simultaneous in situ micro-mechanical sensing and imaging of live 3D biological systems.

Biomechanical cues from the extracellular matrix (ECM) are essential for directing many cellular processes, from normal development and repair, to disease progression. To better understand cell-matrix interactions, we have developed a new instrument named 'OptoRheo' that combines light sheet fluorescence microscopy with particle tracking microrheology. OptoRheo lets us image cells in 3D as they proliferate over several days while simultaneously sensing the mechanical properties of the surrounding extracellular and pericellular matrix at a sub-cellular length scale. OptoRheo can be used in two operational modalities (with and without an optical trap) to extend the dynamic range of microrheology measurements. We corroborated this by characterising the ECM surrounding live breast cancer cells in two distinct culture systems, cell clusters in 3D hydrogels and spheroids in suspension culture. This cutting-edge instrument will transform the exploration of drug transport through complex cell culture matrices and optimise the design of the next-generation of disease models.

Quality of Life in Obstructive Sleep Apnea Patients Who Underwent Maxillomandibular Advancement Surgery.

This study assessed health-related quality of life (HRQOL) and daytime sleepiness in moderate or severe obstructive sleep apnea patients who underwent maxillomandibular advancement (MMA) surgery. We invited patients who had undergone MMA 1 year ago and preoperative patients to answer a self-administered questionnaire to evaluate HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey-SF-36 and Functional Outcomes of Sleep Questionnaire-FOSQ) and daytime sleepiness (Epworth Sleepiness Scale-ESS). Twenty-two patients who underwent MMA and 28 preoperative patients participated in the present study. Patients who underwent MMA reduced their daytime sleepiness [5.0 (3.00-8.00) versus 16.0 (9.00-21.00), P<0.01] and increased their quality of life in the following domains: physical role functioning [100.0 (50.00-100.00) versus 62.5 (0.00-100.00), P<0.05], vitality [65.0 (58.75-90.00) versus 55.0 (21.25-67.50), P<0.0], mental health [78.0 (67.00-88.00) versus 62.0 (45.00-75.00), P<0.01], and social role functioning [88.0 (75.00-100.00) versus 69.0 (41.00-100.00), P<0.05]. Patients also improved their rates of sleep-related quality of life in general productivity [4.00 (3.63-4.00) versus 2.9 (2.03-3.75), P<0.01], social outcome [4.00 (4.00-4.00) versus 3.2 (2.00-4.00), P<0.01], activity level [3.7 (3.56-3.88) versus 2.8 (1.64-3.53), P<0.01], and vigilance [3.9 (3.55-4.00) versus 2.7 (2.03-3.67), P<0.01] when compared with the control group. The results suggest that moderate and severe obstructive sleep apnea patients who undergo MMA have positive impacts on quality of life and daytime sleepiness when compared with preoperative patients.

Nonpharmacological labor pain management methods and risk of cesarean birth: A retrospective cohort study.

BACKGROUND: Nonpharmacological labor pain management methods (NPLPMM) are noninvasive, low-cost practices that may play a role in reducing the rates of unnecessary cesarean birth. We aimed to evaluate whether the NPLPMM is associated with the mode of birth. METHODS: We conducted a retrospective cohort study with clinical records of all women admitted for birth from January 2013 to December 2017. Records of women who had spontaneous labor or received induction or augmentation of labor during hospitalization were eligible for the study. We estimated the risk ratios for cesarean birth in general linear models using the Poisson regression with adjustments for the following variables: age, ethnicity, schooling, parity, gestational age, previous cesarean birth, spontaneous labor before admission, or induction/augmentation of labor. RESULTS: Within the total of 3,391 medical records, 40.1% had the use of a nonpharmacological labor pain management method registered. Cesarean rate among the study population was 44.2%. The use of NPLPMM decreased the risk of cesarean birth by 78% (OR = 0.22; 95% CI 0.19-0.26). History of a previous cesarean birth (RR = 2.63; 95% CI 2.35-2.64), the lack of use of NPLPMM (RR = 2.46; 95% CI 2.22-2.72), and primiparity (RR = 2.09; 95% CI 1.86-2.34) were the strongest risk factors for cesarean birth in the cohort. DISCUSSION: The use of NPLPMM may be an effective strategy to reduce unnecessary cesarean birth. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labor.

Origami: Single-cell 3D shape dynamics oriented along the apico-basal axis of folding epithelia from fluorescence microscopy data.

A common feature of morphogenesis is the formation of three-dimensional structures from the folding of two-dimensional epithelial sheets, aided by cell shape changes at the cellular-level. Changes in cell shape must be studied in the context of cell-polarised biomechanical processes within the epithelial sheet. In epithelia with highly curved surfaces, finding single-cell alignment along a biological axis can be difficult to automate in silico. We present 'Origami', a MATLAB-based image analysis pipeline to compute direction-variant cell shape features along the epithelial apico-basal axis. Our automated method accurately computed direction vectors denoting the apico-basal axis in regions with opposing curvature in synthetic epithelia and fluorescence images of zebrafish embryos. As proof of concept, we identified different cell shape signatures in the developing zebrafish inner ear, where the epithelium deforms in opposite orientations to form different structures. Origami is designed to be user-friendly and is generally applicable to fluorescence images of curved epithelia.

Optical Tweezers with Integrated Multiplane Microscopy (OpTIMuM): a new tool for 3D microrheology.

We introduce a novel 3D microrheology system that combines for the first time Optical Tweezers with Integrated Multiplane Microscopy (OpTIMuM). The system allows the 3D tracking of an optically trapped bead, with ~ 20 nm accuracy along the optical axis. This is achieved without the need for a high precision z-stage, separate calibration sample, nor a priori knowledge of either the bead size or the optical properties of the suspending medium. Instead, we have developed a simple yet effective in situ spatial calibration method using image sharpness and exploiting the fact we image at multiple planes simultaneously. These features make OpTIMuM an ideal system for microrheology measurements, and we corroborate the effectiveness of this novel microrheology tool by measuring the viscosity of water in three dimensions, simultaneously.

Microrheology reveals microscale viscosity gradients in planktonic systems.

Microbial activity in planktonic systems creates a dynamic and heterogeneous microscale seascape that harbors a diverse community of microorganisms and ecological interactions of global significance. In recent decades great effort has been put into understanding this complex system, particularly focusing on the role of chemical patchiness, while overlooking a physical parameter that governs microbial life and is affected by biological activity: viscosity. Here we reveal spatial heterogeneity of viscosity in planktonic systems by using microrheological techniques that allow measurement of viscosity at length scales relevant to microorganisms. We show the viscous nature and the spatial extent of the phycosphere, the region surrounding phytoplankton. In ∼45% of the phytoplankton cells analyzed we detected increases in viscosity that extended up to 30 µm away from the cell with up to 40 times the viscosity of seawater. We also show how these gradients of viscosity can be amplified around a lysing phytoplankton cell as its viscous contents leak away. Finally, we report conservative estimates of viscosity inside marine aggregates, hotspots of microbial activity, more than an order of magnitude higher than in seawater. Since the diffusivities of dissolved molecules, particles, and microorganisms are inversely related to viscosity, microheterogeneity in viscosity alters the microscale distribution of microorganisms and their resources, with pervasive implications for the functioning of the planktonic ecosystem. Increasing viscosities impacts ecological interactions and processes, such as nutrient uptake, chemotaxis, and particle encounter, that occur at the microscale but influence carbon and nutrient cycles at a global scale.

Spirituality of medical students: associations with empathy and attitudes in the doctor-patient relationship / Espiritualidade dos estudantes de Medicina: associações com empatia e atitude na relação médico-paciente

Abstract: Introduction: Currently, the study of the factors that improve interpersonal relationships in patient care and medical education has been considered relevant and necessary. Understanding what precedes empathy and medical interns' and young doctors' attitudes is a relevant topic for health professionals' education and for their academic and professional performance. Although patients and medical students have indicated that spirituality is an important issue, it is not frequently addressed in medical schools. Objective: This study aims to verify the association between (i) well-being related to spirituality, religiosity and the medical interns' and residents' personal beliefs and (ii) empathy and attitudes in the doctor-patient relationship. Methods: This was a quantitative, cross-sectional, observational study. A total of 64 undergraduate students in the last years of medical school and 50 residents answered the following self-administered instruments: WHOQOL-SRPB, Jefferson Scale of Empathy, and Patient-Practitioner Orientation Scale. Descriptive statistics, Pearson's correlation and stepwise linear regressions were used to analyze data. Results: Significant correlations (p<0.05) varying from weak (r=0.10) to moderate (r=0.39) were found. The WHOQOL-SRPB final score affected the global score of empathy (R2 = 0.12; p <0.00; VIF=1.00). The component meaning and purpose in life affected the global score of the patient-centered attitude (R2= 0.14; p <0.00; VIF=1.00). Conclusions: Spirituality, religiosity and personal beliefs are associated with patient-centered attitudes and medical interns' and residents' empathy. In general, well-being related to spirituality preceded empathy, and the component meaning and purpose in life preceded patient-centered attitudes. These results imply the need to consider well-being related to spirituality in interns' and residents' education for a better doctor-patient relationship.

Resumo: Introdução: Na atualidade, considera-se relevante e oportuno estudar os fatores que contribuem para a melhoria das relações interpessoais no contexto da assistência ao paciente e da educação médica. Compreender os preditores em relação à empatia e à atitude do interno de Medicina e do jovem médico é tema em destaque na formação dos profissionais de saúde, no desempenho acadêmico e profissional. A espiritualidade tem sido apontada como tema importante tanto pelos pacientes como pelos estudantes de Medicina, porém ainda pouco abordada nas escolas médicas. Objetivo: O estudo propõe verificar a associação entre o bem-estar relacionado à espiritualidade, à religiosidade e às crenças pessoais do interno e residente de Medicina e a empatia e a atitude na relação médico-paciente. Métodos: Trata-se de um estudo observacional, transversal, de abordagem quantitativa. O questionário WHOQOL-espiritualidade, religiosidade e crenças pessoais, a Escala Jefferson de Empatia e a Escala de Orientação Médico-Paciente foram autoaplicados por 64 estudantes dos últimos anos do curso e 50 residentes de Medicina. Realizaram-se estatística descritiva, correlação de Pearson e regressão linear stepwise para análise dos dados. Resultados: Foram encontradas correlações significativas (p < 0,05), variando de fracas (r = 0,10) a moderadas (r = 0,39). O escore final do WHOQOL-SRPB apresentou efeito sobre o escore global de empatia (R2 = 0,12; p < 0,00; β = 0,35; VIF = 1,00). Sentido da vida apresentou efeito sobre o escore global da atitude centrada no paciente (R2 = 0,14; p < 0,00; β = 0,38; VIF = 1,00). Conclusão: A espiritualidade, a religiosidade e as crenças pessoais foram associadas à atitude centrada no paciente e à empatia dos internos e residentes de Medicina. Em geral, o bem-estar relacionado à espiritualidade foi preditor da empatia, e o sentido da vida, preditor da atitude centrada no paciente. Esses resultados implicam a necessidade de se considerar o bem-estar relacionado à espiritualidade na formação dos internos e residentes para uma melhor qualidade da relação médico-paciente.

Boosting nonverbal physician-patient communication in medical education / Impulsionando a comunicação não verbal na educação médica

Abstract: Introduction: Nonverbal communication is an important part of the medical interview. However, nonverbal skills are still underestimated in medical education and instruments for their teaching and assessing in medical schools are scarce. Objective: We aimed to translate and culturally adapt the Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) to Brazilian Portuguese. Methods: We translated the RCS-O in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through the Delphi technique, review by a language coordinator, and pre-test. We used video recordings of four medical consultations performed by medical students and residents to pre-test the instrument. During this phase, three independent observers assessed the medical students and residents' performance in real health care scenarios through the use of the recordings. Results: Most of the difficulties regarding the translation and cultural adaptation were related to the polysemic meaning of some items. Words and expressions such as "stimulating", "warmth", "desire", "relaxed", "conversation to a deeper level", "deeper relationship", "casual", and "intensely" required adaptation in order to remove the potential sexual connotation that could arise from overintimacy in the physician-patient relationship. Conclusion: The Brazilian version of the RCS-O is a culturally, conceptually, semantically and operationally valid instrument. It may represent an important advance for the strengthening of learning and assessing nonverbal communication in medical education. We hope this study may encourage health educators to invest in the teaching and assessment of nonverbal communication skills in other countries.

Resumo: Introdução: A comunicação não verbal corresponde a importante parte da entrevista médica. No entanto, as habilidades não verbais ainda são subestimadas na educação, e os instrumentos para ensino e avaliação nas escolas de saúde são escassos. Objetivo: Nosso objetivo foi traduzir e adaptar culturalmente a Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) para o português do Brasil. Método: Traduzimos a RCS-O em sete etapas: tradução inicial, reconciliação, retrotradução, revisão pelo autor, revisão independente, consenso pela técnica Delphi, revisão por um coordenador de linguagem e pré-teste. Utilizamos gravações de quatro consultas médicas realizadas por estudantes de Medicina e residentes para pré-testar o instrumento. Durante essa fase, três observadores independentes avaliaram o desempenho de estudantes de Medicina e residentes em cenários reais de assistência médica por meio do uso das gravações. Resultados: A maioria das dificuldades de tradução e adaptação cultural foi relacionada ao significado polissêmico de alguns itens. Palavras e expressões como "stimulating", "warmth", "desire", "relaxed", "conversation to a deeper level", "deeper relationship", "casual", and "intensely" precisaram ser adaptadas para remover a conotação sexual que poderia surgir da intimidade presente na relação médico-paciente. Conclusão: A versão brasileira da RCS-O é cultural, conceitual, semântica e operacionalmente válida. Representa um avanço importante para o ensino e a avaliação da comunicação não verbal na educação médica. Esperamos que este estudo possa incentivar educadores de saúde a investir no ensino e na avaliação dessas habilidades nas escolas médicas.

Esperança, Medo e Qualidade de vida Relacionada à Saúde na Percepção de Mulheres com Câncer de Mama / Hope, Fear, and Health-Related Quality of Life Perceived by Women with Breast Cancer / Esperanza, Miedo y Calidad de Vida Relacionada a la Percepción de Mujeres con Cáncer de Mama

Introdução: O período de diagnóstico e tratamento do câncer de mama é difícil, permeado de incertezas e associado a uma alta taxa de morbimortalidade. Objetivo: Conhecer o significado que as mulheres com câncer de mama em tratamento em um hospital universitário atribuíram à sua experiência de medo mascarado pelo sentimento de esperança, bem como investigar a percepção da qualidade de vida no enfrentamento da doença. Método: Estudo quanti-qualitativo com 78 mulheres. Para a avaliação quantitativa, avaliaram-se os escores do Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey (SF-36) e da Escala de Esperança de Herth. Para a análise qualitativa, conduziram-se narrativas com dez dessas mulheres que foram analisadas por meio de métodos fenomenológicos de investigação. Resultados: Foram detectados escores reduzidos nos domínios capacidade funcional e saúde mental do SF-36 que implicam em impacto negativo na qualidade de vida e alto índice nos escores de esperança, o que é um fator positivo. Três classes centrais emergiram de 243 segmentos das narrativas por meio de declarações significativas e unidades de significado correspondentes. Conclusão: A experiência do período de diagnóstico e tratamento inclui enfrentamento, conhecimento da doença, assistência clínica (médicos, equipes), exaltação ao desespero e o paradoxo entre o medo e a esperança. Foi discutida a essência da experiência vivenciada e compartilhada pelas participantes à luz da teoria da doença, como uma ruptura da narrativa biográfica. O estudo destaca implicações para a equipe de médicos, coordenadores do Sistema Único de Saúde e outros profissionais da saúde

Introduction: The period of diagnosis and treatment of breast cancer is tough, full of uncertainties, and associated with a high morbidity and mortality rate. Objective: To understand the meaning that women with breast cancer under treatment in a university hospital attribute to their experience of fear masked by the feeling of hope and investigate the participants' perception of quality of life while coping with the disease. Method: Quantitative, qualitative study conducted with 78 women. For the quantitative evaluation, the scores of the Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey(SF-36) and the Herth Hope Scale were evaluated. For the qualitative analysis, narratives were conducted with 10 of these women who were analyzed using phenomenological investigation methods. Results: Low scores were detected in the functional capacity and mental health domains of SF-36, which imply in a negative impact on the quality of life and a high index of hope scores, which is a positive factor. Three central classes emerged from 243 segments of the participants' narratives, through meaningful statements and their corresponding meaning units. Conclusion: The experience of the diagnosis and treatment period includes coping, cognizance of the disease, clinical consultation (doctors, teams), from exaltation to despair, and the paradox between fear and hope. It was discussed the essence of the experience the participants lived and shared in light of the theory of the disease as a rupture of the biographic narrative. The study highlights implications for the teams of physicians, SUS ­ National Health System coordinators, and other healthcare professionals.Key words: Breast Neoplasms/psychology; Quality of Life; Hope; Emotions; Fear

Introducción: El período de diagnóstico y tratamiento del cáncer de mama es difícil, puesto que presenta muchas incertidumbres y está asociado con una alta taza de morbilidad. Objetivo: Conocer el significado que las mujeres con cáncer de mama en tratamiento en un hospital universitario le atribuyeron a su experiencia de temor enmascarado por el sentimiento de esperanza, así como investigar la percepción de la calidad de vida al enfrentar la enfermedad. Método: Estudio cuantitativo y cualitativo con 78 mujeres. Para la evaluación cuantitativa, evaluamos las puntuaciones del Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey (SF-36) y la Escala de Esperanza de Herth. Para el análisis cualitativo, se realizaron narrativas con 10 de estas mujeres que fueron analizadas utilizando métodos de investigación fenomenológica. Resultados: Se detectó que la capacidad funcional y de salud mental del SF-36 se redujeron, y al mismo tiempo se presentó un alto índice de Esperanza lo que implica un impacto negativo en la calidad de vida y un alto índice de puntajes de esperanza, lo cual es un factor positivo. Surgieron tres clases centrales de entre los 243 segmentos de las entrevistas a través de declaraciones significativas y sus respectivas unidades de significado. Conclusión: El experimento, durante el periodo de diagnóstico y tratamiento, incluye el enfrentamiento, el conocimiento de la enfermedad, la asistencia clínica (médicos, equipos), la exaltación a la desesperación y una paradoja entre el miedo y la esperanza. Se discutió la esencia de la experiencia vivida y compartida por las participantes a la luz de la teoría de la enfermedad, como una ruptura de la narrativa biográfica. El estudio destaca las implicaciones para el equipo de médicos, coordinadores del Sistema Único de Salud de Brasil y otros profesionales de la salud

Cross-cultural adaptation and validation of the universal Portuguese-version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F) / Adaptação transcultural e validação da versão portuguesa universal da Escala Avaliação Funcional Pediátrica de Terapia de Doença Crônica - Fadiga (pedsFACIT-F)

Abstract Objective: To cross-culturally adapt and validate the universal Portuguese version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F). Method: The universal Portuguese version of the pedsFACIT-F was cross-culturally adapted and validated in 323 children and adolescents aged 8-18 years, 173 healthy individuals, and 150 with chronic diseases (cancer, juvenile idiopathic arthritis, and diabetes). Reliability (internal consistency and test-retest reliability) was assessed. Item response theory model assumptions were evaluated using confirmatory and exploratory factor analyses. Items were calibrated using a graded response model. Differential item functioning was assessed regarding age, gender, and clinical condition (healthy vs. chronic diseases). Results: No major cultural adaptations were needed. Internal consistency (Cronbach's alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.92) were good. CFA (CFI = 0.92, TLI = 0.90, RMSEA = 0.097) and CFE analysis confirmed sufficient unidimensionality. The data also fit the GRM and demonstrated good coverage of the fatigue construct (threshold parameters range: -1.42 to 4.56). No items demonstrated significant differential item functioning. Conclusion: The universal Portuguese version of the pedsFACIT-F provides a reliable, precise, and valid measure after being assessed by robust psychometric properties. Stability of the measurement properties of the pedsFACIT-F scale allows its use to assess fatigue in clinical research in Portuguese-speaking children and adolescents.

Resumo Objetivo: Adaptar transculturalmente e validar a versão portuguesa universal da escala Avaliação Funcional Pediátrica de Terapia de Doença Crônica - Fadiga (pedsFACIT-F). Método: A versão traduzida para o português universal e adaptada transculturalmente da escala pedsFACIT-F foi validada em 323 crianças (entre 8 e 18 anos), 173 saudáveis e 150 com doenças crônicas (câncer, artrite idiopática juvenil e diabetes). A confiabilidade foi avaliada pela consistência interna e confiabilidade teste-reteste. Os pressupostos do modelo da teoria da resposta ao item foram avaliados por meio da análise fatorial confirmatória e exploratória. Os itens foram calibrados segundo modelo de resposta gradual. O funcionamento diferencial do item foi examinado com respeito à idade, ao gênero e à condição de saúde (saudáveis versus doenças crônicas). Resultados: A adaptação cultural não apresentou dificuldades substantivas. A confiabilidade da consistência interna (alfa-Cronbach = 0,84) e do teste-reteste (correlação intraclasse = 0,92) foram adequadas. As análises da AFC (CFI = 0,92, TLI = 0,90, RMSEA = 0,097) e AFE confirmaram suficiente unidimensionalidade. O estudo de calibração demostrou bom ajuste do MRG e boa cobertura do construto fadiga (variação dos limiares das categorias de resposta: -1,42 a 4,56). Não foi verificada presença de funcionamento diferencial do item significante. Conclusão: A versão portuguesa universal da escala pedsFACIT-F é uma medida confiável, precisa e válida, verificada após análises de propriedades psicométricas robustas. A estabilidade das propriedades de medida da escala permite seu uso para avaliação de fadiga em estudos clínicos com crianças e adolescentes em países lusófonos.

[Brazilian validation of the item banks on Sleep Disturbance and Wake Disturbance in the Patient-Reported Outcomes Measurement Information System (PROMIS)]. / Validação brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS).

This study aimed to validate the Brazilian version of the item banks for Sleep Disturbance and Wake Disturbance from the Patient-Reported Outcomes Measurement Information System (PROMIS). Validation of these item banks used classical test theory, item response theory, calibrations of items according to the gradual response model proposed by Samejima, and analysis of Differential Item Functioning (DIF), with a sample consisting of 627 participants over 18 years of age. As for data quality, there were no missing data, five items from the Sleep Disturbance bank and four items from the WE bank showed a floor effect, and none of the banks showed a ceiling effect. The two banks displayed excellent reliability with homogeneous scale and good temporal stability. With confirmatory factor analysis, using absolute and incremental goodness-of-fit indices, both banks displayed good fit, showing that the instruments are valid and sufficiently unidimensional. The calibration showed that the items' psychometric properties were satisfactory with good coverage of the sleep-wake construct. As for DIF, both the Sleep Disturbance and Wake Disturbance banks proved to be homogeneous for the different test groups. In conclusion, the version in Brazilian Portuguese for the item banks on Sleep Disturbance and Wake Disturbance in the PROMIS proved to be a reliable, precise, and valid instrument with robust psychometric analyses.

O objetivo deste estudo foi validar a versão brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS). A validação desses bancos de itens foi feita por meio da Teoria Clássica dos Testes, Teoria de Resposta ao Item, calibração dos itens conforme o modelo de resposta gradual proposto por Samejima e análise do Funcionamento Diferencial do Item (DIF), sendo a amostra constituída por 627 participantes com mais de 18 anos. Em relação à qualidade dos dados, observou-se que não houve dados perdidos, e cinco itens do banco Distúrbio do Sono e quatro itens do banco Distúrbio da Vigília tiveram efeito piso, e nenhum dos bancos apresentou efeito teto. Os dois bancos mostraram excelente confiabilidade com uma escala homogênea e boa estabilidade temporal. Com a Análise Fatorial Confirmatória, através dos índices de qualidade de ajuste absoluto e incremental, verificou-se um bom ajuste para os dois bancos, o que revela que os instrumentos são válidos e suficientemente unidimensionais. A calibração evidenciou que as propriedades psicométricas dos itens foram satisfatórias com boa cobertura do construto sono-vigília. No tocante ao DIF, tanto o banco Distúrbio do Sono quanto o banco Distúrbio da Vigília mostraram ser homogêneos para os diferentes grupos testados. Pode-se concluir que a versão para a língua portuguesa falada no Brasil dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do PROMIS demonstrou ser uma medida confiável, precisa e válida, com análises psicométricas robustas.

El objetivo de este estudio fue validar la versión brasileña de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del Patient-Reported Outcomes Measurement Information System (PROMIS). La validación de esos bancos de ítems se realizó mediante teoría clásica de los tests, teoría de respuesta al ítem, calibración de los ítems, según el modelo de respuesta gradual propuesto por Samejima, así como el análisis del Funcionamiento Diferencial del Ítem (DIF), estando la muestra constituida por 627 participantes con más de 18 años. En relación con la calidad de los datos, se observó que no hubo dados perdidos y cinco ítems del banco Disturbio del Sueño y cuatro ítems del banco Disturbio de la Vigilia tuvieron efecto suelo, además ninguno de los bancos presentó un efecto techo. Los dos bancos mostraron excelente confiabilidad con una escala homogénea y buena estabilidad temporal. Con el análisis factorial confirmatorio, usándose los índices de calidad de ajuste absoluto e incremental, se verificó un buen ajuste para los dos bancos, lo que revela que los instrumentos son válidos y suficientemente unidimensionales. La calibración evidenció que las propiedades psicométricas de los ítems fueron satisfactorias con una buena cobertura del constructo sueño-vigilia. En lo que se refiere al DIF, tanto el banco Disturbio del Sueño como el Disturbio de la Vigilia mostraron ser homogéneos para los diferentes grupos testados. Se puede concluir que la versión para la lengua portuguesa hablada en Brasil de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del PROMIS demostró ser una medida confiable, precisa y válida, con análisis psicométricos robustos.

Validation and calibration of the patient-reported outcomes measurement information system: Pediatric PROMIS® Emotional Distress domain item banks, Portuguese version (Brazil/Portugal).

OBJECTIVE: This paper goal was to validate the Portuguese version (Brazil/Portugal) of the Anger, Anxiety, and Depressive Symptoms item banks of the Pediatric PROMIS® Emotional Distress domain (version 1.0) for the Brazilian and Portuguese pediatric population. METHOD: The total of 1216 participants answered a self-applied version of the Portuguese Anger, Anxiety, and Depressive Symptoms item banks. Reliability was assessed through internal consistency, test-retest reliability, and total information curve (TIC). Confirmatory Factor Analysis (CFA) with a bifactor model was used to confirm construct validity and IRT assumptions. Item calibration was performed according to Graded Response Model (GRM). Differential Item Functioning (DIF) was analyzed according the participants' age, gender, health condition (healthy versus chronic disease), and language. RESULTS: Internal consistency reliability (Cronbach's alpha coefficient = 0.84) and test-retest reliability (intraclass correlation = 0.93) were accurate. Unidimensionality, Local Independency, and construct validity were verified by CFA (CFI = 0.93; TLI = 0.93; RMSEA = 0.05; χ2 = 3052.4 with DIF = 557 and P value = 0.595). GRM was adjusted, and Emotional Distress had a satisfactory coverage. DIF was not significant. CONCLUSION: The results obtained indicate the adequacy of the psychometric properties of the Portuguese version (Brazil/Portugal) of the Anger, Anxiety, and Depressive Symptoms item banks of the Pediatric PROMIS® Emotional Distress domain.

Cross-cultural adaptation and validation of the universal Portuguese-version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F).

OBJECTIVE: To cross-culturally adapt and validate the universal Portuguese version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F). METHOD: The universal Portuguese version of the pedsFACIT-F was cross-culturally adapted and validated in 323 children and adolescents aged 8-18 years, 173 healthy individuals, and 150 with chronic diseases (cancer, juvenile idiopathic arthritis, and diabetes). Reliability (internal consistency and test-retest reliability) was assessed. Item response theory model assumptions were evaluated using confirmatory and exploratory factor analyses. Items were calibrated using a graded response model. Differential item functioning was assessed regarding age, gender, and clinical condition (healthy vs. chronic diseases). RESULTS: No major cultural adaptations were needed. Internal consistency (Cronbach's alpha=0.84) and test-retest reliability (intraclass correlation coefficient=0.92) were good. CFA (CFI=0.92, TLI=0.90, RMSEA=0.097) and CFE analysis confirmed sufficient unidimensionality. The data also fit the GRM and demonstrated good coverage of the fatigue construct (threshold parameters range: -1.42 to 4.56). No items demonstrated significant differential item functioning. CONCLUSION: The universal Portuguese version of the pedsFACIT-F provides a reliable, precise, and valid measure after being assessed by robust psychometric properties. Stability of the measurement properties of the pedsFACIT-F scale allows its use to assess fatigue in clinical research in Portuguese-speaking children and adolescents.

Psychometric validation of PROMIS® Anxiety and Depression Item Banks for the Brazilian population.

PURPOSE: Scientific evidence indicates that depression and anxiety symptoms may be understood as risk factors associated with the incidence and progression of chronic diseases. Considering the lack of mental health assessment tools that meet strict methodological standards, the authors have chosen to validate the psychometric properties of Anxiety and Depression Item Banks - Emotional Distress domain of the Patient-Reported Outcomes Measurement Information System (PROMIS®) for the Brazilian population. METHODS: In this study, 606 adults responded to the self-administered Anxiety and Depression Item Banks, which were calibrated using Factor Analyses (Exploratory and Confirmatory analysis) and adjustment of the Graded Response Model. Transcultural validity was assessed by Differential Item Functioning (DIF). RESULTS: The two-factor analysis confirmed the unidimensionality of Emotional Distress Items (CFI = 0.96, TLI = 0.96, RMSEA = 0.05). The residual correlation matrix did not identify item pairs with local dependence. Indicators marked with DIF presented a low impact for gender, age, and language variables. The instrument demonstrated greater reliability in the moderate-severe range, indicating that the error reduction is reflected in the - 1.0 to + 3.0 amplitude. CONCLUSION: The psychometric measurements of Anxiety and Depression Item Banks in the Brazilian version were equivalent to those in the original version. Additional research contemplating patients with different levels of emotional distress are necessary to better comprehend the results obtained in this study.

Versão Brasileira do Tool for Assessing Cultural Competence Training (TACCT): uma Matriz de Competência Cultural / Brazilian Version of the Tool for Assessing Cultural Competence Training (TACCT): a Cultural Competence Model

Resumo: Introdução: Este estudo teve como objetivos traduzir, adaptar e avaliar as propriedades psicométricas do Tool for Assessing Cultural Competence Training (TACCT) para o português falado no Brasil. Métodos: Os itens do TACCT foram adaptados transculturalmente por meio das etapas de tradução, reconciliação, retrotradução, revisão da retrotradução, revisores independentes, etapa Delphi, pré-teste e incorporação dos resultados do pré-teste no processo de tradução. A versão final do instrumento para a língua portuguesa foi autoaplicada em 320 estudantes de uma escola médica. Para verificar a precisão da escala, adotou-se a análise de confiabilidade. Utilizamos a análise fatorial confirmatória para avaliação da validade de construto e dimensionalidade do instrumento. Resultado: A versão final do TACCT mostrou-se adequada e teve sua validade e confiabilidade confirmadas. Conclusão: A versão brasileira do TACCT é válida e confiável e tem potencial para ser utilizada no processo de implantação, revisão ou aprimoramento de currículos de escolas médicas brasileiras.

Abstract: Introduction: To translate, adapt and evaluate the psychometric properties of the Tool for Assessing Cultural Competence Training (TACCT) to Brazilian Portuguese. Methods: The TACCT items were transculturally adapted through several stages, namely: translation, reconciliation, backtranslation, revision of backtranslation, independent reviews, Delphi stage, pretest, and incorporation of the pretest results into the translation process. The final Portuguese version of the instrument was self-applied by 320 medical students. The scale accuracy was verified using reliability analysis. We employed confirmatory factor analysis to assess the construct validity and instrument dimensionality. Results: The final version of the TACCT was adequate, and its validity and reliability were confirmed. Conclusion: The Brazilian Portuguese version of the TACCT is valid and reliable, and it can be used to implement, review, and improve new curriculum content of Brazilian medical schools.

Validação brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS) / Brazilian validation of the item banks on Sleep Disturbance and Wake Disturbance in the Patient-Reported Outcomes Measurement Information System (PROMIS) / Validación brasileña de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia en el Patient-Reported Outcomes Measurement Information System (PROMIS)

O objetivo deste estudo foi validar a versão brasileira dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do Patient-Reported Outcomes Measurement Information System (PROMIS). A validação desses bancos de itens foi feita por meio da Teoria Clássica dos Testes, Teoria de Resposta ao Item, calibração dos itens conforme o modelo de resposta gradual proposto por Samejima e análise do Funcionamento Diferencial do Item (DIF), sendo a amostra constituída por 627 participantes com mais de 18 anos. Em relação à qualidade dos dados, observou-se que não houve dados perdidos, e cinco itens do banco Distúrbio do Sono e quatro itens do banco Distúrbio da Vigília tiveram efeito piso, e nenhum dos bancos apresentou efeito teto. Os dois bancos mostraram excelente confiabilidade com uma escala homogênea e boa estabilidade temporal. Com a Análise Fatorial Confirmatória, através dos índices de qualidade de ajuste absoluto e incremental, verificou-se um bom ajuste para os dois bancos, o que revela que os instrumentos são válidos e suficientemente unidimensionais. A calibração evidenciou que as propriedades psicométricas dos itens foram satisfatórias com boa cobertura do construto sono-vigília. No tocante ao DIF, tanto o banco Distúrbio do Sono quanto o banco Distúrbio da Vigília mostraram ser homogêneos para os diferentes grupos testados. Pode-se concluir que a versão para a língua portuguesa falada no Brasil dos bancos de itens Distúrbio do Sono e Distúrbio da Vigília do PROMIS demonstrou ser uma medida confiável, precisa e válida, com análises psicométricas robustas.

This study aimed to validate the Brazilian version of the item banks for Sleep Disturbance and Wake Disturbance from the Patient-Reported Outcomes Measurement Information System (PROMIS). Validation of these item banks used classical test theory, item response theory, calibrations of items according to the gradual response model proposed by Samejima, and analysis of Differential Item Functioning (DIF), with a sample consisting of 627 participants over 18 years of age. As for data quality, there were no missing data, five items from the Sleep Disturbance bank and four items from the WE bank showed a floor effect, and none of the banks showed a ceiling effect. The two banks displayed excellent reliability with homogeneous scale and good temporal stability. With confirmatory factor analysis, using absolute and incremental goodness-of-fit indices, both banks displayed good fit, showing that the instruments are valid and sufficiently unidimensional. The calibration showed that the items' psychometric properties were satisfactory with good coverage of the sleep-wake construct. As for DIF, both the Sleep Disturbance and Wake Disturbance banks proved to be homogeneous for the different test groups. In conclusion, the version in Brazilian Portuguese for the item banks on Sleep Disturbance and Wake Disturbance in the PROMIS proved to be a reliable, precise, and valid instrument with robust psychometric analyses.

El objetivo de este estudio fue validar la versión brasileña de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del Patient-Reported Outcomes Measurement Information System (PROMIS). La validación de esos bancos de ítems se realizó mediante teoría clásica de los tests, teoría de respuesta al ítem, calibración de los ítems, según el modelo de respuesta gradual propuesto por Samejima, así como el análisis del Funcionamiento Diferencial del Ítem (DIF), estando la muestra constituida por 627 participantes con más de 18 años. En relación con la calidad de los datos, se observó que no hubo dados perdidos y cinco ítems del banco Disturbio del Sueño y cuatro ítems del banco Disturbio de la Vigilia tuvieron efecto suelo, además ninguno de los bancos presentó un efecto techo. Los dos bancos mostraron excelente confiabilidad con una escala homogénea y buena estabilidad temporal. Con el análisis factorial confirmatorio, usándose los índices de calidad de ajuste absoluto e incremental, se verificó un buen ajuste para los dos bancos, lo que revela que los instrumentos son válidos y suficientemente unidimensionales. La calibración evidenció que las propiedades psicométricas de los ítems fueron satisfactorias con una buena cobertura del constructo sueño-vigilia. En lo que se refiere al DIF, tanto el banco Disturbio del Sueño como el Disturbio de la Vigilia mostraron ser homogéneos para los diferentes grupos testados. Se puede concluir que la versión para la lengua portuguesa hablada en Brasil de los bancos de ítems Disturbio del Sueño y Disturbio de la Vigilia del PROMIS demostró ser una medida confiable, precisa y válida, con análisis psicométricos robustos.