Propriedades psicométricas da versão portuguesa do Kansas City Cardiomyopathy Questionnaire na miocardiopatia dilatada com insuficiência cardíaca congestiva

Vários estudos demonstraram que os doentes com insuficiência cardíaca congestiva (ICC) têm um compromisso da qualidade de vida relacionada com a saúde (QVRS), tendo esta, nos últimos anos, vindo a tornar-se um endpoint primário quando se analisa o impacto do tratamento de situações crónicas como a ICC. Objectivos: Avaliar as propriedades psicométricas da versão portuguesa de um novo instrumento específico para medir a QVRS na ICC em doentes hospitalizados: o Kansas City Cardiomyopathy Questionnaire (KCCQ). População e Métodos: O KCCQ foi aplicado a uma amostra consecutiva de 193 doentes internados por ICC. Destes, 105 repetiram esta avaliação 3 meses após admissão hospitalar, não havendo eventos ocorridos durante este período de tempo. A idade era 64,4± 12,4 anos (entre 21 e 88), com 72,5% a pertencer ao sexo masculino, sendo a ICC de etiologia isquémica em 42%. Resultados: Esta versão do KCCQ foi sujeita a validação estatística semelhante à americana com a avaliação da fidelidade e validade. A fidelidade foi avaliada pela consistência interna dos domínios e dos somatórios, apresentando valores Alpha de Cronbach idênticos nos vários domínios e somatórios ( =0,50 a =0,94). A validade foi analisada pela convergência, pela sensibilidade às diferenças entre grupos e pela sensibilidade à alteração da condição clínica. Avaliou-se a validade convergente de todos os domínios relacionados com funcionalidade, pela relação verificada entre estes e uma medida de funcionalidade, a classificação da New York Heart Association (NYHA), tendo-se verificado correlações significativas (p<0,01), como medida para avaliar a funcionalidade em doentes com ICC. Efectuou-se uma análise de variância entre o domínio limitação física, os somatórios e as classes da NYHA, tendo-se encontrado diferenças estatisticamente significativas (F=23,4; F=36,4; F=37,4; p=0,0001), na capacidade de descriminação da gravidade da condição clínica. Foi realizada uma segunda avaliação em 105 doentes na consulta do 3º mês após a intervenção clínica, tendo-se observado alterações significativas nas médias dos domínios avaliados entre o internamento e a consulta (diferenças de 14,9 a 30,6 numa escala de 0-100), indicando que os domínios avaliados são sensíveis à mudança da condição clínica. A correlação interdimensões da qualidade de vida que compõe este instrumento é moderada, sugerindo dimensões independentes, apoiando a sua estrutura multifactorial e a adequabilidade desta medida para a sua avaliação. Conclusão: O KCCQ é um instrumento válido, sensível à mudança e específico para medir a QVRS numa população portuguesa com miocardiopatia dilatada e ICC. ABSTRACT - Several studies have shown that patients with congestive heart failure (CHF) have a compromised health-related quality of life (HRQL), and this, in recent years, has become a primary endpoint when considering the impact of treatment of chronic conditions such as CHF. Objectives: To evaluate the psychometric properties of the Portuguese version of a new specific instrument to measure HRQL in patients hospitalized for CHF: the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: The KCCQ was applied to a sample of 193 consecutive patients hospitalized for CHF. Of these, 105 repeated the assessment 3 months after admission, with no events during this period. Mean age was 64.4±12.4 years (21-88), and 72.5% were 72.5% male. CHF was of ischemic etiology in 42% of cases. Results: This version of the KCCQ was subjected to statistical validation, with assessment of reliability and validity, similar to the American version. Reliability was assessed by the internal consistency of the domains and summary scores, which showed similar values of Cronbach alpha (0.50-0.94). Validity was assessed by convergence, sensitivity to differences between groups and sensitivity to changes in clinical condition. We evaluated the convergent validity of all domains related to functionality, through the relationship between them and a measure of functionality, the New York Heart Association (NYHA) classification. Significant correlations were found (p<0.01) for this measure of functionality in patients with CHF. Analysis of variance between the physical limitation domain, the summary scores and NYHA class was performed and statistically significant differences were found (F=23.4; F=36.4; F=37.4, p=0.0001) in the ability to discriminate severity of clinical condition. A second evaluation was performed on 105 patients at the 3-month follow-up outpatient appointment, and significant changes were observed in the mean scores of the domains assessed between hospital admission and the clinic appointment (differences from 14.9 to 30.6 on a scale of 0-100), indicating that the domains assessed are sensitive to changes in clinical condition. The correlation between dimensions of quality of life in the KCCQ is moderate, suggesting that the dimensions are independent, supporting the multifactorial nature of HRQL and the suitability of this measure for its evaluation. Conclusion: The KCCQ is a valid instrument, sensitive to change and a specific measure of HRQL in a population with dilated cardiomyopathy and CHF.

Visual Screening Competencies Questionnaire (VSCQ) and orthoptic practice

The identification of core competencies which are important for undertaking accurate visual screening by orthoptists is considered in this study. The aim was to construct and validate a questionnaire for orthoptists to assess visual screening competency. This study comprised three steps. The first step involved a 69-item self-assessment questionnaire constructed to assess orthoptists' perception of their competencies in visual screening programs for children. This questionnaire was constructed with statements from the Orthoptic Benchmark Statement for Health Care Programmes (Quality Assurance Agency for Higher Education, UK) and included three competency dimensions: interpersonal (IP), instrumental (IT) and systemic (ST). The second step involved questionnaire translation.

Validação do questionário 'Prosthesis Evaluation Questionnaire - PEQ'

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Validation of a measurement scale for the relationship between the orientation to corporate social responsibility and other business strategic variables

The importance of Social Responsibility (SR) is higher if this business variable is related with other ones of strategic nature in business activity (competitive success that the company achieved, performance that the firms develop and innovations that they carries out). The hypothesis is that organizations that focus on SR are those who get higher outputs and innovate more, achieving greater competitive success. A scale for measuring the orientation to SR has defined in order to determine the degree of relationship between above elements. This instrument is original because previous scales do not exist in the literature which could measure, on the one hand, the three classics sub-constructs theoretically accepted that SR is made up and, on the other hand, the relationship between SR and the other variables. As a result of causal relationships analysis we conclude with a scale of 21 indicators, validated scale with a sample of firms belonging to the Autonomous Community of Extremadura and it is the first empirical validation of these dimensions we know so far, in this context.

Estudo da qualidade organizacional da unidade de rastreio da retinopatia diabética do Alentejo central: projecto de intervenção comunitária em saúde

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Gestão e Administração dos Serviços de Saúde.

Children visual screening protocol: validation by a focus group panel of experts

Screening programs, particularly the inclusion of specific orthoptic tests to detect visual abnormalities, varies among countries. This study aims to: 1) describes expert perception of issues related with children visual screening; 2) identify specific orthoptic tests to detect visual abnormalities in children visual screening.

Dispositional optimism is unidimensional or bidimensional? The Portuguese Revised Life Orientation Test

The aim of the study is to adapt and then discuss the appropriateness of the Life Orientation Test as a one or two dimension scale. The research includes two studies; one is composed of a sequential sample of 280 people with multiple sclerosis, 71% female, and another includes a convenience sample of 615 individuals from the community, 51.1% female. Because the construct is built upon a theoretical assumption that has one dimension, we examine the hypothesis of one or two factor solutions through confirmatory factor analysis, and the two-dimension solution premise demonstrates better adjustment for both samples. The other psychometric properties explored show appropriate results for the Portuguese sample, and similar to the original ones; the Test therefore seems appropriate for use in cross cultural studies. Based on our results, we discuss whether the questionnaire is a one or two dimension instrument, concluding that it appears appropriate to accept the recommendations of the original authors to use it as a one-dimensional tool and, when necessary, to use both dimensions. - RESUMO: El objetivo del estudio es adaptar y discutir la adecuación de la prueba de Orientación de la Vida en una o dos escalas de dimensión. La investigación engloba dos estudios, uno constituido por una muestra secuencial de 280 personas con esclerosis múltiple, 71% mujeres y otro con una muestra de conveniencia de la comunidad de 615 individuos, 51,1% del sexo femenino. Como el constructo se asienta sobre la presunción teórica de que tiene una dimensión, inspeccionamos la hipótesis de una o dos soluciones de factor a través del análisis factorial confirmatorio y la hipótesis de dos dimensiones manifiesta un mejor ajuste para ambas muestras. Las otras propiedades psicométricas exploradas muestran los resultados apropiados para la muestra portuguesa, y semejantes a los originales. Parece apropiado para los estudios culturales transversales. Basándonos en nuestros resultados, discutimos si el cuestionario es un instrumento de una o dos dimensiones, concluyéndose que parece conveniente seguir las recomendaciones de los autores originales, para utilizarlo como un instrumento unidimensional y, si fuera necesario necesario, utilizar cada una de las dimensiones.

Compreender os atributos da qualidade percebida pelos clientes/utentes do Grupo CUF: o caso de três serviços de imagiologia da Região de Lisboa

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Qualidade e Tecnologias da Saúde.

Qualidade de vida das famílias de crianças com surdez: avaliação na perspectiva das famílias

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de mestre em Ciências da Educação - Especialidade Educação Especial

Monte Carlo modeling and simulations of the High Definition (HD120) micro MLC and validation against measurements for a 6 MV beam

Purpose: The most recent Varian® micro multileaf collimator(MLC), the High Definition (HD120) MLC, was modeled using the BEAMNRCMonte Carlo code. This model was incorporated into a Varian medical linear accelerator, for a 6 MV beam, in static and dynamic mode. The model was validated by comparing simulated profiles with measurements. Methods: The Varian® Trilogy® (2300C/D) accelerator model was accurately implemented using the state-of-the-art Monte Carlo simulation program BEAMNRC and validated against off-axis and depth dose profiles measured using ionization chambers, by adjusting the energy and the full width at half maximum (FWHM) of the initial electron beam. The HD120 MLC was modeled by developing a new BEAMNRC component module (CM), designated HDMLC, adapting the available DYNVMLC CM and incorporating the specific characteristics of this new micro MLC. The leaf dimensions were provided by the manufacturer. The geometry was visualized by tracing particles through the CM and recording their position when a leaf boundary is crossed. The leaf material density and abutting air gap between leaves were adjusted in order to obtain a good agreement between the simulated leakage profiles and EBT2 film measurements performed in a solid water phantom. To validate the HDMLC implementation, additional MLC static patterns were also simulated and compared to additional measurements. Furthermore, the ability to simulate dynamic MLC fields was implemented in the HDMLC CM. The simulation results of these fields were compared with EBT2 film measurements performed in a solid water phantom. Results: Overall, the discrepancies, with and without MLC, between the opened field simulations and the measurements using ionization chambers in a water phantom, for the off-axis profiles are below 2% and in depth-dose profiles are below 2% after the maximum dose depth and below 4% in the build-up region. On the conditions of these simulations, this tungsten-based MLC has a density of 18.7 g cm− 3 and an overall leakage of about 1.1 ± 0.03%. The discrepancies between the film measured and simulated closed and blocked fields are below 2% and 8%, respectively. Other measurements were performed for alternated leaf patterns and the agreement is satisfactory (to within 4%). The dynamic mode for this MLC was implemented and the discrepancies between film measurements and simulations are within 4%. Conclusions: The Varian® Trilogy® (2300 C/D) linear accelerator including the HD120 MLC was successfully modeled and simulated using the Monte CarloBEAMNRC code by developing an independent CM, the HDMLC CM, either in static and dynamic modes.

Functional validation of LexADBDGim chimeras in saccharomyces cerevisiae

GimC/Prefoldin is a hetero-oligomeric complex involved in cytoskeleton biogenesis. In order to identify by two-hybrid system targets that directly interact with Gims and support the stress phenotypes, this work aimed the functional validation of all Gims in saccharomyces cerevisiae.

A educação artística e o desenvolvimento da criatividade e autonomia dos alunos de um curso profissional

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Educação Artística, na Especialização de Artes Plásticas na Educação

Development and validation of a psychometric scale for assessing PA chest image quality: a pilot study

Purpose - To develop and validate a psychometric scale for assessing image quality perception for chest X-ray images. Methods - Bandura's theory was used to guide scale development. A review of the literature was undertaken to identify items/factors which could be used to evaluate image quality using a perceptual approach. A draft scale was then created (22 items) and presented to a focus group (student and qualified radiographers). Within the focus group the draft scale was discussed and modified. A series of seven postero-anterior chest images were generated using a phantom with a range of image qualities. Image quality perception was confirmed for the seven images using signal-to-noise ratio (SNR 17.2–36.5). Participants (student and qualified radiographers and radiology trainees) were then invited to independently score each of the seven images using the draft image quality perception scale. Cronbach alpha was used to test interval reliability. Results - Fifty three participants used the scale to grade image quality perception on each of the seven images. Aggregated mean scale score increased with increasing SNR from 42.1 to 87.7 (r = 0.98, P < 0.001). For each of the 22 individual scale items there was clear differentiation of low, mid and high quality images. A Cronbach alpha coefficient of >0.7 was obtained across each of the seven images. Conclusion - This study represents the first development of a chest image quality perception scale based on Bandura's theory. There was excellent correlation between the image quality perception scores derived using the scale and the SNR. Further research will involve a more detailed item and factor analysis.

Contributo para a validação de uma escala pediátrica, Peabody Developmental Motor Scale-2 (versão portuguesa)

Mestrado em Fisioterapia

Impacto da síncope na qualidade de vida: validação duma escala de avaliação em doentes submetidos a teste de inclinação em mesa basculante

Introdução e objetivos: A síncope recorrente tem um impacto significativo na qualidade de vida. O desenvolvimento de escalas de medida de fácil aplicabilidade clínica para avaliar este impacto é fundamental. O objetivo do presente estudo é a validação preliminar da escala Impact of Syncope on Quality of Life, para a população portuguesa. Métodos: O instrumento foi submetido a um processo de tradução, validação, adequação cultural e cognitive debriefing. Participaram 39 doentes com história de síncopes recorrentes (>1 ano de evolução), submetidos a teste de inclinação em mesa basculante (teste de tilt), que constitui uma amostra de conveniência, com idade de 52,1±16,4 anos (21-83; 43,5% do sexo masculino), a maioria com uma situação profissional ativa (n=18) ou reformados (n=13). A versão portuguesa resultou numa versão semelhante unidimensional à original com 12 itens agregados num único somatório, tendo passado por validação estatística, com avaliação da fidelidade, validade e estabilidade no tempo. Resultados: Em relação à fidelidade, a consistência interna da escala é de 0,9. Avaliámos a validade convergente, tendo obtido resultados estatisticamente significativos (p<0,01). Avaliámos a validade divergente tendo obtido resultados estatisticamente significativos. Relativamente à estabilidade no tempo foi efetuado um teste-reteste do instrumento aos seis meses após o teste de inclinação com 22 doentes desta amostra não submetidos a intervenção clínica, que não mostrou alterações estatisticamente significativas da qualidade de vida. Conclusões: Os resultados obtidos indicam a pertinência da utilização deste instrumento em contexto português na avaliação da qualidade de vida de doentes com síncope recorrente.