Taking the "cross" out of cross-cultural transfer of management practice

Multi-national enterprises often attempt to replicate successful management practices in "foreign" environments. However, such practices may be ethnocentric because they fit the assumptions, behaviors, expectations, and values of the home cultural environment. Unless the underlying assumptions are shared, transfer to a differing environment may fail. Even if the focus is shifted from cultural differences to implementation, implementation approaches may also be criticized as ethnocentric for the same reasons. In this article, a non-ethnocentric model is expanded and used to test the portability of one management practice, performance appraisal, from the USA to Brazil. This "Test of Portability" may help managers understand which management practices are portable, and, perhaps even more valuable, provide a rationale for adaptation or rejection.

Evaluation and additional recommendations for preparing a whole blood control material

OBJECTIVE: The assessment of an easy to prepare and low cost control material for Hematology, available for manual and automated methods. MATERIAL AND METHOD: Aliquots of stabilized whole blood were prepared by partial fixation with aldehydes; the stability at different temperatures (4. 20 and 37 °C) during periods of up to 8-9 weeks and aliquot variability with both methods were controlled. RESULTS: Aliquot variability with automated methods at day 1, expressed as CV% (coefficient of variation) was: white blood cells (WBC) 2.7, red blood cells (RBC) 0.7, hemoglobin (Hb) 0.6, hematocrit (Hct) 0.7, mean cell volume (MCV) 0.3, mean cell hemoglobin (MCH) 0.6, mean cell hemoglobin concentration (MCHC) 0.7, and platelets (PLT) 4.6. The CV (coefficient of variation) percentages obtained with manual methods in one of the batches were: WBC 23, Hct 2.8, Hb 4.5, MCHC 5.9, PLT 41. Samples stored at 4ºC and 20ºC showed good stability, only a very low initial hemolysis being observed, whereas those stored at 37ºC deteriobed a rapidly (metahemoglobin formation, aggregation of WBC and platelets, as well as alteration of erythrocyte indexes). CONCLUSIONS: It was confirmed that, as long as there is no exposure to high temperatures during distribution, this material is stable, allowing assessment, both esternal and internal, for control purposes, with acceptable reproductivity, both for manual and auttomatic methods.

Factorial validity of the Maslach Burnout Inventory (MBI-HSS) among Spanish professionals

OBJECTIVE: To assess the factorial validity and internal consistency of the Maslach Burnout Inventory (MBI-HSS). METHODS: In a sample consisting of 705 Spanish professionals from diverse occupational sectors (health, education, police and so one), seven plausible factorial models hypothesized were compared using LISREL 8. RESULTS: The four-factor oblique solution and the three-factor oblique solution showed the best and similar fit. Deletion of Item 12 and Item 16, taking into consideration the suggestions in the manual, improved the goodness of fit for both models. The four-factor oblique model suggests that, in addition to Emotional Exhaustion (EE) and Depersonalization (DP), Personal Accomplishment (PA) consists of two components labeled here Self-Competence (Items 4, 7, 17, and 21) and the Existential Component (Items 9, 12, 18, and 19). However, the alpha coefficient was relatively low for the Self-Competence component, suggesting that it is more suitable to estimate the syndrome as a threedimensional construct. The Cronbach's alpha was satisfactory for PA (alpha =.71) and EE (alpha =.85), and moderate for DP (alpha =.58). CONCLUSIONS: The results show that the MBI-HSS offers factorial validity and its scales present internal consistency to evaluate the quality of working life for Spanish professionals.

Blood glucose control in diabetes patients seen in primary health care centers

OBJECTIVE: To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS: A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS: The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method) showed that patients with body mass indexes below 27 kg/m², patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS: Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.

Climacteric symptoms and quality of life: validity of women's health questionnaire

OBJECTIVE: To evaluate the reliability and validity of the Portuguese version of the Women's Health Questionnaire. METHODS: In order to evaluate the Women's Health Questionnaire (WHQ), an analytical cross-sectional study was carried out at the women's menopause outpatient clinic of a university hospital in São Paulo, Brazil. There were studied 87 women in perimenopause or menopause, defined as experiencing at least one year's absence of menstrual flow. The following variables were collected: demographic data, clinical variables (Kupperman index and correlate numeric scale) and quality of life indexes (SF-36 and utility). RESULTS: The WHQ proved to be a questionnaire easily translated into Portuguese and well-adjusted to Brazilian women. The internal consistency of the overall WHQ was excellent (Cronbach alpha =0.83; 95% CI: 0.71-0.91). Test-retest reliability was also excellent (intraclass correlation coefficient [ICC]=0.92; 95% IC: 0.86-0.96) and had good absolute agreement (0.84; 95% CI: 0.71-0.92). A satisfactory clinical validity was observed. The construct validity was corroborated by clear associations with others scales. A good index of responsiveness after the intervention was reached. CONCLUSIONS: The Portuguese version of the WHQ is of easy and fast administration and understanding. Its measuring properties were related, allowing its use in the evaluation of Brazilian climacteric women's quality of life for various purposes.

Brazilian WHOQOL-OLD Module version: a Rasch analysis of a new instrument

OBJECTIVE: To evaluate the Brazilian version of WHOQOL-OLD Module and to test potential changes to the instrument to increase its psychometric adequacy. METHODS: A total of 424 older adults living in a city in Southern Brazil completed the WHOQOL-OLD instrument, in 2005. Rasch analysis was used to explore the psychometric performance of the scale, as implemented by the RUMM2020 software. Item-trait interaction, threshold disorders, presence of differential item functioning and item fit, were analyzed. RESULTS: Two ("death and dying" and "sensory abilities") out of six domains showed inadequate item-trait interactions. Rescoring the response scale and deleting the most misperforming items led to scale improvement. The evaluation of domains and items individually showed that the "intimacy" domain does perform well in contrast to the findings using the classical approach. In addition, the "sensory abilities" domain does not derive an interval measure in its current format. CONCLUSIONS: Unidimensionality and local independence were seen in all domains. Changes in the response scale and deletion of problematic items improved the scale's performance.

Validity of the Brazilian version of WHOQOL-BREF in depressed patients using Rasch modelling

OBJECTIVE: To assess the validity of the Brazilian version of the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-BREF) in adults with major depression, using Rasch modelling. METHODS: Study analyzing data from the baseline sample of the Longitudinal Investigation of Depression Outcomes in Brazil, including a total of 208 patients with major depression recruited in a primary care service in Porto Alegre (Southern Brazil), in 1999. The Center for Epidemiological Studies Depression Scale was used to assess intensity of depression; the WHOQOL-BREF to assess generic quality of life; and the Composite International Diagnostic Interview version 2.1 for the diagnosis of depression. RESULTS: In the Rasch analysis, the four domains of WHOQOL-BREF showed appropriate fit to this model. Some items needed adjustments: four items were rescored (pain, finances, services, and transport); two items (work and activity) were identified as having dependency of responses, and one item was deleted (sleep) due to multidimensionality. CONCLUSIONS: The validation of the WHOQOL-BREF Brazilian version using Rasch analysis complements previous validation studies, evidencing the robustness of this instrument as a generic cross-cultural quality of life measure.

Validação da versão brasileira do "Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo" em professores

OBJETIVO: Avaliar a validade fatorial e de construto da versão brasileira do "Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo" (CESQT). MÉTODOS: O processo de versão do questionário original do espanhol para o português incluiu as etapas de tradução, retrotradução e equivalência semântica. Foi realizada análise fatorial confirmatória e utilizados modelos de equações estruturais de quatro fatores, similar ao da estrutura original do CESQT. A amostra foi constituida de 714 professores que trabalhavam em instituições de ensino da cidade de Porto Alegre, RS, e região metropolitana 2008. O questionário possui 20 itens distribuídos em quatro subescalas: Ilusão pelo trabalho (5 itens), Desgaste psíquico (4 itens), Indolência (6 itens) e Culpa (5 itens). O modelo foi analisado com base no programa LISREL 8. RESULTADOS: As medidas de ajuste indicaram adequação do modelo hipotetizado: χ2(164) = 605,86 (p < 0,000), Goodness Fit Index = 0,92, Adjusted Goodness Fit Index = 0,90, Root Mean Square Error of Approximation = 0,062, Non-Normed Fit Index = 0,91, Comparative Fit Index = 0,92, Parsimony Normed Fit Index = 0,77. O valor de alfa de Cronbach para todas as subescalas foi maior que 0,70. CONCLUSÕES: Os resultados indicam que o CESQT possui validade fatorial e consistência interna adequada para avaliar burnout em professores brasileiros.

Adaptação transcultural Portugal-Brasil do Inventário de Burnout de Maslach para estudantes

OBJETIVO: Realizar a adaptação transcultural da versão em português do Inventário de Burnout de Maslach para estudantes e investigar sua confiabilidade, validade e invariância transcultural. MÉTODOS: A validação de face envolveu participação de equipe multidisciplinar. Foi realizada validação de conteúdo. A versão em português foi preenchida em 2009, pela internet, por 958 estudantes universitários brasileiros e 556 portugueses da zona urbana. Realizou-se análise fatorial confirmatória utilizando-se como índices de ajustamento o χ²/df, o comparative fit index (CFI), goodness of fit index (GFI) e o root mean square error of approximation (RMSEA). Para verificação da estabilidade da solução fatorial conforme a versão original em inglês, realizou-se validação cruzada em 2/3 da amostra total e replicada no 1/3 restante. A validade convergente foi estimada pela variância extraída média e confiabilidade composta. Avaliou-se a validade discriminante e a consistência interna foi estimada pelo coeficiente alfa de Cronbach. A validade concorrente foi estimada por análise correlacional da versão em português e dos escores médios do Inventário de Burnout de Copenhague; a divergente foi comparada à Escala de Depressão de Beck. Foi avaliada a invariância do modelo entre a amostra brasileira e a portuguesa. RESULTADOS: O modelo trifatorial de Exaustão, Descrença e Eficácia apresentou ajustamento adequado (χ²/df = 8,498; CFI = 0,916; GFI = 0,902; RMSEA = 0,086). A estrutura fatorial foi estável (λ: χ²dif = 11,383, p = 0,50; Cov: χ²dif = 6,479, p = 0,372; Resíduos: χ²dif = 21,514, p = 0,121). Observou-se adequada validade convergente (VEM = 0,45;0,64, CC = 0,82;0,88), discriminante (ρ² = 0,06;0,33) e consistência interna (α = 0,83;0,88). A validade concorrente da versão em português com o Inventário de Copenhague foi adequada (r = 0,21;0,74). A avaliação da validade divergente do instrumento foi prejudicada pela aproximação do conceito teórico das dimensões Exaustão e Descrença da versão em português com a Escala de Beck. Não se observou invariância do instrumento entre as amostras brasileiras e portuguesas (λ:χ²dif = 84,768, p < 0,001; Cov: χ²dif = 129,206, p < 0,001; Resíduos: χ²dif = 518,760, p < 0,001). CONCLUSÕES: A versão em português do Inventário de Burnout de Maslach para estudantes apresentou adequada confiabilidade e validade, mas sua estrutura fatorial não foi invariante entre os países, apontando ausência de estabilidade transcultural.

Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.