AIDS along Brazil`s borders, 1990-2003

Objective. To study the AIDS epidemic in Brazil`s border areas, from the spatial and temporal perspective. Methods. This was an ecological study in which the cases of AIDS reported to the Ministry of Health of Brazil from 1990-2003 were grouped according to ""hunger areas"" as defined by Josue de Castro in the 1940s and according to 19 cultural subregions. Spatial assessment was based on incidence rates for border municipalities; temporal assessment considered the absolute number of cases occurring quarterly from 1990-2003 in each of the hunger areas studied (Extreme South, Midwest, and Amazon). Results. During the study period, 7 973 cases of AIDS were reported from the Brazilian border areas: 648 in the Amazon area, 1 579 in the Midwest, and 5 746 in the Extreme South (populations of 668 098, 895 489, and 2 769 361, respectively). The subregions with the highest AIDS incidence rates in each of the three border areas were those near triple-borders, between more than two Latin American countries. Sexual transmission was predominant, with heterosexual transmission being the most frequent, followed by transmission by male homosexuality. These two categories accounted for 87.2% of the cases reported. The estimates of the trend parameter in the temporal analysis were 0.53 (P < 0.0001), 0.83 (P < 0.0001), and 3.47 (P < 0.0001), respectively, for the Amazon, Midwest, and Extreme South areas. Conclusion. The improvement of health care services along Brazil`s borders may be a strategy for territorial integration and for dealing with the AIDS epidemic, as long as social, economic, and cultural differences are taken into account.

Cross-cultural Adaptation, Reliability and Validity of the DAFS-R in a Sample of Brazilian Older Adults

The Direct Assessment of Functional Status-Revised (DAFS-R) is an instrument developed to objectively measure functional capacities required for independent living. The objective of this study was to translate and culturally adapt the DAFS-R for Brazilian Portuguese (DAFS-BR) and to evaluate its reliability and validity. The DAFS-BR was administered to 89 older patients classified previously as normal controls, mild cognitive impairment (MCI) and Alzheimer`s disease (AD). The results indicated good internal consistency (Cronbach`s alpha = 0.78) in the total sample. The DAFS-BR showed high interobserver reliability (0.996; p < .001) as well as test-retest stability over 1-week interval (0.995; p < .001). Correlation between the DAFS-BR total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was moderate and significant (r = -.65, p < .001) in the total sample, whereas it did not reach statistical significance within each diagnostic group. Receiver operating characteristic curve analyses suggested that DAFS-BR has good sensitivity and specificity to identify MCI and AD. Results suggest that DAFS-BR can document degrees of severity of functional impairment among Brazilian older adults.

Translation and Cross-Cultural Adaptation of the Brazilian Version of the International Knee Documentation Committee Subjective Knee Form Validity and Reproducibility

Background: The perception of improvement by a patient has assumed a central role in functional evaluation after a variety of knee problems. One of the instruments most used in clinical research is the International Knee Documentation Committee (IKDC) Subjective Knee Form because its psychometric properties are considered to be excellent. Nonetheless, this questionnaire was originally developed for use in the English language. Therefore, to use this questionnaire in the Brazilian population, it is essential to translate and validate it. Purpose: The aim of this study was to translate the IKDC Subjective Knee Form into a Brazilian version and to test its validity and reproducibility. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The translation of the original IKDC Subjective Knee Form into a Brazilian version was accomplished in accordance with the American Orthopaedic Society for Sports Medicine guidelines and was tested in 32 patients with knee pathologic conditions to develop the first Brazilian version. To test validity and reproducibility, 117 patients with several knee complaints completed the Brazilian IKDC Subjective Knee Form, the Short Form 36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lysholm score. From these patients, 85 were retested within a week to achieve reproducibility. The validation was addressed by correlating the Brazilian IKDC Subjective Knee Form to the other outcome measures. The reproducibility was tested by measuring internal consistency, test-retest reliability, and agreement. Results: The Brazilian IKDC Subjective Knee Form was highly related to the physical component summary of the SF-36, the Lysholm score, and the WOMAC, and weakly related to the mental component summary of SF-36 (r=.79, .89, .85, and .51, respectively). The internal consistency was strong, with a Cronbach a value of .928 and .935 in the test and retest assessment, respectively. The test-retest reliability proved to be excellent, with a high value of the intraclass correlation coefficient (.988), as well as the agreement, demonstrated by the low differences between the means of the test and retest, and the short limit of agreement, observed in the Altman-Bland and survival-agreement plots. Conclusion: The results of this study provide evidence that the Brazilian IKDC Subjective Knee Form has psychometric properties similar to the original version. In addition, it was a reliable evaluation instrument for patients with knee-related problems.