Validade de indicadores de atividade física e sedentarismo obtidos por inquérito telefônico

OBJETIVO: Avaliar a reprodutibilidade e a validade de indicadores de atividade física e sedentarismo, obtidos por sistema de vigilância baseado em inquéritos telefônicos. MÉTODOS: Foram realizadas análises de reprodutibilidade e validade em duas subamostras aleatórias (n=110 e n=111, respectivamente) da amostra total (N=2.024) de adultos (>18 anos), estudada pelo sistema, no município de São Paulo, em 2005. Os indicadores avaliados incluíram a freqüência de "suficientemente ativos no lazer", "inativos em quatro domínios da atividade física (lazer, trabalho, transporte e atividades domésticas)" e "ver televisão por longos períodos". A reprodutibilidade foi estudada comparando-se resultados obtidos a partir da entrevista telefônica original do sistema e de outra entrevista idêntica repetida após sete a 15 dias e feita por entrevistador diferente do que fez a entrevista original. A validade foi estudada comparando-se resultados obtidos a partir da entrevista telefônica original e de três recordatórios de 24 horas (método de referência) realizados na semana seguinte à entrevista original. RESULTADOS: A freqüência dos três indicadores avaliados foi idêntica ou muito próxima entre a primeira e a segunda entrevistas telefônicas, e os coeficientes kappa se situaram entre 0,53 e 0,80, indicando boa reprodutibilidade de todos os indicadores. Relativamente ao método de referência, evidenciou-se especificidade de 80% ou mais para os três indicadores e sensibilidade de 69,7% para "ver televisão por longos períodos", 59,1% para "inativos em quatro domínios" e 50% para "suficientemente ativos no lazer". CONCLUSÕES: Os indicadores de atividade física e sedentarismo empregados pelo sistema aparentam ser reprodutíveis e suficientemente acurados. Se mantido em operação nos próximos anos, o sistema poderá oferecer ao Brasil um instrumento útil para avaliação de políticas públicas de promoção da atividade física e controle das doenças crôni

Perceived need for mental health care, findings from the Australian National Survey of Mental Health and Well-being

Background. The Australian National Survey of Mental Health and Well-being was designed to detect and describe psychiatric morbidity, associated disability, service use and perceived need for care. The survey employed a single-phase interview methodology, delivering a field questionnaire to a clustered probability sample of 10641 Australians. Perceived need was sampled with an instrument designed for this survey, the Perceived Need for Care Questionnaire (PNCQ). This questionnaire gathers information about five categories of perceived need, assigning each to one of four levels of perceived need. Reliability and validity studies showed satisfactory performance of the instrument. Methods. Perceived need for mental health care in the Australian population has been analysed using PNCQ data, relating this to diagnostic and service utilization data from the above survey. Results. The survey findings indicate that an estimated 13.8 % of the Australian population have perceived need for mental health care. Those who met interview criteria for a psychiatric diagnosis and also expressed perceived need make up 9.9 % of the population. An estimated 11.0% of the population are cases of untreated prevalence, a minority (3.6% of the population) of whom expressed perceived need for mental health care. Among persons using services, those without a psychiatric diagnosis based on interview criteria (4.4% of the population), showed high levels of perceived met need. Conclusions. The overall rate of perceived need found by this methodology lies between those found in the USA and Canada. The findings suggest that service use in the absence of diagnosis elicited by survey questionnaires may often represent successful intervention. In the survey, untreated prevalence was commonly not accompanied by perceived need for mental health care.

Is the ATIC terminology oriented to nursing phenomena?

The main goal of this observational and descriptive study is to evaluate whether the diagnosis axis of a nursing interface terminology meets the content validity criterion of being nursing-phenomena oriented. Nursing diagnosis concepts were analyzed in terms of presence in the nursing literature, type of articles published and areas of disciplinary interest. The search strategy was conducted in three databases with limits in relation to period and languages. The final analysis included 287 nursing diagnosis concepts. The results showed that most of the concepts were identified in the scientific literature, with a homogeneous distribution of types of designs. Most of these concepts (87.7%) were studied from two or more areas of disciplinary interest. Validity studies on disciplinary controlled vocabularies may contribute to demonstrate the nursing influence on patients" outcomes.

Under-reporting of dietary energy intake in five populations of the African diaspora.

Studies on the role of diet in the development of chronic diseases often rely on self-report surveys of dietary intake. Unfortunately, many validity studies have demonstrated that self-reported dietary intake is subject to systematic under-reporting, although the vast majority of such studies have been conducted in industrialised countries. The aim of the present study was to investigate whether or not systematic reporting error exists among the individuals of African ancestry (n 324) in five countries distributed across the Human Development Index (HDI) scale, a UN statistic devised to rank countries on non-income factors plus economic indicators. Using two 24 h dietary recalls to assess energy intake and the doubly labelled water method to assess total energy expenditure, we calculated the difference between these two values ((self-report - expenditure/expenditure) × 100) to identify under-reporting of habitual energy intake in selected communities in Ghana, South Africa, Seychelles, Jamaica and the USA. Under-reporting of habitual energy intake was observed in all the five countries. The South African cohort exhibited the highest mean under-reporting ( - 52·1% of energy) compared with the cohorts of Ghana ( - 22·5%), Jamaica ( - 17·9%), Seychelles ( - 25·0%) and the USA ( - 18·5%). BMI was the most consistent predictor of under-reporting compared with other predictors. In conclusion, there is substantial under-reporting of dietary energy intake in populations across the whole range of the HDI, and this systematic reporting error increases according to the BMI of an individual.

Développement et validation d’un outil clinique pour l’analyse quantitative de la posture auprès de personnes atteintes d’une scoliose idiopathique

La scoliose idiopathique (SI) est une déformation tridimensionnelle (3D) de la colonne vertébrale et de la cage thoracique à potentiel évolutif pendant la croissance. Cette déformation 3D entraîne des asymétries de la posture. La correction de la posture est un des objectifs du traitement en physiothérapie chez les jeunes atteints d’une SI afin d’éviter la progression de la scoliose, de réduire les déformations morphologiques et leurs impacts sur la qualité de vie. Les outils cliniques actuels ne permettent pas de quantifier globalement les changements de la posture attribuables à la progression de la scoliose ou à l’efficacité des interventions thérapeutiques. L’objectif de cette thèse consiste donc au développement et à la validation d’un nouvel outil clinique permettant l’analyse quantitative de la posture auprès de personnes atteintes d’une SI. Ce projet vise plus spécifiquement à déterminer la fidélité et la validité des indices de posture (IP) de ce nouvel outil clinique et à vérifier leur capacité à détecter des changements entre les positions debout et assise. Suite à une recension de la littérature, 34 IP représentant l’alignement frontal et sagittal des différents segments corporels ont été sélectionnés. L’outil quantitatif clinique d’évaluation de la posture (outil 2D) construit dans ce projet consiste en un logiciel qui permet de calculer les différents IP (mesures angulaires et linéaires). L’interface graphique de cet outil est conviviale et permet de sélectionner interactivement des marqueurs sur les photographies digitales. Afin de vérifier la fidélité et la validité des IP de cet outil, la posture debout de 70 participants âgés entre 10 et 20 ans atteints d'une SI (angle de Cobb: 15º à 60º) a été évaluée à deux occasions par deux physiothérapeutes. Des marqueurs placés sur plusieurs repères anatomiques, ainsi que des points de référence anatomique (yeux, lobes des oreilles, etc.), ont permis de mesurer les IP 2D en utilisant des photographies. Ces mêmes marqueurs et points de référence ont également servi au calcul d’IP 3D obtenus par des reconstructions du tronc avec un système de topographie de surface. Les angles de Cobb frontaux et sagittaux et le déjettement C7-S1 ont été mesurés sur des radiographies. La théorie de la généralisabilité a été utilisée pour déterminer la fidélité et l’erreur standard de la mesure (ESM) des IP de l’outil 2D. Des coefficients de Pearson ont servi à déterminer la validité concomitante des IP du tronc de l’outil 2D avec les IP 3D et les mesures radiographiques correspondantes. Cinquante participants ont été également évalués en position assise « membres inférieurs allongés » pour l’étude comparative de la posture debout et assise. Des tests de t pour échantillons appariés ont été utilisés pour détecter les différences entre les positions debout et assise. Nos résultats indiquent un bon niveau de fidélité pour la majorité des IP de l’outil 2D. La corrélation entre les IP 2D et 3D est bonne pour les épaules, les omoplates, le déjettement C7-S1, les angles de taille, la scoliose thoracique et le bassin. Elle est faible à modérée pour la cyphose thoracique, la lordose lombaire et la scoliose thoraco-lombaire ou lombaire. La corrélation entre les IP 2D et les mesures radiographiques est bonne pour le déjettement C7-S1, la scoliose et la cyphose thoracique. L’outil est suffisamment discriminant pour détecter des différences entre la posture debout et assise pour dix des treize IP. Certaines recommandations spécifiques résultents de ce projet : la hauteur de la caméra devrait être ajustée en fonction de la taille des personnes; la formation des juges est importante pour maximiser la précision de la pose des marqueurs; et des marqueurs montés sur des tiges devraient faciliter l’évaluation des courbures vertébrales sagittales. En conclusion, l’outil développé dans le cadre de cette thèse possède de bonnes propriétés psychométriques et permet une évaluation globale de la posture. Cet outil devrait contribuer à l’amélioration de la pratique clinique en facilitant l’analyse de la posture debout et assise. Cet outil s’avère une alternative clinique pour suivre l’évolution de la scoliose thoracique et diminuer la fréquence des radiographies au cours du suivi de jeunes atteints d’une SI thoracique. Cet outil pourrait aussi être utile pour vérifier l’efficacité des interventions thérapeutiques sur la posture.

Mesures subjectives et épidémiologie : problèmes méthodologiques liés à l'utilisation des techniques psychométriques

L’utilisation des mesures subjectives en épidémiologie s’est intensifiée récemment, notamment avec la volonté de plus en plus affirmée d’intégrer la perception qu’ont les sujets de leur santé dans l’étude des maladies et l’évaluation des interventions. La psychométrie regroupe les méthodes statistiques utilisées pour la construction des questionnaires et l’analyse des données qui en sont issues. Ce travail de thèse avait pour but d’explorer différents problèmes méthodologiques soulevés par l’utilisation des techniques psychométriques en épidémiologie. Trois études empiriques sont présentées et concernent 1/ la phase de validation de l’instrument : l’objectif était de développer, à l’aide de données simulées, un outil de calcul de la taille d’échantillon pour la validation d’échelle en psychiatrie ; 2/ les propriétés mathématiques de la mesure obtenue : l’objectif était de comparer les performances de la différence minimale cliniquement pertinente d’un questionnaire calculée sur des données de cohorte, soit dans le cadre de la théorie classique des tests (CTT), soit dans celui de la théorie de réponse à l’item (IRT) ; 3/ son utilisation dans un schéma longitudinal : l’objectif était de comparer, à l’aide de données simulées, les performances d’une méthode statistique d’analyse de l’évolution longitudinale d’un phénomène subjectif mesuré à l’aide de la CTT ou de l’IRT, en particulier lorsque certains items disponibles pour la mesure différaient à chaque temps. Enfin, l’utilisation de graphes orientés acycliques a permis de discuter, à l’aide des résultats de ces trois études, la notion de biais d’information lors de l’utilisation des mesures subjectives en épidémiologie.

Validade de indicadores do consumo de alimentos e bebidas obtidos por inquérito telefônico

OBJETIVO: Avaliar a reprodutibilidade e a validade de indicadores do consumo de alimentos e bebidas obtidos por sistema de vigilância baseado em inquéritos telefônicos. MÉTODOS: Foram realizadas análises de reprodutibilidade e validade em duas subamostras aleatórias (n=112 e n=109, respectivamente) da amostra total (N=2.024) de adultos (>18 anos) estudada pelo sistema em 2005 no município de São Paulo. Os indicadores avaliados incluíram fatores de proteção (consumo diário ou quase diário de frutas e hortaliças) e de risco (consumo diário ou quase diário de refrigerantes, consumo habitual de alimentos fontes de gorduras saturadas de origem animal, e consumo abusivo de bebidas alcoólicas) para doenças crônicas. Para a análise de reprodutibilidade compararam-se resultados obtidos a partir da entrevista telefônica original do sistema e de outra entrevista idêntica repetida após sete a 15 dias. Para a análise de validade compararam-se resultados obtidos a partir da entrevista telefônica original e de três recordatórios de 24 horas (padrão-ouro) realizados até 15 dias após a entrevista original. RESULTADOS: A freqüência dos indicadores estudados mostrou-se relativamente constante entre a primeira e a segunda entrevistas telefônicas e os coeficientes kappa se situaram entre 0,57 e 0,80, indicando boa reprodutibilidade de todos os indicadores. Relativamente ao padrão-ouro, evidenciou-se tendência de superestimação na freqüência do consumo de alimentos protetores, mas não na freqüência de alimentos associados a risco para doenças crônicas. Sensibilidade e especificidade foram elevadas para indicadores do consumo de alimentos associados a risco (próximas a 80%) e variáveis no caso de alimentos protetores (entre 42% e 80%). CONCLUSÕES: A avaliação indicou boa reprodutibilidade e adequada validade para a maioria dos indicadores empregados pelo sistema, o que indica que a manutenção da sua operação nos próximos anos oferecerá ao Brasil um útil instrumento para avaliação de políticas publicas de promoção da alimentação saudável e controle das doenças crônicas não transmissíveis relacionadas à alimentação.

Validade de indicadores de atividade física e sedentarismo obtidos por inquérito telefônico

OBJETIVO: Avaliar a reprodutibilidade e a validade de indicadores de atividade física e sedentarismo, obtidos por sistema de vigilância baseado em inquéritos telefônicos. MÉTODOS: Foram realizadas análises de reprodutibilidade e validade em duas subamostras aleatórias (n=110 e n=111, respectivamente) da amostra total (N=2.024) de adultos (>18 anos), estudada pelo sistema, no município de São Paulo, em 2005. Os indicadores avaliados incluíram a freqüência de "suficientemente ativos no lazer", "inativos em quatro domínios da atividade física (lazer, trabalho, transporte e atividades domésticas)" e "ver televisão por longos períodos". A reprodutibilidade foi estudada comparando-se resultados obtidos a partir da entrevista telefônica original do sistema e de outra entrevista idêntica repetida após sete a 15 dias e feita por entrevistador diferente do que fez a entrevista original. A validade foi estudada comparando-se resultados obtidos a partir da entrevista telefônica original e de três recordatórios de 24 horas (método de referência) realizados na semana seguinte à entrevista original. RESULTADOS: A freqüência dos três indicadores avaliados foi idêntica ou muito próxima entre a primeira e a segunda entrevistas telefônicas, e os coeficientes kappa se situaram entre 0,53 e 0,80, indicando boa reprodutibilidade de todos os indicadores. Relativamente ao método de referência, evidenciou-se especificidade de 80% ou mais para os três indicadores e sensibilidade de 69,7% para "ver televisão por longos períodos", 59,1% para "inativos em quatro domínios" e 50% para "suficientemente ativos no lazer". CONCLUSÕES: Os indicadores de atividade física e sedentarismo empregados pelo sistema aparentam ser reprodutíveis e suficientemente acurados. Se mantido em operação nos próximos anos, o sistema poderá oferecer ao Brasil um instrumento útil para avaliação de políticas públicas de promoção da atividade física e controle das doenças crônicas não transmissíveis relacionadas ao sedentarismo.

Validação do questionário Baecke modificado para idosos e proposta de valores normativos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Validação do roteiro de entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P)

The study of the parental educative social skills is extremely important for promoting the development and learning of children within interactive situations. The objective of this study was to assess reliability and validity of the Parental Educative Social Skills Interview Script (RE-HSE-P). It was proceeded: a) the test-retest reliability assessment, with a sample of 41 participants assessed in two distinct moments, with an interval of two months and the Cronbach's alpha was calculated; b) 213 parents of preschoolers (n =114) and school age children (n = 98) evaluated their children,were assessed for the construct and discrimination validity studies, differentiated in groups: a) demand for psychological intervention x community children without problems and b) children with behavior problems x children without behavior problems. The results showed satisfactory values of internal consistency and validity; besides, the factorial analysis pointed a unifactorial structure called positive parent-child interaction

Avaliação da equivalência semântica e consistência interna de uma versão em português do Internet Addiction Test (IAT)

OBJETIVO: Este estudo teve por objetivo a adaptação transcultural do Internet Addiction Test (IAT) para o idioma português. MÉTODOS: O trabalho consistiu em cinco etapas: (1) tradução; (2) retradução; (3) revisão técnica e avaliação da equivalência semântica por profissionais da área; (4) avaliação do instrumento por uma amostra de estudantes, avaliando-se o seu grau de compreensão; e (5) análise da consistência interna por meio do coeficiente alfa de Cronbach. RESULTADOS: O instrumento foi traduzido e adaptado para o idioma português, demonstrando ser facilmente compreendido e apresentando valor de consistência interna de 0,85. CONCLUSÃO: O instrumento encontra-se traduzido e adaptado para o português e apresenta consistência interna satisfatória. São necessárias análises de equivalência de mensuração e reprodutibilidade.

Cost-effectiveness of intensified interventions to control healthcare-associated MRSA infections -- A systematic literature review

Methicillin Resistant Staphylococcus aureus healthcare-associated infections (MRSA HAIs) are a major cause of morbidity in hospitalized patients. They pose great economic burden to hospitals caring for these patients. Intensified Interventions aim to control MRSA HAIs. Cost-effectiveness of Intensified Interventions is largely unclear. We performed a review of cost-effectiveness literature on Intensified Interventions , and provide a summary of study findings, the status of economic research in the area, and information that will help decision-makers at regional level and guide future research.^ We conducted literature search using electronic database PubMed, EBSCO, and The Cochrane Library. We limited our search to English articles published after 1999. We reviewed a total of 1,356 titles, and after applying our inclusion and exclusion criteria selected seven articles for our final review. We modified the Economic Evaluation Abstraction Form provided by CDC, and used this form to abstract data from studies.^ Of the seven selected articles two were cohort studies and the remaining five were modeling studies. They were done in various countries, in different study settings, and with different variations of the Intensified Intervention . Overall, six of the seven studies reported that Intensified Interventions were dominant or at least cost-effective in their study setting. This effect persisted on sensitivity testing.^ We identified many gaps in research in this field. The cost-effectiveness research in the field is mostly composed of modeling studies. The studies do not always clearly describe the intervention. The intervention and infection costs and the sources for these costs are not always explicit or are missing. In modeling studies, there is uncertainty associated with some key model inputs, but these inputs are not always identified. The models utilized in the modeling studies are not always tested for internal consistency or validity. Studies usually test the short term cost-effectiveness of Intensified Interventions but not the long results.^ Our study limitation was the inability to adjust for differences in study settings, intervention costs, disease costs, or effectiveness measures. Our study strength is the presentation of a focused literature review of Intensified Interventions in hospital settings. Through this study we provide information that will help decision makers at regional level, help guide future research, and might change clinical care and policies. ^

Validation of a food-frequency questionnaire assessment of carotenoid and vitamin E intake using weighed food records and plasma biomarkers: The method of triads model

Background: Reliability or validity studies are important for the evaluation of measurement error in dietary assessment methods. An approach to validation known as the method of triads uses triangulation techniques to calculate the validity coefficient of a food-frequency questionnaire (FFQ). Objective: To assess the validity of an FFQ estimates of carotenoid and vitamin E intake against serum biomarker measurements and weighed food records (WFRs), by applying the method of triads. Design: The study population was a sub-sample of adult participants in a randomised controlled trial of beta-carotene and sunscreen in the prevention of skin cancer. Dietary intake was assessed by a self-administered FFQ and a WFR. Nonfasting blood samples were collected and plasma analysed for five carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, lycopene) and vitamin E. Correlation coefficients were calculated between each of the dietary methods and the validity coefficient was calculated using the method of triads. The 95% confidence intervals for the validity coefficients were estimated using bootstrap sampling. Results: The validity coefficients of the FFQ were highest for alpha-carotene (0.85) and lycopene (0.62), followed by beta- carotene (0.55) and total carotenoids (0.55), while the lowest validity coefficient was for lutein (0.19). The method of triads could not be used for b- cryptoxanthin and vitamin E, as one of the three underlying correlations was negative. Conclusions: Results were similar to other studies of validity using biomarkers and the method of triads. For many dietary factors, the upper limit of the validity coefficients was less than 0.5 and therefore only strong relationships between dietary exposure and disease will be detected.

Validity of the self reporting questionnaire-20 in epidemiological studies with older adults

This study examined the validity of the self-reporting questionnaire (SRQ-20) in a population-based survey with older adults in Sao Paulo, Brazil. The study sample consisted of 2,008 individuals aged 65 years or more who were living in an economically disadvantaged area of the city. The geriatric mental state (GMS) was used as the gold standard for the assessment of common mental disorders (CMD). The optimal SRQ-20 threshold for case definition was 4/5 (sensitivity = 76.1%, specificity = 74.6%, area under ROC curve = 0.82). Women, older participants and those with lower income were more likely to be misclassified by the questionnaire. The inclusion of older persons with dementia or psychosis did not change the ability of the SRQ-20 to identify cases of CMD. The SRQ-20 may be a useful instrument to be used in large epidemiological studies in resource-poor settings for the identification of cases of depression and anxiety in later life. The performance of the SRQ-20 among older adults was similar to that observed with the adult population in Brazil.