Equivalência semântica da versão em português do instrumento Abuse Assessment Screen para rastrear a violência contra a mulher grávida

INTRODUCTION: Research programs and actions regarding family violence have been growing steadily. Therefore, there's a need to develop data collection tools. In Brazil, further problems come up since tools that have been developed elsewhere need to be adapted and translated. This study focuses on the Abuse Assessment Screening (AAS) used to detect violence against pregnant women. The objective is to evaluate the semantic equivalence between the original tool in English and two Portuguese versions, and propose a synthetic version to be used in the field. METHODS: The evaluation of semantic equivalence was carried out in 4 steps: (1) translation, (2) back translation, (3) formal appreciation of equivalence and (4) a final critical assessment by family violence experts. RESULTS: Translation, back translation and the steps 3 and 4 assessment are presented for each item of the tool, along with the original in English. The text covers each discussion that led to the final version. Both versions were quite similar in 14 out of 15 items. Nevertheless, the second version showed to be slightly more adequate although for some items the decision was to combine both versions or, in one case, use an item from version 1. CONCLUSION: The procedure undertaken in this study is discussed in the light of Herdman et al.'s proposal (1998) regarding transcultural equivalence. The study also stresses the importance of using more than one version in the process and the appropriateness of including an additional step about the assessment of the target population's understanding of the tool.INTRODUÇÃO: Programas de investigação epidemiológica e de ação no âmbito da violência familiar estão em franca ascensão, requerendo instrumentos de aferição adaptados e vertidos para o português. O objetivo do estudo é avaliar a equivalência semântica entre o original em inglês e duas versões para o português do instrumento Abuse Assessment Screen (AAS) usado no rastreamento de casos de violência contra a mulher grávida e recomendar uma versão-síntese para uso corrente. MÉTODOS: O processo de avaliação de equivalência semântica envolveu quatro etapas: tradução, retradução, apreciação formal de equivalência e crítica final através de consultas com especialista na área temática. RESULTADOS: Para cada item do instrumento apresentam-se os resultados relativos às quatro etapas. O texto cobre cada passo do processo que levou à versão final. As duas versões mostraram-se bastante semelhantes, com 14 das 15 assertivas similares, embora a segunda versão tenha se mostrado mais adequada, ainda que para alguns itens tenha sido decidido juntar as duas versões ou mesmo utilizar um item oriundo da versão um. CONCLUSÃO: É importante usar mais de uma versão no processo, em várias etapas de avaliação e de crítica, e discutir a pertinência de se acrescentar uma etapa adicional de interlocução do instrumento com membros da população-alvo

Measurement reliability in a study on family violence and severe acute malnutrition

INTRODUCTION: This study is nested within a research program related to family violence and severe childhood malnutrition. Its aim is to evaluate the reliability of the data collection process in a case-control study. Four components of the main instrument are addressed: (a) CTS (Conflict Tactics Scales) used to measure violence at the family level; (b) CAGE (Cut-down; Annoyed; Guilty & Eye-opener) questionnaire used to gnage suspicion of drinking problems; NSDUQ (Non-student Drugs Use Questionnaire) used to indicate illicit drug consumption; and (d) heigth/lenght measurements. METHOD: Stability (intra-observer or test-retest reliability) and equivalence (inter-observer reliability) were evaluated for the cited components (a), (b) and (c). Information was replicated among the first 50 subjects selected for the underlying case-control study. The Kappa index (k) was used in the analysis. A pseudo-Bayes adjustment was carried out in order to handle estimation problems. Regarding (d), only equivalence was evaluated (n=73), using the Intraclass Correlation Coefficient as the estimator. RESULTS: By and large, all components showed acceptable stability and equivalence. Regarding stability, the estimates of k were around 0.70, 0.78 and 0.85, for CTS, CAGE e NSDUQ, respectively. With respect to equivalence, k was 1.0 for CTS and NSDUQ and 0.75 for CAGE. Equivalence for height/length estimated through the ICC was 0.99. Nevertheless, some deviant situations were detected and are further discussed. The results point to an adequate standardization of observers and reflect the good quality of the data collection procedure concerning the main study, encouraging the research team to press forward with greater assurance.INTRODUÇÃO: Como parte do programa de investigação sobre violência familiar e desnutrição severa na infância, especificamente um estudo do tipo caso-controle foi avaliada a confiabilidade dos instrumentos utilizados no processo de obtenção de dados. Estudou-se a confiabilidade de quatro componentes do instrumento principal: (a) as Escalas sobre Táticas de Conflitos (Conflicts Tactics Scales - CTS) que medem o grau de conflito/violência familiar; (b) o instrumento CAGE (Cut-down; Annoyed; Guilty & Eye-opener) usado para indicar suspeição de alcoolismo; (c) o NSDUQ (Non-student Drugs Use Questionnaire) que visa aferir o uso de drogas ilícitas; e (d) a medida antropométrica de comprimento. MÉTODO: Para os três primeiros componentes citados foram avaliadas a estabilidade (confiabilidade intra-observador ou teste-reteste) e a equivalência (confiabilidade inter-observador), usando-se os 50 primeiros sujeitos captados no estudo caso-controle de fundo. Para a análise, usou-se o índice Kappa (k) com ajustamento (pseudo-Bayes) para lidar com problemas de estimabilidade. Em relação ao componente "d", foi estudada somente a equivalência (n=73), usando-se o Coeficiente de Correlação Intraclasse (Intra-class Correlation Coefficient - ICC) como estimador. RESULTADOS: Todos os componentes mostraram estabilidade e equivalência aceitáveis. Quanto à estabilidade das CTS, CAGE e NSDUQ, as estimações de k foram em torno de 0,70, 0,78 e 0,85, respectivamente. Em relação à equivalência, encontrou-se os valores de 1,0 para as CTS e NSDUQ e 0,75 para CAGE. A equivalência estimada através do ICC para comprimento foi de 0,99. Algumas situações desviantes foram observadas. Os resultados apontam para uma adequada padronização dos observadores e refletem a boa qualidade do processo de aferição referente ao estudo de fundo, encorajando a equipe de pesquisa a prosseguir com maior segurança

Brazilian Maternal and Child Nutrition Consortium: establishment, data harmonization and basic characteristics.

Pooled data analysis in the field of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identified outliers, and assessed heterogeneity for GWG. Outliers identification considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identified 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a final sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were flagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited

Measures and models for causal inference in cross-sectional studies: arguments for the appropriateness of the prevalence odds ratio and related logistic regression

<p>Abstract</p> <p>Background</p> <p>Several papers have discussed which effect measures are appropriate to capture the contrast between exposure groups in cross-sectional studies, and which related multivariate models are suitable. Although some have favored the Prevalence Ratio over the Prevalence Odds Ratio -- thus suggesting the use of log-binomial or robust Poisson instead of the logistic regression models -- this debate is still far from settled and requires close scrutiny.</p> <p>Discussion</p> <p>In order to evaluate how accurately true causal parameters such as Incidence Density Ratio (IDR) or the Cumulative Incidence Ratio (CIR) are effectively estimated, this paper presents a series of scenarios in which a researcher happens to find a preset ratio of prevalences in a given cross-sectional study. Results show that, provided essential and non-waivable conditions for causal inference are met, the CIR is most often inestimable whether through the Prevalence Ratio or the Prevalence Odds Ratio, and that the latter is the measure that consistently yields an appropriate measure of the Incidence Density Ratio.</p> <p>Summary</p> <p>Multivariate regression models should be avoided when assumptions for causal inference from cross-sectional data do not hold. Nevertheless, if these assumptions are met, it is the logistic regression model that is best suited for this task as it provides a suitable estimate of the Incidence Density Ratio.</p

Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): empirical evidence for a general factor

<p>Abstract</p> <p>Background</p> <p>The Edinburgh Postnatal Depression Scale (EPDS) has been proposed as a one-dimensional instrument and used as a single 10-item scale. This might be considered questionable since repeated psychometric studies have shown multi-dimensionality, which would entail using separate component subscales. This study reappraised the dimensional structure of the EPDS, with a focus on the extent of factor correlations and related factor-based discriminant validity as a foundation for deciding how to effectively scale the component items.</p> <p>Methods</p> <p>The sample comprised 811 randomly selected mothers of children up to 5 months attending primary health services of Rio de Janeiro, Brazil. Strict Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis modeled within a CFA framework (E/CFA) were sequentially used to identify best fitting and parsimonious model(s), including a bifactor analysis to evaluate the existence of a general factor. Properties concerning the related 10-item raw-score scale were also investigated using non-parametric items response theory methods (scalability and monotonicity).</p> <p>Results</p> <p>An initial CFA rejected the one-dimensional structure, while an E/CFA subscribed a three-dimensional solution. Yet, factors were highly correlated (0.66, 0.75 and 0.82). The ensuing CFA showed poor discriminant validity (some square-roots of average variance extracted below the factor correlations). A general bifactor CFA was then fit. Results suggested that, although still weakly encompassing three specific factors, the EPDS might be better described by a model encompassing a general factor (loadings ranging from 0.51 to 0.81). The related 10-item raw score showed adequate scalability (Loevinger's H coefficient = 0.4208), monotonicity e partial double monotonicity (nonintersections of Item Step Response Functions).</p> <p>Conclusion</p> <p>Although the EPDS indicated the presence of specific factors, they do not qualify as independent dimensions if used separately and should therefore not be used empirically as sub-scales (raw scores). An all-encompassing scale seems better suited and continuing its use in clinical practice and applied research should be encouraged.</p