Facial filling with polymethylmethacrylate in patients with acquired immunodeficiency syndrome

INTRODUCTION: Patients with acquired immunodeficiency syndrome (AIDS) who use highly active antiretroviral therapy (HAART) can develop lipodystrophy syndrome, for which facial filling with polymethylmethacrylate is a treatment option. The objective is to analyze the procedure of facial filling and evaluate patients in relation to their perception, discomfort, revelation of the diagnosis to third parties, expectation concerning facial filling, and satisfaction with the treatment outcome and its impact on their lives. METHODS: Sixty-three patients who underwent facial filling were evaluated. Procedures performed between January and July 2009 were assessed, the records of the patients were analyzed, and the outpatient lipodystrophy protocol of the STD/AIDS and Viral Hepatitis Municipal Program of São Bernardo do Campo was used. RESULTS: All the 63 patients who agreed to participate in the research completed the study. Only 6 patients (9.5%) were from other municipalities, while 57 patients (90.5%) were residents of São Bernardo. Of the patients, 68.2% were men and 100% were Caucasian. The mean age of the patients was 49.7 years. Human immunodeficiency virus was diagnosed 11.5 years prior on average, with 10-year average use of HAART and 3.8-year average time of facial lipoatrophy. Most of the patients used stavudine and/or efavirenz. The patients themselves felt more uncomfortable with facial changes. Among the patients, 85.7% did not reveal the diagnosis to third parties. CONCLUSION: All of the patients were satisfied or very satisfied with the result obtained, which had a favorable impact on their lives. The filling surgical procedure had no adverse effects

Adaptação cultural em Português Brasileiro da Derriford Appearance Scale – 24 (DAS-24) para pessoas vivendo com HIV/AIDS

Introduction: Body image can be defined as the representation of beliefs, emotions and perceptions about the body itself, manifested in behaviors directed to the body. When the body changes because of a disease and does not seem healthy, the self-concept may be severely challenged. People living with HIV/AIDS (PLHA) are particularly vulnerable to the distress and psychosocial impact of appearance, but in Brazil the assessment of those body image changes was subjective because there was not an available scale in Brazilian Portuguese to assess body image changes in clinical practice or research. Objective: To carry out the cross-cultural adaptation to the Brazilian Portuguese of the Derriford Appearance Scale 24 (DAS-24), with the verification of the linguistic, semantic, conceptual and cultural equivalence of the people living with HIV/AIDS in Brazil. Methods: We followed the five stages of culturally sensitive translation: direct translations, synthesis of translations, back-translations, expert committee meeting and pre-tests. The process of cultural adaptation was presented in a descriptive and analytical way, following patterns of methodological studies. The minimum, maximum and median values of the responses of each item were calculated from the pool of data from the third pretest group of 50 participants. The median of the item scores, the correlation on each item with the total score and the internal reliability, were calculated using the Cronbach alpha test. Results: The analysis of the responses of the last pre-test group indicated that attention must be given to itemsA, H, T and V in a future psychometric study. The present study is not enough for this scale to be used in clinical practice. To ensure that the culturally adapted instrument generates valid and reliable data, a subsequent study investigating its psychometric properties should be conducted. Conclusion: The cross-cultural adaptation of the Derriford Appearance Scale 24 (DAS-24) in its components of linguistic, semantic, conceptual and cultural equivalence to Brazilian Portuguese for the population of people living with HIV/AIDS was fully carried out. Despite this achievement, it is emphasized that the use of the Brazilian versionof DAS-24 in research and clinical routine is advised only after a psychometric study with this instrument.Introdução: A imagem corporal pode ser definida como a representação das crenças, emoções e percepções a respeito do próprio corpo, manifesta em comportamentos voltados ao corpo. Quando o corpo muda como consequência de doença e não parece mais saudável, a definição de si mesmo pode ser severamente desafiada. As pessoas vivendo com HIV/AIDS (PVHA) são um público especialmente vulnerável quando se trata do “distress” e do impacto psicossocial da aparência, mas a avaliação destas alterações de imagem corporal era subjetiva porque não havia nenhuma escala em Português Brasileiro para avaliar alterações da imagem disponível para uso clínico ou para pesquisa. Objetivo: Realizar a adaptação transcultural para o português Brasileiro da Derriford Appearance Scale 24 (DAS-24), com a verificação da equivalência idiomática, semântica, conceitual e cultural, para o público-alvo pessoas vivendo com HIV/AIDS (PVHA) no Brasil. Método: Seguiu-se guia de cinco etapas para adaptação de escala transcultural: traduções, síntese de traduções, retrotraduções, reunião de comitê de especialistas e pré-testes. O processo de adaptação cultural foi apresentado de forma descritiva e analítica, seguindo padrões de estudos metodológicos. Os valores mínimo, máximo e mediano das respostas de cada item foram calculados a partir do pool de dados do terceiro grupo de pré-teste de 50 participantes. A mediana dos escores dos itens, a correlação de cada item com o escore total e a confiabilidade interna foram calculados pelo teste alfa de Cronbach. Resultado: A análise das respostas do último grupo pré-teste indicou que deve ser dada atenção aos itens A, B, G, H e K em um futuro estudo psicométrico. O presente estudo não é suficiente para que essa escala seja utilizada na prática clínica. Para garantir que o instrumento culturalmente adaptado gere dados válidos e confiáveis, um estudo subsequente que investigue suas propriedades psicométricas deve ser conduzido. Conclusão: A adaptação transcultural da Derriford Appearance Scale 24 (DAS-24), em seus componentes de equivalência linguística, semântica, conceitual e cultural para o português brasileiro para a população de pessoas vivendo com HIV/AIDS foi plenamente realizada. Apesar dessa conquista, ressalta-se que o uso da versão brasileira do DAS-24 em pesquisa e rotina clínica é aconselhado somente após um estudo psicométrico com este instrumento

Psychometric validation of the brazilian portuguese version of the derriford appearance scale-24 (DAS-24) for people living with HIV/AIDS

The changes in appearance of people living with HIV/AIDS (PLHA) interferes with how people around them react to their body, how social interactions take place, and how each person perceives and accepts their body. The definition of itself can be severely challenged when the body changes as a result of illness and the person does not look healthier anymore. People living with HIV/AIDS (PLHA) are an especially vulnerable group when it comes to “distress” and the psychosocial impact of appearance, yet the assessment of body image changes in these people was subjective in Brazil. The aim of this paper was to assess the psychometric properties of the Brazilian version of Derriford Appearance Scale 24 (DAS-24) for a sample of Brazilians living with HIV/AIDS. A sample of 400 patients were recruited from an HIV/AIDS ambulatory, aged between 18 and 78 years, of both sexes. The psychometric properties of DAS-24 were investigated while using confirmatory factor analysis (CFA), with unweighted least square estimation and listwise deletion for missing data. The adjustment of three structural models previously established for DAS-24 (single-factor, two-factor, and three-factor) was investigated. Evidences of construct validity—convergent and discriminant—and internal consistency—Cronbach’s alpha and construct reliability—were also generated for the measure model. The results showed that the one-factor model had the best adjustment, after eliminating items 8, 17, and 20, and accepting the covariance of errors between items 4 and 10; 9 and 23; 11 and 14; and, 14 and 22. Additionally, validity and reliability evidence were satisfactory for the model. The Brazilian Portuguese version of DAS-24 seems to be a psychometrically sound scale for measuring body image distress for people living with HIV/AIDS (PLHA)