O quê, para quê e como? Desenvolvendo instrumentos de aferição em epidemiologia

The development and cross-cultural adaptation of measurement instruments have received less attention in methodological discussions, even though it is essential for epidemiological research. At the same time, the quality of epidemiological measurements is often below ideal standards for the construction of solid knowledge on the health-disease process. The scarcity of systematizations in the field about what, what for, and how to adequately measure intangible constructs contributes to this scenario. In this review, we propose a procedural model divided into phases and stages aimed at measuring constructs at acceptable levels of validity, reliability, and comparability. Underlying our proposal is the idea that not only some but several connected studies should be conducted to obtain appropriate measurement instruments. Implementing the model may contribute to broadening the interest in measurement instruments and, especially, addressing key epidemiological problems.Embora fundamental para a pesquisa epidemiológica, o desenvolvimento e a adaptação transcultural de instrumentos de aferição têm recebido menos destaque nas discussões metodológicas que permeiam o campo. Em paralelo, a qualidade das mensurações realizadas em muitos estudos epidemiológicos está frequentemente aquém do desejado para a construção de conhecimento sólido sobre o processo saúde-doença. A escassez de sistematizações sobre o que, para que e como aferir na área provavelmente contribui para esse cenário. Nesta revisão, propomos um modelo processual composto por uma sequência de etapas voltadas à mensuração de construtos em níveis aceitáveis de validade, confiabilidade e, por extensão, comparabilidade. Subjaz à proposta a ideia de que não apenas alguns, mas diversos estudos concatenados entre si e sucessivamente mais aprofundados devem ser conduzidos para obter aferições adequadas. A implementação do modelo poderá contribuir para alargar o interesse sobre instrumentos de aferição e, especialmente, para enfrentar os problemas investigados em epidemiologia

Adult oral health-related quality of life instruments: A systematic review

Objectives: To identify the existing OHRQoL instruments for adults, describe their scope (generic or specific), theoretical background, validation type and cross-cultural adaptation. Methods: A systematic search was conducted, and articles presenting validation of OHRQoL instruments in adults were included. Data were collected about the validation type: external validation (correlations/associations); or internal validation (factor analysis/principal components analysis, item response theory); and cross-cultural adaptation. Results: Of 3730 references identified, 326 were included reporting 392 studies. Forty-two original instruments were found among 74 different versions, 40 generic and 34 condition-specific. Locker's theoretical framework was the predominant model. The oral health impact profile (OHIP) presented 20 versions, with OHIP-14 being the most frequent (26.8%), followed by geriatric oral assessment index (GOHAI) (14.0%), OHIP-49 (11.7%) and oral impacts on daily performances (OIDP) (9.7%). Most studies focused on external validation (65.3%), while internal validation was reported in 24.8% (n = 26) of OHIP-14 studies, 50.9% (n = 28) of GOHAI and 21.1% (n = 8) of OIDP studies. Most internal validation studies were conducted in English-speaking countries (n = 33), and cross-cultural adaptation was mostly in non-English-speaking European countries (n = 40). Conclusions: Many generic and condition-specific instruments were found, but few have gone through a rigorous internal validation process or have undergone cross-cultural adaptation. This, in turn, makes it difficult for researchers to choose an appropriate measure based on known psychometric properties. OHIP-14, OIDP and GOHAI seem to be the most widely validated instruments. Equalizing measurement properties for comparability are challenging due to theoretical heterogeneity. Future studies should assess psychometric properties, explore the factorial structure and work towards a consensus on critical issues

Tecnologias de informação e comunicação (TICS) na gestão da cidade: reflexões e perspectivas

The aim of this final essay was to illustrate and reflect on the influence of Information and Communication Technologies (ICTs) in cities, pointing out conceptual issues which oriented social shifts of the Technological Revolution taken place from the latter part of the 20st century onwards as well as proposing a classification model encompassing the great variety of digital tools made possible and deployed by a diverse range of urban agents. The research’s main goal was to try to unveil important aspects related to the intensification of multi-scale network society, the emergence of alternative content development, new ways of social integration and social action, and opportunities of government openness to popular participation, as well as to classify the variety of urban tools developed and deployed within the ever so increasing “intelligent” or “smart” cities, bringing on relevant issues associated with political and social impacts caused by the introduction of “efficient” and interactive technological tools on urban management and urban planning, besides urban habits and practices.O objetivo do presente trabalho foi ilustrar e refletir sobre a influência das Tecnologias de Informação e Comunicação (TICs) na cidade, atentando às questões conceituais que orientam as transformações sociais ocorridas a partir da Revolução Tecnológica do final do século XX e propondo um modelo de classificação que dê conta do enorme arsenal de ferramentas digitais urbanas potencializadas e desenvolvidas por diversos agentes. O foco central da pesquisa foi tentar revelar aspectos relevantes do ponto de vista da intensificação de uma sociedade transescalar em rede, do surgimento de novos paradigmas de criação de conteúdo, da reconfiguração associativa e manifestativa, bem como das possibilidades de abertura do governo à participação civil, e, ao mesmo, categorizar as diversas ferramentas criadas e potencializadas com vistas a ilustrar o desenvolvimento cada vez mais assíduo de “cidades inteligentes” (smart cities), levantando questões pertinentes aos reflexos políticos e sociais provenientes da adoção de ferramentas tecnológicas “eficientes” e interativas na gestão urbana, no planejamento urbano e em hábitos e práticas na cidade

Adult Oral Health-Related Quality Of Life Instruments: A Systematic Review.

To identify the existing OHRQoL instruments for adults, describe their scope (generic or specific), theoretical background, validation type, and cross-cultural adaptation. Methods: A systematic search was conducted and articles presenting validation of OHRQoL instruments in adults were included. Data were collected about the validation type: external validation (correlations/associations); or internal validation (Factor Analysis/Principal Components Analysis, Item Response Theory); and cross-cultural adaptation. Results: Of 3730 references identified, 326 were included reporting 392 studies. Forty-two original instruments were found among 74 different versions, 40 generic and 34 condition-specific. Locker’s theoretical framework was the predominant model. The Oral Health Impact Profile (OHIP) presented 20 versions, with OHIP-14 being the most frequent (26.8%), followed by Geriatric Oral Assessment Index (GOHAI) (14.0%), OHIP-49 (11.7%) and Oral Impacts on Daily Performances (OIDP) (9.7%). Most studies focused on external validation (65.3%), while internal validation was reported in 24.8% (n=26) of OHIP-14 studies, 50.9% (n=28) of GOHAI, and 21.1% (n=8) of OIDP studies. Most internal validation studies were conducted in English-speaking countries (n=33), and cross-cultural adaptation mostly in non- English-speaking European countries (n=40). Conclusions: Many generic and condition-specific instruments were found, but few have gone through a rigorous internal validation process or have undergone cross-cultural adaptation. This, in turn, makes it difficult for researchers to choose an appropriate measure based on known psychometric properties. OHIP-14, OIDP and GOHAI seem to be the most widely validated instruments. Equalising measurement properties for comparability is challenging due to theoretical heterogeneity. Future studies should assess psychometric properties, explore the factorial structure, and work towards a consensus on critical issues

An intra-community profile of nutritional deficiency: a study of under-fives in a low-income community in Rio de Janeiro (Brazil)

Como parte de um estudo epidemiológico sobre a saúde de crianças abaixo de cinco anos realizado na favela da Rocinha, Rio de Janeiro, RJ (Brasil), avaliou-se o perfil nutricional de uma amostra representativa de 591 crianças. De acordo com o indicador peso-para-idade, 23,9% encontravam-se com desnutrição leve (grau I pela classificação de Gomez), e apenas 22,0% evidenciaram desnutrição moderada (grau II). Esse achado mostrou-se compatível com aqueles onde se utilizaram os indicadores peso-para-altura e altura-para-idade: (a) ausência de desnutrição aguda, com um perfil de peso-para-altura superposto ao de uma população padrão normal, e (b) deficiência de crescimento, com 7% e 15% de crianças excedendo os valores abaixo de, respectivamente, -2 e -1 desvios-padrão esperados numa população normal. Quanto à deficiência estatural, as seguintes variáveis mostraram-se associadas mesmo após controle pelo "status" econômico (indicado pelas condições ambientais do domicílio): baixo peso-ao-nascer, número de irmãos igual ou acima de três, sexo masculino, história de nunca ter amamentado ao seio materno, e história de morte infantil prévia na família. Cada variável é discutida separadamente, bem como o perfil nutricional geral e a marcada estratificação social intracomunitária da deficiência estatural.This study is part of a larger epidemiological study concerned with the health status of children under the age of five carried out in the squatter settlement of Rocinha, and focuses on the nutritional profile of a representative sample of 591 children. According to the weight-for-age criteria (Gomez's classification), 23,9% and 2,0% were, respectively, mildly and moderately malnourished. This finding is in agreement with the assessment using weight-for-height and height-for-age as anthropometric indicators: (a) absence of acute malnutrition (wasting) indicated by a pattern overlapping that of an expected normal population, and (b) growth deficiency (stunting) indicated by 7% and 15% of children exceeding the proportion normally expected to be, respectively, below the -1 and -2 standard deviate limits. So far as growth failure was concerned, the following variables remained associated even when controlling for economic status (indicated by the environmental conditions of the household): low birth weight, number of siblings equal to or above three, male gender, a history of never having breastfed and a family history of previous sibling death. Each variable is discussed separately, as well as the overall nutritional profile and the marked social intra-community stratification related to growth deficit

Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia

The objective of the article was to offer an operational framework to assess cross cultural adaptation processes of instruments developed in other linguistic, social and cultural contexts. It covers the need for using robust measurement tools; the importance of 'universal' instruments that permit cross cultural fine-tuning; and stresses the need for adapting existent instruments rather than developing new ones. Existing controversies and proposals for different procedures in current literature are reviewed and a model for adapting instruments is presented. This synthesis covers the operational steps involved in evaluating concepts, semantic and operational items, and presents psychometric analysis guidelines that underlay an evaluation of measurement equivalence. Finally, the need for adequately controlling the quality of information presented in epidemiological studies, including a meticulous cross-cultural adaptation of research agendas, is reinforced.O objetivo do artigo foi propor uma sistemática operativa para avaliar o processo de adaptação transcultural de instrumentos desenvolvidos em outros contextos lingüístico sócio-culturais. São feitas considerações sobre a necessidade do uso de instrumentos de aferição robustos; a importância de instrumentos "universais" que permitam sintonias transculturais; e a necessidade de partir para adaptação em contraposição ao desenvolvimento de um instrumento novo. Aborda-se a existência de controvérsias e diferentes propostas processuais na literatura e apresenta-se um modelo de adaptação. Essa síntese envolve os passos operativos dos processos de avaliação de equivalência conceitual, de itens, semântica e operacional, e apresenta um roteiro de análise psicométrica que alicerça a avaliação de equivalência de mensuração. Finalmente, reforça-se a necessidade de cuidar da qualidade da informação em estudos epidemiológicos, incluindo meticulosos processos de adaptação transcultural nas agendas de pesquisas