Validade transcultural da escala demanda-controle: trabalhadores suecos e brasileiros

OBJECTIVE To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version. METHODS We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables. RESULTS The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority. CONCLUSIONS The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.OBJETIVO Avaliar a validade transcultural da escala demanda-controle, comparando o questionário original sueco com a versão brasileira. MÉTODOS Foram comparados os dados de trabalhadores de saúde, 362 suecos e 399 brasileiros. Foram utilizadas análise fatorial confirmatória e exploratória para avaliar a validade estrutural, usando o estimador robusto de mínimos quadrados ponderados ajustados para média e variância (WLSMV). A validade de construto via teste de hipóteses foi avaliada pela inspeção da distribuição dos escores médios das dimensões da escala segundo as características sociodemográficas e níveis de apoio social no trabalho. RESULTADOS A análise fatorial confirmatória e exploratória corroborou o instrumento em três dimensões (suecos e brasileiros): demandas psicológicas, uso de habilidades e autonomia para decisão. O modelo de melhor ajuste foi obtido após incluir uma correlação de resíduos entre os itens trabalho rápido e trabalho intenso (demandas psicológicas) e remover o item trabalho repetitivo (uso de habilidades). O teste de hipóteses mostrou que trabalhadores com nível universitário apresentaram maiores escores em uso de habilidades e autonomia para decisão e aqueles com grau elevado de apoio social no trabalho obtiveram escores menores em demandas psicológicas e maiores em autonomia para decisão. CONCLUSÕES Os resultados confirmaram a equivalência da estrutura dimensional em dois contextos laborais culturalmente diferentes. Uso de habilidades e autonomia para decisão formaram duas dimensões distintas e o item trabalho repetitivo deveria ser removido da escala

Predictive validity of the Brazilian version of the Expected Treatment Outcome Scale in cocaine-dependent outpatients at a drug treatment referral center Validade preditiva da versão em português da Escala do Desfecho Esperado do Tratamento em pacientes ambulatoriais dependentes de cocaína em um centro especializado

BACKGROUND: High dropout rates among patients under treatment for cocaine dependence have stimulated research into predictors of treatment outcome. OBJECTIVE: To assess the predictive value of the Brazilian version of the Expected Treatment Outcome Scale. METHODS: The original English version of the scale was translated and back-translated. A total of 210 subjects participating in a 10-week randomized double-blind clinical trial (nefazodone versus placebo) completed the questionnaire at their first appointment. Mean Expected Treatment Outcome Scale scores were compared with treatment outcomes. RESULTS: There were ten subjects (5%) who failed to complete at least six items, and 37 (17.5%) failed to complete 1 to 3 items. The most frequently unanswered questions involved time estimates (treatment time and abstinence) and third-party judgments. The mean score was 34.4 (9.3) (median, 33.9). There were no differences in mean scores between subjects evaluated in the first to the fifth appointment 35.2 (9.3) or in the sixth to the eleventh appointment 35.2 (9.3) (p = 0.13); completing the treatment 33.8 (10.3) or not 34.6 (9.1) (p = 0.64); remaining abstinent for three weeks 34 (9.3) or not 34.8 (9.4) (p = 0.58), and medication compliance 33.9 (8.8) or noncompliance 35.3 (10.3) (p = 0.34). The ROC curve of Expected Treatment Outcome Scale scores, when dropout was defined as not appearing for all 11 appointments, was linear, with an area under the curve of .54 (range, .44-.64), suggesting that the scale is ineffective in discriminating between cases and noncases. CONCLUSION: In this study, the Brazilian version of the Expected Treatment Outcome Scale was found to have no predictive value for treatment adherence and abstinence in cocaine-dependent subjects subjected to a standardized treatment protocol.INTRODUÇÃO: Altas taxas de abandono de tratamento por dependentes de drogas têm intensificado a pesquisa sobre fatores preditivos. OBJETIVO: Estudar a validade preditiva da Escala do Desfecho Esperado (EDET). MÉTODOS: Tradução e back-translation. Auto-aplicação da Escala do Desfecho Esperado na primeira consulta de 210 dependentes de cocaína alocados em grupos iguais (nefazodone ou placebo), aleatoriamente, em um ensaio clínico duplo-cego ambulatorial, com 10 semanas de duração. São descritos os escores médios da Escala do Desfecho Esperado segundo os desfechos do ensaio. RESULTADOS: Dos 210 questionários, 10 (5%) tinham mais do que 6 e 37 (17,5%) tinham 1 a 3 questões não preenchidas. As questões mais freqüentemente não compreendidas envolviam cálculos (tempo de tratamento e de abstinência) ou julgamento de terceiros. O escore médio foi 34,4 (s.d 9,3) e a mediana 33,9. Não há diferença entre os escores médios para 1 a 5 consultas 35,2 (9,3)e 6 a 11 consultas 35,2 (9,3), p = 0,13; completar o tratamento 33,8 (10,3) ou não 34,6 (9,1), p = 0,64; permanecer três semanas abstinente 34 (9,3) ou não 34,8 (9,4), p = 0,58; e aderir à prescrição 33,9 (8,8) ou não 35,3 (10,3), p = 0,34. A curva ROC dos escores da Escala do Desfecho Esperado, assumindo o não comparecimento a todas as 11 consultas como caso de abandono, é linear com uma área sob a curva de 0,54 (0,44-0,64), revelando uma má performance da escala como preditora de abandono. CONCLUSÃO: Neste estudo, a Escala do Desfecho Esperado não evidenciou validade preditiva para adesão ao tratamento e abstinência em dependentes de cocaína submetidos a um protocolo de tratamento padronizado

Quality assessment of clinical guidelines for the treatment of obesity in adults: application of the AGREE II instrument

There are various guidelines for the treatment of obesity, and thus the quality of these clinical guidelines has become a matter of concern. The objective was to describe and assess the quality of clinical guidelines for treatment of obesity in adults. We collected several studies, dated from 1998 to 2016, produced by different countries. The literature search included the National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), PubMed (MEDLINE), Scopus, Web of Science, webpages of health institutions from different countries, and search sites, with the criterion: “clinical guidelines for treatment of obesity in adults and published until the 2016”. The guidelines were assessed with the Appraisal of Guidelines for Research & Evaluation (AGREE II), according to the domains of the instrument. The search identified 21 guidelines: nine from Europe, six from North America, three from Latin America, and one each from Asia and Oceania and a transnational association. The Australian guideline had the best assessment. Of the six guidelines with the highest scores, five had been elaborated by the government sector responsible for the country’s health. The domains “scope and purpose” and “clarity of presentation” had the highest score. Except for the Canadian guideline, the three guidelines drafted before the elaboration of AGREE II had the worst quality. In the domain “stakeholder involvement”, only four guidelines (Australia, Scotland, France, and England) mentioned patient participation. Guideline development and quality enhancement are ongoing processes requiring systematic appraisal of the guideline production process and existing guidelines