Objective:to perform the translation, adaptation and validation of the Diabetes Attitudes
Scale - third version instrument into Brazilian Portuguese. Methods:methodological study carried out in six stages: initial translation, synthesis of
the initial translation, back-translation, evaluation of the translated version by
the Committee of Judges (27 Linguists and 29 health professionals), pre-test and
validation. The pre-test and validation (test-retest) steps included 22 and 120
health professionals, respectively. The Content Validity Index, the analyses of
internal consistency and reproducibility were performed using the R statistical
program. Results:in the content validation, the instrument presented good acceptance among the
Judges with a mean Content Validity Index of 0.94. The scale presented acceptable
internal consistency (Cronbach’s alpha = 0.60), while the correlation of the total
score at the test and retest moments was considered high (Polychoric Correlation
Coefficient = 0.86). The Intra-class Correlation Coefficient, for the total score,
presented a value of 0.65. Conclusion:the Brazilian version of the instrument (Escala de Atitudes dos Profissionais em
relação ao Diabetes Mellitus) was considered valid and reliable for application by
health professionals in Brazil.
Objective: to translate, adapt and validate the contents of the Diabetes Medical Management
Plan for the Brazilian context. This protocol was developed by the American
Diabetes Association and guides the procedure of educators for the care of
children and adolescents with diabetes in schools. Method: this methodological study was conducted in four stages: initial translation,
synthesis of initial translation, back translation and content validation by an
expert committee, composed of 94 specialists (29 applied linguists and 65 health
professionals), for evaluation of the translated version through an online
questionnaire. The concordance level of the judges was calculated based on the
Content Validity Index. Data were exported into the R program for statistical
analysis: Results: the evaluation of the instrument showed good concordance between the judges of
the Health and Applied Linguistics areas, with a mean content validity index of
0.9 and 0.89, respectively, and slight variability of the index between groups
(difference of less than 0.01). The items in the translated version, evaluated as
unsatisfactory by the judges, were reformulated based on the considerations of the
professionals of each group. Conclusion: a Brazilian version of Diabetes Medical Management Plan was constructed, called
the Plano de Manejo do Diabetes na Escola.
Parafba State, Brazil is one of the poorest areas in that country; many of the hospitals are not high quality and medical training is not comparable to that of developed countries. Nevertheless, the rate of cesarean section delivery in urban hospitals has risen from 19.0 per cent in 1977 to 28.5 in 1981. Despite the larger volume of obstetric services in government hospitals, these hospitals had lower cesarean section rates than private hospitals, both profit and non-profit. (Am J Public Health 1988; 78:704-705.)
Urban private hospital discharges in Brazil increased enormously during the last decade. Several measures were taken in an effort to slow the rate of increase in hospital admissions and the escalation of hospital costs, which were out of control by the end of the last decade. The introduction of a new case-based reimbursement method, late in 1983, not only contributed to increased hospitalizations, but to changed hospital case mix, as private hospitals shifted from more costly to less costly patients. This occurred especially in the most developed areas of the country, where the concentration of profit-making hospitals is very high. The case-based prospective payment method can be seen as a good managerial tool for use in comparing hospital performance. However, it seems not to be a good mechanism for controlling health care expenditures, especially when profit-making hospitals dominate the provision of hospital care. Any decrease in hospitalization by private hospitals in Brazil has been caused by the severe economic recession, which hit the Brazilian economy hard, and by the shift in hospital admissions from private to public hospitals, not by the introduction of the new reimbursement method which has changed the unit of payment from 'patient day' to case or procedure.
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