Marcos Bosi Ferraz
Community orients program for the control
of rheumatic diseases
Copcord project in Brazil and Latin America
T h ere is an u rg en t n eed fo r h ig h q u ality d ata ab o u t th e
m ag n itu d e an d im p act o f rh eu m atic d iso rd ers in d ev elo p in g
co u n tries, sp ecially in L atin A m erica. S u ch d ata can b rin g
atten tio n to th e su b stan tial h ealth im p act o f th is g ro u p o f d
is-o rd ers an d can in fis-o rm d ecisio n s reg ard in g ap p ro p riate
ser-v ices fo r d etectio n an d treatm en t.
In o rd er to ev alu ate th e b u rd en o f illn ess attrib u tab le to
rh eu m atic d iso rd ers in L atin -A m erica a g ro u p o f rh eu
-m ato lo g ists an d clin ical ep id em io lo g ists (all m em b ers o f th e
In tern atio n al C lin ical E p id em io lo g y N etw o rk P ro g ram ) d
e-cid ed to u se th e W H O -IL A R -C O P C O R D ap p ro ach .
A fter in itial g ro u p d iscu ssio n s th e o rig in al C O P C O R D
Q u estio n n aire w as slig h tly m o d ified aim in g at th e ach iev
e-m en t o f a g reater face an d co n ten t v alid ity w h en ap p lied to a
L atin -am erican en v iro n m en t. A P an A m erican L eag u e o f A
s-so ciatio n s fo r R h eu m ato lo g y (P A N L A R ) en g lish v ersio n w as
d efin ed .
A s ev ery cro sscu ltu ral p ro ject in v o lv es th e u ses o f lan
-g u a-g e an d p o ten tial p ro b lem s m ay arise w ith th e tran slatio n
o f th e m o st sim p le sen ten ce, th e in v estig ato rs d ecid ed to tran
s-late th e in stru m en t in to P o rtu g u ese an d S p an ish as w ell as to
ev alu ate th e n ew in stru m en t m easu rem en t p ro p erties.
T h e fo llo w in g stu d y p h ases w ere co n d u cted in B razil,
C h ile an d M ex ico :
1 . T ran slatio n o f th e in stru m en t
- P rim ary tran slatio n ;
. - E v alu atio n o f th e p rim ary tran slatio n ;
- E v alu atio n o f th e cu ltu ral eq u iv alen ce;
- D efin itio n o f th e P o rtu g u ese/S p an ish v ersio n .
2 . E v alu atio n o f R eliab ility - H o sp ital b ased sam p le
- In tra-o b serv er;
- T est-retest.
3 . C o m m u n ity v alid atio n stu d y
- D efin itio n o f sen sitiv ity ;
10
- D efin itio n o f sp ecificity ;
- D efin itio n o f th e n u m b er o f p h isical ex am s av o id ed .
T h e o b jectiv e o f th is v alid atio n stu d y w as u ltim ately to
. ev alu ate th e sen sitiv ity an d sp ecifity o f th e P o rtu g u ese an d
S p an ish v ersio n s o f th e Ilar/C o p co rd C o re Q u estio n n aire in
term s o f screen ig rh eu m atic d iseases. .
In B rasil, six streets o f o n e d istrict o f E m b u w ere ran
-d o m ly selecte-d an -d h a-d 7 6 h o u ses ch o sen also at ran -d o n an -d
v isited b y in terv iew ees. 2 0 4 in d iv id u als w ere in terv iew ed an d
ex am in ed (1 1 0 fem ales, ag e 1 6 -8 1 , m ean
=
3 8 y ears an d 9 4m ales, ag e 1 6 -7 9 , m ean
=
4 1 y ears).O n e h u n d red an d sev enin d iv id u als rep o rted p ain ten d ern ess, sw ellin g o r stifn ess in
th eir b o n es, m u scles o r jo in ts (5 0 at p resen t an d 5 7 in th e
p ast). O f th ese, after th e p h y sical ex am in atio n , 6 8 in d iv id u als
h ad 7 2 d iseases d iag n o sed .
In ad ittio n , 1 8 in d iv id u als (8 .8 % ) rep o rted so m e d
is-ab ility d u e to th e rh eu m atic d isease at th e tim e o f th e in
ter-v iew . T h e H ealth A ssessm en t Q u estio n n aire S co res ran g ed
fro m 0 .1 3 to 1 .5 0 , w ith a m ean v alu e o f 0 .6 2 .
B ased o n th ese d ata, th e P o rtu g u ese v ersio n o f th e Ilar/
C o p co rd C o re Q u estio n n aire p resen ted a sen sitiv ity o f 9 2 %
an d a sp ecifity o f 7 0 % . T h e p rev alen ce o f rh eu m atic d isease
in p o p u latio n screen ed an d ex am in ed w as 3 3 % . B y u sin g th is
screen in g q u estio n aire 4 9 9 p h y sical ex am s p er 1 0 0 0 in d iv id u
als in terv iew ed can b e av o id ed . S im ilar stu d ies w ith co in cid
-in g resu lts w ere rep o rted -in C h ile an d M ex ico .
In su m m ary , in L atin A m erica, a rig o ro u s p ro cess o f
cro ss-cu ltu ral ad ap tatio n h as b een ap p lied to th e IL A R /
C O P C O R D Q u estio n n aire an d it h as b een v alid ated ag ain st a
fu ll clin ical ex am b y a rh eu m ato lo g ist. A lso , th e q u estio n
-n aire is easy to ad m i-n ister, accep tab le an d relativ ely in ex p en
-siv e, an d th e seq u en tial ap p ro ach o f C O P C O R D p ro g ram o
f-fers in creased efficien ly in larg e scale su rv ey research th at
aim to estim ate th e p rev alen ce o f sp ecific rh eu m atic d iag
-n o ses.
