Introdução: O conceito de contratransferência evoluiu de “um obstáculo ao tratamento” à ferramenta útil à compreensão do paciente dentro de uma relação bi-pessoal. Atualmente, buscam-se evidências da sua especificidade, correlacionando padrões específicos de contratransferência com características do paciente e terapeuta, classes diagnósticas e desfechos do tratamento. Acredita-se que, devido à intensidade das reações emocionais despertadas nos terapeutas que atendem vítimas de trauma, o estudo da contratransferência nesta população auxilie no autoconhecimento dos terapeutas, amplie a compreensão sobre o fenômeno e contribua para um melhor atendimento dos pacientes. O desenvolvimento de pesquisas nesta área esbarra no reduzido número de escalas validadas para acessar a contratransferência. No Brasil, estão disponíveis a escala para Avaliação da Contratransferência e as versões traduzidas do Inventory of Countertransference Behavior e Mental States Rating System, mas nenhuma validada.A Escala para a Avaliação da Contratransferência (EACT) foi criada em nosso meio, com elevada validade de face, construída em torno de três dimensões conceituais de sentimentos. Entretanto, suas propriedades psicométricas ainda não foram avaliadas. Objetivos: Investigara validade de construto da EACT, respondida por terapeutas de vítimas de trauma psíquico (Artigo 1). Secundariamente, analisar a correlação entre a contratransferência inicial com vítimas de trauma psíquico e os dados demográficos e clínicos de terapeutas e pacientes e o tipo de trauma, e investigar a associação entre a contratransferência inicial e a adesão dos pacientes ao tratamento e o seu desfecho, operacionalizado como alta ou abandono (Artigo 2). Método: Delineamento transversal (Artigo 1) e análises secundárias com dados longitudinais (Artigo 2). A amostra foi composta por 50 psiquiatras no segundo ano de formação durante estágio no Núcleo de Estudos e Tratamento de Trauma Psíquico do Hospital de Clínicas de Porto Alegre, Brasil. Esses terapeutas atenderam 131 pacientes recrutados consecutivamente durante 4 anos, que incluiu a primeira ou segunda consulta de vítimas de abuso sexual, seqüestro, assalto, agressão física, tentativa de homicídio, tortura e trauma indireto, independentemente do tempo decorrido entre a consulta atual e o evento traumático. Foram excluídos atendimentos de pacientes que chegaram à primeira consulta com ideação suicida grave, sintomas psicóticos e/ou com indicação de internação psiquiátrica. Os pacientes foram selecionados após triagem, que avaliou as variáveis clínicas e o diagnóstico segundo os critérios do DSM-IV-TR. Na primeira consulta, foram coletados os dados demográficos e clínicos e avaliada a contratransferência identificada pelo terapeuta através da EACT. Os pacientes foram acompanhados ao longo do tratamento psiquiátrico para determinar o número de consultas, faltas e o desfecho: alta ou abandono. A EACT é uma escala auto-aplicável, composta por 23 itens pontuados para 3 momentos da sessão (início, durante e final) em escala tipo Likert (0=ausência a 3=muito), e distribuídos em 3 domínios: aproximação (10 itens), afastamento (10 itens) e indiferença (3 itens). A validade de constructo da EACT no atendimento desta população foi avaliada através da análise fatorial exploratória (EFA) e consistência interna (α de Cronbach). O tamanho amostral foi calculado a partir de pelo menos 5 aplicações da EACT para cada item da escala (mínimo N = 115). E a análise fatorial confirmatória foi usada para determinar os parâmetros de adequação (goodness-of-fit) da versão da EACT no atendimento de vítimas de trauma obtida na EFA em comparação com a versão original. Resultados: A EFA mostrou 3 fatores com homogeneidade consistente, sendo distinta da versão original da EACT a correlação entre os itens e o terceiro fator: afastamento (9 itens com 24% da variância; α = 0,88), aproximação (7 itens com 15% da variância; α=0,82) e tristeza (6 itens com 9% da variância; α = 0,72). O item alegria, com carga fatorial baixa, foi retirado da análise por ser considerado irrelevante neste contexto. A análise fatorial confirmatória evidenciou melhores critérios de goodness-of-fit em todos os parâmetros testados para a presente versão da EACT do que a original. Secundariamente, as características demográficas e clínicas dos terapeutas e dos pacientes dos grupos alta e abandono foram similares. Os terapeutas com idade ≤ 27 anos pontuaram maior afastamento que os mais velhos (0,14 ± 1 vs. -0,21 ± 0,9; P=0,019). Os pacientes casados induziram nos terapeutas mais sentimentos de afastamento (0,20 ±1 vs. -0,19 ± 0,9; P = 0,016) e tristeza (0,18 ±1 vs. -0,17 ± 1; P = 0,049) que os que vivem sozinhos. Nas variáveis clínicas, as vítimas de trauma indireto e de múltiplos traumas despertaram mais tristeza (0,38 ± 1 e 0,76 ± 0,4, respectivamente), comparadas às vítimas de violência sexual (0,03 ± 0,9) e urbana (-0,3 ± 1) (P = 0,039). A mediana de consultas realizadas foi 5 [4; 8], faltas 1 [0; 1] e a taxa de abandono foi de 34,4%. Na análise multivariada, identificou-se que os pacientes com relato de história de trauma na infância abandonaram menos o tratamento (OR = 0,39; P = 0,039; CI 95% 0,16- 0,95). Não foi detectada associação entre sentimentos contratransferenciais iniciais com os desfechos do tratamento. Conclusões: A EACT apresentou propriedades psicométricas consistentes, demonstrando ser um instrumento confiável para acessara contratransferência inicial de terapeutas de vítimas de trauma psíquico. Os sentimentos contratransferenciais no atendimento inicial destes pacientes associaram-se a parâmetros demográficos e clínicos, mas não se associaram ao abandono do tratamento. Estudos futuros devem avaliar a modificação dos sentimentos contratransferenciais ao longo do tratamento e o seu impacto sobre os desfechos do tratamento. / Introduction: The concept of countertransference (CT) evolved from an “obstacle to treatment” to "an useful tool to understand patients within a bi-personal relationship". Currently, evidences of its specificity are searched for, correlating specific CT patterns to patients and therapists’ features, diagnostic classes, and treatment outcomes. Due to the intensity of emotional reactions aroused in therapists caring for trauma victims, it is believed that the study of CT in this population will help self-knowledge of therapists and contribute for a better patient care. The development of studies in this field is hindered by the reduced number of validated scales to assess CT. In Brazil, the Assessment of Countertransference Scale and the translated versions of the Inventory of Countertransference Behavior and Mental States Rating System are available, however, none of them has been validated. The Assessment of Countertransference Scale (ACS) has been created in our department with high face validity, built around three conceptual dimensions of feelings. However, its psychometric properties have not been assessed yet. Objectives: To investigate the construct validity of the ACS answered by therapists of psychological trauma victims (Article 1). Then, to assess the correlation between initial CT with victims of psychological trauma and the clinical and demographic data of therapists and patients and the type of trauma, and to investigate the association between initial countertransference and patients’ adherence to treatment and its outcome, defined as discharge or drop-out (Article 2). Methods: A Cross-sectional study (Article 1) and secondary analysis with longitudinal data (Article 2) were carried out. The sample was formed by 50 psychiatrists in the second year of training in their internship in the Center for Study and Treatment of Traumatic Stress in Hospital de Clínicas de Porto Alegre, Brazil. These therapists cared for 131 patients consecutively recruited for 4 years, including the first and second appointment with victims of sexual abuse, kidnapping, robbery, physical assault, homicide attempt, torture and indirect trauma, regardless of the time elapsed between the current appointment and the trauma event. We have excluded patients that arrived in the first appointment with severe suicidal ideation, psychotic symptoms and/or referral for psychiatric hospitalization. Patients have been selected after screening, which assessed the clinical variables and the diagnoses according to DSM-IV-TR criteria. In the first appointment, demographic and clinical data were collected and CT, identified by therapists through the ACS, was assessed. Patients were followed-up during psychiatric treatment to determine the number of appointments, absences, and the outcome: discharge or drop-out. ACS is a self-applied scale composed by 23 items scored for 3 moments of the session (start, midpoint and end) in a Likert-type scale (0=absence to 3=very), and distributed into 3 dimensions: closeness (10 items), distance (10 items) and indifference (3 items). The construct validity of ACS in the care for this population was assessed through the Exploratory Factor Analysis (EFA) and the internal consistency (α de Cronbach). The sample size was calculated for at least 5 applications of ACS for each item of the scale (minimum N = 115). The Confirmatory Factor Analysis (CFA) was used to determine the goodness of fit parameters of the ACS version in the care for trauma victims obtained in the EFA compared to the original version. Results: EFA showed 3 factors with consistent homogeneity, but the correlation between the items and the third factor were different from the original version, in the following: rejection (9 items with 24% of variance; α = 0.88), closeness (7 items with 15% of variance; α = 0.82) and sadness (6 items with 9% of variance; α = 0.72). The item “happiness”, with low factorial load, was withdrawn from the analysis because it was considered to be irrelevant in this context. CFA showed better goodness of fit criteria in all tested parameters for the present version of ACS compared to the original version. Secondly, the demographic and clinical characteristics of therapists and patients of the discharge and drop-out groups were similar. Therapists with ages ≤ 27 years scored more rejection than older therapists (0.14 ± 1 vs. -0.21 ± 0.9; P = 0.019). Married patients induced in therapists more feelings of rejection (0.20 ± 1 vs. -0.19 ± 0.9; P = 0.016) and sadness (0.18 ± 1 vs. -0.17 ± 1; P = 0.049) than those patients living alone. In the clinical variables, the victims of indirect trauma and of several traumas aroused more feelings of sadness (0.38 ± 1 and 0.76 ± 0.4, respectively) compared to sexual violence (0.03 ± 0.9) and urban violence victims (-0.3 ± 1) (P = 0.039). Median of appointments performed was 5 [4; 8], absences 1 [0; 1] and the drop-out rate was 34.4%. In the multivariate analysis, we have identified that patients with reported history of childhood trauma were less likelihood of dropping out treatment (OR=0.39; P = 0.039; CI 95% 0.16-0.95). Association between the initial CT feelings and the treatment outcomes has not been detected. Conclusions: ACS presented sound psychometric properties, and it has been demonstrated to be a reliable instrument to access initial CT of therapists in victims of psychological trauma. Countertransference feelings in the initial care of patients were associated with clinical and demographic parameters, but it were not associated with treatment drop-out. Further studies should assess the changes in CT feelings over treatment and their impact on treatment outcomes.

Made available in DSpace on 2016-12-08T15:59:05Z (GMT). No. of bitstreams: 1 Joao Otacilio L dos Santos.pdf: 2060361 bytes, checksum: b4c669f94feb668acc0602d83f24931d (MD5) Previous issue date: 2014-06-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this study was to analyze the content and construct validity of motor tasks proposed by the assessment instruments used to discriminate the motor performance. Nine academic authorities on motor development and motor assessment area were recruited to address the aims in theoretical terms. Three hundred and fifty children from Manaus, aged between eight and ten years of both gender participated of this study to address the empirical terms. The selected variables was: conceptual dimensionality of motor tasks, internal structure of motor tasks, gender, age and motor performance in motor tasks. To determine the conceptual dimensions of the tasks a questionnaire developed by the authors of this study (Appendix 3) was used. To study the internal structure of the task, we used the criteria described in the literature and adapted by the authors based on concepts previous determined. To determine the motor performance in tasks, 27 motor tasks were taken from three instruments of motor assessment: Movement Assessment Battery for Children (MABC-2), Körperkoordination Test für Kinder (KTK) and Test of Gross Motor Development (TGMD - 2). Data were analyzed using descriptive and inferential statistics (p≤0.05). The results showed that 25% of motor tasks demonstrated a level of agreement among the experts, or the experts classified within the same dimension. The internal structure of the motor task had a specific analysis according to their nature depending on the criteria used. When analyzing the complexity/difficulty of the task, 33% of motor tasks showed a distribution similar to a normal distribution curve. The majority of the tasks were negative asymmetric that means an easy task since the most individuals achieved the maximum value proposed by the task. The discrimination according to gender showed that only 30% of the tasks significantly classified boys as superior than girls in the majority of the tasks. The discrimination according to age showed that fourteen tasks were significantly discriminatory (52%). Children of eight years consistently showed lower motor performance in the task compared to children with nine. Furthermore, children of nine years consistently showed lower motor performance in the task compared to children with ten. The construct validity of the motor tasks was assessed by exploratory factor analysis and was possible to extract four factors explaining 50.09% of the variance. From the 27 motor tasks, fifteen tasks (56%) achieved statistical criteria and explain the construct validity. Thus, the psychometric assumptions have to be respected in its entirety; in other words, the choice of items should be based on both theoretical and empirical elements. Therefore, caution on the importance of reversing the traditional procedure of construction and validation of instruments (concept, construct, dimensions, items or tasks) for empirical initial approach of multiple motor possibilities that can converge to the needs of the construct previously defined. / O objetivo da pesquisa foi analisar a validade de conteúdo e construto de tarefas motoras propostas por instrumentos de avaliação utilizados para discriminar o desempenho motor. Para contemplar os objetivos em termos teóricos participaram nove autoridades acadêmicas na área do desenvolvimento motor e avaliação motora. Para contemplar os objetivos em termos empíricos participaram 350 indivíduos, idades entre oito e dez anos, de ambos os sexos, regularmente matriculados em escolas na cidade de Manaus. As variáveis selecionadas para a pesquisa foram: dimensionalidade conceitual das tarefas motoras, organização interna das tarefas motoras, sexo, idade e desempenho motor nas tarefas motoras. Para determinar as dimensões conceituais das tarefas foi utilizado um questionário construído pelos próprios autores desta pesquisa (Apêndice 3). Para o estudo da organização interna da tarefa foram utilizados critérios descritos na literatura e ainda critérios adaptados pelos autores desta pesquisa definidos com base em conceitos já determinados. Para determinar o desempenho motor nas tarefas foram aplicadas 27 tarefas motoras retiradas de três instrumentos de avaliação motora Movement Assessment Battery for Children (MABC-2), Körperkoordination Test für Kinder (KTK) e Test of Gross Motor Development (TGMD-2). Os dados foram analisados a partir dos recursos da estatística descritiva e inferencial (p≤0,05). Os resultados desta pesquisa demonstraram que apenas 25% das tarefas motoras em análise demonstraram um nível de concordância entre os juízes, ou seja, os juízes as classificaram dentro da mesma dimensão. Em relação à organização interna da tarefa motora foi possível observar que as tarefas em análise apresentam especificidades de acordo com sua natureza, variando em função do critério utilizado. Ao analisar a complexidade/dificuldade da tarefa constatou-se que apenas 33% das tarefas motoras apresentaram uma distribuição próxima a uma curva de distribuição normal. Assim, a maioria das tarefas apresentaram assimetria negativa, característica de tarefa fácil, pois a grande parte dos indivíduos conseguiu atingir o valor máximo proposto pela tarefa. Ao observar o poder de discriminação de acordo com o estrato de sexo observou-se que 30% das tarefas apenas discriminaram significantemente meninos de meninas, sendo os meninos superiores na maioria das tarefas. Em relação aos estratos idade quatorze tarefas apresentaram poder de discriminação significante (52%), onde as crianças de 08 anos sempre demonstraram desempenho motor na tarefa inferior as de 9 anos que consecutivamente apresentaram desempenho motor inferior as crianças de 10 anos. Em relação à validade de construto das tarefas motoras desta pesquisa foi possível extrair, por meio da análise fatorial exploratória, quatro fatores explicando 50,09% da variância. Das 27 tarefas motoras analisadas quinze tarefas (56%) supriram os critérios estatísticos e explicam o construto estudado. Conclui que os pressupostos psicométricos na escolha dos itens precisam ser respeitados em sua totalidade, ou seja, a escolha dos itens deve ser baseada tanto em elementos teóricos quanto empíricos. Assim, alerta-se para a importância de reverter o tradicional procedimento de construção e validação de instrumentos de medida (conceito, construto, dimensões, itens ou tarefas) para uma abordagem inicial empírica das múltiplas possibilidades motoras que possa convergir para as necessidades do construto previamente definido.

Introdução: O conceito de contratransferência evoluiu de “um obstáculo ao tratamento” à ferramenta útil à compreensão do paciente dentro de uma relação bi-pessoal. Atualmente, buscam-se evidências da sua especificidade, correlacionando padrões específicos de contratransferência com características do paciente e terapeuta, classes diagnósticas e desfechos do tratamento. Acredita-se que, devido à intensidade das reações emocionais despertadas nos terapeutas que atendem vítimas de trauma, o estudo da contratransferência nesta população auxilie no autoconhecimento dos terapeutas, amplie a compreensão sobre o fenômeno e contribua para um melhor atendimento dos pacientes. O desenvolvimento de pesquisas nesta área esbarra no reduzido número de escalas validadas para acessar a contratransferência. No Brasil, estão disponíveis a escala para Avaliação da Contratransferência e as versões traduzidas do Inventory of Countertransference Behavior e Mental States Rating System, mas nenhuma validada.A Escala para a Avaliação da Contratransferência (EACT) foi criada em nosso meio, com elevada validade de face, construída em torno de três dimensões conceituais de sentimentos. Entretanto, suas propriedades psicométricas ainda não foram avaliadas. Objetivos: Investigara validade de construto da EACT, respondida por terapeutas de vítimas de trauma psíquico (Artigo 1). Secundariamente, analisar a correlação entre a contratransferência inicial com vítimas de trauma psíquico e os dados demográficos e clínicos de terapeutas e pacientes e o tipo de trauma, e investigar a associação entre a contratransferência inicial e a adesão dos pacientes ao tratamento e o seu desfecho, operacionalizado como alta ou abandono (Artigo 2). Método: Delineamento transversal (Artigo 1) e análises secundárias com dados longitudinais (Artigo 2). A amostra foi composta por 50 psiquiatras no segundo ano de formação durante estágio no Núcleo de Estudos e Tratamento de Trauma Psíquico do Hospital de Clínicas de Porto Alegre, Brasil. Esses terapeutas atenderam 131 pacientes recrutados consecutivamente durante 4 anos, que incluiu a primeira ou segunda consulta de vítimas de abuso sexual, seqüestro, assalto, agressão física, tentativa de homicídio, tortura e trauma indireto, independentemente do tempo decorrido entre a consulta atual e o evento traumático. Foram excluídos atendimentos de pacientes que chegaram à primeira consulta com ideação suicida grave, sintomas psicóticos e/ou com indicação de internação psiquiátrica. Os pacientes foram selecionados após triagem, que avaliou as variáveis clínicas e o diagnóstico segundo os critérios do DSM-IV-TR. Na primeira consulta, foram coletados os dados demográficos e clínicos e avaliada a contratransferência identificada pelo terapeuta através da EACT. Os pacientes foram acompanhados ao longo do tratamento psiquiátrico para determinar o número de consultas, faltas e o desfecho: alta ou abandono. A EACT é uma escala auto-aplicável, composta por 23 itens pontuados para 3 momentos da sessão (início, durante e final) em escala tipo Likert (0=ausência a 3=muito), e distribuídos em 3 domínios: aproximação (10 itens), afastamento (10 itens) e indiferença (3 itens). A validade de constructo da EACT no atendimento desta população foi avaliada através da análise fatorial exploratória (EFA) e consistência interna (α de Cronbach). O tamanho amostral foi calculado a partir de pelo menos 5 aplicações da EACT para cada item da escala (mínimo N = 115). E a análise fatorial confirmatória foi usada para determinar os parâmetros de adequação (goodness-of-fit) da versão da EACT no atendimento de vítimas de trauma obtida na EFA em comparação com a versão original. Resultados: A EFA mostrou 3 fatores com homogeneidade consistente, sendo distinta da versão original da EACT a correlação entre os itens e o terceiro fator: afastamento (9 itens com 24% da variância; α = 0,88), aproximação (7 itens com 15% da variância; α=0,82) e tristeza (6 itens com 9% da variância; α = 0,72). O item alegria, com carga fatorial baixa, foi retirado da análise por ser considerado irrelevante neste contexto. A análise fatorial confirmatória evidenciou melhores critérios de goodness-of-fit em todos os parâmetros testados para a presente versão da EACT do que a original. Secundariamente, as características demográficas e clínicas dos terapeutas e dos pacientes dos grupos alta e abandono foram similares. Os terapeutas com idade ≤ 27 anos pontuaram maior afastamento que os mais velhos (0,14 ± 1 vs. -0,21 ± 0,9; P=0,019). Os pacientes casados induziram nos terapeutas mais sentimentos de afastamento (0,20 ±1 vs. -0,19 ± 0,9; P = 0,016) e tristeza (0,18 ±1 vs. -0,17 ± 1; P = 0,049) que os que vivem sozinhos. Nas variáveis clínicas, as vítimas de trauma indireto e de múltiplos traumas despertaram mais tristeza (0,38 ± 1 e 0,76 ± 0,4, respectivamente), comparadas às vítimas de violência sexual (0,03 ± 0,9) e urbana (-0,3 ± 1) (P = 0,039). A mediana de consultas realizadas foi 5 [4; 8], faltas 1 [0; 1] e a taxa de abandono foi de 34,4%. Na análise multivariada, identificou-se que os pacientes com relato de história de trauma na infância abandonaram menos o tratamento (OR = 0,39; P = 0,039; CI 95% 0,16- 0,95). Não foi detectada associação entre sentimentos contratransferenciais iniciais com os desfechos do tratamento. Conclusões: A EACT apresentou propriedades psicométricas consistentes, demonstrando ser um instrumento confiável para acessara contratransferência inicial de terapeutas de vítimas de trauma psíquico. Os sentimentos contratransferenciais no atendimento inicial destes pacientes associaram-se a parâmetros demográficos e clínicos, mas não se associaram ao abandono do tratamento. Estudos futuros devem avaliar a modificação dos sentimentos contratransferenciais ao longo do tratamento e o seu impacto sobre os desfechos do tratamento. / Introduction: The concept of countertransference (CT) evolved from an “obstacle to treatment” to "an useful tool to understand patients within a bi-personal relationship". Currently, evidences of its specificity are searched for, correlating specific CT patterns to patients and therapists’ features, diagnostic classes, and treatment outcomes. Due to the intensity of emotional reactions aroused in therapists caring for trauma victims, it is believed that the study of CT in this population will help self-knowledge of therapists and contribute for a better patient care. The development of studies in this field is hindered by the reduced number of validated scales to assess CT. In Brazil, the Assessment of Countertransference Scale and the translated versions of the Inventory of Countertransference Behavior and Mental States Rating System are available, however, none of them has been validated. The Assessment of Countertransference Scale (ACS) has been created in our department with high face validity, built around three conceptual dimensions of feelings. However, its psychometric properties have not been assessed yet. Objectives: To investigate the construct validity of the ACS answered by therapists of psychological trauma victims (Article 1). Then, to assess the correlation between initial CT with victims of psychological trauma and the clinical and demographic data of therapists and patients and the type of trauma, and to investigate the association between initial countertransference and patients’ adherence to treatment and its outcome, defined as discharge or drop-out (Article 2). Methods: A Cross-sectional study (Article 1) and secondary analysis with longitudinal data (Article 2) were carried out. The sample was formed by 50 psychiatrists in the second year of training in their internship in the Center for Study and Treatment of Traumatic Stress in Hospital de Clínicas de Porto Alegre, Brazil. These therapists cared for 131 patients consecutively recruited for 4 years, including the first and second appointment with victims of sexual abuse, kidnapping, robbery, physical assault, homicide attempt, torture and indirect trauma, regardless of the time elapsed between the current appointment and the trauma event. We have excluded patients that arrived in the first appointment with severe suicidal ideation, psychotic symptoms and/or referral for psychiatric hospitalization. Patients have been selected after screening, which assessed the clinical variables and the diagnoses according to DSM-IV-TR criteria. In the first appointment, demographic and clinical data were collected and CT, identified by therapists through the ACS, was assessed. Patients were followed-up during psychiatric treatment to determine the number of appointments, absences, and the outcome: discharge or drop-out. ACS is a self-applied scale composed by 23 items scored for 3 moments of the session (start, midpoint and end) in a Likert-type scale (0=absence to 3=very), and distributed into 3 dimensions: closeness (10 items), distance (10 items) and indifference (3 items). The construct validity of ACS in the care for this population was assessed through the Exploratory Factor Analysis (EFA) and the internal consistency (α de Cronbach). The sample size was calculated for at least 5 applications of ACS for each item of the scale (minimum N = 115). The Confirmatory Factor Analysis (CFA) was used to determine the goodness of fit parameters of the ACS version in the care for trauma victims obtained in the EFA compared to the original version. Results: EFA showed 3 factors with consistent homogeneity, but the correlation between the items and the third factor were different from the original version, in the following: rejection (9 items with 24% of variance; α = 0.88), closeness (7 items with 15% of variance; α = 0.82) and sadness (6 items with 9% of variance; α = 0.72). The item “happiness”, with low factorial load, was withdrawn from the analysis because it was considered to be irrelevant in this context. CFA showed better goodness of fit criteria in all tested parameters for the present version of ACS compared to the original version. Secondly, the demographic and clinical characteristics of therapists and patients of the discharge and drop-out groups were similar. Therapists with ages ≤ 27 years scored more rejection than older therapists (0.14 ± 1 vs. -0.21 ± 0.9; P = 0.019). Married patients induced in therapists more feelings of rejection (0.20 ± 1 vs. -0.19 ± 0.9; P = 0.016) and sadness (0.18 ± 1 vs. -0.17 ± 1; P = 0.049) than those patients living alone. In the clinical variables, the victims of indirect trauma and of several traumas aroused more feelings of sadness (0.38 ± 1 and 0.76 ± 0.4, respectively) compared to sexual violence (0.03 ± 0.9) and urban violence victims (-0.3 ± 1) (P = 0.039). Median of appointments performed was 5 [4; 8], absences 1 [0; 1] and the drop-out rate was 34.4%. In the multivariate analysis, we have identified that patients with reported history of childhood trauma were less likelihood of dropping out treatment (OR=0.39; P = 0.039; CI 95% 0.16-0.95). Association between the initial CT feelings and the treatment outcomes has not been detected. Conclusions: ACS presented sound psychometric properties, and it has been demonstrated to be a reliable instrument to access initial CT of therapists in victims of psychological trauma. Countertransference feelings in the initial care of patients were associated with clinical and demographic parameters, but it were not associated with treatment drop-out. Further studies should assess the changes in CT feelings over treatment and their impact on treatment outcomes.

Fatores psicossociais não são rotineiramente identificados na avaliação fisioterapêutica e podem influenciar no prognóstico de pacientes com dor lombar. O questionário STarT Back Screening Tool (SBST) foi criado para distinguir subgrupos dentre pacientes com dor lombar em relação ao prognóstico no tratamento considerando fatores físicos e psicossociais, classificando-os em baixo, médio e alto risco de mau prognóstico. Objetivo: Traduzir e adaptar transculturalmente o SBST para Língua Portuguesa do Brasil, testar a confiabilidade e validade de construto. Métodos: A primeira etapa consistiu na tradução, síntese, retro-tradução, revisão pelo grupo de tradução, pré-teste e avaliação dos documentos pelo Comitê. A versão pré-final foi aplicada em duas amostras de 52 pacientes cada, com dor lombar, ambos os sexos, idade acima de 18 anos e níveis educacionais variados. Para verificação da confiabilidade intra-avaliador, foram realizadas duas entrevistas em outra amostra de 50 pacientes, e os resultados analisados pelo Kappa ponderado quadrado. Também foram calculados a consistência interna usando de Cronbach (n=105), o erro padrão da medida (n=50) e a validade de construto (n=151), correlacionando o SBST-Brasil com as versões brasileiras do Oswestry Disability Index (ODI), Rolland Morris (Brasil- RM) e Fear Avoidance Beliefs Questionnaire para trabalho (FABQ-Work) e atividade física (FABQ-Phys). Resultados: O consenso foi atingido nas etapas de tradução e retrotradução, apenas o item 6 não foi compreendido e depois de reformulado foi reaplicado em outros 52 pacientes que não tiveram mais dúvida. A confiabilidade foi considerada substancial (0,79 - 95% IC 0,63 0,95), a consistência interna aceitável (0,74 pontuação total e 0,72 da subescala psicossocial), e o valor do erro de padrão da medida muito bom (1,9%). Em relação à validação, a pontuação total do SBST- Brasil mostrou alta correlação com o Brasil-RM (r=0,61), moderada correlação com o ODI (r = 0,56) e FABQ-Work (r=0,3) e fraca correlação com o FABQ-Phys (r = 0,18). Já a subescala psicossocial mostrou correlação moderada com o Brasil-RM (r =0,49) e ODI (r =0,47) e fraca correlação com o FABQ-Work (r =0,24) e FABQ-Phys (r =0,21). Além disso, a estratificação dos grupos de risco do SBST-Brasil foi compatível com os valores de classificação do ODI, Brasil-RM e FABQ-Phys para risco de mau prognóstico. Conclusão: O SBST-Brasil mostrou-se confiável e válido para avaliar a influência de fatores psicossociais em pacientes com dor lombar. / Psychosocial factors are not usually identified on physiotherapy assessment, what influences on low back pain prognosis. The questionnaire STarT Back Screening Tool\" (SBST) was created to identify patients with potentially treatment modifiable prognostic influenced by physical and psychosocial indicators which are relevant to initial decision making, classifying them into low, medium and high risk categories. Aim: Translation and cross-culturally adaptation of the SBST into Brazilian-Portuguese, assess its reliability and construct validity. Methods: The translation and cross-cultural adaptation process involved the steps of Translation, Synthesis, Back-translation, Committee Revision, Pretesting and Submission the documents to the Committee. The pre-final version was applied to two samples of 52 patients each, with low back pain, both sexes, aged over 18 years, from different education levels. After that, two interviews assessed intra-rater reliability on a different sample of 50 patients, and the quadratic weighted Kappa was used for statistical analysis. The Cronbach´s alpha was also calculated for internal consistency (n=105), standard error measurement (n=50) and construct validity (n=151) analyzing the correlation between the SBST-Brasil and the Brazilian version of Oswestry Disability Index (ODI), Rolland Morris (Brasil- RM) and Fear Avoidance Beliefs Questionnaire for work (FABQ-Work) and physical activity (FABQ-Phys). Results: Consensus was found on translations and back-translations processes, and only the item 6, which patients had some difficulty in understanding, was reviewed and re-applied to 52 additional subjects with no difficulties being reported. The reliability was classified as substantial (0.79 - 95% CI 0.63 0.95), the internal consistency acceptable (0.74 for total score and 0.72 for psychosocial subscale score) and a very good standard measurement error (1.9%). The correlation between the SBST-Brasil total score and Brasil- RM was high (r =0.61), moderate with ODI (r = 0.56) and with FABQ-Work (r = 0.3), and low correlation with FABQ-Phys (r = 0,18). Moderate correlation was found with SBST psychosocial subscale score and Brasil-RM (r = 0.49), also with ODI (r = 0.47), and low correlation with FABQ-Work (r = 0.24) and FABQ-Phys (r = 0.21). After that, the stratification of SBST-Brasil risk groups was compatible with ODI, Brasil-RM and FABQPhys classification for risk of poor prognosis. Conclusion: The SBST-Brasil has shown a reliable and valid tool to screen and identify low back pain patients influenced by psychosocial factors.

Doctor Educationis / The study aims to investigate the fundamental validity issues that can affect the DR Congo English state examination, a national exit test administered to high school final year students for certification. The study aspires to generate an understanding of the potential issues that affect the construct validity of a test within the epistemological stance that supports a strong relationship between test construct and test context. The study draws its theoretical underpinning from three theories: the validity theory that provides a theoretical ground necessary for understanding the quality of tests needed for assessing students’ reading abilities; the construction-integration theory that provides an understanding of how texts used in reading assessments are processed and understood by the examinees; and the strategic competence theory that explains how examinees deploy strategies to complete test tasks, and the extent to which these strategies tap into the reading construct. Furthermore, the study proposes a reading model that signposts the social context of testing; therefore, conceptualizing reading as both a cognitive and a social process. As research design, the study adopts an exploratory design using both qualitative and quantitative data. Besides, the study uses protocol analysis and content analysis methodologies. While the former provides an understanding of the cognitive processes that mediate the reading construct and test performance so as to explore the different strategies examinees use to answer the English state examination (henceforth termed ESE) test questions, the latter examines the content of the different ESE papers so as to identify the different textual and item features that potentially impact on examinees’ performance on the ESE tasks. As instruments, the study uses a concurrent strategies questionnaire administered to 496 student-participants, a contextual questionnaire administered to 26 student-participants, a contextual questionnaire administered to 27 teacher-participants, and eight tests administered to 496 student-participants. The findings indicate that, the ESE appears to be less appropriate to the ESE context as the majority of ESE test items target careful reading than expeditious reading; on the one hand, and reading at global level than to reading at local level; on the other hand. The findings also indicate that the ESE tasks hardly take account of the text structure and the underlined cognitive demands appropriate to the text types. Besides, the ESE fails to include other critical aspects of the reading construct. Finally, the findings also indicate that the ESE constructors may not be capable to construct an ESE with five functioning distractors as expected. Moreover, the inclusion of the implicit option 6 overlaps with the conceptual meaning of this option. The entire process of the present study has generated some insights that can advance our understanding of the construct validity of reading tests. These insights are: (a) the concept of validity is an evolving and context-dependent concept, (b) reading construct cannot be examined outside the actual context of reading activity, (c) elimination of distractors can sometimes be a construct-relevant strategy, (d) construct underrepresentation is a context-dependent concept, and (e) a reading test cannot be valid in all contexts. The suggested proposal for the improvement of the ESE requires the Congolese government through its Department of Education to (a) always conduct validation studies to justify the use of the ESE, (b) always consider the actual context of reading activity while developing the ESE, (c) revisit the meanings and interpretations of the ESE scores, (d) ensure the appropriateness of tasks to be included in the ESE, (e) ensure the construct representativeness of the ESE tasks, (f) revisit the number of questions to be included in the ESE, (g) avoid bias in the ESE texts in order to ensure fairness, (h) diversify the genres of ESE texts, (i) ensure the coherence of ESE texts through the use of transitions and cohesive devices, (j) ensure that the order of test questions is in alignment with the order of text information, (k) revisit the structure and length of the texts to be included in the ESE, (l) revisit the number of alternatives to be included in the ESE, and (m) reconsider the use of the implicit alternative 6.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-04T21:58:47Z No. of bitstreams: 1 Disserta??o Mariana 17_03_15 versao final.pdf: 1700056 bytes, checksum: 584bcb99ef41417f01ec79613db83a82 (MD5) / Made available in DSpace on 2016-10-04T21:58:47Z (GMT). No. of bitstreams: 1 Disserta??o Mariana 17_03_15 versao final.pdf: 1700056 bytes, checksum: 584bcb99ef41417f01ec79613db83a82 (MD5) Previous issue date: 2015-03-27 / Introduction: worldwide, is recognized the importance of cross-cultural studies to study comprehensive, multi-faceted and multi-causal phenomena, such as interpersonal violence among young people, considering the impact of the indicators of this research in the exchange of knowledge and actions for the prevention and control of factors risk and vulnerabilities. It is known that this type of research requires the use of validated research instruments in order to ensure its quality and therefore the results obtained after its application in other studies. The analysis of the psychometric properties, reliability and validity of an instrument is critical to ensure that it is calibrated to measure the phenomenon to which it is proposed. Objective: to determine the psychometric properties of the Brazilian version of the inventory "Parcours des Jeunes Amourex" - Loving Trail Youth - PAJ through construct validation and reliability analysis. Methodology: methodological study which deals with the construct validity and reliability (psychometric analyzes) of the Brazilian version of the PAJ, executed in the period 2013-2015, using a convenience sample of 380 adolescents and young adults in the age groups 14-24 years enrolled in public schools in Feira de Santana, Bahia-Brazil. This research represents the second stage of cultural adaptation process and inventory of content validation, carried out from 2011-2013, which led to the national version (adapted and validated). The original inventory and the national version consist of 64 questions in different formats (dichotomous, open, scales). And reliability analysis was used examining the internal consistency of the questions, by calculating the Cronbach's alpha coefficient, considering the satisfactory value> 0.6; the factorability of the questions was evaluated by the test Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO), with appropriate value> 0.5; the construct validity was verified through exploratory factor analysis using the principal component analysis technique, with varimax rotation, using the latent root criterion to define the number of factors to be extracted. Results: The data showed that the adapted version of the PAJ has construct validity of evidence, since the measures proposed construct and has adequate reliability coefficients, confirming the internal consistency of the scale. It can be said then that the inventory showed good psychometric parameters allowing its applicability in national studies that seek to investigate violence among young couples and factors related to family life and friends. Conclusions: This research contributes to the appropriateness and applicability of an inventory that assesses multiple dimensions of loving violence in youth, encouraging new studies, exchange of information between different contexts, and can support public policies and programs that lead to the prevention and cure cycle intergenerational victimization and aggression between present and future generations. / Introdu??o: em n?vel mundial, reconhece-se a import?ncia dos estudos transculturais para estudar fen?menos abrangentes, multifacetados e multicausais, como a viol?ncia interpessoal entre jovens, considerando o impacto dos indicadores dessas pesquisas nas trocas de conhecimentos e a??es voltadas ? preven??o e controle dos fatores de risco e vulnerabilidades. Sabe-se que este tipo de pesquisa requer a utiliza??o de instrumentos de pesquisa validados, a fim de garantir sua qualidade e consequentemente dos resultados obtidos ap?s sua aplica??o em outras pesquisas.A an?lise das propriedades psicom?tricas, confiabilidade e validade de um instrumento ? fundamental para garantir que seja calibrado em medir o fen?meno ao qual est? proposto. Objetivo:realizar avalia??o das propriedades psicom?tricas da vers?o brasileira do invent?rio ?Parcours Amourex des Jeunes? ?Percurso Amoroso dos Jovens - PAJ, atrav?s da valida??o de construto e an?lise de confiabilidade. Metodologia: estudo metodol?gicoque trata da valida??o de construto e de confiabilidade (an?lises psicom?tricas) da vers?o brasileira do PAJ, executado no per?odo 2013 a 2015, utilizando amostra de conveni?ncia de 380 adolescentes e adultos jovens, nas faixas et?rias de 14 a 24 anos, matriculados nas escolas p?blicas de Feira de Santana-Bahia-Brasil. Esta pesquisa representa a segunda etapa do processo de adapta??o transcultural e valida??o de conte?do do inventario, realizado no per?odo de 2011-2013, o qual originou a vers?o nacional (adaptada e validada). O invent?rio original e a vers?o nacional s?o constitu?dos de 64 quest?es em formatos diversos (dicot?micas, abertas, escalas). Para an?lise da confiabilidade foi utilizado o exame da consist?ncia interna das quest?es, atrav?s do c?lculo do coeficiente alfa de Cronbach, considerando satisfat?rio o valor >0,6; a fatorabilidade das quest?es foi avaliada pelo teste deKaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO), sendo adequado valor >0,5; a validade de construto foi verificada atrav?s da an?lise fatorial explorat?ria, utilizando a t?cnica de an?lise de componentes principais, com rota??o varimax, sendo utilizado o crit?rio da raiz latente para definir a quantidade de fatores a serem extra?dos. Resultados: os dados mostraram que a vers?o adaptada do PAJ apresenta evid?ncias de validade de construto, visto que mede o construto proposto e possui coeficientes de fidedignidade adequados, confirmando a consist?ncia interna da escala. Pode-se afirmar ent?o, que o invent?rio apresentou bons par?metros psicom?tricos o que permite a sua aplicabilidade em estudos nacionais que buscam investigar viol?ncia entre casais jovens e fatores relacionados ao conv?vio familiar e amigos. Conclus?es: essa pesquisa contribui com a adequa??o e aplicabilidade de um invent?rio que avalia m?ltiplas dimens?es da viol?ncia amorosa na juventude, incentivando novos estudos, trocas de conhecimentos entre diferentes contextos, al?m de poder subsidiar pol?ticas p?blicas e programas que conduzam ? preven??o e supera??odo ciclo intergeracional de vitimiza??o e agress?o entre gera??es presentes e futuras.

To obtain valid and reliable research findings it is important to follow the process to validate measuring instruments. This entails determining the psychometric properties of a measure to eliminate or decrease the presence of measurement errors. Measurement errors have a negative impact on the validity of research findings. The aim of this study was to perform a confirmatory factor analytic study on the Aspects of Identity Questionnaire (AIQ-IV) to assess the model fit of the data. Confirmatory factor analysis was employed as part of the process to assess construct validity of a questionnaire to discover the misrepresenting influences of these measurement errors and to provide a foundation for further research. The AIQ-IV was administered to a sample of 157 participants in the South African context including different race, gender, age and occupation groups, drawn by means of convenient sampling. The research results and fit indices indicated that the data reflected a reasonable model fit. Copyright 2010, University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. Please cite as follows: Els, L 2010, A confirmatory factor analytic study of the aspects of identity questionnaire (AIQ-IV), MCom dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd-02092012-122330 / > C12/4/67/gm / Dissertation (MCom)--University of Pretoria, 2010. / Human Resource Management / unrestricted

Internal consistency reliability and validity were established for a new 31 item Imagery Manipulation Scale. Previous attempts to correlate subjectively rated control of visual imagery with tests of spatial ability have been unsuccessful. However, no attempt to construct a subjectively rated control of imagery scale was located which tried to establish internal consistency reliability and both content and construct validity. Further, no research was located in which subjects were requested to rate their imagery ability utilized during the performance of the actual spatial tasks used to try to establish validity. A new scale of subjectively rated control of imagery was devised in which subjects were requested to rate their imagery while solving spatial tasks which involved visualizing the manipulation of geometric forms. Content validity was established by analyzing the transformation involved while solving the spatial problems. Internal consistency reliability for the 31 item scale was established across two samples. Validity was established with the second sample (100 university students: 26 male and 74 female). The task utilized to provide validity could be objectively scored, and was made up of four spatial subtests, which were adapted from the Vandenberg and Kuse Mental Rotations Test, the Kosslyn Directions Test, performed in both the forward and backward direction, and a block task utilized by Snyder. A convergent and discriminant validity analysis established construct validity. Further, the hypotheses of three investigators, Kosslyn, Shepard and his colleagues, and Snyder, were supported by the results of the present investigation, thus substantiating the conclusion that reported control of imagery processing can be operationalized with performance scores on spatial ability tasks.

Den Gemensamma Europeiska Referensramen för Språk (GERS) har haft en betydande inverkan påutvärderingen av språkkunskaper i Europa. Denna studie fokuserar på två nationellaspråkfärdighetstester med avgörande konsekvenser för testtagarna, vilkas utfärdade GERS-nivå kananvändas för antagning till utbildningsprogram, medborgarskap och certifiering i två olika europeiskaländer: CILS i Italien och Swedex i Sverige. Det som testerna avser testa och hur deras innehållåterspeglar detta analyseras i relation till GERS standardnivåer. I analysen fokuseras på inferensernaEvaluation och Explanation i Kanes (1992, 2002, 2013) och Chapelles m. fl. (2008, 2021)tolkningsargument (interpretative argument) som utgörs av sju olika inferenser som används för attanalysera de antaganden som görs om testtagarens språknivå vid tolkning av testresultat ochutvärdering av språktesters användbarhet (figur 1, s. 9, bilaga 2). Resultaten används som en del avett större validitetsargument för språktester kopplade till GERS för att underbygga antaganden omtesternas konstrukt och innehållsrelaterade validitet och konsekvenserna av testernas användning.Den genomgripande frågeställningen är hur den europeiska referensramen tillämpas mellan olikaspråkfärdighetstester och huruvida användningen av en gemensam referensram leder till en jämliktolkning och tillämpning av GERS standardnivåer och en rättvis europeisk språkbedömning. Genomanalysen utkristalliserar sig testernas starka och svaga punkter i relation till grunddokumentet GERS,och vilka sociala konsekvenser testernas användning kan medföra. Resultaten visar att testernauppvisar bristande innehållsvaliditet inom de undersökta områdena, samt att det förekommer faktorersom ligger utanför de konstrukt som testerna avser testa, vilka kan påverka testtagarens testprestation.

The diploma thesis "Health and Socio-economic Indicators - reliability and validity testing of the PSAS" deals with a theoretical concept of health and its socio-economic indicators. A substantial part of the work concentrates on the application of PSAS tools to the Czech population and determining whether the range is reliable and valid for Czech respondents. To determine the reliability, a complex test is used for the whole range through the value of Cronbach's Alpha, and then the Item Response Theory (IRT) is also tested. The IRT test is done using the 18-point Likert's range of responses, of which is the PSAS composed. The validity is tested based on confirmatory factor analysis, using the construct validity as well as analysis of cognitive interviews for face validity. The secondary data analysis is done in SPSS, MPLUS, R, and IRTPRO programs. The last two programs are used to test the lesser known Item Response Theory.