OBJECTIVE: Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7. METHODS: Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM). RESULTS: The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7. CONCLUSION: The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis. / : This research was supported by an award from the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835) at the National Institutes of Health (NIH). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication / Revisión por pares

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2017-03-01T20:56:50Z No. of bitstreams: 1 Flavio de Carvalho Perpetuo.pdf: 4650721 bytes, checksum: f596966b8c89d4fc1b736fb03d34e875 (MD5) / Made available in DSpace on 2017-03-01T20:56:50Z (GMT). No. of bitstreams: 1 Flavio de Carvalho Perpetuo.pdf: 4650721 bytes, checksum: f596966b8c89d4fc1b736fb03d34e875 (MD5) Previous issue date: 2016-12-09 / Diagnostic medicine is a specialty aimed at performing complementary tests to aid diagnosis, with impact on the different stages of the health chain: prevention, diagnosis, prognosis and therapeutic follow-up. Official sources of the public sector – DATASUS (Brazilian Health System Database) and the private sector - ANS estimate that the sector handled R$ 33.24 billion in the year 2015. The purpose of this study is to evaluate the relationship between the definition criteria of outsourcing diagnostic services with Loyalty theory, based on a structural model that portrays, at the consumer level, the relationships of attitudinal and behavioral loyalty with constructs of Loyalty Background: Satisfaction, Trust, Perceived Value, Quality, Cost of Change and Perceived Justice. The main objective of the Research is the Application of Integrative Model for measuring the constructs of Loyalty Background in the B2B relationship in the diagnostic medicine sector. In order to direct the accomplishment of the study, the following main research question was posed: what antecedents are relevant in the construction of Loyalty in B2B relationships in the Diagnostic Medicine Sector? The empirical study can be classified as a quantitative, descriptive survey carried out in cross-section and structured in a strategy of analysis by action research. The present research proposes to study the influence of the antecedents of consumer loyalty. The study collected information from clients for the construction of a theoretical model that was analyzed through the modeling of structural equations and the partial least squares (PLS) technique. The theoretical framework used included relationship marketing and recognized antecedents of consumer loyalty. The results demonstrated the consumers' understanding of the judgment of the results received, mainly the positive influence of this evaluation on their satisfaction as an important aspect for the construction of their loyalty to the supplier. / A medicina diagnóstica é uma especialidade direcionada a realização de exames complementares no auxílio ao diagnostico, com impacto nos diferentes estágios da cadeia de saúde: prevenção, diagnóstico, prognóstico e acompanhamento terapêutico. Fontes oficiais do setor público – DATASUS e do setor privado – ANS estimam que o setor movimentou R$ 33,24 bilhões no ano de 2015. A proposta deste trabalho é avaliar a relação entre os critérios de definição de terceirização de serviços de medicina diagnóstica com a teoria de Lealdade, a partir de um modelo estrutural que retrata, no nível do consumidor, as relações da lealdade atitudinal e comportamental com constructos de Antecedentes da Lealdade: Satisfação, Confiança, Valor Percebido, Qualidade, Custo da Mudança e Justiça Percebida. O objetivo principal da Pesquisa é a Aplicação de Modelo Integrativo para mensuração de construtos dos Antecedentes de Lealdade no relacionamento B2B no setor de medicina diagnóstica. De forma a direcionar a realização do estudo, foi colocada a seguinte questão principal de pesquisa: quais antecedentes são relevantes na construção da Lealdade em relacionamentos B2B no Setor de Medicina Diagnóstica? O estudo empírico realizado pode ser classificado como um survey quantitativo, descritivo realizado em corte transversal e estruturado numa estratégia de análise por pesquisa-ação. A presente pesquisa propõe estudar a influência dos antecedentes da lealdade dos consumidores. O estudo coletou informações dos clientes, para a construção de um modelo teórico que foi analisado por meio da modelagem de equações estruturais e pela técnica de mínimos quadrados parciais (PLS). O arcabouço teórico utilizado englobou o marketing de relacionamento e reconhecidos antecedentes da lealdade dos consumidores. Os resultados demonstraram o entendimento dos consumidores sobre o julgamento dos resultados recebidos, principalmente, a influência positiva dessa avaliação em sua satisfação como importante aspecto para a construção da sua lealdade ao fornecedor.