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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Qualidade de vida foi definida pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41;&#44; em 2000&#44; como a percep&#231;&#227;o do indiv&#237;duo acerca de sua posi&#231;&#227;o na vida no contexto da cultura e do sistema de valores nos quais ele vive e em rela&#231;&#227;o aos seus objetivos&#44; expectativas&#44; padr&#245;es e preocupa&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Os conceitos de qualidade de vida relacionada &#224; sa&#250;de &#40;QVRS&#41; podem englobar duas esferas&#58; gen&#233;rico&#44; bem contemplado pela defini&#231;&#227;o da OMS&#59; e QVRS&#44; que engloba dois par&#226;metros fundamentais &#8211; a subjetividade e a multidimensionalidade&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> A incorpora&#231;&#227;o do estudo de QVRS na &#225;rea da sa&#250;de &#233; algo recente e acompanha a evolu&#231;&#227;o do entendimento do processo sa&#250;de&#8208;doen&#231;a ao longo dos anos&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As doen&#231;as cut&#226;neas conferem&#44; em geral&#44; importante impacto na QVRS&#44; visto que as les&#245;es se localizam&#44; majoritariamente&#44; em &#225;reas expostas ao olhar do outro&#44; podendo afetar aspectos sociais&#44; afetivos e emocionais do indiv&#237;duo&#46; Na Dermatologia&#44; a defini&#231;&#227;o dos desfechos&#8208;alvos a serem alcan&#231;ados com o tratamento &#233; delicada&#44; visto que a maior parte das doen&#231;as da especialidade n&#227;o oferece risco de morte &#8211; ou seja&#44; o desfecho esperado n&#227;o &#233; a sobreviv&#234;ncia&#46; Isso ressalta a import&#226;ncia da avalia&#231;&#227;o da QVRS por meio de instrumentos adequados como par&#226;metro para seguimento e monitoramento&#44; al&#233;m da defini&#231;&#227;o de decis&#245;es e metas terap&#234;uticas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A mensura&#231;&#227;o de QVRS n&#227;o &#233; uma medida direta &#8211; portanto&#44; &#233; necess&#225;rio lan&#231;ar m&#227;o de instrumentos fundamentados na teoria psicom&#233;trica para possibilitar tal avalia&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a> Os question&#225;rios s&#227;o os instrumentos mais utilizados em psicometria&#44; e constituem as ferramentas pelas quais se pode avaliar o impacto da doen&#231;a na QVRS&#46; Nesse &#237;nterim&#44; os question&#225;rios de QVRS devem obedecer aos princ&#237;pios b&#225;sicos da psicometria&#58; viabilidade&#44; confiabilidade&#44; sensibilidade &#224; mudan&#231;a &#40;responsividade&#41; e estabilidade temporal&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A pluralidade das doen&#231;as dermatol&#243;gicas inflige impactos em diferentes dimens&#245;es da QVRS&#46; Em 1996&#44; Chren et al&#46; desenvolveram a primeira vers&#227;o do Skindex &#40;61 itens&#41; &#8722; instrumento multidimensional &#40;oito dimens&#245;es&#41; para avalia&#231;&#227;o da QVRS entre portadores de doen&#231;as dermatol&#243;gicas&#46; Esse question&#225;rio foi desenvolvido para englobar alguns aspectos psicol&#243;gicos e psicossociais ainda n&#227;o abordados especificamente por outros instrumentos de medida de QVRS em Dermatologia&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> A vers&#227;o reduzida do instrumento foi publicada no ano seguinte&#44; e denominado Skindex&#8208;29&#44; com 29 itens&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">No ano 2000&#44; foi publicada uma terceira vers&#227;o do instrumento &#8211; o Skindex&#8208;16&#46; Para seu desenvolvimento&#44; ap&#243;s an&#225;lise do uso das vers&#245;es anteriores&#44; concluiu&#8208;se que os efeitos das dermatoses na qualidade de vida poderiam ser divididos em tr&#234;s dom&#237;nios&#58; sintomas cut&#226;neos&#44; efeitos nas emo&#231;&#245;es e efeito nas fun&#231;&#245;es sociais e f&#237;sicas&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Em 2006&#44; foi realizada uma nova redu&#231;&#227;o a partir do Skindex&#8208;29&#44; chamada Skindex&#8208;17 &#40;SK&#8208;17&#41;&#44; utilizando&#8208;se um modelo estat&#237;stico baseado na teoria de resposta ao item &#40;an&#225;lise de Rasch&#41;&#44; diferentemente da redu&#231;&#227;o realizada com o Skindex&#8208;16&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Foram implementadas algumas modifica&#231;&#245;es para melhor adequa&#231;&#227;o&#58; em vez de cinco escores&#44; as respostas dos itens passaram a contar com tr&#234;s escores&#46; Os itens foram agrupados em duas subescalas&#44; uma delas sobre emo&#231;&#227;o e funcionamento &#40;psicossocial&#41; e outra sobre sintomas&#46; Desse modo&#44; obteve&#8208;se um instrumento com duas dimens&#245;es&#44; totalizando 17 itens&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Dos 12 itens que permaneceram semelhantes entre o Skindex&#8208;29 e o Skindex&#8208;16&#44; nove deles tamb&#233;m est&#227;o presentes no SK&#8208;17&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Como o SK&#8208;17 &#233; uma redu&#231;&#227;o do Skindex&#8208;29&#44; que j&#225; fora traduzido para o portugu&#234;s do Brasil&#44; os itens j&#225; apresentam tradu&#231;&#227;o publicada&#59; entretanto&#44; tal vers&#227;o n&#227;o foi ainda validada nessa popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> O objetivo deste estudo foi validar a vers&#227;o do instrumento SK&#8208;17&#44; assim como avaliar suas propriedades psicom&#233;tricas entre pacientes com doen&#231;as dermatol&#243;gicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudo metodol&#243;gico&#44; transversal e prospectivo&#44; realizado com pacientes atendidos no ambulat&#243;rio de dermatologia e na enfermaria de dermatologia vinculados ao servi&#231;o de Dermatologia da FMB&#8208;Unesp &#40;Botucatu&#44; SP&#41;&#44; ap&#243;s aprova&#231;&#227;o pelo Comit&#234; de &#201;tica em Pesquisa da Institui&#231;&#227;o &#40;parecer n&#176; 2&#46;367&#46;912&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos pacientes atendidos no ambulat&#243;rio de dermatologia do servi&#231;o de Dermatologia da FMB&#8208;Unesp &#40;Botucatu&#44; SP&#41;&#44; com idade &#8805; 18 anos&#44; fluentes em portugu&#234;s do Brasil e que aceitaram a participa&#231;&#227;o mediante assinatura do Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Houve autoriza&#231;&#227;o para utiliza&#231;&#227;o dos instrumentos de avalia&#231;&#227;o pela autora &#8722; Dr&#46; Mary&#8208;Margareth Chren&#46; A autoriza&#231;&#227;o para uso em pesquisas acad&#234;micas &#233; realizada por interm&#233;dio da empresa <span class="elsevierStyleItalic">Mapi Research Institute</span>&#44; respons&#225;vel pela valida&#231;&#227;o de tradu&#231;&#227;o de instrumentos de sa&#250;de que alberga os direitos autorias das diversas vers&#245;es do Skindex &#40;<a href="https://mapi-trust.org/our-resources/questionnaires-distributed-by-the-mapi-research-trust/">https&#58;&#47;&#47;mapi&#8208;trust&#46;org&#47;our&#8208;resources&#47;questionnaires&#8208;distributed&#8208;by&#8208;the&#8208;mapi&#8208;research&#8208;trust&#47;</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os pacientes foram entrevistados durante consulta m&#233;dica&#44; ap&#243;s assinatura do TCLE&#44; entre dezembro de 2017 e setembro de 2019&#46; Foram utilizados os question&#225;rios SK&#8208;17 e DLQI&#59; para responsividade e reteste&#44; os question&#225;rios foram reaplicados em um intervalo de 7 a 30 dias&#46; Foram avaliadas tamb&#233;m vari&#225;veis cl&#237;nicas &#40;diagn&#243;stico&#44; tempo de doen&#231;a&#44; tipo de doen&#231;a&#41;&#44; epidemiol&#243;gicas e sociodemogr&#225;ficas &#40;idade&#44; escolaridade&#44; sexo&#44; fototipo e renda familiar&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O coeficiente de validade de conte&#250;do do SK&#8208;17 foi calculado a partir da avalia&#231;&#227;o de cinco ju&#237;zes &#8722; m&#233;dicos dermatologistas&#44; psic&#243;loga e enfermeiras&#46; Os ju&#237;zes pontuaram um escore de 1 a 5 para cada item quanto &#224; pertin&#234;ncia da avalia&#231;&#227;o do tra&#231;o latente&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Da mesma maneira&#44; foi realizada avalia&#231;&#227;o quanto &#224; pertin&#234;ncia da avalia&#231;&#227;o do conte&#250;do do construto para cada item por um grupo de cinco participantes do estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Levando&#8208;se em conta as avalia&#231;&#245;es realizadas&#44; foram considerados pertinentes os itens que alcan&#231;aram coeficientes maiores que 0&#44;7&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A consist&#234;ncia interna de cada dimens&#227;o dos instrumentos &#40;SK&#8208;17 e DLQI&#41; foi avaliada pelo coeficiente alfa de Cronbach&#44; considerando 95&#37; IC&#44; cujo intervalo inferior deve superar 0&#44;8 em construtos de adequada consist&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Para o SK&#8208;17&#44; foi ainda realizada a an&#225;lise do coeficiente de alfa de Cronbach se cada item fosse exclu&#237;do&#44; visando observar se haveria melhora importante &#40;&#62; 0&#44;1&#41; da consist&#234;ncia interna do instrumento&#46; A consist&#234;ncia interna multidimensional para o SK&#8208;17 foi estimada pelo &#237;ndice de confiabilidade composta de Raykov&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> A correla&#231;&#227;o dos itens entre si &#40;inter&#8208;item&#41; e com o escore total &#40;item&#8208;total&#41; foi calculada pelo coeficiente rho de Spearman&#44; considerando forte correla&#231;&#227;o quando rho<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A validade concorrente foi avaliada a partir da correla&#231;&#227;o entre os escores dos question&#225;rios e SK&#8208;17 e DLQI&#8208;BRA&#44; a partir dos coeficientes de correla&#231;&#227;o de Spearman &#40;rho&#41;&#44; devendo ser maior que 0&#44;7 &#40;forte correla&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">O instrumento DLQI&#8208;BRA foi disponibilizado pelo autor para uso livre em pesquisas acad&#234;micas&#44; conforme condi&#231;&#245;es de uso no site que cont&#233;m os direitos autorais do mesmo &#40;<a href="http://sites.cardiff.ac.uk/">http&#58;&#47;&#47;sites&#46;cardiff&#46;ac&#46;uk&#47;</a> dermatology&#47;quality&#8208;of&#8208;life&#47;dermatology&#8208;quality&#8208;of&#8208;life&#8208;index&#8208;dlqi&#47;dlqi&#8208;instructions&#8208;for&#8208;use&#8208;and&#8208;scoring&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A estrutura bidimensional do SK&#8208;17 foi avaliada pela an&#225;lise fatorial confirmat&#243;ria&#46; O ajuste do modelo foi realizado pelo teste do Qui&#8208;Quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#44; raiz da m&#233;dia dos quadrados dos erros de aproxima&#231;&#227;o &#40;RMSEA&#41;&#44; &#237;ndice de ajuste comparativo &#40;CFI&#41;&#44; raiz quadrada m&#233;dia residual padronizada &#40;SRMR&#41;&#46; Objetiva&#8208;se atingir como crit&#233;rios de ajuste&#58; &#967;<span class="elsevierStyleSup">2</span> valor de p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#59; RMSEA &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;8&#59; CFI &#8805; 0&#44;9&#59; SMR &#8804; 0&#44;08&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A estabilidade temporal &#40;teste&#8208;reteste&#41; do SK&#8208;17 foi avaliada em um subgrupo de 16 sujeitos&#44; selecionados por conveni&#234;ncia &#40;principalmente aqueles que teriam retornos breves ou que se encontravam em regime de interna&#231;&#227;o&#41; num intervalo de 7&#8208;30 dias entre as entrevistas&#44; desde que n&#227;o houvesse altera&#231;&#227;o cl&#237;nica da doen&#231;a&#46; A reprodutibilidade teste&#8208;reteste foi analisada por meio do &#237;ndice de correla&#231;&#227;o intraclasse &#40;CCI&#41; para concord&#226;ncia completa&#46; Foi utilizado intervalo de confian&#231;a de 95&#37; &#40;95&#37; IC&#41;&#44; considerando satisfat&#243;rio se o intervalo inferior for<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Para an&#225;lise de responsividade&#44; foi avaliado o escore do SK&#8208;17 em um subgrupo de 16 pacientes que apresentaram altera&#231;&#227;o cl&#237;nica de sua dermatose&#44; dentro de um intervalo de 7&#8208;30 dias entre as entrevistas&#46; A responsividade dos escores foi testada pelo teste Wilcoxon&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Foi avaliada a frequ&#234;ncia de respostas para cada item do SK&#8208;17 e constru&#237;do diagrama de frequ&#234;ncias&#46; Os efeitos &#8220;teto&#8221; e &#8220;ch&#227;o&#8221; foram considerados quando a frequ&#234;ncia de respostas foi<span class="elsevierStyleHsp" style=""></span>&#62; 50&#37; para alguns o escores m&#225;ximo e m&#237;nimo&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Os sujeitos tamb&#233;m foram classificados em tr&#234;s grupos&#44; segundo a doen&#231;a cut&#226;nea&#58; dermatoses com impacto psicossocial mais evidente &#40;p&#46;ex&#46;&#44; vitiligo&#44; melasma&#44; alopecia&#41;&#44; doen&#231;as predominantemente sintom&#225;ticas &#40;p&#46;ex&#46;&#44; &#250;lcera venosa&#44; urtic&#225;ria&#41; ou impacto sintom&#225;tico e psicossocial &#40;p&#46;ex&#46;&#44; psor&#237;ase&#44; hidradenite supurativa&#41;&#44; por dermatologista titulado&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O comportamento do escore do SK&#8208;17 foi analisado dentro de subgrupos &#40;idade&#44; sexo&#44; escolaridade&#44; tempo do diagn&#243;stico e tipo de doen&#231;a dos sujeitos&#41; por meio de testes de correla&#231;&#227;o de Spearman &#40;idade e tempo de doen&#231;a&#41;&#44; Jonckheere&#8208;Terpstra &#40;escolaridade&#41;&#44; Mann&#8208;Whitney &#40;sexo&#41; e Kruskal&#8208;Wallis &#40;tipo de doen&#231;a&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Foram avaliados itens de factibilidade do question&#225;rio&#44; como tempo de execu&#231;&#227;o&#44; taxa de recusa em responder e entendimento dos termos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dados foram tabulados em planilhas do MS Excel 2010 e analisados pelos softwares IBM SPSS 25 e JASP 0&#46;11&#46; Vari&#225;veis quantitativas foram representadas pela m&#233;dia e desvio padr&#227;o ou mediana e quartis &#40;p25&#8208;p75&#41;&#44; quando a normalidade n&#227;o foi evidenciada pelo teste de Shapiro&#8208;Wilk&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Foram considerados significativos os achados &#40;diferen&#231;as ou associa&#231;&#245;es&#41; quando valor&#8208;p dos testes resultou menor do que 5&#37; &#40;valor&#8208;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Como testes de valida&#231;&#227;o de question&#225;rios demandam 5 a 10 sujeitos para cada item&#44; a amostragem necess&#225;ria para a valida&#231;&#227;o do SK&#8208;17&#44; de acordo com a teoria cl&#225;ssica dos testes&#44; foi estimada entre 85 e 170 pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0130" class="elsevierStylePara elsevierViewall">Foram avaliados 217 pacientes que totalizaram 249 respostas aos question&#225;rios&#46; As caracter&#237;sticas cl&#237;nico&#8208;demogr&#225;ficas est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Houve predom&#237;nio de mulheres&#44; idade adulta&#44; fototipos intermedi&#225;rios e pacientes casados&#46; Os grupos de doen&#231;as cut&#226;neas inclu&#237;das no estudo est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">O escore total das dimens&#245;es dos instrumentos SK&#8208;17&#44; assim como o escore total do DLQI&#44; est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; Os pacientes mostraram impacto majoritariamente leve a moderado na qualidade de vida pelos diferentes instrumentos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia de cada op&#231;&#227;o de resposta para cada item dos instrumentos foi estudada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; a fim de observarmos a presen&#231;a de &#8220;efeito teto&#8221; e &#8220;efeito ch&#227;o&#8221;&#46; O SK&#8208;17 apresentou &#8220;efeito ch&#227;o&#8221; para 13 &#40;76&#37;&#41; itens&#44; sobretudo aqueles presentes na dimens&#227;o &#8220;psicossocial&#8221; &#40;91&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o do conte&#250;do do question&#225;rio SK&#8208;17 foi realizada por cinco profissionais &#40;dermatologistas&#44; enfermeiras e psic&#243;loga&#41; sobre a pertin&#234;ncia de cada item para verifica&#231;&#227;o do tra&#231;o latente&#59; todos os itens apresentaram coeficiente<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7&#46; A valida&#231;&#227;o cultural foi observada pela mesma avalia&#231;&#227;o de pertin&#234;ncia com grupo de cinco pacientes&#44; resultando em coeficientes m&#233;dios<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7 &#40;dados n&#227;o mostrados&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A an&#225;lise da consist&#234;ncia interna foi realizada para cada dimens&#227;o do SK&#8208;17&#8208; sintomas e psicossocial&#46; O alfa de Cronbach revelou &#237;ndices<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;8 para as dimens&#245;es do SK&#8208;17 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46; O &#237;ndice de confiabilidade composta &#40;Raykov&#41; do SK&#8208;17 resultou em 0&#44;94&#46; Foi realizada tamb&#233;m avalia&#231;&#227;o do coeficiente alfa de Cronbach para cada dimens&#227;o do SK&#8208;17 caso o item fosse exclu&#237;do&#44; o que n&#227;o demonstrou varia&#231;&#227;o importante &#40;&#60; 0&#44;1&#41; da consist&#234;ncia em rela&#231;&#227;o &#224; estrutura original&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A correla&#231;&#227;o inter&#8208;item e item&#8208;total podem ser observadas na <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">As correla&#231;&#245;es entres os instrumentos mostraram fortes correla&#231;&#245;es &#40;rho&#41; tanto entre a dimens&#227;o de sintomas do SK&#8208;17 &#40;0&#44;69&#41; como a dimens&#227;o psicossocial &#40;0&#44;75&#41; com o DLQI &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Foi realizada an&#225;lise fatorial confirmat&#243;ria para avalia&#231;&#227;o da dimensionalidade do SK&#8208;17&#46; Demonstrou&#8208;se adequa&#231;&#227;o &#224; dimensionalidade proposta pelo instrumento&#44; por meio da concord&#226;ncia com todos os valores dos crit&#233;rios de ajuste &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">A estabilidade temporal do SK&#8208;17 foi estudada a partir da reaplica&#231;&#227;o dos question&#225;rios para um grupo de 16 pacientes que n&#227;o tiveram varia&#231;&#227;o cl&#237;nica de sua dermatose&#44; durante per&#237;odo que variou de 7 a 30 dias&#46; Os resultados obtidos mostraram adequada reprodutibilidade teste&#8208;reteste para ambos os instrumentos e concord&#226;ncia pela correla&#231;&#227;o intraclasse &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabela 7</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">A responsividade dos instrumentos foi estudada tamb&#233;m pela reaplica&#231;&#227;o dos question&#225;rios a outro subgrupo de 16 pacientes que apresentaram mudan&#231;a cl&#237;nica dermatol&#243;gica&#46; A an&#225;lise revelou piora ou melhora unidirecional para as dimens&#245;es do SK&#8208;17 &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabela 7</a>&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">A compara&#231;&#227;o dos escores das duas dimens&#245;es do SK&#8208;17 com as vari&#225;veis estudadas &#40;idade&#44; sexo&#44; escolaridade&#44; tipo de doen&#231;a e tempo do diagn&#243;stico&#41; est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0040">tabela 8</a>&#46; Houve diferen&#231;a dos escores quanto ao sexo dentro da dimens&#227;o psicossocial&#44; tamb&#233;m para o tipo de doen&#231;a e para escolaridade dentro da dimens&#227;o de sintomas&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">A factibilidade do SK&#8208;17 foi avaliada segundo o tempo de execu&#231;&#227;o do question&#225;rio e dificuldades durante a realiza&#231;&#227;o do mesmo&#46; Foi realizada aferi&#231;&#227;o do tempo de resposta para um grupo de 17 pacientes&#44; com varia&#231;&#227;o de 58 segundos a 4 minutos &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 min 48s&#44; desvio&#8208;padr&#227;o<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42s&#41;&#46; N&#227;o houve recusa &#224; resposta&#44; assim como respostas em branco&#46; N&#227;o foram percebidas grandes dificuldades para interpreta&#231;&#227;o e resposta dos itens do SK&#8208;17&#44; mesmo em pacientes com baixa escolaridade&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0190" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o psicom&#233;trica do SK&#8208;17 torna poss&#237;vel afirmar que o instrumento &#233; fact&#237;vel&#44; confi&#225;vel e v&#225;lido para mensurar o impacto na QVRS de pacientes brasileiros com doen&#231;as de pele&#46; Nesta casu&#237;stica foram inclu&#237;dos pacientes portadores de dermatoses que est&#227;o entre as doen&#231;as cut&#226;neas mais prevalentes no Brasil&#44; segundo pesquisa recente realizada pela Sociedade Brasileira de Dermatologia&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o do impacto de doen&#231;as dermatol&#243;gicas pode ser feita por meio de instrumentos&#44; divididos em par&#226;metros cl&#237;nicos e psicom&#233;tricos&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Como muitas doen&#231;as cr&#244;nicas dermatol&#243;gicas t&#234;m como caracter&#237;stica inerente o impacto predominante na QVRS e n&#227;o a sobreviv&#234;ncia&#44; o estudo e o aperfei&#231;oamento de instrumentos de QVRS s&#227;o fundamentais para a pr&#225;tica cl&#237;nica e ensaios terap&#234;uticos&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A pele &#233; o &#243;rg&#227;o mais importante para a forma&#231;&#227;o da autoimagem&#46; A intera&#231;&#227;o com o ambiente externo e suas altera&#231;&#245;es podem causar influ&#234;ncia significativa nas atividades di&#225;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> A presen&#231;a de dermatoses mostrou&#8208;se relacionada com o aumento do risco de suic&#237;dio em alguns estudos&#44; <a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> e pode causar maior preocupa&#231;&#227;o nos indiv&#237;duos do que doen&#231;as como hipertens&#227;o e diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> A popula&#231;&#227;o estudada foi composta por adultos jovens&#44; faixa et&#225;ria social e profissionalmente ativa&#44; ou seja&#44; com maior intera&#231;&#227;o interpessoal presumida&#46; O predom&#237;nio de mulheres &#233; coincidente com a maior parte dos estudos em Dermatologia da literatura&#44; visto que as mulheres tendem a procurar mais precoce e frequentemente servi&#231;os de sa&#250;de&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da QVRS engloba diversas esferas da vida do portador&#44; o que torna compreens&#237;vel a estrutura multidimensional dos instrumentos&#46; Neste estudo&#44; foi confirmada a estrutura bidimensional do SK&#8208;17 &#40;sintomas e psicossocial&#41;&#46; A an&#225;lise estat&#237;stica mostrou adequa&#231;&#227;o de todos os &#237;ndices de ajuste estudados &#40;Qui&#8208;Quadrado&#44; RMSEA&#44; SRMR&#44; CFI&#41; para dimensionalidade descritas pelos autores dos question&#225;rio original&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">A valida&#231;&#227;o do SK&#8208;17 foi evidenciada pela consist&#234;ncia interna&#44; validade concorrente&#44; estabilidade temporal&#44; responsividade&#44; factibilidade&#44; validade de conte&#250;do e adequa&#231;&#227;o cultural&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A valida&#231;&#227;o concorrente realizada pela correla&#231;&#227;o do SK&#8208;17 com o DLQI&#8208;BRA mostrou &#237;ndices de correla&#231;&#227;o adequados&#44; sugerindo que avaliam o mesmo tra&#231;o latente&#46; DLQI &#233; o instrumento de avalia&#231;&#227;o de QVRS em dermatologia mais utilizado mundialmente&#59; ele se correlacionou fortemente &#40;&#62; 0&#44;7&#41; com ambas as dimens&#245;es do SK&#8208;17&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">A consist&#234;ncia interna do question&#225;rio SK&#8208;17 demonstrou &#237;ndice adequado de confiabilidade para suas duas dimens&#245;es&#44; sugerindo precis&#227;o nas medidas de seus escores nessa popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> O estudo original do SK&#8208;17<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> apresentou &#237;ndices de alfa de Cronbach<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7 para suas duas dimens&#245;es&#44; e realizou a an&#225;lise do coeficiente para cada item&#44; sem melhora do desempenho do instrumento com exclus&#227;o de qualquer item&#44; o que tamb&#233;m foi observado em nosso trabalho&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">A estabilidade temporal do SK&#8208;17 mostrou escores concordantes para um mesmo paciente que n&#227;o teve altera&#231;&#227;o de sua dermatose&#44; o que nos permite dizer que o instrumento &#233; reprodut&#237;vel na pr&#225;tica cl&#237;nica&#46; Da mesma maneira&#44; os indicadores de responsividade mostraram resultados favor&#225;veis&#44; refor&#231;ando sua sensibilidade &#224; mudan&#231;a na pr&#225;tica cl&#237;nica&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">A an&#225;lise de &#8220;efeito teto&#8221; e &#8220;efeito ch&#227;o&#8221; dos instrumentos nem sempre &#233; descrita nos estudos de valida&#231;&#227;o&#46; Observamos expressivo n&#250;mero de itens com efeito ch&#227;o no SK&#8208;17&#46; Os escores de todos os instrumentos avaliados mostram que a popula&#231;&#227;o do estudo foi composta de portadores de dermatoses com comprometimento leve a moderado da QV&#44; o que pode contribuir para as respostas nulas&#46; Como o comprometimento usual dos escores QVRS em dermatologia &#233; leve e moderado&#44; esse fen&#244;meno de efeito &#8220;ch&#227;o&#8221; tamb&#233;m foi descrito em outros estudos envolvendo o DLQI&#8208;BRA&#44; podendo n&#227;o ser uma caracter&#237;stica do instrumento&#44; mas da popula&#231;&#227;o estudada&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;27</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">A factibilidade do uso do SK&#8208;17 foi evidenciada pelo curto tempo dispendido para responder o question&#225;rio&#44; assim como entendimento adequado das quest&#245;es&#46; Durante a valida&#231;&#227;o do Skindex&#8208;16 no Brasil&#44; observou&#8208;se que o tempo de resposta do question&#225;rio tamb&#233;m foi curto e adequado&#44; variando de 2 a 3 minutos &#40;m&#233;dia&#58; 2 min 41s&#59; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51s&#41;&#46; Al&#233;m disso&#44; foi ainda descrito &#237;ndice elevado de n&#227;o reposta ao item 5 &#40;persist&#234;ncia&#47;recorr&#234;ncia&#41;&#59; tal dificuldade n&#227;o foi observada em nosso estudo&#44; tampouco aus&#234;ncia de resposta aos itens&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Realizamos a an&#225;lise de subgrupos de acordo com sexo&#44; idade&#44; escolaridade&#44; tempo de diagn&#243;stico e tipo de doen&#231;a&#46; Foi identificada diferen&#231;a relevante para sexo dentro do dom&#237;nio psicossocial do SK&#8208;17 e tipo de doen&#231;a e escolaridade para o dom&#237;nio de sintomas do SK&#8208;17&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Nosso estudo apresentou popula&#231;&#227;o majoritariamente feminina&#44; que apresenta maiores &#237;ndices de ansiedade e preocupa&#231;&#227;o com a autoimagem&#44; o que poderia explicar a diferen&#231;a observada&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Esse comportamento deve alertar para a influ&#234;ncia do g&#234;nero quando da descri&#231;&#227;o do impacto de QVRS em doen&#231;as dermatol&#243;gicas&#44; especialmente&#44; quando escores de QVRS subsidiarem decis&#245;es terap&#234;uticas&#44; como ocorre em alguns fluxogramas de tratamento da psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">O comportamento diferente entre subgrupos de tipos de doen&#231;a na dimens&#227;o de sintomas pode ser explicado pela pr&#243;pria natureza sintom&#225;tica ou n&#227;o das doen&#231;as estudadas&#46; No artigo original do SK&#8208;17&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> descreve&#8208;se que a escala &#8220;psicossocial&#8221; apresentou comportamento semelhante entre diferentes doen&#231;as e gravidades&#44; tornando poss&#237;vel a compara&#231;&#227;o entre dermatoses distintas&#44; o que n&#227;o ocorreu com a escala &#8220;sintomas&#8221;&#46; Em nossa casu&#237;stica&#44; a subescala &#8220;sintomas&#8221; apresentou funcionamento diferente de acordo com a doen&#231;a estudada&#44; o que orienta compara&#231;&#245;es apenas dentro de um mesmo contexto cl&#237;nico&#44; preferencialmente diante do mesmo tipo de doen&#231;a&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Quando analisado o desempenho da subescala sintomas quanto &#224; escolaridade&#44; evidenciaram&#8208;se maiores escores ligados aos ensinos fundamental e m&#233;dio&#46; Tal associa&#231;&#227;o pode se dar pela procura muitas vezes mais tardia &#40;ou menor acesso ao sistema de sa&#250;de&#41; entre paciente com menor escolaridade&#44; resultando em doen&#231;as mais sintom&#225;ticas&#46; Estudos com desenhos pr&#243;prios para avaliar esse tipo de desfecho devem ser conduzidos posteriormente&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Cabe salientar algumas das limita&#231;&#245;es apresentadas por nosso estudo&#58; pesquisa monoc&#234;ntrica&#44; inclus&#227;o apenas de pacientes provenientes do Sistema &#218;nico de Sa&#250;de e amostra com alguma assimetria quanto ao tipo de doen&#231;a e sexo&#46; Entretanto&#44; essas limita&#231;&#245;es n&#227;o desabonam os resultados voltados ao objetivo de valida&#231;&#227;o do instrumento para a popula&#231;&#227;o brasileira&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">A an&#225;lise comparativa do SK&#8208;17 com outros instrumentos de avalia&#231;&#227;o da QV&#44; como o DLQI&#8208;BRA e o Skindex&#8208;16&#44; possibilitar&#227;o avaliar criteriosamente a informatividade e o desempenho psicom&#233;trico desses instrumentos na Dermatologia&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0270" class="elsevierStylePara elsevierViewall">Skindex&#8208;17 mostrou&#8208;se um instrumento v&#225;lido e consistente para avalia&#231;&#227;o da QVRS entre portadores de doen&#231;as dermatol&#243;gicas no Brasil&#46; Foi confirmada sua estrutura bidimensional&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0275" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0280" class="elsevierStylePara elsevierViewall">Marilia Formentini Scotton Jorge&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Ioana Bittencourt Mour&#227;o&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Camila Fernandes Pollo&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Ticiane Dion&#237;zio de Sousa&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Silmara Meneguin&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0310" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Qualidade de vida relacionada &#224; sa&#250;de avalia como as doen&#231;as afetam o cotidiano do indiv&#237;duo&#46; H&#225; diversos instrumentos gen&#233;ricos para essa avalia&#231;&#227;o em Dermatologia&#46; O Skindex foi descrito em 1996 e &#233; um instrumento multidimensional&#44; que engloba alguns aspectos psicol&#243;gicos e sociais ainda n&#227;o abordados por outros question&#225;rios&#46; Dentre as suas vers&#245;es &#40;Skindex&#8208;29&#44; 16 e 17&#41;&#44; o Skindex&#8208;17 n&#227;o foi validado no Brasil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Valida&#231;&#227;o do Skindex&#8208;17 entre brasileiros portadores de doen&#231;as dermatol&#243;gicas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo metodol&#243;gico transversal e prospectivo com 217 pacientes atendidos no Ambulat&#243;rio do Servi&#231;o de Dermatologia da Faculdade de Medicina de Botucatu&#44; Universidade Estadual Paulista &#40;Botucatu&#44; SP&#44; Brasil&#41; entre dezembro&#47;2017 a setembro&#47;2019&#46; Foram avaliados a validade de conte&#250;do&#44; o tempo de preenchimento&#44; a consist&#234;ncia interna&#44; a estrutura dimensional&#44; a validade concorrente &#40;DLQI&#41;&#44; a estabilidade temporal e a responsividade&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A casu&#237;stica foi composta por 71&#37; de mulheres&#44; com idade m&#233;dia &#40;DP&#41; de 45 &#40;16&#41; anos&#59; fototipos II&#8722;IV representaram 95&#37; dos casos&#46; O coeficiente alfa de Cronbach resultou 0&#44;82 e 0&#44;93 para as dimens&#245;es sintomas e psicossocial&#44; respectivamente&#46; Houve alta correla&#231;&#227;o com o escore DLQI&#58; rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;69 &#40;sintomas&#41; e rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 &#40;psicossocial&#41;&#46; Foi confirmada a estrutura bidimensional do instrumento por meio de an&#225;lise fatorial confirmat&#243;ria&#46; Foi verificada estabilidade temporal &#40;ICC<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;9&#41; e responsividade dos escores &#40;p &#8804; 0&#44;02&#41;&#46; O instrumento mostrou&#8208;se fact&#237;vel na pr&#225;tica cl&#237;nica pela valida&#231;&#227;o de conte&#250;do realizada por profissionais e pacientes&#44; assim como pelo baixo tempo dispendido para resposta &#40;&#60; 5 minutos&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudo monoc&#234;ntrico&#44; com pacientes exclusivamente do sistema p&#250;blico de sa&#250;de&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Skindex&#8208;17 mostrou&#8208;se um instrumento v&#225;lido e consistente para avalia&#231;&#227;o da qualidade de vida entre portadores de doen&#231;as dermatol&#243;gicas no Brasil&#46; Sua estrutura bidimensional foi confirmada&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Como citar este artigo&#58; Jorge MFS&#44; Mour&#227;o IB&#44; Pollo CF&#44; Sousa TD&#44; Meneguin S&#44; Miot HA&#46; Validation of the Skindex&#8208;17 quality of life assessment instrument for a Brazilian population&#46; An Bras Dermatol&#46; 2021&#59;96&#58;51&#8211;8&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Trabalho realizado no Departamento de Dermatologia e Radioterapia&#44; Faculdade de Medicina&#44; Universidade Estadual Paulista&#44; Botucatu&#44; SP&#44; Brasil&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1567
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagrama de frequ&#234;ncia de resposta aos itens do SK&#8208;17 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>217&#41;&#46;</p>"
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        "detalles" => array:1 [
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            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">119 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Separado&#47;vi&#250;vo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classifica&#231;&#227;o da doen&#231;a</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sintom&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Psicossocial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tempo de doen&#231;a &#40;anos&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#8722;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Diagn&#243;stico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Psor&#237;ase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melasma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as eczematosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermatoses infecciosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a bolhosas autoimunes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alopecias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colagenoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#218;lceras cr&#244;nicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ros&#225;cea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fotodano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farmacodermias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumores benignos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitiligo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidradenite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumores malignos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Granuloma anular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pitir&#237;ase r&#243;sea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Queloide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lista de agrupamentos de diagn&#243;sticos amostrados dos pacientes n &#40;&#37;&#41;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#8722;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SK&#8208;17</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#8722;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#8722;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SK&#8208;17 S&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;82 &#40;0&#44;79&#8722;0&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SK&#8208;17 P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;93 &#40;0&#44;91&#8722;0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2518731.png"
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          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Coeficientes de correla&#231;&#227;o &#40;rho&#41; inter&#8208;item e item&#8208;total para SK&#8208;17</p>"
        ]
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        "identificador" => "tbl0030"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SK&#8208;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modelo Qui&#8208;quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#44;81 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;dia da raiz quadrada dos erros de aproxima&#231;&#227;o &#40;RMSEA&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02 &#40;0&#44;00&#8722;0&#44;042&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de ajuste comparativo &#40;CFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;dia da raiz quadrada residual padronizada &#40;SRMR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  """
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                0 => "xTab2518737.png"
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              "identificador" => "tblfn0020"
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          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#205;ndices de ajuste da an&#225;lise fatorial confirmat&#243;ria</p>"
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      7 => array:8 [
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">95&#37; IC</span>&#44; intervalo de confian&#231;a de 95&#37;&#59; ICC&#44; coeficiente de correla&#231;&#227;o intraclasse&#59; <span class="elsevierStyleItalic">SK&#8208;17 S</span> e <span class="elsevierStyleItalic">P</span>&#44; subescalas &#8220;sintomas&#8221; e &#8220;psicossocial&#8221;&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SK&#8208;17 S&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SK&#8208;17 P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#170; entrevista<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#40;1&#44;0&#8722;7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;3 &#40;1&#44;0&#8722;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#170; entrevista<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5 &#40;1&#44;0&#8722;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5 &#40;1&#44;0&#8722;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ICC &#40;95&#37; IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;98 &#40;0&#44;94&#8722;0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94 &#40;0&#44;83&#8722;0&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Responsividade</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Piora cl&#237;nica<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5 &#40;5&#44;5&#8722;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0 &#40;3&#44;5&#8722;15&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Melhora cl&#237;nica<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5 &#40;2&#44;0&#8722;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;0 &#40;1&#44;0&#8722;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p&#8208;valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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            1 => array:3 [
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            ]
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Resultados da estabilidade temporal&#58; teste&#8208;reteste &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#59; e da sensibilidade &#224; mudan&#231;a&#58; responsividade &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#59; para subgrupos do estudo</p>"
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        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "at8"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Par&#226;metro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Par&#226;metro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ensino Fundamental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ensino M&#233;dio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sintom&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Psicossocial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tempo do diagn&#243;stico</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0035"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">p&#8208;valor&#44; dados n&#227;o ajustados&#46;</p>"
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              "identificador" => "tblfn0040"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">rho de Spearman&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Mediana &#40;p25&#8722;p75&#41;&#46;</p>"
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          "pt" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Desempenho de subgrupos para o SK&#8208;17 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>217&#41;</p>"
        ]
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        0 => array:2 [
          "identificador" => "bibs0015"
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The World Health Organization instrument to evaluate quality of life &#40;WHOQOL&#8208;100&#41;&#58; characteristics and perspectives"
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                        0 => array:2 [
                          "etal" => false
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                        "tituloSerie" => "Cien Saude Colet&#46;"
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Investigação
Validação do instrumento de avaliação da qualidade de vida Skindex‐17 para uma população brasileira
Marilia Formentini Scotton Jorge
Corresponding author
marilia_scotton@yahoo.com.br

Autor para correspondência.
, Ioana Bittencourt Mourão, Camila Fernandes Pollo, Ticiane Dionízio de Sousa, Silmara Meneguin, Hélio Amante Miot
Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Qualidade de vida foi definida pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41;&#44; em 2000&#44; como a percep&#231;&#227;o do indiv&#237;duo acerca de sua posi&#231;&#227;o na vida no contexto da cultura e do sistema de valores nos quais ele vive e em rela&#231;&#227;o aos seus objetivos&#44; expectativas&#44; padr&#245;es e preocupa&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Os conceitos de qualidade de vida relacionada &#224; sa&#250;de &#40;QVRS&#41; podem englobar duas esferas&#58; gen&#233;rico&#44; bem contemplado pela defini&#231;&#227;o da OMS&#59; e QVRS&#44; que engloba dois par&#226;metros fundamentais &#8211; a subjetividade e a multidimensionalidade&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> A incorpora&#231;&#227;o do estudo de QVRS na &#225;rea da sa&#250;de &#233; algo recente e acompanha a evolu&#231;&#227;o do entendimento do processo sa&#250;de&#8208;doen&#231;a ao longo dos anos&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As doen&#231;as cut&#226;neas conferem&#44; em geral&#44; importante impacto na QVRS&#44; visto que as les&#245;es se localizam&#44; majoritariamente&#44; em &#225;reas expostas ao olhar do outro&#44; podendo afetar aspectos sociais&#44; afetivos e emocionais do indiv&#237;duo&#46; Na Dermatologia&#44; a defini&#231;&#227;o dos desfechos&#8208;alvos a serem alcan&#231;ados com o tratamento &#233; delicada&#44; visto que a maior parte das doen&#231;as da especialidade n&#227;o oferece risco de morte &#8211; ou seja&#44; o desfecho esperado n&#227;o &#233; a sobreviv&#234;ncia&#46; Isso ressalta a import&#226;ncia da avalia&#231;&#227;o da QVRS por meio de instrumentos adequados como par&#226;metro para seguimento e monitoramento&#44; al&#233;m da defini&#231;&#227;o de decis&#245;es e metas terap&#234;uticas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A mensura&#231;&#227;o de QVRS n&#227;o &#233; uma medida direta &#8211; portanto&#44; &#233; necess&#225;rio lan&#231;ar m&#227;o de instrumentos fundamentados na teoria psicom&#233;trica para possibilitar tal avalia&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a> Os question&#225;rios s&#227;o os instrumentos mais utilizados em psicometria&#44; e constituem as ferramentas pelas quais se pode avaliar o impacto da doen&#231;a na QVRS&#46; Nesse &#237;nterim&#44; os question&#225;rios de QVRS devem obedecer aos princ&#237;pios b&#225;sicos da psicometria&#58; viabilidade&#44; confiabilidade&#44; sensibilidade &#224; mudan&#231;a &#40;responsividade&#41; e estabilidade temporal&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A pluralidade das doen&#231;as dermatol&#243;gicas inflige impactos em diferentes dimens&#245;es da QVRS&#46; Em 1996&#44; Chren et al&#46; desenvolveram a primeira vers&#227;o do Skindex &#40;61 itens&#41; &#8722; instrumento multidimensional &#40;oito dimens&#245;es&#41; para avalia&#231;&#227;o da QVRS entre portadores de doen&#231;as dermatol&#243;gicas&#46; Esse question&#225;rio foi desenvolvido para englobar alguns aspectos psicol&#243;gicos e psicossociais ainda n&#227;o abordados especificamente por outros instrumentos de medida de QVRS em Dermatologia&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> A vers&#227;o reduzida do instrumento foi publicada no ano seguinte&#44; e denominado Skindex&#8208;29&#44; com 29 itens&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">No ano 2000&#44; foi publicada uma terceira vers&#227;o do instrumento &#8211; o Skindex&#8208;16&#46; Para seu desenvolvimento&#44; ap&#243;s an&#225;lise do uso das vers&#245;es anteriores&#44; concluiu&#8208;se que os efeitos das dermatoses na qualidade de vida poderiam ser divididos em tr&#234;s dom&#237;nios&#58; sintomas cut&#226;neos&#44; efeitos nas emo&#231;&#245;es e efeito nas fun&#231;&#245;es sociais e f&#237;sicas&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Em 2006&#44; foi realizada uma nova redu&#231;&#227;o a partir do Skindex&#8208;29&#44; chamada Skindex&#8208;17 &#40;SK&#8208;17&#41;&#44; utilizando&#8208;se um modelo estat&#237;stico baseado na teoria de resposta ao item &#40;an&#225;lise de Rasch&#41;&#44; diferentemente da redu&#231;&#227;o realizada com o Skindex&#8208;16&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Foram implementadas algumas modifica&#231;&#245;es para melhor adequa&#231;&#227;o&#58; em vez de cinco escores&#44; as respostas dos itens passaram a contar com tr&#234;s escores&#46; Os itens foram agrupados em duas subescalas&#44; uma delas sobre emo&#231;&#227;o e funcionamento &#40;psicossocial&#41; e outra sobre sintomas&#46; Desse modo&#44; obteve&#8208;se um instrumento com duas dimens&#245;es&#44; totalizando 17 itens&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Dos 12 itens que permaneceram semelhantes entre o Skindex&#8208;29 e o Skindex&#8208;16&#44; nove deles tamb&#233;m est&#227;o presentes no SK&#8208;17&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Como o SK&#8208;17 &#233; uma redu&#231;&#227;o do Skindex&#8208;29&#44; que j&#225; fora traduzido para o portugu&#234;s do Brasil&#44; os itens j&#225; apresentam tradu&#231;&#227;o publicada&#59; entretanto&#44; tal vers&#227;o n&#227;o foi ainda validada nessa popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> O objetivo deste estudo foi validar a vers&#227;o do instrumento SK&#8208;17&#44; assim como avaliar suas propriedades psicom&#233;tricas entre pacientes com doen&#231;as dermatol&#243;gicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudo metodol&#243;gico&#44; transversal e prospectivo&#44; realizado com pacientes atendidos no ambulat&#243;rio de dermatologia e na enfermaria de dermatologia vinculados ao servi&#231;o de Dermatologia da FMB&#8208;Unesp &#40;Botucatu&#44; SP&#41;&#44; ap&#243;s aprova&#231;&#227;o pelo Comit&#234; de &#201;tica em Pesquisa da Institui&#231;&#227;o &#40;parecer n&#176; 2&#46;367&#46;912&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos pacientes atendidos no ambulat&#243;rio de dermatologia do servi&#231;o de Dermatologia da FMB&#8208;Unesp &#40;Botucatu&#44; SP&#41;&#44; com idade &#8805; 18 anos&#44; fluentes em portugu&#234;s do Brasil e que aceitaram a participa&#231;&#227;o mediante assinatura do Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Houve autoriza&#231;&#227;o para utiliza&#231;&#227;o dos instrumentos de avalia&#231;&#227;o pela autora &#8722; Dr&#46; Mary&#8208;Margareth Chren&#46; A autoriza&#231;&#227;o para uso em pesquisas acad&#234;micas &#233; realizada por interm&#233;dio da empresa <span class="elsevierStyleItalic">Mapi Research Institute</span>&#44; respons&#225;vel pela valida&#231;&#227;o de tradu&#231;&#227;o de instrumentos de sa&#250;de que alberga os direitos autorias das diversas vers&#245;es do Skindex &#40;<a href="https://mapi-trust.org/our-resources/questionnaires-distributed-by-the-mapi-research-trust/">https&#58;&#47;&#47;mapi&#8208;trust&#46;org&#47;our&#8208;resources&#47;questionnaires&#8208;distributed&#8208;by&#8208;the&#8208;mapi&#8208;research&#8208;trust&#47;</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os pacientes foram entrevistados durante consulta m&#233;dica&#44; ap&#243;s assinatura do TCLE&#44; entre dezembro de 2017 e setembro de 2019&#46; Foram utilizados os question&#225;rios SK&#8208;17 e DLQI&#59; para responsividade e reteste&#44; os question&#225;rios foram reaplicados em um intervalo de 7 a 30 dias&#46; Foram avaliadas tamb&#233;m vari&#225;veis cl&#237;nicas &#40;diagn&#243;stico&#44; tempo de doen&#231;a&#44; tipo de doen&#231;a&#41;&#44; epidemiol&#243;gicas e sociodemogr&#225;ficas &#40;idade&#44; escolaridade&#44; sexo&#44; fototipo e renda familiar&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O coeficiente de validade de conte&#250;do do SK&#8208;17 foi calculado a partir da avalia&#231;&#227;o de cinco ju&#237;zes &#8722; m&#233;dicos dermatologistas&#44; psic&#243;loga e enfermeiras&#46; Os ju&#237;zes pontuaram um escore de 1 a 5 para cada item quanto &#224; pertin&#234;ncia da avalia&#231;&#227;o do tra&#231;o latente&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Da mesma maneira&#44; foi realizada avalia&#231;&#227;o quanto &#224; pertin&#234;ncia da avalia&#231;&#227;o do conte&#250;do do construto para cada item por um grupo de cinco participantes do estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Levando&#8208;se em conta as avalia&#231;&#245;es realizadas&#44; foram considerados pertinentes os itens que alcan&#231;aram coeficientes maiores que 0&#44;7&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A consist&#234;ncia interna de cada dimens&#227;o dos instrumentos &#40;SK&#8208;17 e DLQI&#41; foi avaliada pelo coeficiente alfa de Cronbach&#44; considerando 95&#37; IC&#44; cujo intervalo inferior deve superar 0&#44;8 em construtos de adequada consist&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Para o SK&#8208;17&#44; foi ainda realizada a an&#225;lise do coeficiente de alfa de Cronbach se cada item fosse exclu&#237;do&#44; visando observar se haveria melhora importante &#40;&#62; 0&#44;1&#41; da consist&#234;ncia interna do instrumento&#46; A consist&#234;ncia interna multidimensional para o SK&#8208;17 foi estimada pelo &#237;ndice de confiabilidade composta de Raykov&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> A correla&#231;&#227;o dos itens entre si &#40;inter&#8208;item&#41; e com o escore total &#40;item&#8208;total&#41; foi calculada pelo coeficiente rho de Spearman&#44; considerando forte correla&#231;&#227;o quando rho<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A validade concorrente foi avaliada a partir da correla&#231;&#227;o entre os escores dos question&#225;rios e SK&#8208;17 e DLQI&#8208;BRA&#44; a partir dos coeficientes de correla&#231;&#227;o de Spearman &#40;rho&#41;&#44; devendo ser maior que 0&#44;7 &#40;forte correla&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">O instrumento DLQI&#8208;BRA foi disponibilizado pelo autor para uso livre em pesquisas acad&#234;micas&#44; conforme condi&#231;&#245;es de uso no site que cont&#233;m os direitos autorais do mesmo &#40;<a href="http://sites.cardiff.ac.uk/">http&#58;&#47;&#47;sites&#46;cardiff&#46;ac&#46;uk&#47;</a> dermatology&#47;quality&#8208;of&#8208;life&#47;dermatology&#8208;quality&#8208;of&#8208;life&#8208;index&#8208;dlqi&#47;dlqi&#8208;instructions&#8208;for&#8208;use&#8208;and&#8208;scoring&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A estrutura bidimensional do SK&#8208;17 foi avaliada pela an&#225;lise fatorial confirmat&#243;ria&#46; O ajuste do modelo foi realizado pelo teste do Qui&#8208;Quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#44; raiz da m&#233;dia dos quadrados dos erros de aproxima&#231;&#227;o &#40;RMSEA&#41;&#44; &#237;ndice de ajuste comparativo &#40;CFI&#41;&#44; raiz quadrada m&#233;dia residual padronizada &#40;SRMR&#41;&#46; Objetiva&#8208;se atingir como crit&#233;rios de ajuste&#58; &#967;<span class="elsevierStyleSup">2</span> valor de p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#59; RMSEA &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;8&#59; CFI &#8805; 0&#44;9&#59; SMR &#8804; 0&#44;08&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A estabilidade temporal &#40;teste&#8208;reteste&#41; do SK&#8208;17 foi avaliada em um subgrupo de 16 sujeitos&#44; selecionados por conveni&#234;ncia &#40;principalmente aqueles que teriam retornos breves ou que se encontravam em regime de interna&#231;&#227;o&#41; num intervalo de 7&#8208;30 dias entre as entrevistas&#44; desde que n&#227;o houvesse altera&#231;&#227;o cl&#237;nica da doen&#231;a&#46; A reprodutibilidade teste&#8208;reteste foi analisada por meio do &#237;ndice de correla&#231;&#227;o intraclasse &#40;CCI&#41; para concord&#226;ncia completa&#46; Foi utilizado intervalo de confian&#231;a de 95&#37; &#40;95&#37; IC&#41;&#44; considerando satisfat&#243;rio se o intervalo inferior for<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Para an&#225;lise de responsividade&#44; foi avaliado o escore do SK&#8208;17 em um subgrupo de 16 pacientes que apresentaram altera&#231;&#227;o cl&#237;nica de sua dermatose&#44; dentro de um intervalo de 7&#8208;30 dias entre as entrevistas&#46; A responsividade dos escores foi testada pelo teste Wilcoxon&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Foi avaliada a frequ&#234;ncia de respostas para cada item do SK&#8208;17 e constru&#237;do diagrama de frequ&#234;ncias&#46; Os efeitos &#8220;teto&#8221; e &#8220;ch&#227;o&#8221; foram considerados quando a frequ&#234;ncia de respostas foi<span class="elsevierStyleHsp" style=""></span>&#62; 50&#37; para alguns o escores m&#225;ximo e m&#237;nimo&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Os sujeitos tamb&#233;m foram classificados em tr&#234;s grupos&#44; segundo a doen&#231;a cut&#226;nea&#58; dermatoses com impacto psicossocial mais evidente &#40;p&#46;ex&#46;&#44; vitiligo&#44; melasma&#44; alopecia&#41;&#44; doen&#231;as predominantemente sintom&#225;ticas &#40;p&#46;ex&#46;&#44; &#250;lcera venosa&#44; urtic&#225;ria&#41; ou impacto sintom&#225;tico e psicossocial &#40;p&#46;ex&#46;&#44; psor&#237;ase&#44; hidradenite supurativa&#41;&#44; por dermatologista titulado&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O comportamento do escore do SK&#8208;17 foi analisado dentro de subgrupos &#40;idade&#44; sexo&#44; escolaridade&#44; tempo do diagn&#243;stico e tipo de doen&#231;a dos sujeitos&#41; por meio de testes de correla&#231;&#227;o de Spearman &#40;idade e tempo de doen&#231;a&#41;&#44; Jonckheere&#8208;Terpstra &#40;escolaridade&#41;&#44; Mann&#8208;Whitney &#40;sexo&#41; e Kruskal&#8208;Wallis &#40;tipo de doen&#231;a&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Foram avaliados itens de factibilidade do question&#225;rio&#44; como tempo de execu&#231;&#227;o&#44; taxa de recusa em responder e entendimento dos termos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dados foram tabulados em planilhas do MS Excel 2010 e analisados pelos softwares IBM SPSS 25 e JASP 0&#46;11&#46; Vari&#225;veis quantitativas foram representadas pela m&#233;dia e desvio padr&#227;o ou mediana e quartis &#40;p25&#8208;p75&#41;&#44; quando a normalidade n&#227;o foi evidenciada pelo teste de Shapiro&#8208;Wilk&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Foram considerados significativos os achados &#40;diferen&#231;as ou associa&#231;&#245;es&#41; quando valor&#8208;p dos testes resultou menor do que 5&#37; &#40;valor&#8208;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Como testes de valida&#231;&#227;o de question&#225;rios demandam 5 a 10 sujeitos para cada item&#44; a amostragem necess&#225;ria para a valida&#231;&#227;o do SK&#8208;17&#44; de acordo com a teoria cl&#225;ssica dos testes&#44; foi estimada entre 85 e 170 pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0130" class="elsevierStylePara elsevierViewall">Foram avaliados 217 pacientes que totalizaram 249 respostas aos question&#225;rios&#46; As caracter&#237;sticas cl&#237;nico&#8208;demogr&#225;ficas est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Houve predom&#237;nio de mulheres&#44; idade adulta&#44; fototipos intermedi&#225;rios e pacientes casados&#46; Os grupos de doen&#231;as cut&#226;neas inclu&#237;das no estudo est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">O escore total das dimens&#245;es dos instrumentos SK&#8208;17&#44; assim como o escore total do DLQI&#44; est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; Os pacientes mostraram impacto majoritariamente leve a moderado na qualidade de vida pelos diferentes instrumentos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia de cada op&#231;&#227;o de resposta para cada item dos instrumentos foi estudada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; a fim de observarmos a presen&#231;a de &#8220;efeito teto&#8221; e &#8220;efeito ch&#227;o&#8221;&#46; O SK&#8208;17 apresentou &#8220;efeito ch&#227;o&#8221; para 13 &#40;76&#37;&#41; itens&#44; sobretudo aqueles presentes na dimens&#227;o &#8220;psicossocial&#8221; &#40;91&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o do conte&#250;do do question&#225;rio SK&#8208;17 foi realizada por cinco profissionais &#40;dermatologistas&#44; enfermeiras e psic&#243;loga&#41; sobre a pertin&#234;ncia de cada item para verifica&#231;&#227;o do tra&#231;o latente&#59; todos os itens apresentaram coeficiente<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7&#46; A valida&#231;&#227;o cultural foi observada pela mesma avalia&#231;&#227;o de pertin&#234;ncia com grupo de cinco pacientes&#44; resultando em coeficientes m&#233;dios<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7 &#40;dados n&#227;o mostrados&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A an&#225;lise da consist&#234;ncia interna foi realizada para cada dimens&#227;o do SK&#8208;17&#8208; sintomas e psicossocial&#46; O alfa de Cronbach revelou &#237;ndices<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;8 para as dimens&#245;es do SK&#8208;17 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46; O &#237;ndice de confiabilidade composta &#40;Raykov&#41; do SK&#8208;17 resultou em 0&#44;94&#46; Foi realizada tamb&#233;m avalia&#231;&#227;o do coeficiente alfa de Cronbach para cada dimens&#227;o do SK&#8208;17 caso o item fosse exclu&#237;do&#44; o que n&#227;o demonstrou varia&#231;&#227;o importante &#40;&#60; 0&#44;1&#41; da consist&#234;ncia em rela&#231;&#227;o &#224; estrutura original&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A correla&#231;&#227;o inter&#8208;item e item&#8208;total podem ser observadas na <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">As correla&#231;&#245;es entres os instrumentos mostraram fortes correla&#231;&#245;es &#40;rho&#41; tanto entre a dimens&#227;o de sintomas do SK&#8208;17 &#40;0&#44;69&#41; como a dimens&#227;o psicossocial &#40;0&#44;75&#41; com o DLQI &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Foi realizada an&#225;lise fatorial confirmat&#243;ria para avalia&#231;&#227;o da dimensionalidade do SK&#8208;17&#46; Demonstrou&#8208;se adequa&#231;&#227;o &#224; dimensionalidade proposta pelo instrumento&#44; por meio da concord&#226;ncia com todos os valores dos crit&#233;rios de ajuste &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">A estabilidade temporal do SK&#8208;17 foi estudada a partir da reaplica&#231;&#227;o dos question&#225;rios para um grupo de 16 pacientes que n&#227;o tiveram varia&#231;&#227;o cl&#237;nica de sua dermatose&#44; durante per&#237;odo que variou de 7 a 30 dias&#46; Os resultados obtidos mostraram adequada reprodutibilidade teste&#8208;reteste para ambos os instrumentos e concord&#226;ncia pela correla&#231;&#227;o intraclasse &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabela 7</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">A responsividade dos instrumentos foi estudada tamb&#233;m pela reaplica&#231;&#227;o dos question&#225;rios a outro subgrupo de 16 pacientes que apresentaram mudan&#231;a cl&#237;nica dermatol&#243;gica&#46; A an&#225;lise revelou piora ou melhora unidirecional para as dimens&#245;es do SK&#8208;17 &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabela 7</a>&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">A compara&#231;&#227;o dos escores das duas dimens&#245;es do SK&#8208;17 com as vari&#225;veis estudadas &#40;idade&#44; sexo&#44; escolaridade&#44; tipo de doen&#231;a e tempo do diagn&#243;stico&#41; est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0040">tabela 8</a>&#46; Houve diferen&#231;a dos escores quanto ao sexo dentro da dimens&#227;o psicossocial&#44; tamb&#233;m para o tipo de doen&#231;a e para escolaridade dentro da dimens&#227;o de sintomas&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">A factibilidade do SK&#8208;17 foi avaliada segundo o tempo de execu&#231;&#227;o do question&#225;rio e dificuldades durante a realiza&#231;&#227;o do mesmo&#46; Foi realizada aferi&#231;&#227;o do tempo de resposta para um grupo de 17 pacientes&#44; com varia&#231;&#227;o de 58 segundos a 4 minutos &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 min 48s&#44; desvio&#8208;padr&#227;o<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42s&#41;&#46; N&#227;o houve recusa &#224; resposta&#44; assim como respostas em branco&#46; N&#227;o foram percebidas grandes dificuldades para interpreta&#231;&#227;o e resposta dos itens do SK&#8208;17&#44; mesmo em pacientes com baixa escolaridade&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0190" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o psicom&#233;trica do SK&#8208;17 torna poss&#237;vel afirmar que o instrumento &#233; fact&#237;vel&#44; confi&#225;vel e v&#225;lido para mensurar o impacto na QVRS de pacientes brasileiros com doen&#231;as de pele&#46; Nesta casu&#237;stica foram inclu&#237;dos pacientes portadores de dermatoses que est&#227;o entre as doen&#231;as cut&#226;neas mais prevalentes no Brasil&#44; segundo pesquisa recente realizada pela Sociedade Brasileira de Dermatologia&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o do impacto de doen&#231;as dermatol&#243;gicas pode ser feita por meio de instrumentos&#44; divididos em par&#226;metros cl&#237;nicos e psicom&#233;tricos&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Como muitas doen&#231;as cr&#244;nicas dermatol&#243;gicas t&#234;m como caracter&#237;stica inerente o impacto predominante na QVRS e n&#227;o a sobreviv&#234;ncia&#44; o estudo e o aperfei&#231;oamento de instrumentos de QVRS s&#227;o fundamentais para a pr&#225;tica cl&#237;nica e ensaios terap&#234;uticos&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A pele &#233; o &#243;rg&#227;o mais importante para a forma&#231;&#227;o da autoimagem&#46; A intera&#231;&#227;o com o ambiente externo e suas altera&#231;&#245;es podem causar influ&#234;ncia significativa nas atividades di&#225;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> A presen&#231;a de dermatoses mostrou&#8208;se relacionada com o aumento do risco de suic&#237;dio em alguns estudos&#44; <a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> e pode causar maior preocupa&#231;&#227;o nos indiv&#237;duos do que doen&#231;as como hipertens&#227;o e diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> A popula&#231;&#227;o estudada foi composta por adultos jovens&#44; faixa et&#225;ria social e profissionalmente ativa&#44; ou seja&#44; com maior intera&#231;&#227;o interpessoal presumida&#46; O predom&#237;nio de mulheres &#233; coincidente com a maior parte dos estudos em Dermatologia da literatura&#44; visto que as mulheres tendem a procurar mais precoce e frequentemente servi&#231;os de sa&#250;de&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da QVRS engloba diversas esferas da vida do portador&#44; o que torna compreens&#237;vel a estrutura multidimensional dos instrumentos&#46; Neste estudo&#44; foi confirmada a estrutura bidimensional do SK&#8208;17 &#40;sintomas e psicossocial&#41;&#46; A an&#225;lise estat&#237;stica mostrou adequa&#231;&#227;o de todos os &#237;ndices de ajuste estudados &#40;Qui&#8208;Quadrado&#44; RMSEA&#44; SRMR&#44; CFI&#41; para dimensionalidade descritas pelos autores dos question&#225;rio original&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">A valida&#231;&#227;o do SK&#8208;17 foi evidenciada pela consist&#234;ncia interna&#44; validade concorrente&#44; estabilidade temporal&#44; responsividade&#44; factibilidade&#44; validade de conte&#250;do e adequa&#231;&#227;o cultural&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A valida&#231;&#227;o concorrente realizada pela correla&#231;&#227;o do SK&#8208;17 com o DLQI&#8208;BRA mostrou &#237;ndices de correla&#231;&#227;o adequados&#44; sugerindo que avaliam o mesmo tra&#231;o latente&#46; DLQI &#233; o instrumento de avalia&#231;&#227;o de QVRS em dermatologia mais utilizado mundialmente&#59; ele se correlacionou fortemente &#40;&#62; 0&#44;7&#41; com ambas as dimens&#245;es do SK&#8208;17&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">A consist&#234;ncia interna do question&#225;rio SK&#8208;17 demonstrou &#237;ndice adequado de confiabilidade para suas duas dimens&#245;es&#44; sugerindo precis&#227;o nas medidas de seus escores nessa popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> O estudo original do SK&#8208;17<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> apresentou &#237;ndices de alfa de Cronbach<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;7 para suas duas dimens&#245;es&#44; e realizou a an&#225;lise do coeficiente para cada item&#44; sem melhora do desempenho do instrumento com exclus&#227;o de qualquer item&#44; o que tamb&#233;m foi observado em nosso trabalho&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">A estabilidade temporal do SK&#8208;17 mostrou escores concordantes para um mesmo paciente que n&#227;o teve altera&#231;&#227;o de sua dermatose&#44; o que nos permite dizer que o instrumento &#233; reprodut&#237;vel na pr&#225;tica cl&#237;nica&#46; Da mesma maneira&#44; os indicadores de responsividade mostraram resultados favor&#225;veis&#44; refor&#231;ando sua sensibilidade &#224; mudan&#231;a na pr&#225;tica cl&#237;nica&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">A an&#225;lise de &#8220;efeito teto&#8221; e &#8220;efeito ch&#227;o&#8221; dos instrumentos nem sempre &#233; descrita nos estudos de valida&#231;&#227;o&#46; Observamos expressivo n&#250;mero de itens com efeito ch&#227;o no SK&#8208;17&#46; Os escores de todos os instrumentos avaliados mostram que a popula&#231;&#227;o do estudo foi composta de portadores de dermatoses com comprometimento leve a moderado da QV&#44; o que pode contribuir para as respostas nulas&#46; Como o comprometimento usual dos escores QVRS em dermatologia &#233; leve e moderado&#44; esse fen&#244;meno de efeito &#8220;ch&#227;o&#8221; tamb&#233;m foi descrito em outros estudos envolvendo o DLQI&#8208;BRA&#44; podendo n&#227;o ser uma caracter&#237;stica do instrumento&#44; mas da popula&#231;&#227;o estudada&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;27</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">A factibilidade do uso do SK&#8208;17 foi evidenciada pelo curto tempo dispendido para responder o question&#225;rio&#44; assim como entendimento adequado das quest&#245;es&#46; Durante a valida&#231;&#227;o do Skindex&#8208;16 no Brasil&#44; observou&#8208;se que o tempo de resposta do question&#225;rio tamb&#233;m foi curto e adequado&#44; variando de 2 a 3 minutos &#40;m&#233;dia&#58; 2 min 41s&#59; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51s&#41;&#46; Al&#233;m disso&#44; foi ainda descrito &#237;ndice elevado de n&#227;o reposta ao item 5 &#40;persist&#234;ncia&#47;recorr&#234;ncia&#41;&#59; tal dificuldade n&#227;o foi observada em nosso estudo&#44; tampouco aus&#234;ncia de resposta aos itens&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Realizamos a an&#225;lise de subgrupos de acordo com sexo&#44; idade&#44; escolaridade&#44; tempo de diagn&#243;stico e tipo de doen&#231;a&#46; Foi identificada diferen&#231;a relevante para sexo dentro do dom&#237;nio psicossocial do SK&#8208;17 e tipo de doen&#231;a e escolaridade para o dom&#237;nio de sintomas do SK&#8208;17&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Nosso estudo apresentou popula&#231;&#227;o majoritariamente feminina&#44; que apresenta maiores &#237;ndices de ansiedade e preocupa&#231;&#227;o com a autoimagem&#44; o que poderia explicar a diferen&#231;a observada&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Esse comportamento deve alertar para a influ&#234;ncia do g&#234;nero quando da descri&#231;&#227;o do impacto de QVRS em doen&#231;as dermatol&#243;gicas&#44; especialmente&#44; quando escores de QVRS subsidiarem decis&#245;es terap&#234;uticas&#44; como ocorre em alguns fluxogramas de tratamento da psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">O comportamento diferente entre subgrupos de tipos de doen&#231;a na dimens&#227;o de sintomas pode ser explicado pela pr&#243;pria natureza sintom&#225;tica ou n&#227;o das doen&#231;as estudadas&#46; No artigo original do SK&#8208;17&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> descreve&#8208;se que a escala &#8220;psicossocial&#8221; apresentou comportamento semelhante entre diferentes doen&#231;as e gravidades&#44; tornando poss&#237;vel a compara&#231;&#227;o entre dermatoses distintas&#44; o que n&#227;o ocorreu com a escala &#8220;sintomas&#8221;&#46; Em nossa casu&#237;stica&#44; a subescala &#8220;sintomas&#8221; apresentou funcionamento diferente de acordo com a doen&#231;a estudada&#44; o que orienta compara&#231;&#245;es apenas dentro de um mesmo contexto cl&#237;nico&#44; preferencialmente diante do mesmo tipo de doen&#231;a&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Quando analisado o desempenho da subescala sintomas quanto &#224; escolaridade&#44; evidenciaram&#8208;se maiores escores ligados aos ensinos fundamental e m&#233;dio&#46; Tal associa&#231;&#227;o pode se dar pela procura muitas vezes mais tardia &#40;ou menor acesso ao sistema de sa&#250;de&#41; entre paciente com menor escolaridade&#44; resultando em doen&#231;as mais sintom&#225;ticas&#46; Estudos com desenhos pr&#243;prios para avaliar esse tipo de desfecho devem ser conduzidos posteriormente&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Cabe salientar algumas das limita&#231;&#245;es apresentadas por nosso estudo&#58; pesquisa monoc&#234;ntrica&#44; inclus&#227;o apenas de pacientes provenientes do Sistema &#218;nico de Sa&#250;de e amostra com alguma assimetria quanto ao tipo de doen&#231;a e sexo&#46; Entretanto&#44; essas limita&#231;&#245;es n&#227;o desabonam os resultados voltados ao objetivo de valida&#231;&#227;o do instrumento para a popula&#231;&#227;o brasileira&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">A an&#225;lise comparativa do SK&#8208;17 com outros instrumentos de avalia&#231;&#227;o da QV&#44; como o DLQI&#8208;BRA e o Skindex&#8208;16&#44; possibilitar&#227;o avaliar criteriosamente a informatividade e o desempenho psicom&#233;trico desses instrumentos na Dermatologia&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0270" class="elsevierStylePara elsevierViewall">Skindex&#8208;17 mostrou&#8208;se um instrumento v&#225;lido e consistente para avalia&#231;&#227;o da QVRS entre portadores de doen&#231;as dermatol&#243;gicas no Brasil&#46; Foi confirmada sua estrutura bidimensional&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0275" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0280" class="elsevierStylePara elsevierViewall">Marilia Formentini Scotton Jorge&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Ioana Bittencourt Mour&#227;o&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Camila Fernandes Pollo&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Ticiane Dion&#237;zio de Sousa&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Silmara Meneguin&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0310" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Qualidade de vida relacionada &#224; sa&#250;de avalia como as doen&#231;as afetam o cotidiano do indiv&#237;duo&#46; H&#225; diversos instrumentos gen&#233;ricos para essa avalia&#231;&#227;o em Dermatologia&#46; O Skindex foi descrito em 1996 e &#233; um instrumento multidimensional&#44; que engloba alguns aspectos psicol&#243;gicos e sociais ainda n&#227;o abordados por outros question&#225;rios&#46; Dentre as suas vers&#245;es &#40;Skindex&#8208;29&#44; 16 e 17&#41;&#44; o Skindex&#8208;17 n&#227;o foi validado no Brasil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Valida&#231;&#227;o do Skindex&#8208;17 entre brasileiros portadores de doen&#231;as dermatol&#243;gicas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo metodol&#243;gico transversal e prospectivo com 217 pacientes atendidos no Ambulat&#243;rio do Servi&#231;o de Dermatologia da Faculdade de Medicina de Botucatu&#44; Universidade Estadual Paulista &#40;Botucatu&#44; SP&#44; Brasil&#41; entre dezembro&#47;2017 a setembro&#47;2019&#46; Foram avaliados a validade de conte&#250;do&#44; o tempo de preenchimento&#44; a consist&#234;ncia interna&#44; a estrutura dimensional&#44; a validade concorrente &#40;DLQI&#41;&#44; a estabilidade temporal e a responsividade&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A casu&#237;stica foi composta por 71&#37; de mulheres&#44; com idade m&#233;dia &#40;DP&#41; de 45 &#40;16&#41; anos&#59; fototipos II&#8722;IV representaram 95&#37; dos casos&#46; O coeficiente alfa de Cronbach resultou 0&#44;82 e 0&#44;93 para as dimens&#245;es sintomas e psicossocial&#44; respectivamente&#46; Houve alta correla&#231;&#227;o com o escore DLQI&#58; rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;69 &#40;sintomas&#41; e rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75 &#40;psicossocial&#41;&#46; Foi confirmada a estrutura bidimensional do instrumento por meio de an&#225;lise fatorial confirmat&#243;ria&#46; Foi verificada estabilidade temporal &#40;ICC<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;9&#41; e responsividade dos escores &#40;p &#8804; 0&#44;02&#41;&#46; O instrumento mostrou&#8208;se fact&#237;vel na pr&#225;tica cl&#237;nica pela valida&#231;&#227;o de conte&#250;do realizada por profissionais e pacientes&#44; assim como pelo baixo tempo dispendido para resposta &#40;&#60; 5 minutos&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudo monoc&#234;ntrico&#44; com pacientes exclusivamente do sistema p&#250;blico de sa&#250;de&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Skindex&#8208;17 mostrou&#8208;se um instrumento v&#225;lido e consistente para avalia&#231;&#227;o da qualidade de vida entre portadores de doen&#231;as dermatol&#243;gicas no Brasil&#46; Sua estrutura bidimensional foi confirmada&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado civil</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Solteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Separado&#47;vi&#250;vo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escolaridade</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Renda familiar</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At&#233; 1 mil reais&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classifica&#231;&#227;o da doen&#231;a</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sintom&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Psicossocial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tempo de doen&#231;a &#40;anos&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#8722;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">&#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Psor&#237;ase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melasma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as eczematosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermatoses infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a bolhosas autoimunes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alopecias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colagenoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#218;lceras cr&#244;nicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ros&#225;cea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fotodano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farmacodermias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumores benignos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitiligo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidradenite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumores malignos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Granuloma anular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pitir&#237;ase r&#243;sea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Queloide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lista de agrupamentos de diagn&#243;sticos amostrados dos pacientes n &#40;&#37;&#41;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Escore&#44; mediana &#40;p25&#8208;p75&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#8722;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">SK&#8208;17</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SK&#8208;17 S&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#8722;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;1&#8722;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;84 &#40;0&#44;80&#8722;0&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SK&#8208;17 P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2518735.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Coeficiente alfa de Cronbach para as dimens&#245;es do SK&#8208;17 e DLQI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>249&#41;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabela 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span>&#44; quest&#245;es dimens&#227;o psicossocial&#59; <span class="elsevierStyleItalic">S</span>&#44; quest&#245;es dimens&#227;o sintomas&#59; <span class="elsevierStyleItalic">Total P</span>&#44; escore total dimens&#227;o psicossocial&#59; <span class="elsevierStyleItalic">Total S</span>&#44; escore total dimens&#227;o sintomas&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;1&#8722;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Classifica&#231;&#227;o da doen&#231;a</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;01</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sintom&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;5&#8722;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;1&#8722;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Psicossocial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;1&#8722;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;1&#8722;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;3&#8722;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#8722;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tempo do diagn&#243;stico</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Desempenho de subgrupos para o SK&#8208;17 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>217&#41;</p>"
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        0 => array:2 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The World Health Organization instrument to evaluate quality of life &#40;WHOQOL&#8208;100&#41;&#58; characteristics and perspectives"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;P&#46; Fleck"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cien Saude Colet&#46;"
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                        "paginaFinal" => "38"
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                          "etal" => false
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                      "Revista" => array:5 [
                        "tituloSerie" => "da C&#46; Quality of life and health&#58; conceptual and methodological issues&#46; Cad Saude Publica"
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                        "volumen" => "20"
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                    0 => array:2 [
                      "titulo" => "The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments&#58; an international Delphi study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;B&#46; Mokkink"
                            1 => "C&#46;B&#46; Terwee"
                            2 => "D&#46;L&#46; Patrick"
                            3 => "J&#46; Alonso"
                            4 => "P&#46;W&#46; Stratford"
                            5 => "D&#46;L&#46; Knol"
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                        "tituloSerie" => "Qual Life Res&#46;"
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                      "titulo" => "Skindex&#44; a quality&#8208;of&#8208;life measure for patients with skin disease&#58; reliability&#44; validity&#44; and responsiveness"
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                        "volumen" => "107"
                        "paginaInicial" => "707"
                        "paginaFinal" => "713"
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                      "titulo" => "Improved discriminative and evaluative capability of a refined version of Skindex&#44; a quality&#8208;of&#8208;life instrument for patients with skin diseases"
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                        0 => array:2 [
                          "etal" => false
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                        "tituloSerie" => "J Cutan Med Surg&#46;"
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                        "volumen" => "5"
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                      "titulo" => "Testing and Reducing Skindex&#8208;29 Using Rasch Analysis&#58; Skindex&#8208;17"
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                            3 => "D&#46;D&#46; Abeni"
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                        0 => array:2 [
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Article information
ISSN: 26662752
Original language: Portuguese
DOI:10.1016/j.abdp.2020.03.011
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