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few questionnaires consider the patient&#39;s own perception of the severity of their symptoms or response to treatment&#46; Patient-reported outcomes &#40;PRO&#41; have been recognized as key measures for assessing the treatment of chronic diseases over the last decade&#46; Although there are other published scales to evaluate the symptoms of EoE&#44; only one validated tool that takes into account the symptoms reported by the patients or their parents&#47;guardians for the assessment of pediatric EoE was retrieved in the literature&#44; the Pediatric Eosinophilic Esophagitis Symptom Score &#40;PEESS version 2&#46;0&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">PEESS v2&#46;0&#8482; was developed in the United States&#44; based on focal and cognitive interviews&#44; using the perceptions of patients and their parents&#44; with the frequency and severity of EoE-related symptoms as the focus for the questions&#46; Based on the responses and descriptions of patients with EoE and their relatives&#44; as well as on the FDA guidelines&#44; PEESS v2&#46;0 was the first validated symptom score<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;9</span></a> to be used by pediatric patients with symptoms of esophageal diseases and&#47;or their parents&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Brazil&#44; there are no validated tools for the diagnosis of EoE based on the patients&#8217; perception&#46; In order to use the PEESS v2&#46;0 in the Brazilian context&#44; the translation and cultural adaptation&#44; according to the methodological accuracy recommended in international guidelines&#44; are paramount&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The items should not only be translated into the linguistic form&#44; but should also be culturally adapted to maintain the content validity of the tool for different cultures&#44; on a conceptual basis&#44; maintaining the equivalence between the original tool and the target version&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> This study aimed to translate and culturally adapt the PEESS v2&#46;0 to obtain a Brazilian version with conceptual&#44; semantic&#44; and cultural equivalence to the original scale&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a methodological study of translation and cultural adaptation&#44; approved by the Research Ethics Committee of Universidade Federal de Uberl&#226;ndia &#40;UFU&#41; &#40;Protocol CEP&#47;UFU 048050&#47;2015&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After authorization to use the PEESS v2&#46;0 by the Mapi Research Trust &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://mapigroup.com/tag/mapi-research-trust/">http&#58;&#47;&#47;mapigroup&#46;com&#47;tag&#47;mapi-research-trust&#47;</a>&#41;&#44; the authors performed the score translation into the Brazilian Portuguese language&#44; using the translation and cultural adaptation methodologies&#44; according to international translation standards for tools<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;11</span></a> for linguistic validation&#44; in seven stages &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the third stage of translation&#44; the research coordinators compared the back-translation with the original scale&#44; aiming to identify items with inappropriate translations or with greater difficulty of consensus during the translation and reconciliation stages&#46; These items were selected for the independent reviewers&#8217; process &#40;fourth stage&#41;&#46; The reviewers jointly analyzed the translations&#44; the reconciliation&#44; and the original version&#44; using the modified Delphi technique&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#8211;14</span></a> with the main purpose of evaluating the semantic&#44; idiomatic&#44; experimental&#44; and conceptual equivalence between the original score and the back-translation&#46; The modified Delphi technique &#40;decision-making technique by means of electronic rounds&#41; was based on the creation of a questionnaire consisting of all stages of the translation and the original scale and by qualitative and quantitative questions related to items requiring review&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The questionnaire links were e-mailed to the reviewers&#44; who were asked to answer the form within twenty days&#46; Response data were immediately forwarded to the research coordinator by email&#44; through a freely accessible website&#44; and the respondents&#8217; anonymity was maintained &#40;<a id="intr0015" class="elsevierStyleInterRef" href="http://armstrong.wharton.upenn.edu/delphi2/admin/reset_pw.php?ac=1rlaxC">http&#58;&#47;&#47;armstrong&#46;wharton&#46;upenn&#46;edu&#47;delphi2&#47;admin&#47;reset&#95;pw&#46;php&#63;ac&#61;1rlaxC</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the first round&#44; reviewers chose the best translation &#40;FW1 and FW2&#41; and reconciliation &#40;REC&#41; options&#44; or suggested another option&#44; according to their knowledge&#46; Each round was followed by the statistical representation of result distribution&#44; by means of the percentage of agreement between the reviewers and the feedback of the group&#39;s responses for re-evaluation at the subsequent stage&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> The second stage consisted in the analysis of the first stage results&#44; to identify convergence and change in the respondents&#8217; decisions and opinions&#46; The reviewers had free access to the statistical representation of the results distribution&#44; in order to direct the group&#39;s consensus&#46; The process was finished&#44; according to the criteria previously established by the researchers&#44; with a minimum consensus of 80&#37; agreement between the reviewers&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">After the score pre-final review stage&#44; carried out by the language coordinator&#44; the pre-final version was applied by the main investigator to 17 respondents after they signed the informed consent form&#46; The pretest sample was defined according to the translation guidelines of the company responsible for the score copyright<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a>&#58; six patients between 8 and 18 years old&#44; five parents of patients aged between 2 and 8 years old&#44; and six parents of patients between 8 and 18 years&#44; followed-up at the Pediatric Gastroenterology Outpatient Clinic of Uberl&#226;ndia Federal University Hospital &#40;UFU&#41; for EoE diagnostic investigation or clinical follow-up&#46; Illiterate parents or patients were excluded from the study&#46; This stage aimed to identify and correct possible difficulties in understanding items and suggestions for improving the translation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The qualitative analysis was performed by the main investigator through two brief oral interviews&#44; the retrospective and cognitive interviews&#46; During the retrospective interview&#44; subjects were asked about the symptom score comprehension&#44; the importance of the items&#44; and on whether they had suggestions to improve the score comprehension&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The cognitive interview aimed to identify whether the meaning of each item given by the score&#39;s author was understood in the same manner by the interviewee&#46; The subjects identified translation problems and gave translation suggestions for each item&#46; The observations of patients and their parents were considered to determine the cultural adaptation of the translated version&#46; Items reported as difficult to understand&#44; as well as the suggestions made by patients and their parents&#44; were incorporated into a new reading test by the language reviewer&#46; After the final grammatical review&#44; the version was sent for final approval by the company that holds the copyright of the score&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Questionnaires</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sociodemographic questionnaire</span><p id="par0065" class="elsevierStylePara elsevierViewall">Data such as age&#44; gender&#44; and level of schooling of the patients and their parents who participated in the pre-test were collected through an oral interview&#44; before the cognitive and retrospective interviews&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">PEESS v2&#46;0</span><p id="par0070" class="elsevierStylePara elsevierViewall">PEESS is a score that assesses the frequency and intensity of EoE-related symptoms&#46; It consists of twenty items&#44; eleven of which are related to the frequency and nine&#44; to the intensity of the symptoms&#46; The answers to each item are distributed on a scale with scores ranging from 0 to 4&#46; In items referring to frequency&#44; 0 corresponds to &#8220;never&#8221; and 4 corresponds to &#8220;almost always&#8221; &#40;two or more times a day&#41;&#46; In items referring to intensity&#44; 0 corresponds to &#8220;not bad&#8221; and 4 corresponds to &#8220;very bad&#8221;&#46; The scores are transformed into a scale from zero to 100&#44; as follows&#58; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#59; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#59; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#59; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#59; and 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#46; The higher the score&#44; the greater the severity and frequency of symptoms&#46; There are two self-administered scores&#44; one for patients aged 8 to 18 and another for parents or guardians of children aged 2 to 18 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;16</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">After the initial translation&#44; reconciliation&#44; and back-translation process&#44; the title&#44; score guidelines&#44; severity response categories&#44; and two items &#40;items 3 and 20&#41; were submitted to review and consensus-building using the Delphi technique&#46; Only the score title was sent to a second round&#44; when it reached 80&#37; agreement among reviewers&#46; The reviewers chose the reconciled version in the score guidelines&#44; severity response categories&#44; and in items 3 and 20 &#40;80&#37;&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After completing the review stage&#44; the score was submitted for grammatical review&#46; At this stage&#44; items 5 and 6 were corrected in the translation of &#8220;stomach aches or belly aches&#8221;&#44; initially as &#8220;dores de est&#244;mago ou de barriga&#8221; in the reconciliation&#44; to &#8220;dor de est&#244;mago ou de barriga&#8221; in the corrected version &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">One father and one 15-year-old male patient were excluded from the study due to lack of schooling&#46; Thus&#44; the pre-test sample consisted of 15 respondents&#46; The age of the parents or guardians ranged from 28 to 48 years&#44; with 30&#37; males and 70&#37; females&#46; The level of schooling ranged from elementary school to full college&#47;university&#46; Patient age ranged from 10 to 17 years&#44; with 20&#37; females and 80&#37; males&#44; and the level of schooling ranging from elementary to high school&#46; The lack of patients aged 8 to 10 years was considered a limitation&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the retrospective interview&#44; all respondents reported having understood the symptom score&#44; considering its application important&#46; Among the suggestions&#44; five parents of patients aged 2&#8211;18 years and two patients aged 8 to 18 years suggested that in the frequency response categories&#44; the option &#8220;Quase nunca &#40;menos de uma vez por semana&#41;&#8221;&#44; translated from &#8220;Almost never &#40;less than once a week&#41;&#8221; in the reconciliation stage&#44; should be modified to options such as &#8220;Raramente &#40;uma ou mais vezes por m&#234;s&#41;&#8221; or &#8220;De vez em quando &#40;mensalmente&#41;&#8221;&#46; Such modification was suggested because of the difficulty to understand the frequency between the categories &#8220;Nunca&#8221; and &#8220;&#192;s vezes &#40;uma ou mais vezes por semana&#41;&#8221;&#46; According to the opinion of the language reviewer&#44; the option &#8220;Raramente&#8221; would be more appropriate for the frequency between &#8220;Nunca&#8221; and &#8220;&#192;s vezes&#8221; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In the cognitive interview&#44; the respondents showed comprehension difficulties and suggested changes in five items&#59; however&#44; in only three items &#40;15&#44; 19 and 20&#41;&#44; the language and research coordinators considered relevant the comprehension difficulties and suggestions given by the respondents&#44; meeting the criteria for modification &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Suggestions were made to replace the term &#8220;n&#225;usea&#8221; by &#8220;enjoo&#8221; or even by the idiomatic expression &#8220;embrulhar o est&#244;mago&#8221;&#44; making the item easier to understand&#46; The coordinators chose the first suggestion&#44; &#8220;enjoo&#8221;&#44; with no grammatical disagreement&#44; defining the item in the final version as &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; sente enjoos &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&#8221;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Also during the cognitive interview&#44; two parents and one patient suggested replacing the term &#8220;outras crian&#231;as&#8221; by the term &#8220;outras pessoas&#8221; in items 19 and 20 &#40;&#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; come menos do que as outras crian&#231;as&#63;&#8221; and &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&#8221;&#41;&#46; The authors considered that the suggestion would improve the understanding of these items and&#44; therefore&#44; the final translation version consisted of &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; come menos do que as outras pessoas&#63;&#8221; and &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras pessoas&#63;&#8221; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study translated and culturally adapted the Brazilian version of the PEESS v2&#46;0 for evaluation of EoE symptoms in children and adolescents&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The pediatric patient&#39;s symptom perception and the parents&#8217; reports are extremely important to evaluate the current therapeutic options for the EoE and the disease evolution&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> Currently&#44; it is known that the histological severity of EoE inflammation&#44; measured by the eosinophil count in the tissue and the presence and intensity of endoscopic signs&#44; may not be directly related to the severity of the symptoms experienced by the patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">17&#44;18</span></a> Therefore&#44; the introduction of the PEESS v2&#46;0 as a symptom score reported by parents and&#47;or patients with suspected and diagnosed EoE may represent an important advance in the investigation and research of this disease&#46; In fact&#44; previous results have demonstrated the usefulness of the score in clinical practice as an objective measure of patients&#8217; symptoms and assessment of treatment response&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">During the translation process&#44; no translations of difficult consensus or grammatical disagreements were observed&#46; At the independent reviewers&#8217; stage&#44; the Delphi technique was applied until the second stage to attain consensus related to the score title&#46; This technique provided greater authenticity to the translation process and can be considered a support tool in decision-making&#44; as it allowed the participation of a group of specialists in translation and in pediatric gastroenterology&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">At the grammar review stage&#44; the only suggested adjustment was the translation of &#8220;stomach aches or belly aches&#8221;&#44; an expression originally translated as &#8220;dores de est&#244;mago ou de barriga&#8221;&#44; into the singular form &#8220;dor de est&#244;mago ou de barriga&#8221;&#46; When considering the syntactic conventionality in translation&#44; the word &#8220;dor&#8221; in Portuguese has a broad and generalized meaning&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> with its frequency of occurrence being given in the plural form&#46; Moreover&#44; the singular form&#44; considered conventional&#44; that is&#44; &#8220;of use or practice&#44; consolidated by use or practice&#44;&#8221;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> should be preferred in scales to be used with the population&#46; Syntactic conventionality was also the justification for replacing the word &#8220;n&#225;usea&#8221; by &#8220;enjoo&#44;&#8221;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> suggested by patients and their parents after the cognitive interview&#46; These words are considered synonymous&#44; but the word &#8220;enjoo&#8221; was popularly considered to be more easily understood&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Another suggestion provided in the pre-test stage was the replacement of &#8220;quase nunca &#40;menos que uma vez por semana&#41;&#8221;&#44; the translation of &#8220;almost never &#40;less than once a week&#41;&#8221;&#44; by the synonymous adverb &#8220;raramente &#40;uma ou mais vezes por m&#234;s&#41;&#8221;&#46; Both are indicators of frequency&#59; however&#44; the suggestion made by patients and parents in the cognitive interview was referred to as more easily understood&#46; These findings indicate the importance of incorporating the respondents&#8217; suggestions into the processes of cultural adaptation of tools and indicate the need for psychometric evaluation of the items in subsequent studies&#46; Also&#44; during the cognitive interview&#44; it was observed that patients aged 10&#8211;17 years understood well the frequency indicators used in the score response categories&#44; a fact consistent with previous results&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> The easy comprehension among patients in this age group shows that older children have a good understanding of frequency adverbs and a more developed declarative memory than children under 8 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> This evidence reinforces the possibility of using self-report scores in children aged 8 years and older&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The group aged 8 years and older was considered a determinant factor for a better understanding of the score items&#44; especially when considering the patients&#8217; reading and comprehension skills&#59; however&#44; it was not possible to apply the pre-test to patients aged between 8 and 10 years&#44; and this fact constitutes a limitation of this study&#46; Children over 8 years of age are able to discuss and express their experiences of illness&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> The methodology care to use specific scales&#44; appropriate to the age group and according to variations in the cognitive development of the respondents&#44; is an important criterion for the score use in both clinical research and practice&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As for the item &#8220;Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&#8221;&#44; the children understood the meaning of the item&#44; but could not relate to it personally&#46; This was probably due to the fact that they did not have the experience of living in a family environment with other children of the same age&#44; as it is known that eating behavior may vary according to the age group&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> Another possible explanation for these results may be the age of the respondents&#44; who&#44; between the ages of 10 and 17&#44; do not appear to consider themselves as &#8220;children&#8221;&#46; Other studies also reported similar difficulties in children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a> Previous experience related to the symptoms or behaviors measured by the item is an important aspect to be considered in later validation processes of the score&#46; The authors consider these comprehension difficulties to be inherent to the age group&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Another difficulty that is inherent to the pediatric age group emerged during the cognitive interview with parents and guardians&#46; The parents reported having some difficulty answering some items&#46; That occurred because they did not know such information about their children or because they failed to observe the child enough to develop a conclusion about the item&#46; This fact was observed mainly in parents of young children&#44; under 5 years old&#44; who have difficulty to express more subjective symptoms such as &#8220;heartburn&#8221; and &#8220;nausea&#8221;&#46; Although it is known that the use of reporting by parents or guardians in children is highly reliable and valid&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> the authors call attention to the interpretation of items related to more subjective symptoms&#44; which are more difficult to be expressed by children under 8 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewcompact-standard">The translation of the PEESS resulted in a scale adapted to the Brazilian culture&#44; which could be introduced as a tool for clinical investigation and symptom screening in patients with a suspected diagnosis of EoE &#40;<a class="elsevierStyleCrossRef" href="#sec0045">Supplementary materials 1 and 2</a>&#41;&#46; Subsequent score validation studies should elucidate the psychometric parameters of the items&#44; especially those with greater comprehension difficulty by children&#44; adolescents&#44; and parents&#47;guardians in the pre-test&#46; PEESS is an important advance in the evaluation of EoE symptoms&#44; as it values the report of the patients that live with this disease&#44; in the scenario of a chronic disease&#44; with an invasive diagnosis and follow-up&#44; which requires careful evaluation of symptom evolution for appropriate therapeutic planning&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewextended">The translation of the PEESS resulted in a scale adapted to the Brazilian culture&#44; which could be introduced as a tool for clinical investigation and symptom screening in patients with a suspected diagnosis of EoE &#40;<a class="elsevierStyleCrossRef" href="#sec0050">Supplementary materials 1 and 2</a>&#41;&#46; Subsequent score validation studies should elucidate the psychometric parameters of the items&#44; especially those with greater comprehension difficulty by children&#44; adolescents&#44; and parents&#47;guardians in the pre-test&#46; PEESS is an important advance in the evaluation of EoE symptoms&#44; as it values the report of the patients that live with this disease&#44; in the scenario of a chronic disease&#44; with an invasive diagnosis and follow-up&#44; which requires careful evaluation of symptom evolution for appropriate therapeutic planning&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score &#40;version 2&#46;0&#41;&#44; a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and&#47;or their parents&#47;caregivers&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages&#58; initial translation&#44; back-translation&#44; and consensus of independent reviewers through the Delphi technique&#46; The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service &#40;pre-test&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During the translation process&#44; no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed&#46; During the pre-test&#44; difficulties in comprehension of some unconventional terms&#44; <span class="elsevierStyleItalic">e&#46;g</span>&#46;&#44; &#8220;n&#225;usea&#8221;&#44; were observed&#46; Adverbs of frequency&#44; such as &#8220;quase nunca&#8221; were also identified as being of difficult understanding by patients and parents&#44; and the substitution by the term &#8220;raramente&#8221; was suggested&#46; Such difficulties may be inherent to the pediatric age group&#46; Age 8 years or above should be considered adequate for the self-reporting of symptoms&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score&#44; which is adapted to the Brazilian culture&#46; This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms&#46; The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis&#44; since it reinforces the importance of self-reporting by patients who experience this disease&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Traduzir e adaptar culturalmente a <span class="elsevierStyleItalic">Pediatric Eosinophilic Esophagitis Symptom Score</span> &#40;vers&#227;o 2&#46;0&#41;&#44; um instrumento usado para identificar os sintomas relatados pelos pacientes ou seus pais&#47;respons&#225;veis para a avalia&#231;&#227;o da esofagite eosinof&#237;lica pedi&#225;trica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Realizamos o processo de tradu&#231;&#227;o a partir da tradu&#231;&#227;o inicial&#44; retrotradu&#231;&#227;o&#44; seguida da etapa de obten&#231;&#227;o de consenso por revisores independentes por meio da t&#233;cnica Delphi&#46; Aplicamos a vers&#227;o pr&#233;-final a cinco pacientes de 8 a 18 anos e dez pais de pacientes de 2 a 18 anos&#44; no Servi&#231;o de Gastroenterologia Pedi&#225;trica &#40;pr&#233;-teste&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No processo de tradu&#231;&#227;o&#44; n&#227;o encontramos tradu&#231;&#245;es de dif&#237;cil consenso no processo de revis&#227;o ou discord&#226;ncias gramaticais&#46; No pr&#233;-teste&#44; identificamos dificuldades de entendimento de termos pouco convencionais&#44; como &#8220;n&#225;usea&#8221;&#44; com sugest&#227;o de substitui&#231;&#227;o para o termo &#8220;enjoo&#8221;&#46; Outra dificuldade encontrada relacionou-se aos adv&#233;rbios de frequ&#234;ncia da escala&#44; como&#44; por exemplo&#44; &#8220;quase nunca&#8221;&#44; sendo sugerida a substitui&#231;&#227;o pelo termo &#8220;raramente&#8221;&#46; Essas dificuldades podem ser inerentes &#224; faixa et&#225;ria pedi&#225;trica&#46; A idade dos pacientes a partir de oito anos deve ser considerada adequada para o uso de escores de autorrelato&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A tradu&#231;&#227;o do escore de sintomas da esofagite eosinof&#237;lica pedi&#225;trica produziu uma escala adaptada &#224; cultura brasileira&#44; que poder&#225; ser introduzida como instrumento de investiga&#231;&#227;o cl&#237;nica e de pesquisa em pacientes com sintomas sugestivos de doen&#231;as esof&#225;gicas&#46; &#201; um importante avan&#231;o na avalia&#231;&#227;o dos sintomas&#44; j&#225; que valoriza o relato dos pr&#243;prios pacientes que convivem com essa doen&#231;a&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Santos MF&#44; Barros CP&#44; Silva CH&#44; Paro HB&#46; Translation and cultural adaptation of the Pediatric Eosinophilic Esophagitis Symptom Score &#40;PEESS v2&#46;0&#41;&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;642&#8211;51&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0050"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the process of translation and cultural adaptation of PEESS into ESEEP&#46; PEESS&#44; Pediatric Eosinophilic Esophagitis Symptom Score&#59; ESEEP&#44; Escore de Sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">FW1&#44; translator 1&#59; FW2&#44; translator 2&#59; REC&#44; reconciliation&#46;</p>"
          "tablatextoimagen" => array:1 [
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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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Original item&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Translation options&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st stage &#8211; DELPHI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd stage &#8211; DELPHI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-final version&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TITLE&#58; Pediatric Eosinophilic Esophagitis &#40;EoE&#41; Symptom Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Gravidade dos sintomas de Esofagite Eosinof&#237;lica &#40;EoE&#41;<br>FW2&#58; Esofagite Eosinof&#237;lica &#40;EoE&#41; &#8211; An&#225;lise da intensidade dos sintomas<br>REC&#58; Escala de registro dos sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica &#40;EEo&#41;<br>SUGGESTION&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 40&#37;<br>REC&#58; 40&#37;<br>SUGGESTION&#58; 20&#37;<br>ESCORE DE SINTOMAS DA ESOFAGITE EOSINOF&#205;LICA PEDI&#193;TRICA &#40;EEo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 20&#37;<br>REC&#58; 0&#37;<br>SUGGESTION&#58; 80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TITLE&#58; Escore de sintomas da esofagite eosinof&#237;lica pedi&#225;trica &#40;EEo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tell us about your child&#39;s problems with EoE in the past MONTH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Conte-nos como seu filho passou no &#250;ltimo m&#234;s<br>FW2&#58; Conte-nos sobre como foram os sintomas do seu filho com &#40;EoE&#41; no &#250;ltimo m&#234;s<br>REC&#58; Conte-nos sobre quais foram as dificuldades do &#40;a&#41; seu &#40;sua&#41; filho &#40;a&#41; com EEo no &#250;ltimo m&#234;s<br>SUGGESTION&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 20&#37;<br>REC&#58; 80&#37;<br>SUGGESTION&#58; 0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conte-nos sobre quais foram as dificuldades do&#40;a&#41; seu&#40;sua&#41; filho&#40;a&#41; com EEo no &#250;ltimo m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not bad at all&#47;A little bad&#47;Kind of bad&#47;Bad&#47;Very bad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Normal&#47;N&#227;o t&#227;o mal&#47;Um pouco mal&#47;Mal&#47;Muito mal<br>FW2&#58; Normal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal<br>REC&#58; Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 0&#37;<br>REC&#58; 100&#37;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; How often does your child have heartburn &#40;burning in the chest&#44; mouth&#44; or throat&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Com que frequ&#234;ncia seu filho sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;<br>FW2&#58; Com que frequ&#234;ncia seu filho &#40;a&#41; sente queima&#231;&#227;o na boca&#44; peito ou garganta&#63;<br>REC&#58; Com que frequ&#234;ncia seu &#40;sua&#41; filho &#40;a&#41; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 20&#37;<br>FW2&#58; 0&#37;<br>REC&#58; 80&#37;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; How often does your child need more time to eat than others&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Com que frequ&#234;ncia seu filho precisa de mais tempo do que as outras pessoas para terminar suas refei&#231;&#245;es&#63;<br>FW2&#58; Voc&#234; sente que seu filho &#40;a&#41; precisa de mais tempo para comer do que as outras pessoas&#63;<br>REC&#58; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 20&#37;<br>FW2&#58; 0&#37;<br>REC&#58; 80&#37;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Score items for parents of children aged two to eighteen years sent to independent reviewers for consensus-building using the DELPHI technique&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p>"
        ]
      ]
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            "identificador" => "at2"
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        "tabla" => 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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ORIGINAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">REC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PRE-FINAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pediatric Eosinophilic Esophagitis &#40;EoE&#41; Symptom Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Escala de registro dos sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica &#40;EEo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eosinophilic Esophagitis symptoms in children Scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Escore de sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica &#40;EEo&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Children and teens report &#40;ages 8&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relat&#243;rio para crian&#231;as e adolescentes &#40;8&#8211;18 anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Children and adolescents &#40;8&#8211;18&#41; Report&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relat&#243;rio para crian&#231;as e adolescentes &#40;8&#8211;18 anos&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tell us about your problems with EoE in the past MONTH&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conte-nos sobre quais foram suas dificuldades com &#40;EEo&#41; no &#250;ltimo m&#234;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tell us the difficulties that you have had with &#40;EEo&#41; during the last month&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conte-nos sobre quais foram suas dificuldades com a Esofagite no &#250;ltimo M&#202;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">There are no right or wrong answers&#46; Please circle the best number&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#227;o h&#225; respostas certas ou erradas&#46; Por favor&#44; circule o n&#250;mero que melhor representa sua escolha&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There are no right or wrong answers&#46; Please mark the number that best represents your choice&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#227;o h&#225; respostas certas ou erradas&#46; Por favor&#44; circule o n&#250;mero que melhor representa sua escolha&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Please answer the question in the Frequency section and then the related question in the Severity section&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Por favor&#44; responda &#224; pergunta na se&#231;&#227;o de Frequ&#234;ncia e depois &#224; pergunta relacionada na se&#231;&#227;o Gravidade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Please respond to the questions in the Frequency section and then the questions related to the Seriousness section&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Por favor&#44; responda &#224; pergunta na se&#231;&#227;o de Frequ&#234;ncia e&#44; depois&#44; &#224; pergunta relacionada na se&#231;&#227;o Gravidade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Never&#47;Almost never &#40;less than once a week&#41;&#47;Sometimes &#40;1 or more times a week&#41;&#47;Often &#40;1 time a day&#41;&#47;Almost always &#40;2 or more times a day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nunca&#47;Quase nunca &#40;menos de uma vez por semana&#41;&#47;&#192;s vezes &#40;uma ou mais vezes por semana&#41;&#47;Frequentemente &#40;Uma vez por dia&#41;&#47;Quase sempre &#40;duas ou mais vezes ao dia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Never&#47;Almost never &#40;less than once a week&#41;&#47;Sometimes &#40;once or more a week&#41;&#47;Frequently &#40;once a day&#41;&#47;Almost always &#40;twice or more a day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nunca&#47;Quase nunca &#40;menos de uma vez por semana&#41;&#47;&#192;s vezes &#40;uma ou mais vezes por semana&#41;&#47;Frequentemente &#40;Uma vez por dia&#41;&#47;Quase sempre &#40;duas ou mais vezes ao dia&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not bad at all&#47;A little bad&#47;Kind of bad&#47;Bad&#47;Very bad&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Don&#8217;t feel anything&#47;Not so bad&#47;Pretty bad&#47;Terrible&#47;Really terrible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; How often do you have chest pain&#44; ache&#44; or hurt&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Com que frequ&#234;ncia voc&#234; sente dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; How often do you have chest pains&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Com que frequ&#234;ncia voc&#234; sente dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; How bad is the chest pain&#44; ache&#44; or hurt&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46; Como voc&#234; se sente quando est&#225; com dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46; How do you feel when you have chest pains&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46; Como voc&#234; se sente quando est&#225; com dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; How often do you have heartburn &#40;burning in your chest&#44; mouth&#44; or throat&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; Com que frequ&#234;ncia voc&#234; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; How often do you have heartburn&#63; &#40;a burning feeling in the chest&#44; mouth or throat&#63;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; Com que frequ&#234;ncia voc&#234; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; How bad is your heartburn &#40;burning in your chest&#44; mouth&#44; or throat&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46; Como voc&#234; se sente quando est&#225; com azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46; How do you feel when you have heartburn&#63; &#40;burning in the chest&#44; mouth or throat&#63;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46; Como voc&#234; se sente quando est&#225; com azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; How often do you have stomach aches or belly aches&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46; Com que frequ&#234;ncia voc&#234; sente dores de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46; How often do you have stomach or abdominal pain&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46; Com que frequ&#234;ncia voc&#234; sente dor de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; How bad are the stomach aches or belly aches&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46; Como voc&#234; se sente quando est&#225; com dores de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46; How do you feel when you have stomach or abdominal pain&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46; Como voc&#234; se sente quando est&#225; com dor de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; How often do you have trouble swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46; Com que frequ&#234;ncia voc&#234; tem dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46; How often do you have difficulty swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46; Com que frequ&#234;ncia voc&#234; tem dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; How bad is the trouble swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46; Como voc&#234; se sente quando est&#225; com dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46; How do you feel when you have difficulty swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46; Como voc&#234; se sente quando est&#225; com dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; How often do you feel like food gets stuck in your throat or chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46; Com que frequ&#234;ncia voc&#234; sente como se a comida ficasse parada em sua garganta ou peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46; How often do you feel that your food is stuck in your throat or in your chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46; Com que frequ&#234;ncia voc&#234; se sente como se a comida ficasse presa em sua garganta ou peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; How bad is it when food gets stuck in your throat or chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46; Como voc&#234; se sente quando a comida fica parada na sua garganta ou no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46; How do you feel when food is stuck in your throat or chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46; Como voc&#234; se sente quando a comida fica presa em sua garganta ou peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; How often do you need to drink a lot to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46; Com que frequ&#234;ncia voc&#234; precisa beber algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46; How often do you need to drink something to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46; Com que frequ&#234;ncia voc&#234; precisa beber algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; How bad is it if you don&#8217;t drink a lot to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46; Como voc&#234; se sente se n&#227;o bebe algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46; How do you feel if you don&#8217;t drink something to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46; Como voc&#234; se sente se n&#227;o bebe algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; How often do you vomit &#40;throw up&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46; Com que frequ&#234;ncia voc&#234; vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46; How often do you vomit or throw up&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46; Com que frequ&#234;ncia voc&#234; vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; How bad is the vomiting &#40;throwing up&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46; Como voc&#234; se sente quando vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46; How do you feel when you vomit&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46; Como voc&#234; se sente quando vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; How often do you feel nauseous &#40;feel like you&#8217;re going to throw up&#44; but don&#8217;t&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; Com que frequ&#234;ncia voc&#234; sente n&#225;useas &#40;quando voc&#234; sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; How often do you feel nauseated&#63; &#40;when you feel like vomiting but don&#8217;t vomit&#63;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; Com que frequ&#234;ncia voc&#234; sente n&#225;useas &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#46; How bad is the nausea &#40;feeling like you&#8217;re going to throw up&#44; but don&#8217;t&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46; Como voc&#234; se sente quando est&#225; com n&#225;usea &#40;quando voc&#234; sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46; How do you feel when you&#8217;re nauseated&#63; &#40;feel like vomiting but don&#8217;t&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46; Como voc&#234; se sente quando est&#225; com n&#225;useas &#40;sentindo que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46; How often does food come back up your throat when eating&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46; Com que frequ&#234;ncia a comida volta pela sua garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46; How often does the food come back up into your throat after swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46; Com que frequ&#234;ncia a comida volta pela sua garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&#46; How bad is the food coming back up your throat when eating&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46; Como voc&#234; se sente quando a comida volta pela sua garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46; How do you feel when the food comes back up into your throat&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46; Como voc&#234; se sente quando a comida volta pela garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&#46; How often do you eat less food than others&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; Com que frequ&#234;ncia voc&#234; come menos do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; How often do you eat less than other people&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; Com que frequ&#234;ncia voc&#234; come menos do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; How often do you need more time to eat than others&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; How often do you need more time to eat than other people&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&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</td><td class="td" title="table-entry  " align="left" valign="top">Raramente &#40;uma ou mais vezes por m&#234;s&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; sente n&#225;useas &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63; &#40;vers&#227;o para pais&#47;respons&#225;veis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enjoo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; sente enjoos &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; Com que frequ&#234;ncia voc&#234; sente n&#225;useas &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63; &#40;vers&#227;o para pacientes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enjoo<br>Ou<br>&#8220;Embrulhar o est&#244;mago&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; Com que frequ&#234;ncia voc&#234; sente enjoos &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; come menos do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outras pessoas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; come menos do que as outras pessoas&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&#46; Com que frequencia voc&#234; come menos do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outras pessoas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; Com que frequ&#234;ncia voc&#234; come menos do que as outras pessoas&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outras pessoas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras pessoas&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outras pessoas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras pessoas&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Original article
Translation and cultural adaptation of the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0)
Tradução e adaptação cultural da Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0)
Maria Fernanda Oliveira Santosa,
Corresponding author
mariaf.pediatria@gmail.com

Corresponding author.
, Cristina Palmer Barrosb, Carlos Henrique Martins da Silvaa,c,d, Helena Borges Martins da Silva Paroa,c
a Universidade Federal de Uberlândia (UFU), Faculdade de Medicina Programa de Pós-Graduação em Ciências da Saúde, Uberlândia, MG, Brazil
b Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Uberlândia, MG, Brazil
c Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil
d Universidade Federal de Uberlândia (UFU), Grupo de pesquisa em Qualidade de Vida Relacionada à Saúde, Uberlândia, MG, Brazil
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vomiting&#44; abdominal pain&#44; growth deficit&#44; and difficulty in introducing solid foods&#46; Schoolchildren and adolescents may report dysphagia and food impaction in the esophagus&#44; which are more specific and similar to symptoms in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;5</span></a> The absence of specificity of EoE symptoms and its similarity to other age-specific pathological conditions&#44; such as gastroesophageal reflux disease &#40;GERD&#41;&#44; are a diagnostic challenge for the general pediatrician or specialist&#46; Adequate evaluation of these symptoms through valid and reliable tools becomes essential for diagnostic and therapeutic purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Tools that evaluate EoE severity have been developed for assisting in the diagnosis and treatment of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#44;8</span></a> However&#44; few questionnaires consider the patient&#39;s own perception of the severity of their symptoms or response to treatment&#46; Patient-reported outcomes &#40;PRO&#41; have been recognized as key measures for assessing the treatment of chronic diseases over the last decade&#46; Although there are other published scales to evaluate the symptoms of EoE&#44; only one validated tool that takes into account the symptoms reported by the patients or their parents&#47;guardians for the assessment of pediatric EoE was retrieved in the literature&#44; the Pediatric Eosinophilic Esophagitis Symptom Score &#40;PEESS version 2&#46;0&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">PEESS v2&#46;0&#8482; was developed in the United States&#44; based on focal and cognitive interviews&#44; using the perceptions of patients and their parents&#44; with the frequency and severity of EoE-related symptoms as the focus for the questions&#46; Based on the responses and descriptions of patients with EoE and their relatives&#44; as well as on the FDA guidelines&#44; PEESS v2&#46;0 was the first validated symptom score<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;9</span></a> to be used by pediatric patients with symptoms of esophageal diseases and&#47;or their parents&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Brazil&#44; there are no validated tools for the diagnosis of EoE based on the patients&#8217; perception&#46; In order to use the PEESS v2&#46;0 in the Brazilian context&#44; the translation and cultural adaptation&#44; according to the methodological accuracy recommended in international guidelines&#44; are paramount&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The items should not only be translated into the linguistic form&#44; but should also be culturally adapted to maintain the content validity of the tool for different cultures&#44; on a conceptual basis&#44; maintaining the equivalence between the original tool and the target version&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> This study aimed to translate and culturally adapt the PEESS v2&#46;0 to obtain a Brazilian version with conceptual&#44; semantic&#44; and cultural equivalence to the original scale&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a methodological study of translation and cultural adaptation&#44; approved by the Research Ethics Committee of Universidade Federal de Uberl&#226;ndia &#40;UFU&#41; &#40;Protocol CEP&#47;UFU 048050&#47;2015&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After authorization to use the PEESS v2&#46;0 by the Mapi Research Trust &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://mapigroup.com/tag/mapi-research-trust/">http&#58;&#47;&#47;mapigroup&#46;com&#47;tag&#47;mapi-research-trust&#47;</a>&#41;&#44; the authors performed the score translation into the Brazilian Portuguese language&#44; using the translation and cultural adaptation methodologies&#44; according to international translation standards for tools<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;11</span></a> for linguistic validation&#44; in seven stages &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the third stage of translation&#44; the research coordinators compared the back-translation with the original scale&#44; aiming to identify items with inappropriate translations or with greater difficulty of consensus during the translation and reconciliation stages&#46; These items were selected for the independent reviewers&#8217; process &#40;fourth stage&#41;&#46; The reviewers jointly analyzed the translations&#44; the reconciliation&#44; and the original version&#44; using the modified Delphi technique&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#8211;14</span></a> with the main purpose of evaluating the semantic&#44; idiomatic&#44; experimental&#44; and conceptual equivalence between the original score and the back-translation&#46; The modified Delphi technique &#40;decision-making technique by means of electronic rounds&#41; was based on the creation of a questionnaire consisting of all stages of the translation and the original scale and by qualitative and quantitative questions related to items requiring review&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The questionnaire links were e-mailed to the reviewers&#44; who were asked to answer the form within twenty days&#46; Response data were immediately forwarded to the research coordinator by email&#44; through a freely accessible website&#44; and the respondents&#8217; anonymity was maintained &#40;<a id="intr0015" class="elsevierStyleInterRef" href="http://armstrong.wharton.upenn.edu/delphi2/admin/reset_pw.php?ac=1rlaxC">http&#58;&#47;&#47;armstrong&#46;wharton&#46;upenn&#46;edu&#47;delphi2&#47;admin&#47;reset&#95;pw&#46;php&#63;ac&#61;1rlaxC</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the first round&#44; reviewers chose the best translation &#40;FW1 and FW2&#41; and reconciliation &#40;REC&#41; options&#44; or suggested another option&#44; according to their knowledge&#46; Each round was followed by the statistical representation of result distribution&#44; by means of the percentage of agreement between the reviewers and the feedback of the group&#39;s responses for re-evaluation at the subsequent stage&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> The second stage consisted in the analysis of the first stage results&#44; to identify convergence and change in the respondents&#8217; decisions and opinions&#46; The reviewers had free access to the statistical representation of the results distribution&#44; in order to direct the group&#39;s consensus&#46; The process was finished&#44; according to the criteria previously established by the researchers&#44; with a minimum consensus of 80&#37; agreement between the reviewers&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">After the score pre-final review stage&#44; carried out by the language coordinator&#44; the pre-final version was applied by the main investigator to 17 respondents after they signed the informed consent form&#46; The pretest sample was defined according to the translation guidelines of the company responsible for the score copyright<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a>&#58; six patients between 8 and 18 years old&#44; five parents of patients aged between 2 and 8 years old&#44; and six parents of patients between 8 and 18 years&#44; followed-up at the Pediatric Gastroenterology Outpatient Clinic of Uberl&#226;ndia Federal University Hospital &#40;UFU&#41; for EoE diagnostic investigation or clinical follow-up&#46; Illiterate parents or patients were excluded from the study&#46; This stage aimed to identify and correct possible difficulties in understanding items and suggestions for improving the translation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The qualitative analysis was performed by the main investigator through two brief oral interviews&#44; the retrospective and cognitive interviews&#46; During the retrospective interview&#44; subjects were asked about the symptom score comprehension&#44; the importance of the items&#44; and on whether they had suggestions to improve the score comprehension&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The cognitive interview aimed to identify whether the meaning of each item given by the score&#39;s author was understood in the same manner by the interviewee&#46; The subjects identified translation problems and gave translation suggestions for each item&#46; The observations of patients and their parents were considered to determine the cultural adaptation of the translated version&#46; Items reported as difficult to understand&#44; as well as the suggestions made by patients and their parents&#44; were incorporated into a new reading test by the language reviewer&#46; After the final grammatical review&#44; the version was sent for final approval by the company that holds the copyright of the score&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Questionnaires</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sociodemographic questionnaire</span><p id="par0065" class="elsevierStylePara elsevierViewall">Data such as age&#44; gender&#44; and level of schooling of the patients and their parents who participated in the pre-test were collected through an oral interview&#44; before the cognitive and retrospective interviews&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">PEESS v2&#46;0</span><p id="par0070" class="elsevierStylePara elsevierViewall">PEESS is a score that assesses the frequency and intensity of EoE-related symptoms&#46; It consists of twenty items&#44; eleven of which are related to the frequency and nine&#44; to the intensity of the symptoms&#46; The answers to each item are distributed on a scale with scores ranging from 0 to 4&#46; In items referring to frequency&#44; 0 corresponds to &#8220;never&#8221; and 4 corresponds to &#8220;almost always&#8221; &#40;two or more times a day&#41;&#46; In items referring to intensity&#44; 0 corresponds to &#8220;not bad&#8221; and 4 corresponds to &#8220;very bad&#8221;&#46; The scores are transformed into a scale from zero to 100&#44; as follows&#58; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#59; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#59; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#59; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#59; and 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#46; The higher the score&#44; the greater the severity and frequency of symptoms&#46; There are two self-administered scores&#44; one for patients aged 8 to 18 and another for parents or guardians of children aged 2 to 18 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;16</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">After the initial translation&#44; reconciliation&#44; and back-translation process&#44; the title&#44; score guidelines&#44; severity response categories&#44; and two items &#40;items 3 and 20&#41; were submitted to review and consensus-building using the Delphi technique&#46; Only the score title was sent to a second round&#44; when it reached 80&#37; agreement among reviewers&#46; The reviewers chose the reconciled version in the score guidelines&#44; severity response categories&#44; and in items 3 and 20 &#40;80&#37;&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After completing the review stage&#44; the score was submitted for grammatical review&#46; At this stage&#44; items 5 and 6 were corrected in the translation of &#8220;stomach aches or belly aches&#8221;&#44; initially as &#8220;dores de est&#244;mago ou de barriga&#8221; in the reconciliation&#44; to &#8220;dor de est&#244;mago ou de barriga&#8221; in the corrected version &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">One father and one 15-year-old male patient were excluded from the study due to lack of schooling&#46; Thus&#44; the pre-test sample consisted of 15 respondents&#46; The age of the parents or guardians ranged from 28 to 48 years&#44; with 30&#37; males and 70&#37; females&#46; The level of schooling ranged from elementary school to full college&#47;university&#46; Patient age ranged from 10 to 17 years&#44; with 20&#37; females and 80&#37; males&#44; and the level of schooling ranging from elementary to high school&#46; The lack of patients aged 8 to 10 years was considered a limitation&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the retrospective interview&#44; all respondents reported having understood the symptom score&#44; considering its application important&#46; Among the suggestions&#44; five parents of patients aged 2&#8211;18 years and two patients aged 8 to 18 years suggested that in the frequency response categories&#44; the option &#8220;Quase nunca &#40;menos de uma vez por semana&#41;&#8221;&#44; translated from &#8220;Almost never &#40;less than once a week&#41;&#8221; in the reconciliation stage&#44; should be modified to options such as &#8220;Raramente &#40;uma ou mais vezes por m&#234;s&#41;&#8221; or &#8220;De vez em quando &#40;mensalmente&#41;&#8221;&#46; Such modification was suggested because of the difficulty to understand the frequency between the categories &#8220;Nunca&#8221; and &#8220;&#192;s vezes &#40;uma ou mais vezes por semana&#41;&#8221;&#46; According to the opinion of the language reviewer&#44; the option &#8220;Raramente&#8221; would be more appropriate for the frequency between &#8220;Nunca&#8221; and &#8220;&#192;s vezes&#8221; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In the cognitive interview&#44; the respondents showed comprehension difficulties and suggested changes in five items&#59; however&#44; in only three items &#40;15&#44; 19 and 20&#41;&#44; the language and research coordinators considered relevant the comprehension difficulties and suggestions given by the respondents&#44; meeting the criteria for modification &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Suggestions were made to replace the term &#8220;n&#225;usea&#8221; by &#8220;enjoo&#8221; or even by the idiomatic expression &#8220;embrulhar o est&#244;mago&#8221;&#44; making the item easier to understand&#46; The coordinators chose the first suggestion&#44; &#8220;enjoo&#8221;&#44; with no grammatical disagreement&#44; defining the item in the final version as &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; sente enjoos &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&#8221;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Also during the cognitive interview&#44; two parents and one patient suggested replacing the term &#8220;outras crian&#231;as&#8221; by the term &#8220;outras pessoas&#8221; in items 19 and 20 &#40;&#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; come menos do que as outras crian&#231;as&#63;&#8221; and &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&#8221;&#41;&#46; The authors considered that the suggestion would improve the understanding of these items and&#44; therefore&#44; the final translation version consisted of &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; come menos do que as outras pessoas&#63;&#8221; and &#8220;Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras pessoas&#63;&#8221; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study translated and culturally adapted the Brazilian version of the PEESS v2&#46;0 for evaluation of EoE symptoms in children and adolescents&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The pediatric patient&#39;s symptom perception and the parents&#8217; reports are extremely important to evaluate the current therapeutic options for the EoE and the disease evolution&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> Currently&#44; it is known that the histological severity of EoE inflammation&#44; measured by the eosinophil count in the tissue and the presence and intensity of endoscopic signs&#44; may not be directly related to the severity of the symptoms experienced by the patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">17&#44;18</span></a> Therefore&#44; the introduction of the PEESS v2&#46;0 as a symptom score reported by parents and&#47;or patients with suspected and diagnosed EoE may represent an important advance in the investigation and research of this disease&#46; In fact&#44; previous results have demonstrated the usefulness of the score in clinical practice as an objective measure of patients&#8217; symptoms and assessment of treatment response&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">During the translation process&#44; no translations of difficult consensus or grammatical disagreements were observed&#46; At the independent reviewers&#8217; stage&#44; the Delphi technique was applied until the second stage to attain consensus related to the score title&#46; This technique provided greater authenticity to the translation process and can be considered a support tool in decision-making&#44; as it allowed the participation of a group of specialists in translation and in pediatric gastroenterology&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">At the grammar review stage&#44; the only suggested adjustment was the translation of &#8220;stomach aches or belly aches&#8221;&#44; an expression originally translated as &#8220;dores de est&#244;mago ou de barriga&#8221;&#44; into the singular form &#8220;dor de est&#244;mago ou de barriga&#8221;&#46; When considering the syntactic conventionality in translation&#44; the word &#8220;dor&#8221; in Portuguese has a broad and generalized meaning&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> with its frequency of occurrence being given in the plural form&#46; Moreover&#44; the singular form&#44; considered conventional&#44; that is&#44; &#8220;of use or practice&#44; consolidated by use or practice&#44;&#8221;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> should be preferred in scales to be used with the population&#46; Syntactic conventionality was also the justification for replacing the word &#8220;n&#225;usea&#8221; by &#8220;enjoo&#44;&#8221;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> suggested by patients and their parents after the cognitive interview&#46; These words are considered synonymous&#44; but the word &#8220;enjoo&#8221; was popularly considered to be more easily understood&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Another suggestion provided in the pre-test stage was the replacement of &#8220;quase nunca &#40;menos que uma vez por semana&#41;&#8221;&#44; the translation of &#8220;almost never &#40;less than once a week&#41;&#8221;&#44; by the synonymous adverb &#8220;raramente &#40;uma ou mais vezes por m&#234;s&#41;&#8221;&#46; Both are indicators of frequency&#59; however&#44; the suggestion made by patients and parents in the cognitive interview was referred to as more easily understood&#46; These findings indicate the importance of incorporating the respondents&#8217; suggestions into the processes of cultural adaptation of tools and indicate the need for psychometric evaluation of the items in subsequent studies&#46; Also&#44; during the cognitive interview&#44; it was observed that patients aged 10&#8211;17 years understood well the frequency indicators used in the score response categories&#44; a fact consistent with previous results&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> The easy comprehension among patients in this age group shows that older children have a good understanding of frequency adverbs and a more developed declarative memory than children under 8 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> This evidence reinforces the possibility of using self-report scores in children aged 8 years and older&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The group aged 8 years and older was considered a determinant factor for a better understanding of the score items&#44; especially when considering the patients&#8217; reading and comprehension skills&#59; however&#44; it was not possible to apply the pre-test to patients aged between 8 and 10 years&#44; and this fact constitutes a limitation of this study&#46; Children over 8 years of age are able to discuss and express their experiences of illness&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> The methodology care to use specific scales&#44; appropriate to the age group and according to variations in the cognitive development of the respondents&#44; is an important criterion for the score use in both clinical research and practice&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As for the item &#8220;Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&#8221;&#44; the children understood the meaning of the item&#44; but could not relate to it personally&#46; This was probably due to the fact that they did not have the experience of living in a family environment with other children of the same age&#44; as it is known that eating behavior may vary according to the age group&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> Another possible explanation for these results may be the age of the respondents&#44; who&#44; between the ages of 10 and 17&#44; do not appear to consider themselves as &#8220;children&#8221;&#46; Other studies also reported similar difficulties in children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a> Previous experience related to the symptoms or behaviors measured by the item is an important aspect to be considered in later validation processes of the score&#46; The authors consider these comprehension difficulties to be inherent to the age group&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Another difficulty that is inherent to the pediatric age group emerged during the cognitive interview with parents and guardians&#46; The parents reported having some difficulty answering some items&#46; That occurred because they did not know such information about their children or because they failed to observe the child enough to develop a conclusion about the item&#46; This fact was observed mainly in parents of young children&#44; under 5 years old&#44; who have difficulty to express more subjective symptoms such as &#8220;heartburn&#8221; and &#8220;nausea&#8221;&#46; Although it is known that the use of reporting by parents or guardians in children is highly reliable and valid&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> the authors call attention to the interpretation of items related to more subjective symptoms&#44; which are more difficult to be expressed by children under 8 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewcompact-standard">The translation of the PEESS resulted in a scale adapted to the Brazilian culture&#44; which could be introduced as a tool for clinical investigation and symptom screening in patients with a suspected diagnosis of EoE &#40;<a class="elsevierStyleCrossRef" href="#sec0045">Supplementary materials 1 and 2</a>&#41;&#46; Subsequent score validation studies should elucidate the psychometric parameters of the items&#44; especially those with greater comprehension difficulty by children&#44; adolescents&#44; and parents&#47;guardians in the pre-test&#46; PEESS is an important advance in the evaluation of EoE symptoms&#44; as it values the report of the patients that live with this disease&#44; in the scenario of a chronic disease&#44; with an invasive diagnosis and follow-up&#44; which requires careful evaluation of symptom evolution for appropriate therapeutic planning&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewextended">The translation of the PEESS resulted in a scale adapted to the Brazilian culture&#44; which could be introduced as a tool for clinical investigation and symptom screening in patients with a suspected diagnosis of EoE &#40;<a class="elsevierStyleCrossRef" href="#sec0050">Supplementary materials 1 and 2</a>&#41;&#46; Subsequent score validation studies should elucidate the psychometric parameters of the items&#44; especially those with greater comprehension difficulty by children&#44; adolescents&#44; and parents&#47;guardians in the pre-test&#46; PEESS is an important advance in the evaluation of EoE symptoms&#44; as it values the report of the patients that live with this disease&#44; in the scenario of a chronic disease&#44; with an invasive diagnosis and follow-up&#44; which requires careful evaluation of symptom evolution for appropriate therapeutic planning&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score &#40;version 2&#46;0&#41;&#44; a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and&#47;or their parents&#47;caregivers&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages&#58; initial translation&#44; back-translation&#44; and consensus of independent reviewers through the Delphi technique&#46; The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service &#40;pre-test&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During the translation process&#44; no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed&#46; During the pre-test&#44; difficulties in comprehension of some unconventional terms&#44; <span class="elsevierStyleItalic">e&#46;g</span>&#46;&#44; &#8220;n&#225;usea&#8221;&#44; were observed&#46; Adverbs of frequency&#44; such as &#8220;quase nunca&#8221; were also identified as being of difficult understanding by patients and parents&#44; and the substitution by the term &#8220;raramente&#8221; was suggested&#46; Such difficulties may be inherent to the pediatric age group&#46; Age 8 years or above should be considered adequate for the self-reporting of symptoms&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score&#44; which is adapted to the Brazilian culture&#46; This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms&#46; The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis&#44; since it reinforces the importance of self-reporting by patients who experience this disease&#46;</p></span>"
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      "pt" => array:3 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Traduzir e adaptar culturalmente a <span class="elsevierStyleItalic">Pediatric Eosinophilic Esophagitis Symptom Score</span> &#40;vers&#227;o 2&#46;0&#41;&#44; um instrumento usado para identificar os sintomas relatados pelos pacientes ou seus pais&#47;respons&#225;veis para a avalia&#231;&#227;o da esofagite eosinof&#237;lica pedi&#225;trica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Realizamos o processo de tradu&#231;&#227;o a partir da tradu&#231;&#227;o inicial&#44; retrotradu&#231;&#227;o&#44; seguida da etapa de obten&#231;&#227;o de consenso por revisores independentes por meio da t&#233;cnica Delphi&#46; Aplicamos a vers&#227;o pr&#233;-final a cinco pacientes de 8 a 18 anos e dez pais de pacientes de 2 a 18 anos&#44; no Servi&#231;o de Gastroenterologia Pedi&#225;trica &#40;pr&#233;-teste&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No processo de tradu&#231;&#227;o&#44; n&#227;o encontramos tradu&#231;&#245;es de dif&#237;cil consenso no processo de revis&#227;o ou discord&#226;ncias gramaticais&#46; No pr&#233;-teste&#44; identificamos dificuldades de entendimento de termos pouco convencionais&#44; como &#8220;n&#225;usea&#8221;&#44; com sugest&#227;o de substitui&#231;&#227;o para o termo &#8220;enjoo&#8221;&#46; Outra dificuldade encontrada relacionou-se aos adv&#233;rbios de frequ&#234;ncia da escala&#44; como&#44; por exemplo&#44; &#8220;quase nunca&#8221;&#44; sendo sugerida a substitui&#231;&#227;o pelo termo &#8220;raramente&#8221;&#46; Essas dificuldades podem ser inerentes &#224; faixa et&#225;ria pedi&#225;trica&#46; A idade dos pacientes a partir de oito anos deve ser considerada adequada para o uso de escores de autorrelato&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A tradu&#231;&#227;o do escore de sintomas da esofagite eosinof&#237;lica pedi&#225;trica produziu uma escala adaptada &#224; cultura brasileira&#44; que poder&#225; ser introduzida como instrumento de investiga&#231;&#227;o cl&#237;nica e de pesquisa em pacientes com sintomas sugestivos de doen&#231;as esof&#225;gicas&#46; &#201; um importante avan&#231;o na avalia&#231;&#227;o dos sintomas&#44; j&#225; que valoriza o relato dos pr&#243;prios pacientes que convivem com essa doen&#231;a&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Santos MF&#44; Barros CP&#44; Silva CH&#44; Paro HB&#46; Translation and cultural adaptation of the Pediatric Eosinophilic Esophagitis Symptom Score &#40;PEESS v2&#46;0&#41;&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;642&#8211;51&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0050"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the process of translation and cultural adaptation of PEESS into ESEEP&#46; PEESS&#44; Pediatric Eosinophilic Esophagitis Symptom Score&#59; ESEEP&#44; Escore de Sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">FW1&#44; translator 1&#59; FW2&#44; translator 2&#59; REC&#44; reconciliation&#46;</p>"
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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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Original item&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Translation options&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st stage &#8211; DELPHI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd stage &#8211; DELPHI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-final version&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TITLE&#58; Pediatric Eosinophilic Esophagitis &#40;EoE&#41; Symptom Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Gravidade dos sintomas de Esofagite Eosinof&#237;lica &#40;EoE&#41;<br>FW2&#58; Esofagite Eosinof&#237;lica &#40;EoE&#41; &#8211; An&#225;lise da intensidade dos sintomas<br>REC&#58; Escala de registro dos sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica &#40;EEo&#41;<br>SUGGESTION&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 40&#37;<br>REC&#58; 40&#37;<br>SUGGESTION&#58; 20&#37;<br>ESCORE DE SINTOMAS DA ESOFAGITE EOSINOF&#205;LICA PEDI&#193;TRICA &#40;EEo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 20&#37;<br>REC&#58; 0&#37;<br>SUGGESTION&#58; 80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TITLE&#58; Escore de sintomas da esofagite eosinof&#237;lica pedi&#225;trica &#40;EEo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tell us about your child&#39;s problems with EoE in the past MONTH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Conte-nos como seu filho passou no &#250;ltimo m&#234;s<br>FW2&#58; Conte-nos sobre como foram os sintomas do seu filho com &#40;EoE&#41; no &#250;ltimo m&#234;s<br>REC&#58; Conte-nos sobre quais foram as dificuldades do &#40;a&#41; seu &#40;sua&#41; filho &#40;a&#41; com EEo no &#250;ltimo m&#234;s<br>SUGGESTION&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 20&#37;<br>REC&#58; 80&#37;<br>SUGGESTION&#58; 0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conte-nos sobre quais foram as dificuldades do&#40;a&#41; seu&#40;sua&#41; filho&#40;a&#41; com EEo no &#250;ltimo m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not bad at all&#47;A little bad&#47;Kind of bad&#47;Bad&#47;Very bad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Normal&#47;N&#227;o t&#227;o mal&#47;Um pouco mal&#47;Mal&#47;Muito mal<br>FW2&#58; Normal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal<br>REC&#58; Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 0&#37;<br>FW2&#58; 0&#37;<br>REC&#58; 100&#37;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; How often does your child have heartburn &#40;burning in the chest&#44; mouth&#44; or throat&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Com que frequ&#234;ncia seu filho sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;<br>FW2&#58; Com que frequ&#234;ncia seu filho &#40;a&#41; sente queima&#231;&#227;o na boca&#44; peito ou garganta&#63;<br>REC&#58; Com que frequ&#234;ncia seu &#40;sua&#41; filho &#40;a&#41; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 20&#37;<br>FW2&#58; 0&#37;<br>REC&#58; 80&#37;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; How often does your child need more time to eat than others&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; Com que frequ&#234;ncia seu filho precisa de mais tempo do que as outras pessoas para terminar suas refei&#231;&#245;es&#63;<br>FW2&#58; Voc&#234; sente que seu filho &#40;a&#41; precisa de mais tempo para comer do que as outras pessoas&#63;<br>REC&#58; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FW1&#58; 20&#37;<br>FW2&#58; 0&#37;<br>REC&#58; 80&#37;<br>SUGGESTION&#58; &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;<br>&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia seu&#40;sua&#41; filho&#40;a&#41; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Score items for parents of children aged two to eighteen years sent to independent reviewers for consensus-building using the DELPHI technique&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p>"
        ]
      ]
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        "etiqueta" => "Table 2"
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        "tabla" => 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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ORIGINAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">REC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PRE-FINAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pediatric Eosinophilic Esophagitis &#40;EoE&#41; Symptom Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Escala de registro dos sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica &#40;EEo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eosinophilic Esophagitis symptoms in children Scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Escore de sintomas da Esofagite Eosinof&#237;lica Pedi&#225;trica &#40;EEo&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Children and teens report &#40;ages 8&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relat&#243;rio para crian&#231;as e adolescentes &#40;8&#8211;18 anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Children and adolescents &#40;8&#8211;18&#41; Report&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relat&#243;rio para crian&#231;as e adolescentes &#40;8&#8211;18 anos&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tell us about your problems with EoE in the past MONTH&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conte-nos sobre quais foram suas dificuldades com &#40;EEo&#41; no &#250;ltimo m&#234;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tell us the difficulties that you have had with &#40;EEo&#41; during the last month&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conte-nos sobre quais foram suas dificuldades com a Esofagite no &#250;ltimo M&#202;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">There are no right or wrong answers&#46; Please circle the best number&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#227;o h&#225; respostas certas ou erradas&#46; Por favor&#44; circule o n&#250;mero que melhor representa sua escolha&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There are no right or wrong answers&#46; Please mark the number that best represents your choice&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#227;o h&#225; respostas certas ou erradas&#46; Por favor&#44; circule o n&#250;mero que melhor representa sua escolha&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Please answer the question in the Frequency section and then the related question in the Severity section&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Por favor&#44; responda &#224; pergunta na se&#231;&#227;o de Frequ&#234;ncia e depois &#224; pergunta relacionada na se&#231;&#227;o Gravidade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Please respond to the questions in the Frequency section and then the questions related to the Seriousness section&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Por favor&#44; responda &#224; pergunta na se&#231;&#227;o de Frequ&#234;ncia e&#44; depois&#44; &#224; pergunta relacionada na se&#231;&#227;o Gravidade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Never&#47;Almost never &#40;less than once a week&#41;&#47;Sometimes &#40;1 or more times a week&#41;&#47;Often &#40;1 time a day&#41;&#47;Almost always &#40;2 or more times a day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nunca&#47;Quase nunca &#40;menos de uma vez por semana&#41;&#47;&#192;s vezes &#40;uma ou mais vezes por semana&#41;&#47;Frequentemente &#40;Uma vez por dia&#41;&#47;Quase sempre &#40;duas ou mais vezes ao dia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Never&#47;Almost never &#40;less than once a week&#41;&#47;Sometimes &#40;once or more a week&#41;&#47;Frequently &#40;once a day&#41;&#47;Almost always &#40;twice or more a day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nunca&#47;Quase nunca &#40;menos de uma vez por semana&#41;&#47;&#192;s vezes &#40;uma ou mais vezes por semana&#41;&#47;Frequentemente &#40;Uma vez por dia&#41;&#47;Quase sempre &#40;duas ou mais vezes ao dia&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not bad at all&#47;A little bad&#47;Kind of bad&#47;Bad&#47;Very bad&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Don&#8217;t feel anything&#47;Not so bad&#47;Pretty bad&#47;Terrible&#47;Really terrible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nada mal&#47;Um pouco mal&#47;Mais ou menos mal&#47;Mal&#47;Muito mal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; How often do you have chest pain&#44; ache&#44; or hurt&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Com que frequ&#234;ncia voc&#234; sente dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; How often do you have chest pains&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Com que frequ&#234;ncia voc&#234; sente dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; How bad is the chest pain&#44; ache&#44; or hurt&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46; Como voc&#234; se sente quando est&#225; com dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46; How do you feel when you have chest pains&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46; Como voc&#234; se sente quando est&#225; com dor no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; How often do you have heartburn &#40;burning in your chest&#44; mouth&#44; or throat&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; Com que frequ&#234;ncia voc&#234; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; How often do you have heartburn&#63; &#40;a burning feeling in the chest&#44; mouth or throat&#63;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46; Com que frequ&#234;ncia voc&#234; sente azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; How bad is your heartburn &#40;burning in your chest&#44; mouth&#44; or throat&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46; Como voc&#234; se sente quando est&#225; com azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46; How do you feel when you have heartburn&#63; &#40;burning in the chest&#44; mouth or throat&#63;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46; Como voc&#234; se sente quando est&#225; com azia &#40;queima&#231;&#227;o no peito&#44; boca ou garganta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; How often do you have stomach aches or belly aches&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46; Com que frequ&#234;ncia voc&#234; sente dores de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46; How often do you have stomach or abdominal pain&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46; Com que frequ&#234;ncia voc&#234; sente dor de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; How bad are the stomach aches or belly aches&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46; Como voc&#234; se sente quando est&#225; com dores de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46; How do you feel when you have stomach or abdominal pain&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46; Como voc&#234; se sente quando est&#225; com dor de est&#244;mago ou de barriga&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; How often do you have trouble swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46; Com que frequ&#234;ncia voc&#234; tem dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46; How often do you have difficulty swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46; Com que frequ&#234;ncia voc&#234; tem dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; How bad is the trouble swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46; Como voc&#234; se sente quando est&#225; com dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46; How do you feel when you have difficulty swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46; Como voc&#234; se sente quando est&#225; com dificuldade para engolir&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; How often do you feel like food gets stuck in your throat or chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46; Com que frequ&#234;ncia voc&#234; sente como se a comida ficasse parada em sua garganta ou peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46; How often do you feel that your food is stuck in your throat or in your chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46; Com que frequ&#234;ncia voc&#234; se sente como se a comida ficasse presa em sua garganta ou peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; How bad is it when food gets stuck in your throat or chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46; Como voc&#234; se sente quando a comida fica parada na sua garganta ou no peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46; How do you feel when food is stuck in your throat or chest&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46; Como voc&#234; se sente quando a comida fica presa em sua garganta ou peito&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; How often do you need to drink a lot to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46; Com que frequ&#234;ncia voc&#234; precisa beber algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46; How often do you need to drink something to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46; Com que frequ&#234;ncia voc&#234; precisa beber algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; How bad is it if you don&#8217;t drink a lot to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46; Como voc&#234; se sente se n&#227;o bebe algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46; How do you feel if you don&#8217;t drink something to help swallow your food&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46; Como voc&#234; se sente se n&#227;o bebe algo para ajudar a engolir a comida&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; How often do you vomit &#40;throw up&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46; Com que frequ&#234;ncia voc&#234; vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46; How often do you vomit or throw up&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46; Com que frequ&#234;ncia voc&#234; vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; How bad is the vomiting &#40;throwing up&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46; Como voc&#234; se sente quando vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46; How do you feel when you vomit&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46; Como voc&#234; se sente quando vomita&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; How often do you feel nauseous &#40;feel like you&#8217;re going to throw up&#44; but don&#8217;t&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; Com que frequ&#234;ncia voc&#234; sente n&#225;useas &#40;quando voc&#234; sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; How often do you feel nauseated&#63; &#40;when you feel like vomiting but don&#8217;t vomit&#63;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46; Com que frequ&#234;ncia voc&#234; sente n&#225;useas &#40;sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#46; How bad is the nausea &#40;feeling like you&#8217;re going to throw up&#44; but don&#8217;t&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46; Como voc&#234; se sente quando est&#225; com n&#225;usea &#40;quando voc&#234; sente que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46; How do you feel when you&#8217;re nauseated&#63; &#40;feel like vomiting but don&#8217;t&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46; Como voc&#234; se sente quando est&#225; com n&#225;useas &#40;sentindo que vai vomitar&#44; mas n&#227;o vomita&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46; How often does food come back up your throat when eating&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46; Com que frequ&#234;ncia a comida volta pela sua garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46; How often does the food come back up into your throat after swallowing&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46; Com que frequ&#234;ncia a comida volta pela sua garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&#46; How bad is the food coming back up your throat when eating&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46; Como voc&#234; se sente quando a comida volta pela sua garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46; How do you feel when the food comes back up into your throat&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46; Como voc&#234; se sente quando a comida volta pela garganta quando voc&#234; est&#225; comendo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&#46; How often do you eat less food than others&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; Com que frequ&#234;ncia voc&#234; come menos do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; How often do you eat less than other people&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46; Com que frequ&#234;ncia voc&#234; come menos do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&#46; How often do you need more time to eat than others&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; How often do you need more time to eat than other people&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46; Com que frequ&#234;ncia voc&#234; precisa de mais tempo para comer do que as outras crian&#231;as&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outras pessoas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outras pessoas&nbsp;\t\t\t\t\t\t\n
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ISSN: 00217557
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