[Social network and social support measures from the Pró-Saúde Study: pre-tests and pilot study]

Escala de Percepção do Suporte Social (versão adulta) - EPSUS-A: estudo das qualidades psicométricas

A presente pesquisa teve como objetivo realizar estudos de evidência de validade com base na estrutura interna e confiabilidade por meio do índice alfa de Cronbach (α) para a Escala de Percepção do Suporte Social (versão adulta) - EPSUS-A. A amostra do estudo foi composta por 533 universitários, provenientes de três estados brasileiros. Procedeu-se à análise fatorial da EPSUS-A, inicialmente composta por 77 itens, e, por meio dessa, foi possível evidenciar validade com base na estrutura interna para a EPSUS-A. Nesse sentido, a escala ficou composta por 36 itens, aglutinados em quatro fatores, quais sejam, afetivo (composto por 17 itens e α=0,92); interações sociais (cinco itens e α=0,75); instrumental (sete itens e α=0,82) e enfrentamento de problemas (sete itens e α=0,83). A EPSUS-A se mostrou como uma escala adequada para avaliação do suporte social; entretanto, novos estudos são necessários no intuito de evidenciar outras formas de validade para o instrumento.

Social factors associated with mental disorders with risk situations in the primary health care

OBJECTIVE

To evaluate patients with mental disorders, with or without risk situations, treated at primary health care (PHC) units.

METHOD

A cross-sectional study was performed in samples of 240 patients living in a region of high social vulnerability in Belo Horizonte. The response variable was mental disorders with risk situations (MD-WR). The explanatory variables were gender, age, marital status, literacy, education, employment, social benefits and per capita income. Instruments from Berkman and Syme (social network), Sherbourne and Stewart (social support), adapted for Brazil, were applied. Pearson's χ2 test and binary logistic regression were used for the adjusted analyzes.

RESULTS

The factors associated with MD-WR were being male (OR = 3.62; 95%CI 1.84-7.09); having "up to one confident relative" only (OR = 2.53; 95%CI 1.18-5.42); being "not able to return home" when away from their living area (OR = 3.49; 95%CI 1.40-8.71). The reduction in the affective dimension of the Medical Outcomes Study (MOS) scale increases the chance of MD-WR.

CONCLUSION

The availability and access to social and support networks are lower for patients with MD-WR and need to be strengthened to promote autonomy and citizenship among its users. We conclude that there is the need of public policies to increase the availability of social networking equipment and social support projects, encouraging the participation of families.

The relationship between neighborhood empowerment and dental caries experience: a multilevel study in adolescents and adults

OBJECTIVE

To investigate the relationship of contextual social capital (neighborhood empowerment) and individual social capital (social support and social network) with dental caries experience in adolescents and adults.

METHODS

A population-based multilevel study was conducted involving 573 subjects, 15-19 and 35-44 years of age, from 30 census tracts in three cities of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. Caries experience was assessed using the DMFT index (decayed, missing and filled teeth) and participants were divided into two groups according to the median of the DMFT index in low and high caries experience. Demographic, socioeconomic, behaviors, use of dental services and social capital measures were collected through interviews. Neighborhood empowerment was obtained from the mean scores of the residents in each census tract. Multilevel multivariate logistic regression was used to test the relationship between neighborhood empowerment and caries experience.

RESULTS

High caries experience was inversely associated with neighborhood empowerment (OR = 0.58; 95%CI 0.33-0.99). Individual social capital was not associated with caries experience. Other associated factors with caries experience were age (OR = 1.15; 95%CI 1.12-1.18) and being a female (OR = 1.72; 95%CI 1.08-2.73).

CONCLUSION

The association between neighborhood empowerment and caries experience suggests that the perception of features of the place of residence should be taken into account in actions of oral health promotion.

A protocol to identify non-classical risk factors for preterm births: the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA)

Background

Preterm birth is the main cause of morbidity and mortality during the perinatal period. Classical risk factors are held responsible for only 1/3 of preterm births and no current intervention has produced an appreciable reduction of this event. It is necessary to explore new hypotheses and mechanisms of causality by using an integrated approach, collaboration among research groups and less fragmented theoretical-methodological approaches in order to detect new risk factors and to formulate more effective intervention strategies.

Methods

The study will be conducted on a convenience cohort of Brazilian pregnant women recruited at public and private prenatal health services. A total of 1500 pregnant women in São Luís, and 1500 in Ribeirão Preto, will be invited for an interview and for the collection of biological specimens from the 22nd to the 25th week of gestational age (GA). At the time of delivery they will be reinterviewed. GA will be determined using an algorithm based on two criteria: date of last menstruation (DLM) and obstetric ultrasound (OUS) performed at less than 20 weeks of GA. Illicit drug consumption during pregnancy will be determined using a self-applied questionnaire and the following instruments will be used: perceived stress scale, Beck anxiety scale, screening for depression of the Center of Epidemiological Studies (CES-D), experiences of racial discrimination, social network and social support scale of the Medical Outcomes Study and violence (Abuse Assessment Screening and violence questionnaire of the WHO). Bacterial vaginosis, urinary tract infection and periodontal disease will also be identified. Neuroendocrine, immunoinflammatory and medical intervention hypotheses will be tested. The occurrence of elective cesarean section in the absence of labor will be used as a marker of medical intervention.

Conclusion

Psychosocial, genetic and infectious mechanisms will be selected, since there are indications that they influence preterm birth (PTB). The studies will be conducted in two Brazilian cities with discrepant socioeconomic conditions. The expectation is to identify risk factors for PTB having a greater predictive power than classically studied factors. The final objective is to propose more effective interventions for the reduction of PTB, which, after being tested, might subsidize health policies.

Electronic supplementary material

The online version of this article (doi:10.1186/1742-4755-11-79) contains supplementary material, which is available to authorized users.

Social network of family caregivers of disabled and dependent patients

Cross-sectional study that used the Social Network Index and the genogram to assess the social network of 110 family caregivers of dependent patients attended by a Home Care Service in São Paulo, Brazil. Data were analyzed using the test U of Mann-Whitney, Kruskal-Wallis and Spearman correlation. Results were considered statistically significant when p<0,05. Few caregivers participated in activities outside the home and the average number of people they had a bond was 4,4 relatives and 3,6 friends. Caregivers who reported pain and those who had a partner had higher average number of relatives who to trust. The average number of friends was higher in the group that reported use of medication for depression. Total and per capita incomes correlated with the social network. It was found that family members are the primary caregiver’s social network.





Antecedentes à resistência a sistemas empresariais: a perspectiva de gestores brasileiros

O objetivo deste estudo é determinar os antecedentes à resistência a sistemas empresariais (ERP). Assim, por meio de levantamento bibliográfico relacionado às causas de resistência a sistemas de informação, elaborou-se um modelo teórico contendo os fatores que influenciam o comportamento de resistência a sistemas ERP. A partir daí, por meio de survey, foram obtidos 169 questionários válidos, preenchidos por gestores de tecnologia da informação brasileiros que já haviam implantado sistemas empresariais. A pesquisa valeu-se, então, de técnicas de análise fatorial e equações estruturais para refinar e testar o modelo proposto. Verificou-se que os fatores, sistemas e inclinação pessoal explicaram cerca de 49% da variância do comportamento de resistência a sistemas empresariais. Assim, conclui-se que sistemas ERP pouco flexíveis, tecnicamente mal projetados, cuja utilização seja de difícil compreensão e que não atendam às necessidades dos profissionais, geram resistência relacionada aos mesmos. Semelhantemente, conclui-se que há uma predisposição intrínseca de alguns usuários a resistir à implantação de sistemas empresariais, indicando que o estudo da resistência a sistemas de informação necessita explorar, cada vez mais, dimensões que contemplem aspectos eminentemente comportamentais dos profissionais.

Temporal relationship between intimate partner violence and postpartum depression in a sample of low income women

To estimate whether there is a temporal association between Postpartum Depression (PPD) and intimate partner violence (IPV), and to assess the potential role of social support on this relationship. A cross-sectional study was conducted between January 2006 and March 2007 with 701 low income women who received prenatal and postpartum care in primary health care units of the public sector in São Paulo, Brazil. The Self-Report Questionnaire (SRQ-20) was used to assess the presence of PPD. Structured standardized questionnaires were used to assess IPV and social support. The prevalence of PPD was estimated with a 95 % confidence interval. Crude and adjusted prevalence ratios were calculated using Poisson regression to examine the association between PPD and exposure variables. Values of p < 0.05 were considered statistically significant. The prevalence of PPD was 27.9 % (95 %CI 24.6:31.2). The prevalence of psychological IPV was 38.6 %, physical IPV 23.4 %, and sexual IPV 7.1 %. The multivariate analysis showed that PPD was strongly associated with current psychological and physical/sexual violence, after controlling for confounding factors, and less so with past (prenatal or lifetime) IPV. Presence of social support was an independent protective factor for PPD. Identifying and addressing intimate partner violence, including psychological violence, in the postpartum period should be considered as part of a comprehensive approach to caring for new mothers.

Associação entre o apoio social e o perfil de cuidadores familiares de pacientes com incapacidades e dependência

Estudo descritivo, transversal, cujo objetivo foi analisar a associação entre as dimensões de apoio social e o perfil de cuidadores familiares de pacientes com dependência. Entrevistaram-se 110 cuidadores, utilizando os seguintes instrumentos: questionário de caracterização sociodemográfica, Social Network Index , Medical Outcomes Study e Índice de Barthel. Os testes U de Mann-Whitney e Kruskal-Wallis foram usados para comparar as dimensões de apoio social e as variáveis qualitativas, e a correlação de Spearman para as variáveis quantitativas. Cuidadores que não sabiam ler nunca haviam estudado apresentaram melhor percepção de apoio social em todas as dimensões, exceto na afetiva. Na dimensão interação positiva, aqueles que possuíam companheiro e negaram sobrecarga apresentaram média superior a dos demais grupos. O número de familiares e amigos apresentou correlação com todas as dimensões de apoio social. Os resultados indicam que a rede social é importante para a percepção de apoio.

Gender differences in the association of perceived social support and social network with self-rated health status among older adults: a population-based study in Brazil

Background

Older adults are more likely to live alone, because they may have been predeceased by their spouse and friends. Social interaction could also be reduced in this age group due by limited mobility caused by chronic conditions. Therefore, aging is frequently accompanied by reduced social support, which might affect health status. Little is known about the role of gender in the relationship between social support and health in older adults. Hence, the present study tests the hypothesis that gender differences exist in the relationship between perceived social support, social network, and self-rated health (SRH) among older adults.

Methods

A cross-sectional study using two-stage probabilistic sampling recruited 3,649 individuals aged 60 years and above. Data were collected during the national influenza vaccination campaign in Rio de Janeiro, Brazil, in 2006. Individual interviews collected information on SRH, perceived social support, social network, and other covariates. Multivariate logistic regression analyses using nested models were conducted separately for males and females. Independent variables were organised into six blocks: (1) perceived social support and social network, (2) age group, (3) socioeconomic characteristics, (4) health-related behaviours, (5) use of health care services, (6) functional status measures and somatic health problems.

Results

Older men who did not participate in group activities were more likely to report poor SRH compared to those who did, (OR = 1.63; 95% CI = 1.16–2.30). Low perceived social support predicted the probability of poor SRH in women (OR = 1.64; 95% CI = 1.16–2.34). Poor SRH was associated with low age, low income, not working, poor functional capacity, and depression in both men and women. More somatic health problems were associated with poor SRH in women.

Conclusions

The association between social interactions and SRH varies between genders. Low social network involvement is associated with poor SRH in older men, whereas low perceived social support is associated with poor SRH in older women. The hypothesis that the relationship of perceived social support and social networks to SRH differs according to gender has been confirmed.

[Psychic suffering among civil police officers in Rio de Janeiro State]

The paper discusses the relationship between work and psychic suffering among police officers in the State of Rio de Janeiro. A questionnaire was filled out by these professionals in three separate studies: Capital Baixada Fluminense and Interior. The socio-demographic profile, quality of life, health and working conditions were investigated. Psychic suffering was measured by the SRQ-20. A logistic regression model was used to identify factors associated with psychic suffering. The results showed it to be associated with the following variables: level of satisfaction with the ability to react to difficult situations; performing the work for which the officers were trained; suffering some victimization; unit location; problems in the nervous system; and degree of satisfaction with life in general. Those who reported problems in the nervous system and victimization showed an OR of 7.25 and 3.08, respectively. The professionals who considered themselves dissatisfied or very dissatisfied with the ability to react to difficult situations and life in general showed an OR of 10.85 and 6.69, respectively, compared with those who considered themselves satisfied or very satisfied. Professionals from the Baixada showed an increased risk of psychic suffering compared to a reduced risk among those from the Interior.

[Factors associated with psychological distress among military police in Rio de Janeiro, Brazil]

This study investigates factors associated with psychological distress among military police (n = 1,120) in Rio de Janeiro, Brazil. The article describes their social, economic, and demographic characteristics, quality of life, mental health, and work conditions. Measurement of psychological distress used the Self-Reported Questionnaire. Analysis of associations used logistic regression, considering factors associated with psychological distress. The results indicate an association between psychological distress and factors such as ability to react to difficult situations, dissatisfaction with life, health problems (especially digestive, nervous, and musculoskeletal symptoms), and adverse work conditions such as excessive workload, constant stress, and victimization. The article concludes by highlighting the need for health promotion interventions for the military police, focusing especially on their mental health.

Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma

PURPOSE

As the number of survivors of Hodgkin's lymphoma (HL) increases, there has been a growing interest in long-term treatment-related side effects and their impact on the quality of life (QoL). The aim of this study was to assess the association of social network and social support with the QoL and fatigue among long-term HL survivors.

METHODS

A total of 200 HL survivors were included. The generic Short Form-12 (SF-12) questionnaire, the QoL cancer survivor's questionnaire (QOL-CS), and the Multidimensional Fatigue Inventory were used to assess QoL and fatigue. Social network and social support were evaluated with the Social Support Survey.

RESULTS

Social network and all social support measures were favorably associated with two or more SF-12 scales, mainly with physical functioning and the mental health scales. Social network and social support dimensions were also associated with better QOL-CS scores. Affective support, informational support, positive interaction, and emotional support were associated with less fatigue.

CONCLUSIONS

Both social network and social support are associated with better QoL and lower levels of fatigue in HL survivors. This information may be useful to health professionals and community organizations in implementing effective interventions to improve these patients' quality of life.

A rede social e os tipos de apoio recebidos por idosos institucionalizados

Estudo descritivo que teve como objetivo identificar a composição da rede de apoio social de idosos institucionalizados, bem como os tipos e as quantidades de apoios recebidos por eles. O apoio social tem função importante no enfretamento das perdas e limitações da velhice. Participaram 30 idosos institucionalizados com média de idade de 74 anos. Foram aplicadas entrevistas e a escala de apoio social para identificar a composição da rede social e tipos de apoio social que os idosos recebiam. A rede social desses idosos era composta, em ordem decrescente de quantidade, por familiares, amigos, internos e funcionários da instituição. Embora esses idosos possuíssem familiares vivos, 29 deles recebiam mais apoio social dos amigos do que de seus familiares. Somente 13 recebiam apoio de poucos familiares (em média 1,8 membros da família ofereciam apoio aos idosos), sugerindo a existência de comprometimentos na relação desses idosos com os familiares. Os idosos recebiam apoio material, afetivo e emocional quase sempre e apoios de informação e de interação social positiva, às vezes. A conclusão, pelos resultados, é que os idosos recebiam apoio de poucas pessoas de suas redes sociais.

The relationship between perinatal psychiatric disorders and contraception use among postpartum women

BACKGROUND

The relationship between perinatal psychiatric disorders and the use of effective contraceptive methods among postpartum women served by primary care clinics has not been established.

STUDY DESIGN

This was a prospective cohort study with 831 pregnant women recruited from 10 primary care clinics of the public sector in São Paulo followed up to 18 months after delivery.

RESULTS

Among 701 postpartum women, 644 women (91.8%) had resumed sexual activity. Two hundred fifty-three women (39.2%) were classified as using a less effective contraception method (LECM). The presence of perinatal psychiatric disorder (in pregnancy and/or postpartum) was not associated with LECM. Resumption of sexual life 3 months or beyond after delivery was associated with LECM (odds ratio=1.28, 95% confidence interval: 1.02-1.56).

DISCUSSION

Although the use of an LECM after delivery is common, contraception choice is not associated with perinatal depressive/anxiety symptoms. However, women who delay the resumption of sexual activity after delivery should be counseled on the use of available contraceptive methods.

Rede e apoio social e práticas alimentares de crianças no quarto mês de vida

O objetivo deste trabalho foi investigar a associação entre rede e apoio social e as práticas alimentares de lactentes no quarto mês de vida. Estudo seccional com 294 crianças selecionadas em 4 Unidades de Saúde do município do Rio de Janeiro/RJ/Brasil. Para avaliar as práticas alimentares foi aplicado um recordatório 24h, para medir rede social foram feitas perguntas relacionadas ao número de amigos e parentes "com quem a mãe pode contar" e participação em atividades sociais. A versão em português da escala empregada no "Medical Outcomes Study" foi utilizada para aferir apoio social. Análises foram realizadas por meio de modelos de regressão logística multinomial. A maioria dos lactentes recebeu leite de peito (84%), mas apenas 16% o receberam exclusivamente. Crianças filhas de mães com menor número de parentes com quem contar e com baixo apoio social apresentaram maior chance de estarem em aleitamento artificial em relação ao aleitamento materno exclusivo (AME). Destaca-se a necessidade de integrar os membros da rede social da mulher à atenção pré-natal, ao parto e puerpério para prover o apoio social que atenda as suas necessidades e, assim, contribuir para manutenção do AME.

The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women

BACKGROUND

Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum.

METHODS

A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH--good SRH at baseline and follow-up, and, 2. Poor SRH--poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates.

RESULTS

The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house.

CONCLUSIONS

Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women's SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.

Social capital and dental pain in Brazilian northeast: a multilevel cross-sectional study

BACKGROUND

There is limited evidence on possible associations between social determinants and dental pain. This study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents, adults and the elderly.

METHODS

A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15-19, 35-44 and 65-74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic, socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital measures was collected through interviews. Participants underwent a clinical examination for assessment of dental caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control, empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and individual social capital with dental pain after sequential adjustment for covariates.

RESULTS

Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital (positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit, self-perceived oral health and number of decayed teeth were also significantly associated with dental pain.

CONCLUSIONS

Our findings suggest that contextual and individual social capital are independently associated with dental pain.

Validation of the Brazilian Portuguese version of the Medical Outcomes Study-Social Support Survey in Hodgkin's lymphoma survivors

PURPOSE

The aim of this study was to assess the psychometric properties of the Brazilian Portuguese version of the “Medical Outcomes Study-Social Support Survey (MOS-SSS)” in Hodgkin's lymphoma (HL) survivors.

METHODS

The MOS-SSS is a 19-item questionnaire with five scales covering different aspects of social support (affection, positive social interaction, emotional, informational, and material). A sample of 200 HL survivors completed a self-administered questionnaire at the treatment center or at home.

RESULTS

The median age of the patients at diagnosis was 29 years (16–77), and the median follow-up since diagnosis was 7 years (3.6-12.7). Item-corrected Pearson correlation coefficients between items and their dimensions varied from 0.57 to 0.76. Internal consistency, evaluated using Cronbach's alpha, was 0.95 for the overall scale, ranging from 0.78 to 0.87 for the five subscales proposed by the original instrument. An exploratory factor analysis yielded a three-factor solution, aggregating affection and positive social interaction, and emotional and informational dimensions of social support. Higher socioeconomic status and higher social network were associated with higher levels of all kinds of support.

CONCLUSION

Results show good general psychometric properties of the Brazilian version of the MOS-SSS when applied to HL survivors. The three-factor structure identified in this study is in line with a previous validation among Brazilian healthy civil servants. The Brazilian Portuguese version will now be used to evaluate social support and its association with long-term disease outcomes and quality of life of Hodgkin's lymphoma survivors.

CHILDHOOD DEPRESSION. Exploring the association between family violence and other psychosocial factors in low-income Brazilian schoolchildren

BACKGROUND

Childhood depression affects the morbidity, mortality and life functions of children. Individual, family and environmental factors have been documented as psychosocial risk factors for childhood depression, especially family violence, which results in inadequate support, low family cohesion and poor communication. This study investigates the association between psychosocial depression factors in low-income schoolchildren and reveals the potential trouble spots, highlighting several forms of violence that take place within the family context.

METHODS

The study was based on a cross-sectional analysis of 464 schoolchildren aged between 6 and 10, selected by random sampling from a city in the state of Rio de Janeiro, Brazil. Socio-economic, family and individual variables were investigated on the strength of the caregivers' information and organized in blocks for analysis. A binary logistic regression model was applied, according to hierarchical blocks.

RESULTS

The final hierarchical regression analysis showed that the following variables are potential psychosocial factors associated with depression in childhood: average/poor relationship with the father (OR 3.24, 95% CI 1.32-7.94), high frequency of victimization by psychological violence (humiliation) (OR 6.13, 95% CI 2.06-18.31), parental divorce (OR 2.89, 95% CI 1.14-7.32) and externalizing behavior problems (OR 3.53 IC 1.51-8.23).

CONCLUSIONS

The results point to multiple determinants of depressive behavior in children, as well as the potential contribution of psychological family violence. The study also reveals potential key targets for early intervention, especially for children from highly vulnerable families.

The relationship between social capital, social support and the adequate use of prenatal care

This study investigated the relationship between social capital and social support and the adequate use of prenatal care. A follow-up study involving 1,485 pregnant women was conducted in two cities in the Rio de Janeiro State, Brazil. Demographic and socioeconomic characteristics, social support and social capital data were collected during the first trimester of pregnancy. The post-partum period included information on levels of prenatal care utilization, social networks, parity, obstetric and gestational risk and prenatal care attendance. Hierarchized multinomial logistic regression was used in the statistical analysis. Prenatal care use above adequate levels was associated with high social capital at the city level (aggregated social capital), socioeconomic status and working during pregnancy. Lower non-aggregated contextual and compositional social capital, gestational risk and pattern of prenatal care were associated with inadequate prenatal care utilization. Contextual social capital and social support were found to be social determinants for the appropriate use of prenatal care.

Oral health related quality of life in pregnant and post partum women in two social network domains; predominantly home-based and work-based networks

Background

Individuals connected to supportive social networks have better general and oral health quality of life. The objective of this study was to assess whether there were differences in oral health related quality of life (OHRQoL) between women connected to either predominantly home-based and work-based social networks.

Methods

A follow-up prevalence study was conducted on 1403 pregnant and post-partum women (mean age of 25.2 ± 6.3 years) living in two cities in the State of Rio de Janeiro, Brazil. Women were participants in an established cohort followed from pregnancy (baseline) to post-partum period (follow-up). All participants were allocated to two groups; 1. work-based social network group - employed women with paid work, and, 2. home-based social network group - women with no paid work, housewives or unemployed women. Measures of social support and social network were used as well as questions on sociodemographic characteristics and OHRQoL and health related behaviors. Multinomial logistic regression was performed to obtain OR of relationships between occupational contexts, affectionate support and positive social interaction on the one hand, and oral health quality of life, using the Oral Health Impacts Profile (OHIP) measure, adjusted for age, ethnicity, family income, schooling, marital status and social class.

Results

There was a modifying effect of positive social interaction on the odds of occupational context on OHRQoL. The odds of having a poorer OHIP score, ≥4, was significantly higher for women with home-based social networks and moderate levels of positive social interactions [OR 1.64 (95% CI: 1.08-2.48)], and for women with home-based social networks and low levels of positive social interactions [OR 2.15 (95% CI: 1.40-3.30)] compared with women with work-based social networks and high levels of positive social interactions. Black ethnicity was associated with OHIP scores ≥4 [OR 1.73 (95% CI: 1.23-2.42)].

Conclusions

Pregnant and post-partum Brazilian women in paid employment outside the home and having social supports had better OHRQoL than those with home-based social networks.

Suicidal ideation in medical inpatients: psychosocial and clinical correlates

OBJECTIVE

To identify psychosocial and clinical correlates of suicidal ideation in medical inpatients.

METHOD

In a cross-sectional study, all adults consecutively admitted to the medical wards of a University Hospital had their names recorded and were randomized and evaluated during the first week of admission. Suicidal ideation was assessed using Item 9 of Patient Health Questionnaire-9. The Beck Depression Inventory, the Beck Anxiety Inventory, the WHO Subjective well-being scale, the Charlson Comorbidity Index and other numerical rating scales (pain and self-reported physical illness severity) were used. Patients with less than four confidants were considered with poor social support. The Student's t test, Mann-Whitney U test, chi-square test and stepwise logistic regression analysis were used.

RESULTS

Of the 1092 patients who composed the sample, 7.2% reported having suicidal ideation. After adjusting for psychosocial and clinical confounders, prior suicide attempts (OR: 4.41; 95% CI: 2.12-9.15; P<.001), depressive symptoms (OR: 1.11; 95% CI: 1.06-1.17; P<.001), severe anxiety symptoms (OR: 3.04; 95% CI: 1.47-6.26; P=.003) and poor social support (OR: 2.02; 95% CI:1.03-3.96; P=.04) were independently associated with suicidal ideation.

CONCLUSIONS

Three out of the four correlates of suicidal ideation in medical inpatients are potentially modifiable factors: severe anxiety, depressive symptoms and poor social support. The fourth variable, prior suicide attempts, is not modifiable but should serve as a red flag to suspect and investigate current suicide risk. These findings highlight the importance of suicidal ideation as a proxy for the distress that is incumbent upon physicians to manage if they wish to provide excellent and comprehensive inpatient care.

[Influence of social support on the quality of life of family caregivers while caring for people with dependence]

The objective of this study was to evaluate the Quality of Life (QOL) of family caregivers of handicapped people attended at home by Family Health Teams and the relationship with their social support. Sixty-six family caregivers were interviewed using the WHOQOL-bref for a QOL evaluation and Zarit Burden Interview for the burden. The Social Relations domain of the WHOQOL-bref received the second best score within the domains of the instrument. During multiple linear regressions analysis, female caregivers, with low burden scores and who had received help from someone to perform the care, obtained the highest scores. Similarly, caregivers with partners had higher mean scores in the overall global assessment for QOL and health than those without partners. The results provide evidence of the influence of social support regarding Quality of Life and the burden perceived by family caregivers.

[Social support to pregnant adolescents: clarifying perceptions]

This descriptive-exploratory study using a qualitative approach was undertaken to describe the perceptions of pregnant adolescents in relation to social support provided during pregnancy. Twelve adolescents in their first pregnancy who frequented the outpatient health service in Passo Fundo in the state of Rio Grande do Sul (Brazil) participated in the study. The data was obtained by semi-structured interviews, genograms and ecomaps and was assessed by thematic analysis. It highlighted the need for support to overcome the fears and challenges of motherhood. The mothers and partners were perceived as the main sources of support in affective and material terms. Common sense knowledge prevailed in the information dimension and pregnancy as a mediator in the reconciliation with the father fulfilled the emotional dimension. The perception of the dimension of positive social interaction was blurred by self-imposed isolation. Thus the adolescent's perception of the social support received is clear in relation to the family nucleus and includes the people in the family circle. The network of care outside the family, including the healthcare services, is tenuous and generated the perception of psychosocial difficulties. This reveals the need for greater investment of primary healthcare professionals in the inclusion of first-time-pregnancy adolescents in social care groups, which ensure the healthy progress of the pregnancy.

Avaliação perceptivo-auditiva e fatores associados à alteração vocal em professores

O professor é um profissional que exige muito de sua voz e, consequentemente, apresenta elevado risco de desenvolver alteração vocal durante o exercício do seu trabalho. OBJETIVO: Identificar fatores associados à alteração vocal em professores. MÉTODO: Estudo exploratório do tipo corte transversal que investigou 476 professores do ensino fundamental e médio de escolas municipais da cidade de Salvador, BA. Os professores responderam a um questionário e foram submetidos à avaliação fonoaudiológica perceptivo-auditiva da voz. Para diagnóstico de alteração vocal utilizou-se a escala GRBAS. RESULTADOS: A população do estudo foi composta por 82,8% de mulheres. Os professores do estudo tinham média de idade igual a 40,7 anos, escolaridade superior (88,4%), jornada de trabalho média de 38 horas semanais, média de 11,5 anos de atuação profissional e renda média mensal de R$ 1.817,18. A prevalência de alteração vocal foi de 53,6% (255 professores). A análise bivariada evidenciou associações estatisticamente significantes entre alteração vocal e idade maior que 40 anos (RP = 1,83; IC 95%; 1,27-2,64), histórico familiar de disfonia (RP = 1,72; IC 95%; 1,06-2,80), carga horária semanal maior que 20 horas (RP = 1,66; IC 95%; 1,09-2,52) e presença de pó de giz na sala de aula (RP = 1,70; IC 95%; 1,14-2,53). CONCLUSÃO: O estudo realizado concluiu que os professores com 40 ou mais anos de idade, com histórico familiar de disfonia, com carga horária semanal maior que 20 horas e que lecionam em salas de aula com pó de giz têm maior chance de ter alteração vocal do que os demais.

A sustentabilidade da vida cotidiana: um estudo das redes sociais de usuários de serviço de saúde mental no município de Santo André (SP, Brasil)

Estudos sobre redes sociais demonstram que as relações têm impacto significativo na vida das pessoas. Quando associadas à população com transtorno mental, atuam como fator de proteção importante e gerenciador de recursos e suporte social. Entretanto, estudos apontam que pessoas com transtorno mental apresentam redes sociais empobrecidas e poucas relações significativas. Nesta perspectiva, esta pesquisa teve como objetivo caracterizar as redes sociais de usuários do NAPS II, em Santo André (SP). Realizada em 2006, a pesquisa qualitativa, orientada pela postura etnográfica, utilizou entrevistas por pautas, observação participante e caderno de campo. Os resultados apontaram que o grupo estudado possui rede social empobrecida; a trajetória de vida dos sujeitos está relacionada a esse empobrecimento, uma vez que as rupturas provocadas pelas situações de crise ou de institucionalização os retiram da rede de relações, colocando-os em situação de vulnerabilidade social. Buscou-se discutir a importância da intervenção nas relações e o papel dos serviços nesse processo.

Abuso físico infantil: analisando o estresse parental e o apoio social

Verificou-se se o estresse parental e o apoio social relacionar-se-iam ao abuso físico infantil, comparando-se G1 - cuidadores notificados por abusos, e G2 - não-agressores. Utilizou-se um Questionário de caracterização socio-demográfica e econômica e um sobre Apoio Social e o Índice de Estresse Parental. Obteve-se diferença significativa no escore geral de estresse e na dimensão Criança Difícil, com G1 vivenciando mais estresse. Ademais, G1 apresentou menor nível de apoio, no geral e nas dimensões Afetiva e de Interação Social Positiva. G1 também relatou menos satisfação com o bairro de residência e, em média, era mais jovem quando do nascimento do primeiro filho. Essas variáveis devem receber investimentos em programas de prevenção e de tratamento dirigidos a tal problemática.

Avaliação de apoio social em estudos brasileiros: aspectos conceituais e instrumentos

Este estudo investigou como o apoio social tem sido avaliado em estudos brasileiros. Foi realizado um levantamento das publicações científicas de 1987 a 2007, nos indexadores Indexpsi, Pepsic, SciELO e Lilacs, usando as palavras-chave apoio social, suporte social, rede social. Foram encontrados 59 estudos que contemplavam a avaliação de apoio social em amostras brasileiras. Os resultados apontaram um crescimento nos últimos anos no número de estudos brasileiros que incluem a avaliação do apoio social, com a predominância do uso de técnicas de entrevistas para investigar, em especial, o apoio recebido e o apoio percebido. Contudo, o construto foi utilizado, algumas vezes, sem uma fundamentação teórica sólida e associado a vários outros conceitos sem uma articulação clara. Fica também evidente a escassez de instrumentos fidedignos, válidos e padronizados para a realidade brasileira, apesar dos diversos instrumentos já utilizados e que são revisados no presente estudo.

Apoio social na experiência do familiar cuidador

Estudo qualitativo, do tipo descritivo, objetivando conhecer a experiência de cuidar de pessoas doentes no contexto dos lares, analisando as implicações do apoio social na saúde física e emocional do familiar cuidador. Os dados foram coletados por meio da entrevista semi-estruturada junto a dezoito familiares cuidadores de pessoas com doenças crônicas. A técnica do discurso do sujeito coletivo foi utilizada para a organização dos dados. Constatou-se que todos os informantes eram do sexo feminino, com idade média de cinquenta anos, possuiam até o nível médio de escolaridade, cuidavam ininterruptamente de pessoa doente, predominando as mães com sequela de acidente vascular cerebral. Relatavam comprometimento da sua saúde relacionado ao cuidado realizado: dor na coluna, hipertensão, enxaqueca e depressão. Os discursos coletivos são sugestivos da quebra das redes sociais e da escassez de apoio, levando a pessoa a rejeitar a condição de cuidador. A sobrecarga ficou caracterizada pelo familiar cuidador perceber-se diante de inúmeras situações de enfrentamento, muitas das quais não conseguia administrar.

Fatores protetores e de risco para depresão da mulher após o aborto

Objetivou-se identificar fatores de risco e proteção para depressão em decorrência do abortamento. Metodologia qualitativa com depoimentos de 13 mulheres. Os discursos foram analisados e possibilitaram a construção de duas categorias temáticas: fatores de risco e protetores. Os fatores de risco estão associados à precárias condições sócio-econômicas e afetivas; drogas; prostituição; falta de apoio social e familiar; violência. Nos fatores protetores observam-se presença de condições sócio-econômicas favoráveis à criação dos filhos; apoio familiar (especialmente do companheiro) e social; profissão e trabalho. O reconhecimento desses aspectos abre caminhos para dar melhores cuidados às mulheres em abortamento.

Relação entre depressão pós-parto e disponibilidade emocional materna

A depressão pós-parto é um transtorno de alta prevalência que pode comprometer a qualidade da relação mãe-criança. Este estudo pretende determinar a prevalência do referido transtorno, comparar a interação mãe-bebê nos grupos com e sem depressão e verificar a relação entre depressão, apoio social e estilos de relacionamento e disponibilidade emocional maternos. As participantes eram gestantes que pretendiam dar à luz no Hospital Universitário da Universidade de São Paulo entre dezembro de 2006 e dezembro de 2008. A prevalência de depressão pós-parto em nossa amostra foi 28%. Não houve diferença significativa na relação mãe-criança no grupo com e sem depressão. Encontrou-se correlação positiva entre sensibilidade materna e escolaridade e entre sensibilidade e certas dimensões de apoio social e estilo de relacionamento. Conclui-se que a prevalência de depressão pós-parto em nossa amostra é mais alta que a média mundial, mas a sintomatologia depressiva não interfere significativamente na qualidade da interação mãe-bebê. A sensibilidade materna é influenciada por fatores sócio-cognitivos e afetivos.

Social ties in relation to health status of low-income Brazilian women

BACKGROUND

Social support resources are thought to buffer stressful life events and have been associated with numerous health outcomes in industrialized countries. Because the nature of supportive relationships varies by culture and social class, we studied the relationship of informal social support and networks to self-rated health among low-income women in northeastern Brazil.

METHODS

Participants included 595 randomly sampled mothers from nine low-income communities in Teresina, Piauí, Brazil. Data on sociodemographic variables, social support, quality of the partner relationship, and self-rated health were collected cross-sectionally in 2002. Using multivariable logistic regression, we modeled the association between different aspects of social support and self-rated health.

RESULTS

Poor or fair health was reported by 47% of participants. Women with poor partner relationships had an increased likelihood of poor or fair health (OR 1.7, 95% CI 1.1-2.7), as did those with no material support for food or money (OR 1.6, 95% CI 1.2, 2.0) and no support to resolve a conflict (OR 1.5, 95% CI 1.1, 2.1). Likewise, women with the lowest scores of the Medical Outcomes Study (MOS) social support survey were more likely than other women to report poor or fair health (OR 1.5, 95% CI 1.0, 2.1).

CONCLUSIONS

Poor quality of a partner relationship, lack of support to resolve a conflict, and lack of material support as well as such sociodemographic variables as low education, poor sanitation, and depressive symptomatology are associated with lower health status in a population of low-income women from northeastern Brazil.

Social representations about support for breastfeeding in a group of breastfeeding women

This study aimed to get to know the social representations about support for breastfeeding in a group of breastfeeding women, as well as to identify the actions in their social environment these women perceive as supportive in their breastfeeding processes. Data were collected through a qualitative approach, using recorded semistructured interviews, organized in accordance with the Collective Subject Discourse and analyzed under the premises of Social Representations Theory. Results showed that the representations of women in this study about support for breastfeeding consist of actions available in the hospital, family and work contexts. In these women's perspective, support is a broad phenomenon that involves aspects of encouragement, promotion and protection to breastfeeding.

[Depressive symptoms during adolescence: a study on psychosocial factors in a sample of teenage students in a city in Rio de Janeiro State, Brazil]

This study's objective was to identify individual, social, and familial risk factors for depressive symptoms in adolescent students. The study included 1,923 seventh and eighth-grade (junior high) students and first and second-year high school students in public and private schools from a city in Rio de Janeiro State, Brazil. Depressive symptoms were evaluated with the SRQ-20 scale (Harding, 1980) and resilience scale (Wagnild & Young, 1993). Hierarchical logistic regression was the analytical method used. Symptoms of depression were present in 10% of adolescents. Girls had more than twice the odds of presenting these symptoms (CI: 1.58-3.67); adolescent children of divorced parents had 73% greater odds of depression (CI: 1.16-2.57); victims of serious physical abuse by mothers had 6.49 times the odds (CI: 2.07-20.30); those with low self-esteem, 6.43 greater odds (CI: 2.63-15.68); and those displaying dissatisfaction with their lives, 3.19 greater odds (CI: 2.08-4.89). The findings highlight the urgent need to improve public health policies for adolescents, especially at the preventive level, including psychosocial strategies with the development of a treatment network.

[The social network of individuals under treatment at a psychosocial care center for alcohol and drugs (CAPS ad): the ecomap as a resource]

This study assessed individuals undergoing treatment at a Psychosocial Care Center for Alcohol and Drugs Abuse (CAPS ad) in Southern Brazil. There were 300 hours of participant observation and focal groups, in which the ecomap was used as an instrument to describe social support sources. The study objective was to identify the social network of individuals undergoing treatment due to drug abuse, promoting a reflection about the quality and situation of the bonds established with the people they considered important. The results showed a trajectory of separations and losses. The ecomap permitted to identify points of vulnerability in these subjects' bonds, and is thus an ethical strategy that allows for a joint identification (between professionals and users) of the needs regarding the social, family, and individual contexts that should be addressed when planning health care, especially concerning mental health.

The use of social network methodological framework in nursing care to breastfeeding women

This study aimed to discuss the contribution of the social network methodological framework in nursing care delivered to women who breastfeed their children up to six months of age. This qualitative study aimed to elaborate the social network map of 20 women through tape-recorded interview. Social network analysis evidenced a "strong" bond between these women and members from their primary network, especially friends, neighbors, mothers or with the child's father, who were reported as the people most involved in the breastfeeding period. The contribution of this framework to nursing practice is discussed, especially in care and research processes. We believe that nurses' appropriation of this framework can be an important support for efficacious actions, as well as to favor a broader perspective on the social context people experience.

Percepção materna quanto ao apoio social recebido no cuidado às crianças prematuras no domicílio

Este estudo qualitativo objetivou conhecer a percepção das mães de crianças nascidas prematuras acerca do apoio social recebido no domicílio para o cuidado das mesmas. Incluiu 12 mães de prematuros, maiores de 20 anos, da área de cobertura das Unidades de Saúde da Família de Passo Fundo-RS. Os dados foram obtidos por meio de entrevista semi-estruturada, genograma e ecomapa. A análise evidenciou as avós como construtoras e mantenedoras do ninho social; desalento do abandono e base segura; e a inclusão social promovida pelos amigos. O apoio social não suprido centrou-se no cuidado à criança e nas atividades domésticas. A percepção das mães revela um apoio predominantemente intra-familiar, cuja expansão permitiria configurar uma rede social mais efetiva para fortalecimento do cuidado materno.

[Screening for alcohol use by pregnant women of public health care in Rio de Janeiro, Brazil]

OBJECTIVE

To assess the prevalence of suspected cases of alcohol use during pregnancy in women seeking care in public health services.

METHODS

Cross-sectional study comprising 537 women randomly selected in public maternity hospitals in Rio de Janeiro, Southeastern Brazil, from March to October 2000. A well-trained team of female interviewers used the instruments Cut-down, Annoyed, Guilty, Eye-opener (CAGE), Tolerance Cut-down, Annoyed, Eye-opener (T-ACE) and Tolerance Worry Eye-opener Annoyed Cut-down (TWEAK) to assess suspect cases of alcohol misuse. The Chi-square test was used in the analysis according to socioeconomic and demographic variables.

RESULTS

About 40% of women informed having used any type of alcoholic beverage during pregnancy. Beer was the most frequently used drink (83.9%). Depending on the measurement instrument used, estimates of alcohol misuse varied from 7.3% to 26.1%. Suspected cases of alcohol abuse were more common among non-white, older and less educated women; those not living with a partner; those reporting use of tobacco and illicit drugs either by one or both partners in a couple; and those with little social support.

CONCLUSIONS

High prevalence of suspected alcohol misuse and its overlapping with several risk factors for adverse pregnancy outcomes indicate this is an important issue of public health concern requiring continuous screening during prenatal care.

Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life

This study evaluates the association between postpartum depression and interruption of exclusive breastfeeding in the first two months of life. Cohort study of 429 infants < 20 days of age to four primary health care units in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding (outcome) was defined as the introduction of water, other types of liquids, milk, or formulas or any food. Postpartum depression was assessed using the Edinburgh Post-Natal Depression Scale. Associations between variables were expressed as prevalence ratios (baseline) and risk ratios (follow-up), with their respective 95% confidence intervals, estimated by Poisson regression with robust variance. Children of mothers with postpartum depressive symptoms were at higher risk of early interruption of exclusive breastfeeding in the first and second months of follow-up (RR = 1.46; 95%CI: 0.98-2.17 and RR = 1.21; 95%CI: 1.02-1.45, respectively). Considering mothers that were exclusively breastfeeding at the first month, postpartum depression was not associated with interruption of exclusive breastfeeding in the second month (RR = 1.44; 95%CI: 0.68-3.06). The results indicate the importance of maternal mental health for the success of exclusive breastfeeding.

Fatores associados aos problemas de saúde mental em adolescentes

O objetivo do artigo foi investigar os problemas de saúde mental de adolescentes escolares e identificar alguns aspectos individuais, sociais e familiares associados ao seu desenvolvimento. Baseia-se num inquérito epidemiológico com 1.923 alunos de 7ª/8ª séries e de 1º/2º anos de escolas públicas e privadas do município de São Gonçalo, RJ. Para aferir os transtornos psiquiátricos menores utilizou-se a escala Self-Reported Questionnarie. Foram avaliadas questões relativas aos aspectos individuais, familiares e sociais. Utilizou-se a Regressão Logística Simples, tendo a razão de chances como medida para interpretação dos resultados. Constatou-se que violência psicológica, eventos difíceis do relacionamento familiar, auto-estima, satisfação com a vida, sexo e competência na escola se mantiveram no modelo final, indicando seu potencial em comprometer a saúde mental. A apresentação dos dados pode subsidiar o desenvolvimento de políticas públicas para o atendimento do adolescente, especialmente em termos preventivo e de promoção à saúde na área de saúde mental.

Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia

O objetivo do artigo foi propor uma sistemática operativa para avaliar o processo de adaptação transcultural de instrumentos desenvolvidos em outros contextos lingüístico sócio-culturais. São feitas considerações sobre a necessidade do uso de instrumentos de aferição robustos; a importância de instrumentos "universais" que permitam sintonias transculturais; e a necessidade de partir para adaptação em contraposição ao desenvolvimento de um instrumento novo. Aborda-se a existência de controvérsias e diferentes propostas processuais na literatura e apresenta-se um modelo de adaptação. Essa síntese envolve os passos operativos dos processos de avaliação de equivalência conceitual, de itens, semântica e operacional, e apresenta um roteiro de análise psicométrica que alicerça a avaliação de equivalência de mensuração. Finalmente, reforça-se a necessidade de cuidar da qualidade da informação em estudos epidemiológicos, incluindo meticulosos processos de adaptação transcultural nas agendas de pesquisas.

Routine Dental Visits Are Associated with Tooth Retention in Brazilian Adults: the Pró-Saúde Study

OBJECTIVE

This study investigates the effect of routine visits for dental check-up on tooth loss.

METHODS

In a cross-sectional study of university employees, the Rio de Janeiro Pró-Saúde Study, tooth loss was measured as the reported number of missing teeth and routine dental visit as the reported pattern and frequency of visits to the dentist.

RESULTS

Data were obtained from 4,030 individuals (91% of eligible subjects). Odds ratio of excessive tooth loss ("many" or "all" teeth lost) was 2.20 (95% confidence interval [CI]=1.79, 2.72) for subjects who reported visiting the dentist only when in trouble and 1.17 (95% CI=0.90, 1.51) for subjects who reported visiting for routine dental checks every two years or less frequently, compared with those who reported visiting for dental checks at least annually, after controlling for age, sex, education, income, race, smoking, and diet.

CONCLUSIONS

There was a positive effect of routine visits for dental check-up on maintaining teeth. This effect was the same for one year and two years or longer intervals between check-ups.

Sofrimento psíquico entre policiais civis: uma análise sob a ótica de gênero

O objetivo deste trabalho é investigar a existência de sofrimento psíquico entre policiais civis, segundo diferenças de gênero. Analisa dados de pesquisa anterior sobre condições de trabalho, saúde e qualidade de vida desses profissionais, usando métodos quantitativo e qualitativo. No presente estudo são considerados e testados alguns dados do questionário aplicado à amostra estatisticamente representativa de 2.746 (80,8% homens e 19,2% mulheres) policiais civis da cidade do Rio de Janeiro, Brasil, segundo a variável gênero e inserção nos distintos estratos de organização da atividade policial (setores administrativo, técnico e operacional). Apresenta um breve panorama das características sócio-econômicas, das condições de trabalho, dos problemas de saúde e da qualidade de vida desses policiais, destacando as informações em que a variável gênero aparece como fator diferenciador. O Self-Reported Questionaire (SRQ-20) é o instrumento a partir do qual se investigou sofrimento psíquico. Os resultados não indicam diferença de sofrimento psíquico entre os gêneros, mas apontam para a existência de diferenças significativas em alguns itens da escala. As policiais, sobretudo as técnicas, apresentam maiores proporções em relação aos homens. Esses achados são corroborados por algumas pesquisas anteriores.

Maternal social and pyschological conditions and physical growth in low-income children in Piauí, Northeast Brazil

Prevalence of child undernutrition remains high in many developing countries. In settings with scarce resources, modifiable maternal social conditions may influence feeding and parenting practices, in turn affecting child growth. This study aims to quantify the association between maternal social support and depression to children's physical growth outcomes in Teresina, Piauí, northeast Brazil. Interviews were conducted with a random sample of 595 mothers of children 6-24 months old in four low-income sections of Teresina, Piauí. We collected data on sociodemographic factors, mothers' social support, mothers' depressive symptomatology, and child's weight and recumbent length. Weight-for-height z-scores (WHZ), height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) were calculated using the National Center for Chronic Disease Prevention and Health Promotion Center SAS program based on the 2000 Centers for Disease Control reference growth curves. Multivariable linear regression was used to model the association between maternal social support and depression to child growth, adjusting for biological and socio-demographic variables. Interviewer and neighborhood variation was accounted for through the inclusion of random effects. In adjusted models, material support, measured by number of friends or family members available to mothers when needing food or milk, was related to 0.3 higher average WHZ and 0.2 higher average WAZ in their children. Maternal positive social interaction, which reflects engagement in leisure-time activities with others, was associated with 0.3 higher average WHZ. Mothers' affectionate support was related to 0.2 higher average children's WHZ and WAZ, whereas social support for resolving a conflict was associated with 0.2 lower average HAZ. Maternal depression was not associated with child growth. It is concluded that inadequate growth in children may be sensitive to maternal social support.

Psychometric properties of the Portuguese version of the Conflict Tactics Scales: Parent-child Version (CTSPC) used to identify child abuse

This article follows another, which presented the first phase of the cross-cultural adaptation process examining the psychometric properties of the Conflict Tactics Scales, Parent-child Version (CTSPC), Portuguese version. Fieldwork took place in three public maternity wards in Rio de Janeiro, Brazil, from March to September 2000. Interviews relate to siblings of randomly selected live births. Respondents were mothers. Information on partners was obtained by proxy. Almost all intra-observer reliability kappa estimates were above 0.75. Depending on the scale and type of perpetrator, internal consistency (a) estimates ranged from 0.49 to 0.68. Using the same sample, the iterated principal factor analysis identified four dimensions. Although most items performed well, some failed to adequately load in their expected factors. Construct validity involved exploring the relationship between several other theoretical dimensions and a variable encompassing the cumulative pattern of violence severity. All the hypotheses tested were corroborated. The current evaluation indicates that the CTSPC can be recommended for use in Portuguese-speaking contexts. Still, it also identified some important points needing further investigation and discussion.