[Cross-cultural adaptation of the Portuguese version of the Conflict Tactics Scales Form R (CTS-1) used to assess marital violence: semantic and measurement equivalence]

"Everything That Is Here, I Have Lived": A Triangulated Analysis of an Intimate Partner Violence Assessment Tool in Curitiba, Brazil

Using a mixed-methods triangulation approach we piloted the Composite Abuse Scale-Brazilian version (CAS-Brazil) at the House of the Brazilian Woman of Curitiba among 62 survivors of intimate partner violence and four professionals serving survivors to assess its feasibility for use. Quantitative data were tabulated using descriptive statistics while qualitative data were recorded, coded, and thematically analyzed. Four qualitative domains emerged: (a) conceptual understanding; (b) item definitions; (c) women's experiences; and (d) professionals' perspectives. Comprehension of the CAS-Brazil appeared high across participants from diverse backgrounds. Professionals viewed it as highly feasible for use in Brazilian cross-sectoral services to support survivor decision-making.

The relationship of general, physical, and psychological violence with depressive symptoms and cognition in elders (cross-sectional study)

OBJECTIVES

to analyze the relationship of general, physical, and psychological violence with depressive symptoms and cognition in the elderly.

METHODS

quantitative, cross-sectional study, carried out with 323 elders from the Brazilian northeast. Data collection used a sociodemographic instrument; the Conflict Tactics Scales Form R; the Geriatric Depression Scale; and the Mini-Mental State Examination. The analysis employed descriptive and inferential statistics.

RESULTS

as violence increases, so do the depressive symptoms; the opposite was true when comparing violence with cognitive involvement. There is a correlation between physical and psychological violence and depressive symptoms; more depressive elders are from 1.96 to 3.00 times more likely to be the victims of psychological and physical violence, respectively.

CONCLUSIONS

general, physical, and psychological violence is associated with depressive symptoms; those with less cognitive alterations are more vulnerable to abuse. Elders with depressive symptoms are more likely to suffer psychological and physically violence.

Intimate partner physical violence and inadequate weight gain in pregnancy

Abstract Objectives: to evaluate the association between intimate partner physical violence (IPPV) and inadequate gestational weight gain (GWG). Methods: cross-sectional study composed of 554 women who attended four Basic Health Units in the city of Rio de Janeiro between 2005 and 2009. The GWG was calculated through the difference between the final weight of pregnancy and pre-gestational weight. For the measurement of IPPV, the Portuguese version of the Conflict Tactics Scales (CTS-1) was used. Data analysis was based on multinomial logistic regression models, estimating odds ratios and respective 95% confidence intervals for associations between the variables of interest. Results: the prevalence of minor and severe IPPV was 31.6% and 16.3%, respectively. Almost two-thirds of the women had insufficient or excessive GWG. After adjusting the model, it was observed that the presence of IPPV increased by 1.66 (CI95%=1.05-2.64) times the chances of insufficient GWG, compared to couples who did not experience this type of violence. Concerning the excessive GWG, the associations with IPPV were not statistically significant. Conclusion: women who experience IPPV in their relationships are more likely to have insufficient GWG during pregnancy. From this perspective, prenatal care becomes an essential service for screening domestic violence and its possible repercussions.

Rape, Child Sexual Abuse, and Mental Health in a Brazilian National Sample

The objective of this study is to evaluate the prevalence of self-reported rape and its associations with other forms of violence and mental health outcomes. The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey that collected data from 4,283 Brazilians aged 14 years and older in 2012. The prevalence of rape was 2.3% (n = 107) and the majority (n = 81) of rapes were reported by women. Female gender increased the chances of rape (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] = [1.7, 4.3]). Adults aged 35 to 46 years (AOR = 2.0, 95% CI = [1.2, 4.4]) and being without religion (AOR = 2.2, 95% CI = [1.3, 3.8]) were also associated with increased chances of rape. Participants with a history of childhood sexual abuse (CSA) were 16.5 times (95% CI = [10.1, 26.7]) more likely to report having been raped. Other outcomes related to been raped were history of child prostitution (AOR = 5.1, 95% CI = [2.1, 13.4]) and witnesses of violence during childhood (AOR = 2.4, 95% CI = [1.5, 3.8]). People without social support (AOR≅3, 95% CI = [1.8, 4.3]), victims of multiple recent negative events (AOR = 3.7, 95% CI = [2.4, 5.8]), people with depression (AOR = 2.6, 95% CI = [1.7, 3.9]), history of suicidal ideation (AOR = 3.8, 95% CI = [2.0, 7.1]), and history of suicide attempts (AOR = 2.2, 95% CI = [1.1, 4.3]) are other outcomes related to having been raped. In this sample, rape was related to gender and to other forms of violence and victimization. Self-reports of rape appear to underestimate the true prevalence as the figures obtained from the survey were low. Other methods should be used to investigate this issue.

Violence among community elderly and its relationship with the nutritional status and sociodemographic characteristics

OBJECTIVE

To verify the prevalence of violence among elderly community members and its relationship with nutritional status and sociodemographic characteristics.

METHOD

Cross-sectional and analytical study developed with 159 community elderly registered at a Family Health Unit in Recife/Pernambuco between March 2016 and March 2017. The Brazil Old Age Schedule, Conflict Tactics Scales and Mini Nutritional Assessment were used as data collection instruments. Data received descriptive and inferential statistical treatment.

RESULTS

Among the elderly classified as with violence, there was a predominance of psychological violence (64.3%), and the majority were at risk for malnutrition (54.3%). There was an association between 'having a partner' and psychological (48.1%; p=0.02) and physical (48.1%; p=0.03) violence. Logistic regression demonstrated that being in a relationship or being malnourished increases the likelihood of suffering psychological violence (OR=2.63; OR=3.67), just as not being working increases the likelihood of physical violence (OR=5.61).

CONCLUSION

Violence was negatively related to the nutritional status of elderly community members.

Victimization and perpetration of intimate partner violence among elderly people: a cross-sectional study, Florianópolis, Santa Catarina, Brazil, 2013/2014

OBJECTIVE

VTo verify prevalence of intimate partner violence among elderly people and to identify associated factors.

METHODS

This was a cross-sectional population-based study using data from the EpiFloripa Idoso Study, with elderly people living in Florianópolis, Santa Catarina, Brazil, between 2013 and 2014. Prevalence rates were described and factors associated using Poisson regression were analyzed, for violence suffered and perpetrated, stratified by sex.

RESULTS

Among 651 elderly people, 48.3% of males and 46.4% of females suffered intimate partner violence. Psychological violence suffered (48.3% and 44.8%) and perpetrated (49.8% and 44.5%) predominated in males and females, respectively. Perpetrated violence was associated with poor/very poor self-perceived health (PR=1.74) among males, and with regular self-perceived health (PR=1.53) and separated/divorced marital status (PR=1.86) among females.

CONCLUSION

Symmetry was found between the sexes for prevalence of intimate partner violence, for all directionalities of violence analyzed.

Intimate partner violence, breastfeeding, breastmilk substitutes and baby bottle use in the first year of life

This article aims to investigate the relationship between intimate partner physical violence (IPPV) and breastfeeding (BF), use of breastmilk substitutes (BMS) and bottle-feeding among children aged 12 to 15 months. This is a cross-sectional study with mothers in primary care facilities of the city of Rio de Janeiro. IPPV was identified by the Brazilian version of the Conflict Tactics Scales 1-Form R and feeding practices were identified by a 24-hour Dietary Recall. Associations were verified by logistic regression with odds ratio (OR) estimates and 95% confidence intervals. BF was offered to 58.5% of the children and BMS to 88.5%. Also, 70.5% of the children used a baby bottle. Physical violence was observed in 26.7% of couples. Households where couples physically abuse each other are more likely to not breastfeed (OR=2.14, p-value=0.030), to use breastmilk substitutes (OR=5.15, p-value=0.03) and bottle-feed (OR=2.71; p-value=0.01), when compared to households without physical violence. The results highlight the need to investigate intrafamily relationships in cases where inadequate breastfeeding practices are identified, and to enable health professionals to support families in conflict situations.

Validation of Questionnaire on Violence in Affective Relationships

The aim was to describe the criteria for construction, validation of content, and appearance of a questionnaire for the identification of violence in affective relationships in adolescence. Transverse methodological study, with a quantitative approach, conducted in the period between June and November 2017, with the construction of a questionnaire and validation of the content and appearance, by means of a Delphi survey with 20 experts on the area of violence and adolescence. To evaluate the clarity and pertinence of the items of the questionnaire, a pilot test was conducted with 76 adolescents, and analysis of the validity of content and reliability of the items by means of Content Validity Index (CVI), the Interrater Agreement (IRA), and the Cronbach alpha. The data were analyzed and processed by means of the Excel and Stata, version 14.0, programs. The indexes calculated in the first round of Delphi provided the following results: CVI = 0.93 and IRA = 0.93, showing evidence of the validity and reliability of the construct content, and in the second round, the questionnaire yielded a percentage of 100% agreement among the professionals and researchers. Verification of the internal consistency presented a mean value of 0.803, calculated by means of the Cronbach alpha. The questionnaire has validity of content and appearance in accordance with the proposed objective, bearing in mind that the indexes of faithfulness and agreement and the Cronbach alpha attained values above those of the established pattern of 80%.

Association of the functional capacity and violence in the elderly community

OBJECTIVE

To analyze the relationship between the functional capacity of elderly community members and the sociodemographic and violence characteristics.

METHODS

Cross-sectional, epidemiological, analytical study with 159 elderly people. For data collection, a questionnaire was used for sociodemographic characterization; the Katz, Lawton and Brody scale; a questionnaire adapted from the FIBRA network; and the Conflict Tactics Scales, analyzed using descriptive and inferential statistics using Pearson's chi-square test, Fisher's exact test and multiple logistic regression models.

RESULTS

It was observed that the sociodemographic variables influence the prevalence of functional dependence for basic activities of daily living and reduction in advanced activities in elderly people with psychological and physical violence.

CONCLUSION

The dependence of the elderly for basic and intermediate activities is related to characteristics such as advanced age, work exercise and knowing how to read and write. The participants' functional dependence can favor violent outcomes, whether physical or psychological.

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS)

OBJECTIVE

To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals.

METHODS

The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older.

RESULTS

3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM.

CONCLUSION

The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.

Frailty Syndrome: A Risk Factor Associated With Violence in Older Adults

OBJECTIVE

The objective of this study was to analyze the association between frailty syndrome as a risk factor associated with violence in older adults.

METHOD

A cross-sectional study, carried out with older adults, in an emergency care unit of a northeastern Brazilian city was conducted. Three instruments were used: a form for sample characterization (i.e., demographics) and two more scales, namely, the Edmonton Frail Scale and the Hwalek-Sengstock Elder Abuse Screening Test. The results were analyzed through descriptive and inferential statistics, using chi-square or Fisher's exact tests, Spearman's correlation test, and simple logistic regression.

RESULTS

The sample included 146 older adults who were over 70 years old (56.6%), male (56.2%), and at risk of violence (69.86%). Among the categorical variables, there was an association between risk and being of a higher age (80.7%, p < 0.001), unemployed (73.7%, p < 0.05), having more than six children (80.8%, p < 0.05), and frail older adults (88.1%, p < 0.001). There was a correlation (p < 0.05) between the numerical variables of the scales of violence and frailty, with a coefficient of 0.40. The simple logistic regression model showed that frailty syndrome increases the risk of violence among older adults.

CONCLUSIONS

It was concluded that frailty is a factor that increases the occurrence of risk of violence and provides information to guide nursing action in the field of forensic sciences.

Factors associated with depressive symptoms and cognition in elderly victims of violence

ABSTRACT Objective: To identify, among elderly people victims of violence, factors associated with depressive symptoms and cognitive function. Method: This was a cross-sectional study carried out with 56 elderly people classified in situation of violence. To do so it was used the Brazil Old Age Shedule (BOAS), the Conflict Tactics Scales Form R, the Geriatric Depression Scale (GDS) and the Mini-mental State examination (MMSE). Results: Depressive symptoms were more predominant in elderly men, over 70 years old, without partner, illiterate, with no job, receiving up to 1 minimum wage and who lived alone; and the cognitive deficit prevailed in women, over 70 years old, without partner, illiterate, who did not work, receiving up to 1 minimum wage and who lived alone. Conclusion: Among the elderly population victim of violence, lack of a partner and cognitive impairment were associated to depressive symptoms; and finding themselves living alone, with no partner and being illiterate were associated to cognitive deficit.

Abusive alcohol consumption among adolescents: a predictive model for maximizing early detection and responses

OBJECTIVE

To present a predictive model of alcohol abuse among adolescents based on prevalence projections in various population subgroups.

STUDY DESIGN

Cross-sectional study.

METHODS

The sample consisted of 785 adolescents enrolled in the second year of high school in Rio de Janeiro, Brazil. Alcohol consumption was assessed using the Alcohol Use Disorder Identification Test. Socio-economic, demographic, family, individuals, and school-related variables were examined as potential predictors. The logit model was used to estimate the prevalence projections. Model fitting was examined in relation to the observed data set, and in a subset, that was generated from 200 subsamples of individuals via a bootstrap process using general fit estimators, discrimination, and calibration measures.

RESULTS

About 25.5% of the adolescents were classified as positive for alcohol abuse. Being male, being 17-19 years old, not living with mothers, presenting symptoms suggestive of binge eating, having used a strategy of weight reduction in the last 3 months, and, especially, being a victim of family violence were important predictors of abusive consumption of alcohol. While the model's prevalence projection in the absence of these features was 8%, it reaches 68% in the presence of all predictors.

CONCLUSIONS

Knowledge of predictive characteristics of alcohol abuse is essential for screening, early detection of positive cases, and establishing interventions to reduce consumption among adolescents.

Cross-sectional study on the association between frailty and violence against community-dwelling elderly people in Brazil

BACKGROUND

The physical, emotional and cognitive limitations that may be present in the aging process, coupled with family unpreparedness, may lead to greater dependence among the elderly. This favors development of frailty syndrome and greater levels of violence against the elderly. The objective here was to analyze the association between violence against the elderly and frailty; and the geographic distribution of violence against the elderly according to the presence of frailty syndrome.

DESIGN AND SETTING

Cross-sectional study on 705 community-dwelling elderly people in Uberaba (MG), Brazil.

METHODS

The Fried frailty phenotype and conflict tactics scale were used. Data were analyzed using descriptive statistics, the chi-square test and a logistic regression model. The intensity of the events and the relationship between clusters of violence and frailty status were assessed by means of kernel estimation.

RESULTS

The adjusted analysis indicated that pre-frailty and frailty were associated with physical and verbal aggression (odds ratio, OR = 1.51; 95% confidence interval, CI: 1.04-2.19; OR = 2.12; 95% CI: 1.29-3.47), frailty was associated with physical aggression (OR = 2.48; 95% CI: 1.25-4.94) and pre-frailty and frailty were associated with verbal aggression (OR = 1.48; 95% CI: 1.03-2.15; OR = 2.15; 95% CI: 1.31-3.52), respectively. Regardless of frailty status and its relationship with violence, clusters of occurrences were larger in similar regions in the southeastern part of the municipality; but superimposition of overlays relating to aggression showed that for frail individuals the clusters were smaller than for non-frail and pre-frail individuals.

CONCLUSIONS

The condition of frailty was associated with greater chances of violence against the elderly.

Prevalência de violência por parceiro íntimo em idosos e fatores associados: revisão sistemática

Resumo Este artigo tem por objetivo identificar a prevalência de violência por parceiro íntimo (VPI) em idosos e seus fatores associados. Realizou-se revisão sistemática de estudos transversais de base populacional nas bases de dados PubMed, Lilacs e PsycInfo, sem restrições quanto ao período e idioma de publicação. Dois revisores independentes conduziram a seleção, extração dos dados e análise de qualidade metodológica. Dezenove artigos foram selecionados para análise. Houve variação do tipo de violência, sexo dos entrevistados e instrumentos utilizados. A maioria dos estudos apresentou qualidade metodológica moderada ou alta. A VPI ocorreu em homens e mulheres idosos, sendo mais prevalentes a violência psicológica e o abuso econômico. Os fatores associados mais frequentes foram o consumo de álcool, depressão, baixa renda, comprometimento funcional e exposição pregressa à violência.

Prevalence of physical intimate partner violence in the first six months after childbirth in the city of Rio de Janeiro, Brazil

The aim of the study was to estimate the prevalence of physical intimate partner violence in the first six months after childbirth among women attending primary care clinics (UBS) for the infant's follow-up in Rio de Janeiro, Brazil. This is the first study on the theme using a representative sample of primary care clinics in the city of Rio de Janeiro. The study used a cross-sectional design from June to September 2007 and included 927 mothers/infants seen at 27 UBS, selected by complex sampling, geographically representative of the city. The information was collected in face-to-face interviews by a previously trained team, using a structured questionnaire. History of physical intimate partner violence from the child's birth to the date of the interview was obtained with the Brazilian version of the Revised Conflict Tactics Scales (CTS2). Thirty percent (95%CI: 26.2-33.8) of mothers reported having experienced some form of physical intimate partner violence in the postpartum and 14% (95%CI: 11.0-17.0) reported severe physical violence. The physical abuse occurred especially among black teenage mothres, in unfavorable socioeconomic situation, that did not live with the partner and that had received inadequate or no prenatal care and reported difficulties in breastfeeding and use of healthcare services. The widespread occurrence of physical intimate partner violence emphasizes the urgent need to deal with the problem. Primary healthcare services must be linked to other support networks and health professionals need to be prepared to deal with the problem.

Psychometric properties of the Vulnerability to Abuse Screening Scale for screening abuse of older adults

OBJECTIVE

Adapt and evaluate the psychometric properties of the Vulnerability to Abuse Screening Scale to identify risk of domestic violence against older adults in Brazil.

METHODS

The instrument was adapted and validated in a sample of 151 older adults from a geriatric reference center in the municipality of Belo Horizonte, State of Minas Gerais, in 2014. We collected sociodemographic, clinical, and abuse-related information, and verified reliability by reproducibility in a sample of 55 older people, who underwent re-testing of the instrument seven days after the first application. Descriptive and comparative analyses were performed for all variables, with a significance level of 5%. The construct validity was analyzed by the principal components method with a tetrachoric correlation matrix, the reliability of the scale by the weighted Kappa (Kp) statistic, and the internal consistency by the Kuder-Richardson estimator formula 20 (KR-20).

RESULTS

The average age of the participants was 72.1 years (DP = 6.96; 95%CI 70.94–73.17), with a maximum of 92 years, and they were predominantly female (76.2%; 95%CI 69.82–83.03). When analyzing the relationship between the scores of the Vulnerability to Abuse Screening Scale, categorized by presence (score > 3) or absence (score < 3) of vulnerability to abuse, with clinical and health conditions, we found statistically significant differences for self-perception of health (p = 0.002), depressive symptoms (p = 0.000), and presence of rheumatism (p = 0.003). There were no statistically significant differences between sexes. The Vulnerability to Abuse Screening Scale acceptably evaluated validity in the transcultural adaptation process, demonstrating dimensionality coherent with the original proposal (four factors). In the internal consistency analysis, the instrument presented good results (KR-20 = 0.69) and the reliability via reproducibility was considered excellent for the global scale (Kp = 0.92).

CONCLUSIONS

The Vulnerability to Abuse Screening Scale proved to be a valid instrument with good psychometric capacity for screening domestic abuse against older adults in Brazil.

Acceptance of Dating Violence Scale: Checking its psychometric properties

Abstract Violence by intimate partners is a cause of concern in several countries, including Brazil. Although some instruments that measure this phenomenon have been found, the Acceptance of Couple Violence Scale (ACVS) has proven to be a brief measure with satisfactory psychometric properties. For this reason, we have sought to investigate its psychometric properties in Brazilian samples. The ACVS was subjected to two studies. Study 1 indicated a two-factor structure with satisfactory internal consistency. Study 2 showed that a three-factor structure, which is in agreement with the original study, is more plausible than one- and two-factor models, with its reliability varying from 0.61 to 0.80. In addition, a correlation was found between the factor of female violence and social desirability, which suggests that future studies should take this variable into account. It was concluded that the ACVS is a valid and precise measure and that it may be used in future studies.

Intimate partner violence and early interruption of exclusive breastfeeding in the first three months of life

The aim of this study was to investigate the role of intimate partner violence in the early interruption of exclusive breastfeeding in the first three months of life. We used data from a prospective cohort of 564 children attending four primary health clinics in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding was defined as a child receiving any kind of liquid or solid, regardless of breast milk intake, measured by a 24 hour recall. The Portuguese version of the Conflict Tactics Scales (CTS-1) was used to assess intimate partner violence. Associations were expressed as prevalence ratios and relative risks and their respective 95% confidence intervals. Children of mothers who experienced severe violence had 30% greater likelihood of early interruption of exclusive breastfeeding in the second month of life as compared to those who did not experience this type of violence. Strategies in health services for promoting exclusive breastfeeding should consider identifying and addressing family violence.

Physical intimate partner violence and low birth weight in newborns from primary health care units of the city of Rio de Janeiro

ABSTRACT Objective To investigate the association between physical intimate partner violence and low birth weight. Methods This cross-sectional study included 604 children with approximately 30 days of age who visited four primary health care units in the city of Rio de Janeiro , Brazil, for the second dose of hepatitis B vaccine. Children with a birth weight below 2.500 g were considered underweight. Information regarding physical intimate partner violence was obtained by the Portuguese version of the Conflict Tactics Scale. The study investigated the 12 months prior to interview. Physical intimate partner violence was analyzed as a dichotomous variable and cumulatively. Associations between physical intimate partner violence and low birth weight were verified by logistic regression models based on crude and adjusted odds ratios and their respective 95% confidence intervals. Results Some (7.1%) babies were born underweight, and 33.6% of the mothers had been exposed to physical intimate partner violence. Physical intimate partner violence was significantly associated with low birth weight (OR=3.69; 95%CI=1.57-8.66). Notably, the odds of low birth weight increase with the severity of violence. Conclusion These findings draw attention to the consequences of physical intimate partner violence on the nutritional status of newborns and emphasize the need of greater attention during prenatal care to improve women's quality of life and to reduce the rate of low birth weight.

[Adolescent dating in Brazil: the circularity of psychological violence in different relationship contexts]

The scope of this paper is to evaluate the perpetration of psychological violence in current male and female dating relationships and their link to psychological violence experienced in other contexts of their lives, namely family, relationships with friends and dating partners. 3,205 students in the 2nd year of high school (15 to 19 years old) in public and private schools in ten Brazilian cities filled out a closed and self-administered questionnaire. The results highlight the fact that the increase in the number of psychologically violent events perpetrated by adolescents in their intimate relationships is related to greater verbal aggression of the mother and father, and the more frequent experiences of psychological violence between parents, siblings, friends and that existing in earlier dating relationships. This reinforces the notion of circularity of psychological violence in various contexts of socialization of adolescents and highlights the continuity of aggressive behavior in other dating relationships, and those between siblings, family and friends.

Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional

Investigou-se a associação entre sexo e violência física entre parceiros íntimos. Encontrou-se prevalência de sofrer qualquer violência física (17%), violência física moderada (16,6%) e violência física grave (7,3%). Não houve diferença significativa para violência física moderada em homens e mulheres, porém, quanto mais grave o ato maior a ocorrência deste nas mulheres. Por meio de regressão logística testou-se a associação da violência com o sexo, ajustando-se às variáveis exploratórias. Mulheres de maior idade, viúvas/separadas, pobres, menos escolarizadas e pretas registram maior probabilidade de sofrer violência. Nos homens, a prevalência de violência física grave apresentou alteração significativa apenas para estado civil. Uso abusivo de álcool por mulheres representou maior chance de sofrer violência física.

HDL-cholesterol concentrations are inversely associated with Edinburgh Postnatal Depression Scale scores during pregnancy: results from a Brazilian cohort study

Serum lipids have been associated with depression in the adult population; however, this association during pregnancy remains unclear. The aim of this study was to evaluate the association between serum lipids and depressive symptom scores during pregnancy. A prospective cohort of 238 pregnant women was followed at the 5th-13th, 20th-26th and 30th-36th weeks of gestation. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Serum concentrations (mg/dL) of triglycerides, total cholesterol, and low- and high-density lipoproteins (LDL-c; HDL-c) were the main exposures. Marital status (married/single), physical activity (active or very active/low or very low active), unplanned pregnancy (no/yes), pre-pregnancy BMI (<25/≥ 25 kg/m(2)), generalized anxiety disorder (no/yes) and current suicidal ideation (no/yes) were considered as potential confounders. Analyses were performed using linear mixed-effects models. The results showed that the EPDS mean score (95%CI) decreased with time during pregnancy trimesters [1st: 8.89 (95%CI = 8.28-9.51), 2nd: 7.32 (95%CI = 6.67-7.97) and 3rd: 7.08 (95%CI = 6.41-7.74)]. Suicidal ideation frequency at baseline was 18%. HDL-c concentrations were inversely associated with changes in EPDS score (β = -0.080, 95%CI = -0.157 to -0.002), while low or very low active women (β = 1.288, 95%CI = 0.630-1.946), with single marital status (β = 1.348, 95%CI = 0.163-2.534), unplanned pregnancy (β = 1.922, 95%CI = 0.714-3.131), generalized anxiety disorder (β = 2.139, 95%CI = 0.410-3.868) and current suicidal ideation (β = 1.927, 95%CI = 0.596-3.258) tended to have higher EPDS scores. No relationship was observed between other lipids and EPDS scores. HDL-c concentration was inversely associated with changes in depressive symptom scores during pregnancy after adjusting for socio-economic, demographic, behavioral, nutritional, biochemical and mental health disorders.

Cultural adaptation to Brazil of the questionnaire Costs of caring for children with cancer

OBJECTIVE

to present the cultural adaptation of the questionnaire Costs of caring for children with cancer, offering a valid and reliable tool to assess the economic repercussions of childhood cancer for Brazilian families.

METHOD

it is a methodological research with a cross-sectional design. The methodological framework to validate the questionnaire was a combined process that included seven steps: translation to Portuguese; first translated consensus version; evaluation by Expert Committee; consensus on the Expert Committee version; back-translation; consensus of back-translated versions; semantic validation. The study was conducted in two phases: phase one was the translation and back-translations process, with five expert committee members. Phase two was the semantic validation, with 24 participants, who answered an instrument about their impressions of the questionnaire and suggested modifications.

RESULTS

in phase one, items were included, excluded, and replaced to make the content equivalent and valid for use with Brazilian context. In phase two, the majority of the participants were mothers, who made suggestions about the relevance and clarity of the items in the questionnaire.

CONCLUSIONS

the authors discussed these recommendations and made adaptations, turning the questionnaire into a valid and reliable tool for application.

Family and community violence of schoolchildren from the city of São Gonçalo, Rio de Janeiro, Brazil

This descriptive study aimed to investigate the association between violence in the family, school and community experienced by school children/adolescents of the city of São Gonçalo (RJ), Brazil. Questionnaires were administered to the mothers/guardians to assess violence in the family and school and to children to check their perceptions of community violence. Multiple correspondence analysis and cluster analysis, two exploratory descriptive techniques, were employed. Data from 280 schoolchildren were analyzed. A total of 43.9% of mothers reported that their children had been physically abused in their homes. With regard to children's/adolescents' perception of community violence, 93.2% said they had experienced or witnessed these events in their communities. For both sexes there was the formation of a cluster of categories with the presence of violence among siblings, presence of severe physical assault and verbal assault committed by parents. Among girls, the presence of violence in the school formed a cluster with the highest category of violence in the community. In conclusion, it should be emphasized that public policies aimed at dealing with violence should expand their scope to the various forms of violence affecting children.

Resiliência, gênero e família na adolescência

Este estudo busca identificar fatores familiares que influenciam o potencial de resiliência de adolescentes meninos e meninas. É um estudo transversal com dados de um inquérito epidemiológico que contou com a participação de 889 adolescentes do 9º ano de escolas públicas e particulares de um município da região metropolitana do Rio de Janeiro, selecionados por amostragem. Variáveis sociodemográficas do adolescente, da família, dentre os quais a violência familiar, e outros fatores são estudados segundo o potencial de resiliência. Foram feitos testes de associação entre as variáveis estudadas e a resiliência, considerados ao nível de significância de 5%. Os resultados indicam que um relacionamento difícil com a mãe ou madrasta, a ausência de supervisão familiar, a presença de depressão, além da baixa utilização de estratégias de coping de distração, ativo e de suporte são fatores associados ao baixo potencial de resiliência. As variáveis morar amontoado e ter relacionamento difícil com os irmãos se mostram nocivas apenas ao poten cial de resiliência das meninas. Programas e políticas públicas necessitam trabalhar com as famílias para que compreendam as necessidades dos adolescentes como forma de prevenção dos problemas de saúde mental e promoção da saúde desta população segundo a ótica de gênero.

Family violence and body mass index among adolescents enrolled in the Bolsa Família Program and treated at a primary care clinic

This article aimed to investigate the relationship between family violence and body mass index (BMI) in adolescents whose families were enrolled in the Bolsa Família Program. The cross-sectional study included 201 adolescents of both sexes, 10 to 19 years of age, in Rio de Janeiro, Brazil, 2008-2009. BMI and physical, psychological, and verbal abuse of adolescents by their parents were evaluated. The association between family violence and BMI was measured via linear regression models. In girls, verbal abuse was directly associated with BMI, showing a significant mean increase of 2.064, 2.438, and 2.403 in BMI when perpetrated by the mother, father, and both parents, respectively. Among boys, family violence was associated with lower BMI (but without reaching statistical significance). The findings point to the need for innovative practices and approaches in the nutritional care of adolescents enrolled in the Bolsa Família Program, considering family violence as a contributing factor to inadequate nutritional status.

Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk

This study aimed to describe the prevalence of psychiatric disorders and to identify the factors associated with Current Suicide Risk (CSR) in the first trimester of pregnancy. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was employed to diagnose mental disorders in 239 women enrolled in a prospective cohort in Rio de Janeiro, Brazil. Serum lipids, leptin and socio-economic status were the independent variables. CSR, the dependent variable, was entered as binary (yes/no) variable into crude and adjusted Poisson regression models with robust variances. CSR was found to be the main psychiatric syndrome (18.4%), followed by agoraphobia (17.2%), major depressive disorder (15.1%) and generalized anxiety disorder (10.5%). Women with CSR showed higher mean levels of cholesterol (169.2 vs. 159.2; p=0.017), high density lipoprotein (50.4 vs. 47.7; p=0.031) and low density lipoprotein (102.8 vs. 95.6; p=0.022) when compared to women without CSR. The adjusted regression model showed a higher prevalence ratio (PR) of CSR among pregnant women with generalized anxiety disorder (PR=2.70, 95% CI: 1.36-5.37), with ≥ two parturitions (PR=2.46, 95% CI: 1.22-4.93), and with major depressive disorder (PR=2.11, 95% CI: 1.08-4.12). We have shown that generalized anxiety disorder, major depressive disorder and higher parity are associated with CSR in the first trimester of pregnancy.

Association between family environment and attention deficit hyperactivity disorder in children--mothers' and teachers' views

BACKGROUND

To ascertain whether factors of the family environment and gestational period are associated with the appearance of ADHD in children, as reported by various different informants (mothers and teachers).

METHODS

This paper presents results from the dataset of a longitudinal study to evaluate behavioral problems among schoolchildren in São Gonçalo, Rio de Janeiro State, in 2005 and 2006. The cross-section considered for this paper comprises records of exposure factors and ADHD. In all, 370 schoolchildren of the public school system were assessed by 3-stage cluster sampling. The Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) were used to measure outcomes. The exposure factors examined were: profile of child and mother, variables relating to the family environment, and perinatal considerations. The questions were answered by mothers and teachers. A hierarchical logistic regression model was used.

RESULTS

Precariously functioning families, lack of social support for mothers, adverse life events and discord during pregnancy were the factors associated with mother-reported ADHD. When ADHD was reported by teachers, the variables selected were: Intelligence quotient (IQ) and sex, with children with low IQ scores and boys more likely to display the disorder.

CONCLUSIONS

Assessment of ADHD by teachers or mothers reveals specific characteristics that reflect how each of these informants understands the children. This highlights the importance of using informants from different environments in diagnosing the disorder.

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.

[Family environment and attention-deficit hyperactivity disorder]

OBJECTIVE

To analyze factors associated with attention-deficit and hyperactivity disorder in children.

METHODS

This is a longitudinal study about behavior problems in schoolchildren that was carried out in the city of São Gonçalo (Southeastern Brazil) in 2005. A total of 479 students from public schools was analyzed, selected through three-stage cluster sampling. The Child Behavior Checklist was used to measure the outcome. A questionnaire was administered to parents/guardians concerning the exposure factors, which were: child's and family's profile, family relationship variables, physical and psychological violence. The log-binomial regression model with a hierarchical approach was employed in the analysis.

RESULTS

Higher intelligence quotient was inversely associated with the frequency of the disorder (PR=0.980 [95%CI 0.963;0.998]). The prevalence of the disorder in the children was higher when there was family dysfunction than among families with a better way of relating (PR=2.538 [95%CI 1.572; 4.099]). Children who suffered verbal abuse from the mother had a prevalence 3.7 times higher than the ones not exposed to this situation in the last year (PR=4.7 [95%CI 1.254;17.636]).

CONCLUSIONS

Negative family relationships are associated with symptoms of Attention-Deficit and Hyperactivity Disorder. Its association with the intelligence quotient reiterates the importance of the genetic and environmental basis at the origin of the disorder.

Socioeconomic development, family income, and psychosocial risk factors: a study of families with children in public elementary school

This article aims to evaluate the effects of Brazil's recent economic growth on the monetary income, consumption patterns, and risk exposures of families with children enrolled in the public elementary school system in São Gonçalo, Rio de Janeiro State, Brazil. The article analyzes the following information on families of 447 children that participated in two waves in a longitudinal study: social stratum, per capita family income, evolution in income over a three-year period, and psychosocial factors. The findings showed a 74.8% increase in the families' income, accompanied by an increase in the consumption of material assets and access to health services. This increase should not be interpreted as a guarantee of improved living and health conditions, since it was spent on basic products and needs that do not substantially affect the families' form of social inclusion. Psychosocial risk factors were frequent among the families, but decreased during the study period, which may either reflect the improved family situation or result from the later stage in child development.

Tradução e validação para o Brasil da escala de imagem corporal para adolescentes: offer self-image questionnaire (OSIQ)

OBJETIVO: Apreciar a equivalência semântica e de mensuração da subescala de imagem corporal do Offer Self Image Questionnaire (OSIQ). MÉTODOS: Participaram 386 adolescentes, na faixa etária de 10 a 18 anos, de ambos os sexos, de uma escola particular de ensino fundamental e médio. Realizou-se tradução, retrotradução, revisão técnica e avaliação do instrumento. Avaliou-se a consistência interna, a validade discriminante e concorrente e a confiabilidade. RESULTADOS: O instrumento apresentou, para a consistência interna, valores que variaram de 0,43 a 0,51 e foi capaz de discriminar os grupos estudados - população total, meninos, meninas, e meninos em fase inicial de adolescência, segundo o estado nutricional (p<0,001; p<0,009; p=0,030; p=0,043, respectivamente). Na validade concorrente, houve correlação significativa entre algumas medidas antropométricas somente para o sexo feminino (r=-0,16 e p=0,021; r=-0,19 e p=0,007); fase inicial (r=-0,23 e p=0,008; r=-0,26 e p=0,003) e intermediária (r=-0,29 e p=0,010) e no reteste confirmou sua confiabilidade por meio da correlação intraclasse. Embora o instrumento tenha comprovado sua capacidade em discriminar os grupos estudados, de acordo com o estado nutricional, os demais resultados foram menos satisfatórios. Mais estudos são necessários para sua adaptação transcultural, com a aplicação de outras escalas comparativas. CONCLUSÃO: A subescala de imagem corporal do OSIQ encontra-se traduzida, no entanto, os resultados apresentados não são promissores, exigindo-se mais estudos.

Violence and injuries in Brazil: the effect, progress made, and challenges ahead

Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26·8 per 100,000 people and traffic-related mortality was 23·5 per 100,000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport system that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.

Validity of the WHO VAW study instrument for estimating gender-based violence against women

OBJECTIVE

To validate the instrument of the World Health Organization Violence Against Women (WHO VAW) study on psychological, physical and sexual violence against women perpetrated by intimate partners.

METHODS

This was a cross-sectional study conducted in several countries between 2000 and 2003, including Brazil. Representative random samples of women aged 15-49 years with intimate partners were selected, living in the city of São Paulo (n = 940) and in the Zona da Mata, Pernambuco (n = 1,188), southeastern and northeastern regions, respectively. Exploratory factor analysis on questions relating to violence was performed (four psychological, six physical and three sexual questions), with varimax rotation and creation of three factors. Cronbach's alpha was calculated to analyze the internal consistency. To validate through extreme groups, mean scores (0 to 13 points) for violence were tested in relation to the following outcomes: self-rated health, daily activities, presence of discomfort or pain, suicidal ideation or attempts, heavy alcohol consumption and presence of common mental disorders.

RESULTS

Three factors were defined, with similar accumulated variance (0.6092 in São Paulo and 0.6350 in the Zona da Mata). For São Paulo, the first factor was determined by physical violence, the second by sexual violence and the third by psychological violence. For the Zona da Mata, the first factor was formed by psychological violence, the second by physical violence and the third by sexual violence. Cronbach's alpha coefficients were 0.88 in São Paulo and 0.89 in the Zona da Mata. The mean scores for violence were significantly higher for less favorable outcomes, with the exception of suicide attempts in São Paulo.

CONCLUSIONS

The instrument was shown to be adequate for estimating gender-based violence against women perpetrated by intimate partners and can be used in studies on this subject. It has high internal consistency and a capacity to discriminate between different forms of violence (psychological, physical and sexual) perpetrated in different social contexts. The instrument also characterizes the female victim and her relationship with the aggressor, thereby facilitating gender analysis.

A violência doméstica contra idosos nas áreas de abrangência do Programa Saúde da Família de Niterói (RJ, Brasil)

Este artigo investiga a magnitude e as características da violência contra idosos no domicílio por pessoas de confiança no bairro da Ilha da Conceição, em Niterói (RJ), adscritos ao Programa Saúde da Família. Através de um inquérito domiciliar, foram entrevistados 343 indivíduos com 60 anos ou mais, selecionados por amostragem aleatória simples. Para identificação de violência usou-se a Escala Tática de Conflitos. As informações sobre identificação, características demográficas e socioeconômicas foram obtidas pela Pesquisa Nacional por Amostra de Domicílio. Avaliou-se a saúde mental pelo Miniexame do Estado Mental. Para avaliação da capacidade funcional, usou-se o Health Assessment Questionnaire. Quanto à suspeita de uso de álcool pelos homens, utilizou-se o instrumento CAGE; para a idosa ou cuidadora, o instrumento TWEAK. 43% relataram pelo menos um episódio de violência psicológica. A violência física foi relatada por 9,6% dos entrevistados; 6,1% referiram ocorrência de violência física grave nesse período. A prevalência das diversas modalidades de violência foi maior entre os mais novos, com maior escolaridade, entre os que apresentam uma das patologias que caracterizam o idoso como tendo uma vulnerabilidade (depressão e/ou incontinência urinária/fecal e/ou diabetes e/ou reumatismo) e entre os que moram com maior número de indivíduos.

[Cross-cultural adaptation of section A of the Cambridge Examination for Mental Disorders of the Elderly-Revised Version (CAMDEX-R) for dementia diagnosis]

This article concerns the first phase of the cross-cultural equivalence of Section A in the Cambridge Examination for Mental Disorders of the Elderly-Revised Version (CAMDEX-R), a clinical interview for dementia diagnosis. Evaluating conceptual and item equivalencies involved a literature review and expert groups. Semantic equivalence involved translations of the original into Portuguese and back-translations, with analysis of the versions and the original text; meetings with experts; discussions with 52 elders using the focus group technique; further meeting with experts; pretesting on 35 elders; and elaboration of the final version. For the reliability analysis, the version was applied to 160 patients. Inter-observer reliability was nearly perfect in all sub-sections of present state and in individual items of past medical history. Test-retest reliability was moderate or higher in the sub-sections and substantial or nearly perfect in 70% of the items in past history. The Brazilian version shows satisfactory equivalence to the original and good reliability levels.

[Characteristics of access to Pap smear: three methodological stages in the adaptation of a data collection instrument]

The article describes the initial steps in the Portuguese-language adaptation of an instrument to measure characteristics of access to cervical cancer prevention. A universalist approach was adopted to assess conceptual, item, and semantic equivalence. The methodology included a literature review and participation by both experts and women representing the general population. Conceptual and item equivalence was established with participation by experts. Semantic equivalence was analyzed in five stages. Two translations into Portuguese and two back-translations into English were performed independently and evaluated by a third researcher from the public health field. The back-translations showed good referential and connotative similarity to the original, and a consensus version was formulated. Twenty-eight women participated in the pretest, eight of whom in the focus group format. The version proved comprehensible, underwent some modifications, and is ready for the complementary stages in the cross-cultural adaptation process.

[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.

Equivalência conceitual, de itens e semântica da versão brasileira do instrumento Dysfunctional Voiding Scoring System (DVSS) para avaliação de disfunção do trato urinário inferior em crianças

Investiga-se a equivalência conceitual, de itens e semântica entre o instrumento Dysfunctional Voiding Scoring System (DVSS), utilizado para avaliar a disfunção funcional do trato urinário inferior em crianças, concebido em inglês e uma versão em português. Na primeira etapa realizou-se a avaliação da equivalência conceitual e de itens, seguida de duas traduções do instrumento original para o português. Na segunda etapa foram realizadas 63 entrevistas, com crianças de 3 a 10 anos e responsáveis, e modificação de itens segundo dificuldades de interpretação. Na terceira etapa foi realizada a retradução do instrumento em português para o inglês e avaliação da equivalência semântica. Na quarta etapa, a versão pré-teste foi aplicada em vinte duplas de crianças de 3 a 10 anos e responsáveis. Apresenta-se o instrumento em português com equivalência conceitual, de itens e semântica. Sugere-se que a aplicação do DVSS seja realizada por meio de entrevista por profissional treinado e não baseada em autopreenchimento como proposto no instrumento original.

Violência e transtorno de estresse pós-traumático na infância

O artigo apresenta a prevalência dos sintomas de transtorno de estresse pós-traumático (TEPT) em crianças escolares (6-13 anos) do município de São Gonçalo, Rio de Janeiro. Investiga também a associação entre TEPT, violência e outros eventos de vida adversos. O processo de amostragem utilizado foi por conglomerados em três estágios de seleção. Quinhentos pais dos estudantes foram entrevistados sobre o comportamento de seus filhos. Para avaliar os sintomas de TEPT, foi utilizado a Child Behavior Checklist -Posttraumatic Stress Disorder Scale (CBCL). Também foi aplicada a Escala Tática de Conflitos (CTS), que avalia violência familiar, e outros instrumentos que investigam o perfil socioeconômico da criança, a relação familiar, as características da criança e outros eventos de vida difíceis. Foi construído um modelo hierárquico de variáveis associadas ao TEPT, a partir do critério de 5% de significância. A prevalência dos sintomas de TEPT foi 6,5%. A análise estatística multivariada sugeriu um modelo explicativo de TEPT caracterizado por dezoito variáveis, como algumas características da criança, específicos eventos de vida adversos, violência familiar e outros fatores familiares. Os resultados revelam a necessidade de se trabalhar com a criança em momentos de sua vida especialmente difíceis, com a intenção de prevenir ou minimizar o seu impacto no funcionamento mental e social.

Prevalência e fatores associados à violência entre parceiros íntimos: um estudo de base populacional em Lages, Santa Catarina, Brasil, 2007

Estimou-se a prevalência da violência entre parceiros íntimos e os fatores associados em Lages, Santa Catarina, Brasil. Realizou-se um estudo transversal de base populacional domiciliar com mulheres de 20-59 anos (n = 1.042), da zona urbana. As prevalências de agressão verbal, violência física menor e violência física grave foram estimadas pelo questionário Conflict Tactics Scales - Form R. Questões sobre aspectos sócio-econômicos e demográficos foram investigadas. As associações foram testadas pelo teste do qui-quadrado de Pearson e o de tendência linear. A prevalência de violência entre casais para agressão verbal, agressão física menor e agressão física grave foram de 79%, 14,9% e 9,3%, respectivamente. Casais com menos de trinta anos, com renda per capita inferior a meio salário mínimo mensal e vivendo em locais com mais de dois indivíduos por cômodo dormitório apresentaram maiores prevalências das violências mensuradas quando comparados com casais mais velhos, com maior rendimento e menor aglomeração, respectivamente. Programas preventivos, além de estudos qualitativos, podem ser estratégias efetivas para melhor compreender a violência entre parceiros íntimos.

Situação de crianças e adolescentes brasileiros em relação à saúde mental e à violência

Este artigo reflete sobre as violências cometidas contra crianças e adolescentes brasileiros e suas repercussões sobre a saúde mental, propondo um debate sobre a necessidade das políticas públicas de saúde priorizarem temáticas de tamanha relevância. No país, tem-se verificado que a discussão dos temas "violência e problemas de saúde mental em crianças e adolescentes" vem ocorrendo de forma fragmentada e pouco consistente. Este trabalho traz uma seleção não sistemática de estudos epidemiológicos desenvolvidos em escolas e comunidades brasileiras sobre o assunto. A ampla variedade e a prevalência da violência familiar e comunitária e dos problemas de saúde mental são apontadas, ressaltando-se as diferenças metodológicas dos métodos de aferição e a concentração de estudos nas regiões sul e sudeste do país. A ainda escassa rede de atendimento para os problemas aqui tratados é sinalizada, assim como a falta de preocupação com a prevenção do transtorno mental e com a promoção da saúde mental.

[When living with violence brings a child close to depressive behavior]

The present study investigates the relation between withdrawn/depressive behavior of schoolchildren and presence/absence of violence experienced at home, at school and in the community. This descriptive cross-sectional study is based on data from a sample of 479 schoolchildren between 6-13 years of age, attending the first grade in the public elementary schools of a city of the state of Rio de Janeiro, Brazil, 2005. The multi-stage cluster sampling strategy involved three selection stages with 50% proportion, 98% confidence level and relative error of 5%. Socio-demographic variables of the child and the family, the withdrawal/depression sub-scale (CBCL), Conflict Tactics Scale and school and community violence scale are investigated. Multivariate Correspondence Analysis indicates that the different violence victimizations tend to be closer to clinical and borderline withdrawn/depressive behavior. Programs and public policies must address the life circumstances of the child, with focus on interventions in mental health problems, violence and victimization in order to interrupt the cycle of re-victimization through violence and its consequences.

Caracterização dos casos de violência contra a mulher atendidos em três serviços na cidade de Uberlândia, Minas Gerais, Brasil

Este estudo apresenta aspectos epidemiológicos e clínicos da violência contra a mulher, utilizando três fontes de dados: prontuários médicos do Hospital de Clínicas de Uberlândia, Minas Gerais, Brasil, (HCU); fichas de atendimento da ONG SOS Ação Mulher Família (ONG SOS Mulher); laudos de perícia de lesões corporais e de necropsias do Posto Médico Legal (PML). No HCU e no PML, os atendimentos foram decorrentes principalmente por agressão física, não havendo alusão à violência psicológica nos prontuários médicos e nos laudos, revelando que em serviços de atenção primária à saúde esta violência é evidenciada somente em pesquisas pós-entrevistas com as vítimas. Na ONG SOS Mulher foram observadas principalmente as violências psicológica e física. Nas três fontes pesquisadas houve baixa ocorrência da violência sexual, corroborando dados da literatura que retrata a invisibilidade desta questão, principalmente da violência sexual conjugal sofrida pelas mulheres que buscam ajuda nesses serviços. Os dados da presente pesquisa permitem concluir que os tipos de violência contra a mulher nesses três diferentes serviços públicos de saúde e social, em Uberlândia, diferenciam-se conforme as características específicas dos serviços oferecidos nessas instituições.

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.

Assessing the physical violence component of the Revised Conflict Tactics Scales when used in heterosexual couples: an item response theory analysis

Although there are psychometric evaluations of the Revised Conflict Tactics Scales (CTS2) when applied to heterosexual relationships, none has used item response theory (IRT). To address this gap, the present paper assesses the instrument's physical violence subscale. The CTS2 was applied to 764 women who also responded for their partners. Single dimensionality assumption was corroborated. A 2-parameter logistic IRT model was used for estimating location and discriminating power of each item. Differential item functioning and item information pattern along the violence continuum were assessed. Gender differences were detected in 3 out of 12 items. Item coverage of the latent trait spectrum indicated little information at the lower ends, while plenty in the middle and upper ranges. Still, depending on gender, some item overlaps and regions with gaps could be detected. Despite some unresolved problems, the analysis shows that the items form a theoretically coherent information set across the continuum. Provided the user is aware of possible drawbacks, using the physical violence subscale of the CTS2 in heterosexual couples is still a sensible option.

Parental violence and the occurrence of severe and acute malnutrition in childhood

Evidence from developed countries has linked family violence with severe acute malnutrition (SAM), yet no similar studies have been conducted in developing countries where the risk of SAM is higher. To redress this gap, the objective of this study was to explore the role of intimate partner violence (IPV) among caregivers as an independent risk factor for SAM. A hospital-based case-control (n = 172 : 345) study was carried out in six paediatric hospitals of Rio de Janeiro (1995-99). Cases comprised children (1-24 months) admitted with SAM (weight-for-height z-score < -2 SD). Controls were children of the same age admitted for non-traumatic surgery. Couple violence was gauged through the Conflict Tactics Scales from two perspectives: (a) two ordinal variables characterising the intensity of verbal and physical aggression based on scores, and (b) a four-level variable representing a pattern of increasing violence seriousness. Unconditional logistic regression analysis was performed to control for confounding factors. Parents of SAM cases had higher Conflict Tactics scores than parents of controls, indicating more severe partner violence. The adjusted odds ratio for the comparison of the highest to the lowest scores (10 vs. 0) was 4.15 (95% confidence interval 1.55, 11.15). Using the four-level variable for violence seriousness, a threefold SAM risk was found for children with parents reporting severe physical abuse, but not for those with parents reporting verbal aggression or more minor physical assaults. In addition to traditionally studied risk factors, the findings suggest that family violence may also play an important role in SAM among children. Moreover, these findings indicate that the risk for SAM is not associated with all types of IPV, but that children exposed to severe and recurrent events are more likely to be admitted for SAM. For the prevention or early detection of SAM, this result points to a specific population group requiring rigorous public health targeting, especially in terms of accurate detection of both SAM and IPV, as well as appropriate handling and follow-up of violent families.

Uma revisão sobre instrumentos de rastreamento de violência doméstica contra o idoso

Os dados sobre violência contra o idoso são escassos no Brasil. Para estudos adequados sobre a magnitude, fatores de risco e cuidados às vítimas, é necessária documentação sistemática e acurada. Este artigo revisou os instrumentos de rastreamento e avaliação de violência no idoso visando examinar o progresso no contexto internacional e brasileiro. Utilizando as bases de dados MEDLINE, PsycINFO, LILACS, CANE, OVIDs citations e livros de referência, realizou-se uma revisão sistemática da literatura para a seleção dos instrumentos. Fez-se, também, um escrutínio dos estudos de psicometria e utilização dos instrumentos, aplicando-se critérios para avaliar a qualidade dos estudos. Dos dezessete instrumentos encontrados, somente a Conflicts Tactics Scale foi adaptada para o Brasil, ainda que para uso em um grupo etário mais jovem. Alguns outros com boas características psicométricas também foram encontrados, como o Caregiver Abuse Screen, Elder Abuse Assessment Tool, Hwalek Sengstok Abuse Screening Test, Indicators of Abuse Screen, Qualcare scale e Vulnerability to Abuse Screening Scale. Ainda assim, de forma geral, há lacunas importantes nos processos de concepção, validação e adaptação desses instrumentos no Brasil e no exterior.