What have adolescents in Rio de Janeiro city, Brazil, done to reduce their community violence exposure? / O que os adolescentes do município do Rio de Janeiro, Brasil, têm feito para reduzir sua exposição à violência comunitária?

This study aims to identify the individual community strategies to avoid violence exposure most used by adolescents from public and private schools in the IX Administrative Region of Rio de Janeiro and investigate the profile of co-occurrence and its prevalence in specific population subgroups. This is a cross-sectional study with 693 individuals. A multidimensional questionnaire collected information regarding strategies to avoid community violence exposure and was self-completed in the classroom. The most used strategies were avoiding walking close to armed people (55.5%), avoiding walking alone (30.5%), and avoiding returning home at dawn (24.7%). Girls adopt more of all (concurrently) the four limiting behaviors to reduce their community violence exposure (53% vs. 32%). Notably, the adoption of such strategies differed by socioeconomic indicators and was higher among adolescents from lower-income households. These findings point to the high frequency of use of such strategies by adolescents, which may hinder and limit the full development of their social and cultural skills.

O objetivo do estudo é conhecer as estratégias individuais mais utilizadas por adolescentes de escolas públicas e privadas da IX Região Administrativa do município do Rio de Janeiro para evitar a exposição à violência comunitária, bem como investigar o perfil de coocorrência e sua prevalência em subgrupos populacionais específicos. Trata-se de um estudo seccional com 693 indivíduos. As informações referentes às estratégias para evitar a exposição à violência comunitária foram coletadas por meio de questionário multidimensional autopreenchido em sala de aula. As estratégias mais utilizadas foram: evitar passar onde há pessoas armadas (55,5%), evitar andar sozinho (30,5%) e evitar voltar para casa de madrugada (24,7%). Observou-se que as meninas adotam mais todos (concomitantemente) os quatro tipos de comportamento limitantes para reduzir sua exposição à violência comunitária (53% vs. 32%). Ressalta-se que a adoção de tais estratégias diferiu segundo os indicadores socioeconômicos, sendo maior entre os adolescentes oriundos de família de estratos de renda mais baixos. Tais achados chamam a atenção para a alta frequência de utilização de tais estratégias por adolescentes, o que pode cercear e limitar o pleno desenvolvimento de suas habilidades sociais e culturais.

O que os adolescentes do município do Rio de Janeiro, Brasil, têm feito para reduzir sua exposição à violência comunitária? / What have adolescents in Rio de Janeiro city, Brazil, done to reduce their community violence exposure?

Resumo O objetivo do estudo é conhecer as estratégias individuais mais utilizadas por adolescentes de escolas públicas e privadas da IX Região Administrativa do município do Rio de Janeiro para evitar a exposição à violência comunitária, bem como investigar o perfil de coocorrência e sua prevalência em subgrupos populacionais específicos. Trata-se de um estudo seccional com 693 indivíduos. As informações referentes às estratégias para evitar a exposição à violência comunitária foram coletadas por meio de questionário multidimensional autopreenchido em sala de aula. As estratégias mais utilizadas foram: evitar passar onde há pessoas armadas (55,5%), evitar andar sozinho (30,5%) e evitar voltar para casa de madrugada (24,7%). Observou-se que as meninas adotam mais todos (concomitantemente) os quatro tipos de comportamento limitantes para reduzir sua exposição à violência comunitária (53% vs. 32%). Ressalta-se que a adoção de tais estratégias diferiu segundo os indicadores socioeconômicos, sendo maior entre os adolescentes oriundos de família de estratos de renda mais baixos. Tais achados chamam a atenção para a alta frequência de utilização de tais estratégias por adolescentes, o que pode cercear e limitar o pleno desenvolvimento de suas habilidades sociais e culturais.

Abstract This study aims to identify the individual community strategies to avoid violence exposure most used by adolescents from public and private schools in the IX Administrative Region of Rio de Janeiro and investigate the profile of co-occurrence and its prevalence in specific population subgroups. This is a cross-sectional study with 693 individuals. A multidimensional questionnaire collected information regarding strategies to avoid community violence exposure and was self-completed in the classroom. The most used strategies were avoiding walking close to armed people (55.5%), avoiding walking alone (30.5%), and avoiding returning home at dawn (24.7%). Girls adopt more of all (concurrently) the four limiting behaviors to reduce their community violence exposure (53% vs. 32%). Notably, the adoption of such strategies differed by socioeconomic indicators and was higher among adolescents from lower-income households. These findings point to the high frequency of use of such strategies by adolescents, which may hinder and limit the full development of their social and cultural skills.

Challenges in operationalizing conceptual models in aetiological research.

Conceptual or theoretical models are crucial in developing causal hypotheses and interpreting study findings, but they have been underused and misused in aetiological research, particularly in dentistry and oral epidemiology. Good models should incorporate updated evidence and clarify knowledge gaps to derive logical hypotheses. Developing models and deriving testable hypotheses in operational models can be challenging, as seen in the four examples referred to in this commentary. One challenge concerns the theoretical validity of the model, while another relates to difficulties in operationalizing abstract concepts. A third challenge refers to the lack of sufficient information in the dataset to test partially or even the whole model. Finally, a common challenge is the application of a conceptual model to different contexts. Among the existing methodological approaches to operationalize conceptual models, causal graphs may be helpful, especially when combined with approaches from diverse disciplinary fields via triangulation.

Mental Health and Emotional Disorders During the COVID-19 Pandemics: Prevalence and Extent in PICU Staff.

OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.

Measurement of depression in the Brazilian population: validation of the Patient Health Questionnaire (PHQ-8).

We aimed to evaluate the psychometric properties of the Brazilian version of the Patient Health Questionnaire (PHQ-8). A study with a sample of 4,170 individuals (≥ 15 years old) from the urban area. Conglomerate sampling was adopted in two stages (census sectors and streets), with weighting of estimates by sample weights. A structured questionnaire with sociodemographic data, the PHQ - the modules for depression, generalized anxiety disorder and panic disorder - and the Self-Reporting Questionnaire (SRQ-20) were used. In the evaluation of the PHQ-8, we verified the construct validity by analyzing the dimensional structure, convergent validity and internal consistency. We found a linear disorder without losses to maintain the four response categories. The factor analysis found unidimensionality of the depression construct, with strong factor loads, low residual variances, low residual correlation between items, good fit of the model, internal consistency and satisfactory convergent factorial validity (high loads and correlations with other tests/scales of similar constructs). The PHQ-8 has a one-dimensional structure with evidence of good validity and reliability, being suitable for use in the Brazilian population.

Correction: Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra­BR study.

[This corrects the article DOI: 10.1371/journal.pone.0250925.].

Structural validity of the Conflict in Adolescent Dating Relationships Inventory (CADRI): A reduced version for use on respondents as victims and perpetrators.

OBJECTIVES: To evaluate CADRI's configural and metric structures and explore its performance from the perspective of the respondents as perpetrators and victims. In the process, we present shorter versions for both roles. METHODS: The sample consisted of 561 adolescents aged 15 and 19, enrolled in public and private schools in Rio de Janeiro, Brazil. Initially, confirmatory factor analyzes (CFA) tested the originally proposed dimensional structure. Since this model was rejected, the second step analyzed the data via Exploratory Structural Equation Models (ESEM) to reassess the instrument's structure. Applying a decision algorithm on a new dimensional structure, we proceeded to reduce the number of items to establish separate sets for victimization and perpetration. These final models were then analyzed via CFA to assess their psychometric properties. RESULTS: The final solutions contained 15 items comprising four and three factors for victimization and perpetration, respectively. Thirteen items were common to both models, but two were unique to their respective sets. Regardless of their small differences, the final solutions fitted adequately, held factorial item pertinence and unambiguity, contained reliable and non-redundant items, and sustained factor-based convergent and discriminant validities. CONCLUSION: The four and three-factor models were within the dimensional bounds proposed in the original CADRI, the shorter scales still succeeding in partially capturing what was envisaged in the first version of the instrument. However, the shorter versions suggested here are still tentative, thus requiring further examination.

Adult oral health-related quality of life instruments: A systematic review.

OBJECTIVES: To identify the existing OHRQoL instruments for adults, describe their scope (generic or specific), theoretical background, validation type and cross-cultural adaptation. METHODS: A systematic search was conducted, and articles presenting validation of OHRQoL instruments in adults were included. Data were collected about the validation type: external validation (correlations/associations); or internal validation (factor analysis/principal components analysis, item response theory); and cross-cultural adaptation. RESULTS: Of 3730 references identified, 326 were included reporting 392 studies. Forty-two original instruments were found among 74 different versions, 40 generic and 34 condition-specific. Locker's theoretical framework was the predominant model. The oral health impact profile (OHIP) presented 20 versions, with OHIP-14 being the most frequent (26.8%), followed by geriatric oral assessment index (GOHAI) (14.0%), OHIP-49 (11.7%) and oral impacts on daily performances (OIDP) (9.7%). Most studies focused on external validation (65.3%), while internal validation was reported in 24.8% (n = 26) of OHIP-14 studies, 50.9% (n = 28) of GOHAI and 21.1% (n = 8) of OIDP studies. Most internal validation studies were conducted in English-speaking countries (n = 33), and cross-cultural adaptation was mostly in non-English-speaking European countries (n = 40). CONCLUSIONS: Many generic and condition-specific instruments were found, but few have gone through a rigorous internal validation process or have undergone cross-cultural adaptation. This, in turn, makes it difficult for researchers to choose an appropriate measure based on known psychometric properties. OHIP-14, OIDP and GOHAI seem to be the most widely validated instruments. Equalizing measurement properties for comparability are challenging due to theoretical heterogeneity. Future studies should assess psychometric properties, explore the factorial structure and work towards a consensus on critical issues.

The Role of Income on the Relationship Between the Brazilian Cash Transfer Program (Programa Bolsa Família) and Intimate Partner Violence: Evidence From a Multigroup Path Analysis.

Several initiatives are being proposed to reduce the incidence of intimate partner violence (IPV) worldwide. Actions aimed at women's economic empowerment through income transfer programs are one of those. Still, the literature on their impact is scarce and controversial. This study attempts to shed some light on this matter assessing whether the Brazilian Conditional Cash Transfer Program (Programa Bolsa Família [PBF]) is a protective factor for psychological and physical IPV against women in families of different levels of income. This is a cross-sectional, household-based study conducted in the city of Duque de Caxias, Rio de Janeiro, Brazil. The sample comprised 807 women reporting some intimate relationship in the 12 months before the interview. Information on IPV and participation on PBF were collected through face-to-face interviews using the Revised Conflict Tactics Scales (CTS2) and a direct question, respectively. A multigroup path analysis was applied to study the relations between PBF and psychological and physical IPV, considering confounding factors, some mediators, and moderation by income. The prevalence of both psychological and physical IPV are high, be it in the poverty and the extreme poverty income strata (psychological IPV: 66.2% and 72.7%, respectively; physical IPV: 26.2% and 40.6%, respectively). Results also showed a positive and direct association between PBF and psychological violence, yet only among families above the poverty line (ß = .287, p = .001). The same could be found regarding physical violence, but the effect of PBF was indirect, mediated by psychological violence (ß = .220, p = .003). Findings suggest that actions aimed at preventing IPV should go hand in hand with the PBF and, perhaps, other income transfer programs. This is even more relevant in relation to the less extreme poverty group where cash transfer may further raise conflicts and violence.

Measurement of depression in the Brazilian population: validation of the Patient Health Questionnaire (PHQ-8) / Mensuração da depressão na população brasileira: validação do Questionário de Saúde do Paciente (PHQ-8) / Medición de la depresión en la población brasileña: validación del Cuestionario de Salud del Paciente (PHQ-8)

We aimed to evaluate the psychometric properties of the Brazilian version of the Patient Health Questionnaire (PHQ-8). A study with a sample of 4,170 individuals (≥ 15 years old) from the urban area. Conglomerate sampling was adopted in two stages (census sectors and streets), with weighting of estimates by sample weights. A structured questionnaire with sociodemographic data, the PHQ - the modules for depression, generalized anxiety disorder and panic disorder - and the Self-Reporting Questionnaire (SRQ-20) were used. In the evaluation of the PHQ-8, we verified the construct validity by analyzing the dimensional structure, convergent validity and internal consistency. We found a linear disorder without losses to maintain the four response categories. The factor analysis found unidimensionality of the depression construct, with strong factor loads, low residual variances, low residual correlation between items, good fit of the model, internal consistency and satisfactory convergent factorial validity (high loads and correlations with other tests/scales of similar constructs). The PHQ-8 has a one-dimensional structure with evidence of good validity and reliability, being suitable for use in the Brazilian population.

O objetivo deste estudo foi avaliar as propriedades psicométricas da versão brasileira do Questionário de Saúde do Paciente (Patient Health Questionnaire; PHQ-8). Realizamos um estudo com uma amostra de 4.170 indivíduos (≥ 15 anos) em área urbana. A amostragem por conglomerado foi adotada em duas etapas (setores censitários e ruas) com ponderação das estimativas por pesos amostrais. Foi utilizado questionário estruturado com dados sociodemográficos, o PHQ - com módulos para depressão, transtorno de ansiedade generalizada e transtorno do pânico - e o Questionário de Autorrelato (Self-Reporting Questionnaire; SRQ-20). Uma desordem linear sem perdas foi encontrada para manter as quatro categorias de resposta. A análise fatorial revelou unidimensionalidade do construto depressão com cargas fatoriais fortes, baixas variâncias residuais, baixa correlação residual entre os itens, bom ajuste do modelo, consistência interna e validade fatorial convergente satisfatória e altas correlações com outros instrumentos de construtos semelhantes. O PHQ-8 possui estrutura unidimensional com evidência de boa validade e confiabilidade, sendo adequado para uso na população brasileira.

El objetivo de este estudio fue evaluar las propiedades psicométricas de la versión brasileña del Cuestionario de Salud del Paciente (Patient Health Questionnaire; PHQ-8). Se trata de un estudio con una muestra de 4.170 individuos (≥ 15 años) en un área urbana. El muestreo por conglomerados fue adoptado en dos etapas (sectores censuales y calles) con ponderación de las estimaciones por pesos muestrales. Los instrumentos utilizados fueron un cuestionario estructurado con datos sociodemográficos, el PHQ -con módulos para depresión, trastorno de ansiedad generalizada y trastorno de pánico- y el Cuestionario de Autoinforme (Self-Reporting Questionnaire; SRQ-20). Al evaluar el PHQ-8 se verificó la validez de su construcción a través de su estructura dimensional, validez convergente y consistencia interna. Se encontró un desorden lineal sin pérdidas para mantener las cuatro categorías de respuesta. El análisis factorizado encontró unidimensionalidad del constructo depresión con fuertes cargas factoriales, bajas varianzas residuales, baja correlación residual entre ítems, buen ajuste del modelo, consistencia interna y satisfactoria validez factorial convergente (altas cargas y correlaciones con otras pruebas/escalas de constructos similares). El PHQ-8 tiene una estructura unidimensional con evidencia de buena validez y confiabilidad, y es adecuado para su uso en la población brasileña.

Prevalence and co-occurrence of Adverse Childhood Experiences: a school-based survey in Rio de Janeiro. / Prevalência e coocorrência de Experiências Adversas na Infância: um inquérito de base escolar no município do Rio de Janeiro.

This study aimed to estimate the prevalence of categories of adverse childhood experiences (ACE) among high school students in Rio de Janeiro, investigate the ACE co-occurrence profile, and examine the distribution of exposure to ACE according to individual, family, socioeconomic, and school characteristics. A cross-sectional study was conducted with 681 individuals selected using a complex random sampling design. Exposure to ACE categories was identified using a cross-culturally adapted version of the Childhood Trauma Questionnaire (CTQ) and direct questions. We calculated prevalence and correlation between ACE pairs and determined the co-occurrence profile of childhood adversities. The findings reveal that the most common adversities were emotional abuse and neglect and biparental family dissolution. Seventy percent of the sample reported having been exposed to at least one ACE and 9% had been exposed to four or more. Around 20% of respondents reported exposure to abuse and neglect and 9% to the co-occurrence of abuse, neglect, and absence of at least one parent during childhood. The most vulnerable subgroups were girls and respondents who were born to teenage mothers, not living with both parents, studying at public schools, and from low-income families. The high prevalence and co-occurrence profile of ACE reveals the need for wide-ranging intersectoral policies designed to prevent adverse childhood experiences and provide victim support.

Este estudo tem como objetivos estimar a prevalência de Experiências Adversas na Infância (EAI), investigar o seu perfil de coocorrência e sua distribuição de acordo com características individuais, familiares, socioeconômicas e escolares de adolescentes de escolas públicas e privadas de uma Região Administrativa do Rio de Janeiro. Trata-se de um estudo seccional com 681 indivíduos, selecionados através de amostragem aleatória complexa. As EAI foram identificadas através do questionário QUESI e perguntas diretas. Estimou-se as prevalências e a correlação entre pares das EAI e o perfil de coocorrência das EAI. Os resultados revelaram que abuso e negligência emocionais e dissolução da família biparental foram as adversidades mais comuns. Setenta por cento da amostra sofreu pelo menos uma EAI e 9%, quatro ou mais. Cerca de 20% vivenciou abuso e negligência e 9% a coocorrência de abuso, negligência e ausência de pelo menos um genitor durante a infância. Os subgrupos mais vulneráveis foram: meninas, filhos de mães adolescentes, os que não moravam com ambos os pais, os de escola pública e os de baixa renda. As altas prevalências e o perfil de coocorrência das adversidades sugerem que as políticas voltadas à prevenção e ao acolhimento de vítimas sejam abrangentes e multissetoriais.

Prevalência e coocorrência de Experiências Adversas na Infância: um inquérito de base escolar no município do Rio de Janeiro / Prevalence and co-occurrence of Adverse Childhood Experiences: a school-based survey in Rio de Janeiro

Resumo Este estudo tem como objetivos estimar a prevalência de Experiências Adversas na Infância (EAI), investigar o seu perfil de coocorrência e sua distribuição de acordo com características individuais, familiares, socioeconômicas e escolares de adolescentes de escolas públicas e privadas de uma Região Administrativa do Rio de Janeiro. Trata-se de um estudo seccional com 681 indivíduos, selecionados através de amostragem aleatória complexa. As EAI foram identificadas através do questionário QUESI e perguntas diretas. Estimou-se as prevalências e a correlação entre pares das EAI e o perfil de coocorrência das EAI. Os resultados revelaram que abuso e negligência emocionais e dissolução da família biparental foram as adversidades mais comuns. Setenta por cento da amostra sofreu pelo menos uma EAI e 9%, quatro ou mais. Cerca de 20% vivenciou abuso e negligência e 9% a coocorrência de abuso, negligência e ausência de pelo menos um genitor durante a infância. Os subgrupos mais vulneráveis foram: meninas, filhos de mães adolescentes, os que não moravam com ambos os pais, os de escola pública e os de baixa renda. As altas prevalências e o perfil de coocorrência das adversidades sugerem que as políticas voltadas à prevenção e ao acolhimento de vítimas sejam abrangentes e multissetoriais.

Abstract This study aimed to estimate the prevalence of categories of adverse childhood experiences (ACE) among high school students in Rio de Janeiro, investigate the ACE co-occurrence profile, and examine the distribution of exposure to ACE according to individual, family, socioeconomic, and school characteristics. A cross-sectional study was conducted with 681 individuals selected using a complex random sampling design. Exposure to ACE categories was identified using a cross-culturally adapted version of the Childhood Trauma Questionnaire (CTQ) and direct questions. We calculated prevalence and correlation between ACE pairs and determined the co-occurrence profile of childhood adversities. The findings reveal that the most common adversities were emotional abuse and neglect and biparental family dissolution. Seventy percent of the sample reported having been exposed to at least one ACE and 9% had been exposed to four or more. Around 20% of respondents reported exposure to abuse and neglect and 9% to the co-occurrence of abuse, neglect, and absence of at least one parent during childhood. The most vulnerable subgroups were girls and respondents who were born to teenage mothers, not living with both parents, studying at public schools, and from low-income families. The high prevalence and co-occurrence profile of ACE reveals the need for wide-ranging intersectoral policies designed to prevent adverse childhood experiences and provide victim support.

Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra­BR study.

BACKGROUND: Handgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years. METHODS: Participants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) participants comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of participants falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) participants. RESULTS: Across strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided. CONCLUSION: NRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures.

Pathways Linking Childhood Physical Abuse to Alcohol Misuse in Adolescent Boys and Girls: A Prospective Cohort Study From Rio de Janeiro, Brazil.

OBJECTIVE: The purpose of this study was to identify if childhood physical abuse is a risk factor for adolescent alcohol misuse and the specific pathways linking childhood physical abuse and alcohol misuse in boys and girls. METHOD: The study enrolled 785 students from the baseline and first wave of a prospective cohort study developed at six high schools in Rio de Janeiro, Brazil. The Childhood Trauma Questionnaire (CTQ), Conflict Tactics Scale-Form R (CTS-1), and Alcohol Use Disorders Identification Test (AUDIT) were used to identify childhood and adolescence physical abuse and alcohol misuse, respectively. Multigroup path analysis was performed to explore the postulated pathways between the exposures and outcomes. RESULTS: Childhood physical abuse was a significant risk factor for alcohol misuse in adolescence for both sexes. Among girls, childhood physical abuse increased the risk of adolescent revictimization and school delay, which were mediators between childhood physical abuse and alcohol misuse. Among boys, childhood physical abuse has a direct effect on increasing the risk of alcohol misuse. School delay was also a mediator from more social determinants to alcohol misuse in both sexes, whereas not living with the mother in adolescence mediated such effects only among boys. CONCLUSIONS: Childhood physical abuse increases the risk of alcohol misuse in adolescence through different pathways in boys and girls. Strategies aimed at reducing alcohol misuse and other mental health problems in adolescence should incorporate such specificities.

Violence against children and adolescents in Manaus, Amazonas State, Brazil: a descriptive study of cases and evaluation of notification sheet completeness, 2009-2016. / Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016.

OBJECTIVE: to describe cases of violence against children and adolescents and completeness of notification forms registered on the Notifiable Health Conditions Information System (Sinan), Manaus, Amazonas, Brazil, 2009-2016. METHODS: this was a descriptive study based on 38 fields of the notification form held on the information system; analysis of completeness was based on the criteria proposed by the Ministry of Health. RESULTS: 69.3% of the 10,333 reported cases occurred among female children, and parents and step-parents were the perpetrators in 43.0% of cases; among adolescents, about » (24.9%) of cases were committed by friends/acquaintances; sexual violence was the most reported type of violence in both groups; field completeness ranged from 15.1% (occupation) to 100.0% (several fields). CONCLUSION: in contrast to the national scenario, sexual violence was the most reported form of violence in Manaus, indicating that other types of violence are underestimated; data quality points to the need for Sinan improvement in Manaus.

Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016 / Violencia contra niños y adolescentes en Manaus, estado de Amazonas, Brasil: estudio descriptivo de los casos y evaluación de la completitud de las fichas de notificación, 2009-2016 / Violence against children and adolescents in Manaus, Amazonas State, Brazil: a descriptive study of cases and evaluation of notification sheet completeness, 2009-2016

Objetivo: descrever os casos de violência contra crianças e adolescentes e a completude das fichas de notificação registradas no Sistema de Informação de Agravos de Notificação (Sinan), Manaus, Amazonas, Brasil, 2009-2016. Métodos: foi realizado estudo descritivo, considerando-se 38 campos da ficha de notificação no sistema; a análise da completude embasou-se nos critérios propostos pelo Ministério da Saúde. Resultados: dos 10.333 casos registrados, 69,3% ocorreram entre crianças do sexo feminino, e em 43,0% o agressor tinha relação parental com a vítima; entre os adolescentes, aproximadamente » (24,9%) dos agressores foram amigos/conhecidos; a violência sexual foi a mais notificada em ambos os grupos; a completude dos campos variou de 15,1% (ocupação) a 100,0% (vários campos). Conclusão: diferentemente do cenário nacional, a violência sexual foi a mais notificada no município, indicando subestimação dos demais tipos de violência; a qualidade dos dados aponta para a necessidade de aprimoramento do Sinan em Manaus.

Objetivo: describir los casos de violencia contra niños y adolescentes y la integridad de los formularios de notificación registrados en el Sistema de Información de Enfermedades de Notificación (Sinan), Manaus, Amazonas, Brasil, 2009-2016. Métodos: se realizó un estudio descriptivo de 38 campos del formulario de notificación del sistema; el análisis de integridad se basó en los criterios propuestos por el Ministerio de Salud. Resultados: el 69,3% de los 10.333 casos reportados ocurrieron entre niñas, con padres y padrastros como los principales agresores (43,0%); entre los adolescentes, aproximadamente » (24,9%) fue cometido por amigos/conocidos; la violencia sexual fue la más reportada en ambos grupos; la integridad del campo varió de 15,1% (ocupación) a 100,0% (campos múltiples). Conclusión: en contraste con el escenario nacional, la violencia sexual fue la más reportada en la ciudad, lo que indica que también se necesita capacitación para detectar otros tipos de violencia; la calidad de los datos apunta a la necesidad de mejorar el Sinan en Manaus.

Objective: to describe cases of violence against children and adolescents and completeness of notification forms registered on the Notifiable Health Conditions Information System (Sinan), Manaus, Amazonas, Brazil, 2009-2016. Methods: this was a descriptive study based on 38 fields of the notification form held on the information system; analysis of completeness was based on the criteria proposed by the Ministry of Health. Results: 69.3% of the 10,333 reported cases occurred among female children, and parents and step-parents were the perpetrators in 43.0% of cases; among adolescents, about » (24.9%) of cases were committed by friends/acquaintances; sexual violence was the most reported type of violence in both groups; field completeness ranged from 15.1% (occupation) to 100.0% (several fields). Conclusion: in contrast to the national scenario, sexual violence was the most reported form of violence in Manaus, indicating that other types of violence are underestimated; data quality points to the need for Sinan improvement in Manaus.

Childhood abuse and community violence: Risk factors for youth violence.

OBJECTIVE: To investigate the joint effect of child abuse and neglect (CAN) and community violence (CV) on adolescents with peers that commit youth violence (YV). METHODS: This is a school-based cross-sectional study of 699 students enrolled in four public and nine private schools in the municipality of Rio de Janeiro, Brazil. Participants were selected through a complex cluster sampling procedure. CAN was identified using the Childhood Trauma Questionnaire (CTQ). Exposure to CV was assessed by asking students if they have witnessed cases of lethal violence in the community. YV was measured indirectly through questions about having friends who have committed acts of crime. Multivariate logistic models were used to study the effects of emotional, physical, and sexual abuse and emotional and physical neglect in childhood on YV, controlled for confounders, according to different levels of CV. RESULTS: Emotional abuse OR = 3.32 (CI 95%: 1.79-6.17), sexual abuse OR = 2.33 (CI 95%: 1.20-4.54), and physical neglect OR = 1.81 (CI 95%: 1.02-3.20) increased the odds of YV in adolescents, whether cooccurring with CV or not. Physical abuse OR = 3.95 (CI 95%: 2.29 - 6.80) and emotional neglect OR = 2.93 (CI 95%: 1.83-4.72) are only risk factors for YV involvement when associated with CV. CONCLUSIONS: These findings highlight the relevance of CAN and CV as risk factors for YV and the potential increase in adolescents' vulnerability when exposed to both. Policies aiming at preventing and dealing with CAN are essential strategies to reduce YV, especially in areas with high levels of CV.

Women economic empowerment via cash transfer and microcredit programs is enough to decrease intimate partner violence? Evidence from a systematic review.

Intimate partner violence (IPV) is a worldwide public health problem. Many proposals aiming to eliminate its occurrence include the empowerment of women through their socio-economic development. In this context, some studies suggested that microcredit programs (MP) and cash transfer programs (CTP) are initiatives that can also reduce the risk of IPV. Others pointed to an opposite effect. The objective of this study was to investigate the influence of women's economic empowerment in MP and CTP on the risk of physical, psychological and sexual violence through a systematic review. Papers/documents selection was conducted by two researchers according to the following criteria: published in English, Portuguese or Spanish; primary data; assessing the effect of MP or CTP on IPV; in heterosexual couples; on women beneficiaries of the intervention; using a comparator group eligible for an MP or CTP; and focusing on risk IPV as the outcomes. Our results showed that the impact of MP are mixed when it comes to physical and physical/sexual violence. Even so, the review suggests that the effect of MP on sexual violence is trivial or nonexistent. Regarding the impact of CTPs, the present study showed that the effects on physical, physical/sexual, psychological, and sexual violence were also heterogeneous. Women more empowered and with some autonomy could be at risk. Despite that, participation in the empowerment program should be encouraged for poor women and families. However, parallel interventions to lead with IPV should be addressed to the main actions to reduce the risk of increasing IPV prevalence in certain scenarios.

Validity of the factorial structure of the Brazilian version scale of the Food Choice Questionnaire. / Validade da estrutura fatorial da escala de versão brasileira do Food Choice Questionnaire.

This study examines the dimensional structure and reliability of the 36-item Food Choice Questionnaire (FCQ) in a Brazilian Portuguese version, an instrument used to measure the importance of motives behind food choices. The sample includes 502 adults. Confirmatory factorial analysis (CFA) were used to evaluate the configural (dimensionality) and metric (magnitude of factorial loadings, residual correlations and factorial discriminatory validity) structures of the instrument. Internal consistency evaluation used the Omega coefficient (Ω); temporal reproducibility used the Kappa coefficient with quadratic weighting (κ) in a separate sample of 41 subjects. The final CFA corroborates the 9-factor original structure and shows high factorial loadings (λi > 0.80 in 34 items); two residual correlations (r(i2-i3) = 0.773 and r(i16 i17) = 0.853); and factorial correlations indicating factor discriminant validity (φ < 0.80). Regarding reliability, there is adequate internal consistency (Ω = 0.877 to 0.968), and good test-retest reproducibility indicating temporal stability (κ = 0.768 to 0.917). It can be concluded that the FCQ version has good configural and metric properties, and may be recommended for use in Brazil in its present form.

Este estudo examinou a estrutura dimensional e a confiabilidade da versão em português brasileiro do Food Choice Questionnaire (FCQ) de 36 itens, instrumento utilizado para medir a importância dos motivos que levam às escolhas alimentares. A amostra incluiu 502 adultos. Utilizou-se análises fatoriais confirmatórias (AFC) para avaliar a estrutura configural (dimensionalidade) e métrica (magnitude de cargas fatoriais, correlações residuais e validade fatorial discriminante). A avaliação de consistência interna usou o coeficiente ômega (Ω); a reprodutibilidade temporal usou o coeficiente Kappa com ponderação quadrática (κ) em uma amostra separada de 41 indivíduos. A AFC final corrobora a estrutura original de 9 fatores e mostra altas cargas fatoriais (λi > 0,80 em 34 itens); duas correlações residuais (r(i2-i3) = 0,773 e r(i16i17) = 0,853); e correlações fatoriais indicando validade fatorial discriminante (φ < 0,80). Quanto à confiabilidade, há adequada consistência interna (Ω = 0,877 a 0,968) e boa reprodutibilidade teste-reteste indicando estabilidade temporal (κ = 0,768 a 0,917). Conclui-se que a versão do FCQ possui boas propriedades configurais e métricas, já podendo ser recomendada para uso no Brasil na sua presente forma.