Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study.

This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study.

OBJECTIVES: To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. METHODS: We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. RESULTS: The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. CONCLUSION: Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

Comportamentos agressivos de crianças na escola: evidência de validade interna da EPPCACE / Aggressive behaviors of children in school: evidence of EPPCACE internal validity / Coductas agresivas de niños en la escuela: evidencias de validez interna de la EPPCACE

O objetivo do presente estudo foi verificar se os padrões psicométricos da Escala de percepção, por professores, dos comportamentos agressivos de crianças na escola (EPPCACE) evidenciavam sua validade interna. No Estudo 1 (n = 210), foi realizada a adaptação do instrumento e executada uma análise fatorial exploratória. No Estudo 2 (n = 203), efetuou-se uma análise fatorial confirmatória. Participaram professores do ensino fundamental de escolas públicas e particulares. Esses responderam à EPPCACE e a perguntas sociodemográficas. Os resultados indicaram que o instrumento é composto por três fatores: Agressividade direcionada ao âmbito geral (α = 0,95), Comportamentos pró-sociais (α = 0,90) e Agressividade direcionada aos professores (α = 0,90). Conclui-se que a EPPCACE é válida e fidedigna, podendo auxiliar na avaliação do contexto escolar a partir da percepção do professor acerca do comportamento agressivo dos alunos. (AU)

The objective of this study was to verify whether the psychometric patterns of the Scale of teachers' perception of aggressive behavior of children in school (EPPCACE) showed evidence of its internal validity. In Study 1 (n = 210) the instrument was adapted and an exploratory factorial analysis was performed. In Study 2 (n = 203) a confirmatory factorial analysis was performed. Elementary school teachers in public and private schools participated and answered the EPPCACE and sociodemographic questions. Results indicated that the instrument is composed of three factors: Aggressiveness directed to the general scope (α = 0.95), Pro-social behaviors (α = 0.90), and Aggressiveness directed to teachers (α = 0.90). We concluded that the EPPCACE is valid and reliable, and it can help in the evaluation of the school context from the teacher's perception of the aggressive behavior of the students. (AU)

El objetivo del presente estudio fue comprobar si los patrones psicométricos de la Escala de percepción de los maestros sobre el comportamiento agresivo de los niños en la escuela (EPPCACE) evidencian su validez interna. En el estudio 1 (n = 210) se realizó la adaptación del instrumento y se ejecutó un análisis factorial exploratorio. En el estudio 2 (n = 203) se efectuó un análisis factorial confirmatorio. Participaron maestros de Enseñanza Primaria de escuelas públicas y privadas. Estos respondieron a la EPPCACE y preguntas sociodemográficas. Los resultados indicaron que el instrumento está compuesto por tres factores: agresividad dirigida al ámbito general (α = 0,95), comportamientos pro-sociales (α = 0,90) y agresividad dirigida a los maestros (α = 0,90). Se concluye que la EPPCACE es válida y fidedigna, pudiendo auxiliar en la evaluación del contexto escolar a partir de la percepción del maestro sobre el comportamiento agresivo de los alumnos. (AU)

Crenças e influências sobre dietas de emagrecimento entre obesos de baixa renda / Beliefs and influences on weight loss diets among low-income obese individuals

A obesidade tornou-se uma epidemia carente de controle imediato, principalmente entre pobres, mulheres e pessoas de baixa escolaridade. A OMS solicita e vários estudos corroboram que estudos esclarecedores sobre os comportamentos psicológicos e sociais interferentes na aderência terapêutica aos regimes devem ser encorajados. Este estudo usou a Teoria da Ação Racional - TAR, de M. Fishbein, em Psicologia Social, e comparou duas séries de entrevistas abertas (em 2001 e 2005) que eliciaram as crenças positivas (vantagens) e negativas (desvantagens) sobre fazer dieta entre obesos de baixa renda de João Pessoa, Paraíba, além dos referentes (pessoas de opinião influente) destes pacientes quanto a segui-la. Os resultados de 2001 foram corroborados em 2005, revelando o medo das doenças relacionadas à obesidade e a vontade de sentir mais saúde e leveza de corpo. Mães, filhos e principalmente o cônjuge aparecem como apoiadores do regime. Ressaltou-se que não bastaria força de vontade, mas também reflexão e construção de habilidades de controle, apropriação e modificação das condições de vida. Preocupações estéticas não foram prioritárias. Estas informações podem fomentar melhores resultados na aderência terapêutica.

Obesity has become an epidemic that requires immediate control, mainly among the poor, particularly women and the less educated. The WHO requests and several studies confirm that support is needed for research projects examining psychological and social behavior that hampers compliance with weight loss diets. This paper uses the Theory of Reasoned Action (TRA) of M. Fishbein (1975) in social psychology, comparing two series of open interviews (conducted in 2001 and 2005) that disclosed positive (advantageous) and negative (harmful) beliefs about weight loss diets among low-income obese patients in João Pessoa, Paraíba State, as well as their guides (people of influential opinion) on following their diets. The 2001 findings were corroborated in 2005, revealing fears of diseases related to obesity and the wish to feel healthier and lighter. Mothers, children and above all spouses were mentioned as diet supporters. It was stressed that will-power is not be enough, but also reflection and building up control skills, in addition to allocating and altering life styles. Concerns related to appearance were not high priority. This information may lead to better diet compliance.

[Beliefs and influences on weight loss diets among low-income obese individuals]. / Crenças e influências sobre dietas de emagrecimento entre obesos de baixa renda.

Obesity has become an epidemic that requires immediate control, mainly among the poor, particularly women and the less educated. The WHO requests and several studies confirm that support is needed for research projects examining psychological and social behavior that hampers compliance with weight loss diets. This paper uses the Theory of Reasoned Action (TRA) of M. Fishbein (1975) in social psychology, comparing two series of open interviews (conducted in 2001 and 2005) that disclosed positive (advantageous) and negative (harmful) beliefs about weight loss diets among low-income obese patients in João Pessoa, Paraíba State, as well as their guides (people of influential opinion) on following their diets. The 2001 findings were corroborated in 2005, revealing fears of diseases related to obesity and the wish to feel healthier and lighter. Mothers, children and above all spouses were mentioned as diet supporters. It was stressed that will-power is not be enough, but also reflection and building up control skills, in addition to allocating and altering life styles. Concerns related to appearance were not high priority. This information may lead to better diet compliance.

Psicologia e nutrição: predizendo a intenção comportamental de aderir a dietas de redução de peso entre obesos de baixa renda / Psychology and nutrition: predicting behavioral intention to follow weight reduction diets among low-income obese patients

O presente estudo foi realizado entre 189 obesos de baixa renda atendidos por nutricionistas na rede pública de saúde de João Pessoa, Paraíba. Levantou as crenças positivas e negativas e os referentes mais expressivos sobre estes pacientes quanto ao comportamento de seguir uma dieta médica para redução de peso. Um instrumento de medida da intenção comportamental de efetivamente seguir tais dietas foi construído, o que permitiu verificar a ênfase do aspecto normativo geral e atitudinal nos obesos com renda de até um salário-mínimo sobre sua intenção comportamental. Isto pode indicar dois pontos eficazes a serem explorados em comunicações dirigidas a esta classe social em campanhas de saúde para redução de peso. Esta medição torna-se útil para ações preventivas de saúde; a obesidade é considerada uma epidemia mundial carente de controle imediato, aumentando em incidência principalmente nas classes mais baixas dos países em desenvolvimento.

The present study was accomplished with 189 low income obese attended by public health nutritionists of João Pessoa, Paraíba. We found out positive and negative beliefs plus the most expressive referees on these patients about the behavior of following a medical diet to reduce weight. This permitted to build a behavioral intention measurement instrument to check those who might really follow these diets. It was verified the emphasis on general normative and attitudinal aspects over obese who had up to one minimum-wage income. This may indicate two efficacious points to be explored on targeted communications to this social class during weight loss public health campaigns. This measurement can be turned into preventive health actions; obesity is considered worldwide as epidemics, in need of immediate control, growing in incidence mainly among lower ranks of the population of developing countries.

Psicologia e nutrição: predizendo a intenção comportamental de aderir a dietas de redução de peso entre obesos de baixa renda / Psychology and nutrition: predicting behavioral intention to follow weight reduction diets among low-income obese patients

O presente estudo foi realizado entre 189 obesos de baixa renda atendidos por nutricionistas na rede pública de saúde de João Pessoa, Paraíba. Levantou as crenças positivas e negativas e os referentes mais expressivos sobre estes pacientes quanto ao comportamento de seguir uma dieta médica para redução de peso. Um instrumento de medida da intenção comportamental de efetivamente seguir tais dietas foi construído, o que permitiu verificar a ênfase do aspecto normativo geral e atitudinal nos obesos com renda de até um salário-mínimo sobre sua intenção comportamental. Isto pode indicar dois pontos eficazes a serem explorados em comunicações dirigidas a esta classe social em campanhas de saúde para redução de peso. Esta medição torna-se útil para ações preventivas de saúde; a obesidade é considerada uma epidemia mundial carente de controle imediato, aumentando em incidência principalmente nas classes mais baixas dos países em desenvolvimento.(AU)

The present study was accomplished with 189 low income obese attended by public health nutritionists of João Pessoa, Paraíba. We found out positive and negative beliefs plus the most expressive referees on these patients about the behavior of following a medical diet to reduce weight. This permitted to build a behavioral intention measurement instrument to check those who might really follow these diets. It was verified the emphasis on general normative and attitudinal aspects over obese who had up to one minimum-wage income. This may indicate two efficacious points to be explored on targeted communications to this social class during weight loss public health campaigns. This measurement can be turned into preventive health actions; obesity is considered worldwide as epidemics, in need of immediate control, growing in incidence mainly among lower ranks of the population of developing countries.(AU)

Métodos inovadores do tratamento da obesidade / Innovative Methods to Treat Obesity

A obesidade tornou-se uma patologia epidêmica e prioritária para estudo, e seu controle foi aconselhado em caráter emergencial pela OMS. Os resultados obtidos no controle da obesidade subsidiado por tratamento médico e dietoterapia não têm se mostrado tão eficazes. O emprego da psicologia social no tratamento da obesidade deveria ser mais explorado, considerando-se que através de abordagem cognitivo-comportamentais, tem-se obtido êxito na modificação de comportamento ligados à saúde, especialmente a Teoria da Ação Racional, que busca medir a intenção pessoal de aderir a uma modificação de hábitos para, através de comunicações persuasivas específicas, promover a adesão a comportamentos mais saudáveis. Verifica-se ainda um número pequeno de estudos contemplando Nutrição e Psicologia. Estas disciplinas estão separadas pela tradição acadêmica, mas interligam-se inevitavelmente no contexto da Saúde Pública, especialmente no tratamento da obesidade. Espera-se que futuramente a utilização desta teoria conjuntamente com o tratamento nutricional inovador leve os pacientes obesos a assumir comportamentos mais favoráveis à perda de peso, aumentando sua persistência terapêutica