One step further in mistreatment research: Assessing the scalability of the Explicit Discrimination Scale among Brazilian working-age adult respondents.

Though the Explicit Discrimination Scale (EDS) has been subjected to extensive psychometric evaluation in Brazil, the instrument has yet to be comprehensively assessed among working-age adult respondents in the country. This study aimed to fill this knowledge gap. Data from around 1200 diverse members of a cohort investigation were used to examine: (1) the positioning of respondents along the continuum of the EDS latent trait; (2) how well the corresponding items represent the EDS construct map; and (3) the extent to which the EDS items follow their expected levels of intensity. We assessed these properties with Loevinger's H, Guttman errors, and Item Response Theory parameters. Findings suggest that two abridged versions of the instrument-but especially the eight-item EDS-may adequately arrange respondents along the latent trait continuum. Analyses also revealed that scale items are reasonably spread over the construct map, with some discrepancy between the expected levels of intensity and their empirical positioning in the corresponding plot. The shortened versions of EDS have good psychometric properties among Brazilian working-age adult respondents. In addition to examining the invariance of the EDS across multiple groups, future psychometric evaluations should assess the external validity of the scale.

Factorial invariance of the abridged version of the Explicit Discrimination Scale among adults living in southern Brazil.

OBJECTIVE: The Explicit Discrimination Scale (EDS) was developed to assess experiences with discrimination in Brazilian epidemiologic surveys. Though previous analyses have demonstrated that the EDS has good configural, metric, and scalar properties, its invariance has not yet been investigated. In this study, we examined the factorial invariance of two abridged versions of the EDS, according to skin color/ethnicity, sex, socioeconomic status, and their intersections. METHODS: Data from the EpiFloripa Adult Study were used, which include a representative sample of adults residing in a state capital of southern Brazil (n=1,187). Over half of the respondents were women, and around 90% identified as white; the mean age of the participants was 39 years. Two abridged versions of the EDS were analyzed, with seven and eight items, using Multigroup Confirmatory Analysis and the Alignment method. RESULTS: The two versions of the scale may be used to provide estimates of discrimination that are comparable across skin color/ethnicity, sex, socioeconomic status, and their intersections. In the seven-item version of the scale, only one parameter lacked invariance (i.e., threshold of item i13 - called by names you do not like), specifically among black respondents with less than 12 years of formal education. CONCLUSION: The EDS may provide researchers with valid, reliable, and comparable estimates of discrimination between different segments of the population, including those at the intersections of skin color/ethnicity, sex, and socioeconomic status. However, future research is needed to determine whether the patterns we identified here are consistent in other population domains.

[Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students]. / Aferindo experiências com discriminação em múltiplos grupos sociais: análise de invariância da Escala de Discriminação Explícita em estudantes universitários.

This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.

O objetivo foi avaliar a capacidade da Escala de Discriminação Explícita (EDE) de produzir estimativas comparáveis entre grupos de gênero, cor/raça e posição socioeconômica. A análise se baseou em dados de dois estudos, realizados com estudantes de universidades públicas brasileiras. Uma versão abreviada da EDE com oito itens foi avaliada, utilizando o método alignment (alinhamento). Nossos achados indicaram violação de invariância entre grupos de cor/raça e gênero. Os relatos de experiências discriminatórias tiveram melhor comparabilidade entre estratos de posição socioeconômica. Este estudo demonstrou que a EDE deve ser utilizada com cautela, especialmente para fazer comparações de estimativas de discriminação entre respondentes de cor/raça e gênero distintos. A violação de invariância observada reforça a necessidade de pesquisas adicionais, examinando se tal cenário se mantém em amostras mais amplas e diversas do país.

El objetivo fue evaluar la capacidad de la Escala de Discriminación Explícita (EDE) para producir estimaciones comparables entre grupos de género, color/raza y posición socioeconómica. El análisis se basó en los datos de dos estudios, realizados con estudiantes de universidades públicas brasileñas. Se evaluó una versión abreviada de la EDE con 8 ítems, utilizando el método alignment (alineación). Nuestros hallazgos indicaron una violación de la invariancia entre los grupos de color/raza y género. Los informes de experiencias discriminatorias fueron más comparables entre los estratos de posición socioeconómica. Este estudio demostró que la EDE debe usarse con precaución, especialmente para hacer comparaciones de estimaciones de discriminación entre encuestados distintos de color/raza y género. La violación de la invariancia observada refuerza la necesidad de investigaciones adicionales, examinando si tal escenario se mantiene muestras más amplias y diversas del país.

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.

Aferindo experiências com discriminação em múltiplos grupos sociais: análise de invariância da Escala de Discriminação Explícita em estudantes universitários / Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students / Evaluación comparativa de experiencias de discriminación en múltiples grupos sociales: análisis de invariancia de la Escala de Discriminación Explícita en estudiantes universitarios

Resumo: O objetivo foi avaliar a capacidade da Escala de Discriminação Explícita (EDE) de produzir estimativas comparáveis entre grupos de gênero, cor/raça e posição socioeconômica. A análise se baseou em dados de dois estudos, realizados com estudantes de universidades públicas brasileiras. Uma versão abreviada da EDE com oito itens foi avaliada, utilizando o método alignment (alinhamento). Nossos achados indicaram violação de invariância entre grupos de cor/raça e gênero. Os relatos de experiências discriminatórias tiveram melhor comparabilidade entre estratos de posição socioeconômica. Este estudo demonstrou que a EDE deve ser utilizada com cautela, especialmente para fazer comparações de estimativas de discriminação entre respondentes de cor/raça e gênero distintos. A violação de invariância observada reforça a necessidade de pesquisas adicionais, examinando se tal cenário se mantém em amostras mais amplas e diversas do país.

Abstract: This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.

Resumen: El objetivo fue evaluar la capacidad de la Escala de Discriminación Explícita (EDE) para producir estimaciones comparables entre grupos de género, color/raza y posición socioeconómica. El análisis se basó en los datos de dos estudios, realizados con estudiantes de universidades públicas brasileñas. Se evaluó una versión abreviada de la EDE con 8 ítems, utilizando el método alignment (alineación). Nuestros hallazgos indicaron una violación de la invariancia entre los grupos de color/raza y género. Los informes de experiencias discriminatorias fueron más comparables entre los estratos de posición socioeconómica. Este estudio demostró que la EDE debe usarse con precaución, especialmente para hacer comparaciones de estimaciones de discriminación entre encuestados distintos de color/raza y género. La violación de la invariancia observada refuerza la necesidad de investigaciones adicionales, examinando si tal escenario se mantiene muestras más amplias y diversas del país.

Factorial invariance of the abridged version of the Explicit Discrimination Scale among adults living in southern Brazil / Invariância fatorial da versão abreviada da Escala de Discriminação Explícita em adultos do sul do Brasil

ABSTRACT Objective The Explicit Discrimination Scale (EDS) was developed to assess experiences with discrimination in Brazilian epidemiologic surveys. Though previous analyses have demonstrated that the EDS has good configural, metric, and scalar properties, its invariance has not yet been investigated. In this study, we examined the factorial invariance of two abridged versions of the EDS, according to skin color/ethnicity, sex, socioeconomic status, and their intersections. Methods: Data from the EpiFloripa Adult Study were used, which include a representative sample of adults residing in a state capital of southern Brazil (n=1,187). Over half of the respondents were women, and around 90% identified as white; the mean age of the participants was 39 years. Two abridged versions of the EDS were analyzed, with seven and eight items, using Multigroup Confirmatory Analysis and the Alignment method. Results: The two versions of the scale may be used to provide estimates of discrimination that are comparable across skin color/ethnicity, sex, socioeconomic status, and their intersections. In the seven-item version of the scale, only one parameter lacked invariance (i.e., threshold of item i13 - called by names you do not like), specifically among black respondents with less than 12 years of formal education. Conclusion: The EDS may provide researchers with valid, reliable, and comparable estimates of discrimination between different segments of the population, including those at the intersections of skin color/ethnicity, sex, and socioeconomic status. However, future research is needed to determine whether the patterns we identified here are consistent in other population domains.

RESUMO Objective A Escala de Discriminação Explícita (EDE) foi desenvolvida para avaliar experiências com discriminação em inquéritos epidemiológicos no Brasil. Embora análises prévias tenham revelado boas propriedades configurais, métricas e escalares do instrumento, nenhum estudo examinou sua invariância. Este trabalho objetivou examinar a invariância fatorial de duas versões abreviadas da EDE, considerando cor/raça, sexo, posição socioeconômica e suas intersecções. Métodos: Utilizaram-se dados do Estudo EpiFloripa Adulto, que encerra uma amostra representativa de residentes de uma capital do sul do Brasil (n=1.187). Cerca de 57% da amostra foi constituída por mulheres e 90% dos entrevistados se declararam brancos; a média de idade dos participantes foi de 39 anos. Duas versões abreviadas da EDE, com sete e oito itens, foram examinadas por meio de Análises Fatoriais Confirmatórias Multigrupo e o método Alignment. Resultados: As duas versões da escala produziram estimativas comparáveis de discriminação entre grupos definidos por cor/raça, sexo, posição socioeconômica e suas intersecções. Na versão reduzida de sete itens, apenas um parâmetro apresentou violação de invariância (limiar do item i13; i.e., chamado por nomes que não gosta), especificamente no grupo de respondentes negros com menos de 12 anos de escolaridade. Conclusão: Os resultados mostraram que a EDE é capaz de produzir estimativas de discriminação válidas, confiáveis e comparáveis entre diversos segmentos da população, incluindo aqueles situados na intersecção de cor/raça, sexo e posição socioeconômica. Contudo, pesquisas futuras são necessárias para verificar se os padrões identificados aqui podem ser confirmados em outros domínios populacionais.

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.

The best of two worlds: Combining the DSM-5 and ICD-11 clusters of symptoms for posttraumatic stress disorder in a single screening scale.

OBJECTIVES: The most recent DSM-5 (2013) and ICD-11 (2018) diagnostic criteria for posttraumatic stress disorder (PTSD) encompass 20 and six symptoms, respectively, organized in different structures. This study aimed to investigate the dimensions of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) according to the DSM-5's broader definition of PTSD and the ICD-11's narrower approach, as well as to explore an alternative restricted model that retains the core symptoms explicitly related to traumatic experiences. METHODS: Data were gathered from Brazilian employees (n=1,101) who had directly experienced traumatic life events or had been exposed to them because of their work activities. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to evaluate the configural and metric structures of the models. RESULTS: We estimated seven models of the latent structure of PTSD including the four-factor DSM-5 and three-factor ICD-11 PTSD models. Given the lack of evidence of their validity, an alternative 10-symptom model was tested. The final seven-item PTSD model considerably improved estimation of the PTSD construct. This solution showed reliable items with non-redundant content, acceptable fit indices, and satisfactory configural and metric properties. CONCLUSION: The more parsimonious one-dimensional model comprising the core PTSD symptoms has the potential to improve assessment of PTSD.

The best of two worlds: Combining the DSM-5 and ICD-11 clusters of symptoms for posttraumatic stress disorder in a single screening scale

Objectives: The most recent DSM-5 (2013) and ICD-11 (2018) diagnostic criteria for posttraumatic stress disorder (PTSD) encompass 20 and six symptoms, respectively, organized in different structures. This study aimed to investigate the dimensions of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) according to the DSM-5's broader definition of PTSD and the ICD-11's narrower approach, as well as to explore an alternative restricted model that retains the core symptoms explicitly related to traumatic experiences. Methods: Data were gathered from Brazilian employees (n=1,101) who had directly experienced traumatic life events or had been exposed to them because of their work activities. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to evaluate the configural and metric structures of the models. Results: We estimated seven models of the latent structure of PTSD including the four-factor DSM-5 and three-factor ICD-11 PTSD models. Given the lack of evidence of their validity, an alternative 10-symptom model was tested. The final seven-item PTSD model considerably improved estimation of the PTSD construct. This solution showed reliable items with non-redundant content, acceptable fit indices, and satisfactory configural and metric properties. Conclusion: The more parsimonious one-dimensional model comprising the core PTSD symptoms has the potential to improve assessment of PTSD.

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.

Gestational weight gain according to the Brazilian charts and its association with maternal and infant adverse outcomes.

BACKGROUND: The lack of gestational weight gain (GWG) recommendations for low- and middle-income countries is a significant concern. OBJECTIVES: To identify the ranges on the Brazilian GWG charts associated with lowest risks of selected adverse maternal and infant outcomes. METHODS: Data from 3 large Brazilian datasets were used. Pregnant individuals aged ≥18, without hypertensive disorders or gestational diabetes were included. Total GWG was standardized to gestational age-specific z-scores according to Brazilian GWG charts. A composite infant outcome was defined as the occurrence of any of small-for-gestationa lage (SGA), large-forgestationa lage (LGA), or preterm birth. In a separate sample, postpartum weight retention (PPWR) was measured at 6 and/or 12 mo postpartum. Multiple logistic and Poisson regressions were performed with GWG z-scores as the exposure and individual and composite outcomes. GWG ranges associated with the lowest risk of the composite infant outcome were identified using noninferiority margins. RESULTS: For the neonatal outcomes, 9500 individuals were included in the sample. For PPWR, 2602 and 7859 individuals were included at 6 and 12 mo postpartum, respectively. Overall, 7.5% of the neonates were SGA, 17.6% LGA, and 10.5% were preterm. Higher GWG z-scores were positively associated with LGA birth, whereas lower z-scores were positively associated with SGA births. The risk of the selected adverse neonatal outcomes were lowest (within 10% of lowest observed risk) when individuals with underweight, normal weight, overweight, or obesity gained between 8.8-12.6; 8.7-12.4; 7.0-8.9; and 5.0-7.2 kg, respectively. These gains correspond to probabilities of PPWR ≥5 kg at 12 mo of 30% for individuals with under and normal weight, and <20% for overweight and obesity. CONCLUSIONS: This study provided evidence to inform new GWG recommendations in Brazil.

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.

Comparison between the Brazilian and 3 international gestational weight gain charts.

BACKGROUND: Little is known about the ability of the recently released Brazilian gestational weight gain (GWG) charts to predict the occurrence of adverse birth outcomes. OBJECTIVES: We compared the new Brazilian weight gain charts with 3 international charts and determined their ability to predict the occurrence of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births in Brazilian women. METHODS: A subsample of 6888 adult women (43,931 weight measurements) with singleton pregnancies from a nationwide, hospital-based cohort study conducted in 2011-2012 was analyzed. Selected percentiles from Brazilian GWG charts were compared with those from American, International Fetal and Newborn Growth Consortium for the 21st Century study, and Lifecycle consortium charts. Sensitivity, specificity, and AUROC values for SGA and LGA births were estimated with 95% CIs using the classification of GWG below or above selected percentiles of each chart. RESULTS: The weight gain corresponding to a given percentile varied among the charts, especially for women with pre-pregnancy overweight and obesity. The proportions of women with GWG classified below or above selected percentiles were closest to the expected values for all pre-pregnancy BMI categories in the Brazilian and Lifecycle charts. At the 10th percentile, the highest sensitivity for SGA births was observed for the American charts at midpregnancy (36.8%) and the highest specificity was observed using the Brazilian charts in the first trimester (93.4%). At the 90th percentile, the highest sensitivity for LGA births occurred in midpregnancy for the Lifecycle charts (26.8%) and the highest specificity occurred in the American charts using total GWG (97.1%). All the AUROCs were under 0.5 for SGA births and ranged from 0.55 (first trimester) to 0.62 (total GWG) for LGA births. CONCLUSIONS: The charts differ in GWG trajectories, especially for women with overweight and obesity. The 4 charts had low predictive ability of SGA and LGA births and should not be considered as isolated screening tools for those outcomes.

National Trends and Disparities in Severe Food Insecurity in Brazil between 2004 and 2018.

Background: The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil and facilitates the monitoring and improvement of national public policies to promote food security. Since 2004, the Brazilian government has conducted National Household Sample Surveys, and in 2018, the government carried out the last national evaluation of FI. Objectives: To describe trends in severe FI in Brazil from 2004 to 2018. Methods: Data from 3 cross-sectional Brazilian National Household Sample Surveys (sample sizes: 2004 = 112,530; 2009 = 120,910; 2013 = 116,196) and from the last Household Budget Survey (sample size = 57,920) that assessed the status of FI using the EBIA were analyzed. Changes in severe FI during 2 periods (2004-2013; 2013-2018) were estimated while considering sociodemographic factors. Results: The period between 2004 and 2013 was marked by a significant decrease in severe FI (-53.6%), but this trend reversed in 2013-2018 (+43.8%). The greatest decrease in severe FI occurred in the Northeast (-57.6%) among households where the reference person was a man (-57.6%) and self-identified as white (-58.1%) (2004-2013). In 2013-2018, households with children aged ≤4 y (+6.3%) and members aged ≥65 y (+12.5%) experienced the lowest increases in severe FI. Conclusions: After a significant reduction from 2004 to 2013, severe FI increased sharply from 2013 to 2018, likely due to disruptions in public policies aimed at reducing hunger and unemployment rates.

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.