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.

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.

Scaling up research on discrimination and health: The abridged Explicit Discrimination Scale.

Using data from two studies conducted among diverse undergraduate students, we assessed the scalar structure of the Explicit Discrimination Scale (EDS), and developed an abridged version of the instrument. Our findings suggest that the EDS has acceptable scalability properties, including an adequate dispersion of items along the latent trait continuum. Results also support the idea that increasing raw scale scores reflect higher intensities of perceived discrimination. This shortened version of the EDS may be used in large-scale studies on the health impacts of discrimination.

Perceived Experiences of Community Violence Among Adolescents: A School Survey From Rio de Janeiro, Brazil.

Community violence (CV) is a global public health problem due to its high frequency and severe consequences. Although CV is one of the leading causes of death among adolescents, little is known about the everyday CV situations that do not lead to death. This study aimed to estimate the frequency of exposure to and involvement in CV situations among adolescent students from public and private schools in the city of Rio de Janeiro, Brazil. This was a cross-sectional study of 693 individuals in their second year of high school selected through stratified multistage random sampling. Information about their exposure to and involvement in CV was collected through a self-completed multidimensional questionnaire in the classrooms. For approximately 30% of the adolescents, someone close to them had been murdered, and 40% had already seen the corpse of a victim of homicide. Seventeen percent reported having been directly involved in CV situations. Approximately 38%, 13%, and 25% had been victims of robberies, interpersonal aggression, and death threats to either themselves or their relatives, respectively. Many of these situations occurred more than once. In general, CV was more frequently reported by boys and by those who did not live with both parents. Adolescents from higher economic classes experienced more interpersonal aggression and felt a greater need to carry a gun. Those who belonged to the lower economic classes and studied in public schools were more exposed to lethal violence than other students. The results call attention to the very high percentage of adolescent students that are involved in CV situations as well as to the differences in violence rates among population subgroups. Such findings should be considered when planning CV prevention and management actions in schools and other socialization spaces for adolescents.

The Alcohol Use Disorders Identification Test (AUDIT) in Adolescents: Using a Model-Based Approach to Identify Patterns of Alcohol Misuse.

OBJECTIVE: To explore the latent structure of the Alcohol Use Disorders Identification Test (AUDIT) among adolescents of different school grades (age strata). Methods: Data derived from two simultaneous run cohort studies from the "Adolescent Nutritional Assessment Longitudinal Study-ELANA" conducted in private and public schools of Rio de Janeiro/Brazil. Participants comprised 564 seventh-graders and 419 ninth-graders, respectively sampled in 2011 and 2013 from cohort 1, and 730 eleventh-graders sampled in 2011 from cohort 2. Latent class factor analytical (LCFA) models were applied to the AUDIT items to identify internally homogeneous latent groups of individuals representing distinct patterns of alcohol use, and optimal group-separating cutoffs. The classification agreement was also evaluated. Results: Three and two groups (classes) were found for the eleventh and the earlier grades, respectively. These best-fitting models held a very high degree of class separation (entropy >0.9). By contrasting the AUDIT's raw scores (0-10) with the model-based latent classes, the cutoff separating the base (milder) category was found between scores 0 and 1 in all grades. The eleventh-graders differed from the others by showing a third and more intense category of alcohol use (cutoff between 4 and 5). The classification agreement was almost perfect in eleventh-graders (98.6%) and perfect in the earlier grades (100%). Conclusions: Findings show that the AUDIT may be adequately used in adolescents of different ages and school grades, although the number of homogeneous categories may differ accordingly. Besides, raw scores may be pragmatically used to identify groups with confidence by applying specific optimal cutoffs.

Gestational weight gain charts: results from the Brazilian Maternal and Child Nutrition Consortium.

BACKGROUND: Monitoring gestational weight gain (GWG) is fundamental to ensure a successful pregnancy for the mother and the offspring. There are several international GWG charts, but just a few for low- and middle-income countries. OBJECTIVES: To construct GWG charts according to pre-pregnancy BMI for Brazilian women. METHODS: This is an individual patient data analysis using the Brazilian Maternal and Child Nutrition Consortium data, comprising 21 cohort studies. External validation was performed using "Birth in Brazil," a nationwide study. We selected adult women with singleton pregnancies who were free of infectious and chronic diseases, gestational diabetes, and hypertensive disorders; who delivered a live birth at term; and whose children were adequate for gestational age, and with a birth weight between 2500-4000 g. Maternal self-reported pre-pregnancy weight and weight measured between 10-40 weeks of gestation were used to calculate GWG. Generalized Additive Models for Location, Scale and Shape were fitted to create GWG charts according to gestational age, stratified by pre-pregnancy BMI. RESULTS: The cohort included 7086 women with 29,323 weight gain measurements to construct the charts and 4711 women with 31,052 measurements in the external validation. The predicted medians for GWG at 40 weeks, according to pre-pregnancy BMI, were: underweight, 14.1 kg (IQR, 10.8-17.5 kg); normal weight, 13.8 kg (IQR, 10.7-17.2 kg); overweight, 12.1 kg (IQR, 8.5-15.7 kg); obesity, 8.9 kg (IQR, 4.8-13.2 kg). The 10th, 25th, 50th, 75th, and 90th percentiles were estimated. Results for internal and external validation showed that the percentages below the selected percentiles were close to those expected. CONCLUSIONS: The charts proposed provide a description of GWG patterns according to gestational age and pre-pregnancy BMI among healthy Brazilian women with good neonatal outcomes. The external validation indicates that this new tool can be used to monitor GWG in the primary health-care setting and to test potential recommended values.

Brazilian Maternal and Child Nutrition Consortium: establishment, data harmonization and basic characteristics.

Pooled data analysis in the field of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identified outliers, and assessed heterogeneity for GWG. Outliers identification considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identified 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a final sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were flagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited.

Perceived discrimination south of the equator: Reassessing the Brazilian Explicit Discrimination Scale.

OBJECTIVE: To reassess the Explicit Discrimination Scale (EDS; Bastos, Faerstein, Celeste, & Barros, 2012), an instrument developed in Brazil to examine intersecting forms of discrimination, with particular attention to the number of underlying dimensions, residual correlations, share of explained item variance, and stability of the configural and metric structure in broader populations. METHOD: Data from two cross-sectional studies and one cohort investigation were used. Although the cross-sectional studies were conducted among racially diverse undergraduate students (n = 1,022, 45% women, mean age = 23 years; n = 424, 59% women, mean age = 22 years), the cohort study included a probabilistic sample of community residents with 18% racial/ethnic minority respondents (n = 1,187, 57% women, mean age = 42 years). A series of exploratory models, exploratory structural equation models, and confirmatory factor analyses models was estimated. RESULTS: The EDS items might be best represented by a 3-factor model, which includes a second-order factor. Although only 1 pair of correlated residuals emerged, at least 4 different items with a sizable share of error variance were observed. The revised scale structure had an excellent fit to the data and was consistent among both undergraduate students and community residents. CONCLUSIONS: As well as demonstrating that discrimination may be structured by proximal, medial, and distal experiences with mistreatment, we suggest that the EDS has the potential to enhance research on the intersectional health impacts of discrimination. Future studies are required to assess scalability and provide scholars with a shortened version of the instrument. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Suitability of the eight-item version of the Brazilian Household Food Insecurity Measurement Scale to identify risk groups: evidence from a nationwide representative sample.

OBJECTIVE: The Brazilian Household Food Insecurity Measurement Scale (EBIA) has eight general/adult items applied in all households and six additional items exclusively asked in households with children and/or adolescents (HHCA). Continuing an investigation programme on the adequacy of model-based cut-off points for EBIA, the present study aims to: (i) explore the capacity of properly stratifying HHCA according to food insecurity (FI) severity level by applying only the eight 'generic' items; and (ii) compare it against the fourteen-item scale. DESIGN: Latent class factor analysis (LCFA) models were applied to the answers to the eight general/adult items to identify latent groups corresponding to FI levels and optimal group-separating cut-off points. Analyses involved a thorough classification agreement evaluation and were performed at the national level and by macro-regions. SETTING: Data derived from the cross-sectional Brazilian National Household Sample Survey of 2013. PARTICIPANTS: A nationally representative sample of 116 543 households. RESULTS: In all households and investigated domains, LCFA detected four distinct household food (in)security groups (food security and three levels of severity of FI) and the same set of cut-off points (1/2, 4/5 and 6/7). Misclassification in the aggregate data was 0·66 % in adult-only households and 1·06 % in HHCA. Comparison of the scale reduced to eight items with the 'original' fourteen-item scale demonstrated consistency in the classification. In HHCA, the agreement between both classifications was 96·2 %. CONCLUSIONS: Results indicate the eight 'generic' items in HHCA can be reliably used when it is not possible to apply the fourteen-item scale.

Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C

Objective: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. Methods: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. Results: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). Conclusion: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.

Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C.

OBJECTIVE: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. METHODS: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. RESULTS: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). CONCLUSION: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.

Psychologic intimate partner violence and the risk of intrauterine growth restriction in Rio de Janeiro.

OBJECTIVE: To evaluate whether psychologic intimate partner violence (IPV) during pregnancy is a risk factor for intrauterine growth restriction (IUGR). METHODS: The cross-sectional study enrolled randomly selected mothers of infants younger than 5 months attending basic health services in Rio de Janeiro, Brazil, from January to July 2007. Psychologic and physical IPV were evaluated by the Revised Conflict Tactics Scale; IUGR was defined as below the 10th percentile of the Alexander curve. Socioeconomic status, housing conditions, stressful events, life habits, social support, and medical information were obtained by interview or from medical records. Multivariate hierarchical logistic regression models, taking into account potential confounders, were used to evaluate the relationship between mounting acts of psychologic IPV and IUGR. RESULTS: There were 810 women included in the study. Psychologic IPV during pregnancy was reported by 665 women (82.1%) and 126 newborns (15.6%) showed growth restriction. In the final model, each 1-unit increase in psychologic IPV score during pregnancy led to a 15% higher risk of IUGR at birth (odds ratio 1.15; P<0.001). CONCLUSION: Psychologic IPV during pregnancy seems to be a significant and independent risk factor for IUGR. This finding reinforces the importance of preventive and intervention procedures for IPV to reduce adverse perinatal outcomes.

Modeling Optimal Cutoffs for the Brazilian Household Food Insecurity Measurement Scale in a Nationwide Representative Sample.

Background: This is the second part of a model-based approach to examine the suitability of the current cutoffs applied to the raw score of the Brazilian Household Food Insecurity Measurement Scale [Escala Brasileira de Insegurança Alimentar (EBIA)]. The approach allows identification of homogeneous groups who correspond to severity levels of food insecurity (FI) and, by extension, discriminant cutoffs able to accurately distinguish these groups.Objective: This study aims to examine whether the model-based approach for identifying optimal cutoffs first implemented in a local sample is replicated in a countrywide representative sample.Methods: Data were derived from the Brazilian National Household Sample Survey of 2013 (n = 116,543 households). Latent class factor analysis (LCFA) models from 2 to 5 classes were applied to the scale's items to identify the number of underlying FI latent classes. Next, identification of optimal cutoffs on the overall raw score was ascertained from these identified classes. Analyses were conducted in the aggregate data and by macroregions. Finally, model-based classifications (latent classes and groupings identified thereafter) were contrasted to the traditionally used classification.Results: LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.934-0.975). The following cutoffs were identified in the aggregate data: between 1 and 2 (1/2), 5 and 6 (5/6), and 10 and 11 (10/11) in households with children and/or adolescents <18 y of age (score range: 0-14), and 1/2, between 4 and 5 (4/5), and between 6 and 7 (6/7) in adult-only households (range: 0-8). With minor variations, the same cutoffs were also identified in the macroregions. Although our findings confirm, in general, the classification currently used, the limit of 1/2 (compared with 0/1) for separating the milder from the baseline category emerged consistently in all analyses.Conclusions: Nationwide findings corroborate previous local evidence that households with an overall score of 1 are more akin to those scoring negative on all items. These results may contribute to guide experts' and policymakers' decisions on the most appropriate EBIA cutoffs.

[Factor structure validity of the social capital scale used at baseline in the ELSA-Brasil study]. / Validade da estrutura fatorial da escala de capital social utilizada na linha de base no ELSA-Brasil.

This study aims to analyze the factor structure of the Brazilian version of the Resource Generator (RG) scale, using baseline data from the Brazilian Longitudinal Health Study in Adults (ELSA-Brasil). Cross-validation was performed in three random subsamples. Exploratory factor analysis using exploratory structural equation models was conducted in the first two subsamples to diagnose the factor structure, and confirmatory factor analysis was used in the third to corroborate the model defined by the exploratory analyses. Based on the 31 initial items, the model with the best fit included 25 items distributed across three dimensions. They all presented satisfactory convergent validity (values greater than 0.50 for the extracted variance) and precision (values greater than 0.70 for compound reliability). All factor correlations were below 0.85, indicating full discriminative factor validity. The RG scale presents acceptable psychometric properties and can be used in populations with similar characteristics.

A Model-Based Approach to Identify Classes and Respective Cutoffs of the Brazilian Household Food Insecurity Measurement Scale.

BACKGROUND: The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil, assisting in monitoring and improving national public policies to promote food security. Based on the sum of item scores, households have been classified into 4 levels of FI, with the use of cutoffs arising from expert discussions informed by psychometric analyses and policy considerations. OBJECTIVES: This study aimed to identify homogeneous latent groups corresponding to levels of FI, examine whether such subgroups could be defined from discriminant cutoffs applied to the overall EBIA raw score, and compare these cutoffs against those currently used. METHODS: A cross-sectional population-based study with a representative sample of 1105 households from a low-income metropolitan area of Rio de Janeiro was conducted. Latent class factor analysis (LCFA) models were applied to the answers to EBIA's items to identify homogeneous groups, obtaining the number of latent classes for FI measured by the scale. Based on this and a thorough classification agreement evaluation, optimal cutoffs for discriminating between different severity levels of FI were ascertained. Model-based grouping and the official EBIA classification cutoffs were also contrasted. RESULTS: LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.906), endorsing the classification of EBIA as a 4-level measure of FI. Two sets of cutoffs were identified to separate such groups according to household type: 1/2, 5/6, and 10/11 in households with children and adolescents (score range: 0-14); and 1/2, 3/4, and 5/6 in adult-only households (score range: 0-7). CONCLUSION: Although roughly classifying EBIA as in previous studies, the current approach suggests that, in terms of raw score, households endorsing only one item of the scale would be better classified by being placed in the same stratum as those remaining negative on all items.

Validade da estrutura fatorial da escala de capital social utilizada na linha de base no ELSA-Brasil / Factor structure validity of the social capital scale used at baseline in the ELSA-Brasil study / Validez de la estructura factorial de la escala de capital social, utilizada en la línea de base del ELSA-Brasil

Resumo: Esta pesquisa tem por objetivo estudar a estrutura fatorial da versão brasileira da escala Resource Generator (RG), utilizando dados da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Realizou-se validade cruzada com três subamostras aleatórias. A análise fatorial exploratória usando modelos de equação estrutural exploratória foi realizada nas duas primeiras subamostras para diagnóstico da estrutura fatorial e, na terceira, a análise fatorial confirmatória foi utilizada para corroborar o modelo definido pelas análises exploratórias. Com base nos 31 itens iniciais, o modelo de melhor ajuste contemplou 25 itens distribuídos em três dimensões. Todas apresentaram validade convergente (valores acima de 0,50 para a variância extraída) e precisão (valores acima de 0,70 para a confiabilidade composta) satisfatórias. Todas as correlações fatoriais foram abaixo de 0,85, indicando plena validade fatorial discriminante. A escala RG apresenta propriedades psicométricas aceitáveis e pode ser utilizada em populações com características semelhantes.

Abstract: This study aims to analyze the factor structure of the Brazilian version of the Resource Generator (RG) scale, using baseline data from the Brazilian Longitudinal Health Study in Adults (ELSA-Brasil). Cross-validation was performed in three random subsamples. Exploratory factor analysis using exploratory structural equation models was conducted in the first two subsamples to diagnose the factor structure, and confirmatory factor analysis was used in the third to corroborate the model defined by the exploratory analyses. Based on the 31 initial items, the model with the best fit included 25 items distributed across three dimensions. They all presented satisfactory convergent validity (values greater than 0.50 for the extracted variance) and precision (values greater than 0.70 for compound reliability). All factor correlations were below 0.85, indicating full discriminative factor validity. The RG scale presents acceptable psychometric properties and can be used in populations with similar characteristics.

Resumen: Esta investigación tiene por objetivo estudiar la estructura factorial de la versión brasileña de la escala Resource Generator (RG), utilizando datos de la línea de base del Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Se realizó una prueba de validación cruzada con tres sub-muestras aleatorias. El análisis factorial exploratorio, usando modelos de ecuación estructural exploratorio, fue realizado en las dos primeras sub-muestras para diagnóstico de la estructura factorial y, en la tercera, el análisis factorial confirmatorio fue utilizado para corroborar el modelo definido por los análisis exploratorios. A partir de los 31 ítems iniciales, el modelo de mejor ajuste contempló 25 ítems distribuidos en tres dimensiones. Todos presentaron validez convergente (valores por encima de 0,50 para la variancia extraída) y precisión (valores por encima de 0,70 para la confiabilidad compuesta) satisfactorias. Todas las correlaciones factoriales estuvieron por debajo de 0,85, indicando plena validez factorial discriminante. La escala RG presenta propiedades psicométricas aceptables y puede ser utilizada en poblaciones con características semejantes.

Transtorno do estresse pós-traumático no puerpério em uma maternidade de alto risco fetal no Município do Rio de Janeiro, Brasil / Trastorno de estrés postraumático en el puerperio de una maternidad de alto riesgo fetal en el municipio de Río de Janeiro, Brasil / Postpartum posttraumatic stress disorder in a fetal high-risk maternity hospital in the city of Rio de Janeiro, Brazil

Resumo O objetivo deste artigo é estimar a magnitude de transtorno do estresse pós-traumático (TEPT) no puerpério em uma maternidade de referência para agravos perinatais e identificar subgrupos vulneráveis. Trata-se de um estudo transversal realizado uma maternidade de alto risco fetal no Rio de Janeiro, Brasil, com 456 mulheres que realizaram o parto na instituição. O Trauma History Questionnaire e o Post-Traumatic Stress Disorder Checklist foram utilizados para captar experiências traumáticas e sintomas de TEPT, respectivamente. A prevalência geral de TEPT foi de 9,4%. O TEPT mostrou-se mais prevalente entre mulheres com três ou mais partos, que tiveram recém-nascido com Apgar no 1º minuto menor ou igual a sete, com histórico de agravo mental antes ou durante a gravidez, com depressão pós-parto, que sofreram violência física ou psicológica perpetrada por parceiro íntimo na gravidez, que tiveram experiência sexual não desejada e que foram expostas a cinco ou mais traumas. Rápido diagnóstico e tratamento são fundamentais para melhorar a qualidade de vida da mulher e a saúde do recém-nascido.

Resumen El propósito de este artículo es estimar la magnitud del trastorno de estrés postraumático (TEPT) en el período post-parto, en una maternidad de referencia para los problemas perinatales e identificar subgrupos vulnerables. Se trata de un estudio transversal, realizado en una maternidad de alto riesgo fetal de Río de Janeiro, Brasil, a con 456 mujeres que habían realizado parto en la institución. Trauma History Questionnaire y Post-Traumatic Stress Disorder Checklist se utilizaron para capturar experiencias traumáticas y síntomas de TEPT, respectivamente. La prevalencia global de TEPT fue del 9,4%. El TEPT fue más frecuente entre las mujeres con tres o más partos, que tuvieron niños con Apgar en el minuto 1 inferior o igual a siete, con un historial de lesión mental antes o durante el embarazo, con depresión posparto, que sufrieron violencia física o psicológica perpetrada por su pareja durante el embarazo, que tuvieron experiencia sexual no deseada durante la infancia y que fueron expuestas a cinco o más traumas. Diagnóstico precoz y el tratamiento son fundamental para mejora en la calidad de las mujeres de la vida y la salud del recién nacido.

Abstract The objectives of this study were to estimate the prevalence of postpartum posttraumatic stress disorder (PTSD) in a maternity hospital for fetal high-risk pregnancies and to identify vulnerable subgroups. This was a cross-sectional study at a fetal high-risk maternity hospital in Rio de Janeiro, Brazil, with a sample of 456 women who had given birth at this hospital. The Trauma History Questionnaire and Post-Traumatic Stress Disorder Checklist were used to screen for lifetime traumatic events and PTSD symptoms, respectively. Overall prevalence of PTSD was 9.4%. Higher PTSD prevalence was associated with three or more births, a newborn with a 1-minute Apgar score of seven or less, history of mental disorder prior to or during the index pregnancy, postpartum depression, physical or psychological intimate partner violence during the pregnancy, a history of unwanted sexual experience, and lifetime exposure to five or more traumas. Rapid diagnosis and treatment of PTSD are essential to improve the mother’s quality of life and the infant’s health.

Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies.

OBJECTIVE: To conduct a systematic review aimed at identifying and characterizing the experience-based household food security scales and to synthesize their psychometric properties. DESIGN: Search in the MEDLINE, LILACS and SciELO databases, using the descriptors ('food insecurity' OR 'food security') AND ('questionnaires' OR 'scales' OR 'validity' OR 'reliability'). There was no limitation on the period of publication. All articles had their titles and abstracts analysed by two reviewers. The studies of interest were read in their entirety and the relevant information extracted using a standard form. RESULTS: The initial bibliographic search identified 299 articles. Of these, the 159 that seemed to meet the criteria for inclusion were read fully. After consultation of the bibliographic references of these articles, twenty articles and five documents were added, as they satisfied the previously determined criteria for inclusion. Twenty-four different instruments were identified; all were brief and of easy application. The majority were devised in the USA. Forty-seven references reported results of psychometric studies. The instruments that presented the highest number of psychometric studies were the Core Food Security Measurement/Household Food Security Survey Module (CFSM/HFSSM) and the Self-Perceived Household Food Security Scale. CONCLUSIONS: There are a number of structured scales available in the literature for characterization of household food insecurity. However, despite some psychometric studies already existing about the majority of the instruments, it is observed that, except for the studies of the CFSM/HFSSM, these are still restricted to appraisal of a few aspects of reliability and validity.