Screening and determinant of suspected developmental delays among Egyptian preschool-aged children: a cross-sectional national community-based study.

BACKGROUND: Early childhood life is critical for optimal development and is the foundation of future well-being. Genetic, sociocultural, and environmental factors are important determinants of child development. AIM: The objectives were to screen for suspected developmental delays (DDs) among Egyptian preschool children, and to explore the determinants of these delays based on sociodemographic, epidemiological, maternal, and child perinatal risk factors. METHODS: A national Egyptian cross-sectional developmental screening of a representative sample of preschool children (21,316 children) aged 12 to 71 months. The Revised Denver Prescreening Developmental Questionnaire (R-PDQ) followed by the Denver Developmental Screening Test, 2nd edition (DDST) was used. RESULTS: Each screened child manifested at least one of six developmental categories. Either typical development, gross motor delay (GM), fine motor adaptive delay (FMA), Language delay (L), Personal-social delay (PS), or multiple DDs. The prevalence of preschool children with at least one DD was 6.4%, while 4.5% had multiple DDs. Developmental language delay was the most prevalent, affecting 4.2% of children. The least affected domain was GM (1.9% of children). Boys were more likely to have DD than girls. Children in urban communities were more likely to have at least one DD than those in rural areas (OR = 1.28, 95%CI: 1.14-1.42), and children of middle social class than of low or high social class (OR = 1.49, 95%CI: 1.30-1.70 & OR = 1.40, 95%CI: 1.23-1.59 respectively). The strong perinatal predictors for at least one DD were children with a history of postnatal convulsions (OR = 2.68, 95%CI: 1.97-3.64), low birth weight (OR = 2.06, 95%CI: 1.69-2.52), or history of postnatal cyanosis (OR = 1.77, 95%CI: 1.26-2.49) and mothers had any health problem during pregnancy (OR = 1.73, 95%CI: 1.44-2.07). Higher paternal and maternal education decreased the odds of having any DD by 43% (OR = 0.57, 95% CI: 0.47-0.68) and 31% (OR = 0.69, 95%CI: 0.58-0.82) respectively. CONCLUSION: This study demonstrates a considerable attempt to assess the types and the prevalence of DD among preschool children in Egypt. Perinatal factors are among the most common determinants of DD in preschool children and the majority could be preventable risk factors.

Ethnocultural diversity of immigrants' personal social networks, bicultural identity integration and global identification.

There is some evidence that ethnocultural diversity encourages superordinate levels of categorisation, such as feeling identified with people globally. A remaining question is what type of engagement with diversity facilitates this link and why. We use immigrants' personal social network data and examine the link between global identification and ethnocultural diversity among closer relationships (i.e. strong network contacts, such as friendships) and more distant ones (i.e. weak contacts, including neighbours and acquaintances). Furthermore, following exposure to diversity, individuals may internalise more than one culture and differ how they integrate their multiple cultural socialisation into the self (i.e. vary in their degree of bicultural identity integration). We thus test whether relational ethnocultural diversity is linked to a stronger global identification through either cultural blendedness (i.e. combining two cultures) or harmony (i.e. perceiving two cultures as compatible). Relying on a culturally diverse community sample of 216 immigrants residing in Barcelona (53% female, Mage  = 31 years, SD = 10.4), we found that ethnocultural diversity among strong (but not weak) contacts was associated with stronger global identification and that this association is mediated by cultural harmony (but not blendedness). These results attest to the link between having ethnoculturally diverse close social relationships and superordinate identification.

Can servant leadership prevent hotel employee depression during the COVID-19 pandemic? A mediating and multigroup analysis.

The hospitality industry has been severely hit by the COVID-19 pandemic, with changes that have harmed employees' psychological well-being. However, having supervisors who are servant may make a difference. With a focus on serving others and the care taken to ensure their employees' highest priority needs are served, these leaders could help employees feel less depressed in these complicated times. By instilling servant behaviors in followers that help them become people that others can trust or with whom they can develop friendships, leaders could help these employees earn greater levels of personal social capital (PSC) through which to more successfully address pandemic times, especially if furloughed. Using structural equation modeling to analyze a sample of 205 hotel employees in Spain, we found that servant leadership directly decreases depression, and that PSC mediates this relationship. Our multigroup analyses (MGA) findings also reveal that when these employees are furloughed, the negative effect of PSC and the mediating role of PSC in this relationship is stronger. New light is thus shed on how servant leadership is effective in reducing employee depressive symptoms in times of severe changes such as those produced by the COVID-19 pandemic.

Household food insecurity and early childhood development in Brazil: an analysis of children under 2 years of age.

OBJECTIVE: To determine if household food insecurity (HFI) is associated with the risk of developmental delays. DESIGN: Cross-sectional study of a representative sample of children under 2 years old. Risk of developmental delays was assessed with the Denver Developmental Screening Test II. HFI was measured with the Brazilian Food Insecurity Measurement Scale. Multivariable logistic regression was used to test the association between HFI (food secure/insecure) and risk of developmental delays, adjusting for household, maternal and child variables. SETTING: Community Health Centers in the Federal District, Brazil. PARTICIPANTS: 1004 children under 2 years old. RESULTS: Among participants, 15 % were at risk of developmental delays and about 40 % of children lived in food-insecure households. HFI was associated with the risk of developmental delays (adjusted OR 2·61; 95 % CI 1·42, 4·80) compared with food-secure households after adjusting for key confounders. CONCLUSIONS: HFI was strongly associated with the risk of developmental delays in children under 2 years. Investments that prevent or mitigate HFI are likely to be key for improved human and national development.

Bonding personal social capital as an ingredient for positive aging and mental well-being. A study among a sample of Dutch elderly.

OBJECTIVES: The current study aims to add to the limited empirical research of possible benefits of personal social capital for the well-being of elderly. A validated personal social capital scale, measuring both bonding and bridging social capital in a general population, was adjusted to fit the characteristics of the social environment of elderly, to explore the association between social capital and well-being of elderly, as well as the mediating role of loneliness. METHOD: A sample of 328 Dutch adults, varying in age from 65 to 90 years (Mean = 72.07; SD = 4.90) filled out an online questionnaire including the adapted personal social capital scale for elderly (PSCSE), as well as validated scales measuring social, emotional, and psychological well-being and loneliness. Relevant other (demographic) variables were included for testing construct and criterion validity. RESULTS: CFA analysis revealed the subdimensions bonding and bridging social capital with reliability scores of respectively α = .88 and α = .87, and α = .89 for the total scale. Regression analyses confirmed construct and criterion validity. Subsequently, significant positive associations between bonding social capital and respectively social, emotional and psychological well-being were found. These associations were mediated by loneliness. Bridging social capital was only found to be significantly associated with social well-being, not mediated by loneliness. CONCLUSION: Our findings have enhanced our understanding of the association between social capital and mental well-being of elderly and indicate that bonding personal social capital in particular may be considered an ingredient for positive aging.

Choose who's in your circle: how women's relationship actions during and following residential treatment help create recovery-oriented networks.

Women in recovery from substance use disorders often have difficulty establishing recovery-supportive networks. This exploratory study uses qualitative thematic analysis to examine how 88 women in recovery describe the actions they take to manage their personal social networks 12 months after intake into residential substance use treatment. Participants describe disconnecting or limiting contact with recovery-endangering people and adding recovery-supportive people to their networks as primary relationship actions for maintaining recovery. Their actions to build recovery-supportive networks can provide a focus for clinical work to help them become integrated into their communities.

Catch-Up Growth and Neurobehavioral Development among Full-Term, Small-for-Gestational-Age Children: A Nationwide Japanese Population-Based Study.

OBJECTIVE: To examine the relationship between catch-up growth of full-term, small for gestational age (SGA) children and their neurobehavioral development. STUDY DESIGN: Data were obtained from a population-based nationwide Japanese longitudinal survey that started in 2001. Study participants were full-term children with information on height at 2 years of age (n = 32 533). Catch-up growth for SGA infants was defined as achieving a height at 2 years of age of more than -2.0 standard deviations for chronological age. Logistic regression analyses were used to estimate ORs and 95% CIs for the associations of SGA and catch-up growth status with neurobehavioral development at 2.5 and 8 years of age, adjusting for potential infant- and parent-related confounding factors. RESULTS: Fifteen percent of term SGA infants failed to catch up in height. At 2.5 years of age, SGA children without catch-up growth were more likely to be unable to climb stairs (OR, 10.42; 95% CI, 5.55-19.56) and unable to compose a 2-word sentence (OR, 3.58; 95% CI, 1.81-7.08) compared with children with normal growth at birth. Furthermore, SGA children without catch-up growth were at increased risk for aggressive behaviors (OR, 3.85; 95% CI, 1.19-12.47) at 8 years of age. CONCLUSIONS: Continuous follow-up for full-term SGA infants with failure of catch-up growth or poor postnatal growth may be beneficial for early detection and intervention for behavioral problems.

Family and community support among older Chilean adults: the importance of heterogeneous social support sources for quality of life.

Family and community social networks act as social resources that promote well-being at advanced ages. In this study, we analyze the association between social support received from personal social networks (social support from various family members and friends) and community social networks (social support from neighbors and the neighborhood, age, ethnic, or religious group peers and formal social support networks) and quality of life (QoL) for a sample of older Chilean persons (n = 777). The results confirm that social support from family (partner, children, and extended family) and friends, integration in the community (neighbors) and social support from informal systems (social groups) are associated with QoL. Moreover, the model including both types of support explains 25.8% of variance in QoL. The results and their possible implications are discussed.

The Experience in Personal Social Systems Questionnaire (EXIS.pers): Development and Psychometric Properties.

This study presents the theoretical background, development, and psychometric properties of the German and English versions of the Experience in Personal Social Systems Questionnaire (EXIS.pers). It assesses how the members of a personal social system experience their situation within that system. It is designed as a research tool for interventions in which only one member of the system participates (e.g., Family Constellation Seminars). The EXIS.pers was created to measure change on the individual level relating to one's own important personal social system. In Study 1, we used exploratory factor analysis (EFA) for latent variable identification of the original German EXIS.pers (n = 179). In Studies 2 and 3, we used confirmatory factor analysis (CFA) to examine the dimensionality of the German (n = 634) and English (n = 310) EXIS.pers. Internal consistencies and cross-cultural structural equivalence were assessed. EFA indicated that a four-factor model provided best fit for the German EXIS.pers. For both the German and English EXIS.pers, CFA provided the best fit for a five-factor bi-level model that included a general factor (Experience In Personal Social Systems) and four dimensions (Belonging, Autonomy, Accord, Confidence). Good internal consistencies, external associations, and cross-cultural structural equivalence were demonstrated. This study provides first evidence for the German and English EXIS.pers as an economical and reliable measure of an individual's experience within his or her personal social systems.

Lipid-Based Nutrient Supplements Plus Malaria and Diarrhea Treatment Increase Infant Development Scores in a Cluster-Randomized Trial in Burkina Faso.

BACKGROUND: Adequate nutrition is necessary for the rapid brain development that occurs during infancy. OBJECTIVES: We tested the hypothesis that the provision of small-quantity, lipid-based nutrient supplements (SQ-LNSs) plus malaria and diarrhea treatment positively affects infant development. We also tested the effect of various doses of zinc provided in SQ-LNSs or in a tablet. METHODS: In a partially masked, cluster-randomized controlled trial, communities in rural Burkina Faso were stratified by selected characteristics and then randomly assigned within strata to the intervention (IC; 25 communities, 2435 children) or the nonintervention (NIC; 9 communities, 785 children) cohorts. IC children were randomly assigned to 4 groups. As secondary outcomes, a subsample of 3 of these 4 groups (n = 747) and of the NIC (n = 376) were assessed for motor, language, and personal-social development at age 18 mo by using the Developmental Milestones Checklist II. The 3 IC groups received 20 g SQ-LNSs/d containing 0 or 10 mg added zinc with a placebo tablet or 20 g SQ-LNSs/d containing 0 mg added zinc with a tablet containing 5 mg Zn. All IC groups received treatment of malaria and diarrhea from age 9 to 18 mo. Data collectors and participants were aware of allocation to the IC or NIC but did not know the particular IC subgroup. RESULTS: Children in the IC scored 0.34 (95% CI: 0.21, 0.46), 0.30 (95% CI: 0.15, 0.44), and 0.32 (95% CI: 0.16, 0.48) SDs higher in motor, language, and personal-social development, respectively, than did children in the NIC (All P < 0.001). Children who received different amounts of zinc did not differ significantly in any of the scores. No effect on caregiver-child interaction was found. CONCLUSION: In rural Burkina Faso, the provision of SQ-LNSs to infants from age 9 to 18 mo, regardless of added zinc content, plus malaria and diarrhea treatment positively affected motor, language, and personal-social development at age 18 mo. This trial was registered at clinicaltrials.gov as NCT00944281.

Mid- and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up.

In a previous randomized controlled trial (RCT), short-term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid- and long-term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3-day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 8- and 12-month follow-up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals' experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8-month follow-up, p = .000; d = 0.40 at 12-month follow-up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants' experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid- and long-term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.

A Strengths-Based Longitudinal Career Intervention for Junior Secondary School Students with Special Educational Needs: a Mixed-method Evaluation.

The mixed-method study reported here was designed to evaluate a strengths-based career intervention program for secondary school students with mild special educational needs (SEN). A sample of 32 SEN students (19 boys: 13 girls) from 5 inclusive schools in Hong Kong were recruited to a treatment group. An additional 32 SEN students (19 boys: 13 girls) were selected to form the control group matched for age, gender and parents' education level. The special needs exhibited by both groups were in areas of literacy and numeracy, attention deficits, and social-emotional problems, but did not include severe or complex disabilities. Participants in both groups responded to pre- and post-intervention questionnaires covering career development self-efficacy, personal and social development self-efficacy, and meaning in life. As a follow-up, two teachers and three social workers providing support to SEN students, and the 32 participants were interviewed several months after the intervention. Interviews also took place with teachers, social workers and students to evaluate the perceived effects of the intervention. Findings indicated significant interactions between Time 1 and Time 2, and between groups (control vs. treatment) in personal goal-setting, career goal-setting, and the presence of meaning in life. Additionally, several themes were identified from the interviews suggesting that the intervention did have positive effects on SEN students' career, personal and social development self-efficacy, and acquisition of meaning in life.

Personal Social Networks and Relapses in Women With Substance Dependence: Application of the Theory of Planned Behavior.

OBJECTIVE: Establishing positive network resources and rebuilding drug free networks are key components of recovery process for women with substance use disorder (SUDs). Theory of planned behavior (TPB) posits that behaviors are determined by behavioral intentions, which are determined by three factors: attitude toward the behavior, perceived behavioral control, and subjective norms. The current study applied TPB to examine whether women's personal social network characteristics (as subjective norms) were related to intentions towards, and/or a substance use relapse using prospective research design. METHODS: Longitudinal data from 300 American women with SUD who received treatment at three county-funded, women-only intensive treatment programs was utilized for the current study. RESULTS: Bayesian estimation path analyses indicated that attitude and abstinence self-efficacy at intake were not related to intention at the 6-month follow-up, but abstinence self-efficacy was directly related to substance use relapse by 12 months. Personal social network characteristics, number of treatment related persons in personal social network and sobriety support were significantly associated with intention at 6 months. The interaction between the numbers of treatment related persons and density was found on intention, suggesting that density strengthens the relationship between treatment related persons in network and intention. Intention to use substance was associated with relapse to substance use behavior. CONCLUSION: Our findings support that personal social network characteristics can be considered as subjective norms in the TPB model. Personal social network interventions focusing on rebuilding consistent social norms against drug-using behaviors may decrease intention to use substance, which will lead to abstinence.

The association between personal social capital and health-related quality of life among Chinese older people: A cross-sectional study.

Background: Lower health-related quality of life (HRQoL) can result in adverse effects on the health of older people. This study aims to explore the relationship between personal social capital (PSC) and HRQoL among Chinese elderly people from rural-and-urban perspective. Materials and methods: 4,802 samples were included from China's health-related quality of life Survey for Older Adults 2018 (CHRQLS-OA 2018). The PSC, including bonding and bridging social capital (BOC and BRC), was measured by the Chinese version of the Personal Social Capital Scale (PSCS-16). The HRQoL was evaluated by the European Five Dimensions Questionnaire (EQ-5D-3L). Linear and Tobit regression models were conducted to examine the relationship between PSC and HRQoL. Results: The BOC and BRC of rural older people were significantly lower than those of urban older people. Pain/discomfort and anxiety/depression were the most significant health problems affecting the older samples. In the five dimensions, the proportion of rural older people with problems was higher than that of urban older people. Among rural older people, BOC was significantly related to self-rated health and EQ-5D utility index (p < 0.05); while BRC was insignificantly associated with self-rated health (p > 0.05) but related to EQ-5D utility index (p < 0.05). Both BOC and BRC were significantly correlated with self-rated health and EQ-5D utility index (p < 0.05) among urban older people. Conclusion: Our study reveals older people's worrying PSC and HRQoL status. The relationship between PSC and HRQoL suggested that more social support and care of intimates should be encouraged to increase the PSC of older people, especially rural older people.

Multiple Micronutrient Supplementation Using Spirulina platensis during the First 1000 Days is Positively Associated with Development in Children under Five Years: A Follow up of A Randomized Trial in Zambia.

Early childhood development relies on various micronutrients. We recently reported that home fortification of complementary foods using spirulina reduced the time to attain motor milestones in Zambian infants. The objective of this study is to estimate the long-term associations between spirulina supplementation during the first 1000 days and child gross motor development, fine motor development, language, and personal⁻social skills at preschool age. We used longitudinal data from a randomized trial conducted in Zambia. In 2015, 501 infants (age, 6⁻18 months) were provided daily supplements of maize-soy-based porridge with spirulina (SP) and without spirulina (CON). Supplementation period lasted for 16 months. In January 2018, children who participated in the initial trial were resurveyed (CON: 182 children; SP: 188 children; now aged 36⁻48 months). We assessed the infants' gross motor development, fine motor development, language, and personal⁻social skills using a modified version of Malawi Development Assessment Tool. The initial clinical trial registration number was NCT03523182. Children in the SP group had higher scores in gross and fine motor development, language, and social skills than those in the CON group. Home fortification of complementary foods using spirulina during the first 1000 days improved development among Zambian children at preschool age.

Physical work environment factors affecting risk for disability pension due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and other occupations: a prospective, population-based cohort study.

OBJECTIVE: To study the influence of physical work factors on the risks of future disability pension (DP) due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and all other occupations in the general working population in Sweden. METHODS: The prospective population study was based on representative samples of working individuals (n=79 004) aged 16-64, interviewed in the Swedish Work Environment Survey between 1993 and 2013. Information on diagnosed DP in 1994-2014 was gathered from the Social Insurance Agency's database. The focus was on nursing professionals (registered nurses and midwives) and care assistants, for example, assistant nurses and hospital ward assistants. The outcome was DP, classified into two diagnostic groups. Associations between physical work factors and risk of DP were calculated using Cox regression with HR and 95% CI. RESULTS: Physical work factors were associated with future DP after adjusting for sociodemographic conditions and psychosocial work factors among care assistants (n=10 175) and among all other occupations (n=66 253), but not among nursing professionals (n=2576). The increased risk among care assistants (n=197) exposed to heavy physical work was 66% (HR 1.66, 95% CI 1.39 to 1.97), and for those exposed to strenuous work postures (n=420) it was 56% (HR 1.56, 95% CI 1.35 to 1.80). Physical work indicators were mainly associated with musculoskeletal DP diagnoses among care assistants, but two indicators were significant also for mental diagnoses. An increased risk of DP was found among nursing professionals (n=102) exposed to detergents or disinfectants (HR 1.48, 95% CI 1.06 to 2.05), but not among care assistants. CONCLUSIONS: Heavy physical work and strenuous postures are predictors of future DP, particularly among care assistants and in the general working population. In order to reduce early exit from the workforce, efforts should be made to improve physical and ergonomic working conditions.

Social Capital Associated with Quality of Life among People Living with HIV/AIDS in Nanchang, China.

Background: This study aims to explore the relationship between quality of life (QOL) and social capital factors among "people living with HIV/AIDS" (PLWHA), in order to improve their quality of life and help them to release AIDS discrimination. Methods: A cross-sectional survey with 225 PLWHA was done in Nanchang, China, between January and June of 2015. Questionnaires consisted of a socio-demographic questionnaire, Personal Social Capital Scale and Medical Outcomes Study HIV Health Survey. To identify social capital factors influencing QOL among PLWHA, t-test and multiple linear regression were used as statistical tools. The analysis of data was conducted using SPSS 22.0 with a significant value of p < 0.05. Results: The scores of total social capital, bonding social capital and bridging social capital were 23.68 ± 5.55, 14.11 ± 3.40 and 9.46 ± 3.43 respectively. The scores of Physical Health Summary (PHS) and Mental Health Summary (MHS) were 51.88 ± 7.04 and 49.29 ± 6.60. Multiple linear regression analysis showed that age (B = -0.137, p = 0.020), income (B = 0.2170, p ≤ 0.001), employment (B = 0.112, p = 0.043) and bonding social capital (B = 0.178, p = 0.001) had significant effects on PHS. Bonding social capital was the most important influencing factor for MHS (B = 0.506, p < 0.001). There was no significant relationship between bridging social capital and QOL (p > 0.05). Conclusions: The PLWHA community has low social capital and a poor QOL in Nanchang. Bonding social capital had a positive impact on the QOL of PLWHA. There is an urgent need to build a better social support system based on bonding social capital for PLWHA. It is worth further exploring to identify how to make full use of bridging social capital for improving QOL among PLWHA.

Dynamic Assessment of Reading Difficulties: Predictive and Incremental Validity on Attitude toward Reading and the Use of Dialogue/Participation Strategies in Classroom Activities.

Dynamic Assessment (DA) has been shown to have more predictive value than conventional tests for academic performance. However, in relation to reading difficulties, further research is needed to determine the predictive validity of DA for specific aspects of the different processes involved in reading and the differential validity of DA for different subgroups of students with an academic disadvantage. This paper analyzes the implementation of a DA device that evaluates processes involved in reading (EDPL) among 60 students with reading comprehension difficulties between 9 and 16 years of age, of whom 20 have intellectual disabilities, 24 have reading-related learning disabilities, and 16 have socio-cultural disadvantages. We specifically analyze the predictive validity of the EDPL device over attitude toward reading, and the use of dialogue/participation strategies in reading activities in the classroom during the implementation stage. We also analyze if the EDPL device provides additional information to that obtained with a conventionally applied personal-social adjustment scale (APSL). Results showed that dynamic scores, obtained from the implementation of the EDPL device, significantly predict the studied variables. Moreover, dynamic scores showed a significant incremental validity in relation to predictions based on an APSL scale. In relation to differential validity, the results indicated the superior predictive validity for DA for students with intellectual disabilities and reading disabilities than for students with socio-cultural disadvantages. Furthermore, the role of metacognition and its relation to the processes of personal-social adjustment in explaining the results is discussed.

Tecendo redes, criando laços: uma análise das redes sociais pessoais de mulheres em situação de vulnerabilidade social / Weaving wefts, making ties: an analysis of the personal social network of women in social vulnerability situation

Conhecer as Redes Sociais Pessoais (RSP) dos sujeitos permite compreender como estas podem atuar: fontes de saúde ou doença, especialmente em contextos de vulnerabilidade social e violência, em que a (in)existência dessas redes são ainda mais cruciais no enfrentamento dos fenômenos. Objetivando conhecer as RSP de mulheres em situação de vulnerabilidade social e seus impactos nas vivências de violências interpessoais atuais, construiu-se o presente estudo. Com metodologia qualitativa, de estudo de casos múltiplos e caráter transversal, esta pesquisa entrevistou nove mulheres, atendidas em Centro de Referência de Assistência Social (CRAS) de uma cidade da região metropolitana de uma capital no Sul do Brasil. Neste estudo foram analisados, a partir da triangulação de dados e síntese dos casos cruzados, os dados provenientes dos mapas de RSP das participantes, genograma e da entrevista sobre as vivências atuais de violência. Os resultados sugerem as ausências vividas, econômicas e vinculares, especialmente no quadrante trabalho, impactando nos acessos sociais e de renda. O CRAS atuou como importante fonte de acesso a novos contatos e de ajuda material e de serviços. A RSP das entrevistadas se mostrou frágil no suporte às vivências de violência, demonstrando a importância de políticas públicas que invistam no incremento dessas redes e proteções.

To know the Personal Social Network (PSN) of the participants allow us to comprehend if they can act as sources of health or disease, especially in contexts of social vulnerability and violence when the in/existence of those networks are even more crucial for facing this phenomenon. This study aimed to understand the PSN of women in social vulnerability situation and their impacts on the recent interpersonal violence experiences. With qualitative methodology, of multiple cases study and cross-sectional character, this research interviewed nine women accompanied followed up at a public local social service unit in a metropolitan town located in the South of Brazil. In this study, were analyzed, from data triangulation and crossed-case synthesis, the data collected from the participants PSN maps, genogram and interviews about nowadays violence experiences. The results suggest that absences, economical and relational, especially related to the job quadrant, impacting on social and income access. The local social service unit acted as an important source of new contacts access and material/services care. The interviewees' PSN emerged as fragile regarding violence experiences, showing the relevance of public policies that invest in increasing these healthy networks and protections.

Complex and novel determinants of empathy change in medical students.

PURPOSE: Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors. METHODS: We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants. RESULTS: Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load). CONCLUSION: While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.