Avaliação psicométrica de três questionários sobre o historial familiar

BACKGROUND: Family is the primary setting where children develop their social skills. Early experiences may represent protective or risk factors that interact with their vulnerability to or resilience against mental disorders in adulthood. The assessment of the family history of relevant emotional experiences is problematic, and the use of psychometric instruments may help overcome certain methodological limitations. OBJECTIVES: To develop three sub-questionnaires for the assessment of early emotional experiences in the family context in childhood through adolescence. These instruments are Portuguese adaptations of the Family Background Questionnaire (FBQ), addressing aspects of parental care and family environment, and are retrospectively administered to adults. METHODS: Three composite versions of the FBQ addressing (1) Paternal care, (2) Maternal care and (3) Family environment were produced. Questionnaires were administered to 280 participants. The assessment of the psychometric properties of these questionnaires was based on the determination of internal consistency, factor analysis and Spearman's correlations. RESULTS: All three questionnaires proved adequate for the assessment of their respective domains. DISCUSSION: The objective assessment of early emotional experiences in the family context yields important insights to the comprehension of psychological development, with both clinical and research implications.CONTEXTO: A família é a arena primária na qual a criança desenvolve a sua sociabilização. As experiências tidas neste sistema podem constituir um factor protector ou de risco, contribuindo para a sua vulnerabilidade ou resiliência diante de desordens mentais quando adulto. A avaliação da história familiar de experiências emocionais relevantes é problemática, e o uso de instrumentos psicométricos pode auxiliar a superar certas limitações metodológicas. OBJECTIVOS: Desenvolver três subquestionários para avaliação das experiências emocionais decorridas no contexto familiar da infância até a adolescência. Esses instrumentos são adaptações para o português do Family Background Questionnaire (FBQ) tratando dos cuidados paliativos e do ambiente familiar e são administrados retrospectivamente a adultos. MÉTODOS: Três versões do FBQ que tratam de (1) cuidados paternos, (2) cuidados maternos e (3) ambiente familiar foram produzidas. Os questionários foram aplicados a 280 participantes. A avaliação das propriedades psicométricas desses questionários teve como base a determinação da consistência interna, análise factorial e correlação de Spearman. RESULTADOS: Os três questionários mostraram-se adequados para avaliação de seus respectivos domínios. CONCLUSÕES: A avaliação objetiva das primeiras experiências emocionais no contexto familiar produz insights importantes para a compreensão do desenvolvimento psicológico, com implicações clínicas e de investigação

Efeitos do sotalol sobre o eletrocardiograma de alta resolução avaliados por ensaio duplo-cego cruzado randomizado

A presente investigação teve por objetivo avaliar os efeitos do Sotalol sobre o eletrocardiograma de alta resolução (ECGAR), em uma população com arritmia ventricular idiopática. Foi estudado um grupo de 12 pacientes submetidos a um ensaio clínico do tipo duplo-cego cruzado e randomizado, para avaliaçao da eficácia da droga. Foram obtidos ECGAR em condiçoes de controle (C), uso de placebo (P) e de droga (O), confrontando os resultados entre as três situações e a eficácia medicamentosa. No vetor-magnitude foram analisados os seguintes parâmetros: voltagem média dos 40 ms terminais do complexo QRS filtrado (VM - normal > 20 µV), duração dos sinais de baixa amplitude < 40 µV no final da ativação (SBA - normal < 38 ms) e duração total do complexo QRS filtrado (OQRS - normal < 114.0 ms). Em função da resposta terapêutica, os pacientes foram divididos em responsivos (G1) e não-responsivos (G2). Não foram observadas diferenças estatisticamente significativas entre C e P. No Grupo I, composto por 5 pacientes (42% de eficácia), não foram observadas diferenças significativas nas 3 variáveis avaliadas entre as condições de P e O. No Grupo 11, composto por 7 pacientes, ocorreram modificaçoes nos SBA, cujos valores no P estavam em 24.80 ± 7.60 ms e passando com a O para 29.10 ± 14.76 ms (p < 0,01). Em 5 dos 7 pacientes deste grupo (71%), prolongaram-se no pós-droga os SBA, numa média de 11.20 ± 4.80 ms, com significância estatística em relaçao ao placebo (p < 0.04). Frente aos resultados observados com os SBA, foram obtidos sensibilidade de 71 %, especificidade de 86%, valor preditivo positivo de 83% e negativo de 75% para definir a populaçao responsiva à droga. Concluiu-se que na população estudada, o Sotalol, quando efetivo, não produziu modificações significativas nos parâmetros do ECGAR. Um incremento médio dos SBA de 11.2 ± 4.8 ms, por influência da droga, associou-se a uma ausência de resposta terapêutica

Telephone-based psychological crisis intervention: the Portuguese experience with COVID-19

Published online: 07 Jun 2020Portugal is one of the European countries that implemented early protective measures in the context of the COVID-19 pandemic. Portugal declared a state of emergency on 18 March, and a set of regional and national preventive public health measures was progressively implemented. Studies on the psychological impact of pandemics show evidence of the negative impact on mental health. Of particular concern are individuals with previous fragility (e.g. personal, family or occupational) and those undergoing life transitions. In this paper, we present a telephone-based psychological crisis intervention that was implemented to provide brief, appropriate, and timely psychological help. This intervention follows standard models of crisis intervention and is structured in five phases and five different intervention modules to take into account the impact of the pandemic on the mental health of specific risk groups. With these support services, we hope to help our community better cope with the immediate impact of the pandemic and to contribute to preventing serious mental health problems in the medium and long term.This study was partially conducted at the Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through the national funds (PIDDAC). We acknowledge Associação de Psicologia da Universidade do Minho (APsi-UMinho) and APsiUMinho collaborators for supporting the telephone-based psychological crisis intervention: Ana Daniela Silva, Ana Isabel Gonçalves, Ana Rita Pereira, Andreia Milhazes, Ângela Ferreira, Alexandra Vieira, Célia Sampaio, Carina Magalhães, Cátia Braga, Delfina Fernandes, Dulce Lopes, Dulce Pinto, Inês Castro, Inês Marques, Gabriela Santana, Joana Andrade, Joana Coutinho, Joana Guimarães, Joana Soares, Joana Teixeira, Joana Torres, João Batista, João Tiago Oliveira, Mariana Leite, Marta Sousa, Patrícia Mendes, Sara Lima, Soraia Mesquita, Teresa Castanho. We would like to thanks P5 and affiliated Psychologists: Liliana Amorim, and Inês Fernandes. We gratefully acknowledge OutSystems for the financial support through OutSystems COVID-19 Community Response Program

Fatores Críticos de Sucesso para o Planejamento Estratégico em uma Rede Pública de Ensino / Critical success factors for strategic planning in public education network

O objetivo deste estudo foi analisar quais fatores críticos de sucesso contribuem para o planejamento estratégico e como eles estão sendo percebidos por gestores escolares da Rede Municipal de Ensino da cidade de Mossoró/RN. A coleta de dados foi empreendida mediante aplicação de  questionários em 31 escolas municipais de Mossoró-RN, cujos respondentes foram diretores e superiores escolares que participaram da experiência local de planejamento estratégico. O questionário continha 22 questões com opções de respostas em escala Likert de cinco pontos, variando de “sem importância” a “muito importante”, além de duas questões abertas. Para análise dos dados, foi utilizada a análise fatorial exploratória e confirmatória, bem como análise qualitativa do conteúdo. Como resultado, observou-se a existência de três fatores críticos para o sucesso: a adoção do planejamento estratégico pela cúpula gerencial; a implantação e análise dos resultados do plano de ação e o gerenciamento dos aspectos humanos e culturais. Esses fatores foram confirmados e reforçados pela análise qualitativa. Os fatores valorados pelos gestores escolares representam os principais aspectos a ser considerados na aplicação do planejamento estratégico no ambiente escolar público municipal

Adverse childhood experiences and suicide attempts in morbidly obese adults

Introdução: As tentativas de suicídio surgem frequentemente associadas a problemas alimentares, tanto anorexia quanto bulimia. Do mesmo modo, tem-se verifi cado uma elevada ocorrência de suicídio entre obesos. Investigações têm mostrado que a adversidade na infância pode ser um fator de risco para as tentativas de suicídio. Objetivos: Caracterizar e compreender a relação entre experiências de adversidade na infância e tentativas de suicídio em 100 obesos mórbidos candidatos a cirurgia bariátrica. Métodos: Um total de 100 pacientes foram selecionados de setembro de 2007 a outubro de 2007 e de janeiro de 2008 a janeiro de 2009, sendo que 20 pacientes eram do sexo feminino. A média de idade era de 38,89±9,87 anos, e a média do peso máximo era de 136,43±14 kg. O Questionário da História de Adversidade na Infância foi utilizado para avaliar experiências adversas. Resultados: 88% dos pacientes relataram a existência de pelo menos uma experiência de adversidade na infância, e 25% relataram já ter realizado pelo menos uma tentativa de suicídio. A adversidade na infância esteve associada a um risco aumentado para realizar tentativas de suicídio (odds ratio = 2,026). Conclusão: Esses dados devem ser levados em consideração na avaliação e no acompanhamento desses pacientes.Introduction: Suicide attempts are often associated with eating disorders, both anorexia and bulimia. Likewise, a high incidence of suicide has been observed among obese patients. Previous studies have shown that adverse experiences in childhood may be a risk factor for suicide attempts. Objectives: To characterize and to understand the relationship between adverse experiences and suicide attempts in 100 morbidly obese patients referred for bariatric surgery. Methods: A total of 100 patients were selected from September 2007 to October 2007 and from January 2008 to January 2009. Of these, 20 patients were females. Mean age was 38.89±9.87 years, and mean maximum weight was 136.43±14 kg. The Portuguese version of the Family ACE (Adverse Childhood Experiences) Questionnaire was used to assess the occurrence of adverse events. Results: 88% of the patients reported the existence of at least one adverse experience in childhood, and 25% reported at least one previous suicide attempt. Adversity in childhood was associated with an increased risk for suicide attempts (odds ratio = 2.026). Conclusion: These data should be taken into account in the assessment and monitoring of these patients.Fundação para a Ciência e a Tecnologia (FCT); (SFRH/BD/37069/2007)

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. the expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. in this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Campinas UNICAMP, Sch Med Sci, Dept Obstet & Gynaecol, BR-13083881 Campinas, SP, BrazilCtr Res Reprod Hlth Campinas Cemicamp, BR-13083888 Campinas, SP, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilSch Med Sci, CISAM, Recife, PE, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Fed Bahia, Salvador, BA, BrazilHosp Geral Cesar Cals, Fortaleza, Ceara, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilMaternidade Odete Valadares, Belo Horizonte, MG, BrazilHosp Materno Infantil, Goiania, Go, BrazilInst Materno Infantil Pernambuco, Recife, PE, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Fed Campina Grande, Campina Grande, PB, BrazilUniv Fed Maranhao, Sao Luis, MA, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilUniv Fed Paraiba, BR-58059900 Joao Pessoa, Paraiba, BrazilHosp Maternidade Fernando Magalhaes, Rio de Janeiro, RJ, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Maternidade Celso Pierro, Campinas, SP, BrazilInst Fernandes Figueira Fiocruz, Rio de Janeiro, RJ, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniv State São Paulo, Botucatu, SP, BrazilJundiai Sch Med, Jundiai, SP, BrazilUniv São Paulo, BR-14049 Ribeirao Preto, SP, BrazilSanta Casa Limeira, Limeira, SP, BrazilSanta Casa Sao Carlos, Sao Carlos, SP, BrazilMaternidade Leonor Mendes de Barros, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilCNPq: 402702/2008-5Web of Scienc

The clustering of galaxies in the SDSS-III DR10 Baryon Oscillation Spectroscopic Survey: no detectable colour dependence of distance scale or growth rate measurements

We study the clustering of galaxies, as a function of their colour, from Data Release Ten (DR10) of the Sloan Digital Sky Survey III (SDSS-III) Baryon Oscillation Spectroscopic Survey. DR10 contains 540 505 galaxies with 0.43 z k + e corrected (to z =0.55) r − i colours and i-band magnitudes. The samples are chosen such that both contain more than 100 000 galaxies, have similar redshift distributions and maximize the difference in clustering amplitude. The Red sample has a 40 per cent larger bias than the Blue (bRed/bBlue = 1.39 ± 0.04), implying that the Red galaxies occupy dark matter haloes with an average mass that is 0.5 log10 M⊙ greater. Spherically averaged measurements of the correlation function, ξ0, and the power spectrum are used to locate the position of the baryon acoustic oscillation (BAO) feature of both samples. Using ξ0, we obtain distance scales, relative to the distance of our reference Λ cold dark matter cosmology, of 1.010 ± 0.027 for the Red sample and 1.005 ± 0.031 for the Blue. After applying reconstruction, these measurements improve to 1.013 ± 0.020 for the Red sample and 1.008 ± 0.026 for the Blue. For each sample, measurements of ξ0 and the second multipole moment, ξ2, of the anisotropic correlation function are used to determine the rate of structure growth, parametrized by fσ8. We find fσ8,Red = 0.511 ± 0.083, fσ8, Blue = 0.509 ± 0.085 and fσ8, Cross = 0.423 ± 0.061 (from the cross-correlation between the Red and Blue samples). We use the covariance between the bias and growth measurements obtained from each sample and their cross-correlation to produce an optimally combined measurement of fσ8, comb = 0.443 ± 0.055. This result compares favourably to that of the full 0.43 z fσ8, full = 0.422 ± 0.051) despite the fact that, in total, we use less than half of the number of galaxies analysed in the full sample measurement. In no instance do we detect significant differences in distance scale or structure growth measurements obtained from the Blue and Red samples. Our results are consistent with theoretical predictions and our tests on mock samples, which predict that any colour-dependent systematic uncertainty on the measured BAO position is less than 0.5 per cent

Low prevalence of renal, cardiac, pulmonary, and neurological extra-articular clinical manifestations in spondyloarthritis: analysis of the Brazilian Registry of Spondyloarthritis

OBJECTIVE: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological), usually not related to spondyloarthritis (SpA), in a large cohort of Brazilian patients. MATERIALS AND METHODS: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian Registry of Spondyloarthritis (BRS). All patients were assessed for the prevalence of major extra-articular manifestations (cardiac, renal, pulmonary, and neurological), classified according to the diagnosis [ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthritis (uSpA), and juvenile SpA], and according to the clinical presentation (axial, peripheral, mixed, and enthesitis). RESULTS: Of the patients with SpA assessed, 963 had AS, 271 PsA, 49 ReA, 48 arthritis associated with IBD, 98 uSpA, and 43 juvenile SpA. Cardiac involvement was reported in 44 patients (3.0%), pulmonary involvement in 19 (1.3%), renal involvement in 17 (1.2%), and neurological involvement in 13 patients (0.9%). Most patients with visceral involvement had AS or PsA, and the mixed (axial + peripheral) and/or predominantly axial clinical form. CONCLUSION: Cardiac, renal, pulmonary, and neurological extra-articular manifestations are quite infrequent in SpA, ranging from 0.9% to 3% in this large Brazilian cohort, and affected predominantly patients with AS and PsA.OBJETIVO: Descrever as manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas) geralmente não relacionadas às espondiloartrites (EpA) em uma grande coorte de pacientes brasileiros. MÉTODOS: Este estudo retrospectivo analisou 1.472 pacientes com o diagnóstico de EpA atendidos em 29 centros distribuídos pelas cinco principais regiões geográficas do Brasil, integrantes do Registro Brasileiro de Espondiloartrites. Todos os pacientes foram avaliados para a prevalência das principais manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas), divididas por diagnóstico [espondilite anquilosante (EA), artrite psoriásica (AP), artrite reativa (ARe), artrite associada a doença inflamatória intestinal (DII), EpA indiferenciada (EI) e EpA juvenil] e por forma clínica (axial, periférica, mista e entesítica). RESULTADOS: Dentre os pacientes avaliados com EpA, 963 apresentavam EA, 271 AP, 49 ARe, 48 artrite associada a DII, 98 EI e 43 EpA juvenil. Acometimento cardíaco foi observado em 44 pacientes (3,0%), seguido por acometimento pulmonar em 19 (1,3%), renal em 17 (1,2%) e neurológico em 13 pacientes (0,9%). A maioria dos casos de acometimento visceral ocorreu nos pacientes com EA ou AP e naqueles com forma clínica mista (axial e periférica) e/ou predominantemente axial. CONCLUSÃO: As manifestações extra-articulares cardíacas, renais, pulmonares e neurológicas são muito pouco frequentes nas EpA, variando de 0,9%-3% nesta grande coorte brasileira, estando mais associadas a EA e AP.37938

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London