A study on the construct validity of the Parent-Child Conflict Tactics Scale (CTSPC) in an urban population in Northeast Brazil

The Parent-Child Conflict Tactics Scale (CTSPC) is one of the most widely used instruments in the world for investigating domestic violence against children, but targeted use has proven inadequate given the phenomenon's complexity. This study focused on the factor structure of CTSPC scales in an urban population in Northeast Brazil. We conducted a cross-sectional study in a cohort of 1,370 children in Salvador, Bahia State. Factor analysis with promax oblique rotation was performed, and the Kuder-Richardson coefficient was calculated. Factor analysis showed a different distribution of items in the factors as compared to the original instrument. Violence showed a gradual profile in each factor. The Kuder-Richardson coefficient was 0.63 for factor 1, 0.59 for factor 2, and 0.42 for factor 3. The items behaved differently from the original instrument, corroborating international studies. These findings support proposing a resizing of the CTSPC

Adult oral health-related quality of life instruments: A systematic review

Objectives: To identify the existing OHRQoL instruments for adults, describe their scope (generic or specific), theoretical background, validation type and cross-cultural adaptation. Methods: A systematic search was conducted, and articles presenting validation of OHRQoL instruments in adults were included. Data were collected about the validation type: external validation (correlations/associations); or internal validation (factor analysis/principal components analysis, item response theory); and cross-cultural adaptation. Results: Of 3730 references identified, 326 were included reporting 392 studies. Forty-two original instruments were found among 74 different versions, 40 generic and 34 condition-specific. Locker's theoretical framework was the predominant model. The oral health impact profile (OHIP) presented 20 versions, with OHIP-14 being the most frequent (26.8%), followed by geriatric oral assessment index (GOHAI) (14.0%), OHIP-49 (11.7%) and oral impacts on daily performances (OIDP) (9.7%). Most studies focused on external validation (65.3%), while internal validation was reported in 24.8% (n = 26) of OHIP-14 studies, 50.9% (n = 28) of GOHAI and 21.1% (n = 8) of OIDP studies. Most internal validation studies were conducted in English-speaking countries (n = 33), and cross-cultural adaptation was mostly in non-English-speaking European countries (n = 40). Conclusions: Many generic and condition-specific instruments were found, but few have gone through a rigorous internal validation process or have undergone cross-cultural adaptation. This, in turn, makes it difficult for researchers to choose an appropriate measure based on known psychometric properties. OHIP-14, OIDP and GOHAI seem to be the most widely validated instruments. Equalizing measurement properties for comparability are challenging due to theoretical heterogeneity. Future studies should assess psychometric properties, explore the factorial structure and work towards a consensus on critical issues

Transcultural adaptation of the Emotion Matching Task: an emotion neuropsychological assessment

Emotions play a central role in children’s relationships. Deficits in emotional understanding have been associated with several neuropsychiatric disorders. In Brazil, however, few psychological instruments are available to assess young children’s emotional development. The objective of the present study was to make a transcultural adaptation of the Emotion Matching Task (EMT). The EMT was translated and adapted by a team of bilingual researches and then back-translated to English. The preliminary versions were assessed by EMT’s authors and by Brazilians specialized judges. The final version was applied in a sample of 50 children between three and six years of age and answered by nine judges in three Brazilian states. The results indicate good semantic equivalence and good agreement with the answers provided (κ= 0.88, Z=95.2, p<0.001). The final version of the EMT was considered appropriate and satisfactory

Criança, violência e saúde: desafios e questões atuais

This paper examines challenges and current issues involved in measuring exposure to different types of violence which are associated mental health problems in children and adolescents. Standardized measures suitable for epidemiological studies, selected based on their relevance in the current literature, are briefly described and commented. The assessment of child's exposure to violence may focus on a specific event (e.g., kidnapping), a specific context (e.g., war) or even of a certain type of exposure (e.g., intrafamilial physical violence). The assessment of child mental health after exposure to violence has traditionally focused on posttraumatic stress disorder (PTSD) - most frequently measured through non-diagnostic scales. However, other mental health reactions may be present and screening as well as diagnostic instruments which may be used to assess these reactions are also described. Two issues of emerging importance - the assessment of impairment and of traumatic grief in children - are also presented. Availability of culturally appropriate instruments is a crucial step towards proper identification of child mental health problems after exposure to violence.Este artigo examina os desafios e perspectivas atuais envolvidos na mensuração da exposição a diferentes tipos de violência e problemas de saúde mental em crianças e adolescentes. Instrumentos padronizados apropriados para estudos epidemiológicos, selecionados com base em sua relevância na literatura, são brevemente descritos e comentados. A avaliação de exposição à violência em crianças pode dizer respeito a um evento específico (como sequestro) ou um contexto específico (como guerra) ou mesmo um determinado tipo de exposição (como violência física intrafamiliar). A avaliação da saúde mental infantil após a exposição à violência tradicionalmente concentrou-se na avaliação do transtorno de estresse pós-traumático (TEPT) - freqüentemente avaliado através de escalas não-diagnósticas. Porém, outras reações psicológicas podem ocorrer e instrumentos que podem ser usados para avaliar estas reações também são descritos neste artigo. Dois tópicos de importância emergente - a avaliação de prejuízo funcional e do pesar traumático em crianças - são também apresentados. Instrumentos culturalmente apropriados são essenciais para a identificação de problemas de saúde mental em crianças após a exposição à violência.Division of Child and Adolescent PsychiatryUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

BACKGROUND: Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. METHODS: Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. RESULTS: Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. CONCLUSIONS: Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services

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