The positive impact of an intervention for maternal depression on child emotional and behavioral symptoms in a low-resource setting

Objectives: Children of depressed mothers are at risk of developing mental health problems. We sought to determine whether treatment for maternal depression by community-based health workers would decrease behavioral/emotional symptoms in their children. Interventions for maternal depressive symptoms in a low/middle-income country can have a high global impact. Methods: Community-based health workers were trained to deliver a psychosocial intervention for mothers with depression in a primary care setting. A total of 49 mothers and 60 children were assessed pre-intervention, post-intervention, and at 6 months follow-up. Child behavioral/emotional symptoms were evaluated according to type of change in maternal depressive symptoms: response or remission. Results: An overall decrease in maternal depressive symptoms from baseline to post-intervention and 6 months follow-up were found. Response or remission was associated with better outcomes in child behavioral/emotional symptoms at 6 months follow-up (p = 0.0247, Cohen's d: 0.76; p = 0.0224, Cohen's f: 0.44) but not at post-intervention (p = 0.1636, Cohen's d: 0.48; p = 0.0720, Cohen's f: 0.33). Conclusions: Improvement in maternal depression was related to decreased behavioral/emotional symptoms in their children. Our results suggest that providing interventions for maternal depression in primary care is a viable strategy to prevent behavioral/emotional symptoms in the next generation. Clinical Trial registration: Brazilian Clinical Trials, number RBR-5qhmb5.

Compreensões Fenomenológicas da Reexposição ao Trauma Sexual com Base nos Relatos de Mulheres / Phenomenological Understandings About Sexual Trauma Re-Exposure Based on Women's Reports / Comprensiones Fenomenológicas de la Reexposición al Trauma Sexual Basada en Informes de Mujeres

Esta pesquisa foi desenvolvida a partir do projeto temático "Transtorno de estresse pós-traumático e neuroprogressão: trauma e estresse no aumento da carga alostática e aceleração do processo de envelhecimento", realizado com mulheres vítimas de violência sexual e que desenvolveram estresse pós-traumático no estado de São Paulo. Neste estudo, são apresentados relatos de violência sexual na infância e na adolescência e sua reexposição na vida adulta e, com isso, tem como objetivo trazer à luz compreensões acerca dessa vivência a fim de abrir possibilidades de intervenções adequadas. Foram realizadas entrevistas reflexivas com quatro colaboradoras que, na triagem do Projeto Temático, responderam positivamente a um questionário de abuso e negligência durante a infância e na adolescência. Na análise fenomenológica, seus discursos foram separados em oito categorias de sentido (Afeto, Culpa, Mundo familiar, Não dito, Racismo, Profissionais, Hoje e Reexposição à violência sexual). Concluiu-se que a violência sexual diz respeito a uma responsabilidade política, uma vez que as colaboradoras culpam-se por acreditarem que a vulnerabilidade delas reside em algum comportamento provocado por elas mesmas e não por mais um dispositivo de violência contra a mulher.

This paper was developed based upon a thematic project "Posttraumatic stress disorder and neuroprogression: trauma and stress increasing load allostatic and accelerating the aging process", conducted with women who suffered sexual assault and developed post-traumatic stress disorder in the state of São Paulo. This study has reports about sexual violence in childhood and adolescence and its re-exposures in adulthood and seeks to bring up understandings about this experience in order to open possibilities for a more appropriate intervention. Reflective interviews were made with four collaborators that previously answered positively to a questionnaire of abuse and neglect during childhood and adolescence in the screening of the Thematic Project. With the phenomenological analysis their speech was split into eight categories (Affections, Guilt, Familiar world, Unsaid, Racism, Health professionals, Today and Sexual violence re-exposure). It has been concluded that sexual violence concerns to a political responsibility, once the collaborators blamed themselves for they believe that their vulnerability was their fault instead of a tradition of gender violence.

Esta investigación se desarrolló a partir del proyecto temático "Trastorno de estrés postraumático y neuroprogresión: el trauma y el estrés en el aumento de la carga alostática y la aceleración del proceso de envejecimiento", realizado con mujeres víctimas de violencia sexual y que desarrollaron estrés postraumático, en el estado de São Paulo. En este estudio, se presentan relatos de violencia sexual en la infancia y en la adolescencia y su reexposición en la edad adulta y, con ello, se pretende sacar a la luz comprensiones acerca de esa experiencia, para abrir posibilidades de intervenciones adecuadas. Se realizaron entrevistas reflexivas con cuatro colaboradoras que, en el triaje del Proyecto Temático, respondieron positivamente a un cuestionario sobre abuso y negligencia en la infancia y la adolescencia. En el análisis fenomenológico, sus discursos se separaron en ocho categorías de sentido (Afecto, Culpa, Mundo Familiar, No Dicho, Racismo, Profesionales, Actualidad y Reexposición a la Violencia Sexual). Se concluyó que la violencia sexual tiene que ver con una responsabilidad política patriarcal, ya que las colaboradoras se culpan a sí mismas por creer que su vulnerabilidad radica en algún comportamiento causado por ellas mismas y no por más un dispositivo de violencia contra las mujeres.

Double-Blinded Randomized Study of the Correlation between Simple Radiography and Magnetic Resonance Imaging in the Evaluation of the Critical Shoulder Angle: Reproducibility and Learning Curve / Estudo duplo-cego randomizado da correlação entre radiografia simples e ressonância magnética na avaliação do ângulo crítico do ombro: Reprodutibilidade e curva de aprendizado

Abstract Objective To evaluate the feasibility of magnetic resonance imaging (MRI) to obtain the critical shoulder angle (CSA) comparing the results obtained through radiography and MRI, and assess the learning curves. Methods In total, 15 patients were evaluated in a blinded and randomized way. The CSA was measured and compared among groups and subgroups. Results The mean angles measured through the radiographic images were of 34.61 ± 0.67 and the mean angles obtained through the MRI scans were of 33.85 ± 0.53 (p = 0.29). No significant differences have been found among the groups. The linear regression presented a progressive learning curve among the subgroups, from fellow in shoulder surgery to shoulder specialist and radiologist. Conclusion There was no statistically significant difference in the X-rays and MRI assessments. The MRI seems to have its efficacy associated with more experienced evaluators. Data dispersion was smaller for the MRI data regardless of the experience of the evaluator.

Resumo Objetivo Avaliar a confiabilidade da obtenção do ângulo crítico do ombro (ACO) na ressonância magnética (RM) comparada com esse mesmo ângulo obtido por meio de radiografias, e avaliar a curva de aprendizado do método. Métodos As imagens de radiografias e RMs de 15 pacientes foram avaliadas prospectivamente de forma cega e randômica. O ACO foi medido e comparado entre os grupos e subgrupos. Resultados A média dos ACOs nas imagens de radiografia foi de 34,61º ± 0,67, e, na RM, 33,85º ± 0,53 (p = 0,29). Não houve diferença estatisticamente significativa. Houve curva de aprendizado progressiva na regressão linear entre os subgrupos, de especializando em ombro a especialista e radiologista. Conclusão Não houve diferença estatisticamente significativa entre o ACO por imagens de radiografia e RM. O método da RM parece ter sua eficiência associada a avaliadores mais experientes. Independente da experiência do avaliador, a variabilidade dos dados foi menor nas avaliações por RM.

Relationship between right atrium area and right ventricular ejection fraction on magnetic resonance imaging: comparison with other prognostic markers in patients with pulmonary arterial hypertension / Comparação da relação da área do átrio direito e fração de ejeção do ventrículo direito por ressonância magnética com outros marcadores prognósticos de pacientes com hipertensão arterial pulmonar

Abstract Objective: To compare the right atrium (RA) area and right ventricular ejection fraction (RVEF) with other known prognostic markers in patients with pulmonary arterial hypertension (PAH). Materials and Methods: This was a retrospective study of 74 patients diagnosed with PAH by right heart catheterization at a referral center between January 2018 and May 2018. All of the patients underwent cardiac magnetic resonance imaging (MRI) within 3 months of the right heart catheterization (RHC), as well as undergoing echocardiography, a 6-minute walk test, and determination of the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) within a month of the RHC. We attempted to determine whether the cardiac MRI-derived RA area correlated with ions between RVEF and RA area measured by that determined by echocardiography, as well as whether the cardiac MRI-derived RA area and RVEF correlated with the 6-minute walk distance and NT-proBNP level. Results: The MRI-derived RA area demonstrated a weak correlation with the pulmonary vascular resistance measured by RHC (r = 0.268; p = 0.055) and a moderate correlation with the NT-proBNP (r = 0.429; p = 0.003). All correlations between clinical characteristics and the RVEF were statistically significant. In the univariate linear analysis, the RVEF showed stronger correlations with the clinical characteristics than did the RA area. Conclusion: In patients with PAH, cardiac MRI-derived RVEF appears to correlate more strongly with other prognostic factors than does RA area.

Resumo Objetivo: Comparar a área do átrio direito (AD) e a fração de ejeção do ventrículo direito (FEVD) com outros marcadores prognósticos conhecidos em pacientes com hipertensão arterial pulmonar (HAP). Materiais e Métodos: Identificamos, retrospectivamente, 74 pacientes com diagnóstico de HAP por cateterismo cardíaco direito em um centro de referência, no período de 3 meses da ressonância magnética cardíaca (RMC), entre janeiro de 2018 e maio de 2018, que também realizaram ecocardiograma, teste de caminhada de 6 minutos e fração N-terminal do pró-peptídio natriurético tipo B (NT-proBNP) dentro de um mês. Foram realizadas correlações entre a FEVD e a área do AD avaliada por RMC com parâmetros como: ecocardiograma, teste de caminhada de 6 minutos e NT-proBNP. Resultados: A correlação entre a área do AD demonstrou correlação fraca com a resistência vascular pulmonar (r = 0,268; p = 0,055) e correlação moderada com NT-proBNP (r = 0,429; p = 0,003). Todas correlações entre parâmetros clínicos e a FEVD foram estatisticamente significantes. Na análise linear univariada, a FEVD apresentou maior correlação com as variáveis de desfecho clínico do que a área do AD. Conclusão: Ambos, FEVD e área AD por RMC, estão correlacionados com marcadores de prognóstico clínico; no entanto, a FEVD apresentou correlações mais fortes e significativas em relação à área do AD.

Efeitos do Transtorno de Estresse Pós-Traumático na Memória / Effects of Post Traumatic Stress Disorder in Memory / Efectos del Trastorno de Estrés Postraumático en la Memoria

O Transtorno de Estresse Pós-Traumático (TEPT) é frequentemente associado a déficits cognitivos, porém ainda existem divergências com relação as funções cognitivas afetadas. O objetivo do presente estudo foi avaliar o impacto do TEPT na memória operacional, na memória visual de curto prazo, na memória episódica de longo prazo, na memória semântica de longo prazo e na memória prospectiva. A amostra foi composta por 20 mulheres com idades entre 20 e 60 anos, sendo 10 mulheres provenientes do Programa de Atendimento e Pesquisa em Violência da Universidade Federal de São Paulo (PROVE) com diagnóstico de TEPT (GTEPT) e 10 mulheres controle com a mesma idade e escolaridade (GC). O instrumento utilizado foi o Instrumento de Avaliação Neuropsicológica Breve (NEUPSILIN). Os dados foram analisados por teste t de Student para amostras dependentes e o nível de significância adotado foi de 5%. Os resultados obtidos a partir da análise do NEUPSILIN apontam para prejuízos na memória operacional (p = 0,04) e na memória prospectiva (p = 0,02) associados ao TEPT. Porém não foram observadas diferenças entre os grupos no que diz respeito aos outros tipos de memória investigados (p > 0,05). Os achados deste estudo, com relação aos prejuízos na memória operacional e na memória prospectiva associados ao TEPT estão de acordo com a literatura. Ambas funções são de extrema importância para o desempenho de atividades cotidianas, portanto, a intervenção e reabilitação destas funções no sujeito com TEPT podem auxiliar significativamente na melhora da qualidade de vida....(AU)

Posttraumatic Stress Disorder (PTSD) is often associated with cognitive deficits, but there are still some differences regarding cognitive functions affected. Therefore, the aim of this study was to evaluate the impact of PTSD on working memory, visual shortterm memory, long-term episodic memory, long-term semantic memory and prospective memory. The sample consisted of 20 women aged between 20 and 60 years, ten women from the Program of Assistance and Research on Violence of the Federal University of São Paulo (PROVE) diagnosed with PTSD and overlapping violence (GTEPT) and ten women control of the same age and educational level (GC). The instrument used was the Brief Neuropsychological Assessment Instrument (NEUPSILIN). Data were analyzed by Student's t-test for dependent samples, and the significance level was 5%. The results obtained from the analysis NEUPSILIN point to the losses in working memory (p = 0.04) and prospective memory (p = 0.02) associated with PTSD. Differences between groups were not observed on other types of memory investigated (p > 0.05). The findings of this study on losses in working memory and prospective memory associated with PTSD are in agreement with the literature. Both functions are critical to the performance of daily activities. Therefore, intervention and rehabilitation of these functions in the subject with PTSD can help significantly in improving the quality of life....(AU)

El trastorno de estrés postraumático (TEPT) suele asociarse a déficits cognitivos, pero todavía existen divergencias con las funciones cognitivas afectadas. El objetivo del presente estudio fue evaluar el impacto del TEPT en la memoria operativa, en la memoria visual de corto plazo, en la memoria episódica de largo plazo, en la memoria semántica de largo plazo y en la memoria prospectiva. La muestra fue compuesta por 20 mujeres conedades entre 20 y 60 años, siendo 10 mujeres provenientes del Programa de Atención e Investigación en Violencia de la Universidad Federal de São Paulo (PROVE) con diagnóstico de TEPT (GTEPT) y 10 mujeres control con la misma edad y escolaridad (GC). El instrumento utilizado fue el Instrumento de Evaluación Neuropsicológica Breve (NEUPSILIN). Los datos fueron analizados por test t de Student para muestras dependientes y el nivel de significancia adoptado fue del 5%. Los resultados obtenidos a partir del análisis del NEUPSILIN apuntan a pérdidas en la memoria operativa (p = 0,04) y en la memoria prospectiva (p = 0,02) asociados al TEPT. Sin embargo, no se observaron diferencias entre los grupos en lo que se refiere a los otros tipos de memoria investigados (p > 0,05). Los hallazgos de este estudio, con relación a los perjuicios en la memoria operativa y en la memoria prospectiva asociados al TEPT están de acuerdo con la literatura. Ambas funciones son de extrema importancia para el desempeño de actividades cotidianas, por lo tanto, la intervención y rehabilitación de estas funciones en el sujeto con TEPT pueden auxiliar significativamente en la mejora de la calidad de vida....(AU)

Revictimization as a high-risk factor for development of posttraumatic stress disorder: a systematic review of the literature

Objective: Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PTSD). Methods: Electronic searches were conducted in five databases (MEDLINE/PubMed, Cochrane Library, Campbell Library, PsycINFO, and LILACS), using the terms PTSD, posttraumatic stress disorder, child abuse, and rape. Results: We identified nine articles that established a connection among childhood sexual abuse (CSA), sexual revictimization in adulthood, and development of PTSD. Eight of the nine papers included were classified as having strong methodological quality (grade VI). One was classified as IV, with an average quality-of-evidence rating. The mean methodological quality score of the articles was 5.5, and the quality of evidence was deemed strong. Conclusion: In the included studies, PTSD symptoms were most prevalent in the CSA + adult sexual assault groups, providing further evidence for the revictimization hypothesis.

Borderline personality disorder and bias in the recognition of facial expressions of emotion: a pathway to understand the psychopathology

Abstract Background The identification of facial emotions is a key skill as it promotes rapid and accurate recognition of emotions and enables better communication and greater social adaptation. More recent studies have suggested that impaired social interactions may be related to deficits in social cognition and therefore in the recognition of facial expressions, contributing to social disturbance among individuals with borderline personality disorder (BPD). Objective To present the results of an empirical study assessing the recognition of facial emotion expressions in women with BPD, having as reference a group of healthy women from the general population. Methods The subjects (40 female with BPD and 40 controls) were assessed with a dynamic task on a computer screen for recognition of facial expressions of emotion. Results The BPD group had a lower accuracy in perceiving emotions of fear and surprise and slowness in recognising happiness. Logistic regression analyses also identified an association between BPD and higher sensitivity in the recognition of anger. Discussion Women with BPD made more mistakes in the recognition of negative emotions, which can bias the behaviour and regulation of affective states, favouring in turn the emergence of some typical symptoms associated with BPD.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Comparison between four usual methods of identification of candida species / Comparação entre quatro métodos usuais de identificação de espécies de Candida

SUMMARYInfection by Candidaspp. is associated with high mortality rates, especially when treatment is not appropriate and/or not immediate. Therefore, it is necessary to correctly identify the genus and species of Candida. The aim of this study was to compare the identification of 89 samples of Candidaspp. by the manual methods germ tube test, auxanogram and chromogenic medium in relation to the ID 32C automated method. The concordances between the methods in ascending order, measured by the Kappa index were: ID 32C with CHROMagar Candida(κ = 0.38), ID 32C with auxanogram (κ = 0.59) and ID 32C with germ tube (κ = 0.9). One of the species identified in this study was C. tropicalis,which demonstrated a sensitivity of 46.2%, a specificity of 95.2%, PPV of 80%, NPV of 81.1%, and an accuracy of 80.9% in tests performed with CHROMagar Candida;and a sensitivity of 76.9%, a specificity of 96.8%, PPV of 90.9%, NPV of 91%, and an accuracy of 91% in the auxanogram tests. Therefore, it is necessary to know the advantages and limitations of methods to choose the best combination between them for a fast and correct identification of Candidaspecies.

RESUMOA infecção por Candidaspp. está associada com alta mortalidade, principalmente quando o tratamento não é adequado, nem imediato. Assim, a correta identificação do gênero e espécie é necessária. O objetivo deste trabalho foi comparar 89 amostras de Candidaspp. pelos métodos manuais prova do tubo germinativo, auxanograma e CHROMagar em relação ao método automatizado ID 32C. As concordâncias entre os métodos em ordem crescente, medidas pelo coeficiente de Kappa, foram: ID 32C com CHROMagar Candida(κ = 0,38), ID 32C com auxanograma (κ = 0,59) e ID 32C com tubo germinativo (κ = 0,9). Uma das espécies identificadas neste trabalho foi a C. tropicalis, que demonstrou uma sensibilidade de 46,2%, especificidade de 95,2%, VPP de 80%, VPN de 81,1% e acurácia de 80,9% nos testes com CHROMagar Candidae uma sensibilidade de 76,9%, especificidade de 96,8%, VPP de 90,9%, VPN de 91% e acurácia de 91% nos testes de auxanograma. Portanto, o conhecimento das vantagens e limitações dos métodos é necessário para a escolha da melhor combinação entre os mesmos visando uma rápida e correta identificação das espécies de Candida.

Quality of life of mothers whose children work on the streets of São Paulo, Brazil / Qualidade de vida de mães de crianças trabalhadoras de rua da cidade de São Paulo, Brasil / La calidad de vida de las madres de niños trabajadores en las calles de São Paulo, Brasil

The present study evaluated the perceived quality of life of the mothers of street children and investigated the association with their history of childhood violence, the occurrence of current domestic violence, their current mental states and that of their children, and family functioning. The applied instruments were as follows: Strengths and Difficulties Questionnaire, WorldSAFECore Questionnaire, Instrument for the Assessment of Quality of Life of the WHO, Global Assessment of Relational Functioning Scale, Childhood Trauma Questionnaire and a socio-demographic questionnaire. The sample of convenience consisted of 79 low-income mothers who raised their children alone, and most of whom had a positive screening for mental illness. The multiple regression analysis showed that the perception of quality of life of these women was associated with the presence of psychopathology either in themselves or their children and family dysfunction. Thus any program aimed at improving the quality of life of such mothers should consider addressing their mental problems as well as those of their children, besides offering educational and psychotherapeutic approaches to these families to improve the social environment.

Avaliamos a percepção da qualidade de vida de mães de crianças em situação de rua e investigamos a sua possível associação com os antecedentes maternos de abuso e violência na infância e vitimização atual, sintomas emocionais delas e de seus filhos e com o funcionamento familiar. Foram aplicados os seguintes instrumentos: Instrumento para a Avaliação da Qualidade de Vida da OMS - versão abreviada, Questionário de Capacidades e Dificuldades, WorldSAFECore Questionnaire, Escala de Avaliação Global de Funcionamento nas Relações Familiares, Childhood Trauma Questionnaire e um questionário sociodemográfico. Nossa amostra de conveniência foi constituída por 79 mães, a maioria delas com rastreamento positivo para doença mental. Aplicamos um modelo de regressão múltipla que encontrou associação entre a percepção de pior qualidade de vida com a presença de psicopatologia nelas e em seus filhos e com pior funcionamento familiar. Dessa forma, qualquer programa voltado para a melhora da qualidade de vida de mães nessa condição deve considerar a abordagem de problemas mentais nelas e em seus filhos, além de oferecer recursos educacionais e psicoterapêuticos para as famílias, visando à melhora das condições socioambientais.

Se presenta aquí una evaluación de la calidad de vida percibida por madres de niños en las calles, y se investigó la posible asociación con antecedentes maternos de abuso y violencia en la infancia y victimización actual, los síntomas emocionales de ellos y de sus hijos y el funcionamiento familiar. Se aplicaron los Instrumentos para la Evaluación de la Calidad de Vida de la OMS - versión abreviada, Cuestionario de Capacidades y Dificultades, WorldSAFECore Questionnaire, Escala de Evaluación Global de Funcionamiento en las Relaciones Familiares, Childhood Trauma Questionnaire y un cuestionario sociodemográfico. La muestra incluyó a 79 madres, la mayoría de ellas con una detección positiva para la enfermedad mental. La percepción de calidad de vida se asoció con la presencia de psicopatología en ellos y sus hijos y el funcionamiento familiar. Por lo tanto, cualquier programa destinado a mejorar la calidad de vida de las madres en esta condición debe considerar el enfoque de los problemas mentales en ellos y sus hijos y ofrecer trabajo educativo y terapéutico a esas familias.

Lack of association between the 5-HTTLPR and positive screening for mental disorders among children exposed to urban violence and maltreatment

Objective: To ascertain whether genetic variations in the serotonin transporter gene (5-HTTLPR 44-bp insertion/deletion polymorphism) influence an increase in depressive and anxiety symptoms in children and adolescents exposed to high levels of violence. Methods: Saliva samples were collected from a group of children who were working on the streets and from their siblings who did not work on the streets. DNA was extracted from the saliva samples and analyzed for 5-HTTLPR polymorphism genotypes. Results: One hundred and seventy-seven children between the ages of 7 and 14 years were analyzed (114 child workers and 63 siblings). Data on socioeconomic conditions, mental symptoms, and presence and severity of maltreatment and urban violence were collected using a sociodemographic inventory and clinical instruments. There was no positive correlation between the 5-HTTLPR polymorphism and presence of mental symptoms in our sample, although the children were exposed to high levels of abuse, neglect, and urban violence. Conclusions: Despite previous studies that associated adult psychiatric disorders with the 5-HTTLPR polymorphism and a history of childhood maltreatment, no such association was found in this sample of children at risk. .

The joint structure of major depression, anxiety disorders, and trait negative affect

Background: Dimensional models of psychopathology demonstrate that two correlated factors of fear and distress account for the covariation among depressive and anxiety disorders. Nevertheless, these models tend to exclude variables relevant to psychopathology, such as temperament traits. This study examined the joint structure of DSM-IV-based major depression and anxiety disorders along with trait negative affect in a representative sample of adult individuals residing in the cities of São Paulo and Rio de Janeiro, Brazil. Methods: The sample consisted of 3,728 individuals who were administered sections D (phobic, anxiety and panic disorders) and E (depressive disorders) of the Composite International Diagnostic Interview (CIDI) 2.1 and a validated version of the Positive and Negative Affect Schedule. Data were analyzed using correlational and structural equation modeling. Results: Lifetime prevalence ranged from 2.4% for panic disorder to 23.2% for major depression. Most target variables were moderately correlated. A two-factor model specifying correlated fear and distress factors was retained and confirmed for models including only diagnostic variables and diagnostic variables along with trait negative affect. Conclusions: This study provides support for characterization of internalizing psychopathology and trait negative affect in terms of correlated dimensions of distress and fear. These results have potential implications for psychiatric taxonomy and for understanding the relationship between temperament and psychopathology. .

Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A)

Objective: Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD. Methods: PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event. Results: The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQI-A-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD. Conclusion: The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings. .

Exposure to maltreatment and urban violence in children working on the streets in São Paulo, Brazil: factors associated with street work

Objective: To quantitatively study the exposure to childhood maltreatment and urban violence in children from families with at least one child working on the streets and to investigate the relationship between these factors and street work. Methods: Families who participated in a nongovernmental organization (NGO) program to eliminate child labor were included. Data concerning sociodemographic characteristics, punishment methods used in the family environment against the children, five types of abuse and neglect perpetrated by the caregivers, urban violence exposure and family functioning were collected. Results: The sample included 126 children who were working on the streets and 65 siblings who were not working on the streets. Caregivers reported high levels of severe physical punishment. The children reported high levels of abuse and neglect, and high levels of urban violence exposure. The families showed a predominance of dysfunctional and unsatisfactory relationships. A multiple logistic regression model showed that age older than 12 years and severe physical punishment at home were associated with street work. Conclusion: Interventions to decrease the risk of child street work should be family-focused and should aim to reduce violence in the family environment. .

Quality of life of orthopedists in Mato Grosso do Sul / Qualidade de Vida dos Médicos Ortopedistas do Mato Grosso do Sul

OBJECTIVE: Evaluate QOL and its implications for health care providers specialized in orthopedics. METHODS: In this quantitative, descriptive, cross-sectional study two questionnaires, World Health Organization Quality of Life (WHOQOL-100) and sociodemographic, were sent to 117 orthopedic surgeons, with 29 doctor's response. Statistical analysis was performed using three different tests: Analysis of Variance (ANOVA), Student t-test, and Pearson's linear correlation. The tests were applied with a reliability of 95%. RESULTS: Twenty-nine orthopedic surgeons responded to the questionnaire. The studied variables regarding domains were age and employment duration, which have a positive relationship with the environment and social relationships domains; income, which positively influences the level of independence and environment domains; and workload, which negatively influences the psychological domain. CONCLUSION: Orthopedic physicians had high scores in the WHOQOL-100 domains and, in their perception, good quality of life had higher scores compared to other professions.

OBJETIVO: Avaliar a QV e suas implicações nos agentes promotores de saúde especializados em ortopedia. MÉTODOS: Estudo quantitativo-descritivo, de corte transversal, com envio do questionário World Health Organization Quality of Life (WHOQOL-100) e questionário sociodemográfico a 117 ortopedistas, com resposta de 29 médicos. Na análise estatística dos dados, foram aplicados três testes estatísticos distintos: o teste de Análise de Variância (Anova); o teste t de Student e o de correlação linear de Pearson. Os testes foram aplicados com uma confiabilidade de 95%. RESULTADOS: Responderam ao questionário 29 ortopedistas, observando-se que as variáveis estudadas com relação aos domínios foram: idade e tempo de trabalho, onde há uma relação positiva com os domínios relações sociais e ambiente; domínio renda, que influencia positivamente nos domínios nível de independência e ambiente; e carga horária de trabalho, que influencia negativamente na dimensão psicológica. CONCLUSÃO: Os médicos ortopedistas apresentaram altos escores nos domínios do WHOQOL-100 e, em sua percepção, boa qualidade de vida, obtendo escores superiores em relação a outras profissões.

Healthy maternal bonding as a resilience factor for depressive disorder

INTRODUCTION: Depressive disorders (DDs) are very prevalent disorders particularly in women, a high-risk gender group. Determining the risk and protective factors associated with the development of DDs is fundamental to planning preventive and therapeutic strategies. In this study, we evaluated the correlations between healthy maternal attachment and the development of DDs in adulthood. METHODS: We evaluated 52 women at 6 months to 1 year after premature childbirth at Maternidade Vila Nova Cachoeirinha. They were evaluated using the following instruments: Brazilian Criteria of Economic Classification, Parental Bonding Inventory (PBI), Center for Epidemiologic Studies Depression Scale (CES-D), and Edinburgh Postnatal Depression Scale (EPDS). Cut-off scores on the CES-D and EPDS were used to classifythe subjects as currently having a DD or having probable postpartum disorder (PPD) after childbirth. Multiple logistic regression was used to evaluate the risk factors associated with DDs. RESULTS: We found that 49.1% of the sample had a current depressive episode, and 73.6% had probable PPD. Based on logistic regression, current depression (odds ratio = 1.092 [confidence interval: 1.005; 1.186]), and a PPD (odds ratio = 1.108 [confidence interval: 1.011; 1.21]) were negatively correlated with affective maternal relationships. CONCLUSIONS: Women who reported healthy attachment with their mothers did not develop DDs when faced with stressful situations such as premature childbirth.

Indicadores comportamentais de propensão ao homicídio em agressores sexuais / Behavioral indicators of propensity to murder sex offenders

OBJETIVO: Avaliamos se existe associação entre características de personalidade e tipo de estupro cometido (com ou sem a morte da vítima). MÉTODOS: Como estratégias de estudo, utilizaram-se indicadores comportamentais que podem ser associados à personalidade antissocial, de modo a diferenciar os comportamentos externalizantes de agressores sexuais que matam ou não suas vítimas. RESULTADOS: Os agressores sexuais apresentaram comportamentos externalizantes relacionados à personalidade antissocial. O grupo de indivíduos que cometeu estupro seguido de morte tem esses traços comportamentais mais presentes no decorrer da vida. CONCLUSÃO: Concluímos que os agressores sexuais aparentam ter indicadores que permitem uma investigação mais profunda em relação à personalidade antissocial, mas aqueles que matam suas vítimas diferem quanto ao seu histórico comportamental daqueles que não cometem o homicídio subsequente ao ato de estupro. São indicadores comportamentais da propensão ao homicídio em agressores sexuais: estarem, mais comumente, sob os efeitos de álcool/drogas durante o ato de estupro, propensão ao suicídio, prematuridade de início da vida criminosa e alta impulsividade.

OBJECTIVE: We evaluated the association between personality characteristics and type of rape (with or without the victim's death). METHODS: As a strategy to study, we used behavioral indicators that may be associated with antisocial personality in order to differentiate the externalizing behaviors of sex offenders who kill its victims. RESULTS: The sex offenders had externalizing behaviors related to antisocial personality. The group of individuals who committed rape resulting in death has these behavioral traits more prevalent later in life. CONCLUSION: We conclude that sex offenders, appear to have indicators that allow a deeper investigation in relation to antisocial personality, but those who kill their victims differ in their historical behavior of those who do not commit murder subsequent to the act of rape. Are indicators of behavioral propensity to murder sex offenders, are more commonly under the influence of alcohol/drugs during the act of rape, suicidality, premature start of criminal life and high impulsivity.