Abusive alcohol consumption among adolescents: a predictive model for maximizing early detection and responses.

OBJECTIVE: To present a predictive model of alcohol abuse among adolescents based on prevalence projections in various population subgroups. STUDY DESIGN: Cross-sectional study. METHODS: The sample consisted of 785 adolescents enrolled in the second year of high school in Rio de Janeiro, Brazil. Alcohol consumption was assessed using the Alcohol Use Disorder Identification Test. Socio-economic, demographic, family, individuals, and school-related variables were examined as potential predictors. The logit model was used to estimate the prevalence projections. Model fitting was examined in relation to the observed data set, and in a subset, that was generated from 200 subsamples of individuals via a bootstrap process using general fit estimators, discrimination, and calibration measures. RESULTS: About 25.5% of the adolescents were classified as positive for alcohol abuse. Being male, being 17-19 years old, not living with mothers, presenting symptoms suggestive of binge eating, having used a strategy of weight reduction in the last 3 months, and, especially, being a victim of family violence were important predictors of abusive consumption of alcohol. While the model's prevalence projection in the absence of these features was 8%, it reaches 68% in the presence of all predictors. CONCLUSIONS: Knowledge of predictive characteristics of alcohol abuse is essential for screening, early detection of positive cases, and establishing interventions to reduce consumption among adolescents.

Reassessing the construct validity of a Brazilian version of the instrument Caregiver Abuse Screen (CASE) used to identify risk of domestic violence against the elderly.

BACKGROUND: Domestic violence against the elderly (DVAE) is an increasingly recognised problem and its appropriate detection is imperative. As part of an ongoing cross-cultural adaptation process, this study evaluates the construct validity of a Brazilian Portuguese version of the instrument Caregiver Abuse Screen (CASE). METHODS: A cross-sectional study comprising 507 pairs of caregivers/elderly patients was carried out in three geriatric outpatient units. A multidimensional questionnaire was completed for each pair of interviewees covering DVAE, sociodemographic characteristics and several theory-related variables (alcohol misuse, burden, depression, social support, cognitive status, instrumental activities of daily living, general health status and living arrangements). Sequential confirmatory and exploratory factor analyses (CFA/EFA) were implemented to assess construct validity through an in-depth exploration of the instrument's dimensional structure. Construct validity was also assessed through relationships with other variables. RESULTS: The initial CFA did not support the postulated two-factor solution. A one-dimensional solution suggested by an EFA was followed by a CFA, which showed adequate fit (WRMR = 0.985, RMSEA = 0.056, CFI = 0.967 and TLI = 0.969), internal consistency (rho(cr) = 0.85) and temporal stability (kappa(w) = 0.77). Yet, convergent validity was not achieved (average variance extracted <0.50; rho(ve) = 0.45). Using Kendall's Tau-b correlations, the CASE was positively associated with two other instruments assessing DVAE (H/S-EAST: tau(b) = 0.13; and CTS-1 subscales: tau(b) = 0.15-0.37); caregiver burden (Zarit BI: tau(b) = 0.40); and depression (GDS: tau(b) = 0.32). CONCLUSION: In spite of some remaining dimensionality issues needing refinement and the relatively restricted correlations with expected variables, the CASE may be reaffirmed as a promising detection tool for risk of abuse in clinical practice and applied research.

Gestational weight gain differentials in the presence of intimate partner violence.

OBJECTIVE: To assess whether gestational weight gain (GWG) during pregnancy is linked to intimate partner violence (IPV). METHODS: A total of 394 women being delivered at term at Rio de Janeiro public maternities from March to October 2000 were randomly selected. The Revised Conflict Tactics Scales were used to assess IPV and GWG was expressed through the Net Weight Gain (NWG) indicator. Multiple linear regression was used to control for socioeconomic, demographic, reproductive, and nutritional confounding factors, as well as lifestyle factors such as alcohol, drug, and tobacco consumption. RESULTS: Even after adjustment, increased physical abuse from male partners was statistically associated with lesser weight gain during pregnancy. Compared with women unexposed to IPV, those with the highest physical abuse score showed deficits of 3245 g and 3959 g, respectively, according to 2 models that did and did not control for lifestyles factors. CONCLUSION: Physical violence between intimate partners constitutes an independent risk factor for GWG deficit during pregnancy.

Comparison between the abuse assessment screen and the revised conflict tactics scales for measuring physical violence during pregnancy.

STUDY OBJECTIVE: Because of the promise of its ability to quickly identify cases of violence against women during pregnancy, the abuse assessment screen (AAS) should be the focus of numerous psychometric evaluations. This paper assesses its measurement accuracy compared with the revised conflict tactics scales (CTS2) used as standard. DESIGN: Cross sectional study. Besides several ancillary questions, the AAS consists of three anchor questions about violence against pregnant women. These are inclusive, respectively covering lifetime, preceding 12 months, and pregnancy periods. These questions are the main focus of this article. The CTS2 physical aggression scale consists of 12 items divided into minor and severe subscales. A positive event is defined as having at least one positive item in the respective subscale. The 12 item score is also used. SETTING AND PARTICIPANTS: The instruments were applied to 748 women, 24 to 72 hours after delivery in three major public sector maternity wards of Rio de Janeiro from March to September 2000. MAIN RESULTS: According to the CTS2, prevalences of minor and severe physical violence perpetrated against a pregnant woman are 18.4% (95% CI 15.7 to 21.4) and 7.6% (95% CI 5.8 to 9.8), respectively. Taking these subscales as standards, sensitivities are 31.9% (95% CI 24.9 to 40.3) and 61.4% (95% CI 47.6 to 74.0), respectively. Specificities are above 97%. CONCLUSION: These findings are somewhat worrying because the number of victims who are not identified and offered assistance is considerable. On a practical note, it would be sensible not to use the AAS as a stand alone screening tool until more evidence is gathered.

[Video-nystagmography and vibration test in the diagnosis of vestibular schwannoma. Review of 100 cases]. / Vidéonystagmographie et test vibratoire dans le bilan diagnostique des schwannomes vestibulaires. A propos de 100 cas.

OBJECTIVE: To evaluate informations given by the combination of videonystagmography (VNG) including vibratory tests and auditory brainstem responses (ABR) in patients suffering vestibular schwannoma (VS) and try to find the most conclusive test(s). Combination of different functional tests is supposed to improve diagnosis and preoperative evaluation and precise indication for magnetic resonance imaging (MRI) facing audiological and vestibular symptoms. MATERIAL AND METHOD: A prospective study of 100 patients with VS. All patients underwent a preoperative work-up including complete audiometry, auditory brainstem response (ABR) and videonystagmography (VNG). VNG protocol included caloric testing, rotatory tests, oculometry tests (saccade testing, optokinetic testing) and spontaneous and gaze-evoked nystagmus. From these six tests a score of positivity could be set, from 0 to 6. RESULTS: The vibratory test is non invasive and easy to realize. Were observed: 1/ a good sensitivity in vibratory test to elicit nystagmus in this context. 2/ a good correlation between subliminal rotatory chair tests and vibratory tests 3/ a better control of caloric testing using vibratory test. 4/ a good but deficient sensitivity of ABR alone with regard to VS (95%) 5/ an increase of sensitivity of VNG when coupling it with ABR and using as a criterion the score of positivity: no patient had all tests negative. CONCLUSION: The vibratory test is a non-invasive, fast examination with an easy execution. It reinforces VNG-ABR association screening power to diagnose VS. It constitutes, combined to caloric testing a good tool to diagnose and evaluate unilateral vestibular weakness.

[Invasive cholesteatoma of the old radical mastoidectomy]. / Cholestéatome invasif sur ancienne cavité d'évidement pétromastoïdien.

OBJECTIVE: The aim of this study is to show the importance of computed tomography scanning (CT) and magnetic resonance imaging (MRI) in ancient radical cavities and to determinate the risk factors of an invasive cholesteatoma recurrency. MATERIAL AND METHOD: We present 4 cases of medial invasion in the petrous bone of a cholesteatoma without specific symptomatology which appeared many years after undergoing radical mastoidectomy for an acquired cholesteatoma. CONCLUSION: The analysis of this series allowed to put in evidence the factors of suspicion of an underlying cholesteatoma. They are: the age, an aural discharge, numerous surgical interventions, immunodeficiency, cholesteatoma in childhood and antecedent of facial nerve palsy. This trial emphasizes the importance of imaging (CT and MRI) in front of an ancient radical cavity which presents one or some of these factors in order to eliminate a recurrence of an invasive cholesteatoma. Let us note that the demand of the patients is sometimes aesthetic or functional.

Domestic violence during pregnancy in Rio de Janeiro, Brazil.

OBJECTIVES: To estimate the prevalence and risk groups of domestic violence during pregnancy among public health care users in Rio de Janeiro, Brazil. The study focuses on violence perpetrated by both women and partners. METHOD: 526 women giving birth at term in public maternities from March to October 2000 were randomly selected and interviewers used the Revised Conflict Tactics Scales (CTS2). RESULTS: 33.8% [95% confidence interval (CI): 28.8-37.0%] of the respondents reported some form of physical violence and 16.5% (95% CI: 13.3-19.8%) referred to severe forms. A total of 78.3% (95% CI: 74.8-81.8%), 9.9% (95% CI: 7.5-12.7%) and 15.6% (95% CI: 12.6-18.9%) reported psychological aggression, sexual coercion and injuries, respectively. Physical violence mainly occurred among adolescent women with less schooling, who did not work outside the home, with fewer prenatal appointments, and with little social support. Families with more under-five children, alcohol and drug abuse, and low socio-economic status were also involved more frequently. CONCLUSION: High prevalence rates for various forms of domestic violence in Brazil suggest that the issue should be viewed as a major public health problem.

[Validity of neonatal clinical assessment for estimation of gestational age: comparison of new ++Ballard+ score with date of last menstrual period and ultrasonography]. / Validade do exame clínico do recém-nascido para a estimação da idade gestacional: uma comparação do escore New Ballard com a data da última menstruação e ultra-sonografia.

The objective of this article is to evaluate the accuracy of the New Ballard (NB) score in detecting prematurity. Date of last menstrual period (LMP) and ultrasonography (USG) are used as reference procedures. First, an assessment of inter-observer reliability of the NB score measurements and the USG reports was carried out. Regarding the NB scores, the kappa coefficient and the Intraclass Correlation Coefficient were, respectively, 0.74 (CI 95% 0.49-0.99) and 0.88 (CI 95% 0.78-0.93). For the USG analysis an Intraclass Correlation Coefficient of 0.96 (CI 95% 0.91-0.98) was found. Turning to validity, sensitivity of the NB score was below 0.70 in all but one comparison, irrespective of which procedure was taken as reference. Although specificity was consistently above 0.90, results suggest that the diagnostic ability of the NB score to detect prematurity is far from ideal. The proportion of false negatives may be a warning against its use alone, both in clinical practice and in epidemiological research contexts. Rather, the procedure should be recommended mainly as an accessory diagnostic tool.

[Semantic equivalence of the Portuguese version of the Abuse Assessment Screen tool used for the screening of violence against pregnant women]. / Equivalência semântica da versão em português do instrumento Abuse Assessment Screen para rastrear a violência contra a mulher grávida.

INTRODUCTION: Research programs and actions regarding family violence have been growing steadily. Therefore, there's a need to develop data collection tools. In Brazil, further problems come up since tools that have been developed elsewhere need to be adapted and translated. This study focuses on the Abuse Assessment Screening (AAS) used to detect violence against pregnant women. The objective is to evaluate the semantic equivalence between the original tool in English and two Portuguese versions, and propose a synthetic version to be used in the field. METHODS: The evaluation of semantic equivalence was carried out in 4 steps: (1) translation, (2) back translation, (3) formal appreciation of equivalence and (4) a final critical assessment by family violence experts. RESULTS: Translation, back translation and the steps 3 and 4 assessment are presented for each item of the tool, along with the original in English. The text covers each discussion that led to the final version. Both versions were quite similar in 14 out of 15 items. Nevertheless, the second version showed to be slightly more adequate although for some items the decision was to combine both versions or, in one case, use an item from version 1. CONCLUSION: The procedure undertaken in this study is discussed in the light of Herdman et al.'s proposal (1998) regarding transcultural equivalence. The study also stresses the importance of using more than one version in the process and the appropriateness of including an additional step about the assessment of the target population's understanding of the tool.