Professional and informal help-seeking among low-income adolescents exposed to violence in the community and at school.

BACKGROUND: Adolescents may seek help for many reasons beyond health needs, such as personal stress due to violence exposure. OBJECTIVE: To investigate factors associated with receiving professional assistance and informal help due to violence exposure in the community and at school. PARTICIPANTS AND SETTING: This study was conducted in Itaboraí, a low-income medium-size city in the State of Rio de Janeiro, Southeast Brazil, characterized by poverty, inequality and violence. It analyses data reported by 669 in-school adolescents (11-15-years, 51.7% girls). METHODS: This is a cross-sectional study nested in a longitudinal study (Itaboraí Youth Study). The Itaboraí Youth Study involved a probabilistic community-based sample of 1409 6-to-15-year-olds based on a 3-stage probabilistic sampling plan that included a random selection of census units, eligible households and the target child. RESULTS: Professional assistance was mainly received from psychologists (the Brazilian population has free access to health services). Family members were the main source of informal help. Correlates of professional assistance were having clinical emotional problems and not counting on an adult (if needing help) for community violence victims, and absent father for community and school violence victims. Correlates of informal help were female sex, maternal anxiety/depression and absent father for community violence victims, and younger age and higher maternal education for school violence victims. CONCLUSIONS: The mental health needs of violence victims, and maternal difficulties to deal with the adolescent distress resulting from violence exposure (maternal increased burden due to father absence and/or having anxiety/depression) are important influences on the help-seeking process.

Violence and child mental health in Brazil: The Itaboraí Youth Study methods and findings.

OBJECTIVES: To demonstrate a study design that could be useful in low-resource and violent urban settings and to estimate the prevalence of child violence exposure (at home, community, and school) and child mental health problems in a low-income medium-size city. METHODS: The Itaboraí Youth Study is a Norway-Brazil collaborative longitudinal study conducted in Itaboraí city (n = 1409, 6-15 year olds). A 3-stage probabilistic sampling plan (random selection of census units, eligible households, and target child) generated sampling weights that were used to obtain estimates of population prevalence rates. RESULTS: Study strengths include previous pilot study and focus groups (testing procedures and comprehension of questionnaire items), longitudinal design (2 assessment periods with a mean interval of 12.9 months), high response rate (>80%), use of standardized instruments, different informants (mother and adolescent), face-to-face interviews to avoid errors due to the high frequency of low-educated respondents, and information gathered on a variety of potential predictors and protective factors. Children and adolescents presented relevant levels of violence exposure and clinical mental health problems. CONCLUSIONS: Prevalence estimates are probably valid to other Brazilian low-income medium-size cities due to similarities in terms of precarious living conditions. Described study methods could be useful in other poor and violent world regions.

Comorbidity and global functioning (DSM-III-R Axis V) in a Brazilian sample of cocaine users.

We assessed the mental disorders rate in treatment-seeking, nonintravenous cocaine users in a Brazilian outpatient clinic, and evaluated how comorbidity affects global functioning. Fifty male nonintraveneous cocaine users from an outpatient clinic were interviewed with semistructured instruments based on DSM-III-R criteria. All subjects met the DSM-III-R criteria for "cocaine abuse" or "dependence" during the last 6 months. The lifetime Axis I or Axis II disorders rate was 69%, with a higher prevalence of anxiety disorders (31%) and depressive disorders (20%). By using a multivariate analysis, the number of personality disorders, the number of psychiatric diagnoses, and the presence of depressive and anxiety disorders were found as significant factors associated with poor global functioning among nonintraveneous cocaine addicts.

The effect of unmodified or prestorage white cell-reduced allogeneic red cell transfusions on the immune responsiveness in orthopedic surgery patients.

BACKGROUND: The immunomodulatory effects of allogeneic blood transfusions have been attributed to the white cells (WBCs) present in the cellular blood components transfused to patients. STUDY DESIGN AND METHODS: The effect of the transfusion of allogeneic red cells (RBCs) or allogeneic prestorage WBC-reduced RBCs (WBC-reduced RBCs) on host immune responsiveness was evaluated by measuring the lymphocyte subsets and the in-vitro cytokine production in response to phytohemagglutinin stimulation of WBCs of orthopedic surgery patients. Forty-seven patients undergoing hip replacement surgery were randomly assigned to receive allogeneic RBCs (n = 17) or WBC-reduced RBCs (n = 14; 99.95% WBC removal). Sixteen patients were not transfused. Patient blood samples taken before surgery and on Days 1 and 4 after surgery were tested for complete blood count, lymphocyte subset analysis, and measurement of cytokine levels. RESULTS: After surgery, the lymphocyte count was significantly decreased in patients transfused with > or = 3 units of allogeneic RBCs (2.0 +/- 0.5 vs. 1.3 +/- 0.3 x 10(9)/L; p = 0.017), but not in patients transfused with > or = 3 units of WBC-reduced RBCs (2.0 +/- 0.9 vs. 1.7 +/- 0.8 x 10(9)/L). Compared with preoperative levels, on Day 4 after surgery, patients transfused with > or = 3 units of allogeneic RBCs also had a decrease in the number of natural killer cells (0.07 +/- 0.05 vs. 0.04 +/- 0.03 x 10(9)/L; p = 0.018). Postoperatively, interleukin-2 was decreased in one patient who received WBC-reduced RBCs compared with that in four patients transfused with allogeneic RBCs (p = 0.32), and eight untransfused patients (p = 0.01). On Day 4, about 70 percent of patients transfused with allogeneic RBCs showed a 20-percent decrease in the interferon gamma level. CONCLUSION: Taken together, these data support the hypothesis that transfusion of > or = 3 units of allogeneic RBCs is associated with early postoperative lymphopenia in otherwise healthy individuals undergoing surgery. These findings were not observed in those individuals transfused with RBCs that had undergone prestorage WBC reduction.

Validaçao da versao brasileira do "Child Behavior Checklist" (CBCL) (Invent rio de Comportamentos da Infância e Adolescência): dados preliminares / Validation of the Brazilian version of the Child Behavior Checklist (CBCL)

O Child Behavior Checklist (CBCL) é um question rio que avalia competência social e problemas de comportamento em indivíduos de quatro a 18 anos, a partir de informaçöes fornecidas pelos pais. A presente pesquisa utilizou a avaliaçäo psiqui trica como padräo para determinar a validade da versäo brasileira do CBCL. Com o consentimento dos pais, pediatras da Escola Paulista de Medicina encaminharam aleatoriamente pacientes ambulatoriais para participar do estudo. Um total de 49 crianças de ambos os sexos, com idade entre quatro e 12 anos completaram todas as etapas da pesquisa. O CBCL foi aplicado a pais por pessoa leiga previamente treinada na administraçäo do question rio e as crianças foram avaliadas por psiquiatra infantil, sem conhecimento prévio dos resultados do CBCL. Crianças com um ou mais diagnósticos psiqui tricos segundo os critérios da 10§ ediçäo da Classificaçäo Internacional de Doenças (CID-10) foram consideradas "casos", sendo registrados os níveis de gravidade dos distúrbios. Crianças com pelo menos um dos perfís do CBCL (social e/ou comportamental) em nível clínico foram classificadas como "casos". Os pontos de corte em escores T utilizados para classificaçäo da amostra em categorias clínica e näo clínica correspondem ao percentil 90 para Total de Problemas de Comportamento e ao percentil 10 para Competência Social Total, ambos percentis obtidos em amostras de crianças da populaçäo geral americana. A versäo brasileira do CBCL alcançou boa sensibilidade (87 por cento), identificando corretamente 75 por cento dos casos leves, 95 por cento dos moderados e 100 por cento dos casos graves. O estudo examina variaçöes nos índices de validade do CBCL em funçäo de alteraçöes no critério de teste-positividade do instrumento e de modificaçöes no critério de morbidade utilizado pela avaliaçäo psiqui trica. O trabalho também descreve o processo de adaptaçäo cultural do CBCL em nosso meio, visando sua aplicabilidade em populaçöes de nível socioecon"mico baixo

Validacao da versao brasileira do "Child Behavior Checklist" (CBCL) (Inventario de Comportamentos da Infancia e Adolescencia): dados preliminares

O Child Behavior Checklist (CBCL) e um questionario que avalia competencia social e problemas de comportamento em individuos de quatro a 18 anos, a partir de informacoes fornecidas pelos pais. A presente pesquisa utilizou a avaliacao psiquiatrica como padrao para determinar a validade da versao brasileira do CBCL. Com o consentimento dos pais, pediatras da Escola Paulista de Medicina encaminharam aleatoriamente pacientes ambulatoriais para participar do estudo. Um total de 49 criancas de ambos os sexos, com idade entre quatro e 12 anos completaram todas as etapas da pesquisa. O CBCL foi aplicado a pais por pessoa leiga previamente treinada na administracao do questionario e as criancas foram avaliadas por psiquiatra infantil, sem conhecimento previo dos resultados do CBCL. Criancas com um ou mais diagnosticos psiquiatricos segundo os criterios da decima edicao da Classificacao Internacional de Doencas (CID-10) foram consideradas 'casos', sendo registrados os niveis de gravidade dos disturbios. Criancas com pelo menos um dos perfis do CBCL (social e/ou comportamental) em nivel clinico foram classificadas como 'casos'. Os pontos de corte em escores T utilizados para a classificacao da amostra em categorias clinica e nao clinica correspondem ao percentil 90 para Total de Problemas de Comportamento e ao percentil 10 para Competencia Social Total, ambos percentis obtidos em amostras de criancas da populacao geral americana. A versao brasileira do CBCL alcancou boa sensibilidade (87 por cento), identificando corretamente 75 por cento dos casos leves, 95 por cento dos moderados e 100 por cento dos casos graves. O estudo examina variacoes nos indices de validade do CBCL em funcao de alteracoes no criterio de teste-positividade do instrumento e de modificacoes no criterio de morbidade utilizado pela avaliacao psiquiatrica. O trabalho tambem descreve o processo de adaptacao cultural do CBCL em nosso meio, visando sua aplicabilidade em populacoes de nivel socioeconomico baixo.