Estrutura e dinâmica familiar de pessoas com deficiência intelectual / Family structure and dynamics of people with intellectual disabilities

O presente estudo teve o objetivo de explorar a estrutura e a dinâmica de famílias com um filho com deficiência intelectual. Foi utilizada a metodologia qualitativa, a partir do estudo de casos múltiplos, de cinco famílias residentes no Distrito Federal, com análise descritiva e exploratória de entrevistas semiestruturadas para a construção de genogramas, ecomapas, e o ciclo de vital das famílias. Os resultados apresentaram a estrutura e dinâmica familiar através dos dados sociodemográficos, das expectativas atuais e futuras, estratégias de enfrentamento e do ciclo vital. Sugere-se o conhecimento de estratégias familiares adequadas para a transição futura de cuidados no contexto da deficiência intelectual.

This study aimed at exploring the structure and dynamics of families with a child with intellectual disabilities. The qualitative methodology was used, based on the study of multiple cases, of five families living in the Federal District, with descriptive and exploratory analysis of semi-structured interviews for the construction of genograms, ecomapas, and the life cycle of the families. The results presented the family structure and dynamics through sociodemographic data, current and future expectations, coping strategies and life cycle. It is suggested the knowledge of adequate family strategies for the future transition of care in the context of intellectual disability.

Bowel Emptying Methods Used by German Residents Living With Spina Bifida.

PURPOSE: The purpose of this study was to describe and analyze methods of bowel emptying among Germans living with spina bifida. We also analyzed relationships between age, sex, level of spinal bifida anomaly, and methods of bowel elimination. DESIGN: A quantitative, descriptive study. SUBJECTS AND SETTING: The sample comprised 88 persons (56 women and 32 men) residing anywhere in the Federal Republic of Germany. Their mean age was 17.5 years (SD 13.64 years), range 0 to 55 years. METHODS: Data were collected through an online survey questionnaire developed for the urological follow-up protocol for patients with spina bifida. Parents completed the questionnaire for participants younger than 18 years. RESULTS: Twenty participants (22.7%) reported normal defecation and 68 (77.3%) reported neurogenic bowel dysfunction requiring regular bowel management. Participants requiring bowel management predominately used rectal irrigation (40.9%) and digital rectal stimulation (27.3%) to enhance bowel evacuation. Age emerged as the only factor related to the bowel management techniques. Younger participants (≤20 years) were more likely to use rectal irrigation for bowel evacuation (P = .001, Fisher's exact test), whereas older respondents (≥21 years) were more likely to use digital rectal stimulation (P = .015, Fisher's exact test). Analysis revealed no differences in methods of bowel evacuation based on sex or level of spina bifida anomaly (cervical, thoracic, lumbar, or sacral). CONCLUSIONS: Rectal irrigation was the most common method for bowel evacuation. Participants were less likely to employ potentially effective and more conservative measures for intestinal emptying, such as toilet training/timed evacuation associated with Valsalva maneuvers, abdominal press, abdominal massage, and digital rectal stimulation. Additional comparative studies with more participants and other countries with intestinal emptying methods are needed to better understand the needs of individuals with spina bifida and their families and to improve the health-related quality of life of these people.

Quando o ruído de lazer afeta a saúde de uma comunidade / When leisure noise affects the health of a community

O objetivo deste manuscrito foi relatar as ações comunitárias de um grupo de moradores, pesquisadores e profissionais da saúde contra os impactos do ruído de lazer (paredões de sons automotivos) no centro histórico de Porto Nacional-TO, Brasil. Nesta localidade foi implementada, como medida compensatória, uma orla de lazer após o enchimento do lago da Usina Luis Eduardo Magalhães em 2001. O trabalho relata o contexto do surgimento desse fenômeno e a emergência das tensões sociais entre os residentes, comerciantes, gestores públicos e transeuntes que gravitam em torno da exposição ao ruído. A partir das ações de mobilização na comunidade, foi desenvolvida uma revisão junto as publicações do Escritório Europeu da Organização Mundial da Saúde que evidenciaram o ruído de lazer como um problema de saúde pública e uma das formas de poluição que mais afeta as pessoas. Dentre os impactos, destacam-se os efeitos biológicos, qualidade do sono, bem-estar e condições médicas. Apesar das evidências encontradas e das medidas de mitigação adotadas pelos gestores, o ruído ainda incomoda os moradores, o que sugere um forte fator cultural em relação a este problema. Conclui-se que as informações deste relato são promissoras para uma área ainda em desenvolvimento no Brasil e que implica a articulação interdisciplinar em torno dos efeitos dos barulhos de lazer na saúde.

The objective of this manuscript was to report the community actions of a group of residents, researchers and health professionals against the impacts of leisure noise (car sound walls) in the historic center of Porto Nacional-TO, Brazil. In this location, as a compensatory measure, a leisure area was implemented after the filling of the Luis Eduardo Magalhães Power Plant lake in 2001. The work relates the context of the emergence of this phenomenon and the emergence of social tensions among residents, shopkeepers, public managers and passers-by who gravitate around exposure to noise. From the mobilization actions in the community, a research was developed with the publications of the European Office of the World Health Organization that highlighted leisure noise as a public health problem and one of the forms of pollution that most affects people. Among the impacts, biological effects, sleep quality, well-being and medical conditions stand out. Despite the evidence found and the mitigation measures adopted by managers, noise still disturbs residents, suggesting a strong cultural factor in relation to this problem. It is concluded that the information in this report is promising for an area still under development in Brazil and that it implies interdisciplinary articulation around the effects of leisure noise on health.

Bladder Self-management in the Transition to Adulthood With Spina Bifida in 3 Countries: A Comparative Study.

PURPOSE: The purpose of this study was to evaluate bladder self-management in transition to adult care for patients with spina bifida (SB) in 3 countries with similar clinical practice and different social, cultural, and economic milieu. STUDY DESIGN: Cross-sectional study. SUBJECTS AND SETTING: The sample comprised 90 participants: 27 reside in Brazil, 36 reside in Germany, and 27 reside in the United States. Demographic characteristics of the sample are based on country. The distribution of sex in the Brazilian sample was 18 males and 9 females, the German group had 11 males and 25 females, and the United States group had 8 males and 19 females. The age range of the cumulative sample was 13 to 29 years. The age of the German sample (mean 23.56, standard deviation [SD] 4.60 years) was significantly higher (analysis of variance, F(2, 87) = 13.62, P < .001) than the other 2 groups (Brazil mean 20.56 years, SD 5.24; US mean 19.44 years, SD 4.70). METHODS: Demographic, clinical, and social variable data were collected via an online questionnaire distributed to multiple regions of Germany and a multidisciplinary myelomeningocele clinic at the University of Michigan in the Midwestern United States. In Brazil, participants completed a printed version of the survey. In Germany and the United States, an electronic version of the survey was made available online. German and English versions of the survey, originally developed in Portuguese for persons residing in Brazil, were translated and validated. RESULTS: The majority of participants (94.4%) performed intermittent catheterization (IC), 76.5% performed IC independently, whereas 23.5% required assistance with IC or catheterized with aids (handles, leg spreaders, and penis or labia holder). There were no statistically significant group differences in independent self-catheterization by gender. There were significant national group differences in level of lesion (P = .016), use of shunt (P = .012), and medication for bladder management (P < .001). Among participants 18 years and older, there were significantly higher levels of education in the German and the US samples than in the Brazilian sample (P < .001). CONCLUSIONS: Although there were national group differences in medical characteristics and management of SB, differences in independent self-catheterization were not significant. Findings suggest that support from family/caregivers and health care providers appears to facilitate transition to independent self-care, regardless of national context.

Desenvolvimento e validação de vídeo educativo para autocateterismo vesical intermitente limpo / Development and validation of an educational video for clean intermittent bladder catheterization

Trata-se do desenvolvimento e validação de um vídeo educativo sobre autocateterismo vesical intermitente limpo. Estudo metodológico, realizado em três etapas: pré-produção (elaboração e validação do roteiro e storyboard), produção do vídeo, e pós-produção (validação do vídeo por juízes experts em reabilitação e/ou saúde). O roteiro para produção do vídeo foi desenvolvido e validado por 18 juízes, com 91,1% de concordância. O vídeo, com 10 minutos e cinco segundos, também foi validado e atingiu 97,4% de concordância entre os 17 juízes participantes nos quesitos funcionalidade, usabilidade, eficiência, técnica audiovisual, ambiente e procedimentos. A versão final do vídeo desenvolvido e validado pode ser visualizada no Portal do Núcleo de Pesquisa NEUROREHAB, www.demaisinformacao.com.br. Essa ferramenta pode contribuir para a capacitação de pessoas com bexiga neurogênica a realizar o autocateterismo urinário, bem como profissionais de saúde e estudantes de enfermagem, e apoiar metodologicamente o desenvolvimento de outros vídeos educativos na área da saúde.

The purpose of this study was to develop and validate an educational video on clean intermittent self-catheterization. It was a methodological study, carried out in three stages: pre-production (elaboration and validation of the script and storyboard), video production, and post-production (validation of the video by expert judges working in the field of rehabilitation and/or health). The script for video production was developed and validated by 18 judges, with 91.1% agreement. The video, with a duration time of 10 minutes and five seconds, was also validated and reached 97.4% of agreement among the 17 participating judges regarding functionality, usability, efficiency, audiovisual technique, environment and procedures. The final version of the video developed and validated can be viewed at the NEUROREHAB Research Center Portal, https://demaisinformacao.com.br/ autocatetrismourinario/. This tool can contribute to the training of people with neurogenic bladder, as well as health professionals and nursing students, to perform self-catheterization, and methodologically support the development of other educational videos in the health area.

Online health forum as a support for people who perform intermittent vesical catheterization / Fórum virtual de la salud como soporte a personas que realizan cateterismo vesical intermitente / Fórum virtual de saúde como suporte às pessoas que realizam cateterismo vesical intermitente

ABSTRACT Objective: to evaluate the use of an online forum for people with myelomeningocele and their families and the profile of the users, based on intermittent catheterization. Method: a quantitative, cross-sectional, descriptive and exploratory study. Data was collected from users of the online forum, based on an online questionnaire available from March 20 to April 20, 2015. Sample consisted of 30 users. Descriptive statistical data analyses and chi-square test were performed. Results: among users, 27% were people with myelomeningocele and 73% were family members. Age, considering the total sample, ranged from 22 to 58 years old. Women represented 67% of the sample. Most users considered the language used in the forum understandable, and also thought the forum had a proper layout and was easy to navigate. It was noted that the mother and the person with myelomeningocele are the main responsible people for intermittent catheterization; 86% use a simple plastic catheter and 14% use a hydrophilic catheter; 81% do not reuse the catheter, 10% use the same catheter for one day and 9% for up to one week. The main place chosen to perform intermittent catheterization was the bed, followed by the toilet and wheelchairs. Conclusion: the use of the online forum was well evaluated by the users. It can be considered a means to obtain information, create a support network and clarify any doubts, empowering users and contributing to adherence to intermittent catheterization, which is one of the treatments for neurogenic bladder.

RESUMEN Objetivo: evaluar el uso de un fórum virtual para personas con mielomeningocele y sus familiares y el perfil de sus usuarios, según la realización del cateterismo vesical intermitente. Método: estudio cuantitativo, transversal, descriptivo y exploratorio. Se realizó la recolección de datos con usuarios del fórum virtual, en base a una encuesta online, disponible desde el 20 de marzo al 20 de abril de 2015. La muestra estuvo compuesta por 30 usuarios. Se realizaron los análisis estadísticos, descriptivos y test chi cuadrado. Resultados: de los usuarios, 27% eran personas con mielomeningocele y 73% familiares. La edad, considerándose toda la muestra, osciló entre los 22 y 58 años. El sexo femenino representó el 67% de la muestra. La mayoría de los usuarios consideró que el lenguaje utilizado en el fórum es comprensible, la imagen es adecuada y tiene una fácil navegación. Se observó que la madre y la propia persona con mielomeningocele son las principales responsables por la realización del cateterismo vesical intermitente; 86% utilizan catéter de plástico simple y 14% el catéter hidrofilico; 81% no reutilizan el catéter, 10% utilizan el mismo catéter durante un día y el 9% incluso hasta una semana. El principal lugar de realización del cateterismo vesical intermitente fue la cama, seguida de la letrina y la silla de ruedas. Conclusión: el uso del fórum virtual fue bien evaluado por los usuarios. Se lo puede considerar un medio para obtener informaciones, formación de red de apoyo y aclarar dudas, empoderando a los usuarios y contribuyendo a la adhesión al cateterismo vesical intermitente, que es uno de los tratamientos para la vejiga neurogénica.

RESUMO Objetivo: avaliar o uso de um fórum virtual para pessoas com mielomeningocele e seus familiares e o perfil dos usuários, de acordo com a realização do cateterismo vesical intermitente. Método: estudo quantitativo, transversal, descritivo e exploratório. A coleta de dados foi realizada com usuários do fórum virtual, com base em um questionário online, disponibilizado de 20 de março a 20 de abril de 2015. A amostra foi composta de 30 usuários. Foram realizadas análises estatísticas descritivas e teste qui-quadrado. Resultados: dos usuários, 27% eram pessoas com mielomeningocele e 73% familiares. A idade, considerando a amostra total, variou de 22 a 58 anos. O sexo feminino representou 67% da amostra. A maioria dos usuários considerou a linguagem utilizada no fórum compreensível, o visual adequado e a navegação fácil. Foi observado que a mãe e a própria pessoa com mielomeningocele são os principais responsáveis pela realização do cateterismo vesical intermitente; 86% utilizam cateter de plástico simples e 14% o cateter hidrofílico; 81% não reutilizam o cateter, 10% utilizam o mesmo cateter durante um dia e 9% por até uma semana. O principal local de realização do cateterismo vesical intermitente foi a cama, seguida pelo vaso sanitário e cadeira de rodas. Conclusão: o uso do fórum virtual foi bem avaliado pelos usuários. Ele pode ser considerado um meio para obtenção de informações, formação de rede de apoio e esclarecimento de dúvidas, empoderando os usuários e contribuindo para a adesão ao cateterismo vesical intermitente, que é um dos tratamentos para a bexiga neurogênica.

Intermittent Catheterization and Urinary Tract Infection: A Comparative Study Between Germany and Brazil.

PURPOSE: The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN: A quantitative, descriptive, correlational study. SUBJECTS AND SETTING: The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS: Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS: Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS: Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.

Factors Influencing the Use of Intermittent Bladder Catheterization by Individuals With Spina Bifida in Brazil and Germany.

PURPOSE: Intermittent catheterization (IC) often is essential for individuals with spina bifida/myelomeningocele (SBM) and neurogenic bladder. This study aimed to identify and analyze the factors that influence the use of IC. DESIGN AND METHODS: Descriptive study with convenience sampling. Data were collected using printed (Brazil) and online (Germany) questionnaires, and analyzed using multivariate logistical regression and analysis of variance. The study included 100 Brazilian and 100 German patients, aged 0-55 years, with SBM who utilized IC. FINDINGS: Intermittent catheterization was used by 188 of the 200 patients. Three variables were important for predicting who did or did not use IC: no discontinuation of IC, absence of technical difficulty, and daily frequency of IC. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggest that difficulties with IC use experienced by spina bifida patients and their family members that predicted full discontinuation tended to be personal variables, rather than demographic or medical characteristics.

Models of Self in Families of People with Spina Bifida / Modelos de Self em Famílias de Pessoas com Espinha Bífida / Modelos de Self en Familias de Personas con Espina Bífida

Abstract: Models of self reveal cultural views regarding the competences that children should acquire, and these views tend to be shared by people within the same environment. Thus, this study aims to evaluate the models of self in families of people with spina bifida. Seventeen caregivers answered an online questionnaire containing socio-demographic questions and three scales of self: autonomous, related and autonomous-related. The data were analyzed using descriptive statistics and techniques of multivariate analysis. The main results indicate that the most valued model of self was the autonomous-related model, reflecting the desire that children develop autonomy as well as interpersonal relationships. Such a model, however, is distinct from that of family groups of people with typical development living in the same cultural environment, indicating the need for families of people with spina bifida to receive support to reach their developmental goals.

Resumo: Os modelos de self revelam a visão cultural acerca das competências que as crianças devem adquirir e tendem a ser compartilhados pelas pessoas que integram o mesmo ambiente. Neste sentido, este estudo objetiva avaliar os modelos de self em famílias de pessoas com espinha bífida. Dezessete cuidadores responderam um questionário virtual contendo questões sociodemográficas e três Escalas de Self: Autônomo, Relacionado e Autônomo Relacionado. Os dados foram tratados por meio de estatística descritiva, com técnicas de análises multivariadas. Os principais resultados indicam que o modelo de self mais valorizado foi o autônomo relacional que se reflete no desejo que os filhos e filhas desenvolvam a autonomia e, também, relacionamentos interpessoais. Tal modelo, porém, distingue-se dos grupos familiares de pessoas com desenvolvimento típico que residem no mesmo ambiente cultural, o que evidencia a necessidade das famílias de pessoas com espinha bífida receberem apoio para alcançarem seus alvos desenvolvimentais.

Resumen: Los modelos de self revelan la visión cultural de las habilidades que los niños deben adquirir y suelen ser compartidos por personas que pertenecen a un mismo entorno. Así, este estudio tiene como objetivo evaluar los modelos de self en familias de personas con espina bífida. Diecisiete cuidadores contestaron un cuestionario virtual que contiene preguntas demográficas y tres Escalas de Self: Autónomo, Relacional y Autónomo-relacional. Los datos fueron analizados mediante estadística descriptiva, con las técnicas del análisis multivariado. Los principales resultados indican que el modelo de self más valorado es el autónomo relacional, que se refleja en el deseo de que los hijos e hijas puedan desarrollar la autonomía y también las relaciones interpersonales. Este hallazgo es distinto de los grupos familiares de personas con desarrollo típico del mismo entorno cultural. Por eso, las familias de personas con espina bífida deben recibir apoyo para lograr sus objetivos de desarrollo.

Patients With Spina Bifida and Their Caregivers' Feelings About Intermittent Bladder Catheterization in Brazil and Germany: A Correlational Study.

A major complication for individuals with spina bifida (SB) is managing their neurogenic bladder. For many, this process evokes negative feelings associated with guilt, dependence, and lack of self-worth. PURPOSE: The aim of the study was to compare feelings that hinder the performing of intermittent bladder catheterization reported by individuals with SB and their families in two countries of different sociocultural characteristics: Brazil and Germany. DESIGN AND METHODS: Quantitative and comparative study with convenience sampling. The sample comprised 200 SB patients and their caregivers, 100 from Brazil and 100 from Germany. FINDINGS: When asked about the existence of negative feelings or ideas that may hinder the performance of key person responsible for IC, 155 (77.5%) participants did not report such feelings. On the other hand, 45 (22.5%) reported emotional difficulties; among these participants, 31 (69%) were Brazilians and 14 (31%) were Germans. CONCLUSIONS AND CLINICAL RELEVANCE: Although emotional factors are important to the adjustment of using IC methods for bladder management, the majority of people with SB and their caregivers seem to report no major emotional difficulties with this process. Yet a considerable group of participants did report such emotional difficulties associated with fear and shame. Knowing more about the factors associated with such negative feelings can facilitate interactions, provide mutual aid, and assist with resolution of practical concerns related to intermittent bladder catheterization.

Predictive Factors for Intermittent Self-catheterization in German and Brazilian Individuals With Spina Bifida and Neurogenic Bladder Dysfunction.

PURPOSE: Our study aimed to identify predictive factors for the use of intermittent self-catheterization (ISC) in persons with spina bifida (SB) and neurogenic bladder. Cultural effects were evaluated by comparing ISC use in individuals from 2 countries, Germany and Brazil. DESIGN: Cross-sectional, descriptive study. SUBJECTS AND SETTING: The study included 71 Brazilian and 77 German individuals with SB (108 females and 92 males), aged between 6 and 55 years, who have used ISC for bladder management. METHODS: Data were collected using printed (Brazil) and online (Germany) questionnaires, with 53 questions related to intermittent catheterization (IC) technique, the materials used in IC, difficulties with IC, and sociodemographic and health variables. Data were analyzed using analysis of variance and multivariate logistical regression. RESULTS: Self-catheterization and assisted catheterization were used for 92 and 56 patients, respectively. Intermittent self-catheterization was more common in German participants (79.2%), while most Brazilian participants used assisted catheterization (56.3%). The following variables influenced the choice of catheterization method, according to logistic regression: age, education level, presence of hydrocephalus, severity of SB, and nationality. The variables unrelated to ISC use included gender, difficulty obtaining ISC equipment or learning to perform ISC, and wheelchair dependency. CONCLUSIONS: The identification of predictive factors for ISC improved our understanding of ISC in SB patients and should aid in the development of more effective strategies to increase ISC use.

Urinary Continence in German and Brazilian Individuals With Spina Bifida: Influence of Intermittent Catheterization.

PURPOSE: The purpose of this study was to identify the factors associated with acquisition of urinary continence following introduction of intermittent catheterization (IC). STUDY DESIGN: Cross-sectional study. SUBJECTS AND SETTING: The study sample comprised 104 females and 84 males. Their median age was 11 years (interquartile range = 6.0-22.0 years). Data were collected in 2 settings, the Rehabilitation Hospital in Belo Horizonte Brazil and Dortmund University North-Rhine, Westphalia, Germany. METHODS: Ninety-four Brazilian and 94 German individuals who had experienced IC participated in the study. Data were collected using printed (Brazil) and online (Germany) questionnaires and analyzed using multivariate logistical regression and analysis of variance. RESULTS: Out of the 188 participants, 62.2% (117) achieved complete or partial continence. We found that increasing the frequency of IC increases the likelihood that the patient will acquire continence with IC. Using self-catheterization can increase the likelihood of acquiring continence (partial or complete) up to 2.9 times, in relation to someone who uses no self-catheterization. CONCLUSIONS: Among patients with spina bifida and neurogenic bladder dysfunction, acquisition of urinary continence after initiating IC was influenced by the use of self-catheterization and daily frequency of IC.

USE OF VIRTUAL QUESTIONNAIRE AND DISSEMINATION AS A DATA COLLECTION STRATEGY IN SCIENTIFIC STUDIES / USO DE CUESTIONARIO Y DIVULGACIÓN VIRTUALES COMO ESTRATEGIA PARA LA RECOGIDA DE DATOS DE ESTUDIOS CIENTÍFICOS / USO DE QUESTIONÁRIO ONLINE E DIVULGAÇÃO VIRTUAL COMO ESTRATÉGIA DE COLETA DE DADOS EM ESTUDOS CIENTÍFICOS

ABSTRACT This study describes the use of online questionnaires and their virtual dissemination as a data collection strategy in Germany. The online questionnaire was elaborated using a virtual platform, creating a link that was disseminated in virtual environments. Participants were 100 Germans with Spina Bifida; 149 people visited the link, 83 of them coming from virtual forums, 27 from emails, 26 from social networks, ten from the German association of spina bifida site and three from the university website. With 55.7% of the participants, the virtual forum was the most agile dissemination medium to capture the data. This data collection mode should be used in future research, involving different countries, due to the speed, saving, good use of answers and help to overcome the language barrier. Public policies that support people's access to the Internet are necessary, so that these studies can be conducted successfully.

RESUMEN Este estudio describe el uso de un cuestionario online y su divulgación virtual como una estrategia de recolección de datos. El instrumento online fue desarrollado utilizando una plataforma virtual, creando un link que se publicó en ambientes virtuales. Participaron 100 alemanes con Espina Bífida. 149 personas tuvieron acceso al link, 83 oriundos de foros virtuales, 27 de correos electrónicos, 26 de redes sociales, 10 provenientes de la asociación alemana de espina bífida y 3 del website de la universidad. Con el 55,7% de los participantes, el medio de divulgación más ágil para la captura fue el foro virtual. Se sugiere que este método sea utilizado para investigaciones futuras que involucren varios países, esto debido a la velocidad, la economía, el buen uso de respuestas y por permitir a superar la barrera del idioma. Se requieren políticas públicas que apoyen el acceso de las personas a Internet, para que estos estudios se realicen con éxito.

RESUMO Este estudo teve como objetivo descrever o uso de questionário online e sua divulgação virtual como estratégia de coleta de dados na Alemanha. O questionário online foi elaborado com uma plataforma virtual, criando um link que foi divulgado em ambientes virtuais. Participaram 100 indivíduos alemães com Espinha Bífida; 149 pessoas visitaram o link, dessas 83 oriundas de fóruns virtuais, 27 e-mails, 26 redes sociais, dez do site da associação da espinha bífida alemã e três do site da universidade. Com 55,7% dos participantes, o meio de divulgação mais ágil para captação foi o fórum virtual. Sugere-se que esse modo de coleta de dados seja utilizado para pesquisas futuras, envolvendo diversos países, devido à rapidez, economia, bom aproveitamento de respostas e por permitir ultrapassar a barreira linguística. Políticas públicas que apoiem o acesso da população à internet são necessárias, para que esses estudos sejam realizados com êxito.

Longitudinal relations between personality traits and aspects of identity formation during adolescence.

The current study focused on three aspects of identity development relevant to the adolescent years: being an authentic person, perceiving control over and consistency in one's environment, and having consistent expectations from close others. In a two-wave study of adolescents (n = 750), we examined how these aspects change over the course of a year, as well as whether these aspects correspond to the Big Five personality traits. Results indicated three important findings. First, all three aspects evidenced the capacity for change over a year, and appeared more malleable than personality traits. Second, youth higher on all aspects reported a more adaptive personality profile. Third, changes on these aspects coincide with those on personality traits over the year. Findings are discussed with respect to future directions for studying the interplay of identity and personality development.

[The involvement of non-resident fathers--a review of the current research]. / Das Engagement getrennt lebender Väter Eine Ubersicht über den aktuellen Forschungsstand.

Non-resident fathers have been forming one of the fastest growing social groups during the last decades. Nevertheless, their involvement and role in the development of their separated children have received a comparatively modest attention in research. Little is known about the possibilities and limits of their influence after parental separation. This review is meant to give a general overview of the current scientific literature about the involvement of non-resident fathers. Various factors influencing the behaviour of fathers after separation such as the circumstances around the visits, the line-up of families, the role of mothers and general parental conflicts are taken into consideration. Finally, the current research in this field is critically discussed and future research perspectives are formulated.

Family structure, body mass index, and eating behavior.

OBJECTIVE: To explore associations between family structure, children's body mass index (BMI), and eating behaviors of children and their mothers. METHOD: Fifty-seven mothers and their children took part in an experimental study. BMI of children was measured. Mothers were asked to provide self-report data on sociodemographic background, mental health, and eating behaviors about themselves and their children. Parent-child-dyads represented their family structure using the Family System Test. RESULTS: We found negative associations in typical family situations between family hierarchy and children's BMI, mothers' emotional eating and mothers' restrained eating. Family cohesion and restrained eating of the children were also negatively correlated. We obtained positive associations in typical and conflict family situations between family cohesion and external eating of the children. DISCUSSION: We found indications that family structure is associated with overweight and with eating behavior in children and their mothers.

Discrepância e sua utilidade para o estudo da coesão e hierarquia em díades familiares / Discrepancy and its utility for the study of cohesion and hierarchy in family dyads / Discrepancia y su utilidad para el estudio de la cohesión y jerarquía en díadas familiares

Este estudo desenvolve e explora o conceito de discrepância em díades através da avaliação da coesão e hierarquia familiar. Foram investigadas 62 crianças pertencentes a uma escola particular de Belo Horizonte. Os participantes forneceram informações sobre as díades Pai-Criança, Mãe-Criança e Pai-Mãe por meio do Familiograma. Os resultados mostraram que, para a coesão, os atores utilizam, geralmente, a mesma quantidade de recursos, produzindo um padrão de baixa discrepância. A única exceção refere-se ao relacionamento entre as crianças do grupo masculino e respectivas mães. Com relação à hierarquia, foi encontrado um padrão claramente discrepante para as díades Pai-Criança e Mãe-Criança, nas quais os pais possuem mais hierarquia do que as crianças. Os resultados encontrados confirmam, de modo geral, as expectativas teóricas e demonstram a utilidade metodológica do conceito de discrepância na avaliação de sistemas familiares.(AU)

The present study develops and explores the concept of discrepancy in dyads in the context of family cohesion and hierarchy. 62 children from a private school of Belo Horizonte were investigated. The participants gave information about the Father-Child, Mother-Child and Father-Mother Dyads using the Familiogram. The results, for the dimension of cohesion, usually indicate the same amount of resources, showing a pattern of low discrepancy. The only exception refers to boys in their mother-child relationship. Regarding hierarchy, a clear discrepant pattern was found for the Father-Child and Mother-Child Dyads, in which the parents represent a higher hierarchical position compared to their children. The results confirm, in general, the theoretical expectations and demonstrate the methodological utility of the concept of discrepancy in the evaluation of family systems.(AU)

Psychosocial aspects of insomnia. Results of a study in general practice.

The relationship between insomnia and psychosocial factors is focused only in few epidemiological studies. Furthermore, most of them do not control for the mutual interdependencies of variables like age, sex, psychosocial distress and somatic or psychiatric disorders in their relation to insomnia. From a sample of general practice attendants, 516 patients with different grades of insomnia diagnosed according to DSM criteria were selected. Logistic regression analysis revealed seven psychosocial factors with independent predictive value for the occurrence of insomnia: increased age, conflicts with relatives, professional overload, housekeeping overload, illness of relatives, social and psychiatric status. Based on such a risk profile, in more than 2/3 of the cases the presence of insomnia can be predicted correctly. Consequences for diagnostic training and multimodal treatment programs are suggested.