Objective: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. Methods: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. Results: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). Conclusion: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.
The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.
O objetivo do estudo foi estimar a prevalência de violência física entre parceiros íntimos nos primeiros seis meses após o parto entre mulheres que frequentam unidades básicas de saúde (UBS) do Rio de Janeiro, Brasil, para o acompanhamento da criança. Este é o primeiro estudo sobre o tema realizado com uma amostra representativa de UBS do Município do Rio de Janeiro. Trata-se de um estudo transversal, realizado entre junho e setembro de 2007, que incluiu 927 mães/bebês atendidos em 27 UBS, selecionadas por amostragem complexa e geograficamente representativas do município. As informações foram coletadas por meio de entrevistas face a face, por equipe previamente treinada, utilizando questionário estruturado. A história de violência física entre parceiros íntimos desde o nascimento da criança até a data da entrevista foi obtida por meio da versão nacional do instrumento Revised Conflict Tatics Scales (CTS2). Trinta por cento (IC95%: 26,2-33,8) das mães relataram ter vivenciado alguma forma de violência física entre parceiros íntimos no pós-parto e 14% (IC95%: 11,0-17,0) referiram violência física grave. Os abusos físicos ocorreram especialmente entre mães adolescentes, negras, que não viviam com o companheiro, em situação socioeconômica desfavorável, e que apresentavam falhas no cuidado pré-natal, na amamentação e na utilização do serviço de saúde. A ampla magnitude da violência física entre parceiros íntimos reforça a necessidade de enfrentamento imediato do problema. Para isso, é fundamental que os serviços da atenção primária estejam articulados a outras redes de apoio e os profissionais de saúde, preparados para lidar com o problema.
Although recent studies have related the occurrence of violence in childhood and adolescence with the adoption of health risk behaviors, there are no studies that quantify this co-occurrence among adolescent victims of family violence. Our objective was, therefore, to investigate the co-occurrence of health risk behaviors in these adolescent victims. Data from the National School Health Survey, collected in 2015, were used. Co-occurrence of risk behaviors-involvement in fights, substance use (alcohol, drugs, and tobacco), not wearing seat belts and helmets, inadequate food consumption-was analyzed using Venn diagrams, according to the victim's status and sex. The association between the four risk behaviors and victimization was investigated using multiple logistic regression. All the analyses were performed using Stata®13. We found an excess of risk behaviors among victims of family violence in both sexes. The co-occurrence of the four risk behaviors analyzed was higher among male and female adolescents, who were victims of family violence than in nonvictims. Family violence was associated with the adoption of risk behaviors, regardless of sex. This association was stronger as the number of risk behaviors adopted increased. The chance of engaging in one risk behavior was 1.32 (95% confidence interval (CI) = [0.88, 1.98]) and 1.24 (95% CI = [0.90, 1.72]) higher for boys and girls, respectively, who had suffered family violence. This increased to 7.76 (95% CI = [5.33, 11.29]) and 7.28 (95% CI = [5.20, 10.20]) when considering engagement in four risk behaviors. Identifying the prevalence of co-occurrence of health risk behaviors in vulnerable subgroups (such as victims of domestic violence) could help target broader interventions focusing on multiple risk behaviors.
Objetivo: Identificar práticas de consumo e comportamento alimentar saudáveis e não saudáveis de agricultores familiares do bairro Caxambu, no município de Petrópolis-RJ. Metodologia: Trata-se de estudo transversal realizado com amostra de 35 agricultores familiares. Informações foram obtidas por meio de entrevistas, utilizando um questionário estruturado e padronizado. As práticas alimentares foram avaliadas a partir dos itens do questionário utilizado pelo SISVAN associados às frequências de consumo do questionário utilizado pelo VIGITEL. Resultados e Discussão: O consumo de alimentos saudáveis (frutas, legumes e verduras), com exceção do feijão, foi baixo, e o consumo de alimentos não saudáveis, consideravelmente alto, quando comparados com outros estudos. Além disso, quase metade dos agricultores entrevistados possui o hábito de realizar as refeições assistindo TV, mexendo no celular e/ou computador, o que é considerado um comportamento de risco para o desenvolvimento da obesidade. Conclusões: Os agricultores familiares do Caxambu possuem práticas alimentares que merecem atenção, pois apesar do fácil acesso a alimentos saudáveis, foram encontrados baixa ingestão de frutas, legumes e verduras e elevado consumo de alimentos não saudáveis, como as bebidas adoçadas e embutidos. Evidencia-se a necessidade de realizar ações voltadas para a melhoria do perfil alimentar, da saúde e qualidade de vida dos agricultores familiares.DOI: 10.12957/demetra.2018.34989
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