Angelo Brandelli Costa

Qualidade metodológica das revisões sistemáticas em periódicos de psicologia brasileiros

Buscou-se avaliar a qualidade metodologica das revisoes sistematicas (RS) publicadas em periodicos brasileiros de psicologia. Dois autores conduziram uma RS nas bases PePSIC e SciELO, usando as palavras-chave: “revisao” e “sistematica”. Foram identificados e analisados 33 artigos atraves do instrumento Assessment of Multiple Systematic Reviews (AMSTAR) . A pontuacao media das revisoes foi 5,39 (em um escore que podia variar de 0 a 11). Houve diferenca de qualidade das RS publicadas no SciELO e no PePSIC, mas nao foi observada diferenca conforme o estrato do periodico, segundo o Qualis CAPES. Alem disso, nao verificou-se incremento na qualidade das publicacoes de 2001 a 2012. Sugere-se adocao de diretrizes por parte dos periodicos de forma a melhorar a qualidade das RS no Brasil.

WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals

INTRODUCTION The 100-item World Health Organization Quality of Life Assessment (WHOQOL-100) evaluates quality of life as a subjective and multidimensional construct. Currently, particularly in Brazil, there are controversies concerning quality of life after sex reassignment surgery (SRS). AIM To assess the impact of surgical interventions on quality of life of 47 Brazilian male-to-female transsexual individuals using the WHOQOL-100. METHODS This was a prospective cohort study using the WHOQOL-100 and sociodemographic questions for individuals diagnosed with gender identity disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The protocol was used when a transsexual person entered the ambulatory clinic and at least 12 months after SRS. MAIN OUTCOME MEASURES Initially, improvement or worsening of quality of life was assessed using 6 domains and 24 facets. Subsequently, quality of life was assessed for individuals who underwent new surgical interventions and those who did not undergo these procedures 1 year after SRS. RESULTS The participants showed significant improvement after SRS in domains II (psychological) and IV (social relationships) of the WHOQOL-100. In contrast, domains I (physical health) and III (level of independence) were significantly worse after SRS. Individuals who underwent additional surgery had a decrease in quality of life reflected in domains II and IV. During statistical analysis, all results were controlled for variations in demographic characteristics, without significant results. CONCLUSION The WHOQOL-100 is an important instrument to evaluate the quality of life of male-to-female transsexuals during different stages of treatment. SRS promotes the improvement of psychological aspects and social relationships. However, even 1 year after SRS, male-to-female transsexuals continue to report problems in physical health and difficulty in recovering their independence.

Effectiveness of a multidimensional web-based intervention program to change Brazilian health practitioners' attitudes toward the lesbian, gay, bisexual and transgender population.

The objective of this study was to assess the effectiveness of a multidimensional (educational, affective and behavioural) web-based intervention to change healthcare practitioners’ attitudes toward lesbian, gay, bisexual and transgender population. It aimed to measure gender and sexual (GenSex) prejudice pre- and post-intervention in relation to sociodemographic characteristics. A total of 307 health practitioners from southern Brazil enrolled and completed the follow-up assessment. The intervention had significant effects, varying across traditionally high prejudiced groups. State- and street-level continuous prejudice reduction policies are suggested.

Construção de uma escala para avaliar a qualidade metodológica de revisões sistemáticas

The aim of this study was to describe the process of creation and validation of methodology to assess the methodological quality of systematic reviews. From the expansion of the scope and addition of new items to the Assessment of Multiple Systematic Reviews (AMSTAR) instrument evidence of validity and reliability of the new methodology was sought. Firstly, the original scale was translated, adapted, expanded and evaluated by a panel of five experts. Then it was tested by evaluating a random sample of five systematic reviews by three judges with no formal training in the scale. Finally, the consolidated scale was assessed in a new panel by two judges. The panel of experts reached a consensus regarding the validity of the proposed changes. With respect to the scale total and per item score, the average agreement between judges was considered satisfactory in the consolidated scale. From the processes of adaptation and validation performed, the methodology in its final version consisted of 14 items that taken together indicate the methodological quality of systematic reviews from different areas of knowledge.The aim of this study was to describe the process of creation and validation of methodology to assess the methodological quality of systematic reviews. From the expansion of the scope and addition of new items to the Assessment of Multiple Systematic Reviews (AMSTAR) instrument evidence of validity and reliability of the new methodology was sought. Firstly, the original scale was translated, adapted, expanded and evaluated by a panel of five experts. Then it was tested by evaluating a random sample of five systematic reviews by three judges with no formal training in the scale. Finally, the consolidated scale was assessed in a new panel by two judges. The panel of experts reached a consensus regarding the validity of the proposed changes. With respect to the scale total and per item score, the average agreement between judges was considered satisfactory in the consolidated scale. From the processes of adaptation and validation performed, the methodology in its final version consisted of 14 items that taken together indicate the methodological quality of systematic reviews from different areas of knowledge.

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

Avaliação do preconceito contra diversidade sexual e de gênero: construção de um instrumento

In Brazil there is a lack of tools to assess such prejudices with good evidences of validity and reliability, and, especially, contextualized to the Brazilian context. Since prejudice is strongly associated to the culture and that in Brazil prejudice against non-heterosexual orientations is especially related hegemonic discordant gender expressions we created an instrument. The overall objective of this article is to establish evidences of validity and reliability for this instrument developed for the specificities of the Brazilian reality. Eight-hundred respondents from rural and urban areas of southern Brazil completed the Scale of Prejudice Against Sexual and Gender Diversity. Analyzes were conducted using Item Response Theory, criterion validity, and relationship with an instrument that measures the same construct. The scale showed good validity and reliability, and adaptability for the Brazilian reality, suggesting that it is a useful tool to assess prejudice.

BDNF: a biomarker for social vulnerability in individuals diagnosed with gender dysphoria.

Fuss and colleagues discussed in a review the role of brainderived neurotrophic factor (BDNF) in gender identity disorder, now gender dysphoria (GD) (Fuss et al., 2013). In this work, the authors highlighted some aspects of our article (Fontanari et al., 2013) stating that we conclude that BDNF might be a biomarker for GD. We thank Fuss and colleagues for emphasizing important topics of our article. However, we do not agree with some of their assessments. By comparing a group of GD patients (n 1⁄4 45) with a control group (n 1⁄4 66), our study found that the serum BDNF levels were significantly decreased in individuals diagnosed with GD (Fontanari et al., 2013). Decreased serum BDNF levels were also associatedwith childhood traumatic events in patients with bipolar disorder (BD) (Kauer-Sant’Anna et al., 2007). In this study, Kauer-

Laryngeal surgical treatment in transgender women: A systematic review and meta-analysis

To identify the effects of laryngeal surgical treatment in the voice of transgender women, especially on the fundamental frequency (f0).

Follow-up of psychological outcomes of interventions in patients diagnosed with disorders of sexual development: A systematic review.

The objective of this study was to perform a systematic review of articles that followed up the psychological outcomes of interventions in patients with disorders of sexual development. The analysis focused on the methodological quality of the studies and the assumptions on the evaluation of the intervention outcomes. The review signaled the need for better consideration about the complexity of intersexuality and for a shift from the anatomical/functional/aesthetic to the subjective outcomes related to patient’s quality of life. Furthermore, it is suggested that the interventions should be better investigated, given the lack of evidence for the necessity of early procedures.

Discordant Transsexualism in Male Monozygotic Twins: Neuroanatomical and Psychological Differences

One monozygotic male twin pair discordant for transsexualism is described. Both twins were interviewed and tested with the Wechsler Adult Intelligence Scale battery for cognitive functions and they underwent magnetic resonance imaging to measure the volumes of specific cerebral structures. Interviews with the twins and their mother indicated no unusual medical or life history events that could have had a causal role in the emergence of the disorder. Both cognitive function testing and neuroimaging detected differences between the twins that could be related to unexplained epigenetic effects and exogenous hormone usage.