Genário Alves Barbosa

Transtorno de déficit de atenção/hiperatividade

Introducao As primeiras referencias aos transtornos hipercineticos na literatura medica apareceram no meio do seculo XIX. Entretanto, sua nomenclatura vem sofrendo alteracoes continuas. Na decada de 40, surgiu a designacao “lesao cerebral minima”, que, ja em 1962, foi modificada para “disfuncao cerebral minima”, reconhecendo-se que as alteracoes caracteristicas da sindrome relacionam-se mais a disfuncoes em vias nervosas do que propriamente a lesoes nas mesmas. Os sistemas classificatorios modernos utilizados em psiquiatria, CID-10 e DSM-IV, apresentam mais similaridades do que diferencas nas diretrizes diagnosticas para o transtorno, embora utilizem nomenclaturas diferentes (transtorno de deficit de atencao/hiperatividade no DSMIV e transtornos hipercineticos na CID-10). Os estudos nacionais e internacionais situam a prevalencia do transtorno de deficit de atencao/hiperatividade (TDAH) entre 3% e 6%, sendo realizados com criancas em idade escolar na sua maioria. O impacto desse transtorno na sociedade e enorme, considerando-se seu alto custo financeiro, o estresse nas familias, o prejuizo nas atividades academicas e vocacionais, bem como efeitos negativos na auto-estima das criancas e adolescentes. Estudos tem demonstrado que criancas com essa sindrome apresentam um risco aumentado de desenvolverem outras doencas psiquiatricas na infância, adolescencia e idade adulta. A presente atualizacao busca uma revisao critica dos elementos essenciais referentes ao diagnostico e as abordagens terapeuticas do TDAH. Uma revisao mais completa (porem menos atualizada) incluindo dados epidemiologicos, etiologicos, relacionados ao substrato neurobiologico e de evolucao do transtorno podem ser encontrados em Rohde et al. (1998). No presente artigo, o termo crianca sera utilizado englobando a faixa etaria da infância e adolescencia, a menos que seja indicado o contrario.

Factor and Latent Class Analysis of DSM-IV ADHD Symptoms in a School Sample of Brazilian Adolescents

OBJECTIVE To evaluate the validity of the multidimensional construct proposed by DSM-IV for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in a school sample of young Brazilian adolescents. METHOD An instrument including all 18 DSM-IVADHD symptoms was administered to 1,013 students aged 12 to 14 years at 64 state schools by trained research assistants. Each symptom was rated on a Likert scale with five levels of severity (never, almost never, sometimes, frequently, and always). RESULTS Using an exploratory factor analytic approach (principal components analysis), two factors were extracted. Factor I (hyperactivity-impulsivity) comprised eight DSM-IV hyperactive-impulsive symptoms with loadings > or =0.40. Factor II (inattention) included also eight DSM-IV symptoms of inattention. The two factors explained 34% of the total variance and had an interfactor correlation of 0.45. Latent class analysis demonstrated similar classes in males and females, but class structures were markedly different from previous analyses of parent report data. CONCLUSION The findings support the appropriateness of the multidimensional construct introduced by DSM-IV in the diagnosis of ADHD in a different culture but emphasize the possible impact of different reporters on the results of structural model-testing.

Factorial validity and reliability of the General Health Questionnaire (GHQ-12) in the Brazilian physician population

The 12-item General Health Questionnaire (GHQ-12) is a widely used screening instrument. One- and two-factor structures have been identified in some countries. In Brazil, the best factor structure is still unclear. This study aimed at knowing its factorial validity and reliability, and testing the one-factor and two-factor models. The participants were 7,512 Brazilian physicians. They answered the GHQ-12 and demographic questions. Unrotated (one-factor) and rotated (two-factor) structures of the GHQ-12 were extracted by principal component analysis. Confirmatory factor analyses (ML) were used to compare the one- and two-factor solutions. The two-factor model fitted the data better than the one-factor one. Those two factors were depression and social dysfunction, and they showed themselves to be directly correlated to one another. They also showed adequate reliability coefficients. The two-factor model is remarkably adequate, showing better fit indices, although it is acceptable to admit a common factor, which could be defined as psychological distress.

Self-efficacy as a mediator of the relationship between subjective well-being and general health of military cadets

O objetivo do presente estudo e investigar o papel da crenca na autoeficacia como mediadora da relacao entre o bem-estar subjetivo e a saude geral de cadetes militares (policiais e bombeiros). Para tanto, participaram 228 cadetes, sendo a maioria de oficiais da Policia Militar (65%), do sexo masculino (79%), com idades variando entre 17 e 34 anos (99%), e declarados solteiros (74%). Estes responderam as medidas de saude geral (QSG-12), autoeficacia geral percebida, as multiplas escalas que compoem o bem-estar subjetivo e perguntas demograficas. Analises iniciais de regressao apontam o poder preditivo do bem-estar subjetivo sobre a saude geral. Posteriormente, as analises de mediacao fornecem evidencias satisfatorias para o papel da crenca na autoeficacia como mediador da relacao entre as variaveis do bem-estar subjetivo e a saude geral de cadetes militares. As implicacoes destes resultados na formacao dos cadetes sao discutidas.The objective of this study is to investigate the role of self-efficacy beliefs as a mediator of the relationship between the subjective well-being and general health of military cadets (police and firefighters). For this study, 228 cadets participated, the majority being Military Police officer candidates (65%), male (79%), between 17 and 34 years of age (99%), and unmarried (74%). They responded to questionnaires on general health (GHQ-12), perceived general self-efficacy, to the multiple scales that cover subjective well-being, and demographic questions. Initial regression analyses indicate the predictive power of subject well-being regarding general health. Subsequently, the mediation analyses provide satisfactory evidence for the role of perceived self-efficacy as a mediator of the relationship between the subjective well-being variables and the overall health of military cadets. The implications of these results for the professional training of the cadets are discussed.

Bem-Estar Subjetivo e Burnout em Cadetes Militares: O Papel Mediador da Autoeficácia

Este trabalho tem por objetivo testar a hipotese de que a autoeficacia atua como mediador entre o bem-estar subjetivo e o burnout. Participaram 228 cadetes, com idade media de 24 anos (DP = 0,85), sendo 148 policiais e 80 bombeiros. As analises de regressao demonstram que as variaveis do bem-estar subjetivo, principalmente a vitalidade subjetiva e os afetos negativos, predizem significativamente o burnout e suas subdimensoes. As analises de mediacao feitas provem evidencias empiricas satisfatorias para o papel mediador desempenhado pela autoeficacia. Esses resultados poderao apoiar o planejamento de intervencoes que visem o fortalecimento da autoeficacia em cadetes. A academia deve fornecer aos cadetes nao apenas as tecnicas e conhecimentos imprescindiveis para a atuacao profissional, mas tambem proporcionar o desenvolvimento de mecanismos de autorregulacao que possibilitem um senso maior de autoeficacia, alem de condicoes educacionais e laborais adequadas.

A autoeficácia como mediadora da relação entre bem-estar subjetivo e saúde geral de cadetes militares

O objetivo do presente estudo e investigar o papel da crenca na autoeficacia como mediadora da relacao entre o bem-estar subjetivo e a saude geral de cadetes militares (policiais e bombeiros). Para tanto, participaram 228 cadetes, sendo a maioria de oficiais da Policia Militar (65%), do sexo masculino (79%), com idades variando entre 17 e 34 anos (99%), e declarados solteiros (74%). Estes responderam as medidas de saude geral (QSG-12), autoeficacia geral percebida, as multiplas escalas que compoem o bem-estar subjetivo e perguntas demograficas. Analises iniciais de regressao apontam o poder preditivo do bem-estar subjetivo sobre a saude geral. Posteriormente, as analises de mediacao fornecem evidencias satisfatorias para o papel da crenca na autoeficacia como mediador da relacao entre as variaveis do bem-estar subjetivo e a saude geral de cadetes militares. As implicacoes destes resultados na formacao dos cadetes sao discutidas.The objective of this study is to investigate the role of self-efficacy beliefs as a mediator of the relationship between the subjective well-being and general health of military cadets (police and firefighters). For this study, 228 cadets participated, the majority being Military Police officer candidates (65%), male (79%), between 17 and 34 years of age (99%), and unmarried (74%). They responded to questionnaires on general health (GHQ-12), perceived general self-efficacy, to the multiple scales that cover subjective well-being, and demographic questions. Initial regression analyses indicate the predictive power of subject well-being regarding general health. Subsequently, the mediation analyses provide satisfactory evidence for the role of perceived self-efficacy as a mediator of the relationship between the subjective well-being variables and the overall health of military cadets. The implications of these results for the professional training of the cadets are discussed.

La autoeficacia como mediador en la relación entre salud general y bienestar subjetivo de los cadetes militares

O objetivo do presente estudo e investigar o papel da crenca na autoeficacia como mediadora da relacao entre o bem-estar subjetivo e a saude geral de cadetes militares (policiais e bombeiros). Para tanto, participaram 228 cadetes, sendo a maioria de oficiais da Policia Militar (65%), do sexo masculino (79%), com idades variando entre 17 e 34 anos (99%), e declarados solteiros (74%). Estes responderam as medidas de saude geral (QSG-12), autoeficacia geral percebida, as multiplas escalas que compoem o bem-estar subjetivo e perguntas demograficas. Analises iniciais de regressao apontam o poder preditivo do bem-estar subjetivo sobre a saude geral. Posteriormente, as analises de mediacao fornecem evidencias satisfatorias para o papel da crenca na autoeficacia como mediador da relacao entre as variaveis do bem-estar subjetivo e a saude geral de cadetes militares. As implicacoes destes resultados na formacao dos cadetes sao discutidas.The objective of this study is to investigate the role of self-efficacy beliefs as a mediator of the relationship between the subjective well-being and general health of military cadets (police and firefighters). For this study, 228 cadets participated, the majority being Military Police officer candidates (65%), male (79%), between 17 and 34 years of age (99%), and unmarried (74%). They responded to questionnaires on general health (GHQ-12), perceived general self-efficacy, to the multiple scales that cover subjective well-being, and demographic questions. Initial regression analyses indicate the predictive power of subject well-being regarding general health. Subsequently, the mediation analyses provide satisfactory evidence for the role of perceived self-efficacy as a mediator of the relationship between the subjective well-being variables and the overall health of military cadets. The implications of these results for the professional training of the cadets are discussed.