Maria Helena Hasselmann

Semantic equivalence of the Portuguese version of the Abuse Assessment Screen tool used for the screening of violence against pregnant women

INTRODUCTION Research programs and actions regarding family violence have been growing steadily. Therefore, theres a need to develop data collection tools. In Brazil, further problems come up since tools that have been developed elsewhere need to be adapted and translated. This study focuses on the Abuse Assessment Screening (AAS) used to detect violence against pregnant women. The objective is to evaluate the semantic equivalence between the original tool in English and two Portuguese versions, and propose a synthetic version to be used in the field. METHODS The evaluation of semantic equivalence was carried out in 4 steps: (1) translation, (2) back translation, (3) formal appreciation of equivalence and (4) a final critical assessment by family violence experts. RESULTS Translation, back translation and the steps 3 and 4 assessment are presented for each item of the tool, along with the original in English. The text covers each discussion that led to the final version. Both versions were quite similar in 14 out of 15 items. Nevertheless, the second version showed to be slightly more adequate although for some items the decision was to combine both versions or, in one case, use an item from version 1. CONCLUSION The procedure undertaken in this study is discussed in the light of Herdman et al.s proposal (1998) regarding transcultural equivalence. The study also stresses the importance of using more than one version in the process and the appropriateness of including an additional step about the assessment of the target populations understanding of the tool.

Portuguese-language cross-cultural adaptation of the Revised Conflict Tactics Scales (CTS2), an instrument used to identify violence in couples

This article concerns the evaluation of cross-cultural equivalence between the Revised Conflict Tactics Scales (CTS2) originally developed in English and used to identify violence in couples and a Portuguese-language version for use in Brazil. Besides a broad literature review, evaluation of conceptual and item equivalences involved expert discussion groups focusing on the existence and pertinence of the underlying theoretical concepts and corresponding component items in the Brazilian context. Semantic equivalence involved the following steps: two translations and respective back-translations; an evaluation regarding referential and general (connotative) equivalence between the original instrument and each version; further discussions with experts in order to define the final version; and pre-testing the latter on 774 women. It was possible to establish high-quality conceptual, item, and semantic equivalence between the Portuguese-language version and the original CTS2. Acceptability of the version was excellent. Although the results were encouraging, they should be reevaluated in the light of forthcoming psychometric analysis (measurement equivalence).

Cross-cultural adaptation of the Portuguese version of the Conflict Tactics Scales Form R (CTS-1) used to assess marital violence: semantic and measurement equivalence

This paper focuses on the cross-cultural adaptation of the Portuguese version of the Conflict Tactics Scales (CTS-1). Semantic equivalence was evaluated with regard to the referential meaning of words and the general connotative meaning of each item. Measurement equivalence between the Portuguese version and the original instrument was assessed by means of the versions psychometric properties, namely, intra-observer reliability, construct validity, internal consistency, and factor structure. For the different relationships, measurement agreement for physical aggression was moderate to substantial. Cronbachs as were high for the physical and verbal aggression scales and low for the negotiation scale. As in the original instrument, factor analysis identified three dimensions, representing the negotiation, verbal aggression, and physical aggression scales, plus a severe physical aggression sub-scale. Although some problems still remain, the overall results suggest an adequate process of cross-cultural adaptation of the CTS-1, thus endorsing its use in the Brazilian setting.

Tentativas de suicídio em um hospital geral no Rio de Janeiro, Brasil

Previous suicide attempts are an important predictor of both repeated attempts and suicide. This paper presents the profile of patients who had attempted suicide and were admitted to a general hospital in Rio de Janeiro, Brazil. From April 2001 to March 2002, 160 suicide attempts were recorded (68% women; 26% adolescents). Ingestion of pesticides and prescription drugs were the two most common methods used. The two methods had been used by similar numbers of women, while two-thirds of men had used pesticides. As for prevalence of factors associated with attempted suicide, 21% of patients had been in contact with health services within 30 days prior to the event, 28% mentioned previous suicide attempts, and 23% reported other cases of suicide or attempts in the family. Despite the limited data in Brazil, suicide attempts appear to be an important health problem, particularly among youth. Surveillance systems for suicide attempts could help expand knowledge on this problem.

Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life

This study evaluates the association between postpartum depression and interruption of exclusive breastfeeding in the first two months of life. Cohort study of 429 infants < or = 20 days of age to four primary health care units in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding (outcome) was defined as the introduction of water, other types of liquids, milk, or formulas or any food. Postpartum depression was assessed using the Edinburgh Post-Natal Depression Scale. Associations between variables were expressed as prevalence ratios (baseline) and risk ratios (follow-up), with their respective 95% confidence intervals, estimated by Poisson regression with robust variance. Children of mothers with postpartum depressive symptoms were at higher risk of early interruption of exclusive breastfeeding in the first and second months of follow-up (RR = 1.46; 95%CI: 0.98-2.17 and RR = 1.21; 95%CI: 1.02-1.45, respectively). Considering mothers that were exclusively breastfeeding at the first month, postpartum depression was not associated with interruption of exclusive breastfeeding in the second month (RR = 1.44; 95%CI: 0.68-3.06). The results indicate the importance of maternal mental health for the success of exclusive breastfeeding.

Associação entre circunferência abdominal e hipertensão arterial em mulheres: Estudo Pró-Saúde

This study aimed to estimate the prevalence of hypertension according to levels of abdominal circumference (AC) and body mass index (BMI, expressed as kg/m(2)) among public employees at a university in Rio de Janeiro, Brazil. Cross-sectional data were obtained for 1,743 non-pregnant women aged 24-69 years participating in the Pró-Saúde Study. Underweight women and those with BMI > 35 kg/m(2) were excluded. Hypertension was defined as systolic blood pressure >140 mmHg or diastolic > 90 mmHg or the use of anti-hypertensive drugs. Age-adjusted prevalence rates for hypertension were calculated considering two strata of AC (normal: < 88 cm; high: > 88 cm) and three levels of BMI (normal: 18.5-24.9 kg/m(2); overweight: 25.0-29.9 kg/m(2); and obesity I: 30.0-34.9 kg/m(2)). Among normal-weight women, participants with high AC showed a two-fold higher prevalence of hypertension as compared to those with AC < 88 cm (18% vs. 8%, p < 0.05). Routine measurement of AC, in addition to BMI, could contribute to early identification of hypertension in women.

Prepregnancy weight, weight gain during pregnancy, and exclusive breastfeeding in the first month of Life in Rio de Janeiro, Brazil.

To examine the relationship between maternal prepregnancy weight, gestational weight gain and early introduction of non-breast milk foods and fluids (EINB) in the first month of life, we investigated 592 adult women and their newborns, admitted at health care units in Rio de Janeiro, Brazil. EINB was defined as the introduction of water, tea, juice, other types of milk or food during the first month postpartum. Logistic regression models were used for the analyses. Prepregnant obese women had increased odds of EINB as compared to those with normal weight (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.23-3.71). Overweight and obese women who exceeded the recommended gestational weight gain had significantly greater odds of EINB (OR = 2.29, 95% CI = 1.16-4.51, and OR = 3.33, 95% CI = 1.49-7.47, respectively), compared with those with normal weight and adequate gestational weight gain. These findings highlight the importance of providing overweight/obese women with proper lactation guidance in the early postpartum to support for exclusive breastfeeding practices.

Measurement reliability in a study on family violence and severe acute malnutrition

INTRODUCTION This study is nested within a research program related to family violence and severe childhood malnutrition. Its aim is to evaluate the reliability of the data collection process in a case-control study. Four components of the main instrument are addressed: (a) CTS (Conflict Tactics Scales) used to measure violence at the family level; (b) CAGE (Cut-down; Annoyed; Guilty & Eye-opener) questionnaire used to gauge suspicion of drinking problems; NSDUQ (Non-student Drugs Use Questionnaire) used to indicate illicit drug consumption; and (d) height/length measurements. METHOD Stability (intra-observer or test-retest reliability) and equivalence (inter-observer reliability) were evaluated for the cited components (a), (b) and (c). Information was replicated among the first 50 subjects selected for the underlying case-control study. The Kappa index (k) was used in the analysis. A pseudo-Bayes adjustment was carried out in order to handle estimation problems. Regarding (d), only equivalence was evaluated (n = 73), using the Intraclass Correlation Coefficient as the estimator. RESULTS By and large, all components showed acceptable stability and equivalence. Regarding stability, the estimates of k were around 0.70, 0.78 and 0.85, for CTS, CAGE e NSDUQ, respectively. With respect to equivalence, k was 1.0 for CTS and NSDUQ and 0.75 for CAGE. Equivalence for height/length estimated through the ICC was 0.99. Nevertheless, some deviant situations were detected and are further discussed. The results point to an adequate standardization of observers and reflect the good quality of the data collection procedure concerning the main study, encouraging the research team to press forward with greater assurance.

Social network, social support and feeding habits of infants in their fourth month of life

The scope of this study was to investigate the association between the social network, social support and the feeding habits of infants in their fourth month of life. A cross-sectional study was conducted among 294 children selected at 4 Primary Health Care Units in Rio de Janeiro/ Brazil. A 24-hour dietary recall was applied to the mothers to evaluate the feeding habits. Questions related to the number of people upon whom the woman can rely were asked as well as their participation in social activities to measure the social network. The scale in the Medical Outcomes Study was used to measure social support. The analysis was based on multinomial logistic regression models. Most of the infants (84%) received breast milk, but only 16% were exclusively breastfed. Children whose mothers had a small number of relatives to rely on and with low social support were more likely to be bottle-fed rather than exclusively breastfed. The need to integrate members of the social network of the woman during pre-natal care, birth and the after birth period should be encouraged, in such a way that social support can serve the mothers requirements, contributing to exclusive breastfeeding.

Intimate partner violence and early interruption of exclusive breastfeeding in the first three months of life

The aim of this study was to investigate the role of intimate partner violence in the early interruption of exclusive breastfeeding in the first three months of life. We used data from a prospective cohort of 564 children attending four primary health clinics in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding was defined as a child receiving any kind of liquid or solid, regardless of breast milk intake, measured by a 24 hour recall. The Portuguese version of the Conflict Tactics Scales (CTS-1) was used to assess intimate partner violence. Associations were expressed as prevalence ratios and relative risks and their respective 95% confidence intervals. Children of mothers who experienced severe violence had 30% greater likelihood of early interruption of exclusive breastfeeding in the second month of life as compared to those who did not experience this type of violence. Strategies in health services for promoting exclusive breastfeeding should consider identifying and addressing family violence.