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The congruency effect observed in distracter interference tasks is usually smaller after incongruent relative to congruent trials. However, the nature of control processes underlying this congruency sequence effect (CSE) remains a topic of active debate. For example, while some researchers have suggested that these processes are recruited only when participants utilize the same response mode (e.g., the same hand) to respond in consecutive trials, others have argued that these processes can operate independently of response mode. To distinguish between these views, we investigated whether changes of response mode across consecutive trials influence the CSE in a prime-probe task (Experiment 1) or a flanker task (Experiment 2). Such changes did not influence the CSE in either task. Further, the CSE was significant even when participants utilized different response modes (i.e., different hands) to respond in consecutive trials. These findings indicate that control processes underlying the CSE can operate independently of response mode and thereby clarify the nature of control processes that minimize distraction from irrelevant stimuli.

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A anorexia nervosa caracteriza-se pela manutenção voluntária de um peso corporal abaixo do esperado para a idade e altura, justificada pelo medo de engordar. No presente artigo, discutem-se hipóteses sobre os fatores envolvidos na vulnerabilidade psicológica para a anorexia nervosa. Mais especificamente, abordam-se perturbações na relação precoce com a figura materna e na estruturação matriarcal, tanto na polaridade receptiva (filho) como na polaridade ativa, provedora do autocuidado (mãe). Essas perturbações podem gerar dificuldades no estabelecimento do narcisismo saudável, o qual é responsável por um sentimento de continuidade da existência e de validade subjetiva. Tais falhas precoces favorecem a adesão onipotente a um ideal de magreza e autocontrole de forma compensatória. Discutem-se também as implicações que essas hipóteses trazem para o tratamento global da paciente e também para a abordagem psicoterápica. (AU)

Anorexia nervosa is characterized by a refusal to maintain a normal body weight for height and age, based on intense fear of becoming fat. We discuss a few hypothesis concerning psychological vulnerability for anorexia nervosa. We specifically describe problematic issues in the primary relationship between the girl and the mother figure. This experience of the mother archetype impairs both its receptive and active polarity (daughter). We suggest these initial problems interfere with the establishment of healthy narcissism and a basic sense of security and of inner validity that it provides. The anorexic patient seems to compensate this lack of solid narcissistic foundations with omnipotent weight control and rigid ideal of thinness. We also discuss implications of these ideas to patient treatment and psychotherapy. (AU)

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A anorexia nervosa caracteriza-se pela manutenção voluntária de um peso corporal abaixo do esperado para a idade e altura, justificada pelo medo de engordar. No presente artigo, discutem-se hipóteses sobre os fatores envolvidos na vulnerabilidade psicológica para a anorexia nervosa. Mais especificamente, abordam-se perturbações na relação precoce com a figura materna e na estruturação matriarcal, tanto na polaridade receptiva (filho) como na polaridade ativa, provedora do autocuidado (mãe). Essas perturbações podem gerar dificuldades no estabelecimento do narcisismo saudável, o qual é responsável por um sentimento de continuidade da existência e de validade subjetiva. Tais falhas precoces favorecem a adesão onipotente a um ideal de magreza e autocontrole de forma compensatória. Discutem-se também as implicações que essas hipóteses trazem para o tratamento global da paciente e também para a abordagem psicoterápica.

Anorexia nervosa is characterized by a refusal to maintain a normal body weight for height and age, based on intense fear of becoming fat. We discuss a few hypothesis concerning psychological vulnerability for anorexia nervosa. We specifically describe problematic issues in the primary relationship between the girl and the mother figure. This experience of the mother archetype impairs both its receptive and active polarity (daughter). We suggest these initial problems interfere with the establishment of healthy narcissism and a basic sense of security and of inner validity that it provides. The anorexic patient seems to compensate this lack of solid narcissistic foundations with omnipotent weight control and rigid ideal of thinness. We also discuss implications of these ideas to patient treatment and psychotherapy.

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BACKGROUND: Objective binge eating episodes (OBEs) refer to binge eating on an unusually large amount of food and are the core symptom in current definitions of bulimia nervosa (BN) and binge eating disorder (BED). Subjective binge eating episodes (SBEs) refer to eating on a small or moderate amount of food (that is perceived as large) and like OBEs are associated with loss of control (LOC). Reaching consensus on what is considered a large amount of food can however be problematic and it remains unclear if the size of a binge is an essential component for defining a binge eating episode. The aim of this study was to compare the eating disorder features and general psychopathology of subjects reporting OBEs with those reporting only SBEs. METHODS: This is a retrospective secondary analysis of data from 70 obese participants at the recruitment phase of a multicentre trial for BED. Individuals who answered positively to the presence of binge eating and LOC over eating had their binge eating episodes further explored by interview and self-report. Two groups, those who reported current OBEs (with or without SBEs) and those who reported current SBEs only were compared for age, gender, marital status, body mass index (BMI), indicators of LOC over eating, severity of binge-eating and associated psychopathology. RESULTS: The majority of participants in both the OBE and SBE groups endorsed the experience of at least four indicators of LOC. There were no significant differences between the groups. Both groups had high levels of binge-eating severity, moderate severity of associated depressive symptoms and frequent psychiatric co-morbidity. CONCLUSION: Treatment seeking participants with obesity who reported SBEs alone were similar to those who reported OBEs in terms of eating disorder features and general psychopathology. These findings suggest that classificatory systems of mental illnesses should consider introducing SBEs as a feature of the diagnostic criteria for binge eating and, thus, facilitate the inclusion of participants with SBEs in treatment trials.

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CONTEXTO: O objetivo deste estudo foi investigar se antecedente de abuso sexual na infância (ASI) está associado com transtornos alimentares na vida adulta. MÉTODOS: Realizou-se um estudo de caso controle (N = 120) comparando mulheres com transtornos alimentares tratadas em ambulatório universitário especializado com um grupo controle de pacientes de clínica não psiquiátrica (ambulatório de oftalmologia). RESULTADOS: Este estudo encontrou maior prevalência de ASI na anorexia nervosa (AN) comparada ao grupo controle (50% versus 14,8%; OR = 5,8 IC 95% = 1,3-25,6; p < 0,05), entretanto não identificou diferença estatística entre os grupos comparando com casos de bulimia nervosa (BN) (26,7% versus 27% no grupo controle; OR = 0,99; IC 95% = 0,24-4,1) e com transtorno de compulsão alimentar periódica (TCAP), apesar da maior prevalência de ASI observada neste último em relação ao grupo controle (43,7% versus 27,3%; OR = 2,1 IC 95% = 0,5- 8,1). Considerando-se a presença de dois ou mais episódios de ASI, observou-se também maior prevalência em AN (35,7% versus 3,7% nos controles; OR = 14,4 IC 95% = 1,5-140,8; p < 0,05). CONCLUSÃO: Este estudo mostrou forte associação da anorexia nervosa com antecedentes de abuso sexual na infância.

BACKGROUND: The aim of this study is to evaluate if exposure to childhood sexual abuse (CSA) is related with eating disorders in adult life. METHODS: A case-control study was performed comparing women with diagnoses of eating disorders - from PROATA (acronym in Portuguese meaning Eating Disorders Program) of Federal University of São Paulo - and non-psychiatric clinic patients as control group at Ophthalmology Centre. RESULTS: The prevalence of CSA for binge-eating disorder was 43.7%, whilst in the control group it was 27.3% (OR = 2.1; CI 95% = 0.5- 8.1). The prevalence of CSA for bulimia nervosa was 26.7% and, 27% in control group (OR = 0.99; CI 95% = 0.24-4.1). The prevalence of CSA in anorexia nervosa was 50%, whilst in control group it was 14.8% (OR = 5.8; CI 95% = 1.3- 25.6; p < 0.05). Taking into account only the history of two or more CSA episodes, those patients with anorexia nervosa had 35.7% CSA prevalence, and 3.7% in control group (OR = 14.4; CI 95% = 1.5-140.8; p < 0.05). CONCLUSION: This study has shown a strong association between anorexia nervosa and childhood sexual abuse.

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OBJECTIVE: To investigate whether abnormal eating behaviors in young women could predict eating disorders after 4 years. METHOD: 56 women were identified as presenting abnormal eating behaviors in a cross-sectional study (Eating Attitudes Test-26 and Edinburgh Bulimic Investigation Test). They were matched for age and neighborhood to two controls (n = 112). Four years later, they were re-assessed with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI 2.1). RESULTS: Women with abnormal eating behaviors at baseline showed a high probability of presenting abnormal eating behaviors but it was not associated with eating disorders 4 years later. They were also at higher risk for obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobia. DISCUSSION: Abnormal eating behaviors were related to the maintenance of the disturbed behavior over the years, and were associated with increased probability for psychiatric diagnoses.

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OBJECTIVE: The present paper describes the validation of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) designed for the diagnosis of binge eating disorder (BED) and sub-clinical binge eating. METHODS: 89 overweight women seeking treatment for binge eating and/or obesity were assessed with the Portuguese version of the Questionnaire of Eating and Weight Patterns and were, subsequently, interviewed with the eating disorders module of the Structured Clinical Interview for DSM-IV (SCID-I/P). Rates of binge eating disorder and sub-clinical cases of binge eating obtained with the Questionnaire on Eating and Weight Patterns-Revised were then compared to those obtained with the Structured Clinical Interview for DSM-IV. RESULTS: In the identification of binge eating, irrespective of the presence of all criteria for binge eating disorder the QEWP-R Questionnaire on Eating and Weight Patterns-Revised yielded a sensitivity value of 0.88, a specificity value of 0.63 and a positive predictive value of 0.825. Rates for the identification of the full syndrome of binge eating disorder were: sensitivity value of 0.548, a specificity value of 0.8 and a positive predictive value of 0.793. CONCLUSIONS: The Questionnaire on Eating and Weight Patterns-Revised can be useful in a first-step screening procedure to identify probable cases of binge eating. It can be useful as a screening tool and as a first step of clinical assessment of patients seeking treatment for binge eating and/or obesity.

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OBJECTIVE: The present paper describes the validation of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) designed for the diagnosis of binge eating disorder (BED) and sub-clinical binge eating. METHODS: 89 overweight women seeking treatment for binge eating and/or obesity were assessed with the Portuguese version of the Questionnaire of Eating and Weight Patterns and were, subsequently, interviewed with the eating disorders module of the Structured Clinical Interview for DSM-IV (SCID-I/P). Rates of binge eating disorder and sub-clinical cases of binge eating obtained with the Questionnaire on Eating and Weight Patterns-Revised were then compared to those obtained with the Structured Clinical Interview for DSM-IV. RESULTS: In the identification of binge eating, irrespective of the presence of all criteria for binge eating disorder the QEWP-R Questionnaire on Eating and Weight Patterns-Revised yielded a sensitivity value of 0.88, a specificity value of 0.63 and a positive predictive value of 0.825. Rates for the identification of the full syndrome of binge eating disorder were: sensitivity value of 0.548, a specificity value of 0.8 and a positive predictive value of 0.793. CONCLUSIONS: The Questionnaire on Eating and Weight Patterns-Revised can be useful in a first-step screening procedure to identify probable cases of binge eating. It can be useful as a screening tool and as a first step of clinical assessment of patients seeking treatment for binge eating and/or obesity.

OBJETIVO: O presente artigo descreve a validação do Questionário sobre Padrões de Alimentação e Peso-Revisado (QEWP-R), instrumento criado para o diagnóstico do transtorno da compulsão alimentar periódica (TCAP) e de quadros subclínicos de compulsão alimentar. MÉTODOS: A amostra foi composta por 89 mulheres em busca de tratamento especializado para compulsão alimentar e/ou obesidade, que preencheram o Questionário sobre Padrões de Alimentação e Peso-Revisado e, posteriormente, foram entrevistadas com o módulo para transtornos alimentares da Entrevista Clínica Estruturada para o DSM-IV (SCID-I/P). As taxas de transtorno da compulsão alimentar periódica e de diagnósticos subclínicos obtidas pelo Questionário sobre Padrões de Alimentação e Peso-Revisado foram comparadas às obtidas pela Entrevista Clínica Estruturada para o DSM-IV. RESULTADOS: Na identificação de compulsão alimentar (independente da presença de todos os elementos necessários para o diagnóstico de transtorno da compulsão alimentar periódica), a versão em português do Questionário sobre Padrões de Alimentação e Peso-Revisado apresentou sensibilidade de 0,88, especificidade de 0,63 e valor preditivo positivo de 0,825. Já para o diagnóstico de transtorno da compulsão alimentar periódica, o questionário apresentou sensibilidade = 0,548, especificidade = 0,8 e valor preditivo positivo de 0,793. CONCLUSÕES: O Questionário sobre Padrões de Alimentação e Peso-Revisado, em sua versão para o português, mostrou ser um instrumento útil na detecção de prováveis casos de compulsão alimentar. Pode ser utilizado como escala de rastreamento ou ainda como primeiro passo na avaliação clínica de pacientes que procuram tratamento para compulsão alimentar e/ou obesidade.

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Objetivos: Avaliar episódios de descontrole alimentar em crianças com excesso de peso e crianças de peso normal e verificar sua associação com adiposidade, psicopatologia, insatisfação com o corpo e preocupações com peso e alimentação nestes dois grupos. Métodos: Este estudo foi realizado em duas etapas. Na primeira, 112 crianças, de 6 a 10 anos de idade, com excesso de peso (IMC > percentile 85) foram avaliadas com o Questionnaire of Eating and Weight Patterns e categorizadas em dois grupos: aquelas que referiram ao menos um episódio de descontrole alimentar nos últimos 6 meses e aquelas sem perda do controle. Os dois grupos foram comparados em relação à composição corporal, avaliada através de OXA e em relação aos escores no Children's Oepression Inventory (COI), State-Trait Anxiety Inventory for Children, Children's Version of the Eating Attitudes Test (ChEAT), Child Behavior Checklist (CBCL) e também quanto à insatisfação corporal, medida pela diferença entre figuras de corpo ideal e real. Na segunda etapa, estas crianças foram incluídas em um grupo de 149 crianças com excesso de peso 120 crianças de peso normal (IMC > percentil 5 por cento ~ percentile 85)., avaliadas da mesma forma. ). Além de serem classificadas em dois grupos de acordo com seu IMC ( com excesso de peso e de peso normal), as crianças também foram categorizadas em aquelas com episódios de descontrole alimentar e aquelas que negavam este tipo de episódio. Os quarto grupos resultants foram comparados entre si através da análise de variância. Resultados: Nos dois estudos, cerca de 30 por cento das crianças com excesso de peso referiu ao menos um episódio de perda do controle sobre a alimentação nos últimos 6 meses. Estas crianças, quando comparadas àquelas com excesso de peso, mas sem descontrole alimentar, apresentaram obesidade mais acentuada, mais sintomas depressivos, mais traços de ansiedade, maiores distorções dos comportamentos relativos à alimentação e maior insatisfação com o corpo. 5 por cento das crianças com excesso de peso e descontrole alimentar preencheram critérios diagnósticos para o transtorno da compulsão alimentar periódica (TCAP). 20 por cento das crianças de peso normal também referiu episódios descontrole alimentar. O descontrole alimentar está relacionado igualmente à sintomas de ansiedade e depressão em crianças com ou sem excesso de peso, mas apenas nas crianças com excesso de peso se verifica uma relação entre descontrole alimentar, e maior adiposidade, maior insatisfação e maior freqüência de tentativas de perda de peso. Conclusões: O descontrole alimentar já está associado aos afetos negativos desde a infância, independentemente do excesso de peso. A associação do descontrole alimentar com obesidade e insatisfação com o próprio corpo sugere uma possível participação do descontrole alimentar na gênese alou manutenção da obesidade infantil.

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This study examined eating-disordered pathology in relation to psychopathology and adiposity in 162 non-treatment-seeking overweight (OW) and normal weight (NW) children, ages 6-13 years. Participants experienced objective or subjective binge eating (S/OBE; loss-of-control eating), objective overeating (OO), or no episodes (NE). OW children experienced significantly higher eating-disordered cognitions and behaviors than NW children and more behavior problems than NW children: 9.3% endorsed S/OBEs, 20.4% reported OOs, and 70.4% reported NEs. OW children reported S/OBEs more frequently than did NW children (p =.01), but similar percentages endorsed OOs. S/OBE children experienced greater eating-disordered cognitions (ps from <.05 to <.01) and had higher body fat (p <.05) than OOs or NEs. OOs are common in childhood, but S/OBEs are more prevalent in OW children and associated with increased adiposity and eating-disordered cognitions.

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BACKGROUND: Although antidepressants are the pharmacological agents most often studied in the treatment of binge-eating disorder (BED), preliminary evidence from an open trial suggests that the antiobesity agent sibutramine hydrochloride may be effective. The objective of this study was to evaluate the efficacy and tolerability of sibutramine in obese patients with BED. METHODS: After a 2-week run-in period, 60 obese outpatients (body mass index [calculated as weight in kilograms divided by the square of height in meters] 30-45), who met DSM-IV criteria for BED were randomly assigned to receive sibutramine hydrochloride (n = 30), 15 mg/d, or placebo (n = 30) in a 12-week double-blind study at 2 centers. The primary outcome measure was binge frequency, expressed as the number of days with binge-eating episodes during the past week. Secondary outcome measures included Binge Eating Scale, Beck Depression Inventory scores, weight, and treatment responder status (remission and response). For each efficacy outcome, an intent-to-treat analysis was performed using random regression methods. RESULTS: There was a significant reduction in the number of days with binge episodes in the sibutramine group compared with the placebo group (t203 = 2.14; P =.03); this was associated with an important and significant weight loss (-7.4 kg) compared with a small weight gain in the placebo group (1.4 kg) (t147 = 4.88; P<.001). Sibutramine was also associated with a significantly greater rate of reduction in Binge Eating Scale (t202 = 3.64; P<.001) and Beck Depression Inventory (t201 = 3.72; P<.001) scores. Dry mouth (P =.01) and constipation (P<.001) were more common adverse reactions with sibutramine than placebo. CONCLUSIONS: Sibutramine is effective and well tolerated in the treatment of obese patients with BED. Its effects address 3 main domains of the BED syndrome, ie, binge eating, weight, and related depressive symptoms.

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OBJECTIVE: In adults, interview methods may detect eating-disordered behaviors more accurately than self-report methods. However, no studies have investigated the relationships between interview and self-report assessments in children. We compared results from the Eating Disorder Examination adapted for Children (ChEDE) with the Adolescent version of the Questionnaire on Eating and Weight Patterns (QEWP-A) and with the Children's Eating Attitude Test (ChEAT) in a nontreatment sample of overweight and normal weight children. METHOD: The ChEDE, QEWP-A, and ChEAT were administered to 46 overweight (body mass index [BMI] at or above the 85th percentile) and 42 normal weight (BMI at the 15th-85th percentile) children, 10 +/- 1.8 years, recruited from the community. RESULTS: The ChEDE and QEWP-A were not concordant for the number or type of eating episodes that occurred in the past month. Compared with the ChEDE, the QEWP-A was reasonably specific, but it was not sensitive for the presence of objective (17 % sensitivity, 91% specificity) or subjective bulimic episodes (0 % sensitivity, 89 % specificity) during the past month. ChEDE and ChEAT global scores were significantly related (Kendall's tau = 0.286, p <.001), but specific items assessing guilt in relation to eating and preoccupation with food were not. DISCUSSION: Although self-report methods of eating disorder assessment in children may provide some general information regarding eating psychopathology in non-treatment-seeking children, they do not accurately reflect the results of a structured interview.

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Os transtornos alimentares possuem uma etiologia multifatorial, composta de predisposições genéticas, socioculturais e vulnerabilidades biológicas e psicológicas. Entre os fatores predisponentes, destacam-se a história de transtorno alimentar e (ou) transtorno do humor na família, os padröes de interaçäo presentes no ambiente familiar, o contexto sociocultural, caracterizado pela extrema valorizaçäo do corpo magro, disfunções no metabolismo das monoaminas centrais e traços de personalidade. A dieta é o comportamento precursor que geralmente antecede a instalaçäo de um transtorno alimentar. Contudo, a presença isolada da dieta näo é suficiente para desencadear o transtorno alimentar, tornando-se necessária uma interaçäo entre os fatores de risco e outros eventos precipitantes. Por último, o curso transitório ou crônico de um transtorno alimentar está relacionado à persistência de distorções cognitivas, à ocorrência de eventos vitais significativos e a alterações secundárias ao estado de desnutriçäo

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OBJECTIVE: To examine binge-eating disorder (BED) and its association with obesity, weight patterns, and psychopathology in a Brazilian sample of female participants of a weight-loss program in São Paulo, Brazil. RESEARCH METHODS AND PROCEDURES: Two hundred and seventeen overweight (body mass index >/= 25 kg/m(2)) women, ages 15 to 59 years, enrolled in the Weight Watchers Program were recruited for the study at a program branch meeting after completing the Questionnaire on Eating and Weight Patterns-Revised, Beck Depression Inventory, and the Toronto Alexithymia Scale-20. Participants were categorized into four groups: those who met questionnaire criteria for BED, those who met questionnaire criteria for bulimia nervosa (BN), those that reported binge eating but did not meet all the criteria for any eating disorder (BE), and those with no eating disorder symptoms (No ED). Groups were compared on measures of weight, depressive symptoms, and alexithymia. RESULTS: Binge eating was frequently reported by women in this study (BED, 16.1%; BN, 4.6%; BE, 22.6%). BED women had significantly higher body mass index, greater highest weight ever, and more frequent weight cycling than the No ED group. BED women also reported more depressive symptoms than BE and No ED women, and were more alexithymic than the No ED group. BE women presented more frequent weigh cycling and were also more depressed and alexithymic than the No ED group. DISCUSSION: BED is not uncommon in overweight Brazilian women, and similar to North American and European samples, it is associated with overweight and higher levels of psychopathology in this population.

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The prevalence of childhood obesity is rising, and pediatric obesity has become an important public health issue. It can be defined as BMI more than 95th percentile for age and sex, whereas overweight is defined as BMI more than 85th percentile. Using these cut points, more than one quarter of all children and adolescents are either overweight or obese. The recent increases in the prevalence of childhood obesity result from the interaction between a strong genetic predisposition that facilitates storage of fat, easy access to calorically dense foods, and the low levels of physical activity that characterize modern societies. Childhood obesity has pervasive psychosocial and medical consequences in the short term and the long term. Many of these consequences may not be apparent for decades, but the metabolic complications of obesity and the insidious effects of early psychosocial stigmatization are sometimes observed even in young children. For pediatric obesity, behavioral approaches seem moderately efficacious in younger children. Comprehensive programs generally include modification of dietary and activity habits and some degree of parental involvement. Medication for pediatric obesity cannot be recommended currently outside the context of clinical trials. Gastric bypass surgery is effective but should be considered a last resort for the child with life-threatening complications of obesity.

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OBJECTIVE: To investigate the relationship between loss of control over eating, adiposity, and psychological distress in a nontreatment sample of overweight children. METHOD: Based on self-reports of eating episodes, 112 overweight children, 6-10 years old, were categorized using the Questionnaire of Eating and Weight Patterns-Adolescent Version into those describing episodes of loss of control over eating (LC), and those with no loss of control (NoLC). Groups were compared on measures of adiposity, dieting, and eating behavior, and associated psychological distress. RESULTS: LC children (33.1%) were heavier and had greater amounts of body fat than NoLC children. They also had higher anxiety, more depressive symptoms, and more body dissatisfaction. 5.3% met questionnaire criteria for BED. Episodes of loss of control occurred infrequently, were often contextual, and involved usual meal foods. DISCUSSION: As in adults, overweight children reporting loss of control over eating have greater severity of obesity and more psychological distress than those with no such symptoms. It remains unknown whether children who endorse loss of control over eating before adolescence will be those who develop the greatest difficulties with binge eating or obesity in adulthood.

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O transtorno da compulsão alimentar periódica (binge eating disorder/BED) é uma terceira e nova categoria diagnóstica de transtorno alimentar, ainda em fase de pesquisa, incluída no Apêndice B do DSM-IV. Caracteriza-se por episódios recorrentes de compulsão alimentar (binge eating) na ausência de métodos de controle de peso extremados, característicos da bulimia nervosa. Neste artigo, são revisados os antecedentes que levaram à proposta de inclusão dessa categoria nas classificações diagnósticas oficiais e são delineados aspectos que requerem novos estudos. Enfatiza-se a importância da pesquisa na área e, para tanto, apresenta-se a versão em português do Questionário sobre Padrões de Alimentação e Peso - Revisado, único instrumento desenvolvido até o momento para o estudo e diagnóstico do transtorno da compulsão alimentar periódica. Expõe-se o método da tradução para o português em detalhes, assim como as adaptações necessárias. Por fim, indicam-se os possíveis usos do questionário

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