RESUMEN
OBJECTIVES: This research evaluated the association between exposure to common mental disorder (CMD) and the presence of periodontitis. BACKGROUND: Common mental disorder is characterized by the presence of irritation, fatigue, insomnia, forgetfulness, decreased ability to concentrate, anxiety, and depression. It has been associated with several diseases; however, there are few studies that have associated it with periodontitis. METHODS: This cross-sectional study was carried out with 621 individuals. Data collection involved the application of a general questionnaire and the self-reporting questionnaire for diagnosis of CMD. The diagnosis of periodontitis involved a full mouth periodontal examination using: clinical attachment level, probing depth, and bleeding on probing. Prevalence ratios and 95% confidence intervals between CMD (exposure) and periodontitis (outcome) were obtained. RESULTS: In the final sample, 38.16% (237) of the individuals were classified with CMD. Among these, 28.27% (67) had periodontitis. Association measurements showed that the occurrence of periodontitis among those exposed to CMD is approximately 50% higher than in those without this mental condition, with statistical significance, after adjustment for age, sex, family income, current smoking habit, alcohol beverage consumption, and cardiovascular disease (PRadjusted = 1.54, 95% CI: [1.13 to 2.10]). CONCLUSIONS: The findings showed a positive association between exposure to CMD and periodontitis, revealing the importance of broadening public actions targeting mental health, which seems to be related to oral health, mainly due to the high frequency of the diseases in the studied sample.
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Trastornos Mentales/complicaciones , Periodontitis/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
Objective: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. Methods: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. Results: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). Conclusions: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Servicios de Salud del Niño/estadística & datos numéricos , Servicios de Salud del Adolescente/estadística & datos numéricos , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Factores Socioeconómicos , Brasil , Grupos Diagnósticos Relacionados , Distribución por Edad , Trastornos Mentales/clasificaciónRESUMEN
BACKGROUND: Genetic variants underlying African ancestry have been suggested be implicated in the ethnic-racial inequalities reported for asthma and allergies. OBJECTIVES: To investigate the association between individual African ancestry and asthma symptoms, atopic and non-atopic asthma, and atopy in children. METHODS: A cross-sectional study encompassing 1190 individuals was conducted. African biogeographic ancestry was estimated using 370 539 genome-wide SNPs. Serum levels of specific IgE were measured, and skin prick test (SPT) performed for the most common local aeroallergens. Information on asthma symptoms was obtained by applying the International Study of Allergy and Asthma in Childhood questionnaire. The associations between the proportion of individual African ancestry and the outcomes investigated were analyzed through multivariate models adjusted for socio-environmental variables, infections markers, and psychosocial factors. RESULTS: Each 20% increase in the proportion of African ancestry was negatively associated with SPT reactivity (OR: 0.79, 95%CI: 0.66-0.96) and positively associated with asthma symptoms in non-atopic individuals (OR: 1.40, 95%CI: 1.03-1.89). We estimated that socioeconomic status and number of infections mediated 28.4% of the effect of African ancestry on SPT reactivity, while 20.2% of the effect on non-atopic asthma was explained by socioeconomic status and behavioral problems in children. CONCLUSIONS: The negative association observed between African ancestry and atopy is most probably explained by unobserved environmental or social factors that covariate with ancestry. For non-atopic asthma, in turn, putative genetic variants of risk underlying African ancestry may play some role.
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Asma/genética , Población Negra/genética , Hipersensibilidad Inmediata/genética , Alérgenos/inmunología , Asma/sangre , Asma/inmunología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Hipersensibilidad Inmediata/sangre , Hipersensibilidad Inmediata/inmunología , Inmunoglobulina E/sangre , Lactante , Recién Nacido , América Latina , Masculino , Polimorfismo de Nucleótido Simple , Pruebas CutáneasRESUMEN
OBJECTIVE: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. METHODS: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. RESULTS: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). CONCLUSIONS: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.
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Servicios de Salud del Adolescente/estadística & datos numéricos , Servicios de Salud del Niño/estadística & datos numéricos , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Adolescente , Distribución por Edad , Brasil , Niño , Preescolar , Grupos Diagnósticos Relacionados , Femenino , Humanos , Lactante , Masculino , Trastornos Mentales/clasificación , Factores Socioeconómicos , Adulto JovenRESUMEN
Objective: To analyze the prevalence of common mental disorders (CMD) assessed with the Self Reporting Questionnaire (SRQ-20), using the established cutoff point, and comparing it with the results of a joint correspondence factor analysis (CFA) and cluster analysis and of a latent class analysis (LCA). Methods: A cross-sectional study was carried out in an urban sample of 1,095 women aged 19 to 55 years. Joint CFA-cluster analysis and LCA were used. Results: We found a high prevalence of CMD, regardless of classification method (37.6% when using the cutoff point; 44.4% and 52% for LCA and joint CFA-cluster, respectively). The alternative analysis strategies describe the cases more efficiently when compared to the traditional cutoff method, especially regarding more severe symptoms. Both alternative strategies also provide a description of the SRQ-20 dimensions in their particularities, which may be useful for the planning and implementation of specific actions in a given population. Conclusion: The SRQ-20 cutoff point seems to underestimate the magnitude of CMD among women. The alternative methods of analysis presented herein highlight the different possibilities of using this important instrument of screening for mental health.
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Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Trastornos Mentales/diagnóstico , Escalas de Valoración Psiquiátrica , Factores Socioeconómicos , Población Urbana , Brasil/epidemiología , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios , Análisis Factorial , Autoinforme , Trastornos Mentales/epidemiologíaRESUMEN
Objective: To analyze the prevalence of common mental disorders (CMD) assessed with the Self Reporting Questionnaire (SRQ-20), using the established cutoff point, and comparing it with the results of a joint correspondence factor analysis (CFA) and cluster analysis and of a latent class analysis (LCA). Methods: A cross-sectional study was carried out in an urban sample of 1,095 women aged 19 to 55 years. Joint CFA-cluster analysis and LCA were used. Results: We found a high prevalence of CMD, regardless of classification method (37.6% when using the cutoff point; 44.4% and 52% for LCA and joint CFA-cluster, respectively). The alternative analysis strategies describe the cases more efficiently when compared to the traditional cutoff method, especially regarding more severe symptoms. Both alternative strategies also provide a description of the SRQ-20 dimensions in their particularities, which may be useful for the planning and implementation of specific actions in a given population. Conclusion: The SRQ-20 cutoff point seems to underestimate the magnitude of CMD among women. The alternative methods of analysis presented herein highlight the different possibilities of using this important instrument of screening for mental health.
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Trastornos Mentales/diagnóstico , Adulto , Anciano , Brasil/epidemiología , Estudios Transversales , Análisis Factorial , Femenino , Humanos , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Prevalencia , Escalas de Valoración Psiquiátrica , Autoinforme , Factores Socioeconómicos , Encuestas y Cuestionarios , Población UrbanaRESUMEN
Objective: To identify the prevalence of internalizing and externalizing behavior problems among preschoolers from the city of Salvador, state of Bahia, Brazil, and their associations with maternal mental health and family characteristics. Methods: This was a cross-sectional study of 349 children aged 49 to 72 months, randomly selected from 20,000 households representing the range of socioeconomic and environmental conditions in Salvador. In 1999, we assessed sociodemographic variables and family environment characteristics. In 2001, we used the Child Behavior Checklist to measure and describe the frequencies of behavior problems. We conducted bivariate and multivariate analysis to estimate associations between family and maternal factors and prevalence of behavior problems. Results: The overall prevalence of behavior problems was 23.5%. The prevalence of internalizing problems was 9.7%, and that of externalizing problems, 25.2%. Behavior problems were associated with several maternal mental health variables, namely: presence of at least one psychiatric diagnosis (odds radio [OR] 3.01, 95%CI 1.75-5.18), anxiety disorder (OR 2.06, 95%CI 1.20-3.46), affective disorder (OR 2.10, 95%CI 1.21-3.65), and mental health disorders due to use of psychoactive substances (OR 2.31, 95%CI 1.18-4.55). Conclusion: The observed prevalence of child behavior problems fell within the range reported in previous studies. Maternal mental health is an important risk factor for behavior problems in preschool-aged children.
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Humanos , Masculino , Femenino , Preescolar , Niño , Trastornos de la Conducta Infantil/epidemiología , Salud Mental/estadística & datos numéricos , Trastornos Mentales/epidemiología , Madres/psicología , Medio Social , Brasil , Trastornos de la Conducta Infantil/psicología , Composición Familiar , Prevalencia , Estudios Transversales , Factores de Riesgo , Trastornos Mentales/psicología , Relaciones Madre-Hijo , Madres/estadística & datos numéricosRESUMEN
BACKGROUND: Asthma prevalence in Latin America is high and continues to increase. There is evidence that the psychologic characteristics of the child are associated with greater asthma morbidity. This study aimed to investigate the independent effect of internalizing/externalizing problems on two asthma/wheeze outcomes: (i) remission and (ii) progression to severity on Latin American children with mild asthma symptoms at baseline. METHODS: This was a prospective study in a cohort of 371 asthmatic children living in a poor urban area in Salvador, Brazil. The psychologic characteristics of the child were assessed using the Child Behavior Checklist (CBCL), and wheezing was defined using the ISAAC questionnaire at the start and end of follow-up. A multiple logistic regression model with random effects was used to examine the association between the psychologic components and both outcomes. RESULTS: Remission of symptoms of wheeze was observed among 229 (61.73%) children. Remission was 56% lower among children with internalizing problems (OR = 0.54, 95% CI 0.33-0.87, p = 0.01). In addition, we found that 19 (8.76%) of the children acquired severe symptoms during follow-up and there was strong evidence of the effect of internalizing problems in increasing the risk of progression to severe wheeze symptoms (OR = 4.03, 95% CI 1.39-11.70, p = 0.01). CONCLUSIONS: Children with internalizing problems but not externalizing had less remission of wheezing, and a higher risk of acquiring severe symptoms. These results highlight the importance of psychologic care for children with asthma, to improve the prognosis of this condition.
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Adaptación Psicológica , Asma/psicología , Conducta Infantil , Costo de Enfermedad , Pulmón/fisiopatología , Ruidos Respiratorios , Factores de Edad , Asma/diagnóstico , Asma/fisiopatología , Brasil , Lista de Verificación , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Oportunidad Relativa , Estudios Prospectivos , Inducción de Remisión , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To identify the prevalence of internalizing and externalizing behavior problems among preschoolers from the city of Salvador, state of Bahia, Brazil, and their associations with maternal mental health and family characteristics. METHODS: This was a cross-sectional study of 349 children aged 49 to 72 months, randomly selected from 20,000 households representing the range of socioeconomic and environmental conditions in Salvador. In 1999, we assessed sociodemographic variables and family environment characteristics. In 2001, we used the Child Behavior Checklist to measure and describe the frequencies of behavior problems. We conducted bivariate and multivariate analysis to estimate associations between family and maternal factors and prevalence of behavior problems. RESULTS: The overall prevalence of behavior problems was 23.5%. The prevalence of internalizing problems was 9.7%, and that of externalizing problems, 25.2%. Behavior problems were associated with several maternal mental health variables, namely: presence of at least one psychiatric diagnosis (odds radio [OR] 3.01, 95%CI 1.75-5.18), anxiety disorder (OR 2.06, 95%CI 1.20-3.46), affective disorder (OR 2.10, 95%CI 1.21-3.65), and mental health disorders due to use of psychoactive substances (OR 2.31, 95%CI 1.18-4.55). CONCLUSION: The observed prevalence of child behavior problems fell within the range reported in previous studies. Maternal mental health is an important risk factor for behavior problems in preschool-aged children.
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Trastornos de la Conducta Infantil/epidemiología , Trastornos Mentales/epidemiología , Salud Mental/estadística & datos numéricos , Madres/psicología , Brasil/epidemiología , Niño , Trastornos de la Conducta Infantil/psicología , Preescolar , Estudios Transversales , Composición Familiar , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Relaciones Madre-Hijo , Madres/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Medio SocialRESUMEN
BACKGROUND: Rural residence is protective against atopy and wheeze-rhinitis-eczema symptoms in developed countries, an effect attributed to farming and poor hygiene exposures. There are few data from developing countries addressing this question. We compared atopy and wheeze-rhinitis-eczema symptoms between urban and rural Ecuador, and explored the effects of farming and poor hygiene exposures. METHODS: We performed cross sectional studies of schoolchildren living in rural and urban Ecuador. Data on symptoms and farming/hygiene exposures were collected by parental questionnaire, atopy by allergen skin prick test reactivity and geohelminth infections by stool examinations. RESULTS: Among 2526 urban and 4295 rural schoolchildren, prevalence was: atopy (10.0% vs 12.5%, p=0.06), wheeze (9.4% vs 10.1%, p=0.05), rhinitis (8.1% vs 6.4%, p=0.02) and eczema (5.9% vs 4.7%, p=0.06). A small proportion of symptoms were attributable to atopy (range 3.9-10.7%) with greater attributable fractions for respiratory symptoms observed in urban schoolchildren. Respiratory symptoms were associated with poor hygiene/farming exposures: wheeze with lack of access to potable water; and rhinitis with household pets, no bathroom facilities and contact with large farm animals. Birth order was inversely associated with respiratory symptoms. Area of residence and atopy had few effects on these associations. CONCLUSIONS: Urban schoolchildren living in Ecuador have a similar prevalence of atopy, eczema and wheeze but a higher prevalence of rhinitis compared with rural children. Some farming and poor hygiene exposures were associated with an increase in the prevalence of wheeze or rhinitis while birth order was inversely associated with these symptoms.
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Eccema/epidemiología , Higiene , Hipersensibilidad Inmediata/epidemiología , Ruidos Respiratorios , Rinitis/epidemiología , Población Rural/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Alérgenos/inmunología , Animales , Niño , Preescolar , Estudios Transversales , Ecuador/epidemiología , Eccema/diagnóstico , Eccema/inmunología , Heces/parasitología , Femenino , Vivienda , Humanos , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/inmunología , Masculino , Prevalencia , Ruidos Respiratorios/inmunología , Rinitis/diagnóstico , Rinitis/inmunología , Factores de Riesgo , Instituciones Académicas , Pruebas Cutáneas/métodos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Asthma is the most common chronic disease in childhood and has been designated a public health problem due to the increase in its prevalence in recent decades, the amount of health service expenditure it absorbs and an absence of consensus about its etiology. The relationships among psychosocial factors and the occurrence, symptomatology, and severity of asthma have recently been considered. There is still controversy about the association between asthma and a child's mental health, since the pathways through which this relationship is established are complex and not well researched. This study aims to investigate whether behavior problems are associated with the prevalence of asthma symptoms in a large urban center in Latin America. METHODS: It is a cross-section study of 869 children between 6 and 12 years old, residents of Salvador, Brazil. The International Study of Allergy and Asthma in Childhood (ISAAC) instrument was used to evaluate prevalence of asthma symptoms. The Child Behavior Checklist (CBCL) was employed to evaluate behavioral problems. RESULTS: 19.26% (n=212) of the children presented symptoms of asthma. 35% were classified as having clinical behavioral problems. Poisson's robust regression model demonstrated a statistically significant association between the presence of behavioral problems and asthma symptoms occurrence (PR: 1.43; 95% CI: 1.10-1.85). CONCLUSION: These results suggest an association between behavioral problems and pediatric asthma, and support the inclusion of mental health care in the provision of services for asthma morbidity.
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Asma/psicología , Trastornos de la Conducta Infantil/psicología , Salud Mental , Brasil/epidemiología , Niño , Trastornos de la Conducta Infantil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , PrevalenciaRESUMEN
BACKGROUND: The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children. METHODS: 1445 children were recruited from a population-based cohort in Salvador, Brazil. Wheezing was assessed using the ISAAC questionnaire and atopy defined as allergen-specific IgE ≥ 0.70 kU/L. Relevant social factors, environmental exposures and serological markers for childhood infections were investigated as risk factors using multivariate multinomial logistic regression. RESULTS: Common risk factors for wheezing in atopic and non-atopic children, respectively, were parental asthma and respiratory infection in early childhood. No other factor was associated with wheezing in atopic children. Factors associated with wheezing in non-atopics were low maternal educational level (OR 1.49, 95% CI 0.98-2.38), low frequency of room cleaning (OR 2.49, 95% CI 1.27-4.90), presence of rodents in the house (OR 1.48, 95% CI 1.06-2.09), and day care attendance (OR 1.52, 95% CI 1.01-2.29). CONCLUSIONS: Non-atopic wheezing was associated with risk factors indicative of poverty, dirt and infections. Further research is required to more precisely define the mediating exposures and the mechanisms by which they may cause non-atopic wheeze.
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Asma/epidemiología , Higiene , Hipersensibilidad Inmediata/epidemiología , Ruidos Respiratorios , Infecciones del Sistema Respiratorio/epidemiología , Población Urbana/estadística & datos numéricos , Brasil/epidemiología , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Masculino , Áreas de Pobreza , Prevalencia , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition. METHODS: This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework. RESULTS: Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance. CONCLUSION: Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.
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Cognición/fisiología , Inteligencia , Análisis de Varianza , Peso al Nacer , Brasil , Protección a la Infancia , Preescolar , Estudios de Cohortes , Diarrea/epidemiología , Evaluación Educacional , Femenino , Humanos , Renta/clasificación , Pruebas de Inteligencia , Masculino , Estado Nutricional , Características de la Residencia , Escuelas de Párvulos/estadística & datos numéricos , Medio Social , Factores SocioeconómicosRESUMEN
BACKGROUND: A city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age. METHODS: The investigation was composed of two longitudinal studies done in 1997-98 before the intervention (the sanitation programme) and in 2003-04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0-36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models. FINDINGS: Diarrhoea prevalence fell by 21% (95% CI 18-25%)-from 9.2 (9.0-9.5) days per child-year before the intervention to 7.3 (7.0-7.5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19-26%). INTERPRETATION: Our results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.
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Diarrea Infantil/epidemiología , Saneamiento/tendencias , Brasil/epidemiología , Preescolar , Diarrea Infantil/prevención & control , Vivienda , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Prevalencia , Análisis de Regresión , Saneamiento/economía , Vigilancia de GuardiaRESUMEN
Foi desenvolvida uma escala para medir aderência ao conceito Bleuleriano Schneideriano de esquizofrenia entre psiquiatras trabalhando em Säo Paulo, analisando relaçöes entre variáveis sociodemográficas e de formaçäo sobre o escore obtido. Questionário contendo escala visual analógica com dezessete enunciados sobre conceitos Schneideriano e Bleuleriano de esquizofrenia, foi distribuído para 150 psiquiatras. As sub-escalas Bleuleriana e Schneideriana foram avaliadas por métodos psicométricos de consistência interna, estrutura das subescalas e confiabilidade test-reteste. Completaram o questionário 117 psiquiatras. A sub-escala Schneideriana demonstrou melhor consistência interna e melhores coeficientes de correlaçäo intraclasse. Näo houve associaçäo negativa entre os escores das sub-escalas. Discordância com o conceito Bleuleriano predominou entre profissionais treinados na USP. A baixa confiabilidade da sub-escla Bleuleriana limita a confiabilidade do instrumento como um todo, embora contribua para a discussäo dos modelos em questäo. Argumenta-se que o modelo Bleuleriano, por exigir maior inferência, torna-se propenso a baixa confiabilidade