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BACKGROUND: Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS: The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS: The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION: The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

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Infertility constitutes an essential source of stress in the individual and couple's life. The Infertility-Related Stress Scale (IRSS) is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals' lives. In the present study, the IRSS was translated into Brazilian-Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals (54.2% female, mean aged 36 ± 6 years) completed the Brazilian-Portuguese IRSS (IRSS-BP), and a subsample of 222 participants also completed the BDI-II. A sample of 526 Italian infertile individuals (54.2% female, mean aged 38 ± 6 years) was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling (ESEM) indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings.

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Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

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Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.

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This study examines measurement invariance, reliability and scores differences of the Peer Aggressive and Reactive Behaviors Questionnaire (PARB-Q) across Italian and Brazilian children, gender and age. Participants were 587 Italian and 727 Brazilian children, aged 7-13 years from 12 elementary schools. The PARB-Q is a brief self-report instrument composed by two scales that assess aggressive behavior and reactions to peer aggression. Multigroup confirmatory factor analyses indicated full measurement invariance of the PARB-Q across groups based on country, gender and age, providing support for the unidimensionality of the first scale (direct peer aggression, PA) and a 3-factor model of the second scale (reactive aggression, RA; seeking teacher support, STS; internalizing reaction, IR). Reliability indices were good for all factors. Italian children reported a higher frequency of PA and a lower frequency of IR than the Brazilian children. Boys scored higher than girls on PA and RA, while girls scored higher than boys on STS and IR. Younger children reported a lower frequency of PA and a higher frequency of STS than older children. Results provide support for structure validity and reliability of the PARB-Q in two countries and information on differences related to gender, age and culture in peer relationships in elementary school.

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This study presents the psychometric properties of the Peer Aggressive and Reactive Behaviors Questionnaire (PARB-Q), a self-report questionnaire to measure child overt aggression (PA) and reaction to peer aggression (RPA). Participants were 587 Italian elementary school children, aged 7-10 years (51.5% female). Exploratory and confirmatory factor analyses presented a one-factor solution for the PA scale and a three-factor solution for the RPA scale (reactive aggression, seeking teacher support and internalizing reaction), presenting adequate reliability and goodness-of-fit indexes for both scales. Criterion validity presented satisfactory evidence. The PARB-Q appears to be a psychometrically sound tool to evaluate aggressive behavior and reactions to peer aggression in elementary school children...

Este estudo apresenta as propriedades psicométricas do Questionário de Comportamentos Agressivos e Reativos entre Pares (Q-CARP), instrumento de autorrelato que avalia comportamentos agressivos infantis diretos (ECA) e reações frente à agressão de pares (ERA). Participaram do estudo 587 crianças italianas, estudantes do ensino fundamental, com idade entre 7-10 anos (51,5% meninas). Análises fatoriais exploratórias e confirmatórias apresentaram uma solução unifatorial para a escala ECA e uma solução de três fatores para a ERA (reações agressivas, busca de apoio do professor e reações internalizadas), apresentando bons índices de consistência interna e de ajuste para ambas as escalas. A validade de critério apresentou índices satisfatórios. O Q-CARP apresenta-se como uma ferramenta útil para avaliar comportamentos agressivos e diferentes reações em crianças escolares...

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RESUMO

This study presents the psychometric properties of the Peer Aggressive and Reactive Behaviors Questionnaire (PARB-Q), a self-report questionnaire to measure child overt aggression (PA) and reaction to peer aggression (RPA). Participants were 587 Italian elementary school children, aged 7-10 years (51.5% female). Exploratory and confirmatory factor analyses presented a one-factor solution for the PA scale and a three-factor solution for the RPA scale (reactive aggression, seeking teacher support and internalizing reaction), presenting adequate reliability and goodness-of-fit indexes for both scales. Criterion validity presented satisfactory evidence. The PARB-Q appears to be a psychometrically sound tool to evaluate aggressive behavior and reactions to peer aggression in elementary school children.(AU)

Este estudo apresenta as propriedades psicométricas do Questionário de Comportamentos Agressivos e Reativos entre Pares (Q-CARP), instrumento de autorrelato que avalia comportamentos agressivos infantis diretos (ECA) e reações frente à agressão de pares (ERA). Participaram do estudo 587 crianças italianas, estudantes do ensino fundamental, com idade entre 7-10 anos (51,5% meninas). Análises fatoriais exploratórias e confirmatórias apresentaram uma solução unifatorial para a escala ECA e uma solução de três fatores para a ERA (reações agressivas, busca de apoio do professor e reações internalizadas), apresentando bons índices de consistência interna e de ajuste para ambas as escalas. A validade de critério apresentou índices satisfatórios. O Q-CARP apresenta-se como uma ferramenta útil para avaliar comportamentos agressivos e diferentes reações em crianças escolares.(AU)

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