The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders

BACKGROUND: Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work. METHOD: The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness. RESULTS: The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings. CONCLUSIONS: The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.(Au)

Angiotensinogen levels and obesity in four black populations. ICSHIB Investigations

BACKGROUND: The relationship between circulating levels of angiotensinogen and hypertension in the epidemiologic setting has not been studied much. Recent findings related to the association between hypertension and polymorphisms of the angiotensinogen gene have generated new interest in this potential pathway to hypertension. OBJECTIVES: To examine environmental factors associated with levels of circulating angiotensinogen as determinants of hypertension in populations of African origin. METHODS: We recruited 1557 participants from communities in Nigeria (n = 611), Zimbabwe (n = 161), Jamaica (n = 476), and Maywood, Illinois, USA (n = 309). RESULTS: Mean angiotensinogen levels varied widely across groups (Nigeria 1381 ng/ml angiotensin I generated, Zimbabwe 1638 ng/ml angiotensin and I generated Jamaica 1801 ng/ml angiotensin I generated, and Maywood 2039 ng/ml angiotensin I generated). Average body mass index was highly correlated to angiotensinogen level across the population samples, accounting for 90 percent of the between-sample variation. At the individual level the correlation between body mass index and angiotensinogen level was substantially smaller, in the range 0.04-0.15, although the association attained statistical significance for all but one of the populations. Women had higher levels of angiotensinogen and mean levels in subjects of both sexes declined in late middle age. Hypertensives also had significantly higher levels of angiotensinogen and we noted correlations to blood pressure for two of the four populations. CONCLUSIONS: Obesity, sex and age would all appear to be important modifiers of circulating angiotensinogen levels. The variation in level across populations was substantially larger than that which has been found previously in association with known genetic polymorphisms within populations, suggesting the possibility that environmental effects are more important than had previously been recognised.(AU)

Cancer of the bladder in Jamaica

The pattern of carcinoma of the bladder in Jamaica is presented. The high incidence squamous carcinoma in both sexes is discussed together with possible etiological factors. The incidence of urethral stricture in association with carcinoma is given (Summary)