Revictimization of violence suffered by those diagnosed with alcohol dependence in the general population.

OBJECTIVE: To verify the association between violence and alcohol dependence syndrome in sample populations. METHOD: Population-wide survey with multistage probabilistic sample. 3,744 individuals of both genders, aged from 15 to 75 years, were interviewed from the cities of São Paulo and Rio de Janeiro using the Composite International Diagnostic Interview (CIDI 2.1). RESULTS: In both cities, alcohol dependence was associated with the male gender, having suffered violence related to criminality, and having suffered familial violence. In both cities, urban violence, in more than 50% of cases, and familial violence, in more than 90% of cases, preceded alcohol dependence. The reoccurrence of traumatic events occurred in more than half of individuals dependent on alcohol. In São Paulo, having been diagnosed with PTSD is associated with violence revictimization (P = 0.014; Odds = 3.33). CONCLUSION: Alcohol dependence syndrome is complexly related to urban and familial violence in the general population. Violence frequently precedes alcoholism, but this relationship is dependent on residence and traumatic events. This vicious cycle contributes to perpetuating the high rates of alcoholism and violence in the cities. Politicians ordering the reduction of violence in the large metropolises can, potentially, reduce alcoholism and contribute to the break of this cycle.

Increased health burden associated with comorbid depression in older Brazilians with diabetes.

BACKGROUND: The health burden associated with comorbid depression and diabetes in older community residents in middle income countries is unclear. METHODS: Data came from a statewide representative sample (N = 6963, age ≥ 60) in Brazil. Controlled polytomous logistic regression was used to determine whether four mutually exclusive groups (all possible combinations of the presence or absence of depression and diabetes) differed in sociodemographic characteristics, social resources, health behaviors, and selected health conditions. RESULTS: While 2.37% were expected to have comorbid depression/diabetes given sample base rates (depression: 20.92% [1457/6963]; diabetes: 11.35% [790/6959]), comorbidity was present in 3.62% (52.5% beyond expectation; P<0.0001; OR = 1.58, 95% Confidence Interval 1.29-1.95). Depression without diabetes was reported by 17.3%, and diabetes without depression by 7.7%. In controlled analyses, the depression group had poorer socioeconomic status and health behaviors, and a greater likelihood of vascular, respiratory, and musculoskeletal problems than the diabetes group. Vascular, respiratory, and urinary problems were exacerbated in comorbid depression/diabetes; the comorbid group was also more likely to be female and younger. LIMITATIONS: Cross-sectional design. CONCLUSIONS: To our knowledge, this is the first study that explicitly reports on all four possible depression/diabetes combinations in an older representative community-resident sample, using controlled analyses to identify unique associations with sociodemographic characteristics and other health conditions. The burden of comorbid depression/diabetes in Brazil, a middle income country, appears to be comparable to that found in higher income countries. So, similarly, depression without diabetes had a greater odds of adverse sociodemographic and health conditions than diabetes without depression; comorbid depression/diabetes was more likely in women and young elderly, and the odds of vascular, respiratory, and urinary conditions was increased significantly. Attention to comorbid depression/diabetes as a unique entity is needed.

Frequency of Werner helicase 1367 polymorphism and age-related morbidity in an elderly Brazilian population.

Werner syndrome (WS) is a premature aging disease caused by a mutation in the WRN gene. The gene was identified in 1996 and its product acts as a DNA helicase and exonuclease. Some specific WRN polymorphic variants were associated with increased risk for cardiovascular diseases. The identification of genetic polymorphisms as risk factors for complex diseases affecting older people can improve their prevention, diagnosis and prognosis. We investigated WRN codon 1367 polymorphism in 383 residents in a district of the city of São Paulo, who were enrolled in an Elderly Brazilian Longitudinal Study. Their mean age was 79.70 +/- 5.32 years, ranging from 67 to 97. This population was composed of 262 females (68.4%) and 121 males (31.6%) of European (89.2%), Japanese (3.3%), Middle Eastern (1.81%), and mixed and/or other origins (5.7%). There are no studies concerning this polymorphism in Brazilian population. These subjects were evaluated clinically every two years. The major health problems and morbidities affecting this cohort were cardiovascular diseases (21.7%), hypertension (83.7%), diabetes (63.3%), obesity (41.23%), dementia (8.0%), depression (20.0%), and neoplasia (10.8%). Their prevalence is similar to some urban elderly Brazilian samples. DNA was isolated from blood cells, amplified by PCR and digested with PmaCI. Allele frequencies were 0.788 for the cysteine and 0.211 for the arginine. Genotype distributions were within that expected for the Hardy-Weinberg equilibrium. Female gender was associated with hypertension and obesity. Logistic regression analysis did not detect significant association between the polymorphism and morbidity. These findings confirm those from Europeans and differ from Japanese population.

Frequency of Werner helicase 1367 polymorphism and age-related morbidity in an elderly Brazilian population

Werner syndrome (WS) is a premature aging disease caused by a mutation in the WRN gene. The gene was identified in 1996 and its product acts as a DNA helicase and exonuclease. Some specific WRN polymorphic variants were associated with increased risk for cardiovascular diseases. The identification of genetic polymorphisms as risk factors for complex diseases affecting older people can improve their prevention, diagnosis and prognosis. We investigated WRN codon 1367 polymorphism in 383 residents in a district of the city of São Paulo, who were enrolled in an Elderly Brazilian Longitudinal Study. Their mean age was 79.70 ± 5.32 years, ranging from 67 to 97. This population was composed of 262 females (68.4 percent) and 121 males (31.6 percent) of European (89.2 percent), Japanese (3.3 percent), Middle Eastern (1.81 percent), and mixed and/or other origins (5.7 percent). There are no studies concerning this polymorphism in Brazilian population. These subjects were evaluated clinically every two years. The major health problems and morbidities affecting this cohort were cardiovascular diseases (21.7 percent), hypertension (83.7 percent), diabetes (63.3 percent), obesity (41.23 percent), dementia (8.0 percent), depression (20.0 percent), and neoplasia (10.8 percent). Their prevalence is similar to some urban elderly Brazilian samples. DNA was isolated from blood cells, amplified by PCR and digested with PmaCI. Allele frequencies were 0.788 for the cysteine and 0.211 for the arginine. Genotype distributions were within that expected for the Hardy-Weinberg equilibrium. Female gender was associated with hypertension and obesity. Logistic regression analysis did not detect significant association between the polymorphism and morbidity. These findings confirm those from Europeans and differ from Japanese population.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1).

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

[Psychiatric cases identification by multi-step epidemiological studies: methods, problems and applicability]. / Identificação de casos psiquiátricos em estudos epidemiológicos multifásicos: métodos, problemas e aplicabilidade.

OBJECTIVE: To discuss methodological aspects of the two stages in the identification of psychiatric cases in epidemiological studies. METHODS: Analyze the methodology used in the Multicentric Psychiatric Morbidity Study, which was conducted in three Brazilian cities (São Paulo, Brasília and Porto Alegre). In the first stage of that study, a random sample (6,740 individuals) of the population was drawn and all the participants were screened with the Questionnaire of Psychiatric Morbidity of the Adult (QMPA). In the second stage, a sample (775 individuals) of this population was drawn and these individuals were submitted to the Inventory of Symptoms of DSM-III, carried out by psychiatrists and trained psychologists. RESULTS: The study procedure for estimating the prevalence is described in details, showing that though the screening scales are a weak tool, they don't interfere with the methodology. CONCLUSION: The advantage of this methodology is to correct any distortions caused by the current tools used in the identification of psychiatric cases.

Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses.

OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.

Brazilian multicentric study of psychiatric morbidity. Methodological features and prevalence estimates.

BACKGROUND: Psychiatric morbidity studies in developing countries have used diagnostic procedures of low reliability, without a clinical definition of caseness, producing descriptive data with limited application for mental health planning. METHOD: A two-stage cross-sectional design (with a sample size of 6476) was conducted to estimate the prevalence of DSM-III psychiatric diagnoses in three metropolitan areas of Brazil (Brasília, São Paulo and Porto Alegre). All subjects were screened for the presence of psychopathology with a 44-item instrument (the QMPA) and a subsample was selected for a psychiatric interview. RESULTS: Age-adjusted prevalence of cases potentially in need of care ranged from 19% (São Paulo) to 34% (Brasília and Porto Alegre). Anxiety disorders comprised the highest prevalences (up to 18%). Alcoholism yielded the most consistent prevalence levels, around 8% in all sites. Depression showed great variation between areas: from less than 3% (São Paulo and Brasília) to 10% (Porto Alegre). CONCLUSIONS: Overall prevalences were high in comparison with previous studies conducted in Brazil. A female excess of non-psychotic disorders (anxiety, phobias, somatisation and depression) and a male excess for alcoholism were consistently found.

Mental health of the mothers of malnourished children.

BACKGROUND: The objective of this study is to measure the association between protein-energy malnutrition (PEM) in children and their mothers' mental health, in a low income area in the city of Embú, São Paulo, Brazil. METHODS: A case-control study was performed. Cases were 60 moderately and severely malnourished children (Gomez criteria) selected from two primary health care units. Controls consisted of 45 eutrophic children attending the same units. The main outcome measure was for the mothers to present a mental health score > 6 according with the 'Adult Psychiatric Morbidity Questionnaire' (QMPA), a psychiatric screening instrument. RESULTS: Of mothers of children with PEM, 63% and 38% of mothers in the control group were QMPA positive: odds ratio (OR) = 2.8 (95% confidence interval [CI]: 1.2-6.9). Of PEM children, 27% had low birthweight (LBW = < 2500 g) and 6% of the control group had LBW. Interactions were found between: mothers' mental health and number of children (with > or = 4 children: OR = 20.0 [95% CI: 2.1-274.2], with < or = 3 children: OR = 1.6 [95% CI: 0.6-4.5), as well as mothers' mental health and maternal age (in women > 30: OR = 12.5 [95% CI: 2.0-93.4], in women < or = 30: OR = 1.5 [95% CI: 0.5-4.4]. CONCLUSIONS: Mothers of children with PEM showed a higher rate of mental disturbances than mothers of eutrophic children. Unlike LBW, maternal age and number of children interact with mothers' mental health, increasing the association. Management of poor mental health may lead to mothers being better caretakers of their children and this may have a positive impact on PEM.

[Capture and recapture method: a new methodology for epidemiological research]. / Método de captura e recaptura: nova metodologia para pesquisas epidemiológicas.

Although capture-recapture method is not new, their use in epidemiological studies has so far been limited. The method was developed by animal ecologists to estimate the size of various species populations, but in recent years it has been used to measure the incidence and prevalence of a variety of non-communicable diseases. Capture-recapture allows more accurate estimates to be made than is the case with traditional methods and is more cost-effective. The method is ideally suited to studying rare or elusive populations, such as intravenous drug misusers; but they are highly adaptable and have been used to study populations as diverse as street working prostitutes and the human red-cell volume. The objectives of this review are to explain the mathematical theory behind capture-recapture, give examples of its use and application in clinical epidemiology and out line some of the modifications that have been made to the theory, which take into account the complex nature of samples used in clinical research. An increasing number of medical epidemiologists have started to use the method, and its potential for future epidemiological research is enormous.

[The factor structure of the adult psychiatry morbidity questionnaire in a community sample of Brazilian cities]. / Estrutura fatorial do questionário de morbidade psiquiátrica de adultos aplicado em amostras populacionais de cidades brasileiras.

Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptoms and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasília, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue = 3.81, 10.9%); Irritability/Depression (eigenvalue = 2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue = 1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

The epidemiology of psychotropic use in the city of São Paulo.

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.

Profissional de saúde versus desnutriçäo / Health professional versus desnutrition

A partir do relato de uma experiência de formaçäo de um programa de integraçäo docente-assistencial (PIDA) envolvendo o Hospital Brigadeiro e a Escola Paulista de Medicina, os autores discutem as vicissitudes e as dificuldades do trabalho intedisciplinar, as especificidades da implantaçäo de um PIDA e, finalmente, enfatizam os aspectos psicodinâmicos da relaçäo do profissional de saúde e a questäo da desnutriçäo