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BACKGROUND: There is evidence of an association between life events and psychosis in Europe, North America and Australasia, but few studies have examined this association in the rest of the world. AIMS: To test the association between exposure to life events and psychosis in catchment areas in India, Nigeria, and Trinidad and Tobago. METHOD: We conducted a population-based, matched case-control study of 194 participants in India, Nigeria, and Trinidad and Tobago. Cases were recruited through comprehensive population-based, case-finding strategies. The Harvard Trauma Questionnaire was used to measure life events. The Screening Schedule for Psychosis was used to screen for psychotic symptoms. The association between psychosis and having experienced life events (experienced or witnessed) was estimated by conditional logistic regression. RESULTS: There was no overall evidence of an association between psychosis and having experienced or witnessed life events (adjusted odds ratio 1.19, 95% CI 0.62-2.28). We found evidence of effect modification by site (P = 0.002), with stronger evidence of an association in India (adjusted odds ratio 1.56, 95% CI 1.03-2.34), inconclusive evidence in Nigeria (adjusted odds ratio 1.17, 95% CI 0.95-1.45) and evidence of an inverse association in Trinidad and Tobago (adjusted odds ratio 0.66, 95% CI 0.44-0.97). CONCLUSIONS: This study found no overall evidence of an association between witnessing or experiencing life events and psychotic disorder across three culturally and economically diverse countries. There was preliminary evidence that the association varies between settings.
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INTRODUCTION: There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health. METHODS: INTREPID II is a programme of research incorporating incidence, case-control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological. ETHICS AND DISSEMINATION: Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.
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Servicios de Salud Mental , Trastornos Psicóticos , Proyectos de Investigación , Estudios de Casos y Controles , Estudios de Seguimiento , Conducta de Búsqueda de Ayuda , Humanos , Incidencia , India/epidemiología , Nigeria/epidemiología , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/terapia , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: There is scant information on sexually transmitted infection (STI) prevalence and risk factors among Latin American indigenous populations. We investigated STI prevalence and risk factors among adolescents of the Comarca Ngäbe-Buglé indigenous region of Panama. METHODS: A population-based cross-sectional study was conducted among school-going adolescents aged 14 to 19 years. Eligible consenting participants self-completed a questionnaire and provided blood and urine samples. Female participants provided additional self-administered genital swabs. Seroprevalences of human immunodeficiency virus (HIV), syphilis, hepatitis B (HBsAg, anti-HBc), and herpes simplex virus type 2 (HSV-2) were determined in all participants; genital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) by PCR among participants who reported sexual experience or were seropositive for HIV/syphilis/HSV2/HBsAg; high-risk human papillomavirus (HPV) by qualitative DNA assay and bacterial vaginosis (BV) by Gram-stain among female participants. Risk factors were identified by estimating adjusted odds ratios (AOR) using random-effects logistic regression. RESULTS: We enrolled 700 participants (median age, 17 years [female participants]; 18 years [male participants]) from 20 schools. Sexual experience was reported by 536 participants (76.6%). The HIV/STI prevalences among females and males were: HIV 0.4% and 1.0%, high-titer active syphilis 1.3% and 6.6%, HSV-2 16.1% and 16.1%, HBsAg 1.3% and 1.4%, anti-HBc 3.2% and 1.4%, NG 1.8% and 1.7%, CT 17.5% and 10.7%; among females: BV 42.9% and HPV 33.2%. CT was independently associated with being female (AOR, 2.02; 95% confidence interval [CI], 1.20-3.41); high-titer active syphilis with being male (AOR, 4.51; 95% CI, 1.17-17.40). Bacterial vaginosis was associated with sexual behavior (≥3 lifetime sex partners: AOR, 3.81; 95% CI, 1.29-11.26), HPV with sexual experience (AOR, 4.05; 95% CI, 1.62-10.09). CONCLUSIONS: School-going indigenous adolescents in rural Panama have substantial STI burden. Targeted STI screening is required.
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Salud del Adolescente , Pueblos Indígenas/estadística & datos numéricos , Salud de las Minorías , Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Panamá/epidemiología , Prevalencia , Factores de Riesgo , Instituciones Académicas , Conducta Sexual/etnología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/etnología , Adulto JovenRESUMEN
BACKGROUND: In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. METHODS: We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. RESULTS: Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. CONCLUSIONS: The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
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Trastornos Psicóticos/diagnóstico , Actitud del Personal de Salud , Cuidadores , Grupos Focales , Humanos , India , Nigeria , Investigación Cualitativa , Trinidad y TobagoRESUMEN
PURPOSE: Our understanding of psychotic disorders is largely based on studies conducted in North America, Europe and Australasia. Few methodologically robust and comparable studies have been carried out in other settings. INTREPID is a programme of research on psychoses in India, Nigeria, and Trinidad. As a platform for INTREPID, we sought to establish comprehensive systems for detecting representative samples of cases of psychosis by mapping and seeking to engage all professional and folk (traditional) providers and potential key informants in defined catchment areas. METHOD: We used a combination of official sources, local knowledge of principal investigators, and snowballing techniques. RESULTS: The structure of the mental health systems in each catchment area was similar, but the content (i.e., type, extent, and nature) differed. Tunapuna-Piarco (Trinidad), for example, has the most comprehensive and accessible professional services. By contrast, Ibadan (Nigeria) has the most extensive folk (traditional) sector. We identified and engaged in our detection system-(a) all professional mental health services in each site (in- and outpatient services-Chengalpet, 6; Ibadan, 3; Trinidad, 5); (b) a wide range of folk providers (Chengalpet, 3 major healing sites; Ibadan, 19 healers; Trinidad: 12 healers); and c) a number of key informants, depending on need (Chengalpet, 361; Ibadan, 54; Trinidad, 1). CONCLUSIONS: Marked differences in mental health systems in each catchment area illustrate the necessity of developing tailored systems for the detection of representative samples of cases with untreated and first-episode psychosis as a basis for robust, comparative epidemiological studies.
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Áreas de Influencia de Salud , Servicios de Salud Mental , Trastornos Psicóticos/diagnóstico , Conducta de Búsqueda de Ayuda , Humanos , India , Medicinas Tradicionales Africanas , Nigeria , Aceptación de la Atención de Salud , Trastornos Psicóticos/psicología , Trinidad y TobagoRESUMEN
To determine the presence of Kaposi sarcoma-associated herpesvirus (KSHV) and other serologic markers, we tested serum specimens of 339 Amerindians, 181 rural non-Amerindians, and 1,133 urban blood donors (13 Amerindians) in the Brazilian Amazon. High KSHV seroprevalence in children and inverse association with herpes simplex virus type 2 indicates predominant nonsexual transmission among Amerindians.
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Anticuerpos Antivirales/sangre , Enfermedades Transmisibles Emergentes/epidemiología , Infecciones por Herpesviridae/epidemiología , Herpesvirus Humano 8/inmunología , Adolescente , Adulto , Donantes de Sangre , Brasil/epidemiología , Niño , Preescolar , Enfermedades Transmisibles Emergentes/inmunología , Enfermedades Transmisibles Emergentes/transmisión , Estudios Transversales , Femenino , Infecciones por Herpesviridae/inmunología , Infecciones por Herpesviridae/transmisión , Humanos , Indígenas Sudamericanos , Lactante , Recién Nacido , Trastornos Linfoproliferativos/epidemiología , Trastornos Linfoproliferativos/inmunología , Masculino , Población Rural , Sarcoma de Kaposi/epidemiología , Sarcoma de Kaposi/inmunología , Estudios Seroepidemiológicos , Población Urbana , Adulto JovenRESUMEN
Kaposi's sarcoma-associated herpesvirus (KSHV) is endemic in the Amazon and rare in southern regions of Brazil. However, geographical distribution and epidemiological correlates of infection in this large country are still poorly defined. To estimate the seroprevalence of, and risk factors for, KSHV infection in Brazil, a multi-center study was conducted among 3,493 first-time voluntary unpaid blood donors from Salvador, Sao Paulo and Manaus. Antibodies against KSHV were detected using a whole-virus ELISA validated prior to the serosurvey. Antibodies against the latency-associated nuclear antigen (LANA) were detected by immuno-fluorescence assay (IFA) among ELISA-positive sera and a random sample of ELISA-negative sera. Overall, seroprevalence of KSHV by whole-virus ELISA was 21.7% (95% confidence interval (CI): 20-23.4%) in men and 31.7% (95% CI: 29-34.3%) in women (P<0.0001). KSHV antibodies were detected by IFA-LANA in 3% (95% CI: 2-4.3%) of 867 ELISA-positive samples and in none of 365 randomly selected ELISA-negative samples. In multivariate analysis, KSHV seroprevalence by whole-virus ELISA was independently associated with female sex (odds ratio [OR]=1.6, 95% CI: 1.4-1.9); residence in the Amazon (OR=1.4, 95% CI: 1.2-1.8; compared to Salvador); Caucasian ethnicity (OR=1.3, 95% CI: 1.1-1.6) and herpes simplex virus type 2 (HSV-2) infection (OR=1.3, 95% CI: 1.1-1.6). KSHV seroprevalence did not significantly increase with age, nor was it associated with self-reported sexual behavior. KSHV seroprevalence is high among Brazilian blood donors, particularly from the Amazon region. This study supports the co-existence of sexual and non-sexual routes of KSHV transmission in this population.
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Donantes de Sangre , Herpesvirus Humano 8/aislamiento & purificación , Sarcoma de Kaposi/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Sarcoma de Kaposi/etiología , Sarcoma de Kaposi/virologíaRESUMEN
BACKGROUND: Kaposi's sarcoma (KS) is caused by Kaposi's sarcoma associated herpesvirus (KSHV/HHV-8), the eighth Herpesvirus found to infect humans. The molecular epidemiology of KSHV is related closely to ethnicity and geographical location of studied populations. There is little epidemiological and molecular information about KSHV strains circulating in Brazil. OBJECTIVES: To characterize KSHV strains isolated from AIDS patients with Kaposi's sarcoma (AIDS-KS) in Sao Paulo, Brazil, and to examine associations between KSHV subtypes, ethnicity and HIV risk categories. METHODS: AIDS-KS patients were recruited consecutively at the largest AIDS reference hospital in Sao Paulo. Fragments (420 bp) of the VR1 and VR2 regions of KSHV open reading frame (ORF) K1 were amplified by nested PCR and sequenced directly. RESULTS: We analysed 37 samples from 33 patients, and found subtypes A-C in 48%, 21% and 30% of patients respectively, including two patients infected with subtype A5, a first report from Brazil. Sexual orientation was associated with subtype: 12/14 (86%) patients with subtype A were male homo/bisexual, compared with 3/8 (38%) among patients infected with subtype C (P = 0.05). A higher proportion of male patients with subtype C were of Caucasian origin (7/8 (87%)), compared with 7/16 (44%) among male patients with subtype A (P = 0.08). CONCLUSIONS: This first detailed report of KSHV subtypes among AIDS-KS patients in Brazil reports the first isolation of KSHV subtype A5 in this country, and suggests KSHV strain transmission between different ethnic groups, and association of specific strains with sexual orientation.
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Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Herpesvirus Humano 8/clasificación , Herpesvirus Humano 8/genética , Sarcoma de Kaposi/epidemiología , Sarcoma de Kaposi/virología , Infecciones Oportunistas Relacionadas con el SIDA/etnología , Adulto , Población Negra , Brasil/epidemiología , Femenino , Herpesvirus Humano 8/aislamiento & purificación , Humanos , Indígenas Sudamericanos , Masculino , Datos de Secuencia Molecular , Sarcoma de Kaposi/etnología , Análisis de Secuencia de ADN , Población BlancaRESUMEN
Herpes simplex virus type 2 (HSV-2) is a common infection in many countries, with prevalence in some regions, such as sub-Saharan Africa, higher than in the USA. Prevalence in adult general populations in sub-Saharan Africa ranges from 30% to 80% in women, and from 10% to 50% in men. Most data from Central and South America are from women, in whom HSV-2 prevalence ranges from about 20% to 40%. Prevalence in the general population in developing Asian countries appears to be lower (10-30%). In common with the developed world, HSV-2 seropositivity is uniformly higher in women than in men and increases with age. In general, HSV-2 seroprevalence is high in populations whose behaviour leads to a high risk of acquiring other sexually transmitted infections (STIs), such as STI clinic attendees and sex workers (SWs), with some African studies reporting greater than 80% HSV seropositivity in SWs. New infections are most common among young adults, a fact that should be considered when proposing and implementing measures to reduce HSV, and possibly HIV, transmission. Currently, comparison between studies is hampered by the lack of a validated type-specific serological assay that has a similar performance across a range of populations. HSV-2 is a major cause of genital ulcer disease (GUD) in the developing world. Genital herpes is a cause of morbidity and increases the risk of HIV acquisition, due to disruption of mucosal membranes. Where possible, the aetiology of GUD should be evaluated using polymerase chain reaction (PCR), while recognizing that co-pathogens can exist in a lesion. GUD management should incorporate HIV testing and antiherpetic treatment.