RESUMO
BACKGROUND: In countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement. We tested the predictive validity of physical and multidimensional frailty phenotypes in settings in Latin America, India, and China. METHODS: Population-based cohort studies were conducted in catchment area sites in Cuba, Dominican Republic, Venezuela, Mexico, Peru, India, and China. Seven frailty indicators, namely gait speed, self-reported exhaustion, weight loss, low energy expenditure, undernutrition, cognitive, and sensory impairment were assessed to estimate frailty phenotypes. Mortality and onset of dependence were ascertained after a median of 3.9 years. RESULTS: Overall, 13,924 older people were assessed at baseline, with 47,438 person-years follow-up for mortality and 30,689 for dependence. Both frailty phenotypes predicted the onset of dependence and mortality, even adjusting for chronic diseases and disability, with little heterogeneity of effect among sites. However, population attributable fractions (PAF) summarising etiologic force were highest for the aggregate effect of the individual indicators, as opposed to either the number of indicators or the dichotomised frailty phenotypes. The aggregate of all seven indicators provided the best overall prediction (weighted mean PAF 41.8 % for dependence and 38.3 % for mortality). While weight loss, underactivity, slow walking speed, and cognitive impairment predicted both outcomes, whereas undernutrition predicted only mortality and sensory impairment only dependence. Exhaustion predicted neither outcome. CONCLUSIONS: Simply assessed frailty indicators identify older people at risk of dependence and mortality, beyond information provided by chronic disease diagnoses and disability. Frailty is likely to be multidimensional. A better understanding of the construct and pathways to adverse outcomes could inform multidimensional assessment and intervention to prevent or manage dependence in frail older people, with potential to add life to years, and years to life.
Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Idoso , China/epidemiologia , Doença Crônica/epidemiologia , Estudos de Coortes , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , América Latina , Masculino , México/epidemiologia , Fatores SocioeconômicosRESUMO
OBJECTIVE: The study aims to investigate whether longitudinal data on the structure of the mini mental state examination (MMSE) collected in an older Brazilian cohort support factorial invariance over time. DESIGN: Analysis of 10-year data from a community-based cohort study was performed. SETTING: The study took place in Bambuí, Brazil. PARTICIPANTS: The study sample comprised 1558 (89.4%) of all eligible 1742 elderly residents. MEASUREMENTS: A standard Brazilian version of the MMSE was used. RESULTS: A five-factor solution (developed on the baseline of the cohort) either with no constraints or with loadings constrained to equality across time provided a reasonable fit for the MMSE. A comparison between both models suggested that the model with no constraints was superior. However, the five absolute goodness-of-fit indices suggest that the fully constrained model was also adequate and did not differ substantively from the model without any restriction. CONCLUSION: The structure of the MMSE remained relatively unchanged across the 10 measurement times, thus providing evidence for the good construct validity of the scale across time.
Assuntos
Envelhecimento , Escalas de Graduação Psiquiátrica Breve/normas , Transtornos Cognitivos/diagnóstico , Escolaridade , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Psicometria , Fatores de TempoRESUMO
BACKGROUND: Studies aimed at understanding the association between induced abortion and HIV are scarce and differ on the direction of the association. This paper aims to show the prevalence of induced abortion in a sample of pregnancies of women living and not living with HIV/Aids, determining variables associated with pregnancy termination and linked to the life course of women and to the specific context of the pregnancy. METHODS: Data came from a cross-sectional study, using interviewer-administered questionnaire, developed with women that attended public health services in Porto Alegre, Brazil. A generalized estimating equation model with logit link measured the association between determinants and abortion. FINDINGS: The final sample was composed of 684 women living with HIV/Aids (2,039 pregnancies) and 639 women not living with HIV/Aids (1,539 pregnancies). The prevalence of induced abortion among pregnancies in women living with HIV/Aids was 6.5%, while in women not living with HIV/Aids was 2.9%. Among women living with HIV/Aids, the following were associated with induced abortion in the multivariable analysis: being older, having a higher education level, having had more sexual partners (i.e., variables linked to the life course of women), having had children prior to the index pregnancy and living with a sexual partner during pregnancy (i.e., variables linked to the context of each pregnancy). On the other hand, among women not living with HIV/Aids, only having a higher education level and having had more sexual partners (i.e., determinants linked to the life course of women) were associated with voluntary pregnancy termination in multivariable analysis. CONCLUSION: Although determinants are similar between women living and not living with HIV/Aids, prevalence of induced abortion is higher among pregnancies in women living with HIV/Aids, pointing to their greater social vulnerability and to the need for public policy to address prevention and treatment of HIV associated with reproductive issues.
Assuntos
Aborto Induzido/estatística & dados numéricos , Infecções por HIV/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Gravidez , Adulto JovemRESUMO
BACKGROUND: Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC). AIMS: To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil. METHODS: Cross-sectional survey carried out in 2007-2008 with a probabilistic representative sample of 15- to 75-year-old residents in Sao Paulo and Rio de Janeiro, Brazil, using the Composite International Diagnostic Interview. RESULTS: The sample comprised 3744 interviews. Nearly 90% of participants faced lifetime traumatic events. Lifetime prevalence of any disorders was 44% in Sao Paulo and 42.1% in Rio de Janeiro. One-year estimates were 32.5% and 31.2%. One-year prevalence of traumatic events was higher in Rio de Janeiro than Sao Paulo (35.1 vs. 21.7; p<0.001). Participants from Rio de Janeiro were less likely to have alcohol dependence (ORâ=â0.55; pâ=â0.027), depression (ORâ=â0.6; pâ=â0.006) generalized anxiety (ORâ=â0.59; pâ=â0.021) and post-traumatic stress disorder (ORâ=â0.62; pâ=â0.027). Traumatic events correlated with all diagnoses--e.g. assaultive violence with alcohol dependence (ORâ=â5.7; p<0.001) and with depression (ORâ=â1.7; pâ=â0.001). CONCLUSION: Our findings show that psychiatric disorders and traumatic events, especially violence, are extremely common in Sao Paulo and Rio de Janeiro, supporting the idea that neuropsychiatric disorders and external causes have become a major public health priority, as they are amongst the leading causes of burden of disease in low and middle-income countries. The comparison between the two cities regarding patterns of violence and psychiatric morbidity suggests that environmental factors may buffer the negative impacts of traumatic events. Identifying such factors might guide the implementation of interventions to improve mental health and quality of life in LMIC urban centers.
Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , População Urbana/estatística & dados numéricos , Violência/psicologia , Brasil/epidemiologia , Estudos Transversais , Humanos , Modelos Logísticos , Razão de Chances , PrevalênciaRESUMO
BACKGROUND: Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. METHODS: We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3-5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. FINDINGS: 12,887 participants were interviewed at baseline. 11,718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34,718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4-2·7 times higher than were those for DSM-IV dementia (9·9-15·7 per 1000 person-years). Mortality hazards were 1·56-5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4-19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56-1·79), female sex (0·72; 0·61-0·84), and low education (0·89; 0·81-0·97), but not with occupational attainment (1·04; 0·95-1·13). INTERPRETATION: Our results provide supportive evidence for the cognitive reserve hypothesis, showing that in middle-income countries as in high-income countries, education, literacy, verbal fluency, and motor sequencing confer substantial protection against the onset of dementia. FUNDING: Wellcome Trust Health Consequences of Population Change Programme, WHO, US Alzheimer's Association, FONACIT/ CDCH/ UCV.
Assuntos
Transtornos Cognitivos/mortalidade , Demência/mortalidade , Idoso , Idoso de 80 Anos ou mais , América Central/epidemiologia , China/epidemiologia , Estudos de Coortes , Cuba/epidemiologia , Demência/psicologia , Feminino , Humanos , Incidência , Masculino , Saúde da População Rural , Fatores Socioeconômicos , América do Sul/epidemiologia , Saúde da População UrbanaRESUMO
BACKGROUND: Rapid demographic ageing is a growing public health issue in many low- and middle-income countries (LAMICs). Mild cognitive impairment (MCI) is a construct frequently used to define groups of people who may be at risk of developing dementia, crucial for targeting preventative interventions. However, little is known about the prevalence or impact of MCI in LAMIC settings. METHODS AND FINDINGS: Data were analysed from cross-sectional surveys established by the 10/66 Dementia Research Group and carried out in Cuba, Dominican Republic, Peru, Mexico, Venezuela, Puerto Rico, China, and India on 15,376 individuals aged 65+ without dementia. Standardised assessments of mental and physical health, and cognitive function were carried out including informant interviews. An algorithm was developed to define Mayo Clinic amnestic MCI (aMCI). Disability (12-item World Health Organization disability assessment schedule [WHODAS]) and informant-reported neuropsychiatric symptoms (neuropsychiatric inventory [NPI-Q]) were measured. After adjustment, aMCI was associated with disability, anxiety, apathy, and irritability (but not depression); between-country heterogeneity in these associations was only significant for disability. The crude prevalence of aMCI ranged from 0.8% in China to 4.3% in India. Country differences changed little (range 0.6%-4.6%) after standardization for age, gender, and education level. In pooled estimates, aMCI was modestly associated with male gender and fewer assets but was not associated with age or education. There was no significant between-country variation in these demographic associations. CONCLUSIONS: An algorithm-derived diagnosis of aMCI showed few sociodemographic associations but was consistently associated with higher disability and neuropsychiatric symptoms in addition to showing substantial variation in prevalence across LAMIC populations. Longitudinal data are needed to confirm findings-in particular, to investigate the predictive validity of aMCI in these settings and risk/protective factors for progression to dementia; however, the large number affected has important implications in these rapidly ageing settings.
Assuntos
Atividades Cotidianas , Transtornos Cognitivos/epidemiologia , Demência/etiologia , Pessoas com Deficiência , Transtornos Mentais/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Algoritmos , Ansiedade/complicações , China/epidemiologia , Transtornos Cognitivos/complicações , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Índia/epidemiologia , América Latina/epidemiologia , Masculino , Testes Neuropsicológicos , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Classe SocialRESUMO
Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91%) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.
Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/epidemiologia , Fatores Etários , Idoso , Brasil/epidemiologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Estudos de Coortes , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
This study investigates the association of sleep duration with risk of all-cause mortality among elderly Brazilians using data from a 9-year population-based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox's proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9h or more per night were found to be at higher risk of mortality than those who slept 7h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12-2.09]. Excluding those whose deaths occurred within 2years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12-2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02-1.15) and following exclusion of those whose deaths occurred within 2years after entry (HR: 1.13; 95% CI: 1.06-1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all-cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.
Assuntos
Causas de Morte , Distúrbios do Sono por Sonolência Excessiva/psicologia , Privação do Sono/mortalidade , Fatores Etários , Idoso , Brasil , Estudos de Coortes , Feminino , Seguimentos , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Apneia Obstrutiva do Sono/mortalidade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. There is a limited literature linking short legs and small skulls to an increased risk for cognitive impairment and dementia in late life. METHODS: One phase cross-sectional surveys were carried out of all residents aged over 65 years in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru (n = 14,960). The cross-culturally validated 10/66 dementia diagnosis, and a sociodemographic and risk factor questionnaire were administered to all participants, and anthropometric measures taken. Poisson regression was used to calculate prevalence ratios for the effect of leg length and skull circumference upon 10/66 dementia, controlling for age, gender, education and family history of dementia. RESULTS: The pooled meta-analyzed fixed effect for leg length (highest vs. lowest quarter) was 0.82 (95% CI, 0.68-0.98) and for skull circumference 0.75 (95% CI, 0.63-0.89). While point estimates varied between sites, the proportion of the variability attributable to heterogeneity between studies as opposed to sampling error (I2) was 0% for leg length and 22% for skull circumference. The effects were independent and not mediated by family history of dementia. The effect of skull circumference was not modified by educational level or gender, and the effect of leg length was not modified by gender. CONCLUSIONS: Since leg length and skull circumference are said to remain stable throughout adulthood into old age, reverse causality is an unlikely explanation for the findings. Early life nutritional programming, as well as neurodevelopment may protect against neurodegeneration.
Assuntos
Demência/patologia , Perna (Membro)/anatomia & histologia , Crânio/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Antropometria , China/epidemiologia , Estudos Transversais , Cuba/epidemiologia , Demência/diagnóstico , Demência/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , República Dominicana/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Estado Nutricional , Peru/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Venezuela/epidemiologiaRESUMO
Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91 percent) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.
Poucos estudos de base populacional examinaram a trajetória no longo prazo do declínio cognitivo. Os estudos existentes foram conduzidos em países de alta renda. Nós investigamos as associações entre idade, sexo e escolaridade e o declínio cognitivo em uma população idosa bem definida, utilizando dados de 10 anos de seguimento da coorte de Bambuí, Minas Gerais, Brasil. A cognição foi aferida anualmente por meio do Mini-Exame do Estado Mental (MEEM). Essa análise foi baseada em 12.206 medidas do MEEM de 1.461 (90 por cento) participantes da linha de base. Foram utilizados modelos de efeitos mistos, considerando-se o escore do MEEM como variável de desfecho. As mulheres e os indivíduos com maior escolaridade apresentaram resultados mais altos no MEEM na linha de base, enquanto que os idosos mais velhos apresentaram pontuações mais baixas. Com relação ao declínio cognitivo, participantes do sexo feminino, com maior escolaridade e mais velhos, apresentam reduções mais rápidas dos escores do MEEM.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envelhecimento/fisiologia , Transtornos Cognitivos , Fatores Etários , Brasil , Estudos de Coortes , Transtornos Cognitivos , Transtornos Cognitivos , Escolaridade , Fatores SexuaisRESUMO
OBJECTIVES: To determine if living in areas where higher proportions of people of the same ethnicity reside is protective for common mental disorders, and associated with a reduced exposure to discrimination and improved social support. Finally, to determine if any protective ethnic density effects are mediated by reduced exposure to racism and improved social support. DESIGN: Multi-level logistic regression analysis of national survey data, with area-level, own-group ethnic density modelled as the main exposure. Participants and setting 4281 participants of Irish, black Caribbean, Indian, Pakistani, Bangladeshi, and white British ethnicity, aged 16-74 years, randomly sampled from 892 "middle layer super output areas" in England. MAIN OUTCOME MEASURES: Common mental disorders (assessed via structured interviews); discrimination (assessed via structured questionnaire); and social support and social networks (assessed via structured questionnaire). RESULTS: Although the most ethnically dense areas were also the poorest, for each 10 percentage point increase in own-group ethnic density, there was evidence of a decreased risk of common mental disorders, for the full ethnic minority sample (odds ratio 0.94 (95% confidence interval 0.89 to 0.99); P=0.02, trend), for the Irish group (odds ratio 0.21 (0.06 to 0.74); P=0.01, trend), and for the Bangladeshi group (odds ratio 0.75 (0.62 to 0.91); P=0.005, trend), after adjusting for a priori confounders. For some groups, living in areas of higher own-group density was associated with a reduction in the reporting of discrimination and with improved social support and improved social networks. However, none of these factors mediated ethnic density effects. CONCLUSIONS: A protective effect of living in areas of higher own-group ethnic density was present for common mental disorders for some minority groups. People living in areas of higher own-group density may report improved social support and less discrimination, but these associations did not fully account for density effects.
Assuntos
Transtornos Mentais/etnologia , Adolescente , Adulto , Idoso , Ásia/etnologia , Inglaterra/epidemiologia , Etnicidade , Humanos , Irlanda/etnologia , Pessoa de Meia-Idade , Densidade Demográfica , Preconceito , Apoio Social , Índias Ocidentais/etnologia , Adulto JovemRESUMO
We evaluated the psychometric properties of the 12-item interviewer-administered screener version of the World Health Organization Disability Assessment Schedule-version II (WHODAS II) among older people living in seven low- and middle-income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites. PCA generated a one-factor solution in most sites. In CFA, the two-factor solution generated in Dominican Republic fitted better for all sites other than rural China. The two factors were not easily interpretable, and may have been an artefact of differing item difficulties. Strong internal consistency and high factor loadings for the one-factor solution supported unidimensionality. Furthermore, the WHODAS II was found to be a 'strong' Mokken scale. Measurement invariance was supported by the similarity of factor loadings across sites, and by the high between-site correlations in item difficulties. The Mokken results strongly support that the WHODAS II 12-item screener is a unidimensional and hierarchical scale confirming to item response theory (IRT) principles, at least at the monotone homogeneity model level. More work is needed to assess the generalizability of our findings to different populations.
Assuntos
Envelhecimento/psicologia , Demência/diagnóstico , Avaliação da Deficiência , Pessoas com Deficiência/psicologia , Programas de Rastreamento/estatística & dados numéricos , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , China , Comparação Transcultural , Demência/psicologia , Países em Desenvolvimento/economia , Pessoas com Deficiência/classificação , República Dominicana , Análise Fatorial , Feminino , Humanos , Masculino , Análise de Componente Principal , Escalas de Graduação Psiquiátrica , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
OBJECTIVES: To investigate the validity of previously suggested dimensions underlying the Mini-Mental State Examination (MMSE) and differences in associations of these dimensions with sociodemographic and health characteristics in an older Latin-American community sample with low levels of education. DESIGN: Secondary analysis of baseline data from a population-based cohort study. SETTING: Bambuí, Brazil. PARTICIPANTS: Of 1,742 total residents aged 60 years or older, 1,558 (89.4%) participated at this study. MEASUREMENTS: A standard Brazilian version of the MMSE. RESULTS: A five-factor solution (Concentration, Language/Praxis, Orientation, Attention, and Memory) for the MMSE was generated from Principal Components Analysis, and the five-factor solutions proposed in previous studies of developed nation samples were tested in this sample by Confirmatory Factor Analysis. In the adjusted linear regression models, MMSE factors varied in their correlates: for example, female gender was associated with higher concentration, orientation, and attention but lower Language/Praxis; increased age was inversely associated only with language and attention; and activity of daily living impairment was principally associated with lower Language/Praxis. CONCLUSION: This study provides support for the cross-sectional equivalence of the MMSE, suggesting that most of the items and underlying constructs remain meaningful after alteration and translation in a low-education sample with lower overall distribution of scores.
Assuntos
Envelhecimento , Transtornos Cognitivos/diagnóstico , Escolaridade , Avaliação Geriátrica , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Atenção , Brasil , Doença Crônica/psicologia , Feminino , Humanos , Idioma , Masculino , Memória , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
BACKGROUND: violence is a public health major concern, and it is associated with post-traumatic stress disorder and other psychiatric outcomes. Brazil is one of the most violent countries in the world, and has an extreme social inequality. Research on the association between violence and mental health may support public health policy and thus reduce the burden of disease attributable to violence. The main objectives of this project were: to study the association between violence and mental disorders in the Brazilian population; to estimate the prevalence rates of exposure to violence, post-traumatic stress disorder, common metal disorder, and alcohol hazardous use and dependence: and to identify contextual and individual factors, including genetic factors, associated with the outcomes. METHODS/DESIGN: one phase cross-sectional survey carried out in Sao Paulo and Rio de Janeiro, Brazil. A multistage probability to size sampling scheme was performed in order to select the participants (3000 and 1500 respectively). The cities were stratified according to homicide rates, and in Sao Paulo the three most violent strata were oversampled. The measurements included exposure to traumatic events, psychiatric diagnoses (CIDI 2.1), contextual (homicide rates and social indicators), and individual factors, such as demographics, social capital, resilience, help seeking behaviours. The interviews were carried between June/2007 February/2008, by a team of lay interviewers. The statistical analyses will be weight-adjusted in order to take account of the design effects. Standardization will be used in order to compare the results between the two centres. Whole genome association analysis will be performed on the 1 million SNP (single nucleotide polymorphism) arrays, and additional association analysis will be performed on additional phenotypes. The Ethical Committee of the Federal University of Sao Paulo approved the study, and participants who matched diagnostic criteria have been offered a referral to outpatient clinics at the Federal University of Sao Paulo and Federal University of Rio de Janeiro.
Assuntos
Transtornos de Estresse Pós-Traumáticos/epidemiologia , Violência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Brasil/epidemiologia , Distúrbios de Guerra/epidemiologia , Distúrbios de Guerra/genética , Estudos Transversais , Feminino , Estudo de Associação Genômica Ampla , Genótipo , Inquéritos Epidemiológicos , Homicídio/psicologia , Homicídio/estatística & dados numéricos , Humanos , Acontecimentos que Mudam a Vida , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Prevalência , Transtornos de Estresse Pós-Traumáticos/genética , População Urbana/estatística & dados numéricos , Violência/psicologiaRESUMO
BACKGROUND: Studies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis. METHODS: We undertook one-phase cross-sectional surveys of all residents aged 65 years and older (n=14 960) in 11 sites in seven low-income and middle-income countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Dementia diagnosis was made according to the culturally and educationally sensitive 10/66 dementia diagnostic algorithm, which had been prevalidated in 25 Latin American, Asian, and African centres; and by computerised application of the dementia criterion from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). We also compared prevalence of DSM-IV dementia in each of the study sites with that from estimates in European studies. FINDINGS: The prevalence of DSM-IV dementia varied widely, from 0.3% (95% CI 0.1-0.5) in rural India to 6.3% (5.0-7.7) in Cuba. After standardisation for age and sex, DSM-IV prevalence in urban Latin American sites was four-fifths of that in Europe (standardised morbidity ratio 80 [95% CI 70-91]), but in China the prevalence was only half (56 [32-91] in rural China), and in India and rural Latin America a quarter or less of the European prevalence (18 [5-34] in rural India). 10/66 dementia prevalence was higher than that of DSM-IV dementia, and more consistent across sites, varying between 5.6% (95% CI 4.2-7.0) in rural China and 11.7% (10.3-13.1) in the Dominican Republic. The validity of the 847 of 1345 cases of 10/66 dementia not confirmed by DSM-IV was supported by high levels of associated disability (mean WHO Disability Assessment Schedule II score 33.7 [SD 28.6]). INTERPRETATION: As compared with the 10/66 dementia algorithm, the DSM-IV dementia criterion might underestimate dementia prevalence, especially in regions with low awareness of this emerging public-health problem.
Assuntos
Demência/epidemiologia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Vigilância da População/métodos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Demência/classificação , Feminino , Humanos , Índia/epidemiologia , América Latina/epidemiologia , Masculino , Prevalência , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
BACKGROUND: The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba. METHODS: The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule - Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study). RESULTS: The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia. CONCLUSION: The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder.
Assuntos
Algoritmos , Demência/diagnóstico , Diagnóstico por Computador , Manual Diagnóstico e Estatístico de Transtornos Mentais , Idoso , Estudos de Casos e Controles , Área Programática de Saúde , Cognição , Serviços Comunitários de Saúde Mental , Cuba , Feminino , Avaliação Geriátrica , Humanos , Entrevistas como Assunto , Masculino , Testes PsicológicosRESUMO
BACKGROUND: Knowledge about co-occurrence of the most frequent chronic pain symptoms with psychiatric morbidity in older people is very limited. OBJECTIVE: To study the association of psychiatric morbidity and painful physical conditions in people aged 60 years and over. METHOD: Population-based random sample of 7,040 household residents, aged 60 years and over, in Brazil. RESULTS: The overall prevalence of pain conditions is 76%. Age-sex specific prevalence of chronic pain conditions such as back pain, joint, abdominal, chest, headaches, reported by respondents ranged from 11.6% up to 51.1%. In logistic regression models, chest pain, head pain, back pain, joint pain and abdominal pain emerged as predictors of psychiatric morbidity. The odds of psychiatric morbidity are also affected by income, ethnicity, origin (urban/rural), and marital status. CONCLUSION: The association of chronic painful conditions and psychiatric morbidity in late life is statistically strong in this surveyed population.
Assuntos
Transtornos do Humor/etiologia , Dor/complicações , Distribuição por Idade , Idoso , Doença Crônica , Estudos Transversais , Etnicidade , Feminino , Humanos , Renda , Modelos Logísticos , Masculino , Casamento , Pessoa de Meia-Idade , Medição da Dor , Prevalência , Características de Residência , Distribuição por Sexo , Perfil de Impacto da DoençaRESUMO
BACKGROUND: Psychotherapy research rarely has studied outcome in the longer term. AIMS: To evaluate the effectiveness of brief group dynamic psychotherapy (BGDP) intervention in patients with minor psychiatric disorders compared with the usual clinical management shortly after treatment termination and to investigate whether intervention would show a differential effect at 2-year follow-up. METHOD: Patients were allocated randomly to an experimental or control group. The General Health Questionnaire (GHQ) was used as a primary outcome measure. RESULTS: Based on improvement in the GHQ, at termination of treatment the BGDP group showed a significant improvement in 23 out of 42 (54.8%) compared with 11 out of 41 (26.8%) in the clinical management group. The difference in the total improvement rate is 28% (95% C18-48) (chi(2)=6.7; d.f.=1; P=0.009). In contrast, no differential follow-up effects were found between the BGDP and clinical management groups. CONCLUSIONS: Psychotherapy appears to have beneficial effects at termination of treatment but the changes attained were not stable.