Gender and minor psychiatric morbidity: results of a case-control study in a developing country

OBJECTIVE

Women suffer from minor psychiatric disorders (MPM) more frequently than men. Most of the studies were conducted in England and in the United States and some reported the higher occurrence of MPM among women to be modified by marital status and others by sociodemographic variables. The present study intends to address this question in a developing country.

METHOD

A population based case-control study was conducted in three important urban centers in Brazil. Two hundred seventy-six individuals diagnosed as new cases of MPM and 261 controls were selected to investigate the role of a set of sociodemographic variables in the association between gender and MPM using logistic regression models.

RESULTS

Univariate analysis showed that women were more likely than men to suffer from MPM (OR = 3.34; 2.27-4.91). After controlling for other sociodemographic variables, female gender was still positively associated with MPM, but not in a homogeneous way. A multiplicative interaction of gender with age group was found (LRT = 6.01; 2 df; p = 0.05) suggesting an increment in the magnitude of the association among those older than thirty years. Odds-ratios were 2.33 (1.19-4.55), 6.85 (2.86-16.41), and 7.47 (2.90-19.22) for age groups of fourteen to twenty-nine; thirty to forty-four; forty-five or more, respectively. There was no evidence of interaction of gender with marital status or other sociodemographic variables.

CONCLUSIONS

The findings are consistent with the modification of the association between gender and MPM being mediated by social factors.

Detection of antibodies against hepatitis A virus in eluates of blood spotted on filter-paper: a pilot study in Rio de Janeiro, Brazil

The validity of blood spotted on to filter-paper (BSOFP) eluates for the detection of antibodies against hepatitis A virus (HAV) was investigated in 718 individuals (children and adults) during a field study in a small area in Rio de Janeiro State, Brazil. Serum samples were considered the 'gold standard'. BSOFP eluates were analyzed by 2 different techniques: microplate competitive enzyme-linked immunosorbent assay (ELISA) of the whole study group and microparticle enzyme immune assay (MEIA) of a subsample of 59 individuals. For BSOFP eluates by ELISA, sensitivity and specificity were 89.6% (95% CI: 84.7-93.1) and 97.5% (95% CI: 95.6-98.7), respectively. For a seroprevalence of anti-HAV antibodies of 32%, the positive predictive value was 94.5% (95% CI: 90.3-97.0) and the negative predictive value was 95.2% (95% CI: 92.8-96.8). The test efficiency was 95.0% (95% CI: 93.1-96.4). Similar results were found for BSOFP eluates by MEIA. Agreement between the 2 techniques used for BSOFP (ELISA and MEIA) was also high (kappa = 0.93). These results encourage the more widespread application of BSOFP as a means of surveillance for large-scale epidemiological studies for hepatitis A.

Reliability of self-reported weight and height among state bank employees

INTRODUCTION

Self-reported weight and height were compared with direct measurements in order to evaluate the agreement between the two sources.

METHODS

Data were obtained from a cross-sectional study on health status from a probabilistic sample of 1,183 employees of a bank, in Rio de Janeiro State, Brazil. Direct measurements were made of 322 employees. Differences between the two sources were evaluated using mean differences, limits of agreement and intraclass correlation coefficient (ICC).

RESULTS AND CONCLUSION

Men and women tended to underestimate their weight while differences between self-reported and measured height were insignificant. Body mass index (BMI) mean differences were smaller than those observed for weight. ICC was over 0.98 for weight and 0.95 for BMI, expressing close agreement. Combining a graphical method with ICC may be useful in pilot studies to detect populational groups capable of providing reliable information on weight and height, thus minimizing resources needed for field work.

Minor psychiatric morbidity and internal migration in Brazil

Studies of non-psychotic disorders in migrants have shown inconsistent results. This paper reports the findings of a case-control study carried out in three cities in Brazil to investigate the association between migration and minor psychiatric morbidity (MPM). Two hundred and seventy-six cases and 261 controls were selected from a survey of 6740 people aged 15 years or more. Diagnoses were made using the DSM-III Symptom Checklist. A statistically significant increase in risk of MPM in migrants was found by univariate analysis [odds ratio (OR) = 1.76; 95% confidence interval (CI) = 1.21-2.57. After controlling for gender, age, educational level, marital status, place of residence and position in the labour market, the overall increase in risk of MPM disappeared (OR = 1.02; 95% CI = 0.64-1.64), but a statistically significant increase in risk was present only in migrant unemployed women. This finding did not support models that explain risk in migrants by viewing migration as associated with cultural change and stressful life events. On the other hand, models based on the concept of selection- displacement from the labour market are more consistent with the present findings.

Consumo de psicofármacos em uma região administrativa do Rio de Janeiro: a Ilha do Governador

Em 1988, um inquérito epidemiológico foi realizado para se estimar a prevalência de alcoolismo crônico e uso de álcool na população da XX Região Administrativa da cidade do Rio de Janeiro. O instrumento incluiu perguntas sobre o consumo de psicofármacos, café e cigarros. Este trabalho analisa os dados referentes ao consumo de psicofármacos nos 30 dias anteriores à pesquisa. A amostra representativa da população acima de 13 anos foi composta por 1.459 pessoas, Os resultados mostram uma prevalência de consumo global de 5,2% (3,1% para homens e 6,7% para mulheres). As mulheres, as pessoas mais velhas (especialmente pessoas entre 60 e 69 anos), os separados e viúvos, e as pessoas de renda mais baixa apresentaram prevalências mais elevadas. Avaliou-se a associação de cada variável demográfica através do cálculo deodds ratio ajustado por regressão logística. Os tranqüilizantes derivados dos benzodiazepínicos predominaram entre os tipos de psicofármacos referidos (85,23%), seguidos pelos antiepilépticos (5,68%) e pelos hipnóticos e sedativos (4,54%). Os clínicos não-especializados em neurologia ou psiquiatria lideraram as prescrições (65,8%). Oitenta por cento dos medicamentos foram obtidos na rede privada, enquanto 13,16% foram adquiridos na farmácia pública, quase todos mediante a apresentação do receituário controlado. Os resultados são discutidos e novas linhas de pesquisa são apontadas.

[Prevalence of alcoholic beverage consumption and alcoholism in a metropolitan region of Brazil]

An epidemiological survey was carried out for the purpose of estimating the use of psycho-active substances and the prevalence of alcoholism. The target population consisted of people over 13 years old living in a district of Rio de Janeiro city-Brazil. A random sample of 1,459 people was researched. Data on the use of alcohol and on alcoholism are presented. The diagnosis of this latter, based upon the CAGE Test, showed that 51% used alcohol and 3% were suspected of alcoholism: 4.9% and 1.7% among men and women, respectively. The greatest prevalence of the use of alcohol and of alcoholism was found among men between 30 and 49 years of age. Abstinence from alcohol was more frequent among widowed, Evangelical and low-income groups.

[Sources of discrepancy in psychiatric diagnosis at hospitals in Rio de Janeiro, Brazil]

The hospitalization records for two consecutive admissions of the same patients were examined at three psychiatric hospitals in Rio de Janeiro, Brazil. The authors investigated sources of discrepancy between diagnosis, examining such data as sex and age of patients, type of hospital (public, private or academic), type of diagnosis, interval between admissions, average duration of stay, and whether or not the evaluating physicians and the institutions were the same in both admissions. The diagnosis categories "Schizophrenia" and "Alcohol and drugs" showed fewer discrepancies than the other groups of diagnoses as a whole, regardless of the hospital in which the admissions had been (P less than 0.01). In the case of patients with the two admissions at different hospitals, the type of diagnosis and the interval between the last two admissions were found to be associated with diagnosis discrepancy (P less than 0.05). When the last two admissions were to the same institution, discrepancies were associated with the type of hospital and whether or not the attending physician was the same in both events (P less than 0.01).