Breastfeeding among teenage and adult mothers in Brazil

OBJECTIVE: To estimate the prevalence of breastfeeding among teenage (younger than 20 years old) and adult mothers of six-month-old children and to identify factors associated with weaning. METHODS: A cross-sectional study of a sample of 237 teenage mothers and 239 adult mothers living in the city of Montes Claros, Brazil, whose babies were six-month-old at the time of the interview was carried out. Mothers answered a questionnaire at home. To assess factors associated with weaning, univariate, Mantel-Haenszel, and multiple logistic regression analyses were performed. RESULTS: Breastfeeding prevalence in children aged 6 months was 71.3% among teenage mothers and 77.4% among adult mothers (crude OR=1.38; p=0.128), but after adjusting for control variables the role of adolescence added considerable weight to weaning. Factors associated with weaning were: marital status, mother's occupation after delivery (both showed interaction with teenage years), difficulty to breastfeeding in the first days after delivery, and exclusive breastfeeding at the time of hospital discharge. CONCLUSIONS: The observed interactions with teenage in regard to weaning suggest that motherhood in this age group has unique features that should be further investigated.     

Prevalence of asthma and asthma symptoms among 13 and 14-year-old schoolchildren, Brazil

OBJECTIVE: Before the use of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire in epidemiologic surveys, little could be told about the comparative occurrence of asthma in the world due to differences in employed methods. In Brazil, the ISAAC questionnaire has been used in some urban regions. In this study it was applied in both, urban and rural areas, in order to estimate the prevalence of asthma among schoolchildren living in Montes Claros, Brazil. METHODS: A cross-sectional study was carried out using the ISAAC written questionnaire with four questions added on exposures of interest. The questionnaire was self-applied in 3,770 randomly selected schoolchildren aged 13 and 14 years. RESULTS: The prevalence of "wheezing in the last year" was 15.8%, and "asthma or bronchitis ever" was 23.8% with no statistically significant difference between boys and girls. There were significant differences between girls and boys regarding "wheezing ever" (37.8% and 33.6%), "sleeping disturbed by wheezing" (13.7% and 9.5%), and "nocturnal dry coughing without respiratory infection" (36.6% and 28.7%), respectively. "Wheezing in the last year" was found to be positively associated with "pet contact" (OR=1.27; 95% CI: 1.03-1.56), and "family history of asthma" (OR=1.79; 95% CI: 1.50-2.14), and negatively associated with "rural school" (OR=0.63; 95% CI: 0.44-0.91). But no association was found with sex, age, private/public school, and passive smoking. CONCLUSIONS: The prevalence of asthma in Montes Claros was high and some symptoms were seen mainly among girls. The occurrence of "wheezing in the last year" showed to be associated with family history, contact with pets and urban schools.     

Higher prevalence of mental disorders in socioeconomically deprived urban areas in The Netherlands: community or personal disadvantage?

OBJECTIVE: Major mental disorders occur more frequently in deprived urban areas. This study examines whether this occurs for all mental disorders, including less serious ones. It further assesses whether such a concentration can be explained by the socioeconomic status (SES) of the residents concerned or that a cumulation of problems in deprived areas reinforces their occurrence. DESIGN: Mental disorders were assessed by means of the General Health Questionnaire (GHQ) among 4892 residents. Additional data were obtained on area deprivation, and on individual SES. Multilevel logistic regression models were used to take the hierarchical structure of the data into account, residents being nested in boroughs. SETTING: General population of the city of Amsterdam, the Netherlands. MAIN OUTCOME MEASURE: Prevalence of an increased (> or = 2) score on the GHQ, 12 item version. RESULTS: Mental disorders occur more frequently in deprived areas but this can be explained by the lower SES of the residents concerned. CONCLUSIONS: The cumulation of mental disorders in deprived urban areas is mainly a result of a concentration of low SES people in these areas. Contextual factors of deprived urban areas give hardly any additional risk above that resulting from a low individual SES.

 

     

深圳市户籍及非户籍居民精神疾病现况调查

目的 了解深圳市户籍及非户籍≥18岁居民各类精神疾病的患病率及分布特点.方法 以世界卫生组织一世界精神健康联盟(WHO-WMH)提供的复合性国际诊断访谈表(CIDI3.1)为访谈工具,采用多阶段分层随机抽样方法对7134名受访人进行面对面调查.结果 (1)深圳市居民各类精神疾病加权终生患病率为21.87%,其中户籍居民为19.99%,非户籍居民为22.34%明显高于户籍居民(OR=1.15,95%CI:1.03～1.29;P<0.05),女性患病率明显高于男性(22.68%vs.19.67%;OR=1.20,95%CI:1.07～1.34;P<0.05);情感障碍、焦虑障碍和精神病性障碍的患病率分别为9.62%、14.45%和1.40%.(2)各类精神疾病加权12个月患病率为13.42%,户籍居民为11.90%,非户籍居民为13.80%明显高于户籍居民(OR=1.19,95%CI:1.03～1.36;P<0.05).(3)精神疾病之间的伴随疾病患病率为35.76%.(4)患病率及病情严重程度与性别、户籍、婚姻状况、文化程度、经济状况和职业等因素有关.结论 精神疾病已经成为深圳市的常见病,非户籍居民及女性的精神健康问题尤应引起关注.     

新疆南疆精神障碍流行病学调查及影响因素分析

目的 分析南疆≥15岁人群各类精神障碍分布特征及影响因素,为制定有效的防治措施提供参考依据。方法 2019年4月至11月按分层、整群、随机抽样方法抽取南疆5个市（县）3883名城乡居民,以国际疾病分类第10版（ICD-10）精神与行为障碍分类为诊断标准,对各类精神障碍进行评估诊断。采用卡方检验对定性资料进行比较、logistic回归分析探讨各类精神障碍的影响因素。结果 各类精神障碍总时点患病率为9.68%。其中情感障碍5.07%、焦虑障碍3.24%、精神分裂症0.67%、器质性精神障碍0.26%、精神发育迟滞0.44%。总时点患病率女性高于男性（〖XC五号.EPS;P〗=24.89,P<0.05）,不同婚姻状况（〖XC五号.EPS;P〗=38.16,P<0.05）、不同文化程度（〖XC五号.EPS;P〗=147.23,P<0.05）人群精神障碍患病率有差异。回归分析显示:女性、未婚、丧偶、居住乡村是患精神障碍的风险人群。结论 南疆精神障碍患病率高,应定期在全省范围内评估精神障碍的患病情况,针对性地采取防治措施,合理分配医疗资源,有效降低精神障碍患病率。     

Hepatitis B vaccination among dentists surgeons

OBJECTIVE: Serological studies in several countries have found a higher prevalence of hepatitis B virus (HBV) among dentists when compared to the general population, especially among surgical specialties. The present study was carried out to determine the prevalence of hepatitis B (HB) vaccination and factors associated with no vaccination and incomplete vaccination among dentists. METHODS: A survey was conducted among 299 dentists living in Montes Claros, southeast Brazil, using a self-administered questionnaire. HBV vaccination prevalence was determined according to the number of doses of vaccine and factors associated with no vaccination or incomplete HBV vaccination were investigated using multinomial logistic regression analysis. RESULTS: Participation rate in the study was very high (296/299). Of the participants, 74.9% received three doses of HBV vaccine, 14% two doses, 2% a single dosis and 10% were not vaccinated. Complete vaccination rate was higher among surgeons and periodontists (89%). The main reason reported for not being vaccinated or incomplete vaccination was the need of more information. No vaccination was significantly higher among dentists aged 40 years and over (OR=8.62; 95%CI: 1.88-39.41) and those who did not attend refreshment courses in the last two years prior to the survey (OR=2.72; 95%CI: 1.02-7.22). Incomplete vaccination was positively associated with non-use of gloves during work (OR=2.32; 95%CI: 1.08-4.97). CONCLUSIONS: Lack of information, possibly associated to lower attendance to refreshment courses, seems to be one of the main factors affecting the vaccination rate.     

Psychological comorbidity in elderly patients with cancer

Human life expectancy has increased, nationally and internationally, during recent years and will continue to increase in the future. Old age is commonly associated with health-related impairments, chronic diseases, increasing multimorbidity, as well as with psychosocial burdens, such as social deprivation, reduced social participation, and impairment in activities of daily living. Against this background, studies on mental health addressing psychological?distress and mental disorders of older people have gained increasing attention. The aim of the present overview is to provide insight into psychological comorbidity in elderly with chronic illnesses. The following questions are addressed: (1) what are the prevalence rates of mental disorders in the elderly in general and, specifically, in patients with cancer? (2) How are mental disorders and cancer, respectively, diagnosed in elderly?patients? (3) What are common risk factors associated with the development of mental disorders? (4) Which treatment options are available, and which aspects of health care for elderly patients with chronic diseases need to be considered?     

Characteristics of older adults referred to a psychiatric emergency outreach service

Although older adults typically underutilize mental health services, problems associated with dementing illnesses, chronic medical illnesses, affective disorders, social isolation, and multiple medication use, among other phenomena, have increased referrals of the elderly to psychiatric emergency services. The present study reviewed characteristics of elderly adults referred to a psychiatric emergency outreach/screening service. Of all individuals for whom a referral was made, 24% were aged 60 or older. Among those older adults referred, 63% were seen by screening service personnel; 37% did not meet screening criteria or voluntarily sought mental health services. Diagnoses of individuals evaluated included dementia (27%), affective disorders (27%), schizophrenia (16%), psychosis (12%), alcohol abuse (7), and diagnosis deferred (11%). Findings highlight the limited options available for mental health care of the aged.     

Use of medication by the elderly in urban and rural areas in southern Brazil: a population-based study

The study aimed to measure use of medication and polypharmacy among the elderly in Carlos Barbosa, Rio Grande do Sul State, Brazil, and to compare socio-demographic, economic, and health characteristics in relation to area of residence (urban versus rural) in a random sample of 811 persons 60 year of age or older. Interviews were used to collect data on socio-demographic characteristics, chronic illnesses, and self-reported use of medications. The association between area of residence and medication or polypharmacy was adjusted for confounders using Poisson regression with robust variance. Prevalence rates for use of medication and polypharmacy were higher among older persons living in the urban area. Living in the urban area was positively and independently associated with use of medication (PR = 1.10; 95%CI: 1.02-1.20) and polypharmacy (PR = 1.83; 95%CI: 1.27-2.65) in this group of elderly in southern Brazil.     

Alcohol consumption among urban, suburban, and rural Veterans Affairs outpatients

Purpose: United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care‐based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol consumption among urban, suburban, and rural Veterans Affairs (VA) outpatients. Methods: Outpatients from 7 VA facilities responded to mailed surveys that included the validated Alcohol Use Disorders Identification Test Consumption (AUDIT‐C) screening questionnaire. The ZIP code approximation of the US Department of Agriculture's rural‐urban commuting area (RUCA) codes classified participants into urban, suburban, and rural areas. For each area, adjusted logistic regression models estimated the prevalence of past‐year abstinence among all participants and unhealthy alcohol use (AUDIT‐C ≥ 3 for women and ≥ 4 for men) among drinkers. Findings: Among 33,883 outpatients, 14,967 (44%) reported abstinence. Among 18,916 drinkers, 8,524 (45%) screened positive for unhealthy alcohol use. The adjusted prevalence of abstinence was lowest in urban residents (43%, 95% CI 42%‐43%) with significantly higher rates in both suburban and rural residents [45% (44%‐46%) and 46% (45%‐47%), respectively]. No significant differences were observed in the adjusted prevalence of unhealthy alcohol use among drinkers. Conclusions: Abstinence is slightly more common among rural and suburban than urban VA outpatients, but unhealthy alcohol use does not vary by rurality. As the VA and other health systems implement evidence‐based care for unhealthy alcohol use, more research is needed to identify whether preventive strategies targeted to high‐risk areas are needed.     

Heavy alcohol consumption and associated factors: a population-based study

OBJECTIVE: To determine the prevalence of heavy alcohol consumption and factors associated with it in a Brazilian adult population. METHODS: Cross-sectional population-based study including 2,177 adults (aged 20 to 69), living in the urban area of the municipality of Pelotas, Rio Grande do Sul State, Brazil. The sample was selected in multiple stages. Heavy alcohol consumption was defined as above 30g/day. The adjusted analysis was conducted by logistic regression. RESULTS: The prevalence of heavy alcohol consumption was 14.3% (29.2% among men and 3.7% among women). The following groups presented higher prevalences of heavy alcohol consumption after adjusted analysis: men, elderly people, blacks or mulattoes, heavy smokers, and people who present some kind of chronic disease. Men with minor psychiatric disorders showed higher prevalences of heavy alcohol consumption than other men. Among women, association between age and heavy alcohol consumption was inversely related. Furthermore, the study indicates that among hypertensive subjects, those with heavy alcohol consumption presented worse disease management. CONCLUSIONS: Heavy alcohol consumption is high and results in countless negative consequences for the individual's health and quality of life. Our results highlight the high prevalence of heavy alcohol consumption and indicate subsections of the whole population more susceptible to alcoholism.     

Prevalence of tobacco use in individuals with severe mental illnesses, São Paulo, Brazil

OBJECTIVE: To analyze the prevalence of cigarette smoking in individuals with severe mental illnesses in a large urban centre of a middle income country. METHODS: Cross-sectional study carried out in S?o Paulo. The sample (N=192) comprised individuals diagnosed with severe mental illnesses who had contact with public psychiatric care services from September to November 1997 and were aged between 18 and 65 years. Prevalence of daily tobacco smoking in the 12 months previous to the interview and characteristics associated were studied. RESULTS: Out of 192 subjects with severe mental illnesses interviewed, 115 (59.9%; 95% CI: 52.6%; 66.9%) reported smoking cigarettes on a daily basis. Male gender, marital status separated or widowed, irregular use of neuroleptic drugs and history of ten or more psychiatric admissions were independently associated with cigarette smoking. CONCLUSIONS: The prevalence of cigarette smoking in the present sample was higher than that found in the general Brazilian population. Mental care services should implement non-smoking policies and mental health providers need to help patients with severe mental illness who want to quit smoking.     

Healthy skepticism

OBJECTIVE: To investigate the relationship between medical skepticism and overall self-rated health and to identify disparities in health for vulnerable subgroups among the elderly. DESIGN: A cross-sectional telephone survey involving multiple callbacks. Independent variables included three measures of medical skepticism and disparities variables (low income, low education, race/ethnicity, gender, rural residence) along with several control variables (body weight, marital status, employment, insurance coverage, number of medical visits). SETTING: West Texas, a sparsely populated 108-county region. PARTICIPANTS: Five thousand six persons aged 65 and over. MAIN RESULTS: Multiple logistic regression analysis revealed that medical skepticism (believing that one can overcome illnesses without the help of a medical professional) was independently related to better self-rated overall health. Disparities in health were found for income, race/ethnicity, and low education but not for residents of rural or frontier areas (vs. urban residents). CONCLUSIONS: Belief in one's own ability to manage most illnesses may or may not be causally related to better health. However, the association is promising and deserves further investigation. Programs promoting self-care among groups facing health disparities should be considered.     

Development, testing, and validation of two scales measuring nursing home management of subjects with mental disorder

This paper describes the development, testing, and validation of summary scales measuring nursing processes commonly used in caring for elderly nursing home residents with cognitive, mood, and behavior problems, or other markers of mental disorder. Data were obtained from a cross-sectional study of 1017 residents from a proportionate random sample in Delaware nursing facilities, to determine the prevalence of mental disorders and to describe distinguishing characteristics and treatments. An exploratory factor analysis was performed on 11 frequently encountered nursing management strategies as applied to 808 subjects with some indicator of mental disorder. Two factors emerged, which were subsequently conceptualized as separate scales (composed of six and five elements, respectively) that measure the basic approaches termed Encouragement and Control. Alpha reliability levels determined internal consistency for each scale. Cognitive, behavioral, and mood correlates were identified for each scale using multiple regression. Replication and validation were achieved when similar findings were obtained using a random sample of 290 residents at Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston. LISREL analyses confirmed the presence of at least two dimensions in behavior management strategies. The identification of these approaches is significant in providing non-pharmacologic and non-restraint alternatives to managing elderly residents with symptom distress.     

Inequities in mental health care after health care system reform in Chile

OBJECTIVES: We compared differences in mental health needs and provision of mental health services among residents of Santiago, Chile, with private and public health insurance coverage. METHODS: We conducted a cross-sectional survey of a random sample of adults. Presence of mental disorders and use of health care services were assessed via structured interviews. Individuals were classified as having public, private, or no health insurance coverage. RESULTS: Among individuals with mental disorders, only 20% (95% confidence interval [CI]=16%, 24%) had consulted a professional about these problems. A clear mismatch was found between need and provision of services. Participants with public insurance coverage exhibited the highest prevalence of mental disorders but the lowest rates of consultation; participants with private coverage exhibited exactly the opposite pattern. After adjustment for age, income, and severity of symptoms, private insurance coverage (odds ratio [OR]=2.72; 95% CI=1.6, 4.6) and higher disability level (OR=1.27, 95% CI=1.1, 1.5) were the only factors associated with increased frequency of mental health consultation. CONCLUSIONS: The health reforms that have encouraged the growth of the private health sector in Chile also have increased risk segmentation within the health system, accentuating inequalities in health care provision.     

徐州市新城镇社区老年居民抑郁心理现状及其影响因素研究

目的 了解徐州市新城镇社区老年居民抑郁心理现状,分析其影响因素,为新型城镇化建设、提高新城镇社区老年居民心理健康水平及营造良性生活环境提供科学依据。方法 采用分层整群抽样的方法,分别抽取徐州市多个新城镇社区老年居民进行问卷调查。采用单因素分析及二分类logistic回归分析明确新城镇社区老年居民抑郁症状及影响因素。结果 参与调查的2 345名新城镇老年人中,554名CES-D10抑郁量表得分≥12分,抑郁症状发生率为23.6%。logistic分析结果显示有配偶、是否有宗教信仰、经常运动锻炼、较好就业机会、较好基础设施等因素可以减少新城镇老年居民抑郁状况的发生(P均<0.05);有宗教信仰、较高住房价格、较高生活成本、与原住地跨省、恋乡情结较重是新城镇老年居民抑郁的危险因素(P<0.05)。结论 新城镇社区老年居民存在抑郁症状,情况不容乐观,因此,应对高危人群从不同维度、有重点地进行防控,以确保社区老年居民心理健康。     

安徽省农村老年人高血压患病影响因素分析

目的 探讨安徽省农村地区老年人高血压患病现状及影响因素,为制定老年人保健措施提供依据.方法 采用自编问卷和现场体格检查方法,对安徽省部分农村地区751名60岁～的老年人进行高血压患病现状及患病危险因素调查,并进行多因素Logistic回归分析.结果 在751名农村老年人中,高血压患病率为54.1%.单因素分析结果显示:高血压患病率的影响因素有年龄(χ2=12.968,P=0.011)、爱吃甜食(χ2=4.349,P=0.039)、爱吃成食(χ2\6.398,P=0.013)、食用蔬菜量(χ2=15.223,P=0.004)、体质指数(BMI)(χ2=26.106,P=0.000)、腹型肥胖(χ2=14.591,P=0.000).多因素分析结果显示,高血压危险系数与BMI、年龄、咸食食用量、腹型肥胖程度呈正比,与蔬菜食用量呈反比.结论 安徽省农村老年人高血压现状不容乐观,应加强高血压患病相关因素的健康教育,促进农村老年人养成良好的生活习惯,预防和控制高血压的发生.     

Evaluation of labor-related and physical risk factors for cardiovascular disease in drivers of urban transport buses in Montes Claros in the state of Minas Gerais

The scope of this study was to evaluate risk factors for cardiovascular disease among bus drivers in Montes Claros in the state of Minas Gerais. A semi-structured questionnaire covering personal, anthropometric, professional and labor-related data was used, in addition to a questionnaire on the level of stress. 53 bus drivers were surveyed and the average age was 30 to 39 years of age. 81.1% were non-smokers; 58% of the sample were teetotalers; and 50% took regular exercise. In the assessment of BMI, 40 drivers (75.4%) were overweight. The prevalence in eating habits revealed excess consumption of sugar (66.0%), fat (64.2%), coffee (69.8%), salt (60.4%), coca cola (64.2%) and soft drinks (54.7%). Among reports of chronic diseases, no diabetic (98.1%) or hypertensive (94.3%) drivers were observed. Most of the sample (69.7%) had normal stress levels. With respect to laboratory data, the vast majority of drivers had hypertriglyceridemia and hypercholesterolemia. HDL levels were satisfactory, and the LDL revealed normal and desirable levels in more than half of the sample. The prevalence of cardiovascular disease was low.     

Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.     

Prevalence of mental disorders and suicidal thoughts among community-dwelling elderly adults 3 years after the niigata-chuetsu earthquake

Background

Japan is located in an area prone to natural disasters, and major earthquakes have occurred recently in rural areas where the proportion of elderly adults is high. Although elderly persons are vulnerable members of communities at a time of disaster, the prevalence of mental disorders among this population has yet to be reported in Japan. This study aimed to determine the prevalence of mental disorders and suicidal thoughts among community-dwelling elderly persons 3 years after an earthquake and to identify risk factors associated with their quality of life (QOL).

Methods

Face-to-face interviews were conducted with 496 community-dwelling persons aged 65 years or older in areas of Japan where 2 major earthquakes had occurred during a 3-year period. The main outcome was diagnosis of a mental disorder or suicidality.

Results

During the 3-year period after the earthquake, 1.6% of men and 5.5% of women had received a diagnosis of major depression. There were no cases of posttraumatic stress disorder. Women were more likely than men to report suicidality (7.8% vs 3.8%, P = 0.075).

Conclusions

The prevalence of mental disorders was lower than that reported in previous studies. Despite the low prevalence of mental disorders, the percentage of community-dwelling elderly persons with subclinical mental health symptoms was high. The results indicate that appropriate public health and medical interventions are warranted after a natural disaster.Key words: prevalence, mental disorders, suicidality, older adults, natural disasters