Autoria, subjetividade e poder: devolução de dados em um centro de saúde na Guariroba (Ceilândia/DF) / Authority, subjectivity and power: data devolution at a primary care unit in Guariroba (Ceilândia/Federal District/Brazil)

ResumoA devolução, restituição ou compartilhamento pode significar, dentre outras possibilidades, entregar produtos aos partícipes de um empreendimento de pesquisa/extensão. A entrega de resultados não é uma prática nova na antropologia, embora ainda seja pouco usual, sistematizada e valorizada. Neste artigo, relato e discuto uma experiência de devolução de materiais de um projeto de extensão da antropologia, que foi desenvolvido dentro de um centro de saúde, na região periférica do Distrito Federal. As reações aos materiais foram muito diferentes do esperado pela equipe do projeto, mas ainda assim permitiu fazer avançar o diálogo entre os envolvidos e, mais do que isso, permitiu que o conhecimento sobre as relações de trabalho dentro dessa instituição de saúde fosse aprofundado. Não é somente porque foi logrado o aval de comitês de ética que as negociações sobre a entrada e permanência em projetos acadêmicos estão garantidas continuamente. As relações de subjetividade, poder e autoria permeiam qualquer iniciativa antropológica, antes de começá-la e muito depois de, supostamente, terminá-la.

AbstractDevolution, restitution or sharing can mean, within other possibilities, to offer products to participants of a research or an extension project. Far from a new practice in Anthropology, returning results is still unusual, little organized and valued. This paper presents and discusses a devolution experience by an extension project in Anthropology that was developed in a primary care unit in the outskirts of Distrito Federal (Brazil). Local reactions were very different from what was expected by the project's staff, but still permitted dialogue with the health professionals and, more important, deepened our knowledge about work relations in this health institution. Even though IRB approval has been granted, negotiations about starting and continuing academic projects have to be negotiated continuously. Subjectivity, power and authority permeate any anthropological initiative from its beginning and much after it supposedly has been concluded.

Ethnicity modifies the additive effects of anxiety and drug use disorders on suicidal ideation among black adults in the United States

This study aimed to test if ethnicity moderates the additive effects of lifetime psychiatric disorders on serious suicidal thoughts among a nationally representative sample of Black adults in the United States. For this study, we used data of 5,181 Black adults [3,570 African Americans and 1,621 Caribbean Blacks] who participated in the National Survey of American Life, 2001 2003. Five lifetime psychiatric disorders [i.e., major depressive disorder, general anxiety disorder, post-traumatic stress disorder, alcohol abuse disorder, and drug abuse] were considered as the independent variables. Lifetime serious suicidal ideation was considered as the dependent variable. Logistic regressions were used to determine if ethnicity modifies the effects of each psychiatric disorder on serious suicide ideation. Ethnicity was conceptualized as the possible moderator and socio demographics [i.e., age, gender, education level, employment, marital status and country region] were control variables. Among African Americans, major depressive disorder, general anxiety disorder, post-traumatic stress disorder and alcohol abuse disorder were associated with higher odds of suicidal thoughts. Among Caribbean Blacks, major depressive disorder and drug abuse disorder were associated with higher odds of suicidal thoughts. In the pooled sample, there was a significant interaction between ethnicity and anxiety disorder and a marginally significant interaction between ethnicity and drug abuse. Based on our study, suicidality due to psychiatric disorders among Black adults in the United States may depend on ethnicity. General anxiety disorder seems to be a more important risk factor for suicidal ideation among African Americans while drug abuse may contribute more to the risk of suicidal thoughts among Caribbean Blacks.

Reliability and validity of a modified phq-9 item inventory (Phq-12) as a screening instrument for assessing depression in Asian Indians (Cures - 65).

Objectives: To evaluate the validity and reliability of the modified Patient Health Questionnaire(PHQ) 12 item instrument as a screening tool for assessing depression compared to the PHQ -9 in a representative south Indian urban population. Methods: The Chennai Urban Rural Epidemiology Study [CURES] is a large cross-sectional study conducted in Chennai, South India. In Phase 1 of CURES(urban component), 26,001 individuals aged ≥ 20 years individuals were selected by a systematic sampling technique of whom one hundred subjects were randomly selected, using computergenerated numbers, for this validation study. Two self-reported questionnaires (modified PHQ-12 item and PHQ-9 item) were administered to the subjects to compare their effectiveness in detecting depression. Reliability and validity were assessed and Receiver Operating Characteristic (ROC) curves were plotted. Pearson’s correlation was used to compare the two questionnaires. Results: The mean age of the study was 38.6±11.6 years and 48% were males. Pearson’s correlation coefficient between the modified PHQ-12 and the PHQ-9 item was 0.913 [p<0.0001]. Factor Analysis revealed that the modified PHQ-12 item scale can be used as a unidimensional scale and had excellent internal consistency(Cronbach’s alpha:0.88). A cut point of >4 calculated using the ROC curves for the modified PHQ-12 item had the highest sensitivity (92.0%) and specificity (90.7%) using PHQ-9 as the gold standard. The positive predictive value was 76.7%, and the negative predictive value, 97.1% and the area under the ROC curve, 0.979 (95% Confidence Interval: 0.929 - 0.997, p<0.0001). Conclusion: The modified PHQ-12 item is a valid and reliable instrument for large scale population based screening of depression in Asian Indians and a cut point score of greater than 4 gave the highest sensitivity and specificity. ©

Primary care psychiatry: pertinent Arabian perspectives

There is substantive evidence of significant psychiatric morbidity among primary care patients, mainly in the form of anxiety and depressive disorders. A careful critical approach is essential for ensuring the cultural relevance, validity and reliability of the psychiatric screening instruments used to identify such morbidity. Most psychiatric morbidity among primary care patients passes undetected by the primary care practitioners. This will inevitably lead to unnecessary investigation and medication and the continuation of suffering for patients. Comorbidity and physical presentation in most instances contribute significantly to failure to detect psychiatric disorders. To deal with this problem of hidden psychiatric morbidity, carefully designed educational and training programmes need to be tailored to address the particular weaknesses and needs of primary care doctors