[Validation of diagnostic scales of family functioning for use in primary health care services]. / Validação de escalas diagnósticas do funcionamento familiar para utilização em serviços de atenção primária à saúde.

Care provided to patients in primary health services should include both a physical and a psychological assessment. In many cases treatment success depends on understanding individuals and their interactions, especially within the family; it is important for health professionals to be trained in this area. We investigated the validity of three well-known diagnostic scales of family functioning from the United States of America (FACES III, Beavers-Timberlawn, and GARF) for use in our setting in Porto Alegre, Brazil. The three scales were used with 31 families and compared to the results from clinical evaluations (semistructured family interviews), which were considered the gold standard. FACES III was also used with a sample of 102 families in the community. The Beavers-Timberlawn and GARF scales were strongly and positively correlated with the clinical evaluations. In contrast, our results suggest that FACES III is not a useful screening tool in primary care to detect the risk of psychiatric disorders. The Beavers-Timberlawn and GARF instruments showed great usefulness for formulating and classifying diagnoses of family functioning.

[Diagnostic reliability in mental disorders of the International Classification of Diseases in primary care]. / Confiabilidade diagnóstica dos transtornos mentais da versão para cuidados primários da Classificação Internacional das Doenças.

INTRODUCTION: The objective is to evaluate the test version of Chapter V - "Mental and Behavioral Disorders reliability", of the 10th revision of the International Classification of Diseases, Version for Primary Care (ICD -10 PC), prepared by the Division of Mental Health of the World Health Organization (WHO). METHODS: During September and October of 1994, Community General Physicians (CGP) from the Health and Environment Department of the State of Rio Grande do Sul were trained in the use of this version, prepared for the field trial, according to the design proposed by WHO. RESULTS: The results refer to a study about reliability of diagnosis attributed by 9 pairs of CGP to 460 patients in their first appointments. Cohen's Kappa for Mental Health Disorder, present or absent, was 0,79 (CI 95%: 0,69 - 0,88). CONCLUSION: The use of ICD-10 CP will give more specificity to the information and will allow a better communication between health workers at the level of primary care

Who in Brazil has a personal doctor?

BACKGROUND: Continued medical care (including having a personal doctor) is regarded as an essential aspect of a good health service. OBJECTIVES: The objectives of the present study were to investigate the reasons for not having a personal doctor, and the satisfaction with the care received by patients with and without a personal doctor. METHODS: We conducted a cross-sectional study with data collected during 20 days over 6 months in the Emergency Service of the Conceição Hospital, the busiest emergency service in Porto Alegre. The subjects were 553 patients selected through systematic random sampling. The main outcome measure was having a personal doctor. Patients who reported usually to see the same doctor and remembered their physician's name were regarded as having a personal doctor. RESULTS: Patients who usually use primary care service represented 23% of the sample, and were four times more likely to have a personal doctor (OR = 3.83, CI 95% = 2.41-6.11). Independent, statistically significant variables associated with having a personal physician were: usually receiving care from a primary health care service (OR = 3.8, CI 95% = 2.39-6.00) and from a physician in the private sector (OR = 2.16, CI 95% = 1.15-4.00). Patients who had a personal doctor reported higher satisfaction with their access to health care. The personal doctors' specialties were: internal medicine (37%), cardiologist (17%), gynaecologist-obstetrician (13%), family physician (8%) and pneumologist (6%). CONCLUSIONS: For patients who attend emergency services in Brazil, primary health care and private medical care provide better access to continuity of patient care. Patients with personal doctors report higher satisfaction with access to consultations.

Brazilian multicentric study of psychiatric morbidity. Methodological features and prevalence estimates.

BACKGROUND: Psychiatric morbidity studies in developing countries have used diagnostic procedures of low reliability, without a clinical definition of caseness, producing descriptive data with limited application for mental health planning. METHOD: A two-stage cross-sectional design (with a sample size of 6476) was conducted to estimate the prevalence of DSM-III psychiatric diagnoses in three metropolitan areas of Brazil (Brasília, São Paulo and Porto Alegre). All subjects were screened for the presence of psychopathology with a 44-item instrument (the QMPA) and a subsample was selected for a psychiatric interview. RESULTS: Age-adjusted prevalence of cases potentially in need of care ranged from 19% (São Paulo) to 34% (Brasília and Porto Alegre). Anxiety disorders comprised the highest prevalences (up to 18%). Alcoholism yielded the most consistent prevalence levels, around 8% in all sites. Depression showed great variation between areas: from less than 3% (São Paulo and Brasília) to 10% (Porto Alegre). CONCLUSIONS: Overall prevalences were high in comparison with previous studies conducted in Brazil. A female excess of non-psychotic disorders (anxiety, phobias, somatisation and depression) and a male excess for alcoholism were consistently found.

[The factor structure of the adult psychiatry morbidity questionnaire in a community sample of Brazilian cities]. / Estrutura fatorial do questionário de morbidade psiquiátrica de adultos aplicado em amostras populacionais de cidades brasileiras.

Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptoms and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasília, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue = 3.81, 10.9%); Irritability/Depression (eigenvalue = 2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue = 1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries.

A semi-structured interview for assessing the knowledge and attitude of health workers concerning mental health problems was applied in seven developing country areas within the context of a World Health Organization coordinated collaborative study. The results indicate a lack of basic mental health training associated with a failure to recognize mental health problems, restricted knowledge concerning psychotropic drug therapy, and an inability to visualize practical forms of mental health care which could be introduced at primary care level. The results were used to design appropriate training programs, and the observations will be repeated to assess the effectiveness of training.