ABSTRACT
BACKGROUND: Major Depressive Disorder (MDD) is a public health problem of increasing severity in Chile. However, prevalence studies of MDD yield discordant results. Reconciling these discordances, at least in part, requires improving the estimate of MDD prevalence in Chile. AIM: To improve the estimate of MDD prevalence in Chile, by combining data from the 2016/17 Chilean National Health Survey (ENS) with data from the mandatory notifications of users of the Explicit health guaranties (GES acronym in Spanish) program of the Ministry of Health for MDD treatment. MATERIAL AND METHODS: The 2016/17 ENS, applied a Composite International Diagnostic Interview (CIDI) module (n = 3,403), to diagnose individuals with MDD. This article presents an approach that combines the CIDI/ENS diagnoses with GES depression notifications for this period. This dataset combination was applied first to individual macro-zones, then at a national level. RESULTS: The analysis with ENS 2016/17 data only, yields a prevalence of MDD in subjects 18 years or older of 6.19% (95% CI: 4.51-8.43). However, the analysis of the combined data sources yields a prevalence that increases to 6.65% (95% CI: 4.63-8.67). In terms of number of cases, this prevalence increase translates into 63,474 additional MDD cases per year. CONCLUSIONS: The MDD prevalence that results from combining ENS 2016/17 and GES data is greater than the prevalence reported by the ENS 2016/17 alone. This increase in cases allows policymakers to improve budgeting and implementation of public policies concerning the prevention and treatment of MDD.
Subject(s)
Humans , Depression/diagnosis , Depression/epidemiology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/therapy , Depressive Disorder, Major/epidemiology , Chile/epidemiology , Prevalence , Health SurveysABSTRACT
BACKGROUND: Major Depressive Disorder (MDD) is a public health problem of increasing severity in Chile. However, prevalence studies of MDD yield discordant results. Reconciling these discordances, at least in part, requires improving the estimate of MDD prevalence in Chile. AIM: To improve the estimate of MDD prevalence in Chile, by combining data from the 2016/17 Chilean National Health Survey (ENS) with data from the mandatory notifications of users of the Explicit health guaranties (GES acronym in Spanish) program of the Ministry of Health for MDD treatment. MATERIAL AND METHODS: The 2016/17 ENS, applied a Composite International Diagnostic Interview (CIDI) module (n = 3,403), to diagnose individuals with MDD. This article presents an approach that combines the CIDI/ENS diagnoses with GES depression notifications for this period. This dataset combination was applied first to individual macro-zones, then at a national level. RESULTS: The analysis with ENS 2016/17 data only, yields a prevalence of MDD in subjects 18 years or older of 6.19% (95% CI: 4.51-8.43). However, the analysis of the combined data sources yields a prevalence that increases to 6.65% (95% CI: 4.63-8.67). In terms of number of cases, this prevalence increase translates into 63,474 additional MDD cases per year. CONCLUSIONS: The MDD prevalence that results from combining ENS 2016/17 and GES data is greater than the prevalence reported by the ENS 2016/17 alone. This increase in cases allows policymakers to improve budgeting and implementation of public policies concerning the prevention and treatment of MDD.
Subject(s)
Depression , Depressive Disorder, Major , Humans , Depression/diagnosis , Depression/epidemiology , Chile/epidemiology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/therapy , Prevalence , Health SurveysABSTRACT
OBJECTIVES: To improve our understanding of climate variability and diarrheal disease at the community level and inform predictions for future climate change scenarios, we examined whether the El Niño climate pattern is associated with increased rates of diarrhea among Peruvian children. METHODS: We analyzed daily surveillance data for 367 children aged 0 to 12 years from 2 cohorts in a peri-urban shantytown in Lima, Peru, 1995 through 1998. We stratified diarrheal incidence by 6-month age categories, season, and El Niño, and modeled between-subject heterogeneity with random effects Poisson models. RESULTS: Spring diarrheal incidence increased by 55% during El Niño compared with before El Niño. This increase was most acute among children older than 60 months, for whom the risk of a diarrheal episode during the El Niño spring was nearly 100% greater (relative risk=1.96; 95% confidence interval=1.24, 3.09). CONCLUSIONS: El Niño-associated climate variability affects community rates of diarrhea, particularly during the cooler seasons and among older children. Public health officials should develop preventive strategies for future El Niño episodes to mitigate the increased risk of diarrheal disease in vulnerable communities.
Subject(s)
Diarrhea/epidemiology , El Nino-Southern Oscillation , Age Factors , Child , Child, Preschool , Cryptosporidiosis/epidemiology , Cryptosporidium , Diarrhea/parasitology , Feces/parasitology , Female , Humans , Incidence , Infant , Infant, Newborn , Longitudinal Studies , Male , Peru/epidemiology , Seasons , Urban Population/statistics & numerical dataABSTRACT
This study evaluated the association of pediatrician training on the identification and management of current and ongoing emotional or behavioral problems among children ages 4-8 years in 19 practices in south-central Connecticut. Pediatricians with advanced training in psychosocial issues were more likely to identify children's psychosocial problems and use multiple management strategies compared with pediatricians with no specialized training. Although pediatricians with moderate training in psychosocial issues were more likely to identify psychosocial problems compared with pediatricians with no training, there was no relationship between moderate training and management of psychosocial problems. These results suggest that identification and management of young children's psychosocial problems demands advanced training and support the American Academy of Pediatrics' call for more extensive training.
Subject(s)
Child Behavior Disorders/diagnosis , Mood Disorders/diagnosis , Pediatrics/education , Adult , Aged , Child , Child Behavior Disorders/therapy , Child, Preschool , Cognition Disorders/diagnosis , Connecticut , Developmental Disabilities/diagnosis , Expressed Emotion , Family , Female , Humans , Language Disorders/diagnosis , Male , Middle Aged , Mood Disorders/therapy , Motor Activity , Peer Group , Psychophysiologic Disorders/diagnosis , Sleep Wake Disorders/diagnosis , Social WorkABSTRACT
BACKGROUND: Inadequate water and sanitation adversely affect the health of children in developing countries. We aimed to assess the effects of water and sanitation on childhood health in a birth cohort of Peruvian children. METHODS: We followed up children once a day for diarrhoea and once a month for anthropometry, and obtained data for household water and sanitation at baseline. FINDINGS: At 24 months of age, children with the worst conditions for water source, water storage, and sanitation were 1.0 cm (95% CI 0.1-0.8) shorter and had 54% (-1 to 240) more diarrhoeal episodes than did those with the best conditions. Children from households with small storage containers had 28% (1-63) more diarrhoeal episodes than did children from households with large containers. Lack of adequate sewage disposal explained a height deficit of 0.9 cm (0.2-1.7) at 24 months of age. Better water source alone did not accomplish full health benefits. In 24-month-old children from households with a water connection, those in households without adequate sewage disposal and with small storage containers were 1.8 cm (0.1-3.6) shorter than children in households with sewage and with large storage containers. INTERPRETATION: Our findings show that nutritional status is a useful endpoint for water and sanitation interventions and underscores the need to improve sanitation in developing countries. Improved and more reliable water sources should discourage water storage at risk of becoming contaminated, decrease diarrhoeal incidence, and improve linear growth in children.
Subject(s)
Diarrhea/epidemiology , Growth Disorders/epidemiology , Poverty Areas , Sanitary Engineering/standards , Water Microbiology/standards , Water Supply/standards , Age Factors , Child, Preschool , Developing Countries/statistics & numerical data , Follow-Up Studies , Humans , Incidence , Infant, Newborn , Nutritional Status , Peru/epidemiologyABSTRACT
Linear growth retardation during childhood is a determinant of short stature and impaired capacities in adults of developing countries. To study the effect of diarrhea on height during childhood, the authors followed a birth cohort of 224 Peruvian children for 35 months with records of daily diarrhea and monthly anthropometry. This study was conducted from April 1995 to December 1998. At 24 months of age, study children were 2.5 cm shorter than the US National Center for Health Statistics/World Health Organization growth reference. A diarrheal prevalence of 2.3% in the first 24 months of life explained 2-27% of this growth deficit. There was a 2-month delay before the effects of diarrhea on height became manifest. Height deficits were proportional to diarrheal prevalence. For example, children ill with diarrhea 10% of the time during the first 24 months were 1.5 cm shorter than children who never had diarrhea. In addition, the adverse effects of diarrhea on height varied by age. Diarrhea during the first 6 months of life resulted in long-term height deficits that were likely to be permanent. In contrast, diarrhea after 6 months of age showed transient effects. Study results indicate that diarrhea control, especially during the first 6 months of life, is likely to improve linear growth in Peruvian children.
