Community violence in neighborhoods and common mental disorders among Brazilian adolescents.

BACKGROUND: This study aims to explore the association between exposure to neighborhood violence and the presence of common mental disorders (CMDs) among Brazilian adolescents aged 12 to 17 years. Additionally, we aim to analyze whether sex, age and race are modifiers of the effect of this association. METHODS: The study comprised 1,686 adolescents residing in the municipality of Rio de Janeiro, situated in the Southeast region of Brazil. To measure exposure to community violence, we constructed three crime indicators using data from Civil Police of the State of Rio de Janeiro: crimes against property, nonlethal crimes, and lethal crimes. Employing geospatial analysis based on the adolescents' residence location, logistic regression modeling was performed to measure the association between violence and CMDs. RESULTS: Adolescents living in regions with higher rates of the three types of violence studied herein were more likely to have CMDs, with odds ratios (ORs) ranging from 2.33 to 2.99. When stratified by sex, age and race, girls, older adolescents and blacks have a greater magnitude of effect on the measure of association, indicating a heightened risk for CMDs. CONCLUSION: This study provides important contributions to the public health field, as it reveals new information on the influence of community violence on the mental health of adolescents. Given the elevated rates of violence globally, knowing the effects of such violence on adolescents becomes crucial for the prevention and treatment of CMDs within this population.

Burnout among primary health care workers in Brazil: results of a multilevel analysis.

PURPOSE: Burnout among health care workers may hamper the quality of care and effectiveness of health systems. Hence, we examined the prevalence of burnout in primary care teams, including community health workers; and investigated associations between individuals' characteristics, team and primary care center factors, and burnout. METHODS: We carried out a cross-sectional study among primary care teams in the city of São Paulo, Brazil (n = 2940). We randomly selected 66 primary care centers. The Maslach burnout inventory was used to investigate burnout. We used multilevel modelling to examine the associations between individuals' characteristics, team and primary care center variables with burnout. RESULTS: We addressed 351 primary care teams, with 11.4% of participants presenting severe burnout. The variance in burnout among primary care workers was partially explained by individuals' characteristics, and by team and primary care center factors. Severe burnout was associated with the following: (1) individuals' characteristics: being black, being younger, a higher length of employment in primary care, and presenting a lack of feedback from supervisors; (2) team factors: working in deprived areas and not receiving the support of a multidisciplinary team; and (3) primary care center factors: inadequate infrastructure (less than one office available per team), and having a bad/very bad relationship with the community council. CONCLUSIONS: To reduce burnout among primary care teams, stakeholders should: (1) train managers/supervisors on leadership styles that prioritize performance feedback, support, and communication skills; (2) allocate catchment areas to teams according to each community's vulnerability; (3) provide a multidisciplinary team to support primary care workers; and (4) offer suitable facilities and infra-structure.

Prevalence of dementia in elderly clients of a private health care plan: a study of the FIBRA-RJ, Brazil.

AIMS: To describe the overall prevalence of dementia syndrome and its major subtypes among elderly clients of a private health care plan and to ascertain the association between this syndrome and socioeconomic characteristics. METHODS: A survey was organized in two stages: screening for cognitive impairment and diagnostic evaluation. The study population comprised 683 elderly subjects (aged >67 years), an expanded sample of 7,486 individuals, of the database of the FIBRA-RJ, which evaluated clients of a private health care plan residing in northern districts of the municipality of Rio de Janeiro, Brazil. The diagnosis of dementia was obtained according to DSM-IV criteria. RESULTS: A total of 115 individuals were diagnosed with dementia, resulting in a prevalence of 16.9% (95% CI = 14.4-19.8). The association was strongest among older age groups, i.e. 85-89 years old (prevalence ratio = 8.85; 95% CI = 2.11-37.11) and 90 or more years old (prevalence ratio = 8.85; 95% CI = 2.11-37.11), and among illiterate people (prevalence ratio = 2.77; 95% CI = 1.07-7.19). Sex, personal income and marital status displayed no association with dementia. CONCLUSION: The prevalence of dementia was higher than found by population-based studies. These findings point to a possibility of a high demand for specialized services among older adults served by the private health care sector.

Depression symptoms and hypothyroidism in a population-based study of middle-aged Brazilian women.

BACKGROUND: Overt hypothyroidism is often recognized as an important cause of depression, but in sub-clinical cases, results are inconsistent and most prior studies have involved small samples. METHODS: We evaluated the association between hypothyroidism and depressive symptoms (PRIME-MD) in a population-based study of 1298 middle-aged women living in a large metropolitan city in Brazil. RESULTS: 45.7% presented depressive symptoms, and 12.3% presented hypothyroidism. Multiple logistic regression analysis adjusting for age, race, smoking and body mass index showed that women with TSH>10 mUI/ml had a threefold chance of presenting depressive symptoms compared to those with normal levels of TSH. Among those with clinical hypothyroidism the adjusted OR was 8.7. CONCLUSION: High levels of TSH were associated to an increased chance of developing depression in the general population. Therefore, depressive symptoms must be considered in patients with thyroid dysfunction and depressed patients should be tested for TSH.

How reproducible is self-reported information on exposure to smoking, drinking, and dietary patterns? Evidence among Brazilian adults in the Pró-Saúde Study.

CONTEXT: Epidemiological studies of the validity and reliability of self-reported information on important risk factors for non-communicable chronic diseases are scarce in Brazil. OBJECTIVE: We evaluated the test-retest reliability of information--overall and stratified by gender, age and education--on active and passive smoking, alcohol intake and aspects of dietary habits. TYPE OF STUDY: Test-retest reliability. SETTING: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. PARTICIPANTS: 192 University employees. PROCEDURES: Self-administered questionnaires were completed on two occasions, two weeks apart. MAIN MEASUREMENTS: Kappa Statistics; Intraclass Correlation Coefficient. RESULTS: Information on smoking status and pack-years smoked had almost perfect levels of agreement, respectively, kappa = 0.97 (95% CI, 0.92-1.00), and intraclass correlation coefficient = 0.93 (CI 95%, 0.89-0.96). Characteristics of alcohol intake yielded substantial levels of agreement (kappa ranging from 0.62 to 0.69). The reproducibility of the information on dietary habits varied from 0.67 to 0.79 (kappa). No clear-cut patterns could be identified comparing information by age or gender. There was a slight tendency towards greater reliability among people with higher levels of education. CONCLUSION: The reproducibility of information on smoking, drinking, and dietary patterns ranged from substantial to excellent, as investigated in the Pró-Saúde Study, a longitudinal investigation recently launched in Rio de Janeiro.