The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.UNIFESP Departamento de PsiquiatriaUNIFESP Departamento de Psiquiatria Núcleo de Estatística e Metodologia AplicadaEscola de Medicina da Universidade Católica de PelotasDivision of Mental Health PAHOUNIFESP, Depto. de PsiquiatriaUNIFESP, Depto. de Psiquiatria Núcleo de Estatística e Metodologia AplicadaSciEL

Controle estatistico de processo: um modelo para a avaliacao da qualidade de servicos de internacao psiquiatrica

BV UNIFESP: Teses e dissertaçõe

Equity of access to outpatient care and hospitalization among older community residents in Brazil

Objective: To determine whether, as mandated by Brazilian law, health care (outpatient care, hospitalization) among older community residents is based on health-related criteria and not on other characteristics.Research Design: Cross-sectional, population-representative.Subjects: Multistage, random sample of 7040 household residents aged >= 60 years in the state of Rio Grande do Sul, Brazil.Measures: Structured in-person interviews to determine sociodemographic characteristics, self-reported health conditions, psychiatric status, outpatient service use within the previous 6 months, and number of hospitalizations within the previous 12 months.Results: Seventy two percent reported an outpatient visit, 20% reported hospitalization. in controlled analyses, being female, older, unemployed, having private health insurance, increased the odds of an outpatient visit. Males, older persons, the insured, and more educated were more likely to report hospitalization. Race/ethnicity and religious affiliation were not associated with outpatient or hospital use. Pneumonia, heart disease, and urinary tract infection were particularly associated with both outpatient visits and hospitalization; diabetes, hypertension, and cancer with outpatient visit; stroke, cancer and psychiatric disorder with hospitalization; and heart disease, pneumonia, and psychiatric disorder with multiple hospitalizations.Conclusions: Use of health services did not differ by race/ethnicity or religion, but private health insurance facilitated outpatient access, and increased education facilitated hospitalization. Gender, age, and employment status likely reflected differential health needs. Improved access is needed for older persons lacking private health insurance, and those with little education. Patients with psychiatric problems merit increased attention to reduce excessive hospitalization.National Institute on AgingConselho Estadual do Idoso, Secretaria do TrabalhoCidadania a Assistencia SocialGoverno do Estado do Rio Grande do SulUniversidade Federal de São Paulo, Dept Psychiat, BR-04023900 São Paulo, BrazilDuke Univ, Med Ctr, Ctr Study Aging & Human Dev, Durham, NC 27710 USAVet Adm Med Ctr, Geriatr Res Educ & Clin Ctr, Durham, NC USAUniversidade Federal de São Paulo, Dept Psychiat, BR-04023900 São Paulo, BrazilNational Institute on Aging: IP30 AG028716-01Web of Scienc

The Relationship Between Religiosity and Tobacco, Alcohol Use, and Depression in an Elderly Community Population

Objective: the objective of this study is to examine the religious characteristics of older subjects and the associations of these characteristics to the use of tobacco, alcohol, and depression. Methods: Data from a multistage random sample were used to examine associations between religiosity and health behaviors (tobacco use, alcohol) and depression among elderly house hold residents aged 60+ in Rio Grande do Sul, Brazil. Survey measures included sociodemographic characteristics, four aspects of religiosity, tobacco use, alcohol abuse and dependence, depression, life style, social context, functional status, and health conditions. Results: After controlling for demographic, social connections, health behavior, functional status, and health conditions, evangelical affiliation reduced the odds of being a current tobacco user by 51%. Those reporting affiliation as Afro-Brazilian and not having a religion had, respectively, a 74% and 124% increased risk. All other religious domains protect against tobacco use. Not having a religion affiliation and the experience of a religious change increased the risk of alcohol misuse by 88% and 31%, respectively. in contrast, orienting-motivating force increased the odds of depression by 38%. Participating in social religious activities had reduced the risk of depression by 16%. Conclusion: Several aspects of religiosity reduced the odds of being a tobacco user. Not having a religion and the experience of a religious change increased the risk of alcohol misuse. However, the domain orienting-motivating force increased the odds, and participating in social religious activities had reduced the risk of a depressive state. (Am J Geriatr Psychiatry 2008; 16: 934-943)Conselho Estadual do IdosoSecretaria do TrabalhoCidadania e Assistencia SocialGoverno do Estado do Rio Grande do SulUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med, BR-04023900 São Paulo, BrazilHerminio Ometto Univ Ctr, Araras, SP, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med, BR-04023900 São Paulo, BrazilWeb of Scienc