Comparing Regional Cultures Within a Country: Lessons From Brazil

In this joint article we test the common assumption that a measure of culture developed for the national level can also be used for comparing regions within a country. Three different research projects independently measured culture differences within the Federal Republic of Brazil, all three using a version of Hofstede`s Values Survey Module (VSM). The largest provided separate scores for all of Brazil`s 27 states, the next largest for 17 of the more populous states. Factor analyses of VSM item scores across states in both cases only very partly replicated Hofstede`s cross-national dimension structure; only Individualism versus Collectivism reappeared clearly. We attribute this lack of fit to a restriction of range of VSM item scores among states within a common Brazilian national culture. The item scores did show a cultural clustering of states that fairly closely followed the administrative division of the country into five regions. The culture profiles for these regions show remarkable differences between the Northeast with its Afro-Brazilian roots and the North with its native Indian roots. On the issue of comparing regional cultures, we found the VSM, based on global differences, too coarse a net for catching the finer cultural nuances between Brazilian states. Adding locally defined items would have made the studies more meaningful to Brazilians.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.