Trans-cultural aspects of social anxiety disorder and related conditions: a Brazilian case series and a review of international clinical studies

Cross-cultural studies have much to teach clinicians and researchers alike about psychopathology in general and about social anxiety disorder (SAD) in particular. Unfortunately, little is known about the degree and the mechanisms through which cultural environment may influence clinical manifestations of SAD. OBJECTIVE: Our objective was to identify culture-related clinical patterns in SAD and related disorders. METHODS: We described socio-demographic and clinical characteristics of a sample of 62 adult outpatients with SAD seen at a university clinic for anxiety and depressive disorders in Rio de Janeiro, Brazil, and compared them with those reported in clinical samples from North America, Europe, Asia and Oceania identified through a systematic review in Medline, PsychINFO, and LILACS. RESULTS: Our comparison of trans-cultural features of SAD lends partial support to Heimberg's (1997) contention that the majority of socio-demographic features and symptoms of this disorder are relatively independent of geographic and cultural differences. CONCLUSION: Patients with SAD were almost universally characterized by: 1) a predominance of males in clinical samples; 2) early onset of the disorder; 3) high educational attainment; and 4) great frequency of comorbidities.

Diversity and aspects of the ecology of social wasps (Vespidae, Polistinae) in Central Amazonian "terra firme" forest

Diversity and aspects of the ecology of social wasps (Vespidae, Polistinae) in Central Amazonian "terra firme" forest. The knowledge of social wasp richness and biology in the Amazonian region is considered insufficient. Although the Amazonas state is the largest in the region, until now only two brief surveys were conducted there. Considering that the systematic inventory of an area is the first step towards its conservation and wise use, this study presents faunal data on social wasp diversity in a 25 km² area of "terra firme" (upland forest) at the Ducke Reserve, Manaus, Amazonas, Brazil. Wasps were collected in the understory, following a protocol of three collectors walking along 60 trails 1,000 m in extension for 16 days between August and October 2010. Methods used were active search of individuals with entomological nets and nest collecting. Fifty-eight species of social wasps, allocated in 13 genera, were recorded; 67% of the collected species belong to Polybia, Agelaia and Mischocyttarus; other genera were represented by only four species or less. The most frequent species in active searches were Agelaia fulvofasciata (DeGeer, 1773), Agelaia testacea (Fabricius, 1804) and Angiopolybia pallens (Lepeletier, 1836). Twelve species were collected in nests. Prior to this study, 65 Polistinae species were deposited at the INPA Collection. Collecting in the study grid, an area not previously sampled for wasps, resulted in an increase of 25% species, and species richness was 86. According to the results, there is evidence that the diversity of social wasps at the Ducke Reserve is even higher, making it one of the richest areas in the Brazilian Amazonia.

Demand for and availability of online support to stop smoking

OBJECTIVES: Estimate the frequency of online searches on the topic of smoking and analyze the quality of online resources available to smokers interested in giving up smoking. METHODS: Search engines were used to revise searches and online resources related to stopping smoking in Brazil in 2010. The number of searches was determined using analytical tools available on Google Ads; the number and type of sites were determined by replicating the search patterns of internet users. The sites were classified according to content (advertising, library of articles and other). The quality of the sites was analyzed using the Smoking Treatment Scale- Content (STS-C) and the Smoking Treatment Scale - Rating (STS-R). RESULTS: A total of 642,446 searches was carried out. Around a third of the 113 sites encountered were of the 'library' type, i.e. they only contained articles, followed by sites containing clinical advertising (18.6) and professional education (10.6). Thirteen of the sites offered advice on quitting directed at smokers. The majority of the sites did not contain evidence-based information, were not interactive and did not have the possibility of communicating with users after the first contact. Other limitations we came across were a lack of financial disclosure as well as no guarantee of privacy concerning information obtained and no distinction made between editorial content and advertisements. CONCLUSIONS: There is a disparity between the high demand for online support in giving up smoking and the scarcity of quality online resources for smokers. It is necessary to develop interactive, customized online resources based on evidence and random clinical testing in order to improve the support available to Brazilian smokers.

Epidemology and clinical aspects of human rabies in Minas Gerais, Brasil: misdiagnosis and misunderstandings on the psychopathological disturbances

This paper reports 40 cases of human rabies studied at the Carlos Chagas Hospital of UFMC, State of Minas Gerais, Brazil, from 1963 through 1976. From the epidemioiogical point of view it is concluded that the magnitude of the problem of human rabies in underdeveioped countries remains quite unknown. Speciai emphasis is given to the lack of apropriate knowledge of the recommended preventive measures, and to the influence of health education and socio-economic-cultural structure of the communities. The classic clinical picture of human rabies is briefiy described, particular attention being drawn to psychopathologic features of rabies encephalomyeiitis. it is pointed out that in some cases the mental symptoms may predominate from the onset of the illness, adding difficuity to the diagnosis. According to the Authors, human rabies must be differentiated from several psychopathologic syndromes and also from encephalomyelitis due to other central nervous system infections. It is discussed whether the fataiistic concept of human rabies would be somehow contributing to delay a better understanding of the natural history of the disease.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7% were male participants, and 60% were brown. Concerning the age, 54.8% of women were between 35 and 49 years, and 57.6% of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3% of cases, and the multibacillary form was found in 72.9%. The skin smear was positive in 42.3%. The occurrence of reaction was found in 43.5% of cases, and 83.5% had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7% of the patients. Most of the individuals (96.4%) lived in houses made of brick with more than three rooms (72.6%) and two persons per room (65.1%). Concerning the level of education, 41.4% of women and 34.1% of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5%), and that in the end was the age group of 20 to 34 (29.9%) with Grade 0, 30.7% Grade 1, and 11.5% Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

Epidemiologic aspects of toxoplasmosis and evaluation of its seroprevalence in pregnant women

INTRODUCTION: The aim of the present study was to analyze the exposure to risk factors for toxoplasmosis disease and the level of knowledge in pregnant women who were treated by the Public Health Care System (SUS) from October 2007 to September 2008 in Divinópolis City, Brazil. METHODS: We analyzed 2,136 prenatal exams of pregnant women that were treated from October 2007 to September 2008. RESULTS: Out of the 2,136 pregnant women evaluated, 200 answered a quantitative questionnaire; 49.5% were seropositive for immunoglobulin (Ig) G and 3.6% for IgM. Comparative analysis of congenital toxoplasmosis cases were evaluated in 11 regions and showed an irregular distribution (p < 0.01). This difference was also observed among the pregnant women observed in each location. The results from the questionnaire show that 93% of the pregnant women had no knowledge about toxoplasmosis, and 24% presented with positive serology, but no clinical manifestation. Analysis for pregnant IgG-positive women and the presence of pets showed a statistically significant correlation (p < 0.05), suggesting that the transmission of this disease might occur in the domestic environment. CONCLUSIONS: We suggest the implementation of a triage program for pregnant women and health education to encourage their use of SUS services.

Epidemiological aspects of schistosomiasis in workers of the Movement of Landless Rural Workers

Introduction Schistosomiasis is endemic in 74 countries and is considered a serious public health problem in some locations. Methods A transverse study was performed of 13 landless settlements in southern Sergipe from February to December 2009. The study included 822 settlers, of whom 601 underwent stool testing. Results The prevalence of schistosomiasis in landless workers was 4.3%. The population has a low education level, and basic sanitation services are not available to all residents. Conclusions The prevalence of schistosomiasis was low in the population and among different settlements, possibly because of different forms of water use by the settlers.

Socioeconomic aspects of spousal concordance for hypertension, obesity, and smoking in a community of Rio de Janeiro, Brazil

OBJECTIVE: The present study aims to evaluate the environmental role in the distribution of hypertension, obesity, and smoking and spousal concordance for the presence/absence of these 3 cardiovascular risk factors. METHODS: A cross-sectional study was conducted in a community in Rio de Janeiro, Brazil. The households were randomly selected. Odds ratios were estimated to measure spousal concordance, across socioeconomic levels.. RESULTS: Overall a significant aggregation of all 3 risk factors was present. The crude odds ratio for hypertension was 1.78 (95%CI=1.02-3.08); for obesity, it was 1.80 (95%CI=1.09-2.96); and for smoking, it was 3.40 (95% CI=2.07-5.61). The spousal concordance for hypertension decreased significantly (p<0.001) from the lower to the higher educational level. In the case of obesity and smoking, the opposite was observed, although p-values for the linear trend were 0.10 and 0.08, respectively. CONCLUSION: In lower socioeconomic levels, couples are more concordant for hypertension and discordant for smoking. For hypertension and smoking, education seems to be a discriminant stronger than income, but for obesity the 2 socioeconomic indicators seem to represent different aspects of the environmental determinants of risk factor distribution.

Epidemiological and control aspects of schistosomiasis in Brazilian endemic areas

The present work analyzes the epidemiology of schistosomiasis in Brazil, its expansion, the attempts to control the disease, and the overall difficulties. The authors present the distribution of schistosomiasis intermediary hosts in Brazil, the migration routes of the human population, and disease distribution in highly and lowly endemic areas and isolated foci. They also analyze the controlling programs developed from 1977 to 2002, indicating the prevalence evolution and the reduction of disease morbi-mortality. In addition, the authors also evaluate controlling methods and conclude that: (a) no isolated method is able to control schistosomiasis, and every controlling program should consider the need of a multidisciplinary application of existing methods; (b) in long term, basic sanitation, potable water supply, as well as sanitary education, and community effective participation are important for infection control; (c) in short term, specific treatment at endemic areas, associated with control of intermediary hosts at epidemiologically important foci, are extremely relevant for controlling disease morbidity, although not enough for interrupting infection transmission.

The impact of two education methods on knowledge of schistosomiasis transmission and prevention among schoolchildren in a rural community in northern Minas Gerais, Brazil

The objective of this study was to analyse the effect of using two health education approaches on knowledge of transmission and prevention of schistosomiasis of school children living in a rural endemic area in the state of Minas Gerais, Brazil. The 87 children participating in the study were divided into three groups based on gender, age and presence or absence of Schistosoma mansoni infection. In the first group the social representation model and illness experience was used. In the second group, we used the cognitive model based on the transmission of information. The third group, the control group, did not receive any information related to schistosomiasis. Ten meetings were held with all three groups that received a pre-test prior to the beginning of the educational intervention and a post-test after the completion of the program. The results showed that knowledge levels in Group 1 increased significantly during the program in regard to transmission (p = 0.038) and prevention (p = 0.001) of schistosomiasis. Groups 2 and 3 did not show significant increase in knowledge between the two tests. These results indicate that health education models need to consider social representation and illness experience besides scientific knowledge in order to increase knowledge of schistosomiasis transmission and prevention.

Solvability of mental health care in the Family Health Strategy: social representation of professionals and users

Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.


Social representation of domestic violence against women among Nursing Technicians and Community Agents

OBJECTIVE To analyze the social representations of the Nursing Technicians and Community Health Agents about domestic violence against women. METHOD A qualitative study carried out in the city of Rio Grande, RS, in which evocations and interviews were collected between July and November 2013. For the treatment of data were used the EVOC 2005 software and the context analysis. RESULT It is a structured representation, in which the central nucleus contains conceptual, imaging and attitudinal elements, namely: abuse, aggression, physical aggression, cowardice and lack of respect. Such terms were present in the context of the interviews. The professionals acknowledged that violence is not limited to physical aspects and were judgemental about the acts of the aggressor. CONCLUSION This knowledge may enable the problematization of the studied phenomenon with the team, and facilitate the search for prevention and intervention strategies for victims, offenders and managers of health services.

Social representation of Alzheimer's disease for family caregivers: stressful and rewarding

Abstract OBJECTIVE To understand the content of Social Representation (SR) of family caregivers of Alzheimer's disease patients. METHOD Interviews were conducted with 26 caregivers and analyzed by the ALCESTE software. RESULTS The SR content was structured in two thematic axes called Daily Life and Care and Medical and Emotional Concepts and Outcomes. The first axis creates images related to the routine of interaction with the sick person, and contains a description of care procedures, experiences, and practices applied every day. The second is composed of subjective and conceptual aspects that make up the social representation of Alzheimer's disease, with meanings related to the emotional, medical, and biological contexts. CONCLUSION Due to the importance of topics related to patients' dependence and the personal and emotional consequences of the disease, overload is the main content of the SR of Alzheimer's disease for caregivers, and the understanding of these SR by health professionals should support the planning of interventions addressing this group of individuals.

Social disability of Brazilian mood disorder patients

Mood disorders cause many social problems, often involving family relationships. Few studies are available in the literature comparing patients with bipolar, unipolar, dysthymic, and double depressive disorders concerning these aspects. In the present study, demographic and disease data were collected using a specifically prepared questionnaire. Social adjustment was assessed using the Disability Adjustment Scale and family relationships were evaluated using the Global Assessment of Relational Functioning Scale. One hundred patients under treatment for at least 6 months were evaluated at the Psychiatric Outpatient Clinic of the Botucatu School of Medicine, UNESP. Most patients were women (82%) more than 50 (49%) years old with at least two years of follow-up, with little schooling (62% had less than 4 years), and of low socioeconomic level. Logistic regression analysis showed that a diagnosis of unipolar disorder (P = 0.003, OR = 0.075, CI = 0.014-0.403) and dysthymia (P = 0.001, OR = 0.040, CI = 0.006-0.275) as well as family relationships (P = 0.002, OR = 0.953, CI = 0914-0.992) played a significant role in social adjustment. Unipolar and dysthymic patients presented better social adjustment than bipolar and double depressive patients (P < 0.001), results that were not due to social class. These patients, treated at a teaching hospital, may represent the severest mood disorder cases. Evaluations were made knowing the diagnosis of the patients, which might also have influenced some of the results. Social disabilities among mood disorder patients are very frequent and intensive.