Cross-national epidemiology of DSM-IV major depressive episode

Background: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low-to middle-income countries in the World Mental Health Survey Initiative. Methods: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. Results: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2: 1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low-to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. Conclusions: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

The interaction between technologies and society: Lessons learnt from 160 evolutionary years of online news services

In mapping the evolutionary process of online news and the socio-cultural factors determining this development, this paper has a dual purpose. First, in reworking the definition of “online communication”, it argues that despite its seemingly sudden emergence in the 1990s, the history of online news started right in the early days of the telegraphs and spread throughout the development of the telephone and the fax machine before becoming computer-based in the 1980s and Web-based in the 1990s. Second, merging macro-perspectives on the dynamic of media evolution by DeFleur and Ball-Rokeach (1989) and Winston (1998), the paper consolidates a critical point for thinking about new media development: that something technically feasible does not always mean that it will be socially accepted and/or demanded. From a producer-centric perspective, the birth and development of pre-Web online news forms have been more or less generated by the traditional media’s sometimes excessive hype about the power of new technologies. However, placing such an emphasis on technological potentials at the expense of their social conditions not only can be misleading but also can be detrimental to the development of new media, including the potential of today’s online news.

Patterns of alcohol consumption in young Australian women: socio-demographic factors, health-related behaviours and physical health

Objective: To determine which sociodemographic factors. health-related behaviours and physical health conditions are associated with non-drinking, binge drinking and hazardous/harmful drinking in young Australian women. Methods: Cross-sectional data were obtained from the baseline survey of 14,762 young women (aged 18-23 years) enrolled in the Women's Health Australia study in 1996. Associations between a range of drinking patterns and sociodemographic factors, health-related behaviours and health conditions were examined. Results: Half the women were 'low intake' drinkers, a third 'rarely drank' and 9% were non-drinkers; however, 70% reported binge drinking with one-quarter of the binge drinkers doing so at least weekly. Nondrinkers were more likely than drinkers to be married, pregnant, non-smokers, born in non-English speaking countries, to live in the Northern Territory, and to have lower levels of education, employment, and private health insurance. Low intake/binge weekly' drinkers (12%) and 'hazardous/ harmful' drinkers (5%) were more likely than 'low risk' drinkers to be unmarried; to live in shared accommodation, alone or with their parents; to live in rural or remote areas; to have ever had any sexually transmitted infection; to be current smokers or ex-smokers and to have used unhealthy weight-control practices. Conclusions: The results confirm findings from other countries about the importance of social conditions as determinants of alcohol consumption by young women. Implications: Health promotion to reduce young women's alcohol consumption needs to be carefully targeted to take account of their demographies, living environments and beliefs.

An unbridgeable gap? Comparing the HIV/AIDS epidemics in Australia and sub-Saharan Africa

OBJECTIVE: To compare the HIV/AIDS epidemics in Australia and sub-Saharan Africa, to outline reasons for differences, and to consider implications for the Asia and Pacific region. METHODS: Comparison of key indicators of the epidemic in Australia, and Africa viewed largely through the experience of the Hlabisa health district, South Africa. RESULTS: To the end of 1997, for all Australia, the estimated cumulative number of HIV infections was approximately 19,000, whereas in Hlabisa 31,000 infections are estimated to have occurred. Compared with the low and declining incidence of HIV in Australia (<1%), estimated incidence in Hlabisa rose to 10% in 1997. In all, 94% of Australian infections have been amongst men; in Hlabisa equal numbers of males and females are infected. Consequently, whereas 3000 children were perinatally exposed to HIV in Hlabisa in 1998 alone, 160 Australian children have been exposed this way. In Australia, HIV-related disease is characterised by opportunistic infection whereas in Hlabisa tuberculosis and wasting dominate. Surveys among gay men in Sydney and Melbourne indicate >80% of HIV infected people receive antiretroviral therapy whereas in Hlabisa these drugs are not available. IMPLICATIONS: It seems possible that Asia and the Pacific will experience a similar HIV/AIDS epidemic to that in Africa. Levels of HIV are already high in parts of Asia, and social conditions in parts of the region might be considered ripe for the spread of HIV. As Australia strengthens economic and political ties within the region, so should more be done to help Pacific and Asian neighbours to prevent and respond to the HIV epidemic.

A typology of community opportunity and vulnerability in metropolitan Australia

A multivariate model using hierarchical clustering and discriminant analysis is used to identify clusters of community opportunity and community vulnerability across Australia's mega metropolitan regions, Variables used in the model measure aspects of structural economic change, occupational change, human capital, income, unemployment, family/household disadvantage, and housing stress. A nine-cluster solution is used to categorise communities across metropolitan space. Significant between-city variations in the incidence of these clusters of opportunity and vulnerability are apparent, suggesting the emergence of marked differentiation between Australia's mega metropolitan regions in their adjustments to changing economic and social conditions. JEL classification: C49, R11, R12.

Os gêneros de discurso, cenografia e ethos em discursos da obra O templo e a forca de Luiz Guilherme Santos Neves

A pesquisa busca mostrar como o discurso religioso do gênero sermão, na voz do enunciador Frei Gregório José Maria de Bene, pode influir na estratégia de adesão e convencimento dos escravos da região de Serra, província do Espírito Santo, para a construção da igreja do Queimado. O sermão citado é o recorte fundamental do discurso literário O Templo e a Forca (1999), recriado por Luiz Guilherme Santos Neves, analisado a partir de cena englobante legitimadora. O trabalho insere-se nos estudos da Analise do Discurso (AD) de linha francesa, pelo referencial teórico de Dominique Maingueneau, que nos orientará quanto às cenografias do padre, sua imagem de enunciador, as condições de produção do sermão, ressaltando elementos que interagem no embate, visando à sociedade da época e às questões culturais dos envolvidos na eclosão da revolta. O principal objetivo é examinar as cenas de enunciação e como se constrói o ethos religioso em cada cena e suas variadas funções. É elementar dizer que o religioso se reconstrói a cada momento a partir do comprometimento com as situações de comunicação. Para maior entendi-mento, dizemos que essas diversas reconstruções apresentam nos discursos diferentes encenações desse tão fomentado religioso com suas estratégias de adesão, apresentando-se ora com a imagem daquele que fala em nome de Deus, preza a docilidade da vida do campo à sombra das andirobeiras gigantes onde se pode sentir o silêncio que convida à contemplação e à prece; ora aquele comprometido com seus propósitos interesseiros e pessoais. Fala para não ser entendido, e o que vale é erguer a casa de São José sem poupar a carne e o sangue das mortes que virão. Importa ressaltar que sempre há possibilidade de olhar ingênuo sobre texto religioso, que, conforme Main-gueneau (2010), só é legível relacionado a vasto intertexto que contribuirá para estruturar o discurso. Para enriquecer ainda mais este estudo, afora o gênero sermão usamos recortes que estruturam o discurso de Neves e sinalizam as variadas cenografias e a forma como se constituem enquanto gêneros: Diálogo interior – momentos solitários do frade – Visão do frade e Monólogo; Diálogo Compartilhado – segmenta diálogos entre o enunciador e seus vários co-enunciadores, que estruturam os acontecimentos do discurso; e o gênero exortação, do padre aos escravos. Os recortes são momentos de grandes embates recriados pelo autor, em discurso leve fazendo seu leitor transitar prazerosamente junto ao frade entre as suas variadas imagens nos discursos. Levando o leitor a acreditar tratar-se de cenas relacionadas ao gênero cômico. E talvez o fosse, se não terminasse em revolta.

Multidimensional aspects related to shiftworkers' health and well-being

The impact of shift and night work on health shows a high inter- and intra-individual variability, both in terms of kind of troubles and temporal occurrence, related to various intervening factors dealing with individual characteristics, lifestyles, work demands, company organisation, family relations and social conditions. The way we define "health" and "well-being" can significantly influence appraisals, outcomes and interventions. As the goal is the optimisation of shiftworkers' health, it is necessary to go beyond the health protection and to act for health promotion. In this perspective, not only people related to medical sciences, but many other actors (ergonomists, psychologists, sociologists, educators, legislators), as well as shiftworkers themselves. Many models have been proposed aimed at describing the intervening variables mediating and/or moderating the effects; they try to define the interactions and the pathways connecting risk factors and outcomes through several human dimensions, which refer to physiology, psychology, pathology, sociology, ergonomics, economics, politics, and ethics. So, different criteria can be used to evaluate shiftworkers' health and well-being, starting from biological rhythms and ending in severe health disorders, passing through psychological strain, job dissatisfaction, family perturbation and social dis-adaptation, both in the short- and long-term. Consequently, it appears rather arbitrary to focus the problem of shiftworkers' health and tolerance only on specific aspects (e.g. individual characteristics), but a systemic approach appears more appropriate, able to match as many variables as possible, and aimed at defining which factors are the most relevant for those specific work and social conditions. This can support a more effective and profitable (for individuals, companies, and society) adoption of preventive and compensative measures, that must refer more to "countervalues" rather than to "counterweights".

Impact of socioeconomic status on Brazilian elderly health

OBJECTIVE: To investigate the impact of socioeconomic status on elderly health. METHODS: The study was based on cross-sectional data from Survey on Health, Well-Being, and Aging in Latin America and the Caribbean. The sample comprised 2,143 non-institutionalized elderly aged 60 years and older living in the urban area of São Paulo, southeastern Brazil. Linear regression models estimated the effect of socioeconomic status indicators (years of schooling completed, occupation and purchasing power) on each one of the following health indicators: depression, self-rated health, morbidity and memory capacity. A 5% significance level was set. RESULTS: There was a significant effect of years of education and purchasing power on self-rated health and memory capacity when controlled for the variables number of diseases during childhood, bed rest for at least a month due to health problems during childhood, self-rated health during childhood, living arrangements, sex, age, marital status, category of health insurance, intake of medicines. Only purchasing power had an effect on depression. Despite the bivariate association between socioeconomic status indicators and number of diseases (morbidity), this effect was no longer seen after including the controls in the model. CONCLUSIONS: The study results confirm the association between socioeconomic status indicators and health among Brazilian elderly, but only for some dimensions of socioeconomic status and certain health outcomes.

The epidemiologic paradox of low birth weight in Brazil

OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS: LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS: In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS: The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.

Cognitive models for the concept of angle

Tese de doutoramento em Filosofia