Biomedical subjects

O Gureje

Publications and source records attributed to O Gureje.

At least 19 recordsLinked to original sources

PubMed2006

Risk factors for incident Alzheimer's disease in African Americans and Yoruba.

INTRODUCTION: The incidence rate of Alzheimer's disease (AD) was found to be 2 times lower in Yoruba than in African Americans. This study was aimed at identifying the factors associated with increased risk of incident AD in the two communities. METHODOLOGY: A two-stage design with initial screening using the CSI'D followed by neuropsychological test battery, relations' interview and physician assessment in a sub-sample.NINCDS-ADRDA criteria were met for AD. The risk factor variables assessed included demographic, lifestyle, medical and family history items. RESULTS: In the Yoruba, AD was associated with age (OR = 1.07) and female gender (OR = 2.93). In African Americans, age (OR = 1.09) and rural living (OR = 2.08) were the significant risk factors, while alcohol was protective (OR = 0.49). DISCUSSION: Age was a significant risk factor for AD at both sites. The higher risk of incident AD in the Yoruba female, and in African Americans who resided in rural areas in childhood were similar with the prevalence cases. Alcohol emerged a protective factor in African Americans. More studies are required, including biological measurements, to adequately explain the differences in rates.

Black or African American↗

PubMed2006

The development of a semi-structured home interview (CHIF) to directly assess function in cognitively impaired elderly people in two cultures.

BACKGROUND: Assessing function is a crucial element in the diagnosis of dementia. This information is usually obtained from key informants. However, reliable informants are not always available. METHODS: A 10-item semi-structured home interview (the CHIF, or Clinician Home-based Interview to assess Function) to assess function primarily by measuring instrumental activities of daily living directly was developed and tested for inter-rater reliability and validity as part of the Indianapolis-Ibadan dementia project. The primary validity measurements were correlations between scores on the CHIF and independently gathered scores on the Blessed Dementia Scale (from informants) and the Mini-mental State Examination (MMSE). Sensitivities and specificities of scores on the CHIF and receiver operator characteristic (ROC) curves were constructed with dementia as the dependent variable. RESULTS: Inter-rater reliability for the CHIF was high (Pearson's correlation coefficient 0.99 in Indianapolis and 0.87 in Ibadan). Internal consistency, in both samples, was good (Cronbach's alpha 0.95 in Indianapolis and 0.83 in Ibadan). Scores on the CHIF correlated well with the Blessed Dementia scores at both sites (-0.71, p < 0.0001 for Indianapolis and -0.56, p < 0.0001 for Ibadan) and with the MMSE (0.75, p < 0.0001 for Indianapolis and 0.44, p < 0.0001 for Ibadan). For all items at both sites, the subjects without dementia performed significantly better than those with dementia. The area under the ROC curve for dementia diagnosis was 0.965 for Indianapolis and 0.925 for Ibadan. CONCLUSION: The CHIF is a useful instrument to assess function directly in elderly participants in international studies, particularly in the absence of reliable informants.

Activities of Daily Living↗

PubMed2006

Cholesterol, APOE genotype, and Alzheimer disease: an epidemiologic study of Nigerian Yoruba.

OBJECTIVE: To examine the relationship between cholesterol and other lipids, APOE genotype, and risk of Alzheimer disease (AD) in a population-based study of elderly Yoruba living in Ibadan, Nigeria. METHODS: Blood samples and clinical data were collected from Yoruba study participants aged 70 years and older (N = 1,075) as part of the Indianapolis-Ibadan Dementia Project, a longitudinal epidemiologic study of AD. Cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels were measured in fasting blood samples. DNA was extracted and APOE was genotyped. Diagnoses of AD were made by consensus using National Institute of Neurologic Disorders/Stroke-Alzheimer's Disease and Related Disorders Association criteria. RESULTS: Logistic regression models showed interaction after adjusting for age and gender between APOE-epsilon4 genotype and biomarkers in the risk of AD cholesterol*genotype (p = 0.022), LDL*genotype (p= 0.018), and triglyceride*genotype (p = 0.036). Increasing levels of cholesterol and LDL were associated with increased risk of AD in individuals without the APOE-epsilon4 allele, but not in those with APOE-epsilon4. There was no significant association between levels of triglycerides and AD risk in those without APOE-epsilon4. CONCLUSIONS: There was a significant interaction between cholesterol, APOE-epsilon4, and the risk of Alzheimer disease (AD) in the Yoruba, a population that has lower cholesterol levels and lower incidence rates of AD compared to African Americans. APOE status needs to be considered when assessing the relationship between lipid levels and AD risk in population studies.

Aged↗

PubMed2004

[Mental health care in developing countries: the example of Nigeria].

The availability of mental health resources in most developing countries is poor due to scarcity of resources, competing health problems, and the low priority given to mental health issues. In Nigeria, modern psychiatric care is developing, but as yet most people have no access to it because they cannot afford the treatment. Moreover, treatment facilities are mainly concentrated in large urban centers. The cooperation between the authors of this article is aimed at improving the provision of psychiatric care for people living in Ibadan, Nigeria and rural areas close to the city. We report about the foundation of an association to provide help for mentally ill patients in Africa.

Cross-Sectional Studies↗

PubMed2003

Psychosocial problems of clinical students in the University of Ibadan Medical School.

A cross sectional study was carried out among medical students in the University of Ibadan to identify their socio economic and psychological problems. Three hundred and sixteen students, 159 males and 157 females participated in the study. The questionnaire, which was self-administered, sought information about sources of financial support, type of accommodation, use of recreational facilities, smoking and drinking habits and sources of stress and insecurity on the campus. The GHQ-12 was used to assess their mental status. Ninety-four percent of students were sponsored by their parents. Average monthly income as pocket money ranged from N800-N15,000. Sixty-three (20%) reported that their pocket money was inadequate and 11 (3.5%) engage in business ventures to supplement their income. Two hundred and fifty-seven (81%) live on the campus, 11 (3.5%) were current smokers and 54 (18%) were current drinkers. Stealing and lack of money were the commonest causes of insecurity on the campus. Lack of money, fear of failure of examinations, family problems and broken relationships were reported as causes of depression among this study population. GHQ scores ranged from 1 to 9 using a cut-off point of 3 scores, 38 students (12.0%) were categorised as having traits of poor mental health. GHQ scores were not associated with age, sex, smoking or drinking status or students' assessment of the adequacy of their pocket money. However, living off campus and poor self-perception were associated with poor mental health (p < 0.01). Counseling services should be provided in the medical school to assist students to handle issues that constitute a source of stress in their psychosocial environment.

Adult↗

PubMed2002

The Australian National Survey of Psychotic Disorders: profile of psychosocial disability and its risk factors.

BACKGROUND: Knowledge of the level of psychosocial impairment associated with psychosis is important in evaluating the impact of the illness on those affected. When such knowledge is derived from community-based epidemiological surveys, it can help in providing a public health perspective for service planning with information derived from representative samples of patients. METHODS: A two-phase epidemiological survey of persons with psychosis in four predominantly urban areas of Australia. First phase screening for psychosis (N= 5,710) was followed by a semi-structured interview of a stratified random sample (N = 980) to assess psychopathology (lifetime and current) and psychosocial disability. RESULTS: Most of the interviewees were unemployed and had never married. There was widespread impairment in sexual and social relationships and in the performance of activities of daily living. Over half expressed dissatisfaction with life in general. Persons with affective psychoses were often as disabled as those with schizophrenia and diagnostic categorizations were not important in the conferment of risk for disability. Rather, poor pre-morbid work or social adjustment and poor course of illness were potent risk factors for diverse forms of disability in persons with psychosis. CONCLUSION: A large proportion of persons with experience of psychosis living in the community suffers from significant levels of psychosocial disability. Disablement seems to reflect, in part, a diathesis of poor pre-morbid functioning and less than optimal response to treatment of the disorder.

Activities of Daily Living↗

PubMed2002

Cognitive impairment in community-dwelling older Nigerians: clinical correlates and stability of diagnosis.

To determine correlates and outcome of cognitive impairment without dementia in community-dwelling elderly Nigerians. A total of 2487 community residents aged 65 years and over were screened using the Community Screening Interview for Dementia. A subset of 423 individuals received diagnostic clinical evaluation. Participants were diagnosed normal, demented, or cognitive impairment no dementia (CIND). Follow-up clinical diagnostic evaluation was conducted on CIND subjects approximately 2 years later. One hundred and fifty-two persons were diagnosed CIND. Eighty-seven CIND subjects were seen at follow-up assessment, 14 (16.1%) had converted to dementia, 22 (25.3%) reverted to normal, and 51 (58.6%) remained CIND. No baseline factors predicted later development of dementia amongst the CIND subjects. CIND subjects who reverted to normal tended to be male and to have higher baseline cognitive scores. Apolipoprotein status was not related to diagnosis at follow-up. CIND is common in community-dwelling Nigerians. Although the outcome is variable, it does represent a high-risk group for subsequent dementia.

Aged↗

PubMed2001

Prevalence of cognitive impairment: data from the Indianapolis Study of Health and Aging.

BACKGROUND: The epidemiology and natural history of cognitive impairment that is not dementia is important to the understanding of normal aging and dementia. OBJECTIVE: To determine the prevalence and outcome of cognitive impairment that is not dementia in an elderly African American population. METHOD: A two-phase, longitudinal study of aging and dementia. A total of 2212 community-dwelling African American residents of Indianapolis, IN, aged 65 and older were screened, and a subset (n = 351) received full clinical assessment and diagnosis. Subsets of the clinically assessed were seen again for clinical assessment and rediagnosis at 18 and 48 months. Weighted logistic regression was used to generate age-specific prevalence estimates. RESULTS: The overall rate of cognitive impairment among community-dwelling elderly was 23.4%. Age-specific rates indicate increasing prevalence with increasing age: 19.2% for ages 65 to 74 years, 27.6% for ages 75 to 84 years, and 38.0% for ages 85+ years. The most frequent cause of cognitive impairment was medically unexplained memory loss with a community prevalence of 12.5%, followed by medical illness-associated cognitive impairment (4.0% prevalence), stroke (3.6% prevalence), and alcohol abuse (1.5% prevalence). At 18-month follow-up, 26% (17/66) of the subjects had become demented. CONCLUSIONS: Cognitive impairment short of dementia affects nearly one in four community-dwelling elders and is a major risk factor for later development of dementia.

Age Distribution↗

PubMed2001

Incidence of dementia and Alzheimer disease in 2 communities: Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana.

CONTEXT: Alzheimer disease (AD) represents a major and increasing public health problem. If populations were identified with significantly lower or higher incidence rates of AD, the search for risk factors in the genesis of AD could be greatly enhanced. OBJECTIVE: To compare incidence rates of dementia and AD in 2 diverse, elderly community-dwelling populations. DESIGN: The Indianapolis-Ibadan Dementia Project, a longitudinal, prospective population-based study consisting of a baseline survey (1992-1993) and 2 subsequent follow-up waves after 2 years (1994-1995) and 5 years (1997-1998). Each wave followed a 2-stage design, with an in-home screening interview followed by a full diagnostic workup of a subsample of participants based on screening performance. SETTING AND PARTICIPANTS: A total of 2459 community-dwelling Yoruba residents of Ibadan, Nigeria, without dementia, and 2147 community-dwelling African American residents of Indianapolis, Ind, without dementia (all aged 65 years or older). The cohorts were followed up for a mean of 5.1 years and 4.7 years, respectively. MAIN OUTCOME MEASURES: Incident cases of dementia and AD in each of the 2 populations. RESULTS: The age-standardized annual incidence rates were significantly lower among Yoruba than among African Americans for dementia (Yoruba, 1.35% [95% confidence interval [CI], 1.13%-1.56%]; African Americans, 3.24% [95% CI, 2.11%-4.38%]) and for AD (Yoruba, 1.15% [95% CI, 0.96%-1.35%]; African Americans, 2.52% [95% CI, 1.40%-3.64%]). CONCLUSION: This is the first report of incidence rate differences for dementia and AD in studies of 2 populations from nonindustrialized and industrialized countries using identical methods and the same group of investigators in both sites. Further explorations of these population differences may identify potentially modifiable environmental or genetic factors to account for site differences in dementia and AD.

Aged↗

PubMed2001

The burden of mental disorders in Victoria, 1996.

BACKGROUND: Between 1998 and 1999, a burden of disease assessment was carried out in Victoria, Australia applying and improving on the methods of the Global Burden of Disease Study. This paper describes the methods and results of the calculations of the burden due to 22 mental disorders, adding 14 conditions not included in previous burden of disease estimates. METHODS: The National Survey of Mental Health and Wellbeing provided recent data on the occurrence of the major adult mental disorders in Australia. Data from international studies and expert advice further contributed to the construction of disease models, describing each condition in terms of incidence, average duration and level of severity, with adjustments for comorbidity with other mental disorders. Disability weights for the time spent in different states of mental ill health were borrowed mainly from a study in the Netherlands, supplemented by weights derived in a local extrapolation exercise. RESULTS: Mental disorders were the third largest group of conditions contributing to the burden of disease in Victoria, ranking behind cancers and cardiovascular diseases. Depression was the greatest cause of disability in both men and women. Eight other mental disorders in men and seven in women ranked among the top twenty causes of disability. CONCLUSIONS: Insufficient information on the natural history of many of the mental disorders, the limited information on the validity of mental disorder diagnoses in community surveys and considerable differences between ICD-10 and DSM-IV defined diagnoses were the main concerns about the accuracy of the estimates. Similar and often greater concerns have been raised in relation to the estimation of the burden from common non-fatal physical conditions such as asthma, diabetes and osteoarthritis. In comparison, psychiatric epidemiology can boast greater scientific rigour in setting standards for population surveys.

Adolescent↗

PubMed2001

A cross-national study of the course of persistent pain in primary care.

Data from the World Health Organization's study of psychological problems in general health care were used to examine the course of persistent pain syndromes among primary care patients. Across 15 sites in 14 countries, 3197 randomly selected primary care patients completed baseline and 12-month follow-up assessments of pain, other somatic symptoms, and anxiety and depressive disorders (the Composite International Diagnostic Interview), and an assessment of occupational role disability (the Social Disability Schedule). Of patients with a persistent pain condition at baseline, 49% had not recovered 12 months later. The probability of non-recovery varied significantly across study centers and was significantly associated with the number of pain sites at baseline. After adjustment for age, sex, and study center, baseline anxiety or depressive disorder did not predict non-recovery of persistent pain. Among those without a persistent pain disorder at baseline, the rate of onset was 8.8% with a significant variability in risk across centers. The baseline characteristics predicting the onset of persistent pain disorder were psychological disorder, poor self-rated health, and occupational role disability. A persistent pain disorder at baseline predicted the onset of a psychological disorder to the same degree that a baseline psychological disorder predicted the subsequent onset of persistent pain. Persistent pain conditions are common among primary care patients, and the probability of resolution over 12 months is approximately 50%. We found a strong and symmetrical relationship between persistent pain and psychological disorder. Impairment of daily activities appears to be a central component of that relationship.

Adult↗

PubMed2001

Defining disability in psychosis: performance of the diagnostic interview for psychosis-disability module (DIP-DIS) in the Australian National Survey of Psychotic Disorders.

OBJECTIVE: We aimed to use data from the Australian Survey of Mental Health and Wellbeing to examine the psychometric properties of the Diagnostic Interview for Psychosis-Disability Module (DIP-DIS). The DIP-DIS is a semi-structured questionnaire specially designed to assess disability associated with psychotic disorders. METHOD: The psychometric properties of the instrument were determined by examining its inter-rater reliability, internal structure, as well as its criterion and discriminant validities. RESULTS: Analysis shows: (1) that it can be rated reliably by trained interviewers, (2) that the items are complementary but tap a number of different domains, (3) that four factors account for over 66% of the variance, and (4) that it is sensitive to differing clinical populations with expected differences in level of disability. Ratings on the DIP-DIS bore significant relationships with a criterion measure of quality of life. CONCLUSIONS: The DIP-DIS has encouraging psychometric properties for cross-sectional assessment of disability and may be useful in future studies of disablement associated with psychosis. Future work should examine its sensitivity to change.

Adult↗

PubMed2000

Epidemiology of dementia in Nigeria: results from the Indianapolis-Ibadan study.

We determined the prevalence of dementia in a cohort of 2494 elderly Nigerians residents in Idikan Community, Ibadan, Nigeria. We utilized the Community Screening Instrument for Dementia to select subjects for clinical assessment in the second stage. The findings were compared with those of 2212 African Americans living in Indianapolis, studied simultaneously using similar methodology. The overall age-adjusted prevalence rates of dementia and Alzheimer's disease in Ibadan were 2.29% and 1.41%, respectively. These rates were much lower than the respective values of 8.24% and 6.24% obtained for African Americans. In Ibadan, Alzheimer's disease accounted for 64.3% of the cases, with old age and female gender being the significant risk factors, whilst 'living with others' appeared to be protective (P < 0.05). Amongst African Americans, on the other hand, old age, rural living below the age of 19 years, low educational attainment and family history of dementia were the risk factors. There was a lack of association between Alzheimer's disease and possession of the apolipoprotein E epsilon4 allele in the Nigerian sample, unlike the finding in African Americans, where significant association was shown. In addition, the frequencies of the vascular risk factors investigated were lower in Nigerians. Our results showed lower prevalence of dementia and Alzheimer's disease in Nigerians, compared with African Americans. There was no association between Alzheimer's disease and apolipoprotein E (epsilon4 allele) in the former. The differences in the frequencies of vascular risk factors between Nigerian subjects and African Americans would suggest involvement of environmental factors in disease process.

Age Factors↗

PubMed2000

Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders.

OBJECTIVE: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses. METHOD: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n=980) of the screen-positive individuals (n=3800) using a standardised instrument. RESULTS: The point prevalence (1 month) of psychotic disorders in the urban population aged 18-64 is in the range of 4-7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent. CONCLUSIONS: The so-called 'low-prevalence' psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal functioning and socioeconomic environment that influence the course and outcome of psychosis and ultimately determine the effectiveness of service-based intervention.

Activities of Daily Living↗

PubMed2000

Mental health policy development in Africa.

Mental health issues are usually given very low priority in health service policies. Although this is changing, African countries are still confronted with so many problems caused by communicable diseases and malnutrition that they have not waken up to the impact of mental disorders. Every country must formulate a mental health policy based on its own social and cultural realities. Such policies must take into account the scope of mental health problems, provide proven and affordable interventions, safeguard patients' rights, and ensure equity.

Africa↗

PubMed1999

Stability of somatization disorder and somatization symptoms among primary care patients.

BACKGROUND: Diagnostic criteria for somatization disorder emphasize its early onset and long-term stability. Research assessments of somatization disorder depend on lifetime recall of medically unexplained somatic symptoms. METHODS: Longitudinal data from the World Health Organization Psychological Problems in General Health Care study were used to examine stability of somatization disorder and somatization symptoms over 12 months. At 15 study sites in 14 countries, consecutive primary care patients (N = 25916) were screened using the 12-item General Health Questionnaire. A stratified random sample (n = 5447) was selected for a baseline diagnostic assessment using the Composite International Diagnostic Interview. All cases and a random sample of noncases were asked to complete a follow-up diagnostic assessment 12 months later (n = 3196). RESULTS: While the baseline and 12-month interviews identified a similar number of patients with DSM-IV somatization disorder (74 and 70), only 21 cases were consistently identified at both assessments. Examination of individual symptoms found that 61% of lifetime medically unexplained somatic symptoms detected at baseline were not detected during the lifetime interview 12 months later. When analyses were broadened to all lifetime symptoms reported at baseline (including those found to be "medically explained" or "not clinically significant"), 43% of lifetime symptoms reported at baseline were "lost" 12 months later. CONCLUSIONS: Given that the baseline and follow-up assessments both asked about lifetime symptoms, the loss of somatization disorder or individual somatic symptoms can only represent inconsistent recall. The instability of recall observed here has significant implications for the diagnosis of somatization disorder by structured interview and may also have implications for current diagnostic criteria.

Adolescent↗

PubMed1999

Thirteen-year social outcome among Nigerian outpatients with schizophrenia.

It has been suggested that the short-term clinical outcome of schizophrenia may be better in developing than in industrialised countries. Little is known of the social outcome of the disorder in the medium term in developing societies. In a study of 120 clinically stable outpatients in a clinic in Nigeria, we examined the social, occupational and residential outcomes of schizophrenia after 13 years. A substantial proportion of patients showed a moderate to severe degree of disability in the areas of occupation and social contact. Four percent were homeless or of unstable abode. While men were particularly disadvantaged in establishing a marital relationship and also evidenced impaired fecundity, women had a more impaired outcome in the domain of frequency and quality of social contact. Poor response to initial treatment and indices of impaired premorbid adjustment were associated with poor outcome 13 years after illness onset. Even though these patients had come predominantly from low social (and occupational) groups, they still manifested a downward drift on the social ladder. In the medium to long term, traditional family networks may be inadequate to prevent patients with schizophrenia in developing societies from acquiring significant and multiple disablement.

Adult↗

PubMed1999

The natural history of somatization in primary care.

BACKGROUND: Somatization is often regarded as a chronic disorder. However, empirical studies to support this view and to determine its natural history in primary care are lacking. This paper provides data on the incidence and persistence of current somatization syndrome in a large cross-national sample drawn from 15 sites in 14 countries. METHODS: After screening with the General Health Questionnaire, a stratified sample of 5438 primary care patients was interviewed with the Composite International Diagnostic Interview and evaluated for physical health status, self-rated overall health and for occupational disability. Twelve months later, 3204 of the patients completed follow-up interviews. RESULTS: Over a 12-month period, an abridged form of somatization defined as four current symptoms in males and six in females was persistent in 45.9% of the patients. Persistence of syndrome was related to age and to subjective indices of psychological distress at baseline. Persistence was unrelated to depression. The 12-month incidence of the abridged somatization syndrome was 7.1% (95% CI, 6.1-8.3%). Individuals with depression at baseline and those with poor view of their health were more likely to develop new episodes of somatization 12-months later. CONCLUSION: Somatization syndrome showed considerable change over time. Persistence and onset of somatization were related to both level of psychopathology and health beliefs.

Adolescent↗