Biomedical subjects

O Gureje

Publications and source records attributed to O Gureje.

At least 37 records · Page 2Linked to original sources

PubMed1998

Persistent pain and well-being: a World Health Organization Study in Primary Care.

CONTEXT: There is little information on the extent of persistent pain across cultures. Even though pain is a common reason for seeking health care, information on the frequency and impacts of persistent pain among primary care patients is inadequate. OBJECTIVE: To assess the prevalence and impact of persistent pain among primary care patients. DESIGN AND SETTING: Survey data were collected from representative samples of primary care patients as part of the World Health Organization Collaborative Study of Psychological Problems in General Health Care, conducted in 15 centers in Asia, Africa, Europe, and the Americas. PARTICIPANTS: Consecutive primary care attendees between the age of majority (typically 18 years) and 65 years were screened (n = 25 916) and stratified random samples interviewed (n = 5438). MAIN OUTCOME MEASURES: Persistent pain, defined as pain present most of the time for a period of 6 months or more during the prior year, and psychological illness were assessed by the Composite International Diagnostic Interview. Disability was assessed by the Groningen Social Disability Schedule and by activity-limitation days in the prior month. RESULTS: Across all 15 centers, 22% of primary care patients reported persistent pain, but there was wide variation in prevalence rates across centers (range, 5.5%-33.0%). Relative to patients without persistent pain, pain sufferers were more likely to have an anxiety or depressive disorder (adjusted odds ratio [OR], 4.14; 95% confidence interval [CI], 3.52-4.86), to experience significant activity limitations (adjusted OR, 1.63; 95% CI, 1.41 -1.89), and to have unfavorable health perceptions (adjusted OR, 1.26; 95% CI, 1.07-1.49). The relationship between psychological disorder and persistent pain was observed in every center, while the relationship between disability and persistent pain was inconsistent across centers. CONCLUSIONS: Persistent pain was a commonly reported health problem among primary care patients and was consistently associated with psychological illness across centers. Large variation in frequency and the inconsistent relationship between persistent pain and disability across centers suggests caution in drawing conclusions about the role of culture in shaping responses to persistent pain when comparisons are based on patient samples drawn from a limited number of health care settings in each culture.

Adult↗

PubMed1998

Gender and schizophrenia: association of age at onset with antecedent, clinical and outcome features.

OBJECTIVE: There is evidence that gender and age at onset may have a bearing on schizophrenia. The extent to which this differential age at onset influences the clinical features of schizophrenia and its outcome in males and females is not clear. METHOD: One hundred and twenty outpatients with DSM-III-R schizophrenia were studied to determine the association of antecedent, historical, clinical and 13-year outcome features with age at onset in females (n = 64) and in males (n = 56). RESULTS: Males were significantly younger at illness onset but were not otherwise different from females in antecedent features of illness. For males, age at onset bore little relationship to outcome after 13 years. Females with early onset of illness were more likely to have experienced obstetric complications, to evidence poorer premorbid functioning, and to have a worse clinical, social and functional outcome than females with late onset. CONCLUSIONS: Even though females may have a more benign illness than males, among females, those with early age at onset may be characterised by neurodevelopmental deviance and worse illness outcome.

Adult↗

PubMed1998

Risk factors and Alzheimer's disease: a comparative study of two communities.

OBJECTIVE: To determine the association between demographic, lifestyle and medical history factors to Alzheimer's disease (AD), we studied samples of two community dwelling populations with significantly different prevalence rates of AD in Indianapolis, USA (6.24%) and Ibadan, Nigeria (1.4%). METHODS: The samples were drawn from African-American community dwelling residents 65 years of age and over in Indianapolis, and Yoruba community-dwelling residents 65 years of age and over in Ibadan. A two-stage epidemiological design was used in which diagnosis of AD was by National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria. RESULTS: In Indianapolis, age (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.11-1.21), family history of dementia (OR = 5.40; 95% CI = 1.99-14.62), low education (0-6 years, OR = 3.49; 95% CI = 1.06-11.48) and rural residence (OR = 2.49; 95% CI = 1.05-5.88) were associated with a higher risk of AD. In Ibadan, age (OR = 1.15; 95% CI = 1.12-1.18) and female gender (OR = 13.9; 95% CI = 3.85-50.28) were associated with a higher risk of AD. CONCLUSIONS: The remarkably similar odds ratios between age and AD between sites suggest that biological processes associated with ageing are essential elements in the development of AD but that genetic and environmental risk factors may alter age-specific rates. In our longitudinal study, we intend to investigate in more depth the interaction between these ageing, genetic and environmental factors.

Aged↗

PubMed1998

Alcoholic beverage consumption in India, Mexico, and Nigeria: a cross-cultural comparison.

Drinking practices vary substantially among different countries. An understanding of such differences can help researchers, clinicians, and policymakers develop prevention, diagnostic, and treatment measures as well as overall alcohol policies that are appropriate for a given country. Accordingly, researchers have conducted cross-cultural analyses of drinking patterns and practices. Three countries included in such analyses are India, Mexico, and Nigeria. These countries differ substantially in their ethnic and cultural characteristics, including the role that alcohol plays in daily life. To gain a better insight into the attitudes toward alcohol in these countries, researchers have analyzed the alcoholic beverage preferences, gender and age differences in alcohol consumption patterns, drinking contexts and drinking patterns, alcohol-related problems, approaches to prevention and treatment, and drinking indicators in each nation. These analyses demonstrate that no single definition of "normal" drinking, problem drinking, or alcohol dependence can apply equally to all countries or cultures.

Alcohol Drinking↗

PubMed1997

Apolipoprotein E-associated risk for Alzheimer's disease in the African-American population is genotype dependent.

As a part of our ongoing study on Alzheimer's disease (AD) in elderly African Americans, we obtained clinical assessment and apolipoprotein E (ApoE) genotype data on 288 individuals (including 60 with AD). The ApoE epsilon4 allele frequency was significantly increased in AD patients compared with controls. The age-adjusted odds ratio (OR) for AD in epsilon4 homozygotes was 4.83 (95% confidence interval [CI], 1.71-13.64) compared with the epsilon3/epsilon3 genotype, but the OR for AD with the epsilon3/epsilon4 genotype did not reach significance (1.20; 95% CI, 0.58-2.45). These findings suggest that the association between ApoE epsilon4 and AD is weaker in African Americans than in whites.

Aged↗

PubMed1997

The validity of two versions of the GHQ in the WHO study of mental illness in general health care.

BACKGROUND: In recent years the 12-item General Health Questionnaire (GHQ-12) has been extensively used as a short screening instrument, producing results that are comparable to longer versions of the GHQ. METHODS: The validity of the GHQ-12 was compared with the GHQ-28 in a World Health organization study of psychological disorders in general health care. Results are presented for 5438 patients interviewed in 15 centres using the primary care version of the Composite International Diagnostic Instrument, or CIDI-PC. RESULTS: Results were uniformly good, with the average area under the ROC curve 88, range from 83 to 95. Minor variations in the criteria used for defining a case made little difference to the validity of the GHQ, and complex scoring methods offered no advantages over simpler ones. The GHQ was translated into 10 other languages for the purposes of this study, and validity coefficients were almost as high as in the original language. There was no tendency for the GHQ to work less efficiently in developing countries. Finally gender, age and educational level are shown to have no significant effect on the validity of the GHQ. CONCLUSIONS: If investigators wish to use a screening instrument as a case detector, the shorter GHQ is remarkably robust and works as well as the longer instrument. The latter should only be preferred if there is an interest in the scaled scores provided in addition to the total score.

Female↗

PubMed1997

The syndrome of hypochondriasis: a cross-national study in primary care.

BACKGROUND: The nature and correlates of hypochondriasis are still poorly understood, especially in settings other than those in North America and Western Europe. METHODS: A total of 25,916 consecutive patients making ambulatory visits to primary care clinics at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Based on the screen-score performance, a stratified sample of 5447 of respondents was evaluated at the second-stage (response rate: 62%). Evaluation consisted of physician-rated physical and psychological health status and self-ratings of overall health, physical disability and GHQ-28. Interviewers conducted assessment of psychiatric status, using the Composite International Diagnostic Interview (CIDI) and occupational disability. RESULTS: Across the sites, the occurrence of ICD-10 hypochondriasis was 0.8% (95% Confidence Interval, 0.5-1.0%) and over 1.5% at only two sites. A less restrictively-defined form of the disorder had a pooled frequency of 2.2% (95% Confidence Interval, 1.8-2.6%) across the sites. Patients with this abridged hypochondriasis were more likely than those without to have co-morbid major depression and generalized anxiety disorder. They had a poorer perception of their health, were more physically disabled, were more impaired in the performance of occupational role, and were above-average utilizers of health service. Patients with ICD-10 hypochondriasis were no more impaired than those with abridged hypochondriasis. CONCLUSION: Even though the ICD-10-defined hypochondriasis is rare, a form consisting of the triad of disease conviction, associated distress and medical help-seeking is present in primary-care settings in different cultures. This syndrome is associated with considerable psychiatric ill-health and functional disability.

Adolescent↗

PubMed1997

Problems related to alcohol use: a cross-cultural perspective.

The assessment, diagnosis, and classification of mental disorders are embedded in social and cultural norms. In view of their Anglo-Saxon origins, the prevailing diagnostic criteria and instruments for their assessment have a strong Western influence. Yet they are used internationally with the implied assumption of their cross-cultural applicability. The WHO Cross-Cultural Applicability Research (CAR) study was designed to test this assumption as it applies to disorders relating to the use of alcohol and drugs. This multi-disciplinary research project was conducted in nine countries having different patterns of alcohol and drug use. The results suggest that, even though some similarities exist with respect to the definition of problematic use of alcohol in these ethnically diverse societies, very substantial differences also exist. A number of core concepts underpinning diagnosis of disorders relating to the use of alcohol have no equivalence in the local languages of the various cultures, while some others lacked cultural applicability because of their relative 'distance' from cultural and ethnic norms of drinking. This distance often relates to the difficulties of adapting descriptors of drinking norms in a 'wet' culture to one that is decidedly 'dry'.

Alcohol Drinking↗

PubMed1997

Somatization in cross-cultural perspective: a World Health Organization study in primary care.

OBJECTIVE: The purpose of this study was to examine the phenomenon of somatization in different cultures by determining its frequency and correlates in primary care settings in 14 countries. METHOD: Consecutive primary care patients (N = 25,916) were screened with the 12-item General Health questionnaire, and a stratified sample (N = 5,438) was interviewed with the Composite International Diagnostic Interview. Interviewed patients were also assessed for physical disease burden, self-rated overall health, physician-rated physical health status, number of disability days, and interviewer-rated occupational role functioning. The authors determined center-specific associations with the use of logistic regression analyses in which confounding variables were controlled. RESULTS: ICD-10 defined somatization disorder was relatively uncommon in most primary care settings. A less restrictively defined form was more common. Symptom rates were much higher in South American sites. There was a modest association with low education. Otherwise, frequency of unexplained somatic symptoms did not clearly vary according to geography or level of economic development. Somatizing patients were at elevated risk for self-reported disease burden, negative perception of their health, and comorbid depression and generalized anxiety disorder. Somatization was also commonly associated with disability. Cultures did not differ markedly in the pattern of these associated features. CONCLUSION: Somatization is a common problem in primary care across cultures and is associated with significant problems and disability.

Absenteeism↗

PubMed1997

Profile of dementia in a Nigerian community--types, pattern of impairment, and severity rating.

Out of 2494 subjects screened in a Nigerian community, 28 patients with dementia were identified. Alzheimer's disease was diagnosed in 18 patients (64.3%), 16 of whom had probable Alzheimer's disease. Eight patients (28.6%) had vascular dementia while one patient each had parkinsonism with dementia and depression with dementia. Patients with Alzheimer's disease were significantly older, predominantly females and illiterates. Cognitive deficit commonly took the form of memory and judgment impairment while financial mismanagement was the most frequent impaired activity of daily living. More than half of the cases had mild disease on severity rating and were comprised mainly of Alzheimer's disease subjects. These results confirm the higher frequency of Alzheimer's disease over the other types as reported in other communities.

Age Distribution↗

PubMed1996

Psychiatric morbidity in a Nigerian paediatric primary care service: a comparison of two screening instruments.

We evaluated the screening properties of the Children's Behaviour Questionnaire (CBQ) and the Reporting Questionnaire for Children (RQC) in an urban primary care setting in Nigeria. Using various validity indices and the results of Receiver Operating Characteristic analysis, we showed that the two instruments had identical abilities at differentiating children with specific psychiatric disorders from those without. The cut-off threshold for the CBQ in this setting was different from what is commonly reported elsewhere. While the CBQ was able to differentiate between conduct and emotional disorders, the RQC had the advantage of relative brevity.

Adolescent↗

PubMed1996

Comparisons of alcohol and other drugs: experience from the WHO Collaborative Cross-Cultural Applicability Research (CAR) Study.

Current psychiatric classificatory systems commonly provide similar criteria for the identification of disorders relating to the use of alcohol and other drugs. However, since cultural views of substance use disorders are influenced by prevailing norms in the society, it is unlikely that a given culture will have identical threshold for the identification of disorders relating to the use of alcohol, commonly socially approved, and those relating to the use of other mood-altering substances, commonly socially disapproved. Using data derived from the WHO nine-country Cross-Cultural Applicability Research (CAR) study, we studied the cultural views on the use and abuse of alcohol and other drugs. Our observations suggest that, with a few notable exceptions, any use of addictive substances other than alcohol is commonly considered socially aberrant. Most cultures set a much lower threshold for the identification of disorders relating to these substances than they do for alcohol-related ones.

Alcoholism↗

PubMed1996

Symptom dimensions of schizophrenia: a selective integration of neurophysiological and neuropsychological correlates.

Schizophrenia is a heterogeneous and multidimensional disorder. The different syndromes or dimensions of this disorder represent distinct pathophysiological processes. Evidence is growing that each of the composite syndromes or dimensions of this disorder is associated with specific validators. This article reviewed neurophysiological and neuropsychological studies in schizophrenia in order to determine the external validators of its syndromes. The review reveals compelling findings in some instances and contradictory findings in other instances.

Brain↗

PubMed1996

Factor structure of the 28-item general health questionnaire in a sample of antenatal women.

OBJECTIVE: The factor structure of responses to the twenty-eight-item General Health Questionnaire (GHQ-28) in a sample of 277 Nigerian antenatal women was examined. METHOD: Principal Component Analysis (PCA) and Varimax rotation were used. RESULTS: A four factor structure interpretable as social dysfunction, somatic-anxiety, depression-anxiety, and severe depression was obtained. CONCLUSION: Although the factor structure in this sample is similar to that previously reported with this instrument, the factor loadings particularly for the anxiety subscale differed. Thus, the factor structures of the GHQ may differ depending on the cultural background of the sample.

Adult↗

PubMed1995

Lack of an association between apolipoprotein E epsilon 4 and Alzheimer's disease in elderly Nigerians.

As part of a community-based study of Alzheimer's Disease (AD) in a Nigerian population aged 65 years and over, we have determined apolipoprotein E (APOE) genotypes on 56 subjects (39 controls and 17 subjects with dementia, including 12 with AD). The epsilon 4 allele of APOE was not associated with AD or dementia in this community-based sample. The epsilon 4 allele frequency was 17.6% in demented patients and 16.7% in AD patients compared with 20.5% in the control subjects. These findings are in marked contrast to the strong association between the epsilon 4 allele and AD in our previously reported study with African Americans.

Aged↗

PubMed1995

Is the lifetime risk of depression actually increasing?

Data from an international study of psychological problems in primary care were examined for evidence of increasing depression risk. At 15 sites, patients aged 15-65 (n = 26,421) were screened with the GHQ-12 and a stratified random sample (n = 5603) selected for psychiatric assessment (Composite International Diagnostic Interview). Initial analyses agreed with earlier cross-sectional studies, finding higher depression risk and earlier onset in recent birth cohorts. Additional analyses suggested that methods effects may explain these findings. First, apparent prevalence increases were nonspecific with similar trends seen across all study sites and for all disorders examined. Second, reporting patterns suggested significant under-counting of past depressive episodes. Respondents of all ages typically reported first onset of depression during the last 5 years. Reported lifetime prevalence was only 2.02 times current prevalence. These findings suggest that depression risk is not rapidly increasing and that true lifetime prevalence is much higher than estimated by cross-sectional surveys.

Adolescent↗

PubMed1995

Three syndromes in schizophrenia: validity in young patients with recent onset of illness.

The heterogeneity of schizophrenia constitutes an impediment in the identification of reliable biological markers of the illness and aetiological factors. The two syndrome concept of the illness has proved a powerful stimulus in this endeavour. There is however evidence now to regard this construct as inadequate and in need of refinement. Using a sample of young patients with early onset of illness who fulfilled the Research Diagnostic Criteria for schizophrenia, we have shown that three rather than two dimensions better describe the pathology of the illness. The results of factor analysis showed these syndromes, termed disorganization, positive, and negative syndromes, to account for 65% of the total variance of the psychopathology of the disorder. The negative syndrome was associated with disturbed pre-morbid functioning while the disorganization syndrome bore significant association with early onset of illness, poorer socio-educational attainment, and impairment on neuropsychological tests, especially those designed to evaluate frontal lobe functioning. The positive syndrome was not associated with any of the assessed variables. These results provide strong support for the validity of the three-syndrome construct even among a sample of non-institutionalized patients.

Adult↗

PubMed1995

Children with mental disorders in primary care: functional status and risk factors.

Using data derived from a large epidemiological survey of children attending a pediatric primary care clinic, this article reports the relationship between the presence of mental disorders and functional status and the risk factors for depressive, anxiety-related and conduct disorders in these children. The results suggest that children with mental disorders in primary care are more functionally impaired than those without such disorders, with depressive and conduct disorders more often associated with such impairment. Analysis using logistic regression analysis to determine risk factors showed that broadly different familial and antecedent features predicted the presence of these groups of disorders. The findings confirmed the salience of factors relating to family and socioeconomic status and of maternal psychological health in a culture characterized by the extended family structure and widespread economic deprivation.

Achievement↗