Naomar Almeida-Filho

Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil

OBJETIVOS: Investigar padroes de consumo de alcool e prevalencia de consumo de alto risco. METODOS: Inquerito domiciliar realizado no municipio de Salvador, Bahia, com amostra de 2.302 adultos. Casos de consumo de alto risco foram definidos como sujeitos que referiram uso diario ou semanal mais episodios de embriaguez, alem daqueles que informaram qualquer uso de bebidas alcoolicas com embriaguez frequente (pelo menos uma vez por semana). RESULTADOS: Cinquenta e seis por cento da amostra referiram consumo atual de bebidas alcoolicas. Consumo global estava significantemente associado a genero (homens), estado civil (solteiros), migracao (nao-migrantes), educacao (nivel superior) e classe social (alta). Nenhuma diferenca significante foi encontrada com relacao a etnicidade, com excecao de cachaca e outras bebidas destiladas. A prevalencia anual de consumo de alto risco foi 7%, seis vezes mais prevalente entre homens que entre mulheres (quase 13% comparado a 2,4%). Foi encontrada uma associacao positiva de prevalencia de consumo de alto risco com educacao e classe social. Nenhuma relacao global foi encontrada entre etnicidade e consumo de alto risco. Genero masculino e niveis socioeconomicos mais altos foram associados ao aumento de consumo de alto risco. Analises estratificadas revelaram um efeito consistente de genero, atraves de todos os estratos de variaveis independentes. CONCLUSOES: Os resultados sugerem que elementos sociais e culturais determinam padroes locais de consumo de bebidas alcoolicas. Pesquisas adicionais sobre efeitos de longo prazo de etnicidade, classe social e genero sobre consumo de alcool sao necessarias, visando a explicar o seu papel como fontes de desigualdades sociais em saude.OBJECTIVEnTo study patterns of alcohol consumption and prevalence of high-risk drinking.nnnMETHODSnA household survey was carried out in a sample of 2,302 adults in Salvador, Brazil. Cases of High-Risk Drinking (HRD) were defined as those subjects who referred daily or weekly binge drinking plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week).nnnRESULTSnFifty-six per cent of the sample acknowledged drinking alcoholic beverages. Overall consumption was significantly related with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper). No significant differences were found regarding ethnicity, except for cachaça (Brazilian sugarcane liquor) and other distilled beverages. Overall 12-month prevalence of high-risk drinking was 7%, six times more prevalent among males than females (almost 13% compared to 2.4%). A positive association of HRD prevalence with education and social class was found. No overall relationship was found between ethnicity and HRD. Male gender and higher socioeconomic status were associated with increased odds of HRD. Two-way stratified analyses yielded consistent gender effects throughout all strata of independent variables.nnnCONCLUSIONSnThe findings suggest that social and cultural elements determine local patterns of alcohol-drinking behavior. Additional research on long-term and differential effects of gender, ethnicity, and social class on alcohol use and misuse is needed in order to explain their role as sources of social health inequities.

Research on Health Inequalities in Latin America and the Caribbean: Bibliometric Analysis (1971–2000) and Descriptive Content Analysis (1971–1995)

We conducted a bibliometric and content analysis of research on health inequalities produced in Latin American and Caribbean countries. In our bibliometric analysis (n = 576), we used indexed material published between 1971 and 2000. The content analysis (n = 269) covered the period 1971 to 1995 and included unpublished material. We found recent rapid growth in overall output. Brazil, Chile, and Mexico contributed mostly empirical research, while Ecuador and Argentina produced more conceptual studies. We found, in the literature reviewed, a relative neglect of gender, race, and ethnicity issues. We also found remarkable diversity in research designs, however, along with strong consideration of ecological and ethnographic methods absent in other research traditions.

Estrutura fatorial do questionário de morbidade psiquiátrica de adultos aplicado em amostras populacionais de cidades brasileiras

Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptons and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasilia, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue=3.81, 10.9%); Irritability/Depression (eigenvalue =2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue =1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/ Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

A elaboracao de teorias constitui um dos desafios mais cruciais enfrentados pela pesquisa basica, clinica e populacional que forma as bases cientificas das praticas de saude nas sociedades contemporâneas. O objetivo deste estudo e propor uma teoria unificada da saude-doenca como ferramenta conceitual para a modelagem da saude-doenca-cuidado a luz de abordagens da complexidade. Discute-se a base epistemologica do trabalho teorico no campo da saude bem como conceitos relacionados a teoria da complexidade aplicada a problemas de saude. Em segundo lugar, os conceitos de objeto-modelo, multi-planos de ocorrencia, modos de saude e complexo doenca-enfermidade-molestia sao introduzidos e integrados numa estrutura teorica unificada. Finalmente, a luz de desenvolvimentos epistemologicos recentes, atualiza-se o conceito de integrais de saude-doenca-cuidado como um complexo objeto de referencia ajustado para a modelagem de processos e fenomenos relacionados com a saude.Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

Para una teoría unificada sobre salud-enfermedad: I. Salud como objeto- modelo complejo

A elaboracao de teorias constitui um dos desafios mais cruciais enfrentados pela pesquisa basica, clinica e populacional que forma as bases cientificas das praticas de saude nas sociedades contemporâneas. O objetivo deste estudo e propor uma teoria unificada da saude-doenca como ferramenta conceitual para a modelagem da saude-doenca-cuidado a luz de abordagens da complexidade. Discute-se a base epistemologica do trabalho teorico no campo da saude bem como conceitos relacionados a teoria da complexidade aplicada a problemas de saude. Em segundo lugar, os conceitos de objeto-modelo, multi-planos de ocorrencia, modos de saude e complexo doenca-enfermidade-molestia sao introduzidos e integrados numa estrutura teorica unificada. Finalmente, a luz de desenvolvimentos epistemologicos recentes, atualiza-se o conceito de integrais de saude-doenca-cuidado como um complexo objeto de referencia ajustado para a modelagem de processos e fenomenos relacionados com a saude.Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

Para uma teoria unificada sobre saúde-doença: I. Saúde como objeto-modelo complexo

A elaboracao de teorias constitui um dos desafios mais cruciais enfrentados pela pesquisa basica, clinica e populacional que forma as bases cientificas das praticas de saude nas sociedades contemporâneas. O objetivo deste estudo e propor uma teoria unificada da saude-doenca como ferramenta conceitual para a modelagem da saude-doenca-cuidado a luz de abordagens da complexidade. Discute-se a base epistemologica do trabalho teorico no campo da saude bem como conceitos relacionados a teoria da complexidade aplicada a problemas de saude. Em segundo lugar, os conceitos de objeto-modelo, multi-planos de ocorrencia, modos de saude e complexo doenca-enfermidade-molestia sao introduzidos e integrados numa estrutura teorica unificada. Finalmente, a luz de desenvolvimentos epistemologicos recentes, atualiza-se o conceito de integrais de saude-doenca-cuidado como um complexo objeto de referencia ajustado para a modelagem de processos e fenomenos relacionados com a saude.Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

The Case for Transdisciplinarity in Mental Health Promotion

This article discusses historical, epistemological and etymological features associated with the construction of the notions of analysis, method and – principally – discipline in the mental health field, building the argument that mental health-disease is a complex dynamic object. It goes on to evaluate critically certain logical and epistemological aspects of established schemata towards a definition of disciplinarity and correlates (multidisciplinarity, pluridisciplinarity, interdisciplinarity, transdisciplinarity). A more precise definition of the concept of transdisciplinarity is proposed from a pragmatic perspective, exploring its potential for mental health promotion. In conclusion, the author contends that, in order to respond to the challenges of mental health-illness-care today, we must rely on a renewed form of encyclopaedism constructed collectively, making the process of scientific knowledge-production in the field of mental health epistemologically more rigorous as much as socially and politically-oriented.