Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: Results from ISoS, the WHO collaborative followup project
Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: Results from ISoS, the WHO collaborative followup project
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DOI：
10.1093/oxfordjournals.schbul.a033498
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发表时间：
2000-01-01
影响因子：
6.6
通讯作者：
Wanderling, J
中科院分区：
文献类型：
--
作者：
Hopper, K;Wanderling, J
本文探讨了长期存在的和挑衅性的发现，粗和结果的差异优势，精神分裂症患者生活在“发展中”国家，使用的结果，从新完成的世界卫生组织（WHO）的合作项目，精神分裂症的国际研究（ISoS）。这篇文章解决了两个问题：自上次报告以来，这种差异是否已经存在了13年？如果是，这些结果是否可证明不归因于人为混杂？分析重点关注组成ISoS合并发生率队列的809例受试者。这些包括世卫组织早期两项研究（严重精神障碍结局的决定因素和减少残疾研究）的原始治疗发病率队列的成员，以及从两个额外样本（香港和马德拉斯/钦奈）中抽取的受试者。我们首先回顾了在病程和结局中发现的“发展中与发展中”差异的一致性，然后研究了ISoS发病率队列的各种病程和结局指标。支持发展中中心的疾病轨迹的差异的证据一致finding. Six潜在的偏差来源进行了检查：在后续的差异，任意分组的中心，诊断的模糊性，选择性的结果措施，性别和年龄。这些潜在的混淆都不能解释过程和结果的差异。最后，我们提出了进一步研究的建议，特别注意需要密切记录当地道德世界中的日常实践，“文化”是指。
This article examines the long-standing and provocative finding of a differential advantage in coarse and outcome for persons with schizophrenia living in "developing" countries, using results from the newly completed World Health Organization (WHO) collaborative project, the International Study of Schizophrenia (ISoS). The article addresses two questions: Has the differential survived the 13 years since it was last reported? If so, are the results demonstrably not attributable to artifactual confounding? The analysis focuses on the 809 subjects who make up the combined incidence cohort of ISoS. These include members of the original treated incidence cohorts of two earlier WHO studies (the Determinants of Outcome of Severe Mental Disorders and the Reduction of Disability Studies) as well as subjects drawn from two additional samples (Hong Kong and Madras/Chennai). We first review the consistency of the finding of a "developed versus developing" differential in course and outcome and then examine a variety of course and outcome measures for the ISoS incidence cohorts. Evidence of differences in illness trajectory in favor of the developing centers was consistently found. Six potential sources of bias are then examined: differences in followup, arbitrary grouping of centers, diagnostic ambiguities, selective outcome measures, gender, and age. None of these potential confounds explains away the differential in course and outcome. We conclude with suggestions for further research, with particular attention to the need for close documentation of everyday practices in the local moral,worlds that "culture" refers to.