Assessing workplace discrimination among medical practitioners in Western Sydney.

OBJECTIVES: To investigate the presence of different forms of experiences of discrimination in the medical workplace. METHODS: A total of 526 questionnaires were sent out, including a demographic survey form and the Everyday Discrimination Scale. RESULTS: Experiences of being "treated with less courtesy than other people are" and feeling as "others acted if they're better than [me]" were reported as having occurred with almost daily frequency by 4.1 % of respondents. Those whose main language was not English and classified as "non-whites" had significantly more experiences ("ever") of discrimination in the medical workplace. The most commonly reported reasons for discrimination were ancestry (31.3%), "race" (28.1%), and gender (21.1%). CONCLUSIONS: The results of this survey indicate that a proportion of doctors experience discrimination in the workplace in Australia. This phenomenon was more commonly reported by doctors of minority status.

Comparison and concordance of health-related quality of life tests among substance users.

BACKGROUND: In the field of drug and alcohol abuse, health-related quality of life (HRQoL) has been used as an important clinical and research outcome. The aim of this study was to establish score linkages (concordance) among three HRQoL assessment tools: WHOQOL-BREF, DUQOL and HRQOLDA scores, applying a Rasch-based common person equating procedure. METHODS: One hundred and twenty one adults were recruited from inpatient and outpatient treatment facilities in Sydney West Area Health Service. WHOQOL-BREF, DUQOL and HRQOLDA tests were administered. Item parameters were calculated applying Rating Scale Model, a Rasch model. RESULTS: Fit statistics suggest acceptable goodness-of-fit to the RSM for three instruments. Correlations between HRQOLDA and WHOQOL-BREF and between HRQOLDA and DUQOL scores were 0.719 and 0.613, and the RiU index was 30.4 % and 20.9 %, respectively. All three tests performed adequately for differentiating between individuals whose scores are located at different points along the continuum of the HRQoL construct. CONCLUSION: The results demonstrated a higher concordance between the HRQoLDA and WHOQOL-BREF than between the HRQoLDA and the DUQOL. However, it cannot be established unequivocally that the scores of these tools are concordant. In this study, the utility of the application of the Rasch model to provide an empirical benchmark for the selection of measurement tools to be used in the context of health care and research is demonstrated.

Quality of life and adherence to antiretroviral therapy in Southern Brazil.

The absence of or limited adherence to treatment is the main cause for the failure of Highly Active Antiretroviral Therapy (HAART). In Brazil, adherence to antiretroviral therapy has been lower than the recommended levels. Although HAART may produce adverse reactions, failure to comply with it may aggravate patients' health status and impair Quality of Life (QoL). The QoL of individuals living chronically with HIV and AIDS has been considered one of the main treatment outcomes. This study is part of a 225-day prospective trial in which participants were enrolled in two different modalities of follow-up: the usual model medical follow-up or an intervention based on the Medication Adherence Training Instrument (MATI). The WHOQOL-HIV BREF questionnaire was used to evaluate QoL of research participants in both groups on the 15th and 225th days of follow-up after the baseline assessment. The result of this study revealed no significant differences of WHOQOL-HIV BREF scores between participants allocated to MATI and non-MATI groups in the first assessment. However, there was a significant difference between the scores obtained on the 15th and 225th days in the domain related to spirituality and personal beliefs irrespective of the modality of follow-up. Other domains of the WHOQOL-HOV BREF remained unchanged. These results indicate that, in this sample, personal beliefs and spirituality may be relevant subjects to explain sustained levels of adherence to HAART.

A validation study of the English version of the AlQol 9 to measure quality of life.

BACKGROUND: Quality of life (QoL) is an important clinical and research outcome within the drug and alcohol abuse context. The AlQoL 9 is a specific questionnaire designed to assess health- and non-health-related consequences of alcoholism. The English version of the AlQoL 9 has not been validated using a larger sample. OBJECTIVES: The aim of this study was to assess the psychometric properties of the English version of AlQoL 9 in a sample of treatment-seeking individuals in Australia. METHODS: A sample of 138 participants from inpatient and outpatient treatments facilities completed the AlQoL 9 test and the World Health Organisation Quality of Life Assessment-BREF (WHOQOL-BREF). The study's investigative parameters included the demographic characteristics of the sample, internal structure, and convergent validity. Furthermore, correlations between the AlQoL 9 scale scores and the scores obtained from the WHOQOL-BREF test were investigated using Pearson product-moment correlation analyses. RESULTS: The English version of the AlQoL 9 attained a significant Cronbach's alpha of 0.825. The mean score obtained in the test was 21.92 (SD = 6.79). Using Varimax rotation, the AlQoL 9 yielded one principal factor that had accounted for 37.85% of variance. Convergent validity analysis demonstrated significant correlations (p < 0.001) between the AlQoL 9 scores and the scores of all four dimensions of the WHOQOL-BREF questionnaire. CONCLUSION: The present study demonstrated that the English version of the AlQoL 9 constitutes a valid and reliable research instrument for evaluating quality of life among alcohol-dependent individuals.

The application of the Drug User Quality of Life Scale (DUQOL) in Australia.

BACKGROUND: The concept of quality of life relates to the perceptions of individuals about their mental and physical health as well as non-health related areas. The evaluation of quality of life in the context of substance abuse has been conducted using generic instruments. The Drug Users Quality of Life Scale (DUQOL) is a specific assessment tool in which the most pertinent and salient areas to drug abusers are taken into consideration. In this study, the authors report the results of a validation study in which the DUQOL was used for the first time in Australia. METHODS: A sample of 120 participants from inpatient and outpatient treatment facilities completed a series of questionnaires, including the DUQOL and the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF). Parameters investigated in this study included the demographic characteristics of the sample, internal structure, and convergent validity. Correlations between the DUQOL scale scores and the scores of the WHOQOL-Bref test were investigated via Pearson product-moment correlation analyses. RESULTS: The English version of the DUQOL attained a significant overall Cronbach's alpha of 0.868. The factorial analysis of the DUQOL identified one principal factor that accounted for 28.499% of the variance. Convergent validity analyses demonstrate significant correlations (p < 0.01) between the DUQOL scores and the scores of all four dimensions of the WHOQOL-BREF questionnaire. CONCLUSIONS: This study demonstrates that the DUQOL constitutes a reliable research instrument for evaluating quality of life of substance users in Australia.

Validation of the English version of the Health-Related Quality of Life for Drug Abusers (HRQoLDA) test.

BACKGROUND: The Health-Related Quality of Life for Drug Abusers (HRQoLDA) test was designed to specifically evaluate quality of life among substance users. In this study, the validity and reliability of the English version of the HRQoLDA test are reported for the first time. METHODS: A sample of 121 participants from inpatient and outpatient treatment facilities completed the HRQoLDA test. RESULTS: The mean HRQoLDA score was 45.9 (SD = 16.9), while the overall Cronbach's alpha coefficient was 0.905. The factorial analysis of the HRQoLDA test revealed a unidimensional structure. Convergent validity analyses demonstrated significant correlations between the HRQoLDA test scores and the scores of the World Health Organization Quality of Life Assessment-Bref Questionnaire in different dimensions. CONCLUSION: The results revealed that the HRQoLDA was successfully adapted to English. The HRQoLDA is a reliable research instrument for evaluating quality of life of substance users.

Demoralization, depression and anxiety in postpartum women of culturally and linguistic diverse backgrounds in Australia.

INTRODUCTION: The present study aims to investigate whether mothers from Culturally and Linguistically Diverse (CALD) backgrounds present with higher levels of demoralization in comparison with their non-minority counterparts, and to explore potential correlations between demoralization and anxiety as well as depression in the same sample of mothers. METHODS: Women admitted to a public tertiary care teaching hospital were invited to participate in the study within 24-48 hours following delivery. The study compared women who did not regard English as their main spoken language to native English-speaking women. Women were asked to complete the demographic Kissane Demoralization Scale (KDS) and Being a Mother Scale (BaM-13) questionnaires. Participants were contacted by phone, 6 to 8 weeks after they had completed the KDS and the BaM-13 questionnaires, to complete an Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Scale (STAI) questionnaires. RESULTS: Mothers of CALD background presented with significantly higher scores on the KDS (p<0.001), STAI (p<0.001) and EPDS (p<0.001) scales in comparison with their non-CALD counterparts. Furthermore, when mothers were reassessed after 6 to 8 weeks, higher KDS scores in the postnatal period predicted significantly higher anxiety and depression scores, according to STAI (p<0.001) and the EPDS (p<0.001), respectively. CONCLUSIONS: The results of this study reveal that, mothers of CALD background manifest higher levels of demoralization as well as anxiety and depression in the postpartum period when compared with their non-CALD counterparts.

The correlation between postpartum depression and health status.

To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure, was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for DSM-IV Disorders (SCID), the 12-item General Health Questionnaire (GHQ), the PHS, the Postpartum Depression Screening Scale (PDSS), and the Edinburgh Postnatal Depression Scale (EPDS). Correlation coefficients were computed among the scores of the health status questionnaires and the postnatal depression scales. Bivariate linear regression analyses were conducted to evaluate the prediction of scores of postnatal depression scales having the scores of health status questionnaires as predictors. Significant correlations among both health status questionnaires and both postnatal screening tools attest to a significant interconnection between the expression of depressive symptoms and maternal health status in the postpartum period. The health status measures predicted the scores of postpartum depression scales. This study demonstrates that both general health questionnaires and postpartum depressive rating scales are useful tools for detecting depressive phenomena in postpartum women. The association between self-rated health measures and postpartum depression may be even more significant in the context of socioeconomic deprivation.

The Portuguese version of the Postpartum Depression Screening Scale-Short Form.

AIMS: The aim of this study was to demonstrate the validity and reliability of the short form of the Postpartum Depression Screening Scale in Southern Brazil. MATERIAL & METHODS: Research volunteers completed the Postpartum Depression Screening Scale-Short Form (PDSS-SF) and a Structured Clinical Interview for Mental Disorders (SCID). Evaluation parameters included reliability and correlational investigations analyses. RESULTS: The proposed Portuguese version of the PDSS-SF attained significant Cronbach's alphas (0.71 or superior). The best cut-off score (≥17) accounted for 89% of sensitivity and 77% of specificity. In addition, nonparametric correlation procedures revealed a significant correlation between the screening results of the PDSS-SF and the assessment based on the SCID. CONCLUSIONS: The Portuguese version of the PDSS-SF demonstrated sound psychometric properties. The results of the correlation analyses between the PDSS-SF and the SCID assessment also indicate a significant concurrent validity. The Portuguese version of the PDSS was adequately translated and adapted to Portuguese.

Depressive symptoms in crack and inhalant users in Southern Brazil.

In this study the authors investigated depressive symptoms and correlated psychopathology in crack cocaine and inhalant users in Southern Brazil. Participants completed the Beck Depression Inventory, the Montgomery-Asberg Depression Rating Scale, and the Hamilton Depression Rating Scale. General psychopathology, hopelessness and suicidal tendencies were also investigated. Crack and inhalants users presented significant levels of depressive symptoms and psychiatric morbidity. These disorders were significantly associated with hopelessness and suicidal tendencies. These findings underscore the need for more rigorous and extensive screening efforts to detect and treat depressive symptoms in crack and inhalent users.

The Portuguese Version of the Schedule of Racist Events.

OBJECTIVE: There is a lack of research tools in Portuguese to evaluate racial discrimination. The purpose of this study was to psychometrically assess the Portuguese version of the Schedule of Racist Events (SRE) in a sample of individuals enrolled in a research trial with antiretroviral medications in southern Brazil. METHODS: Sample of 147 individuals living with HIV and/or AIDS. Research participants completed the Schedule of Racist Events and the WHOQOL-HIV BREF questionnaires. RESULTS: The SRE scores of non-white participants were significantly higher than the scores of white-participants. The Crombach's alpha coefficients, for the three subscales of the Portuguese version of the SRE, were high and significant. There were significant correlations between all subscales of the SRE and relevant domains of the WHOQOL-HIV BREF. CONCLUSION: The original English version of the SRE was successfully adapted to Portuguese. The Portuguese version of SRE constitutes a valid research instrument for evaluating racial discrimination.

Using the Portuguese version of the Bicultural Scale in Brazil.

INTRODUCTION:: Brazil has received influxes of people, mainly from Africa, Europe and Japan, forming one of the most heterogeneous populations in the world. Some groups, particularly in Southern Brazil, have retained their original cultural traditions, whilst acquiring elements of the typical local Brazilian cultural identity. This is the first study designed to formally evaluate biculturality in Brazil. OBJECTIVE:: To psychometrically assess and validate the Portuguese version of the Bicultural Scale (BS) in Brazil. METHODS:: The BS was adapted and translated to Portuguese and tested for the first time in Brazil in a sample of descendants (n = 160) from four immigrant groups and respective locations in Southern Brazil. A series of psychometric tests were conducted in order to examine the validity of the Portuguese version of the BS. Analyses of variance across scores for all subgroups were also conducted. RESULTS:: Factor analysis revealed two main factors contributing to most of the variance in scores. The 10 items measuring affiliation with minority cultural characteristics and the typical Brazilian culture yielded Cronbach's alpha coefficients of 0.69 and 0.78 respectively, whereas the overall Cronbach's alpha for all 20 items of the BS was 0.67. There was a significant correlation between items related to the typical Brazilian culture and the generation since immigration of research participants (r = 0.23, p = 0.004). The mean time taken to complete the questionnaire was 7.4 minutes. CONCLUSION:: The results indicate that the Portuguese version of the BS is a valid, reliable and easy-to-use instrument to assess biculturality experienced by descendants of immigrants in southern Brazil.

A polytomous rasch analysis of the english version of health-related quality of life for drug abusers test.

The specific aim of this study was to analyze the psychometric properties of the English version of the Health-Related Quality of Life for Drug Abusers Test (HRQoLDA Test) applying the Rasch model, and emphasizing fit between empirical data and theoretical Rasch model assumptions; item(s) category probability curve; and precision in terms of information function. In this study, the authors present the results of the translation and adaptation of the original Spanish version to English, as applied to a sample of substance users in Australia. The authors evaluated 121 adults recruited from inpatient and outpatient treatment facilities in Sydney, Australia. The Rating Scale Model was used in the psychometric analysis of the English version of the HRQoLDA Test. The items and persons revealed a fit between the reported data and the model. It was also demonstrated that respondents did not discriminate among the five response categories, which led to a reduction to three response categories. The adaptation of the TECVASP to the English language, renamed the HRQoLDA test, as developed with an Australian sample revealed adequate psychometric properties.

Retention in medical care and antiretroviral treatment according to skin color in southern Brazil.

The aim of this study was to compare the retention in medical care and antiretroviral (ARV) treatment of individuals living with HIV and AIDS to antiretroviral therapy in southern Brazil according to their "race" or skin color. This study is part of a 225-day prospective trial, comprising 7 interviews, in which an intervention designed to improve adherence to treatment was tested. A convenience sample of 73 individuals living with HIV and/or AIDS enrolled in this follow-up procedure. The mean length of continuance in treatment was 161.5 (standard deviation [SD] = 18.6; 95% confidence interval [CI] = 125-198) and 138.4 (SD = 14.1; 95% C.I. = 111-166) days in the "nonwhite" and "white" categories, respectively. There was no significant difference between the 2 categories, χ(2)(1, n = 72) = 0.76, P = .38, which include similar levels of retention in medical care and treatment with ARV medications between groups of individuals categorized as white and nonwhite in this sample.

The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil.

OBJECTIVE: To investigate the relationship between breastfeeding self-efficacy and postpartum depression symptoms in a sample of Portuguese-speaking mothers in southern Brazil. BACKGROUND: There remains equivocal evidence regarding a putative association between breastfeeding self-efficacy and postpartum depression. METHOD: This is a cross-sectional study in which eligible research participants completed screening questionnaires and other assessment tools. Mothers were interviewed once only in their homes between the 2nd and 12th week of the postpartum period. Research participants completed the Portuguese version of the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS). Breastfeeding self-efficacy was evaluated through the Breastfeeding Self-Efficacy Scale (BSES-SF). RESULTS: A total number of 89 mothers completed the investigation: 69 (77%) were exclusively breastfeeding, whereas 20 mothers (22.7%) were partially breastfeeding at the time of the interview. Mothers who combined breastfeeding and bottle-feeding presented higher PDSS and EPDS scores. The breastfeeding self-efficacy scores were higher in mothers who exclusively breastfed and were negatively associated (p<0.001) with both EPDS and PDSS (postpartum depression) scores. CONCLUSION: These findings suggest that mothers who suffer from depressive symptoms may experience less confidence in their ability to breastfeed. This association may be particularly relevant for the purpose of screening procedures for depression and unsatisfactory breastfeeding during the postpartum period.

Correlation between breastfeeding and maternal health status.

OBJECTIVE: To examine the relation between breastfeeding efficacy and health status in a sample of 88 mothers from Southern Brazil. METHODS: Research participants completed the Portuguese version of the General Health Questionnaire and the Personal Health Scale. Breastfeeding efficacy was evaluated using the Breastfeeding Self-Efficacy Scale. Correlations between breastfeeding and health status scores were examined using Pearson's correlation coefficient. RESULTS: The results of this study revealed significant correlations between the scores of the two general health and well-being questionnaires and the Breastfeeding Self-Efficacy Scale. Bivariate regression analyses revealed that both health status instruments significantly predicted Breastfeeding Self-Efficacy Scale scores. CONCLUSION: Breastfeeding efficacy is significantly related to maternal health status in Southern Brazil.

Aborigines, colonizers and newcomers: the landscape of transcultural psychiatry research in Australia.

The authors present an analysis of transcultural psychiatry research in relation to three main population groups in Australia: Aboriginal Australians, documented immigrants, and refugees. The pioneering reports produced by Western psychiatrists in Aboriginal communities are examined in this article. Additional quantitative and qualitative studies developed with Aboriginal people in the context of a traumatic acculturation process are also reviewed. Subsequently, the authors examine the challenges faced by immigrants with mental disorders in a health care system still unequipped to treat a new array of clinical presentations unfamiliar to the clinical staff. The authors also highlight the development of policies aimed at providing quality mental health care to a mosaic of cultures in an evolving multicultural society. Lastly, the psychiatric manifestations of refugees and asylum seekers are analysed in the context of a series of vulnerabilities and deprivations they have experienced, including basic human rights.

Anxiety symptoms in crack cocaine and inhalant users admitted to a psychiatric hospital in southern Brazil.

OBJECTIVE: The occurrence of psychiatric comorbidity among individuals with crack or inhalant dependence is frequently observed. The objective of this study was to investigate anxiety symptoms among crack cocaine and inhalant users in southern Brazil. METHODS: The study investigated two groups of volunteers of equal size (n=50): one group consisted of crack cocaine users, and the other group consisted of inhalant users. Research volunteers completed the Portuguese versions of the State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Self-Report Questionnaire (SRQ). RESULTS: Both crack and inhalant users experience significant symptoms of anxiety. Inhalant users presented significantly more anxiety symptoms than crack users according to the HAM-A questionnaire only. In contrast to the results of the HAM-A, the STAI failed to demonstrate a significant difference between the two groups of substance users. SRQ scores revealed that crack and inhalants users had significant degrees of morbidity. CONCLUSION: A significant difference regarding anxiety symptomatology, especially state anxiety, was observed among inhalant and crack users. Anxiety and overall mental psychopathology were significantly correlated in this sample. The results indicate that screening initiatives to detect anxiety and additional psychiatric comorbidities among crack and inhalant users are feasible and relevant.

Investigating quality of life and depressive symptoms in the postpartum period.

BACKGROUND: Mood disturbances represent the most frequent form of maternal psychiatric morbidity in the postpartum period. Nevertheless, few studies have examined the impact of postpartum depression on the mother's quality of life. RESEARCH QUESTION OR PROBLEM: The present study aims to assess the quality of life of a sample of mothers in Southern Brazil, in order to investigate the association between postpartum depression and quality of life (QoL) standards. PARTICIPANTS AND METHODS: This study investigates a sample of 101 adult volunteers who completed the Portuguese version World Health Organization Quality of Life Assessment-Bref (WHOQOL-Bref) and Multicultural Quality of Life Index (MQLI) questionnaires. Postnatal depressive symptoms were evaluated through the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS). Multiple regression analyses were conducted to predict the overall PDSS and EPDS scores. Pearson Product-Moment Correlation coefficients were computed between the global scores of the quality of life measurements and the screening questionnaires for postnatal depression. RESULTS: Both socio-economic status and quality of life have influenced significantly the depressive symptomatology and correlated epiphenomena. Significant correlations were observed among scores of postpartum depression screening tools and quality of life questionnaires. The socio-economic status of research participants was only significantly correlated to the scores generated by the WHOQOL-Bref questionnaire. CONCLUSIONS: These findings confirm that socio-economic deficiencies and low quality of life can facilitate the expression of depressive symptomatology during the postpartum period. The results also emphasize the salience of psychosocial risk factors in the diathesis of postnatal depression.

The correlation between breastfeeding and maternal quality of life in southern Brazil.

PURPOSE: This study examined the relationship between the breastfeeding efficacy and quality of life (QoL) in a sample of 89 mothers from southern Brazil. To the authors' knowledge, this is the first study to explore correlations between maternal QoL and breastfeeding efficacy in Brazil. METHODS: Research participants completed the Portuguese version of the World Health Organization Quality of Life-BREF and Multicultural Quality of Life Index questionnaires. Breastfeeding efficacy was evaluated through the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Correlations between the scores of the QoL instruments and the BSES-SF were examined using Pearson product-moment correlation coefficients. RESULTS: There were significant correlations among the scores of the two QoL questionnaires and the BSES-SF. Multiple regression analysis revealed that both QoL instruments significantly predicted BSES-SF scores. Neither socioeconomic status nor level of educational attainment was a significant predictor of breastfeeding efficacy. CONCLUSIONS: The results from the present study indicate that breastfeeding efficacy is significantly related to QoL among mothers in southern Brazil. The association between QoL and breastfeeding efficacy appears to be independent from any effect of socioeconomic status or level of educational achievement.