Determinants of substance use amongst Brazilians residing in the UK: The role of acculturation.

INTRODUCTION AND AIMS: Evidence suggests that patterns of substance use are changing amongst some members of migrant groups in the UK. This study explored the extent to which residing in the UK has an impact on substance use behaviours amongst Brazilian migrants. DESIGN AND METHODS: A mixed methods approach was adopted comparing Brazilians residing in the UK (n = 164) and Brazilians residing in Brazil (n = 161), age 27.82 (SD = 5.65) average. Participants' socio-demographic characteristics, resilience, personality traits, drinking motives, psychological distress, frequency of alcohol intake, smoking and other drugs used (Brazil and UK), acculturation outcomes and length of residence (UK) were explored. Six in-depth interviews were conducted with Brazilian residents in the UK and analysed using thematic analysis. RESULTS: Participants from the UK reported higher prevalence of substance use; however, significant country differences were only found in binge drinking and poly drug use. While in Brazil, substance use was associated with being male, no religious practices, having resided in another country and higher scores in drinking for social motives and sensation seeking, in the UK it was associated with elementary occupations, higher scores in drinking for social and enhancement motives, threat to cultural identity and lower length of residence in the UK. Interview data suggested that living in the UK was stressful. CONCLUSIONS: Country differences in patterns of substance use were associated with changes resulting from the migratory process to the UK. The stresses associated with the process of acculturation presents a promising path for addressing substance use problems in migrant populations.

Discourses of sexual relationships in a sample of German and British young people: a Q methodological study.

Young people live in an environment that sexualises them, particularly women, along traditional gender roles. This, in parallel with a silence about positive sexuality in policy development, means that sexual double standards prevail in young people's lives. The aim of this study was to explore the discourses young women and men from two European countries, Germany and England, draw on when making sense of sexual relationships and how these are steeped in the local cultural climate and messages. The study used Q methodology and included 65 German and English young people between 16 and 19 years of age. Six accounts emerged: sex as responsible, intimate and shared experience; sex as joint fun; ideal versus reality; sex has to be responsible, consensual and shared; caring relationships offer the perfect context for fulfilling sex; and equality between partners. The importance of cultural context in the availability of specific dominant and alternative discourses is discussed with a focus on how this influences young people's sense-making with regard to sexuality and sexual relationships. Future directions for research are highlighted.

"What am I Going to Say Here?" The Experiences of Doctors and Nurses Communicating with Patients in a Cancer Unit.

This paper describes a study investigating the provider-patient communication perceptions, experiences, needs, and strategies of doctors and nurses working together in a UK cancer setting. This was a qualitative study using individual interviews and focus group discussions. Interpretative phenomenological analysis was used to underpin data collection and analysis. Twenty-six staff participated in the project (18 nurses and 8 doctors). Both professional groups identified an inherent emotional strain in their daily interactions with patients. The strategies they adopted to reduce this strain fell into two main categories: (1) Handling or managing the patient to keep negative emotion at bay; and (2) Managing self to keep negative emotion at bay. These strategies allowed staff to maintain a sense of control in an emotionally stressful environment. Most believed that their communication skills were sufficient. In conclusion, communicating with and caring for cancer patients causes considerable psychosocial burden for doctors and nurses. Managing this burden influences their communication with patients. Without recognition of the need for staff to protect their own emotional well-being, communication skills training programs, emphasized in current UK cancer care guidelines, may have little impact on practice.

Palliative care and circumstances of dying in German ALS patients using non-invasive ventilation.

Non-invasive ventilation (NIV) is known to improve quality of life and to prolong survival in amyotrophic lateral sclerosis (ALS) patients. However, little is known about the circumstances of dying in ventilated ALS patients. In the light of the debate on legalizing euthanasia it is important to provide empirical data about the process of dying in these patients. In a structured interview, 29 family caregivers of deceased ALS patients were asked about their own and the patient's attitude toward physician-assisted suicide (PAS) and euthanasia, circumstances of dying, and the use of palliative medication. Quantitative and qualitative content analysis was performed on the data. Non-recurring suicidal thoughts were reported by five patients. Three patients and seven relatives had thought about PAS. Seventeen caregivers described the patients' death as "peaceful", while choking was reported in six bulbar patients. In final stages of dying, the general practitioner (GP) was involved in the treatment of 10 patients, with palliative medication including sedatives and opiates being administered in eight cases. In conclusion, in contrast to the Netherlands, where 20% of terminal ALS patients die from PAS or euthanasia, only a small minority of our patients seems to have thought about PAS. The legal situation in Germany (where euthanasia is illegal), a bias due to the selection of NIV patients as well as a high percentage of religious patients and those with good levels of social support from family and friends, might account for this. Most of our patients died peacefully at home from carbon dioxide narcosis, but choking was described in some bulbar patients. Thus, palliative care, especially the use of opiates, anxiolytics and sedatives should be optimized, and the involvement of GP should be strongly encouraged, especially in bulbar patients.

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers.

Smokers in Greece and the UK are habitually exposed to different levels of social disapproval. This qualitative study explored the accounts of smoking and disapproval offered by 32 UK and Greek smokers. Accounts were framed with reference to a highly moralized construction of smoking. Participants were sensitive to social disapproval of their smoking. While disapproval from those close to them was accepted, disapproval from the general public was not. Two discursive repertories 'smoking works for me now' and 'the struggle to quit' were identified as resources that participants drew upon to enable continued smoking while acknowledging the health issues. While there were many similarities in the accounts provided, there were important differences that seem to reflect the different 'smoking worlds' inhabited.