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 uncertainty trope: the duty to treat during a pandemic.

BACKGROUND: Past guidance in the codes of practice urged doctors to provide treatment even in the context of extreme adversities. Despite the significant societal changes of recent times, contemporary guidance regarding the duty to treat during a pandemic has been limited. OBJECTIVE: The authors herewith examine deontological aspects pertaining to the duty to treat during a pandemic and the potential disruptions to health care services. CONCLUSION: The ethical, legal and professional guidance for duty of care during a pandemic is uncertain and demands further debate.

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.

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.

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.

Using the Portuguese version of the Bicultural Scale in Brazil / O uso da versão em português da Escala de Biculturalidade no Brasil

Abstract 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.

Resumo Introdução: O Brasil recebeu afluxo de imigrantes principalmente da África, Europa e Japão, formando uma das populações mais heterogêneas do mundo. Alguns grupos, particularmente no Sul do Brasil, têm mantido suas tradições culturais originais, ao mesmo tempo que adquirem elementos típicos da identidade cultural brasileira local. Este é o primeiro estudo a avaliar formalmente a biculturalidade no Brasil. Objetivo: Avaliação psicométrica e validação da versão em português da Escala de Biculturalidade (EB) no Brasil. Métodos: A EB foi adaptada e traduzida para o português e testada pela primeira vez no Brasil em uma amostra de descendentes de quatro grupos de imigrantes (n = 160) em diferentes localizações no Sul do Brasil. Uma série de testes psicométricos foram aplicados a fim de examinar a validade da versão em português da EB. Análises de variância através dos escores obtidos em cada subgrupo também foram conduzidas. Resultados: A análise fatorial revelou que dois fatores principais contribuem para a maioria da variância nos escores. Os 10 items que medem afiliação com características culturais minoritárias e cultura típica brasileira demonstraram índice de Cronbach de 0,69 e 0,78, respectivamente, enquanto que o alfa global de Cronbach para todos os 20 itens da EB foi de 0,67. Houve correlação significativa entre os itens relacionados à cultura típica brasileira e a geração dos voluntários desde o período de imigração (r = 0,23, p = 0,004). O tempo médio para completar o questionário foi de 7,4 minutos. Conclusões: Os resultados indicam que a versão em português da EB é um instrumento válido, confiável e de fácil utilização para avaliar expêriencias de biculturalidade de descendentes de imigrantes no Sul do Brasil.

Ethnic Classification in the New Zealand Health Care System.

The ethnic or "racial" classification of Maori and non-Maori is a pivotal feature of New Zealand's health system and affects government policy and professional practice within the context of Treaty of Waitangi "partnership" politics. Although intended to empower Maori, ethnic categorization can have unintended and negative consequences by ignoring the causality of material forces in social phenomena. The authors begin by showing how the use of ethnic categories in health policy is justified by the Treaty of Waitangi partnership policies. This provides the context for the argument made in the manuscript that an understanding of the social experience of ethnicity within the complex interaction of sociocultural factors such as socioeconomic location and lifestyle is more useful than using the political construct of ethnic categories in explaining the persistence of low health status for a section of the Maori population.

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.

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.

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 (AU)

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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.

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.

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.

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 / Sintomas de ansiedade em usuários de crack e inalantes admitidos em uma unidade psiquiátrica na Região Sul do Brasil

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.

OBJETIVO: Investigar sintomas de ansiedade em usuários de crack e inalantes no Sul do Brasil. MÉTODOS: Oestudo investigou dois grupos de voluntárioscomomesmonúmero de indivíduos (n = 50): um grupo consistiu de usuários de crack e o outro grupo, de usuários de inalantes. Os voluntários da pesquisa completaram as versões em português das escalas de ansiedade State-Trais Anxiety Inventory (STAI) e Hamilton Anxiety Rating Scale (HAM-A), e o Questionário de Autoavaliação (SRQ). RESULTADOS: Ambos os grupos apresentaram sintomas significativos de ansiedade. Os usuários de inalantes apresentaram escores quanto a HAM-A significativamente superiores aos usuários de crack. Ansiedade e psicopatologia geral se apresentaram significativamente correlacionados. CONCLUSÃO: Sintomas de ansiedade são frequentes entre usuários de crack e inalantes. Um processo de triagem de sintomas de ansiedade entre usuários de crack e inalantes deve facilitar ainda mais as intervenções terapêuticas nesta área.

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.

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.

Estudo da correlação entre aleitamento e estado de saúde materno / 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.

OBJETIVO: Examinar a relação entre eficácia do aleitamento e o estado de saúde em uma amostra de 88 mães na Região Sul do Brasil. MÉTODOS: As participantes da pesquisa completaram a versão em português do Questionário de Saúde Geral e da Escala de Saúde Pessoal. A eficácia do aleitamento foi avaliada por meio da Escala de Autoeficácia no Aleitamento. As correlações entre o escore do questionário referente ao aleitamento e os instrumentos de avaliação do estado de saúde foram examinadas usando-se o coeficiente de correlação de Pearson. RESULTADOS: Houve correlação significante entre os escores dos questionários de estado de saúde e da escala de eficácia do aleitamento. Análises de regressão bivariada revelaram valores preditivos significantes de ambos os instrumentos de avaliação do estado de saúde sobre os escores da escala de eficácia do aleitamento. CONCLUSÃO: A eficácia do aleitamento está relacionada ao estado de saúde materno no sul do Brasil.

The use of appetite suppressants among health sciences undergraduate students in Southern Brazil.

OBJECTIVE: To investigate the prevalence of appetite suppressant use among health sciences students in Southern Brazil. METHODS: Undergraduate students (n=300) from seven health science undergraduate courses of the Universidade de Caxias do Sul completed a questionnaire about the use of substances to suppress appetite. RESULTS: A significant percentage (15%; n=45) of research participants used appetite suppressants at least once in their lives. The most commonly used substances were sympathomimetic stimulant drugs (5%), including amfepramone (3.3%) and fenproporex (1.7%). The lifetime use of appetite suppressants was more prevalent among Nursing (26.7%) and Nutrition (24.4%%) students. There was no reported use of appetite suppressants among medical students. The use of appetite suppressants was significantly more prevalent among women. The majority of those who used these substances did so under medical recommendation. Most of users took appetite suppressants for more than 3 months. CONCLUSION: Lifetime use of appetite suppressants was substantial, being sympathomimetic stimulant drugs the most commonly used agents. Students enrolled in Nursing and Nutrition courses presented a significantly higher prevalence of lifetime use of appetite suppressants.