Causes of schizophrenia reported by patients' family members in China. (25/2237)

BACKGROUND: Better methods of assessing patients' and family members' causal models of illness are needed to improve adherence with biomedical interventions and to design services that meet the needs of consumers. AIMS: To develop a quantitative measure suitable for assessing the relationship of causal beliefs to expressed emotion, stigma, care-seeking and adherence. METHOD: The Causal Models Questionnaire for Schizophrenia, which includes 45 causes identified during in-depth interviews with family members, was administered to 245 family members of 135 patients with DSM-III-R schizophrenia in Suzhou and Siping, China at the time of admission to hospital. RESULTS: Respondents, who identified a mean of 2.5 causes (range 1-10, mode 2), attributed 84% of the cause of schizophrenia to social, interpersonal and psychological problems. Hence, their beliefs do not concur with Chinese professionals' ideas about the biomedical causes of schizophrenia. Multivariate analyses identified the socio-economic factors that influence family members' causal beliefs. CONCLUSIONS: Despite the complexity of causal models, measures can be developed that will help improve clinicians' communication with patients and understanding of help-seeking behaviours.  (+info)

Three-factor model of schizotypal personality: invariance across culture, gender, religious affiliation, family adversity, and psychopathology. (26/2237)

Whilst the syndrome approach to schizotypy has recently demonstrated differential correlates of a three-factor model of schizotypal personality, variations in the nature of these factors question a basic assumption of this approach. This study tested competing models of the factor structure of schizotypal personality using the Schizotypal Personality Questionnaire (SPQ) in a sample of 1,201 Mauritians. Factor invariance across gender, ethnicity, family adversity, and religion and across a psychopathologically select group was also assessed. Results suggest that a three-factor model, Cognitive-Perceptual Deficits, Interpersonal Deficits, and Disorganization, underlies individual differences across widely varying groups. Other competing three-factor schizotypal personality models did not fit the data better. It is argued that the three-factor Disorganized model is a well-replicated model of DSM schizotypal personality in community samples but possibly not in some clinical samples.  (+info)

Type 2 diabetes mellitus in Canada's first nations: status of an epidemic in progress. (27/2237)

This review provides a status report on the epidemic of type 2 diabetes mellitus that is affecting many of Canada's First Nations. We focus on the published literature, especially reports published in the past 2 decades, and incorporate data from the Aboriginal Peoples Survey and the First Nations and Inuit Regional Health Survey. We look at the extent and magnitude of the problem, the causes and risk factors, primary prevention and screening, clinical care and education, and cultural concepts and traditional knowledge. The epidemic of type 2 diabetes is still on the upswing, with a trend toward earlier age at onset. Genetic-environmental interactions are the likely cause. Scattered intervention projects have been implemented and evaluated, and some show promise. The current health and social repercussions of the disease are considerable, and the long-term outlook remains guarded. A national Aboriginal diabetes strategy is urgently needed.  (+info)

Bioethics for clinicians: 18. Aboriginal cultures. (28/2237)

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community.  (+info)

Differences in personal models among Latinos and European Americans: implications for clinical care. (29/2237)

OBJECTIVE: To describe and contrast the personal models of type 2 diabetes in European Americans (EAs) and Latinos and to highlight differences that require a reorientation of clinical care. RESEARCH DESIGN AND METHODS: A total of 116 EAs and 76 Latino individuals with type 2 diabetes were interviewed about their personal model of diabetes. Responses to open-ended questions about the perceived cause, nature, seriousness, course, and future course of diabetes and its impact on everyday life were analyzed using an iterative process, and categories of response were established. Responses were examined within ethnic group, and comparisons across ethnic groups were made for clinically significant differences. RESULTS: Disease descriptions about the nature of the disease were categorized as experiential, biomedical, or psychosocial. Disease descriptions varied significantly by ethnicity (chi2 = 35.92, 2 df, P < 0.001), with more Latinos using an experiential model and more EAs using a biomedical model. Significant differences in life changes caused by the disease were found, with EAs reporting changes in exercise and spontaneity and Latinos in fatigue and mood. Individuals with diabetes from both ethnic groups gave comparable assessments about the cause, seriousness, and effectiveness of treatments for the disease. CONCLUSIONS: Clinical practice that attends to the concerns and experiences of individuals with diabetes from diverse ethnic groups is warranted. Broad assessment of personal models in diverse ethnic groups is recommended.  (+info)

Peopling the past: new perspectives on the ancient Maya. (30/2237)

The new direction in Maya archaeology is toward achieving a greater understanding of people and their roles and their relations in the past. To answer emerging humanistic questions about ancient people's lives Mayanists are increasingly making use of new and existing scientific methods from archaeology and other disciplines. Maya archaeology is bridging the divide between the humanities and sciences to answer questions about ancient people previously considered beyond the realm of archaeological knowledge.  (+info)

Patients in Europe evaluate general practice care: an international comparison. (31/2237)

BACKGROUND: Patients' evaluations can be used to improve health care and compare general practice in different health systems. AIM: To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision. METHOD: An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP. RESULTS: The patient sample included 17,391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed care as good or excellent; in particular, keeping records confidential, GP listening to patients, time during consultations, and quick services in case of urgent problems were evaluated positively. Patients were relatively negative about organisational aspects of care. The evaluations in different countries were largely similar, with some interesting differences; for instance, service and organisational aspects were evaluated more positively in fee-for-service health systems. CONCLUSIONS: Patients in Europe are positive about general practice but improvements in practice management in some countries are requested. More research is needed to study the complex field of differences in expectations and evaluations between countries with different health systems.  (+info)

Inuit myopia: an environmentally induced "epidemic"? (32/2237)

Among Inuit less than 30 years old the prevalence of myopia is far in excess of that of their elders. This is especially true for females. There seems to be little, if any, genetic contribution to this "epidemic" of myopia in the young. The age and sex distribution indicates the likelihood of an environmental factor, probably cultural, being responsible for the current pattern. Other data implicate school attendance as a possible etiologic factor.  (+info)