Consent for Research Involving Spanish- and English-Speaking Latinx Adults With Schizophrenia

BACKGROUND

Latinxs are vastly underrepresented in mental health research; one of many contributing factors may be complexities in the research consent process, including language preferences. We examined determinants of comprehension of research consent procedures and tested the effects of a preconsent research schema condition among 180 adults with schizophrenia (60 Latinx-English and 60 Latinx-Spanish preference, and 60 non-Latinx White).

STUDY DESIGN

Participants were randomly assigned (equal allocation) to an educational session regarding clinical research concepts and processes (schema condition) or to an attention control. Following a subsequent simulated consent procedure for a hypothetical drug trail, comprehension of consent disclosures was measured with 2 standard measures.

STUDY RESULTS

One-way ANOVAs showed significant medium effect size differences between ethnicity/language groups on both measures of comprehension (η2s = 0.066-0.070). The Latinx-Spanish group showed lower comprehension than non-Latinx White participants; differences between the 2 Latinx groups did not reach statistical significance. Group differences were not statistically significant after adjusting for differences in education, or on scores from structured measures of acculturation, health literacy, or research literacy. Two-way ANOVAs showed no significant main effects for consent procedure on either comprehension measure (Ps > .369; partial η2s < 0.006) and no significant group-by-consent interactions (Ps > .554; partial η2s < 0.008).

CONCLUSIONS

Although the preconsent procedure was not effective, the results suggest health and research literacy may be targets for reducing disparities in consent comprehension. The onus is on researchers to improve communication of consent information as an important step to addressing health care disparities.

Recruitment of Asian Americans with Schizophrenia Spectrum Disorder for Research Participation: Barriers, Strategies, and Outcomes

Difficulty reaching Asian Americans with schizophrenia spectrum disorder has prompted mental health researchers to exclude this subpopulation from the sampling frame or enroll a comparatively smaller sample compared to other races and ethnicities with similar diagnoses. Understanding potential influences on research participation may facilitate efforts to increase the representation of this vulnerable yet underrepresented population in research. We detailed our experiences recruiting Asian Americans with schizophrenia spectrum disorder for participation in an observational study that evaluated their clinical outcomes. We applied the matching model of recruitment by identifying recruitment barriers encountered by or arising from the target group and researchers at the macro (community mental health center and academic institution), mediator (gatekeepers and research team), and micro (participant and interviewer) levels and then implementing a multilevel approach to overcoming identified obstacles. Our yearlong recruitment efforts yielded a diverse community sample (n = 75) recruited from six urban community mental health centers. Barriers to involving Asian Americans with schizophrenia spectrum disorder in research are complex and associated with being a member of a heterogeneous racial and ethnic minority group and having a serious psychiatric condition. Engaging Asian Americans with schizophrenia spectrum disorder in research is feasible if researchers devote time and resources to address barriers confronting the target group and challenges researchers encounter.

Family processes and duration of untreated psychosis among US Latinos

AIM

Little is known about family processes and treatment seeking among Latinos with first-episode psychosis (FEP) living in the United States. This study examined family processes prior to treatment and their relation to duration of untreated psychosis (DUP) among Latinos with FEP and their family caregivers.

METHODS

Thirty-three Latinos with FEP and their low-acculturated family caregivers (n = 33) participated in qualitative semi-structured interviews focused on treatment-seeking experience and family relationships. Transcripts were analysed using thematic analysis and themes were grouped based on short (n = 18) or long (n = 15) DUP.

RESULTS

Findings revealed differences based on DUP length. Patients with short DUP had stronger family relationships characterized by open communication and disclosure of symptoms that facilitated awareness and direct action by family caregivers. However, patients with long DUP had more troubled family relationships that often challenged early treatment seeking.

CONCLUSIONS

Findings highlight the relevance of family context in the provision of early treatment for Latinos with FEP. Family-based services are needed that increase awareness of symptoms and provide families with support that can facilitate ongoing patient treatment during this critical period.

Effectiveness of a multimodal training programme to improve general practitioners' burnout, job satisfaction and psychological well-being

BACKGROUND

The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners' (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs' work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being.

METHOD

Eighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme.

RESULTS

In relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.

CONCLUSIONS

Findings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs' management of mental-health patients and its positive effects on work-related health factors.

Lessons Learned in Clinical Research Recruitment of Immigrants and Minority Group Members with First-Episode Psychosis

Recruitment of immigrants and racial and ethnic minorities with first-episode psychosis (FEP) for research studies presents numerous challenges. We describe methods used to recruit 43 U.S. Latinos with FEP and their family caregivers (n = 41) participating in a study to reduce duration of untreated psychosis. A key challenge was that patients were not continuing treatment at an outpatient clinic, as initially expected. To facilitate identification of patients prior to outpatient care, we collaborated with clinic and hospital administrators. Many patients and families were grappling with the aftermath of a hospitalization or adjusting to a diagnosis of a serious mental illness. A considerable amount of time was devoted to addressing participants' concerns and when possible, facilitating needed services. Our experience underscores the importance of establishing long-term relationships through multiple contacts with patients, families, and stakeholders to address recruitment barriers among underserved groups with FEP.

Family involvement in eating disorder treatment among Latinas

Latinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders.

Hope and Schizophrenia in the Latino Family Context

This study explored hope among Latinos with schizophrenia and their family caregivers to gain a greater understanding of how it is experienced in the family context. Data were collected from 34 participants (14 individuals with schizophrenia; 20 family caregivers). Semistructured in-depth interviews were analyzed using thematic analysis, comparing codes across and within consumer and family caregiver transcripts. Findings revealed that hope was conceptualized as a multidimensional construct and was a vital resource for participants. Specifically, there was an emphasis on contextual factors that included religion and spirituality and interpersonal relationships. Findings underscore the need to expand our understanding of how hope is perceived and developed among Latinos and other underserved groups. This could lead to better recognition of this salient resource to incorporate its varied dimensions into treatment models that address the needs of consumers and family caregivers.

Families and medication use and adherence among Latinos with schizophrenia

BACKGROUND

Medication nonadherence among Latinos with schizophrenia represents a significant treatment obstacle. Although some studies have examined patient and family perceptions of adherence, few have examined these perceptions together. However, such knowledge can provide a deeper understanding of how family processes may contribute to or impede adherence among underserved groups such as Latinos.

AIMS

This study explored perceptions of medication and adherence among Latinos with schizophrenia and key family members.

METHOD

Purposive sampling was used to collect data from 34 participants: 14 patients with schizophrenia receiving community-based mental health services in an urban public setting and 20 key family members. Informed by grounded theory, semistructured interviews were analyzed by bilingual-bicultural team members.

RESULTS

Salient themes emerged indicating facilitators of and obstacles to medication use. Specifically, challenges centered on medication side effects, autonomy and choice, and illness insight, whereas facilitators focused on family support and holistic views of treatment and empowerment.

CONCLUSIONS

Because the majority of Spanish-speaking Latinos with schizophrenia live with family, it is important to examine family factors that may influence medication use. Findings suggest that patient and family perceptions of medication should be examined as part of the treatment process, particularly regarding issues of autonomy and choice.

Selecting an Acculturation Measure for Use With Latino Older Adults

The purpose of this article is to ascertain the degree to which acculturation measures have been validated for use with older Latino adults and to offer recommendations to assist practitioners and researchers in selecting an empirically sound acculturation measure. The authors analyzed the psycho-metric properties of 15 subjective acculturation instruments that sampled Latino older adult respondents in their development or validation. In general, the limited data suggest a tendency for lower acculturation scores among older Latinos. A number of scales suffer from methodological flaws or lack sufficient psychometric data. The effect of age on acculturation was infrequently analyzed, and no measure was designed specifically for use with older adults, although several measures appear to have promise for use with Latino older adults. Because Latinos are one of the fastest growing sectors of the older adult population, further attention to the development and validation of acculturation measures for this population is urged.

Correlates in the Endorsement of Psychotic Symptoms and Services Use: Findings from the Collaborative Psychiatric Epidemiology Surveys

Endorsement of psychotic symptoms serves as an indicator of significant health issues and interpersonal distress. Seeking services is the ultimate recourse for many individuals, yet few studies have assessed the help-seeking process in a nationally representative sample. This study, guided by Lewis-Fernández et al.'s (J Nerv Ment Dis 197(5):337-347, 2009) analyses, examined the association of lifetime endorsement of psychotic symptoms with demographic, clinical and support system variables and types of services received. Based on nationally weighted epidemiological data, 11.6 % of adults reported one or more psychotic symptoms. Psychotic symptoms were associated with poor physical and mental health, specifically depressive, anxiety, and substance use disorders. Respondents were more likely to receive services from both informal and mental health providers and were more likely to be hospitalized than those not endorsing psychotic symptoms. Study findings inform community efforts to develop comprehensive services for individuals experiencing psychotic symptoms.

Remission of symptoms in community-based psychosocial rehabilitation services for individuals with schizophrenia

OBJECTIVE

The aims of this study were to determine the prevalence of remission in individuals with schizophrenia at baseline and 6 months after admission to community-based psychosocial rehabilitation and whether baseline intrapersonal and environmental resources predicted remission at 6 months, controlling for relevant demographic and clinical variables.

METHOD

The sample featured 187 individuals with schizophrenia spectrum disorder. To determine remission status, consensus-based criteria proposed by the Remission in Schizophrenia Working Group were adapted to identify predictors of remission outcomes, direct binary logistic regression analysis was performed.

RESULTS

Findings indicated that 34.57% and 55.61% of the sample was in remission at baseline and 6 months, respectively. Remission at 6 months was predicted by shorter length of illness and being in remission at admission.

CONCLUSIONS

Remission of schizophrenia is an achievable outcome in community psychosocial rehabilitation settings. Clinical characteristics exerted a significantly stronger influence on remission outcomes compared with psychosocial factors.

Perceptions of Subjective Burden Among Latino Families Caring for a Loved One with Schizophrenia

The purpose of this study was to explore perceptions of subjective burden among Latino family members providing care for a loved one with schizophrenia. Data were collected from outpatient community mental health centers and featured 64 Latino family members who were primarily Spanish speaking and of Mexican origin. We used qualitative methods to examine subjective burden based on an open section of the Family Burden Interview Schedule. Five salient themes emerged capturing family members' subjective burden experience: (a) interpersonal family relationships, (b) emotional and physical health, (c) loss of role expectations, (d) religion and spirituality, and (e) stigma. Overall, findings illustrated that families perceived numerous challenges in their caregiving. Implications for research and practice among Latino family members are discussed.

Hope and burden among Latino families of adults with schizophrenia

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family member's increased hope for the patient's future would be associated with decreased family burden beyond effects explained by the patient's length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patient's future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.

Culturally Based Intervention Development: The Case of Latino Families Dealing With Schizophrenia

OBJECTIVES: This article describes the process of developing a culturally based family intervention for Spanish-speaking Latino families with a relative diagnosed with schizophrenia. METHOD: Our iterative intervention development process was guided by a cultural exchange framework and based on findings from an ethnographic study. We piloted this multifamily group 16-session intervention with 59 Latino families in a randomized control trial. Data were collected on family- and client-level outcomes, and poststudy focus groups were conducted with intervention participants. RESULTS: Preliminary evidence indicates that the intervention is effective by increasing illness knowledge and reducing family burden. CONCLUSIONS: This work can provide a model for how to integrate cultural factors into psychosocial services and enhance interventions in real-world settings for culturally diverse populations.

Intrinsic motivation as a mediator of relationships between symptoms and functioning among individuals with schizophrenia spectrum disorders in a diverse urban community

This study investigated intrinsic motivation as a mediator of the relationship between clinical symptoms and functioning. The mediation model was tested with a sample of 166 adults with schizophrenia spectrum disorders attending psychosocial rehabilitation programs in a diverse urban community. Ethnic minority status was examined as a moderator of the mediation model. Motivation was measured using items reflecting intrapsychic drive. Symptoms were assessed with the expanded Brief Psychiatric Rating Scale and functioning with the Role Functioning Scale. Motivation was a significant mediator of the relationship between functioning and all symptom scores; fully mediating the relationship between functioning and negative, disorganized, and global symptoms, and partially mediating the relationship between positive symptoms and functioning. Motivation scores between ethnic minority and nonminority individuals differed significantly (p < 0.05), but no moderation effect was indicated. The strong mediation effect schizophrenia of motivation on the symptoms-functioning relationship supports future work to translate findings into effective recovery-oriented services.

[Minor cutaneous ambulatory surgery and cryotherapy. Comparative study between a dermatologist and family physicians]

INTRODUCTION

Lack of diagnostic skill in cutaneous surgery may lead to erroneous and potentially detrimental therapies. This study compares the diagnosis and treatment in cutaneous surgery, including cryotherapy, between a dermatologist and family physicians.

METHODS

It is an observational, prospective study on a random sample of patients that consulted the dermatologist for candidate lesions. Each lesion was independently evaluated by a dermatologist and a family physician, both of whom assigned the clinical diagnosis and therapeutic advice. Concordance for diagnosis, recommended treatment and indication for cryotherapy was calculated by Cohen's kappa coefficient.

RESULTS

Six hundred forty-six lesions were evaluated. Global kappa indexes were 0.69 (95 % CI, 0.65-0.73) for diagnostic concordance, 0.62 (95 % CI, 0.56-0.67) for recommended treatment and 0.73 (95 % CI, 0.67-0.78) for indication of cryotherapy. Diagnostic concordance was significantly better for melanocytic nevus, achrocordon and for lesions with multiple and monomorphous presentation, and worse for isolated pigmented lesions. For recommended treatment concordance was better for multiple and monomorphous lesions and worse for skin cancer and seborrheic keratosis. For indication of cryotherapy concordance was worse for skin cancer, melanocytic nevus, acrochordon and seborrheic keratosis. Family physicians made an erroneous indication for cryotherapy in 5.88 % of cases, including 3 non melanoma skin cancers.

CONCLUSIONS

Concordance between dermatologists and family physicians for minor cutaneous surgery is generally good. Family physicians should be more careful in evaluating solitary pigmented lesions and patients at risk for skin cancer.

Psychometric evaluation of the Spanish version of CONNECT: a measure of continuity of care in mental health services

This article provides the results of the psychometric testing of the Spanish version of CONNECT(-S), a measure of continuity of care in mental health services. CONNECT-S is a multidimensional measure designed for use with seriously mentally ill respondents. Consisting of 12 scales and one single-item indicator, it addresses qualities of interaction in current relationships between mental health service providers and consumers in five conceptual domains: (1) practitioner knowledge of their clients, (2) creating flexibility, (3) practitioner availability, (4) practitioner co-ordination, and (5) smoothing transitions. One-hundred-and-fifty participants took part in the study. Participants were recruited from mental health outpatient clinics in both the Puerto Rican (n = 109) and the San Antonio (n = 41) samples. Internal consistency for scales in a combined site estimate ranged from 0.68 to 0.96. Test-retest reliability ranged from fair to substantial in all but one scale. Concurrent validity hypotheses based on a priori predictions were mostly supported. The Spanish translation and adaptation of CONNECT-S provided sound psychometric results across both sites. CONNECT-S addresses the gap in measurement of continuity of care for the two largest US Latino subgroups, Mexican Americans and Puerto Ricans; and provides an encouraging starting point for a measure that is both relevant and culturally sensitive.

Cross-ethnic evaluation of psychotic symptom content in hospitalized middle-aged and older adults

OBJECTIVE

The objective of this study was to examine ethnic differences in the content of delusions and hallucinations among a tri-ethnic sample of adult psychiatric inpatients older than 40 years who were hospitalized with an acute psychotic episode.

METHODS

A chart review of inpatient episodes for 133 middle-aged and older adult patients (31 African Americans, 50 Latinos, and 52 Euro-Americans) with a mean age of 50 years was performed at an acute behavioral medicine unit at a university hospital. All patients were diagnosed with a severe psychotic disorder. The content and frequency of psychotic symptoms were systematically reviewed using a structured checklist and comparisons across ethnic groups were made using chi(2) statistics.

RESULTS

Ethnic group differences were found in the contents and subtypes of delusions and hallucinations. Significant ethnic differences were found in symptom content, consistent with findings from studies on younger samples of inpatients. Euro-Americans were nearly twice as likely as Latinos to report delusions of grandiosity. African Americans were more likely than Latinos to report general paranoid delusions of persecution. Latinos reported more culturally influenced contents than the other groups.

CONCLUSION

Raising provider awareness of ethnic variation in symptom expression is a key step in the process of developing effective treatments for ethnically diverse middle-aged and older patient populations.

Ethnic differences in social network help-seeking strategies among Latino and Euro-Aamerican dementia caregivers

This research explores the help-seeking behavior of Euro-American and Latino caregivers who provide homecare assistance to an older adult with dementia. A community sample of 89 caregiver-care recipient pairs (39 Latino and 50 Euro-American) was interviewed. Descriptive, bivariate, and multivariate analyses were conducted to examine ethnic differences in use of an informal social network for help with caregiving tasks. Caregiver experiences that may impact help-seeking behaviors such as perceived availability of support network, satisfaction with support received and caregiver distress were also considered. Latino caregivers reported less help-seeking than did the Euro-American caregivers. Overall, ethnicity accounted for 16% of the variation in help-seeking behaviors. Ethnicity accounted for a significant portion of the variation in most of the help-seeking characteristics examined even after adjusting for socioeconomic variables. In the multivariate model, the effects of ethnicity on help-seeking persisted, while the effects of other likely predictors did not. The size of social network may not be synonymous with the seeking of support by caregivers. Likewise, higher levels of distress among Latino caregivers did not result in increased help-seeking behaviors. There remains a need to identity what other factors may contribute to the cultural variability in caregivers' use of informal support.

Successful use of tissue plasminogen activator in catheter-related intracardiac thrombus of a premature infant

The incidence of clinically apparent neonatal thrombosis is about 0.1 to 0.2% in the neonatal intensive care unit (NICU). The optimal treatment modalities for neonates with thromboses are not known. We report on our experience with recombinant tissue type plasminogen activator (rt-PA) in a premature infant with an intracardiac thrombus.

Culture and schizophrenia: a cross-ethnic growth curve analysis

This study examined the longitudinal trajectory of a sociocentric construct among African-Americans, Latinos, and nonminorities. Participants were 163 individuals diagnosed with schizophrenia who were admitted to community-based psychosocial programs. Previous research had established empathy and social competence as sociocentric cultural mediators of a benign symptom profile for ethnic minorities. Data on sociocentric indicators were collected every 6 months for over 3 years. Growth curve methodology was used to examine the empathy and social competence outcomes over time and across ethnic groups. The results revealed a dynamic course for both sociocentric mediators. However, the dynamic growth curve for empathy was related to ethnicity; for social competence it was not. Empathy levels for African-Americans decreased and then attenuated, whereas empathy levels for Latinos decreased over the entire study. Nonminorities showed very little change overall. The nature of sociocentric phenomena is dynamic and complex. These qualities can apparently be cultivated or diminished over time.

Theory and computer simulation for the equation of state of additive hard-disk fluid mixtures

A procedure previously developed by the authors to obtain the equation of state for a mixture of additive hard spheres on the basis of a pure fluid equation of state is applied here to a binary mixture of additive hard disks in two dimensions. The equation of state depends on two parameters which are determined from the second and third virial coefficients for the mixture, which are known exactly. Results are compared with Monte Carlo calculations which are also reported. The agreement between theory and simulation is very good. For the fourth and fifth virial coefficients of the mixture, the equation of state gives results which are also in close agreement with exact numerical values reported in the literature.

The cultural relevance of community support programs

The research and practice literature was examined to determine whether community support programs are responsive to ethnocultural issues and to derive strategies for developing culturally relevant programming. Great variation exists across cultures in family practices, conceptions of mental illness, stigma attributed to mental illness, and expectations of the provider system. Ethnic minority cultures are typically centered on the family, whereas Western European cultures are characterized as more individualistic and as valuing independence. Research shows that some rehabilitation approaches based on Western models may produce adverse effects when used with patients from ethnic minority groups. Interventions that incorporate family networks and use group modalities are considered culturally congruent. Clients from sociocentric cultures may have strong support networks and display prosocial behaviors that can be tapped in the rehabilitation process. Community support programs should incorporate cultural factors into psychosocial assessments, train staff to conduct ethnographic interviews, and use focus groups to gain an understanding of the cultures of clients they serve.

[Estimate of HIV-1 infection prevalence in pregnant women and effectiveness of zidovudine administered during pregnancy in the prevention of vertical transmission]

BACKGROUND

Despite the proven efficacy of zidovudine (ZDV) for reducing perinatal transmission of HIV-1, questions remain about its implementation and effectiveness in routine practice. The aims of this study were to assess the impact of ZDV administered during pregnancy in preventing perinatal HIV-1 transmission, and to determine the proportion of early identification of maternal HIV-1 infection over time.

PATIENTS AND METHODS

We prospectively followed from birth a cohort of children born between 1/1/1987 and 31/10/1997 to HIV-1-infected mothers. Infant infection status was assessed by follow-up beyond 18 months or HIV-PCR up to 3 months of age.

RESULTS

229 mothers and 248 infants were identified in the cohort. ZDV was administered during pregnancy as monotherapy to 34 mothers for a mean of 4.7 (3.1) months prior to delivery. There were no differences in baseline characteristics between the treated and untreated groups. Mean (SD) CD4 cell count was 465 (261) cells x 10(6)/l. Factors associated with transmission were a more prolonged time of rupture of obstetric membranes (median 6 vs 1.04 hours; p = 0.023) and ZDV treatment. Among the ZDV-treated mothers only one child was infected (2.9%), whereas 37 children born to 212 untreated women became infected. (OR: 0.14; 95% CI: 0.07-0.92). The estimated prevalence of HIV-1 in pregnant women in our area is about 0.39% (95% CI: 0.34-0.45). From 1987 to 1991, 9.7% of infected women were nor identified at the perinatal period, as compared to 2.5% in the last 5 years of the study period (p = 0.034).

CONCLUSIONS

In this study, the estimated prevalence of HIV-1 infection is high. ZDV during pregnancy is significantly associated with a decrease in perinatal transmission in our setting. The awareness of an effective treatment might have contributed to the increased identification of HIV-infected mothers prior to delivery observed over time in our cohort of children born to HIV-infected mothers.

Cross-ethnic symptom differences in schizophrenia: the influence of culture and minority status

The two objectives of this tri-ethnic study were (1) to test competing hypotheses from the minority status and ethnic culture perspectives in examining cross-ethnic symptom differences in schizophrenia and (2) to test cultural mediators of the symptom differences. Analyses were done on samples of minority (African-American and Latino) and nonminority (white) groups. Hypothesized cross-ethnic symptom differences were tested, and indicators of sociocentricity were examined as cultural mediators of symptom differences. The sample consisted of 184 individuals (51.6% white, 32.6% African-American, 15.8% Latino, 75% male) diagnosed with schizophrenia in an outpatient, urban setting. Symptom variables were obtained from the Brief Psychiatric Rating Scale and the Quality of Life Scale. Two sociocentric indicators (empathy and social competence) were used to differentiate minority from nonminority groups. Multiple regression was used to test the mediational influence of the sociocentric indicators on the symptom differences. After controlling for social class, significant differences were found in eight symptom variables. These showed the nonminority group to be consistently more symptomatic than the ethnic minority groups, findings which supported the ethnic culture hypothesis. Sociocentric indicators were found to be significant mediators of the cross-ethnic symptom differences. This study supported the ethnic culture hypothesis, which predicted lower symptoms for the ethnic minority groups, and showed that sociocentric variables strongly mediated the more benign symptom profile for the ethnic minority groups. The study indicates that culture should be more fully integrated into current biopsychosocial models of schizophrenia.

[Meconium aspiration syndrome with severe hypoxemia. Treatment with a pulmonary vasodilator (tolarzoline) (author's transl)]

Three patients with Meconium Aspiration Syndrome (S.A.M.) and severe hypoxemia are reported. From the first hours of life they needed mechanical ventilation, showing no improvement in PaO2 in spite of usual respiratory support measures. In one case, pulmonary hypertension and ductal right to left shunt through ductus arteriosus and foramen ovale was objetivated by cardiac catheterization. Following intravenous prefusion of a pulmonary vasodilator (Tolazoline) patients showed a clinical amelioration and a definite increase in PaO2. Results and evolution with the use of this drug are commented.