[Obstacles and practical perspectives of the consultation in general medicine of migrants with psychological disorders. Qualitative study among French general practitioners]

OBJECTIVE

The aim of this study is to understand the problems of managing psychological disorders in migrant populations, based on the experience of general practitioners.

METHOD

A qualitative study was carried out with general practitioners interviewed in a semi-directive mode. We chose the continuous comparison method and Peirce's pragmatic phenomenological approach to explore the lived experience.

RESULTS

Thirteen interviews revealed four phenomenological categories: (1) Immigration was an experience of mental suffering from beginning to end at the source of psychological disorder migrant population (PDMPs) with the need for specialized follow-up. (2) Inadequate support on arrival, with complicated administrative procedures and insecure societal and environmental conditions, exacerbated the precariousness of migrants, making follow-up difficult. (3) Immigration was a transcultural journey in which the language, attitudes and perceptions of each individual blurred understanding of symptoms and care, and thus professional communication. (4) Unprepared general practitioners found counselling migrants to be difficult, time-consuming and complex. They pointed to the need for a coordinated system with comprehensive multidisciplinary care.Data saturation was reached. Three researchers were brought together.

CONCLUSION

This study highlights the difficulties encountered by general practitioner (GPs) dealing with migrant patients in France. They feel helpless in the face of the nature of the disorders encountered and experience a disparity between the connections that are difficult to establish and those in their usual practice, even when professional experience with this population is acquired. They point to the need for coordinated models of care, financed by public policy.

On the concept, taxonomy, and transculturality of disordered grief

The enduring question of whether grief can ever be pathological (and, if so, when) has been shrouding mental health and psychiatric care over the last few years. While this discussion extends beyond the confines of psychiatry to encompass contributions from diverse disciplines such as Anthropology, Sociology, and Philosophy, scrutiny has been mainly directed toward psychiatry for its purported inclination to pathologize grief-an unavoidable facet of the human experience. This critique has gained particular salience considering the formal inclusion of prolonged grief disorder (PGD) in the 11th edition of the International Classification of Diseases (ICD-11) and the subsequent Text Revision 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This study contends that the inclusion of prolonged grief disorder as a diagnostic entity may be excessively rooted in Western cultural perspectives and empirical data, neglecting the nuanced variations in the expression and interpretation of grief across different cultural contexts. The formalization of this disorder not only raises questions about its universality and validity but also poses challenges to transcultural psychiatry, due to poor representation in empirical research and increased risk of misdiagnosis. Additionally, it exacerbates the ongoing concerns related to normativism and the lack of genuine cultural relativism within the DSM. Furthermore, the passionate discussion surrounding the existence, or not, of disordered forms of grief may actually impede effective care for individuals genuinely grappling with pathological forms of grief. In light of these considerations, this study proposes that prolonged grief disorder should be approached as a diagnostic category with potential Western cultural bias until comprehensive cross-cultural studies, conducted in diverse settings, can either substantiate or refute its broader applicability. This recalibration is imperative for advancing a more inclusive and culturally sensitive understanding of grief within the field of psychiatry.

A qualitative study exploring nurses' experiences of supporting South Asian people with dementia and their family carers

AIMS

To explore nurses' experiences of providing support to South Asian (SA) people with dementia and their family carers and to identify barriers and enablers of good transcultural care.

DESIGN

A qualitative, phenomenological design was used.

METHODS

Fifteen registered community and in-patient nurses were recruited via one NHS Mental Health Foundation Trust. Nurses were from diverse backgrounds (Black, Ghanaian, Irish, Mauritian and White), 13 females and 2 males, and had been qualified from between 2 and 49 years. One-to-one semi-structured interviews were conducted between July and October 2019.

RESULTS

A thematic analysis identified three themes. 'Communication challenges' highlighted the impact of language barriers and the consequences of misunderstandings due to a dissonance in cultural values between nurses and interpreters. 'The bi-directional impact of culture' identified the two-way dynamics of transcultural work, the process of countering mutual stigma, and revealed an original perspective on how 'cultural desire' grows through practice experiences rather than being a prior motivation for learning. 'Learning experiences' showed that most learning was informal, experiential and prolonged, with nurses feeling they had unmet learning needs.

CONCLUSION

Nurses have minimal training opportunities and are under-supported in their transcultural work, potentially perpetuating the disadvantages that SA people with dementia and their families face in relation to healthcare. Enhanced cultural understanding of self and others and application of specific communication strategies could support nurses, together with interpreters, to build rapport and effective working relationships with each other and service users.

IMPACT

Transcultural nursing is a key competency, but nurses experience difficulties with providing care which is recognized as effective by SA family carers. The development of more acceptable and effective services requires improved mutual cultural understanding between nurses, interpreters and families, underpinned by joint brief training interventions, leading to more effective professional communication, better care outcomes and improved satisfaction with services.

Giving Meaning to the Dark Triad: Comparison of Different Factor Structures of the Dirty Dozen Through Eight Regions of the World

The traits of the dark triad (narcissism, psychopathy, and Machiavellianism) capture the individual differences in the aversive personality. The dark triad has shown significant relations with behaviors that affect people's lives. One of the best-known instruments to assess the dark triad is the Dirty Dozen. However, controversy continues over the use of one general dark triad score or, conversely, three different scores. This study aimed to investigate the factor structure of the Dirty Dozen across eight global regions. There were 11,477 participants in 49 countries grouped into eight regions. Different factor structures were studied using confirmatory factor analyses. Both the three-dimensional models and the bifactor models (symmetrical or traditional and non-symmetrical or bifactor-[S - 1]) showed a good fit to the data. The bifactor-(S - 1) models (with psychopathy or Machiavellianism as the reference factors) show adequate fit to the data, supported by the coherence of the factorial loadings and the bifactor indices. Regarding measurement invariance for both models, configural, metric, and scalar invariance were satisfied. The results indicate that it is not clear whether a psychopathy or Machiavellianism reference factor predominates in the Dirty Dozen. For both models, templates are provided to obtain standardized scores for applied researchers in the eight studied world regions until future studies offer a greater amount of validity evidence for this instrument.

Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders

Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.

Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample

Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.

Quality of life in parents of autistic children: A transcultural perspective

Introduction

The concepts of health, illness, and disability as well as the perceptions of autism and quality of life (QoL) vary greatly across cultures and across time. This study sought to explore the interplay of culture on QoL and impact on parents caring for autistic children.

Methods

We used a transcultural dataset from seven countries (Australia, Hungary, Malaysia, Romania, Singapore, Spain, and the United Kingdom) with participating parents/carers reporting on the Quality of Life in Autism (QoLA) questionnaire. The QoLA questionnaire is a validated measure of QoL for parents of autistic children, with Part A subscale measuring parental QoL and part B subscale assessing the parental impact of the child's autism spectrum disorder (ASD) symptoms or features. We used the Quade's ranked analysis of covariance to determine significant differences between the countries in relation to QoLA Part A and Part B scores while adjusting for baseline differences using covariates such as parents' gender, child's age, and gender. Additionally, a post-hoc analysis with Bonferroni correction was also conducted to examine multiple pairwise comparisons.

Results and conclusion

We found that while the effect of features of ASD (Part B subscale) stayed strongly comparable between cultures, the self-reported parental QoL was most likely determined by different aspects of culture in different countries. It is concluded that while the ASD symptoms or features appear to affect parents in the same way across different countries, the parental QoL may be a culturally informed construct.

Psychometrics of the Persian version of the COVID-19-related health literacy in the Iranian population

Background

Since the occurrence of the COVID-19 pandemic, information dissemination has increased rapidly. Promoting health literacy is currently crucial to prepare people to respond quickly to situations, such as the COVID-19 pandemic. Due to the importance of health literacy in this critical situation, we are looking for a questionnaire to measure COVID-19 health literacy. The COVID-19 Germany Health Literacy Questionnaire (HLS-COVID-Q22) is an excellent tool, so the study aimed to create a cultural validity of this questionnaire for the Iranian population.

Methods

In this validation study, 880 samples were enrolled using a convenient sampling method. The questionnaire was translated through a backward forwarding procedure. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were employed for Persian version validity. McDonald's omega (Ω), Cronbach's alpha, and average inter-item correlation (AIC) coefficients were assessed for reliability.

Results

Using EFA on the random half sample (n = 440), the EFA indicated that the scale had four factors: accessing, understanding, appraising, and applying health-related information in the COVID-19 pandemic context, which explained 59.3% of the total variance. CFA was used for the sample's second part (n = 440) to evaluate the goodness of fit of the four-factor solution. CFA showed the model fit. All indices RMSEA = 0.067, CFI = 0.934, IFI = 0.934, PCFI = 0.772, PNFI = 0.747, and CMIN/DF = 2.972 confirmed the model fit. The convergent validity of the HLS-COVID-Q22 was confirmed. McDonald's omega and Cronbach's alpha were very good (α and Ω >0.80).

Conclusion

The Persian version of the HLS-COVID-Q22 had acceptable psychometric properties and is applicable to measure COVID-19 health literacy.

[Post-traumatic grief and the need for ritual in therapy]

This clinical history retraces the treatment of an Ivorian man presenting with a state of post-traumatic mourning following the assassination of his family ten years ago, in a context of crisis. The aim is to illustrate the need for flexibility in the therapeutic framework in this mourning process, which is complicated or even prevented by psychotraumatic symptoms and the absence of rituals. The transcultural approach initiates here a first evolution in the patient's symptomatology.

A new tool for assessing the cultural adaptation of cognitive tests: demonstrating the utility of the Manchester Translation Evaluation Checklist (MTEC) through the Mini-Mental State Examination Urdu

BACKGROUND

Low- and middle-income countries contribute to the majority of dementia and mild cognitive impairment cases worldwide, yet cognitive tests for diagnosis are designed for Western cultures. Language and cultural discrepancies mean that translated tests are not always reliable or valid. We propose a model for culturally adapting cognitive tests, one step of which is to assess the quality of any translation and cultural adaptation undertaken. We developed the Manchester Translation Evaluation Checklist (MTEC) to act as a tool for quality assessment and demonstrated its use by assessing a popular cognitive test that had been adapted.

AIMS

Assess quality of the translation and cultural adaptation of the Urdu Mini-Mental State Examination developed for a Pakistani population.

METHOD

Two raters completed the MTEC for the Mini-Mental State Examination (MMSE) Urdu and compared feedback. All authors were fluent in English and Urdu and familiar with Pakistani culture.

RESULTS

Raters had 78.5% agreement across the MTEC. The MMSE Urdu was appropriately translated and retained grammar and verb tense, but three questions had spelling errors. Across 20 MMSE questions, 5 required further cultural adaptation because the questions were not understandable in daily use, comfortable to answer, relevant to the language and culture, and relevant to original concepts.

CONCLUSIONS

The MTEC highlighted errors in the MMSE Urdu and demonstrated how this tool can be used to improve it. Future studies could employ the MTEC to improve existing translated measures of health assessment, particularly cognitive tests, and act as a quality check when developing new adaptations of tests and before psychometric validation.

A Transcultural Perspective of Systemic Lupus Erythematosus-Related Fatigue: Systematic Review and Narrative Synthesis

BACKGROUND

Fatigue is one of the most common symptoms of systemic lupus erythematosus (SLE) worldwide, yet it remains poorly assessed and managed. The lack of universal definition and standard measurement of fatigue may add to the continued limitations in its understanding across cultures.

OBJECTIVE

The psycho-sociocultural underpinnings of fatigue are understudied; therefore, in this paper, we conducted a systematic review to understand a transcultural perspective of SLE-related fatigue.

METHODS

Following PRISMA (Preferred Reporting items for Systematic Reviews and Meta-Analysis) systematic review guidelines, we searched CINAHL Complete, Scopus, and PubMed databases for all published articles covered until the search date. Search was expanded using citation and web search. A 3-step process was used to identify articles meeting the inclusion criteria. The results were analyzed using narrative synthesis.

RESULTS

From a total of 370 (n=364, 98.4% scientific databases; n=6, 1.6% web and citation search) articles searched, 18 (4.9%) studies met the inclusion and exclusion criteria and were included in this review. All (18/18, 100%) studies enrolled primarily female participants, and half (9/18, 50%) had cross-sectional designs. Although race was not reported in all studies, most studies had White racial background as the largest proportion of their samples. A majority (7/18, 39%) of the studies were conducted in the United States. Using a narrative synthesis, the prominent themes drawn based on the domains of the culture care theory (CCT) and the sunrise enabler were as follows: SLE-related fatigue (1) as an integral component of the disease process, (2) as a personal challenge, and (3) as a psychosocial dimension.

CONCLUSIONS

CCT and sunrise enabler by Leininger guided this review. There are still gaps on how other domains of the CCT and sunrise enabler might influence SLE-related fatigue experience, assessment, and evaluation. The findings from this review showed that SLE-related fatigue has disease, personal, and psychosocial components. Thus, a purely subjective assessment of fatigue in SLE and even other conditions may limit a more accurate assessment and management. The inclusion of disease, personal, and psychosocial indicators is warranted and essential. A culturally sensitive and congruent assessment as well as evaluation models and measurement tools should be developed to capture fatigue experiences accurately. In addition, since global migration is inevitable, advancement in symptom management strategies should coincide with the understanding that fatigue has subjective and objective indicators present across cultures.

Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur

Aims

Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade.

Methods

This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult.

Results

The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria.

Conclusion

This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research.

Protocol PROSPERO registration number

CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.

The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version

Diabetes prevalence is on the rise in the Middle East. In countries of the Gulf region-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-prevalence rates are among the highest in the world. Further, Egypt now ranks as one of the top 10 countries in the world for high number of people with diabetes. Medical nutrition therapy is key to optimal management of diabetes. Patient adherence to nutritional guidance depends on advice that is tailored to regional foods and cultural practices. In 2012, international experts created a transcultural Diabetes Nutrition Algorithm (tDNA) for broad applicability. The objective of this current project was to adapt the algorithm and supportive materials to the Middle East region. A Task Force of regional and global experts in the fields of diabetes, obesity, and metabolic disorders met to achieve consensus on Middle East-specific adaptations to the tDNA. Recommendations, position statements, figures, and tables are presented here, representing conclusions of the tDNA-Middle Eastern (tDNA-ME) Task Force. Educational materials can be used to help healthcare professionals optimize nutritional care for patients with type 2 diabetes. The tDNA-ME version provides evidence-based guidance on how to meet patients' nutritional needs while following customs of people living in the Middle Eastern region.

Development of a Complex Intervention for Health Care Professionals' Care of Patients With African Background and HIV Infection Using the Behavior Change Wheel Method

Introduction. Insufficient cultural competences among health care professionals (HCPs) working with ethnic minorities may result in poorer quality of care. This study aimed to develop a cultural intervention for HCPs. Method. The intervention was designed using the Behavior Change Wheel. The development phase contained empirical studies of patients with HIV and African background, literature review, observations from a migrant health clinic, and transcultural care theory. Results. Systematic development will facilitate an intervention tailored to focus on nurses' sensitivity and awareness, and aims to give them tools to identify narratives about patients' life situation and self-management as well as provide effective, compassionate, and culturally competent care. Discussion. Higher cultural competence among nurses may improve their support of patients to manage their disease.

Teaching Gerontology in Transcultural Academics: A Phenomenographic Study of Thai and Swedish Nurse Educators' Conceptions of Gerontological Nursing

INTRODUCTION

There is an urgent need for registered nurses with gerontological competence within long-term care (LTC) of older adults. Despite increases of life expectancy, LTC for older adults is not emphasized in nursing curricula in neither Sweden nor Thailand. Thus, the aim was to explore conceptions on gerontological nursing (GN) among Swedish and Thai nurse educators.

METHOD

A qualitative phenomenographic method, based on open-ended interviews with five Thai and nine Swedish nurse educators was conducted.

RESULTS

The results indicate a paradox between the educators' knowledge about the implications of global aging, their hope of own aging, and LTC. The ethical responsibility of being credible and a source of inspiration in teaching about aging are focused, while GN seem to be less important.

DISCUSSION

To increase students' interest in GN, measures need to be taken within the educational arenas, where the educators' own conceptions toward GN, cultural aspects of aging, and LTC are discussed.

The Impact of Binational Barriers to Medical Care on the Care-Seeking Practices of Mexican Immigrants

Barriers to health care access faced by Mexican immigrants in the United States have been well-documented, including lack of insurance, fear of deportation, and language barriers. However, little is known about this population's care-seeking experiences before migration. In this article, I use a life-course approach to explore binational isolation from health care and the ways in which early-life experiences pattern Mexicans' care-seeking practices in the United States. This ethnographic research project took place in Tucson, Arizona, between 2013 and 2014 and used semistructured interviews with service providers and first-generation Mexican immigrants. The majority of participants faced significant barriers to medical care in Mexico, which resulted in low rates of care utilization and heavy reliance on lay modalities. Immigrants faced an even broader array of barriers to care in the United States, and their lack of prior health care access further discouraged care utilization and compromised their medical care experiences after migration.

Transcultural adaptation of cognitive behavioral therapy (CBT) in Asia

BACKGROUND

Cognitive behavior therapy (CBT) is an evidence based therapy and is now recommended by national organizations in many high income countries. CBT is underpinned by the European values and therefore for it to be effective in other cultures it needs to be adapted.

AIMS

This paper describes an evidence based approach to culturally adapt CBT in Asian context, areas of focus for such adaptation and lessons learned.

METHODS

An environmental scan of the literature, description of local CBT associations and perspectives from these organizations.

RESULTS

Cultural adaptation of CBT focuses on three main areas; 1 awareness of culture and related issues, 2 assessment and 3 adjustment in therapy techniques.

CONCLUSIONS

The last decade has seen an increase in culturally adapted CBT in Asia, however, more work needs to be done to improve access to CBT in Asia.

Sense of community in poverty contexts in Brazil, Colombia, and Mexico: A transcultural study

The aim of this article is to analyze the sense of community of three communities in conditions of poverty in Brazil, Colombia and Mexico. The general sample was composed of 533 people: 124 from Bogotá (Colombia), 200 from Mérida (Mexico), and 209 from Porto Alegre (Brazil). The scale applied was the Sense of Community Index, performing variance analysis, and multivariate analysis of variance. The results conclude that there are significant differences between the general averages of the Sense of Community Index between the countries, observing the largest differences between the samples of Brazil and Mexico. The interaction between the factors has significant differences, particularly in the factors of influence and emotional connection in account of specific cultural aspects in each country and community. The sense of community derives from the encounter of transcultural and contextual aspects linked to poverty.

Assessment of transcultural psychotherapy to treat resistant major depressive disorder in children and adolescents from migrant families: Protocol for a randomized controlled trial using mixed method and Bayesian approaches

OBJECTIVES

Cultural variations complicate psychiatric care, especially for migrant children. Transcultural psychotherapy (TCP) is an original psychotherapeutic technique developed to address complex situations of resistant mental disorders in the context of migration. This research will aim to assess the efficacy, the acceptability, and describe the therapeutic processes of TCP for the treatment of depression in first or second generation of migration children and adolescents.

METHOD

Mixed method study using a multicenter, Bayesian randomized clinical trial with blinded evaluation of the primary outcome. Two parallel groups of 40 children or adolescents from 6 to 20 years old and their family will be included. In the experimental group, patients will attend six sessions of transcultural therapy in addition to usual care.

RESULTS

The improved Clinical Global Impression scale scores at 6 months will be compared across groups. Qualitative analysis of families and therapists' interviews will allow to specify the therapeutic processes and acceptability of the therapy.

CONCLUSION

The findings will encourage the development and routinization of TCP for second-line use and its adaption as a first-line technique in this population.

Expanding the Contours of Forensic Consulting

Forensic psychiatry as a subspecialty discipline is presently experiencing a broad and essentially constructive conversation concerning its foundations and their implications for teaching and practice. The essay by Griffith and Greenidge proposes developing the art of consultation to include bringing out the contextual realities often invisible at first to the quarreling parties. Often enough they can thus be spared embarrassment as they come to recognize that their shared values matter more than any differences. This outcome may prove especially broadly true in the religious arena.

Somatization and Coping in Ethnic Minority Recruits

INTRODUCTION

Military service can have beneficial social effects on minorities. However, minority groups are also often at greater risk of somatizing psychological distress and coping maladaptively. In military training this would result in lower mental health of minorities and contribute to higher drop-out rates. We thus examined if recruits with different ethnocultural backgrounds report different somatization levels and coping styles.

MATERIALS AND METHODS

Seven hundred and forty male recruits of the Swiss Armed Forces aged 18-26 took part in a cross-sectional study during basic training. Participants filled out self-rating questionnaires covering sociodemographics, somatization (SCL-90-R), coping styles (INCOPE-2), and social support (F-SozU). The recruits' ethnic self-identification was used to compare three groups: native Swiss (89%); Turkish or Balkan minority (5%); heterogeneous ethnic minority (6%). Group differences in somatization scores were tested with a Kruskal-Wallis test; group differences in coping styles were tested with a multivariate ANCOVA, controlling for the level of social support experienced.

RESULTS

Recruits from the heterogeneous ethnic minority group reported significantly greater levels of somatization than their native Swiss comrades. Coping styles did not differ between the three ethnic groups, but higher levels of social support were associated with better coping.

CONCLUSION

Military doctors ought to place importance on the differential diagnosis of medically unexplained physical symptoms in ethnic minority recruits. This would contribute to minimize the risk of misdiagnosis. Military mental health professionals who counsel recruits reporting somatic symptoms are advised to be sensitized to an ethnic minority status. Physical complaints could mask affective problems or be part of an adjustment disorder symptomatology.

[The "Creation of History" workshop: a clinical device for migrant children in Brazil]

A clinical research device, the "Creation of History" workshop was set up in schools in São Paulo, Brazil, with migrant children aged 6 to 10. This workshop allows these children to retrace their migratory history with the help of a family album, based on the construction of the space-time dimension present in their interpretation of their drawings.

[Study on parent-to-child transmission related to Sri Lanka's civil war]

The dynamics of transmission between Tamil parents who fled the civil war in Sri Lanka and their children born in France were studied. The possible trauma that results from the transmission can affect the following generations in a more or less conscious way. The qualitative methodology was based on T-MADE, a method of transcultural analysis of the children's drawings, linked to the analysis of the parents' narrative.

[The choice of modeling clay as a support medium with three children undergoing transcultural psychotherapy]

In a transcultural therapy session, an auxiliary therapist brings in play dough to the children. This medium will allow the youngs to anchor in the here and now of the session and will ease the therapeutic alliance.

Transcultural Nursing Care in Turkey

AIM

For quality and adequate nursing care, nurses should evaluate the cultural factors that patients have, respect these factors, and consider their impact on the patient's health. This review aimed to examine studies conducted in the field of transcultural nursing in Turkey.

METHOD

Studies published between 2000 and 2018 were searched from the electronic databases of ScienceDirect, Web of Science, Academic Search Complete, PubMed, Scopus, and Google Academic using the keywords care, culture, nursing, transcultural, transcultural nursing, and Turkey.

RESULTS

As a result of the search, 150 studies were obtained, and 31 studies that fit the inclusion criteria were evaluated. These studies attempted to determine the factors that cover different dimensions of transcultural nursing, nursing education and training process, clinical and hospital applications, and several scales and guides and have been adapted and used in the Turkish population.

CONCLUSION

Studies conducted in the field of transcultural nursing in Turkey have gained momentum recently and have a more basic descriptive level.

[Assessment and health needs of unaccompanied minors]

Unaccompanied minors are particularly vulnerable due to their pathway marked with multiple bereavements and constant uprooting. They find themselves confronted with the ordeal of mistrust due to administrative contradictions between the need to protect and immigration control. They are particularly at risk of developing psychiatric pathologies. Care must be multidisciplinary and in continuity with the educational support, taking into account the young person's original culture.

[Representations and experience of caregivers on the pathway of pregnant unaccompanied minors]

Pregnancy and motherhood are additional ordeals for young unaccompanied girls, a particularly vulnerable section of the population. They are marked by the revival of the traumatic valence, the need to reconstruct themselves through the pregnancy and the importance of establishing a relationship of trust with the professionals supporting them. A qualitative study was carried out through the prism of the perspective of these professionals.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys

AIMS

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment.

METHODS

Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment.

RESULTS

Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites.

CONCLUSIONS

These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Leininger's Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View Toward the Future

An historical overview of Leininger's Theory of Culture Care Diversity and Universality also known as the Culture Care Theory (CCT) and evolution of the Sunrise Enabler are presented along with descriptions of the theory purpose, goal, tenets, basic assumptions, major core constructs, and orientational definitions. Recent articles, books, and book chapters provide relevant exemplars to enhance scholarly understanding and application of theory constructs. Proposed future directions encompass using the CCT to guide research of discovery and translational research projects for evidenced-based nursing practice; develop nursing courses and curricula to prepare culturally competent nurses; guide future culturally competent administrative and leadership policies and procedures; inform public policy related to cultural diversity and underserved populations; promote grant writing initiatives to enhance cultural diversity in hiring nursing staff, supervisors, and faculty; and promote admission of nursing students from underserved and/or diverse backgrounds.

Is early management of psychosis designed for migrants? Improving transcultural variable collection when measuring duration of untreated psychosis

AIM

A background of migration is an established risk factor for psychosis. At the same time, over the last 25 years, many countries have developed specialized services for the assessment and care of people with early psychosis. Evaluation of these services often focuses on the duration of untreated psychosis (DUP).

METHODS

We conducted a systematic review with an electronic search of key words in 3 databases to determine the extent to which studies measuring DUP consider transcultural variables, including migration status, national origin, ethnicity and language.

RESULTS

We identified 18 studies that included transcultural variables and measured DUP. They differed in their design, aims and methodology, and could not be directly compared. Common themes nonetheless appeared.

CONCLUSIONS

Most of the studies exploring DUP took little account of transcultural variables. Definitions of transcultural indicators were heterogeneous and often vague. Lack of language proficiency was often an exclusion criterion, and none of the studies used interpreters. We propose some basic transcultural variable and recommendations to include in future studies and recommendations to improve their internal and external validity.

Profile of transcultural patients in a regional Child and Adolescent Mental Health Service in Gippsland, Australia: The need for a multidimensional understanding of the complexities

BACKGROUND

Several childhood stressors related to immigration have been documented, and it is important for clinicians to understand and address the various factors that may lead to or act as maintaining factors of mental disorders in children and adolescents.

AIMS

To describe the cultural profile of transcultural patients presenting to a Child and Adolescent Mental Health Service (CAMHS) in regional Victoria and identify the most common disorders and psychosocial stressors they presented with.

METHOD

Descriptive analysis was applied to 101 case records of patients with a transcultural background who attended the CAMHS of Latrobe Regional Hospital in Gippsland Victoria from 2013 to 2017. The Adverse Childhood Experience questionnaire was retrospectively applied to capture psychosocial stressors such as 'bullying', 'racism' and 'family conflict', sexual abuse, physical violence, parents with mental illness and parental substance use.

RESULTS

Almost 60% of patients were male and over 46% Aboriginal. Those from a non-Aboriginal background belonged to 19 different cultural entities, the most common of which was a mixed Asian and European heritage. The most common diagnoses were disruptive mood dysregulation disorder (38.6%), attention-deficit hyperactivity disorder (32.7%) and developmental trauma disorder (26.7%). The most common psychosocial stressors were conflict and death in the family (44.6%), domestic violence (41.6%) and emotional abuse (34.7%). 'Parent in jail' and 'domestic violence' were associated with having an Aboriginal background ( p < .005). 'Cultural differences with parent' was associated with a non-Aboriginal background ( p < .005).

CONCLUSION

This study provides a snapshot of challenges faced by children from different cultural backgrounds while adjusting in a rural area in Australia. A broad-based formulation and cultural awareness by clinicians can enable a better understanding of the complexities, guide management plans and inform public health policies for primary prevention and early intervention.

Transcultural, transdiagnostic, and concurrent validity of a revised metacognitions about symptoms control scale

Anxiety and depression add to the burden of chronic fatigue syndrome (CFS), fibromyalgia (FM), and type 1 diabetes mellitus (T1DM). Metacognitions play a role in this distress. The metacognitions about symptoms control scale (MaSCS) measure metacognitive beliefs regarding symptoms but have weaknesses. The current study created a revised MaSCS (MaSCS-R) in English, German, and Arabic versions using CFS, FM, and T1DM samples and examined the transcultural, transdiagnostic, and concurrent validity of metacognitions about symptom control. This study used data from 563 participants clinically diagnosed with CFS (n = 124; English), FM (n = 348; German), or T1DM (n = 91; Lebanese). CFS and FM data had been used in earlier published studies but were subjected to new analyses. CFS data were used to create the English version of the MaSCS-R and FM and T1DM data for German and Arabic versions. Metacognitions about worry, anxiety, depression, and symptom severity were measured. The three MaSCS-R versions, consisting of two factors (each with four items), had adequate psychometric properties, possessing configural and metric invariance. Metacognitive factors were associated with distress and symptom severity in all three samples. Metacognitions about symptom control have transcultural, transdiagnostic, and concurrent validity.

Migrant Parents of Adolescents With School Refusal: A Qualitative Study of Parental Distress and Cultural Barriers in Access to Care

Introduction: School refusal is an important problem in adolescent psychiatry. However, little is known about the experience of school refusal among minority youth (migrants and minority ethnic groups). This study assesses how parents of various cultural backgrounds experience their adolescents' school refusal. Method: This qualitative study is based on interviews of 11 parents of teenagers diagnosed with school refusal at three adolescent outpatient mental health units in Paris and its suburbs. Interpretative phenomenological analysis was used for the thematic investigation. Results: The analysis found four themes: (i) confronting school and school refusal distresses parental representations; (ii) school refusal as a failure of the family's obligation to succeed after migration; (iii) representations of school that fluctuate with time since arrival: idealization, followed by mistrust and disappointment in the inequalities, even the racism; (iv) solutions envisioned for school refusal, confronting the healthcare system, stigma, and, again, inequality. Conclusion: All parents question their parenting choices when their children become school refusers. However, when families belong to minority groups, school refusal calls into question parents' relations with the French school system and their immigration choices. At the same time, the construction of a multicultural identity for children and adolescents in transcultural situations requires them to strike a balance between two worlds, and school refusal endangers this delicate negotiation. Subsequent misunderstandings can lead clinicians to misdiagnose school refusal as truancy. Clinicians must take the parents' culture and migration history into account to minimize the risk of complete failure of treatment for school refusal and the ensuing inequality of care and opportunity that can result.

Case-Based Insights: Arab Muslim Mothers' Experiences of Managing a Child Newly Diagnosed With Type 1 Diabetes Mellitus

Mothers frequently fulfill the role of primary caregiver for children diagnosed with type 1 diabetes mellitus (T1DM). A T1DM diagnosis has a significant impact on the child and the wider family unit. The objective is to develop understanding of mothers' experiences caring for children diagnosed with T1DM in the cultural context of the Middle East to facilitate enhanced health service provision and support. This study used a qualitative design. Data were collected in individual semistructured interviews. Participants were mothers of Arabic descent and Muslim belief who had a child diagnosed with T1DM within the last 12 months. All mothers were registered at the health service where this research was conducted and resident in the United Arab Emirates at the time of this study. COREQ guidelines informed reporting of the research and findings. Participating mothers described initial reactions of shock and disbelief, followed by transition to near ordinary and near normal (85% normal) family functioning. Family, culture, and faith emerged as critical supports in the whirlwind daily challenge of balancing the multiple demands and competing needs of the newly diagnosed child and the broader family. This study is the first of its kind from countries comprising the Gulf Cooperation Council. The findings provide insight into the challenges and support needs of mothers caring for children newly diagnosed with T1DM in an Arab Muslim context. The findings also provide a basis for enhancing health service support and suggest themes to inform further research.

Religiosity and psychological resilience in patients with schizophrenia and bipolar disorder: an international cross-sectional study

OBJECTIVE

The impact of religious/spiritual activities on clinical outcomes in patients with serious mental illnesses remains controversial, which was addressed in this international cross-sectional study.

METHOD

Three-hundred sixty-nine subjects were recruited from Austria (n = 189) and Japan (n = 180), consisting of 112 outpatients with paranoid schizophrenia, 120 with bipolar I disorder (DSM-IV), and 137 healthy controls. Religiosity was assessed in terms of attendance and importance of religious/spiritual activities, while resilience was assessed using the 25-item Resilience Scale. General linear models were used to test whether higher religiosity will be associated with higher resilience, higher social functioning, and lower psychopathology. The association between levels of spiritual well-being and resilience was also examined.

RESULTS

Attendance of religious services (F_[4,365] = 0.827, P = 0.509) and importance of religion/spirituality (F_[3,365] = 1.513, P = 0.211) did not show significant associations with resilience. Regarding clinical measures, a modest association between higher importance of religion/spirituality and residual manic symptoms was observed in bipolar patients (F_[3,118] = 3.120, P = 0.029). In contrast to the findings regarding religiosity, spiritual well-being showed a strong positive correlation with resilience (r = 0.584, P < 0.001).

CONCLUSION

The protective effect of religiosity in terms of resilience, social functioning, and psychopathology was not evident in our sample. Spiritual well-being appears more relevant to resilience than religiosity.

Culture's Influence on Stressors, Parental Socialization, and Developmental Processes in the Mental Health of Children of Immigrants

Children of immigrants represent one in four children in the United States and will represent one in three children by 2050. Children of Asian and Latino immigrants together represent the majority of children of immigrants in the United States. Children of immigrants may be immigrants themselves, or they may have been born in the United States to foreign-born parents; their status may be legal or undocumented. We review transcultural and culture-specific factors that influence the various ways in which stressors are experienced; we also discuss the ways in which parental socialization and developmental processes function as risk factors or protective factors in their influence on the mental health of children of immigrants. Children of immigrants with elevated risk for mental health problems are more likely to be undocumented immigrants, refugees, or unaccompanied minors. We describe interventions and policies that show promise for reducing mental health problems among children of immigrants in the United States.

Dementia and Migration: Family Care Patterns Merging With Public Care Services

This article focuses on cognitive impairment and dementia in the context of transnational migration. Based on data from focus group discussions and interviews, we conclude that to adjust to the needs of care within ethnic-minority communities, it is important to consider not only the availability of household and kin members but also the present understanding of obligation and reciprocity underlying the perception of care. Another important issue to realize is that caregivers, women in particular, might feel obliged to conform to a traditional caregiver role, but without the support from a wider extended family, and in the context of other pressing roles and duties. Consequently, health personnel should be wary of stereotyping and generalizing groups through "othering" ideologies and rather try to explore, understand, and adjust to the present and often fluctuating set of needs, as well as be aware of how and by whom these needs are articulated.

A Transcultural Structural Equation Modeling (SEM) Study

Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.

Multidisciplinary treatment for traumatized refugees in a naturalistic setting: symptom courses and predictors

Background: Multidisciplinary treatment approaches are commonly used in specialized psychosocial centres for the treatment of traumatized refugees, but empirical evidence for their efficacy is inconsistent. Objective: In order to obtain more evidence on the development of mental health and well-being of traumatized refugees who receive multidisciplinary treatment, symptom courses of posttraumatic stress disorder (PTSD), anxiety, depression and somatoform symptoms as well as in the subjective quality of life were investigated in the course of a multidisciplinary treatment. In addition, it was analysed if sociodemographic variables were predictors for possible changes in symptomatology and quality of life. Method: N = 76 patients of the outpatient clinic of a psychosocial centre for traumatized refugees receiving regular multidisciplinary treatment were surveyed using standardized questionnaires at three measurement points (at the beginning of treatment, and after an average of 7 and 14 months of treatment) in a single-group design. Results: Multilevel analysis showed significant improvements of symptoms of PTSD (p < .001), depression (p < .001), anxiety (p < .001), and somatoform symptoms (p = .002) as well as of the subjective quality of life (p < .001) over time. Among the tested predictors (gender, age, country of origin), age was a significant predictor for the course of somatoform symptoms (p < .05). Younger patients showed greater improvements in symptomatology over time than older ones. Conclusions: The results suggest that the received multidisciplinary treatment had a positive effect on trauma-related symptoms as well as on quality of life of traumatized refugees. There was no indication that sociodemographic characteristics predicted the symptom courses of the patients, except for somatoform symptoms. Younger patients benefitted more from multidisciplinary treatment than older ones.

An ISBD perspective on the sociocultural challenges of managing bipolar disorder: A content analysis

OBJECTIVE

Clinical management of bipolar disorder patients might be affected by culture and is further dependent on the context of healthcare delivery. There is a need to understand how healthcare best can be delivered in various systems and cultures. The objective of this qualitative study was to gain knowledge about culture-specific values, beliefs and practices in the medical care provided to patients with bipolar disorders from a provider perspective in various areas of the world.

SAMPLING AND METHODS

The International Society for Bipolar Disorders (ISBD) network provided the framework for this qualitative study. An electronic interview with open-ended questions was administered to 19 international experts on bipolar spectrum disorder representing the International Society for Bipolar Disorders chapter network in 16 countries and six continents. In addition, there were two in-depth interviews with bipolar spectrum disorder experts done prior to the survey. The data were analysed using content analysis, and the information was structured using the software NVivo by QSR International Pty Ltd.

FINDINGS

All participants described sociocultural factors as important in healthcare delivery to bipolar patients in their part of the world, both in accessing healthcare and in providing culturally appropriate care. Factors that affected the provider's ability to supply good clinical management of patients were access to treatment options and long-term follow-up, as well as general strategies to combat stigma. In some societies, the patients' use of alternative treatments, gender issues and religion were also important factors. Understanding the impact of such culturally specific factors was overall regarded as essential for proper treatment interventions.

CONCLUSION

Sociocultural factors clearly affect the nature and quality of medical services delivered to bipolar patients. Financial, social and cultural factors affect patients' health-seeking behaviour, and this highlights the need for knowledge about such factors in order to adequately identify and treat bipolar patients globally. Culturally adapted training and psychoeducation programmes are particularly warranted.

Transcultural Diabetes Nutrition Algorithm: Brazilian Application

The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.

A narratology of postpartum psychosis in an Orthodox Jewish woman

PURPOSE

The purpose of this study was to understand the experience of postpartum psychosis in an Orthodox Jewish woman.

DESIGN AND METHODS

A case-based narratology using an unstructured interview was conducted to facilitate the telling of her story.

FINDINGS

While the nurses were unable to recognize her symptoms in the hospital, her family members were also unable to recognize escalating symptoms once she returned home, until she became a danger to herself.

PRACTICE IMPLICATIONS

Better recognition of symptoms, empathetic connections, cultural appreciation of faith-based rituals and their effect on patient isolation, and education of families and nursing staff may be vital components to successful recovery from postpartum psychosis.

Current research in transcultural psychiatry in the Nordic countries

This article discusses major themes in recent transcultural psychiatric research in the Nordic countries from 2008 to 2011: (a) epidemiological studies of migration, (b) indigenous populations, and (c) quality of psychiatric care for migrants. Over the past several decades, the populations of the Nordic countries, Denmark, Finland, Norway, and Sweden, which were relatively homogeneous, have become increasingly culturally diverse. Many migrants to Nordic countries have been exposed to extreme stress, such as threats of death and/or torture and other severe social adversities before, during, and after migration, with potential effects on their physical, mental, social, and spiritual health. Growing interest in transcultural issues is reflected in the level of scientific research and clinical activity in the field by Nordic physicians, psychologists, social scientists, demographers, medical anthropologists, as well as other clinicians and policy planners. Research includes work with migrants and indigenous minorities in the Nordic countries, as well as comparisons with mental health in postconflict countries. We conclude by suggesting future directions for transcultural psychiatry research and providing guidelines for the education and training of future clinicians in the Nordic countries.

Diabetes-specific nutrition algorithm: a transcultural program to optimize diabetes and prediabetes care

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports.

'Deradiating' the former uranium capital

Background

The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses’ Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments.

Objective

The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors.

Methods

The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool’s internal structure. The tool’s reliability will be assessed by exploring internal consistency and calculating the Cronbach α coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is <.05 for the null hypothesis of sphericity, the null hypothesis will be rejected.

Results

Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023.

Conclusions

We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management.

International Registered Report Identifier (IRRID)

PRR1-10.2196/39482