Selecting instruments for assessing psychological wellbeing in Afghan and Kurdish refugee groups

Background. Afghan and Iraqi refugees comprise nearly half of all those currently under United Nations protection. As many of them will eventually be resettled in countries outside the region of origin, their long term health and settlement concerns are of relevance to host societies, and will be a likely focus for future research. Since Australia and New Zealand have both accepted refugees for many years and have dedicated, but different settlement and immigration policies, a study comparing the resettlement of two different refugee groups in these countries was undertaken. The purpose of this article is to describe the instrument selection for this study assessing mental health and psychological well being with Afghan and Kurdish former refugees, in particular to address linguistic considerations and translated instrument availability. A summary of instruments previously used with refugee and migrant groups from the Middle East region is presented to assist other researchers, before describing the three instruments ultimately selected for the quantitative component of our study.Findings. The Kessler-10 Psychological Distress Scale (K10), General Perceived Self-Efficacy Scale (GPSE), and Personal Well-Being Index (PWI) all showed good reliability (Cronbach's alphas of 0.86, 0.89 and 0.83 respectively for combined language versions) and ease of use even for pre-literate participants, with the sample of 193 refugees, although some concepts in the GPSE proved problematic for a small number of respondents. Farsi was the language of choice for the majority of Afghan participants, while most of the Kurds chose to complete English versions in addition to Farsi. No one used Arabic or Turkish translations. Participants settled less than ten years were more likely to complete questionnaires in Farsi. Descriptive summary statistics are presented for each instrument with results split by gender, refugee group and language version completed. Conclusion. This paper discusses instrument selection for Farsi and Arabic speaking refugee participants from the Middle East and Afghanistan, concluding that the Kessler-10, GPSE scale and PWI were suitable for use with these groups. Suitable language translations are freely available. Our experience with these instruments may help inform other studies with these vulnerable groups

Beyond policy and planning to practice: getting sexual health on the agenda in Aboriginal communities in Western Australia

Background: Indigenous Australians have significantly poorer status on a large range of health,educational and socioeconomic measures and successive Australian governments at state andfederal level have committed to redressing these disparities. Despite this, improvements inAboriginal health status have been modest, and Australia has much greater disparities in the healthof its Indigenous people compared to countries that share a history characterised by colonisationand the dispossession of indigenous populations such as New Zealand, Canada and the UnitedStates of America. Efforts at policy and planning must ultimately be translated into practicalstrategies. This article outlines an approach that was effective in Western Australia in increasingthe engagement and concern of Aboriginal people about high rates of sexually transmissibleinfections and sexual health issues. Many aspects of the approach are relevant for other healthissues. Results: The complexity of Indigenous sexual health necessitates inter-agency and crossgovernmental collaboration, in addition to Aboriginal leadership, accurate data, and communitysupport. A recent approach covering all these areas is described. This has resulted in Aboriginalsexual health being more actively discussed within Aboriginal health settings than it once was andadditional resources for Indigenous sexual health being available, with better communication andpartnership across different health service providers and sectors. The valuable lessons in capacitybuilding, collaboration and community engagement are readily transferable to other health issues, and may be useful for other health professionals working in the challenging area of Aboriginal health.Conclusion: Health service planners and providers grapple with achieving Aboriginal ownershipand leadership regarding their particular health issue, despite sincere concern and commitment toaddressing Aboriginal health issues. This highlights the need to secure genuine Aboriginalengagement. Building capacity that enables Indigenous people and communities to fulfill their owngoals is a long-term strategy and requires sustained commitment, but we argue is a prerequisite for better Indigenous health outcomes

Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services

<p>Abstract</p> <p>Background</p> <p>Despite a lower overall incidence, Aboriginal Australians experience poorer outcomes from cancer compared with the non-Aboriginal population as manifested by higher mortality and lower 5-year survival rates. Lower participation in screening, later diagnosis of cancer, poor continuity of care, and poorer compliance with treatment are known factors contributing to this poor outcome. Nevertheless, many deficits remain in understanding the underlying reasons, with the recommendation of further exploration of Aboriginal beliefs and perceptions of cancer to help understand their care-seeking behavior. This could assist with planning and delivery of more effective interventions and better services for the Aboriginal population. This research explored Western Australian (WA) Aboriginal peoples' perceptions, beliefs and understanding of cancer.</p> <p>Methods</p> <p>A total of 37 Aboriginal people from various geographical areas within WA with a direct or indirect experience of cancer were interviewed between March 2006 and September 2007. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. A social constructionist framework provided a theoretical basis for analysis. Interpretation occurred within the research team with member checking and the involvement of an Aboriginal Reference Group assisting with ensuring validity and reliability.</p> <p>Results</p> <p>Outcomes indicated that misunderstanding, fear of death, fatalism, shame, preference for traditional healing, beliefs such as cancer is contagious and other spiritual issues affected their decisions around accessing services. These findings provide important information for health providers who are involved in cancer-related service delivery.</p> <p>Conclusion</p> <p>These underlying beliefs must be specifically addressed to develop appropriate educational, screening and treatment approaches including models of care and support that facilitate better engagement of Indigenous people. Models of care and support that are more culturally-friendly, where health professionals take account of both Indigenous and Western beliefs about health and the relationship between these, and which engage and include Indigenous people need to be developed. Cultural security, removing system barriers and technical/scientific excellence are all important to ensure Indigenous people utilise healthcare to realise the benefits of modern cancer treatments.</p

"If you don't believe it, it won't help you": use of bush medicine in treating cancer among Aboriginal people in Western Australia

<p>Abstract</p> <p>Background</p> <p>Little is known about the use of bush medicine and traditional healing among Aboriginal Australians for their treatment of cancer and the meanings attached to it. A qualitative study that explored Aboriginal Australians' perspectives and experiences of cancer and cancer services in Western Australia provided an opportunity to analyse the contemporary meanings attached and use of bush medicine by Aboriginal people with cancer in Western Australia</p> <p>Methods</p> <p>Data collection occurred in Perth, both rural and remote areas and included individual in-depth interviews, observations and field notes. Of the thirty-seven interviews with Aboriginal cancer patients, family members of people who died from cancer and some Aboriginal health care providers, 11 participants whose responses included substantial mention on the issue of bush medicine and traditional healing were selected for the analysis for this paper.</p> <p>Results</p> <p>The study findings have shown that as part of their healing some Aboriginal Australians use traditional medicine for treating their cancer. Such healing processes and medicines were preferred by some because it helped reconnect them with their heritage, land, culture and the spirits of their ancestors, bringing peace of mind during their illness. Spiritual beliefs and holistic health approaches and practices play an important role in the treatment choices for some patients.</p> <p>Conclusions</p> <p>Service providers need to acknowledge and understand the existence of Aboriginal knowledge (epistemology) and accept that traditional healing can be an important addition to an Aboriginal person's healing complementing Western medical treatment regimes. Allowing and supporting traditional approaches to treatment reflects a commitment by modern medical services to adopting an Aboriginal-friendly approach that is not only culturally appropriate but assists with the cultural security of the service.</p

Noun and Verb Production and Comprehension in Stroke-Induced and Primary Progressive Aphasia: An Introduction to the Northwestern Naming Battery

This study examined production and comprehension of nouns and verbs using the Northwestern Naming Battery (NNB), a new test designed to assess naming ability in individuals with stroke-induced or primary progressive aphasia (PPA). Scores derived from the NNB were also compared to scores from published, standardized tests to evaluate the NNB&rsquo;s validity. Dissociations between word classes in production were observed for participants with stroke-induced anomic and Broca&rsquo;s aphasia with agrammatism and individuals with logopenic and agrammatic variants of PPA, with the two agrammatic groups showing greater impairment for verb compared to noun naming. Clinical and theoretical implications will be discussed

Slip behavior in liquid films on surfaces of patterned wettability: Comparison between continuum and molecular dynamics simulations

We investigate the behavior of the slip length in Newtonian liquids subject to planar shear bounded by substrates with mixed boundary conditions. The upper wall, consisting of a homogenous surface of finite or vanishing slip, moves at a constant speed parallel to a lower stationary wall, whose surface is patterned with an array of stripes representing alternating regions of no-shear and finite or no-slip. Velocity fields and effective slip lengths are computed both from molecular dynamics (MD) simulations and solution of the Stokes equation for flow configurations either parallel or perpendicular to the stripes. Excellent agreement between the hydrodynamic and MD results is obtained when the normalized width of the slip regions, $a/\sigma \gtrsim {\cal O}(10)$, where $\sigma$ is the (fluid) molecular diameter characterizing the Lennard-Jones interaction. In this regime, the effective slip length increases monotonically with $a/\sigma$ to a saturation value. For $a/\sigma \lesssim {\cal O}(10)$ and transverse flow configurations, the non-uniform interaction potential at the lower wall constitutes a rough surface whose molecular scale corrugations strongly reduce the effective slip length below the hydrodynamic results. The translational symmetry for longitudinal flow eliminates the influence of molecular scale roughness; however, the reduced molecular ordering above the wetting regions of finite slip for small values of $a/\sigma$ increases the value of the effective slip length far above the hydrodynamic predictions. The strong inverse correlation between the effective slip length and the liquid structure factor representative of the first fluid layer near the patterned wall illustrates the influence of molecular ordering effects on slip in non-inertial flows.Comment: 12 pages, 10 figures Web reference added for animations: http://www.egr.msu.edu/~priezjev/bubble/bubble.htm

Under-ascertainment of Aboriginality in records of cardiovascular disease in hospital morbidity and mortality data in Western Australia: a record linkage study

<p>Abstract</p> <p>Background</p> <p>Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease.</p> <p>Methods</p> <p>Persons with public hospital admissions for cardiovascular disease in Western Australia during 2000-2005 (and their 20-year admission history) or who subsequently died were identified from linkage data. The Aboriginal status flag in all records for a given individual was variously used to determine their ethnicity (index positive, and in all records both majority positive or ever positive) and stratified by region, age and gender. The index admission was the baseline comparator.</p> <p>Results</p> <p>Index cases comprised 62,692 individuals who shared a total of 778,714 hospital admissions over 20 years, of which 19,809 subsequently died. There were 3,060 (4.9%) persons identified as Aboriginal on index admission. An additional 83 (2.7%) Aboriginal cases were identified through death records, increasing to 3.7% when cases with a positive Aboriginal identifier in the majority (≥50%) of previous hospital admissions over twenty years were added and by 20.8% when those with a positive flag in any record over 20 years were incorporated. These results equated to underestimating Aboriginal status in unlinked index admission by 2.6%, 3.5% and 17.2%, respectively. Deaths classified as Aboriginal in official records would underestimate total Aboriginal deaths by 26.8% (95% Confidence Interval 24.1 to 29.6%).</p> <p>Conclusions</p> <p>Combining Aboriginal determinations in morbidity and official death records increases ascertainment of unlinked cardiovascular morbidity in Western Australian Aboriginals. Under-identification of Aboriginal status is high in death records.</p