ACCULTURATION, ALIENATION, AND HIV RISK AMONG THE RUSSIAN-SPEAKING DRUG USERS IN ESTONIA

In 1991, dramatic socio-political changes transformed the Russian-speaking population in Estonia from the governing class to an immigrant minority virtually overnight absent of a relocation or emigration process. New citizenship and language policies, and associated socioeconomic hardships, drove many of the Russian-speaking population to the edges of the society. These processes were amplified by traditional acculturation challenges that led to increased psychological distress, rising indicators of social exclusion and social alienation, and poor health, including HIV/AIDS and substance abuse, in this linguistic group during the past two decades. Given the growing relevance of cultural issues in this group as well as the public health importance of drug abuse and HIV/AIDS epidemics in Estonia, this study aimed to: 1) develop an optimal group classification which adequately represents acculturation to Estonian culture among the Russian-speaking drug users in Estonia and to compare the defined groups in their demographic characteristics, acculturation stress, level of alienation, and HIV drug risk; 2) determine quality and nature of the relationship between acculturation stress, alienation, severity of drug abuse and their predictive strength on the level of HIV drug risk among the Russian-speaking drug users in Estonia. A convenience sample comprised of 150 Russian-speaking IDUs living in Tallinn was recruited through \u27AIDS-i Tugikeskus\u27 (AIDS Information and Support Center) in Tallinn. Participants completed a survey assessing acculturation to Estonian and Russian culture (Language, Identity, and Behavior Scale), acculturation stress (Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale), level of alienation (Alienation scale), HIV drug risk (Risk Assessment Battery), and socio-demographic data. Univariate and bivariate statistics, cluster analysis, discriminant function and factors analyses, and structural equation modeling (SEM) were employed to test the research hypotheses. The results revealed that two acculturation typologies exist among Russian-speaking drug users in Estonia: Russian and bicultural. Better able to navigate Estonian society, bicultural individuals had significantly higher legal incomes and were more likely to have health insurance. At the same time, this group experienced higher levels of acculturation stress and cultural estrangement, compared to the Russian orientation group. The tenable model, developed in the process of SEM revealed that acculturation stress had a significant positive effect on social alienation. Social alienation, duration of drug injection and polydrug use all predicted a higher level of HIV drug risk. The effect of acculturation stress on HIV drug risk was fully mediated by alienation. Overall, the model explained 25% variance in HIV drug risk. These findings supported the acculturation stress framework that guided the research and pointed to the importance of focusing on socio-cultural factors in developing interventions for immigrant minorities to reduce their vulnerability to HIV infection. The results highlighted the role of social alienation as a measure of adaptation among immigrant minorities and as an important mediator in the relationship between acculturation stress and vulnerability to HIV infection. In addition, significance and implications of the findings, study limitations and suggestions for future research were discussed

Construct Validity of the SF-12v2 for the Homeless Population with Mental Illness: An Instrument to Measure Self-Reported Mental and Physical Health.

BACKGROUND:Self-reported health measures are important indicators used by clinicians and researchers for the evaluation of health interventions, outcome assessment of clinical studies, and identification of health needs to improve resource allocation. However, the application of self-reported health measures relies on developing reliable and valid instruments that are suitable across diverse populations. The main objective of this study is to evaluate the construct validity of the SF-12v.2, an instrument for measuring self-rated physical and mental health, for homeless adults with mental illness. Various interventions have been aimed at improving the health of homeless people with mental illness, and the development of valid instruments to evaluate these interventions is imperative. STUDY DESIGN:We measured self-rated mental and physical health from a quota sample of 575 homeless people with mental illness using the SF-12v2, EQ-5D, Colorado Symptoms Index, and physical/mental health visual analogue scales. We examined the construct validity of the SF-12v2 through confirmatory factor analyses (CFA), and using ANOVA/correlation analyses to compare the SF-12v2 to the other instruments to ascertain discriminant/convergent validity. RESULTS:Our CFA showed that the measurement properties of the original SF-12v2 model had a mediocre fit with our empirical data (χ2 = 193.6, df = 43, p < .0001, CFI = 0.85, NFI = 0.83, RMSEA = 0.08). We demonstrate that changes based on theoretical rationale and previous studies can significantly improve the model, achieving an excellent fit in our final model (χ2 = 160.6, df = 48, p < .0001, CFI = 0.95, NFI = 0.95, RMSEA = 0.06). Our CFA results suggest that an alternative scoring method based on the new model may optimize health status measurement of a homeless population. Despite these issues, convergent and discriminant validity of the SF-12v2 (scored based on the original model) was supported through multiple comparisons with other instruments. CONCLUSION:Our study demonstrates for the first time that the SF-12v2 is generally appropriate as a measure of physical and mental health status for a homeless population with mental illness

Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings

Abstract Background Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination. Objectives: (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization. Methods We used baseline data from the Toronto site of the At Home/Chez Soi randomized controlled trial of Housing First for homeless adults with mental illness (n = 550). Bivariate statistics and multivariable logistic regression models were used for the analysis. Results Perceived discrimination related to homelessness/poverty (30.4%) and mental illness/alcohol/substance use (32.5%) is prevalent among ethnically diverse homeless adults with mental illness in healthcare settings. Only 15% of the total participants reported discrimination due to race/ethnicity/skin color. After controlling for relevant confounders and presence of psychosis, all types of discrimination in healthcare settings were associated with more frequent ED use, a greater - 3 - severity of lifetime substance abuse, and mental health problems. Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination. Conclusions Understanding the experience of discrimination in healthcare settings and associated healthcare utilization is the first step towards designing policies and interventions to address health disparities among vulnerable populations. This study contributes to the knowledge base in this important area. Trial registration number This study has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374

Welfare assessment of cattle on the farms

This thesis is focused on evaluation of welfare quality in dairy cows at 10 farms (factory farming) in the Czech Republic. Studies concerned with this topic are showing that the quality of welfare and the farm environment has a significant influence on their efficiency. Welfare evaluation in this thesis was done in accordance to European project Welfare Quality. In processing of this thesis was evaluated ten of totally twelve criterions; absence of prolonged hunger and thirst, comfort around resting, ease of movement, absence of injuries, diseases and painful procedures, expression social and other behaviours, and good human animal relationship. From four principles based on criterions above, i.e. good feeding, good housing, good health and appropriate behaviour, were only three evaluated. Most of the farms had a low scoring of good feeding including part of very lean cows and bad access to the water. Favourable was evaluation of good housing, because 60% of farms had above-standard results. Lower evaluation was in the principle of good health due to dehorning on all monitored farms. Czech farms had significantly higher percent of very lean cows comparing to foreign breeds. Lameness in the Czech Republic was different in comparison with foreign studies. Small part of cows suffering of discharge, cough, or hampered respiration was detected. Number of animals suffering from diarrhoea is comparable to foreign studies. Expression of agonistic behaviour was minimal in monitored farms. That is displayed in excellent evaluation of criteria expression of social behaviour. Almost all farms had acceptable evaluation of good human animal relationship. Hypothesis, that in farms with lower quality of environment is higher percentage of cows that hobble, than in farms with better quality of environment, was not confirmed. Another hypothesis was partly confirmed. The farms with higher percentage of cows with health issues struggle with problems during the rest time, than the farm with lower percentage of cows with health issues. Part of cows that lameness correlate with part of cows with patches and part of very lean cows is affiliated to part of cows with diarrhoea. Welfare quality in monitored herds, were at an acceptable level. Most need to improve the area of good feeding, but for accurate results it would be appropriate to evaluate a greater number of farms

Sample Characteristics, and the mean and standard deviations of SF-12 v.2 physical subscale, SF-12 v.2 mental subscale, CSI score, EQ-5D physical score, and EQ-5D mental score by demographic groups (n = 574).

<p>Sample Characteristics, and the mean and standard deviations of SF-12 v.2 physical subscale, SF-12 v.2 mental subscale, CSI score, EQ-5D physical score, and EQ-5D mental score by demographic groups (n = 574).</p

Abbreviations and description of SF-12v2 subdomains and items.

<p>Abbreviations and description of SF-12v2 subdomains and items.</p

Standardized solution of the confirmatory factor analysis for the Model 1.

<p>GH1—General Health: rating of general health; PF2—Physical Functioning: moderate activities; PF3—Physical Functioning: climbing several flights of stairs; RP4—Role Functioning (Physical): accomplished less; RP5—Role Functioning (Physical): limited in the kind work or other activities; RE6—Role Functioning (Emotional): accomplished less (emotional problems); RE7—Role Functioning (Emotional): less carefully than usual; BP8—Bodily Pain: pain interference; MH9—Mental Health: calm and peaceful; VT10—Vitality: energy; MH11—Mental Health: downhearted and depressed; SF12—Social Functioning: health/emotional problems interfered with activities.</p

Mean (SD) SF-12v2 Composite Scores by EQ-5D Dimensions, and ANOVA results.

<p>Mean (SD) SF-12v2 Composite Scores by EQ-5D Dimensions, and ANOVA results.</p

Summary of fit statistics of the specified models (n = 574).

<p>Summary of fit statistics of the specified models (n = 574).</p

SF-12 items by mean visual analogue scale score, ANOVA, and test of linear trend results.

<p>SF-12 items by mean visual analogue scale score, ANOVA, and test of linear trend results.</p