Balancing the act : the international migration of medical graduates

In this article I examine the phenomenon of international migration of medical graduates. The debate involving the ethical aspects of medical migration as well as the obstacles faced by doctors to practice unreservedly in their host countries are addressed. The situation of Australia in this context is also scrutinised. Finally, I propose a series of strategies aimed at minimising the unfavourable consequences of the international migration of doctors. This commentary favours a reform in the way institutions and society respond to the process of medical migration and to the needs of migrant doctors. Continued research on this health care topic is required in order to identify the major factors that play a role in this process

Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia

Letter to the editor in response to the article “Risks of complaints and adverse disciplinary finding against international medical graduates in Victoria and Western Australia”

The international migration of health care professionals

Objectives: The international migration of health care professionals has been recognized as a public health concern. A series of 'push' and 'pull' factors have been identified as driving forces for migration of doctors. The USA, UK, Canada and Australia are the main beneficiaries of medical migration, which has adverse consequences for health care systems in developing countries. Recently, a Global Code of Practice on the International Recruitment of Health Personnel was adopted by the World Health Assembly. In this paper, a summary of the most important recommendations of the Code is presented. In addition, the case of overseas trained psychiatrists in Australia is illustrated. These specialists complain of discriminatory practices due to the lack of recognition of their professional credentials. Research evidence from different countries confirms that international medical graduates face discriminatory obstacles to exercise their rights and practise their professions in developed countries. Conclusions: An international strategy is required to promote sustainable health care systems worldwide. Additional academic and scientific partnerships must be established between developed and developing nations in order to minimize discrepancies. There is an urgent need to review policies related to the recognition of medical credentials in host countries, including Australia. There are clear implications for psychiatry and psychiatrists

Human nomenclature: from race to racism

Throughout time, evolutionary biologists have attempted to classify human beings according to a nomenclature based on supposed patterns of biological differences that have been used to suggest hierarchical categories. Recent genetic evidence disproves the assumption that races are genetically distinct human populations. Several studies refute human categorization as a severely flawed yardstick. For many, race is a construct that must be overcome in order to eradicate racism. Personal experiences of racism, harassment and discrimination are associated with multiple indicators of poorer physical and mental health status. Additionally, socio-economic differentials are likely to be a fundamental explanation for the observed inequalities in health status among minority groups. This commentary examines the discrepancies that race, ethnicity and similar human nomenclatures present. Furthermore, the potentially harmful consequences of the "scientific" use of race, in the form of stereotyping and racism, are discussed

Psychoanalysis and its role in brain plasticity : much more than a simple bla, bla, bla : commentaries on the letter to the editor

In the letter by Scorza and Cavalheiro1, the authors posit that the use of psychoanalysis for neuropsychiatric syndromes “has a direct positive influence” on neurogenesis. Yet, the authors acknowledge that the putative mechanisms to explain the alleged role of psychoanalysis on neuroplasticity remain “still poorly explored”

The use of appetite suppressants among health sciences undergraduate students in Southern Brazil

Objective: To investigate the prevalence of appetite suppressant use among health sciences students in Southern Brazil. Methods: Undergraduate students (n=300) from seven health science undergraduate courses of the Universidade de Caxias do Sul completed a questionnaire about the use of substances to suppress appetite. Results: A significant percentage (15%; n=45) of research participants used appetite suppressants at least once in their lives. The most commonly used substances were sympathomimetic stimulant drugs (5%), including amfepramone (3.3%) and fenproporex (1.7%). The lifetime use of appetite suppressants was more prevalent among Nursing (26.7%) and Nutrition (24.4%%) students. There was no reported use of appetite suppressants among medical students. The use of appetite suppressants was significantly more prevalent among women. The majority of those who used these substances did so under medical recommendation. Most of users took appetite suppressants for more than 3 months. Conclusion: Lifetime use of appetite suppressants was substantial, being sympathomimetic stimulant drugs the most commonly used agents. Students enrolled in Nursing and Nutrition courses presented a significantly higher prevalence of lifetime use of appetite suppressants

The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil

Objective: To investigate the relationship between breastfeeding self-efficacy and postpartum depression symptoms in a sample of Portuguese-speaking mothers in southern Brazil. Background: There remains equivocal evidence regarding a putative association between breastfeeding self-efficacy and postpartum depression. Method: This is a cross-sectional study in which eligible research participants completed screening questionnaires and other assessment tools. Mothers were interviewed once only in their homes between the 2nd and 12th week of the postpartum period. Research participants completed the Portuguese version of the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS). Breastfeeding self-efficacy was evaluated through the Breastfeeding Self-Efficacy Scale (BSES-SF). Results: A total number of 89 mothers completed the investigation: 69 (77%) were exclusively breastfeeding, whereas 20 mothers (22.7%) were partially breastfeeding at the time of the interview. Mothers who combined breastfeeding and bottle-feeding presented higher PDSS and EPDS scores. The breastfeeding self-efficacy scores were higher in mothers who exclusively breastfed and were negatively associated (p<0.001) with both EPDS and PDSS (postpartum depression) scores. Conclusion: These findings suggest that mothers who suffer from depressive symptoms may experience less confidence in their ability to breastfeed. This association may be particularly relevant for the purpose of screening procedures for depression and unsatisfactory breastfeeding during the postpartum period

Investigating quality of life and depressive symptoms in the postpartum period

Background: Mood disturbances represent the most frequent form of maternal psychiatric morbidity in the postpartum period. Nevertheless, few studies have examined the impact of postpartum depression on the mother's quality of life. Research question or problem: The present study aims to assess the quality of life of a sample of mothers in Southern Brazil, in order to investigate the association between postpartum depression and quality of life (QoL) standards. Participants and methods: This study investigates a sample of 101 adult volunteers who completed the Portuguese version World Health Organization Quality of Life Assessment-Bref (WHOQOL-Bref) and Multicultural Quality of Life Index (MQLI) questionnaires. Postnatal depressive symptoms were evaluated through the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS). Multiple regression analyses were conducted to predict the overall PDSS and EPDS scores. Pearson Product-Moment Correlation coefficients were computed between the global scores of the quality of life measurements and the screening questionnaires for postnatal depression. Results: Both socio-economic status and quality of life have influenced significantly the depressive symptomatology and correlated epiphenomena. Significant correlations were observed among scores of postpartum depression screening tools and quality of life questionnaires. The socio-economic status of research participants was only significantly correlated to the scores generated by the WHOQOL-Bref questionnaire. Conclusions: These findings confirm that socio-economic deficiencies and low quality of life can facilitate the expression of depressive symptomatology during the postpartum period. The results also emphasize the salience of psychosocial risk factors in the diathesis of postnatal depression

Peers or pariahs? The quest for fairer conditions for international medical graduates in Australia

It has been more than 2 years since the final report of the inquiry into the registration processes and support for overseas-trained doctors1 was tabled in Parliament. The scope of the inquiry was extensive, involving over 200 submissions and 22 public hearings held in 12 different locations across Australia. In the foreword of the report, entitled Lost in the labyrinth, Steve Georganas, Chair of the Committee, acknowledged that “whilst IMGs [international medical graduates] generally have very strong community support, [they] do not always receive the same level of support from institutions and agencies that accredit and register them”.1 The report outlined 45 recommendations which, if implemented, would create a fairer registration and accreditation system without compromising patient safety. In spite of the significant cost of the inquiry, borne by taxpayers, its recommendations have yet to be formally endorsed by the federal government. This is not a new situation. Over the past 25 years, a number of major inquiries have investigated the fairness and/ or effectiveness of the registration and accreditation system, but have largely failed to produce meaningful improvements.2 For instance, in 2005 the Australian Competition and Consumer Commission and Australian Health Workforce Officials’ Committee recommended fairer methods of assessing and recognising the credentials of overseas-trained specialists, but those recommendations were not fully implemented either

The use of the computerized version of quality of life and health status questionnaires in a community sample in southern Brazil

Computerized data collection is an efficient process and well accepted by patients with different disorders. Although computer-based systems have been used to assess health status and quality of life in various areas of healthcare, there is a lack of studies to investigate the effectiveness of these instruments in Brazil. The aims here were to assess the usability of the Portuguese-language versions of the Personal Health Scale (PHS) and the Multicultural Quality of Life Index (MQLI) in southern Brazil and to determine the correlation between these two questionnaires. This was a cross-sectional community-based survey in which participants completed computerized versions of these two questionnaires. In a survey conducted in 16 different locations, 458 volunteers completed both questionnaires. Pearson correlation coefficients were generated between the scores of the two questionnaires. The inclusion criteria allowed all volunteers who were able to understand the questions in both questionnaires to participate in the study. The percentage of proper data collection via the computerized versions of the two questionnaires combined was 97.45%. A significant correlation (P < 0.01) between the PHS and the MQLI was observed. The computerized versions of the PHS and MQLI demonstrated efficient data collection patterns during the field survey trials. Health-related issues were significantly correlated with the overall experience of wellbeing and quality of life. The computerized versions of the PHS and MQLI are valid tools for research and clinical use in Brazil