Issues for cross-cultural psychiatric research in South Africa

South Africa's heterogenous society offers many opportunities for cross-cultural psychiatric research, but researchers in the country are subject to a number of restraints. Apart from legally enforced segregation, there are strict censorship laws and restricted access to certain types of information. The issues surrounding categorization of cultures and factors affecting publishing research from South Africa have important implications for the type of work that is done. It is a central argument of this article that the issues affecting research in South Africa are relevant to other countries as well, and parallels between the local and international context are drawn. The South African experience suggests that analysis of the research enterprise itself is a useful part of the business of cross-cultural psychiatric research.I am grateful to Beverley Jo Dickman, Terry Dowdall, Ronith Elk, Alan Flisher, Don Foster, Jane Steere and Sally Swartz for their comments on this article. Emile Boonzaaier provided a useful critique on an earlier draft. The arguments presented in this article are, however, my responsibility alone.     

Comorbidity: Meaning and uses in cross-cultural clinical research

American Indians and Alaska Natives were the subject of a workshop sponsored by the National Institute of Mental Health and the Indian Health Service. Comorbidity of anxiety, depression, and substance abuse is highly prevalent in these two populations, and this was the focus of the meeting. This paper introduces the topic of psychiatric comorbidity, and considers the topics of culture, psychiatric diagnosis, and assessment. Future research directions and a brief summary of the papers presented at the workshop, which are included in this issue, are provided.     

Prostaglandin formation in bacteria : A reevaluation

We report here that production and release of PGE₂ do not occur in common bacteria. The apparent production in the presence of arachidonic acid, previously reported (1) may be explained by PGE₂ contamination and autooxidation of the AA used. The presence of PGE₂ like material in some but not all isolates of Propionibacterium acnes is confirmed.     

Data analysis strategies for reducing the influence of the bias in cross-cultural research

In cross-cultural research, researchers have to adjust the constructs and associated measurement instruments that have been developed in one culture and then imported for use in another culture. Importing concepts from other cultures is often simply reduced to language adjustment of the content in the items of the measurement instruments that define a certain (psychological) construct. In the context of cross-cultural research, test bias can be defined as a generic term for all nuisance factors that threaten the validity of cross-cultural comparisons. Bias can be an indicator that instrument scores based on the same items measure different traits and characteristics across different cultural groups. To reduce construct, method and item bias,the researcher can consider these strategies: (1) simply comparing average results in certain measuring instruments; (2) comparing only the reliability of certain dimensions of the measurement instruments, applied to the "target" and "source" samples of participants, i.e. from different cultures; (3) comparing the "framed" factor structure (fixed number of factors) of the measurement instruments, applied to the samples from the "target" and "source" cultures, using explorative factor analysis strategy on separate samples; (4) comparing the complete constructs ("unframed" factor analysis, i.e. unlimited number of factors) in relation to their best psychometric properties and the possibility of interpreting (best suited to certain cultures, applying explorative strategy of factor analysis); or (5) checking the similarity of the constructs in the samples from different cultures (using structural equation modeling approach). Each approach has its advantages and disadvantages. The advantages and lacks of each approach are discussed.     

The ethics of population policy: emphasizing female sterilization in the third world

Rapid population growth in the Third World is a major social and economic problem, with attempts having been made to reduce the rapid growth rate through national family planning programs. Policies used by the programs, especially those concerning female sterilization, need to be examined to determine whether they are ethically acceptable. Such an analysis of the ethics of family planning policies raises awareness of not only the population problem, but also of the potential which exists for violating human rights when attempts are made to reduce population growth. The analysis also points to the need which exists in the Third World to create family planning programs which protect basic human rights. The population problem, reproductive rights, family planning programs, ethical principles, the ethics of incentives, alternatives, and decreasing maternal mortality are discussed.     

Challenges and prospects for biomarker research: A current perspective from the developing world

Majority of deaths due to communicable and non-communicable diseases occur in the low and middle-income nations (LMNs), mainly due to the lack of early diagnoses and timely treatments. In such a scenario, biomarkers serve as an indispensible resource that can be used as indicators of biological processes, specific disease conditions or response to therapeutic interventions. Evaluation, diagnosis and management of diseases in developing world by following/extrapolating the findings obtained on the basis of the research work involving only the populations from the developed countries, could often be highly misleading due to existence of diverse patterns of diseases in developing countries compared to the developed world. Biomarker candidates identified from high-throughput integrated omics technologies have promising potential; however, their actual clinical applications are found to be limited, primarily due to the challenges of disease heterogeneity and pre-analytical variability associated with the biomarker discovery pipeline. Additionally, in the developing world, economic crunches, lack of awareness and education, paucity of biorepositories, enormous diversities in socio-epidemiological background, ethnicity, lifestyle, diet, exposure to various environmental risk factors and infectious agents, and ethical and social issues also cumulatively hinder biomarker discovery ventures. Establishment of standard operating procedures, comprehensive data repositories and exchange of scientific findings are crucial for reducing the variability and fragmentation of data. This review highlights the challenges associated with the discovery, validation and translational phases of biomarker research in LMNs with some of their amenable solutions and future prospects. This article is part of a Special Issue entitled: Biomarkers: A Proteomic Challenge.     

Acute myocardial infarction system of care in the third world

Background

We studied the characteristics of ST-elevation myocardial infarction (STEMI) patients from a local acute coronary syndrome (ACS) registry in order to find and build an appropriate acute myocardial infarction (AMI) system of care in Jakarta, Indonesia.

Methods

Data were collected from the Jakarta Acute Coronary Syndrome (JAC) registry 2008–2009, which contained 2103 ACS patients, including 654 acute STEMI patients admitted to the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

Results

The proportion of patients who did not receive reperfusion therapy was 59% in all STEMI patients and the majority of them (52%) came from inter-hospital referral. The time from onset of infarction to hospital admission was more than 12 h in almost 80% cases and 60% had an anterior wall MI. In-hospital mortality was significantly higher in patients who did not receive reperfusion therapy compared with patients receiving acute reperfusion therapy, either with primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy (13.3% vs 5.3% vs 6.2%, p < 0.001).

Conclusion

The Jakarta Cardiovascular Care Unit Network System was built to improve the care of AMI in Jakarta. This network will harmonise the activities of all hospitals in Jakarta and will provide the best cardiovascular services to the community by giving two reperfusion therapy options (PPCI or pharmaco-invasive strategy) depending on the time needed for the patient to reach the cath-lab.