Development of an Item Scale to Assess Attitudes towards Domestic Dogs in the United Republic of Tanzania

ABSTRACT

Domestic dogs are important sources of rabies exposure for humans in the developing world. Control of the disease in endemic areas relies on the vaccination of owned dogs, and thus owners' attitudes and behavior towards household dogs may be of relevance to rabies control programs. However, none of the instruments used to evaluate attitudes towards companion animals have been validated for use in developing countries. In this paper, we present the development of an item scale to measure attitudes towards owned dogs in Tanzania. We assess the scale's reliability and validity, and conduct a preliminary analysis of factors affecting respondents' attitudes. Twelve 5-point Likert scale items were selected from an item pool during the pilot phase. Following administration of these items to 824 dog owners across 12 study sites in Tanzania, two subscales were derived, representing the acceptance of dogs as equals and physical interactions with household dogs. Both subscales showed acceptable levels of reliability and concurrent validity, although the latter estimates were found to be influenced by interviewer identity. Male respondents had significantly higher scores on both subscales than females, and Muslim respondents showed more positive attitudes towards dogs as equals than did Christians. Among those respondents who were also the heads of their households, those whose dogs were vaccinated against rabies had a more positive attitude towards dogs as equals. It is hoped that the derived item scale will serve as a basis to further understanding of the motivational considerations of attitudes towards dogs in developing countries, and how these may influence aspects of dog ownership, welfare, and disease control.     

The Social Explanatory Styles Questionnaire: Assessing Moderators of Basic Social-Cognitive Phenomena Including Spontaneous Trait Inference,the Fundamental Attribution Error,and Moral Blame

Why is he poor? Why is she failing academically? Why is he so generous? Why is she so conscientious? Answers to such everyday questions—social explanations—have powerful effects on relationships at the interpersonal and societal levels. How do people select an explanation in particular cases? We suggest that, often, explanations are selected based on the individual''s pre-existing general theories of social causality. More specifically, we suggest that over time individuals develop general beliefs regarding the causes of social events. We refer to these beliefs as social explanatory styles. Our goal in the present article is to offer and validate a measure of individual differences in social explanatory styles. Accordingly, we offer the Social Explanatory Styles Questionnaire (SESQ), which measures three independent dimensions of social explanatory style: Dispositionism, historicism, and controllability. Studies 1–3 examine basic psychometric properties of the SESQ and provide positive evidence regarding internal consistency, factor structure, and both convergent and divergent validity. Studies 4–6 examine predictive validity for each subscale: Does each explanatory dimension moderate an important phenomenon of social cognition? Results suggest that they do. In Study 4, we show that SESQ dispositionism moderates the tendency to make spontaneous trait inferences. In Study 5, we show that SESQ historicism moderates the tendency to commit the Fundamental Attribution Error. Finally, in Study 6 we show that SESQ controllability predicts polarization of moral blame judgments: Heightened blaming toward controllable stigmas (assimilation), and attenuated blaming toward uncontrollable stigmas (contrast). Decades of research suggest that explanatory style regarding the self is a powerful predictor of self-functioning. We think it is likely that social explanatory styles—perhaps comprising interactive combinations of the basic dimensions tapped by the SESQ—will be similarly potent predictors of social functioning. We hope the SESQ will be a useful tool for exploring that possibility.     

Psychometric Evaluation of the HIV Stigma Scale in a Swedish Context

Background

HIV-related stigma has negative consequences for infected people''s lives and is a barrier to HIV prevention. Therefore valid and reliable instruments to measure stigma are needed to enable mapping of HIV stigma. This study aimed to evaluate the psychometric properties of the HIV stigma scale in a Swedish context with regard to construct validity, data quality, and reliability.

Methods

The HIV stigma scale, developed by Berger, Ferrans, and Lashley (2001), was distributed to a cross-sectional sample of people living with HIV in Sweden (n = 194). The psychometric evaluation included exploratory factor analysis together with an analysis of the distribution of scores, convergent validity by correlations between the HIV stigma scale and measures of emotional well-being, and an analysis of missing items and floor and ceiling effects. Reliability was assessed using Cronbach''s α.

Results

The exploratory factor analysis suggested a four-factor solution, similar to the original scale, with the dimensions personalised stigma, disclosure concerns, negative self-image, and concerns with public attitudes. One item had unacceptably low loadings and was excluded. Correlations between stigma dimensions and emotional well-being were all in the expected direction and ranged between −0.494 and −0.210. The instrument generated data of acceptable quality except for participants who had not disclosed their HIV status to anybody. In line with the original scale, all subscales demonstrated acceptable internal consistency with Cronbach''s α 0.87–0.96.

Conclusion

A 39-item version of the HIV stigma scale used in a Swedish context showed satisfactory construct validity and reliability. Response alternatives are suggested to be slightly revised for items assuming the disclosure of diagnosis to another person. We recommend that people that have not disclosed should skip all questions belonging to the dimension personalised stigma. Our analysis confirmed construct validity of the instrument even without this dimension.     

Psychometric properties of the Nurses Work Functioning Questionnaire (NWFQ)

Objectives

The Nurses Work Functioning Questionnaire (NWFQ) is a 50-item self-report questionnaire specifically developed for nurses and allied health professionals. Its seven subscales measure impairments in the work functioning due to common mental disorders. Aim of this study is to evaluate the psychometric properties of the NWFQ, by assessing reproducibility and construct validity.

Methods

The questionnaire was administered to 314 nurses and allied health professionals with a re-test in 112 subjects. Reproducibility was assessed by the intraclass correlations coefficients (ICC) and the standard error of measurement (SEM). For construct validity, correlations were calculated with a general work functioning scale, the Endicott Work Productivity Scale (EWPS) (convergent validity) and with a physical functioning scale (divergent validity). For discriminative validity, a Mann Whitney U test was performed testing for significant differences between subjects with mental health complaints and without.

Results

All subscales showed good reliability (ICC: 0.72–0.86), except for one (ICC = 0.16). Convergent validity was good in six subscales, correlations ranged from 0.38–0.62. However, in one subscale the correlation with the EWPS was too low (0.22). Divergent validity was good in all subscales based on correlations ranged from (−0.06)–(−0.23). Discriminative validity was good in all subscales, based on significant differences between subjects with and without mental health complaints (p<0.001–p = 0.003).

Conclusion

The NWFQ demonstrates good psychometric properties, for six of the seven subscales. Subscale “impaired decision making” needs improvement before further use.     

Physicians' Own Health—Some Advice for the Advisors

Information about physicians'' health and health practices is sparse and scattered. With a few exceptions, however—notably suicide and substance abuse—it appears that physicians'' health and health-promotion activities are at least similar to those of the general public. In some areas, such as smoking cessation, physicians have far outstripped the general public. As physicians gain more insight into their own health and health habits, advice to patients can be realistic and effective. Indeed, several personal health activities, including immunization, have direct, salutary impacts on patient care. Physicians should analyze and change their own health practices as indicated and pay special attention to “high yield” health habits, such as seat-belt use.     

Reliability and validity of the Ethiopian version of the hospital anxiety and depression scale (HADS) in HIV infected patients

Background

The hospital anxiety and depression scale (HADS) is a widely used instrument for evaluating psychological distress from anxiety and depression. HADS has not yet been validated in Ethiopia. The aim of this study was to evaluate the reliability and validity of the Amharic (Ethiopian language) version of HADs among HIV infected patients.

Methods

The translated scale was administered to 302 HIV/AIDS patients on follow up for and taking anti-retroviral treatment. Consistency assessment was conducted using Cronbach''s alpha, test-retest reliability using intra-class correlation coefficients (ICC). Construct validity was examined using principal components analysis (PCA). Parallel analysis, Kaiser''s criterion and the scree test were used for factor extraction.

Results

The internal consistency was 0.78 for the anxiety, 0.76 for depression subscales and 0.87 for the full scale of HADS. The intra-class correlation coefficient (ICC) was 80%, 86%, and 84% for the anxiety and depression subscales, and total score respectively. PCA revealed a one dimensional scale.

Conclusion

This preliminary validation study of the Ethiopian version of the HADs indicates that it has promising acceptability, reliability and validity. The adopted scale has a single underlying dimension as indicated by Razavi''s model. The HADS can be used to examine psychological distress in HIV infected patients. Findings are discussed and recommendations made.     

Validation of the German Version of the Social Functioning Scale (SFS) for Schizophrenia

Deficits in social functioning are a core symptom of schizophrenia and an important criterion for evaluating the success of treatment. However, there is little agreement regarding its measurement. A common, often cited instrument for assessing self-reported social functioning is the Social Functioning Scale (SFS). The study aimed to investigate the reliability and validity of the German translation. 101 patients suffering from schizophrenia (SZ) and 101 matched controls (C) (60 male / 41 female, 35.8 years in both groups) completed the German version. In addition, demographic, clinical, and functional data were collected. Internal consistency was investigated calculating Cronbach’s alpha for SFS full scale (α: .81) and all subscales (α: .59-.88). Significant bivariate correlation coefficients were found between all subscales as well as between all subscales and full scale (p <.01). For the total sample, principal component analysis gave evidence to prefer a single-factor solution (eigenvalue ≥ 1) accounting for 48.5 % of the variance. For the subsamples, a two-component solution (SZ; 57.0 %) and a three-component solution (C; 65.6 %) fitted best, respectively. For SZ and C, significant associations were found between SFS and external criteria. The main factor “group” emerged as being significant. C showed higher values on both subscales and full scale. The sensitivity of the SFS was examined using discriminant analysis. 86.5% of the participants could be categorized correctly to their actual group. The German translation of the SFS turned out to be a reliable and valid questionnaire comparable to the original English version. This is in line with Spanish and Norwegian translations of the SFS. Concluding, the German version of the SFS is well suited to become a useful and practicable instrument for the assessment of social functioning in both clinical practice and research. It accomplishes commonly used external assessment scales.     

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large,Multinational Sample Using the Childhood Trauma Questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.     

Validation of a Sinhalese translation of the Oral Health Impact Profile-14 for use with older adults

Objective : To test the psychometric properties of a Sinhalese translation of the OHIP‐14 scale for use among older adults in Sri Lanka. Design : A cross‐sectional survey. The English version of the OHIP‐14 was translated in to Sinhalese, pre‐tested and subsequently administered to the subjects by a trained interviewer. Setting : Moratuwa — a densely populated urban area in the Western province of Sri Lanka. Subjects: 585 individuals aged 60 years and above. Main outcome measures : Reliability of the translated scale was assessed in terms of internal consistency using Cronbach's alpha. Construct validity was evaluated by examining the associations between perceived oral health status, perceived need for dental care and the OHIP scores. Results : Cronbach's alpha of the translated scale was 0.93. Corrected item‐total correlation coefficients ranged from 0.53–0.80. The highly significant associations between perceived oral health status, perceived need for dental care and the OHIP scores support the construct validity of the translated scale. Conclusion : The Sinhalese translation of the OHIP‐14 is a valid and reliable instrument to measure oral health related quality of life in older adults of Sri Lanka.     

Development of a Short Version of MSQOL-54 Using Factor Analysis and Item Response Theory

BackgroundThe Multiple Sclerosis Quality of Life-54 (MSQOL-54, 52 items grouped in 12 subscales plus two single items) is the most used MS specific health related quality of life inventory.ObjectiveTo develop a shortened version of the MSQOL-54.MethodsMSQOL-54 dimensionality and metric properties were investigated by confirmatory factor analysis (CFA) and Rasch modelling (Partial Credit Model, PCM) on MSQOL-54s completed by 473 MS patients. Their mean age was 41 years, 65% were women, and median Expanded Disability Status Scale (EDSS) score was 2.0 (range 0–9.5). Differential item functioning (DIF) was evaluated for gender, age and EDSS. Dimensionality of the resulting short version was assessed by exploratory factor analysis (EFA) and CFA. Cognitive debriefing of the short instrument (vs. the original) was then performed on 12 MS patients.ResultsCFA of MSQOL-54 subscales showed that the data fitted the overall model well. Two subscales (Role Limitations—Physical, Role Limitations—Emotional) did not fit the PCM, and were removed; two other subscales (Health Perceptions, Social Function) did not fit the model, but were retained as single items. Sexual Satisfaction (single-item subscale) was also removed. The resulting MSQOL-29 consisted of 25 items grouped in 7 subscales, plus 4 single items. PCM fit statistics were within the acceptability range for all MSQOL-29 items except one which had significant DIF by age. EFA and CFA indicated adequate fit to the original two-factor (Physical and Mental Health Composites) hypothesis. Cognitive debriefing confirmed that MSQOL-29 was acceptable and had lost no key items.ConclusionsThe proposed MSQOL-29 is 50% shorter than MSQOL-54, yet preserves key quality of life dimensions. Prospective validation on a large, independent MS patient sample is ongoing.     

Validity and Reliability of the Dutch Adaptation of the Psoriatic Arthritis Quality of Life (PsAQoL) Questionnaire

Objective

The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is a disease- specific instrument developed to measure quality of life (QoL) in patients with psoriatic arthritis (PsA). The aim of this study was to translate the measure into Dutch and to determine its psychometric properties.

Method

Translation of the original English PsAQoL into Dutch was performed by bilingual and lay panel. Ten field-test interviews with PsA patients were performed to assess face and content validity. In total, 211 PsA patients were included in a test-retest postal survey to investigate the reliability and construct validity of the Dutch adaptation of the PsAQoL. The PsAQoL, Health Assessment Questionnaire (HAQ) and Skindex-17 were administered on two different occasions approximately two weeks apart.

Results

The Dutch version of the PsAQoL was found to be relevant, understandable and easy to complete in only a few minutes. It correlated as expected with the HAQ (Spearman’s ρ = 0.72) and the 2 subscales of the Skindex-17 (ρ = 0.40 for the psychosocial and ρ = 0.46 for the symptom scale). Furthermore, the measure had good internal consistency (Cronbach’s α = 0.92) and test-retest reliability (ρ = 0.89). The PsAQoL was able to define groups of patients based on self-reported general health status, self-reported severity of PsA and flare of arthritis. Duration of PsA did not influence PsAQoL scores.

Conclusions

The Dutch version of the PsAQoL is a valid and reliable questionnaire suitable for use in clinical or research settings to asses PsA-specific QoL.     

Measuring Health-Related Quality of Life in Strabismus: A Modification of the Adult Strabismus-20 (AS-20) Questionnaire Using Rasch Analysis

PurposeTo evaluate the psychometric properties of the Adult Strabismus-20 (AS-20)- a health-related quality of life (HRQoL) questionnaire in adults with strabismus, and if flawed, to revise the AS-20 and its subscales creating valid measurement scales.Methods584 adults (meanage, 27.5 years) with strabismus were recruited from an outpatient clinic at a South Indian tertiary eye care centre and were administered the AS-20 questionnaire.The AS-20 was translated and back translated into two Indian languages. The AS-20 and its two 10-item subscales – ‘psychosocial’ and ‘function’were assessed separately for fit to the Rasch model, including an assessment of the rating scale, unidimensionality (by principal components analysis), measurement precision by person separation reliability, PSR, targeting, and differential item functioning (DIF; notable > 1.0 logits).ResultsResponse categories were not used as intended, thereby, required re-organization and reducing their number from 5 to 3. The AS-20 had adequate measurement precision (PSR = 0.87) but lacked unidimensionality; however, deletion of the six multi-dimensionality causing items and an additional three misfitting items resulted in 11-item unidimensional questionnaire (AS-11). Two items failed to satisfy the model expectations in the ‘psychosocial’ subscale and were deleted – resulting in an 8-item unidimensional scale with adequate PSR (0.81) and targeting (0.23 logits). One item misfit in the ‘function’ subscale and was deleted—resulting in a 9 item Rasch-revised unidimensional subscale with acceptable PSR (0.80) and targeting (0.97 logits).None of the items displayed notable DIF by age, gender and level of education.ConclusionsThe AS-11 and its two Rasch-revised subscales – 8-item psychosocial and 9-item function subscale may be more appropriate than the original AS-20 and its two 10-item subscales for use as unidimensional measures of HRQoL in adults with strabismus in India. Further work is required to establish the validity of the revised rating scale.     

Occam's Razor in sensorimotor learning

A large number of recent studies suggest that the sensorimotor system uses probabilistic models to predict its environment and makes inferences about unobserved variables in line with Bayesian statistics. One of the important features of Bayesian statistics is Occam''s Razor—an inbuilt preference for simpler models when comparing competing models that explain some observed data equally well. Here, we test directly for Occam''s Razor in sensorimotor control. We designed a sensorimotor task in which participants had to draw lines through clouds of noisy samples of an unobserved curve generated by one of two possible probabilistic models—a simple model with a large length scale, leading to smooth curves, and a complex model with a short length scale, leading to more wiggly curves. In training trials, participants were informed about the model that generated the stimulus so that they could learn the statistics of each model. In probe trials, participants were then exposed to ambiguous stimuli. In probe trials where the ambiguous stimulus could be fitted equally well by both models, we found that participants showed a clear preference for the simpler model. Moreover, we found that participants’ choice behaviour was quantitatively consistent with Bayesian Occam''s Razor. We also show that participants’ drawn trajectories were similar to samples from the Bayesian predictive distribution over trajectories and significantly different from two non-probabilistic heuristics. In two control experiments, we show that the preference of the simpler model cannot be simply explained by a difference in physical effort or by a preference for curve smoothness. Our results suggest that Occam''s Razor is a general behavioural principle already present during sensorimotor processing.     

Development and Validation of a Smartphone Addiction Scale (SAS)

Objective

The aim of this study was to develop a self-diagnostic scale that could distinguish smartphone addicts based on the Korean self-diagnostic program for Internet addiction (K-scale) and the smartphone''s own features. In addition, the reliability and validity of the smartphone addiction scale (SAS) was demonstrated.

Methods

A total of 197 participants were selected from Nov. 2011 to Jan. 2012 to accomplish a set of questionnaires, including SAS, K-scale, modified Kimberly Young Internet addiction test (Y-scale), visual analogue scale (VAS), and substance dependence and abuse diagnosis of DSM-IV. There were 64 males and 133 females, with ages ranging from 18 to 53 years (M = 26.06; SD = 5.96). Factor analysis, internal-consistency test, t-test, ANOVA, and correlation analysis were conducted to verify the reliability and validity of SAS.

Results

Based on the factor analysis results, the subscale “disturbance of reality testing” was removed, and six factors were left. The internal consistency and concurrent validity of SAS were verified (Cronbach''s alpha = 0.967). SAS and its subscales were significantly correlated with K-scale and Y-scale. The VAS of each factor also showed a significant correlation with each subscale. In addition, differences were found in the job (p<0.05), education (p<0.05), and self-reported smartphone addiction scores (p<0.001) in SAS.

Conclusions

This study developed the first scale of the smartphone addiction aspect of the diagnostic manual. This scale was proven to be relatively reliable and valid.     

Eastern and Western Approaches to Medicine

An objective comparison of Eastern and Western approaches to medicine is necessary to further evaluate the validity of Oriental medical techniques such as acupuncture. The development of medicine in Western nations follows the way of hypothetical deduction and the Eastern approach uses the inductive method. The Western approach clearly divides the health from the disease, yet the Eastern approach considers health as a balanced state versus disease as an unbalanced state. The Western approach tends to change the environment and the Eastern way is to prefer to adapt to the environment. There are numerous difficulties in comparing these two approaches. The same terminology may apply to entirely different facts, the teaching and learning methods are quite different, and the evaluation of the treatment is almost not comparable.In order to help understand the Eastern approach better, an understanding is needed of the basic Chinese concepts: the concept of a small universe living in a large universe; the duality concept of yin and yang; the concept of anatomy; the concept of physiology in Chinese medicine—the state of equilibrium expressed by the five elements; the concept of pathophysiology expressed by the external and internal insults; the concept of maintaining and promoting health expressed by the circulation of chi and hsieh; the therapeutic concept in Chinese medicine—the normalization or reestablishment of balance of the body function; the concept of preventive medicine.     

Development of a Multimorbidity Illness Perceptions Scale (MULTIPleS)

Background

Illness perceptions are beliefs about the cause, nature and management of illness, which enable patients to make sense of their conditions. These perceptions can predict adjustment and quality of life in patients with single conditions. However, multimorbidity (i.e. patients with multiple long-term conditions) is increasingly prevalent and a key challenge for future health care delivery. The objective of this research was to develop a valid and reliable measure of illness perceptions for multimorbid patients.

Methods

Candidate items were derived from previous qualitative research with multimorbid patients. Questionnaires were posted to 1500 patients with two or more exemplar long-term conditions (depression, diabetes, osteoarthritis, coronary heart disease and chronic obstructive pulmonary disease). Data were analysed using factor analysis and Rasch analysis. Rasch analysis is a modern psychometric technique for deriving unidimensional and intervally-scaled questionnaires.

Results

Questionnaires from 490 eligible patients (32.6% response) were returned. Exploratory factor analysis revealed five potential subscales ‘Emotional representations’, ‘Treatment burden’, ‘Prioritising conditions’, ‘Causal links’ and ‘Activity limitations’. Rasch analysis led to further item reduction and the generation of a summary scale comprising of items from all scales. All scales were unidimensional and free from differential item functioning or local independence of items. All scales were reliable, but for each subscale there were a number of patients who scored at the floor of the scale.

Conclusions

The MULTIPleS measure consists of five individual subscales and a 22-item summary scale that measures the perceived impact of multimorbidity. All scales showed good fit to the Rasch model and preliminary evidence of reliability and validity. A number of patients scored at floor of each subscale, which may reflect variation in the perception of multimorbidity. The MULTIPleS measure will facilitate research into the impact of illness perceptions on adjustment, clinical outcomes, quality of life, and costs in patients with multimorbidity.     

Assessing the Assessment in Emergency Care Training

Objective

Each year over 1.5 million health care professionals attend emergency care courses. Despite high stakes for patients and extensive resources involved, little evidence exists on the quality of assessment. The aim of this study was to evaluate the validity and reliability of commonly used formats in assessing emergency care skills.

Methods

Residents were assessed at the end of a 2-week emergency course; a subgroup was videotaped. Psychometric analyses were conducted to assess the validity and inter-rater reliability of the assessment instrument, which included a checklist, a 9-item competency scale and a global performance scale.

Results

A group of 144 residents and 12 raters participated in the study; 22 residents were videotaped and re-assessed by 8 raters. The checklists showed limited validity and poor inter-rater reliability for the dimensions “correct” and “timely” (ICC = .30 and.39 resp.). The competency scale had good construct validity, consisting of a clinical and a communication subscale. The internal consistency of the (sub)scales was high (α = .93/.91/.86). The inter-rater reliability was moderate for the clinical competency subscale (.49) and the global performance scale (.50), but poor for the communication subscale (.27). A generalizability study showed that for a reliable assessment 5–13 raters are needed when using checklists, and four when using the clinical competency scale or the global performance scale.

Conclusions

This study shows poor validity and reliability for assessing emergency skills with checklists but good validity and moderate reliability with clinical competency or global performance scales. Involving more raters can improve the reliability substantially. Recommendations are made to improve this high stakes skill assessment.     

Issues in Health Care of Middle Eastern Patients

Relationships between Middle Eastern patients and Western health care professionals are often troubled by mutual misunderstanding of culturally influenced values and communication styles. Although Middle Easterners vary ethnically, they do share a core of common values and behavior that include the importance of affiliation and family, time and space orientations, interactional style and attitudes toward health and illness. Problems in providing health care involve obtaining adequate information, “demanding behavior” by a patient''s family, conflicting beliefs about planning ahead and differing patterns of communicating grave diagnoses or “bad news.” There are guidelines that will provide an understanding of the cultural characteristics of Middle Easterners and, therefore, will improve rather than impede their health care. A personal approach and continuity of care by the same health care professional help to bridge the gap between Middle Eastern cultures and Western medical culture. In addition, periodic use of cultural interpreters helps ameliorate the intensity of some cultural issues.     

The Role of Self-Compassion in Buffering Symptoms of Depression in the General Population

Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the “self-coldness”, composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a “self-compassion composite”, the positive SCS subscales significantly moderated the relationship between “self-coldness” and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression—providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself.     

Traditional Health Beliefs and Practices Among Lower Class Black Americans

The medical belief system of lower class black Americans reflects their social, political and economic marginality in the larger society. A moderate life-style is regarded as the basis for good health with special emphasis on protecting one''s body from cold, keeping it clean inside and out and maintaining a proper diet. Illnesses and other life events are classified as “natural” or “unnatural.” Natural illnesses result from the effects of cold, dirt and improper diet on the body causing changes in the blood. A number of beliefs about blood and its functions have important clinical implications for the treatment of hypertension and venereal disease and for family planning. Natural illnesses also result from divine punishment and serve as an instrument of social control. Unnatural illnesses are the result of witchcraft and reflect conflict in the social network. It is believed that physicians do not understand and cannot effectively treat such illnesses, but a variety of traditional healers offer help to the victims. Physicians must elicit such beliefs if they are to interact effectively and sensitively with black patients. Social change is required, however, to eliminate the feelings of powerlessness at the root of many of the health problems of poor black Americans.