Adapting World Health Organization Disability Assessment Schedule 2.0 for Nepal.

BACKGROUND: Disability is a vital public health issue for health care programs. Affluent countries usually prioritize disability-related research, while often it remains neglected in resource-poor countries like Nepal. The aim of this study was to make available a translated and culturally adapted version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring disability in the Nepalese population. METHODS: WHODAS 2.0 (12-items version) was translated into Nepali using a standard forward-backward translation protocol. Purposive and convenience recruitment of participants with psychiatric disabilities was done at the Psychiatry services in a tertiary care hospital. Age and gender-matched participants with physical disabilities were selected from the Internal Medicine department, and participants with no disability were recruited from their accompanying persons. A structured interview in Nepali including the translated WHODAS 2.0 was administered to all participants. Exploratory factor analysis and parallel analysis assessed the construct validity. Content validity was explored, and a quality of life instrument was used for establishing criterion validity. Reliability was measured via Cronbach alpha. Mann-Whitney test explored score differences between the disabled and non-disabled. RESULTS: In total, 149 persons [mean age: 40.6 (12.8); 43.6% males, 56.4% females; 61.7% disabled, 38.3% non-disabled] consented to participate. Parallel analysis indicated that a single factor was adequate for the Nepali WHODAS version that captured 45.4% of the total variance. The translated scale got a good Cronbach alpha (= 0.89). Satisfactory construct, content and criterion validity was found. The WHODAS total scores showed a significant difference between the disabled and non-disabled (U = 2002.5; p = 0.015). However, the difference between psychiatric and physical disabilities was not significant, which underscores that the scale is rating disability in general. CONCLUSION: The one-factor structure of the translated and culturally adapted Nepali-version of WHODAS 2.0 showed acceptable validity and an adequate reliability. For epidemiological research purposes, this version of WHODAS 2.0 is now available for measuring global disability in Nepal.

Quality of life and its predictors among aging people in urban and rural Nepal.

PURPOSE: We studied the quality of life (QoL) of the elderly in Nepal and their special needs. Nepal is a low- and middle-income country where the elderly population is growing significantly. METHODS: A random selection of informants from the Kavre district was carried out in this cross-sectional, population-based, door-to-door survey. The district has a mixture of urban and rural communities. In Nepal, families generally take care of their elderly. Hardly any placement is made in institutions. A validated Nepali version of World Health Organization Quality of Life 8-question scale (WHOQoL-8) estimated QoL among the elderly (≥ 60 years; N = 439). Other variables of interest were socio-demographics, substance use, physical and psychological health, and family support. Depression was measured by Geriatric Depression Scale short form [GDS-15]. Due to a high illiteracy rate, a structured and culturally adapted questionnaire was presented in an interview format. The relationships between the variables and QoL were analyzed using independent sample t tests, linear regression and Pearson's correlations. RESULTS: The mean QoL score was 25.7 (± 4.2); 49.2% rated their QoL as good. Positive predictors of QoL were: urban residence (p = 0.03); employment (p = 0.02); absence of chronic physical health problems (p = 0.02); absence of depression (p < 0.001); adequate time given by family (p = 0.001), and reports of non-abusive family relationships (p < 0.001). A negative correlation was found between geriatric depression and the QoL score (r = - 0.697; p < 0.001). CONCLUSION: QoL of the elderly in Nepal may potentially improve by care directed towards their physical and psychological health, by strengthening family relations, and by financial independence.

Nepali Version of Geriatric Depression Scale-15 - A Reliability and Validation Study.

BACKGROUND: Geriatric depression is a significant problem in both the developed and the developing world. To identify this condition, Geriatric Depression Scale has been used in different languages and cultural settings; it has proved to be a reliable and valid instrument. However, the Geriatric Depression Scale-15 version in Nepali has so far not been validated. METHODS: The original 15-item version of the Geriatric Depression Scale-15 was translated into Nepali and administered by trained nurses to a target sample aged ?60 years at Dhulikhel Hospital (n=106). Subsequently, the participants were blindly interviewed by a consultant psychiatrist for possible geriatric depression according to the ICD-10 criteria. Cronbach's alpha checked the reliability. Validity was assessed for three different cut-off points (4/5, 5/6, and 6/7); the related sensitivity, specificity, positive predictive value, and the negative predictive value of the scale were estimated. RESULTS: The mean participant age was 68.1 (±7.2); males and females, 50.9% and 49.1%, respectively. Cronbach's alpha was 0.79.The optimal cut-off point was found to be 5/6 with sensitivity and specificity 86.3% and 74.5%, respectively. CONCLUSIONS: Using a standard statistical protocol, a reliable and valid Geriatric Depression Scale-15-Nepali was developed with an adequate internal consistency and an optimal balance between sensitivity and specificity at cut-off point 5/6.The Geriatric Depression Scale-15-Nepali can serve as an appropriate instrument for assessing geriatric depression in epidemiological research as well as in primary health care settings in Nepal.

Diagnoses related to abuse of alcohol and addictive substances after gastric bypass and sleeve gastrectomy: a nation-wide registry study from Norway.

BACKGROUND: After Roux-en-Y gastric bypass (RYGB) patients are at higher risk of alcohol problems. In recent years, sleeve gastrectomy (SG) has become a common procedure, but the incidence rates (IRs) of alcohol abuse after SG are unexplored. OBJECTIVES: To compare IRs of diagnoses indicating problems with alcohol or other substances between patients having undergone SG or RYGB with a minimum of 6-month follow-up. SETTING: All government funded hospitals in Norway providing bariatric surgery. METHODS: A retrospective population-based cohort study based on data from the Norwegian Patient Registry. The outcomes were ICD-10 of Diseases and Related Health Problems diagnoses relating to alcohol (F10) and other substances (F11-F19). RESULTS: The registry provided data on 10,208 patients who underwent either RYGB or SG during the years 2008 to 2014 with a total postoperative observation time of 33,352 person-years. This corresponds to 8196 patients with RYGB (27,846 person-yr, average 3.4 yr) and 2012 patients with SG (5506 person-yr; average 2.7 yr). The IR for the diagnoses related to alcohol problems after RYGB was 6.36 (95% confidence interval: 5.45-7.36) per 1000 person-years and 4.54 (2.94-6.70) after SG. When controlling for age and sex, adjusted hazard ratio was .75 (.49-1.14) for SG compared with RYGB. When combining both bariatric procedures, women <26 years were more likely to have alcohol-related diagnoses (3.2%, 2.1-4.4) than women of 26 to 40 years (1.6%, 1.1-2.1) or women >40 (1.3%, .9-1.7). The IR after RYGB for the diagnoses related to problems with substances other than alcohol was 3.48 (95% confidence interval: 2.82-4.25) compared with 3.27 (1.94-5.17) per 1000 person-years after SG. Controlling for age and sex, the hazard ratio was .99 (.60-1.64) for SG compared with RYGB. CONCLUSIONS: In our study, procedure-specific differences were not found in the risks (RYGB versus SG) for postoperative diagnoses related to problems with alcohol and other substances within the available observation time. A longer observation period seems required to explore these findings further.

Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study.

BACKGROUND: Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. METHODS: The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. RESULTS: Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. CONCLUSIONS: Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

Prevalence of geriatric depression in the Kavre district, Nepal: Findings from a cross sectional community survey.

BACKGROUND: The increasing elderly population worldwide is likely to increase mental health problems such as geriatric depression, which has mostly been studied in high-income countries. Similar studies are scarce in low-and-middle-income-countries like Nepal. METHODS: A cross-sectional, population-based, door-to-door survey was conducted in randomly selected rural and urban population clusters of the Kavre district, Nepal. Trained nurses (field interviewers) administered structured questionnaires that included a validated Nepali version of the Geriatric Depression Scale short form (GDS-15) for identifying geriatric depression among the elderly (≥60 years) participants (N = 460). Those scoring ≥6 on GDS-15 were considered depressed. Logistic regression analysis explored the associations of geriatric depression with regard to socio-demographic information, life style, family support and physical well-being. RESULTS: Of the total 460 selected elderly participants, 439 (95.4%) took part in the study. More than half of them were females (54.2%). The mean age was 70.9 (± 8.6) years. Approximately half (50.6%) were rural inhabitants, the majority (86.1%) were illiterate, and about three-fifths (60.1%) were living with their spouses. The gender-and-age adjusted prevalence of geriatric depression was 53.1%. Geriatric depression was significantly associated with rural habitation (AOR 1.6), illiteracy (AOR 2.1), limited time provided by families (AOR 1.8), and exposure to verbal and/or physical abuse (AOR 2.6). CONCLUSION: Geriatric depression is highly prevalent in Kavre, Nepal. The findings call for urgent prioritization of delivery of elderly mental health care services in the country.

Danger- and non-danger-based stressors and their relations to posttraumatic deprecation or growth in Norwegian veterans deployed to Afghanistan.

Objective: This study aimed to explore how exposure to danger-based and non-danger-based stressors may influence personal changes in veterans (N = 4053) after deployment to Afghanistan. Method: Twelve war zone related traumatic events were used to form two stressor categories. The non-danger-based category included two stressor types: Moral Challenges and Witnessing, and the danger-based category included one type: Personal Threat. Thus, three stressor types were explored in relation to self-reported personal changes after war zone stressor exposure, e.g. negative changes labelled posttraumatic deprecation, positive changes labelled posttraumatic growth or no major change. Furthermore, the relationship between the stressor types and reported levels of distress were explored. Results: The two non-danger-based stressor types, Moral Challenges (p < .001) and Witnessing (p < .001), were both significantly more associated with deprecation rather than growth, when compared to Personal Threat. Moreover, the non-danger-based stressors were significantly associated with a rise in posttraumatic stress symptoms, as well as a rise in symptoms of depression, anxiety and insomnia (p < .001). In contrast, exposure to the danger-based stressor was only significantly associated with a rise in the posttraumatic stress symptoms in the current model (p < .001). Reports of no-change were significantly associated with low degrees of exposure to all the three stressor types (p < .001). Conclusion: The current study highlights the special adverse effects of non-danger-based stressors. Our findings show that they are more associated with posttraumatic deprecation rather than with growth. This underscores the heterogeneity of responses to traumatic events and adds to the current knowledge about the impact of various stressor types.

Objetivo: El objetivo del estudio fue explorar cómo la exposición a estresores basados en peligro y a estresores no basados en peligro puede influenciar cambios personales en veteranos (N = 4053) luego de ser desplazados a Afganistán.Métodos: Doce eventos traumáticos relacionados a zonas de guerra se usaron para elaborar dos categorías de estresores. La categoría de estresores no basados en peligro incluyó a dos tipos: Desafíos Morales y Ser Testigo. La categoría de estresores basados en peligro incluyó un tipo: Amenaza Personal. Consecuentemente, se exploró la relación de tres tipos de estresores con los cambios personales auto reportados luego de la exposición a estresores de zona de guerra; así, los cambios negativos fueron etiquetados como 'declive postraumático', y los cambios positivos como 'crecimiento postraumático' o como 'sin cambio significativo'. Adicionalmente, se exploró la relación entre los tipos de estresores y los niveles reportados de sufrimiento.Resultados: Los dos tipos de estresores no basados en peligro, Desafíos Morales (p < .001) y Ser Testigo (p < .001) estuvieron significativamente más asociados a declive que a crecimiento, cuando fueron comparados con Amenaza Personal. Asimismo, los estresores no basados en peligro estuvieron significativamente asociados a un incremento en síntomas de estrés postraumático, así como a un incremento en síntomas de depresión, ansiedad e insomnio (p < .001). En contraste, la exposición a estresores basados en peligro estuvo únicamente asociada de manera significativa a un incremento de síntomas de estrés postraumático según el modelo actual (p < .001). Los reportes de no haber experimentado un cambio estuvieron asociados significativamente a bajos niveles de exposición a los tres tipos de estresores (p < .001).Conclusiones: El presente estudio resalta los efectos adversos particulares de los estresores no basados en peligro; nuestros hallazgos muestran que están más asociados con declive postraumático que con crecimiento postraumático. Esto enfatiza la heterogeneidad de las repuestas ante eventos traumáticos y añade información sobre el impacto de los diferentes tipos de estresores al conocimiento actual.

Former Work Life and People With Dementia.

Twelve persons with dementia were interviewed about their former work lives. Their motivation for choosing their past work was influenced by values of their contemporary culture. Those who had come to terms with their illness had positive feelings about their past contributions in their former paid work. However, they often felt that unpaid work was taken for granted and not fully recognized by family or society. Some wrestled with accepting their illness; they were grieving their losses, regardless of former success. Caregivers may use parts of work narratives to elevate the self-esteem and quality of life of persons with dementia.

Measuring psychological change after trauma: Psychometric properties of a new bi-directional scale.

OBJECTIVE: The current scientific measures of posttraumatic changes in the wake of major stressors have mostly been unidirectional. This study is an attempt to develop a scale that will capture the continuum of positive to negative psychological changes after trauma. METHOD: Forty-five statements were presented to a veteran sample (N = 4,053) with the request to report for each item their experiences of negative, positive, or no posttraumatic changes as a result of their deployment to Afghanistan. RESULTS: Principal component analysis brought out 4 dimensions; 26 nonoverlapping items that had correlations above .40 were selected for the final version of the scale. The 4 dimensions were given the following designations: Self-Confidence, Interpersonal Involvement, Awareness, and Social Adaptability. Most veterans reported positive changes (36.8-80.8%) whereas a minority reported negative changes (4.5-22.0%). The total scale score correlated negatively with measures of depression, anxiety, sleep disorders, and posttraumatic stress symptoms. CONCLUSION: The posttraumatic change scale (PTCS) demonstrated acceptable psychometric properties and captured the range from negative to positive posttraumatic changes after major stress. Contrary to several previous studies, positive posttraumatic change, as measured by the PTCS, was not associated with increased symptoms of psychopathology. This underscores the heterogeneity of psychological responses to traumatic events. (PsycINFO Database Record

Anxiety and depression in Nepal: prevalence, comorbidity and associations.

BACKGROUND: Anxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed. METHODS: A nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18-65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health. RESULTS: Age- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9% respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p < 0.001) and neuroticism (AOR = 1.32; p < 0.001), and negatively with alcohol consumption (AOR = 0.71; p = 0.041). HADS-D was positively associated with marijuana use (AOR = 3.61; p = 0.017) and negatively with quality of life (QoL) (AOR = 0.86; p < 0.001). HADS-cAD was positively associated with widowhood (AOR = 2.71; p = 0.002), urban residence (AOR = 2.37; p = 0.001), living at altitude ≥2000 m (AOR = 2.32; p = 0.002) and neuroticism (AOR = 1.26; p < 0.001), and negatively with alcohol use (AOR = 0.56; p = 0.026) and QoL (AOR = 0.79; p < 0.001). CONCLUSION: Depression and anxiety are important mental health conditions in Nepal, and major contributors to public ill health, being very highly prevalent, comorbid and associated with psychosocial burden. They are also linked to the unique topography, habitation and social structure of the country. High prevalence coupled with the disabling nature of these disorders establishes their health-care priority and their importance in national health policy.

Comorbidities of psychiatric and headache disorders in Nepal: implications from a nationwide population-based study.

BACKGROUND: Headache disorders, anxiety and depression - the major disorders of the brain - are highly comorbid in the western world. Whether this is so in South Asia has not been investigated, but the question is of public-health importance to countries in the region. We aimed to investigate associations, and their direction(s), between headache disorders (migraine, tension-type headache [TTH] and headache on ≥15 days/month) and psychiatric manifestations (anxiety, depression and neuroticism), and how these might affect quality of life (QoL). METHODS: In a nationwide, cross-sectional survey of the adult Nepalese population (N = 2100), trained interviewers applied: 1) a culturally-adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire to diagnose headache disorders; 2) a validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) to detect anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD); 3) a validated Nepali version of the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N); and 4) the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Associations with headache types were analysed using logistic regression for psychiatric caseness and linear regression for neuroticism. Adjustments were made for age, gender, household consumption, habitat, altitude and use of alcohol and marijuana. RESULTS: HADS-A was associated with any headache (p = 0.024), most strongly headache on ≥15 days/month (AOR = 3.2) followed by migraine (AOR = 1.7). HADS-cAD was also associated with any headache (p = 0.050, more strongly among females than males [p = 0.047]) and again most strongly with headache on ≥15 days/month (AOR = 2.7), then migraine (AOR = 2.3). Likewise, neuroticism was associated with any headache (p < 0.001), most strongly with headache on ≥15 days/month (B = 1.6), followed by migraine (B = 1.3). No associations were found between HADS-D and any headache type, or between TTH and any psychiatric manifestation. Psychiatric caseness of any sort, when comorbid with migraine or TTH, aggravated the negative impact on QoL (p < 0.001). CONCLUSION: Headache disorders are highly comorbid with anxiety and show associations with neuroticism in Nepal, with negative consequences for QoL. These findings call for reciprocal awareness, and a holistic coordinated approach to management and in the health service. Care for common headache and common psychiatric disorders should be integrated in primary care.

Sick Leave and Disability Across Three Decades After a Major Disaster.

Extended functional impairment characterized by sick leave and disability after a single disaster has not been documented before. This prospective, longitudinal, case-control study applied growth mixture modeling to predict trajectories of functional impairment in oil rig workers, survivors (n = 68) and a matched comparison group (n = 84), over 27 years after the 1980 North Sea oil rig disaster. In the initial 12 years post-disaster, survivors displayed higher rates of functional impairment than the comparison group. A minor group of survivors (n = 8, 11.8%) demonstrated persistent functional impairment from the start and remained unable to work during the subsequent three decades. Long-term sick leave and disability were related to perceived peritraumatic death threat and a propensity towards social withdrawal. Most survivors (n = 60) revealed no major functional impairment. The study indicates that functional impairment should be counteracted in the early support after a single disaster.

A 15-Year Follow-Up Study of Sense of Humor and Causes of Mortality: The Nord-Trøndelag Health Study.

BACKGROUND: Associations between the sense of humor and survival in relation to specific diseases has so far never been studied. METHODS: We conducted a 15-year follow-up study of 53,556 participants in the population-based Nord-Trøndelag Health Study, Norway. Cognitive, social, and affective components of the sense of humor were obtained, and associations with all-cause mortality, mortality due to cardiovascular diseases (CVD), infections, cancer, and chronic obstructive pulmonary diseases were estimated by hazard ratios (HRs). RESULTS: After multivariate adjustments, high scores on the cognitive component of the sense of humor were significantly associated with lower all-cause mortality in women (HR = 0.52, 95% confidence interval [CI] = 0.33-0.81), but not in men (HR = 0.88, 95% CI = 0.59-1.32). Mortality due to CVD was significantly lower in women with high scores on the cognitive component (HR = 0.27, 95% CI = 0.15-0.47), and so was mortality due to infections both in men (HR = 0.26, 95% CI = 0.09-0.74) and women (HR = 0.17, 95% CI = 0.04-0.76). The social and affective components of the sense of humor were not associated with mortality. In the total population, the positive association between the cognitive component of sense of humor and survival was present until the age of 85 years. CONCLUSIONS: The cognitive component of the sense of humor is positively associated with survival from mortality related to CVD and infections in women and with infection-related mortality in men. The findings indicate that sense of humor is a health-protecting cognitive coping resource.

The prevalence of primary headache disorders in Nepal: a nationwide population-based study.

BACKGROUND: Headache disorders are among the most prevalent and burdensome global public-health problems. Within countries, health policy depends upon knowledge of health within the local populations, but the South-East Asia Region (SEAR), among WHO's six world regions, is the only one for which no national headache prevalence data are available. METHODS: In a cross-sectional population-based study, adults representative of the Nepali-speaking population aged 18-65 years and living in Nepal were randomly recruited using stratified multistage cluster sampling. They were visited unannounced at home by trained interviewers who used a culturally-adapted Nepali translation of the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire. RESULTS: There were 2,100 participants (1,239 females [59.0 %], 861 males [41.0 %]; mean age 36.4 ± 12.8 years) with 9 refusals (participation rate 99.6 %). Over half (1,100; 52.4 %) were resident above 1,000 m and almost one quarter (470; 22.4 %) lived at or above 2,000 m. The 1-year prevalence of any headache was 85.4 ± 1.5 % (gender- and age-adjusted 84.9 %), of migraine 34.7 ± 2.0 % (34.1 %), of tension-type headache (TTH) 41.1 ± 2.1 % (41.5 %), of headache on ≥15 days/month 7.7 ± 1.1 % (7.4 %) and of probable medication-overuse headache (pMOH) 2.2 ± 0.63 % (2.1 %). There was a strong association between migraine and living at altitude ≥1,000 m (AOR = 1.6 [95 % CI: 1.3-2.0]; p < 0.001). There was a less strong association between TTH and urban dwelling (AOR = 1.3 [95 % CI: 1.1-1.6]; p = 0.003), and a possibly artefactual negative association between TTH and living above 1,000 m (AOR = 0.7 [95 % CI: 0.6-0.8]; p < 0.001). CONCLUSION: Headache disorders are very common in Nepal. Migraine is unusually so, and strongly associated with living at altitude, which in very large part accounts for the high national prevalence: the age- and gender- standardised prevalence in the low-lying Terai is 27.9 %. Headache occurring on ≥15 days/month is also common. This new evidence will inform national health policy and provide a basis for health-care needs assessment. However, research is needed to explain the association between migraine and altitude, since it may be relevant to health-care interventions.

Obese, fat, or just overweight?

BACKGROUND: Discussing obesity with the patient without this being perceived as offensive may represent a challenge. Prevention of lifestyle diseases requires that this topic be addressed with those concerned. In this study, we investigate the patients' sensitivity to expressions, i.e. their notions of appropriateness or inappropriateness regarding various terms for obesity, and what patient characteristics are associated with such sensitivity to expressions. MATERIAL AND METHOD: The investigation is part of a five-year study of patients in Central Norway who were treated for morbid obesity. The terms used in the study had been suggested by the Overweight Patients' Association. Data on sensitivity to expressions were collected with the aid of a questionnaire one year after completion of the treatment. RESULTS: Altogether 157 out of 206 participants completed the questionnaire. Their average body mass index (BMI) (SD) amounted to 37.6 kg/m² (7.3 kg/m²). Their sensitivity to 14 different designations varied. «Weight¼, «overweight¼ and «weight problem¼ returned the best scores, whereas «obesitas¼, «obese¼ and «fat¼ were deemed least appropriate. The highest sensitivity to expressions was found among women, those who developed overweight early in life, those who had higher education and those who were dissatisfied with their weight. INTERPRETATION: The perceptions of various expressions for overweight and obesity varied considerably. Knowledge about this topic may be relevant for doctors and other health personnel in prevention and treatment of obesity.

Medical students' preferences for problem-based learning in relation to culture and personality: a multicultural study.

OBJECTIVE: The aim of this study was to explore positive and negative preferences towards problem-based learning in relation to personality traits and socio-cultural context. METHODS: The study was an anonymous and voluntary cross-sectional survey of medical students (N=449) in hybrid problem-based curricula in Nepal, Norway and North Dakota. Data was collected on gender, age, year of study, cohabitation and medical school. The PBL Preference Inventory identified students' positive and negative preferences in relation to problem-based learning; the personality traits were detected by the NEO Five-Factor Inventory. The determinants of the two kinds of preferences were analyzed by hierarchical multiple linear regressions. RESULTS: Positive preferences were mostly determined by personality; associations were found with the traits Extra-version, Openness to experience, Conscientiousness and Neuroticism; the first three are related to sociability, curiosity and orderliness, the last, to mental health. The learn-ing environments of such curricula may be supportive for some and unnerving for others who score high on Neuroticism. Negative preferences were rather determined by culture, but also, they correlated with Neuroticism and Conscientiousness. Negative preferences were lower among females and students living in symmetrical relationships. Some high on Conscientiousness disliked group work, and the negative correlation with Agreeableness indicated that less sociable students were not predisposed to this kind of learning activity. CONCLUSIONS: Preferences related to problem-based learning were significantly and independently determined both by personality traits and culture. More insights into the nature of students' preferences may guide aspects of curriculum modifications and the daily facilitation of groups.

Prognosis and psychosocial outcomes of attempted suicide by early adolescence: a 6-year follow-up of school students into early adulthood.

Adulthood psychiatric and psychosocial outcomes of early adolescence suicidal acts were studied. A representative sample of school adolescents (T1, mean age, 13.7 years; n = 2464; 50.8% female; 88.3% participation) was followed up a year later with the same questionnaire (T2). High scorers of depression were matched with low or moderate scorers and interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (mean age, 14.9 years; n = 345; 94% participation). They were reassessed after 5 years (T3, mean age, 20.0 years; n = 242; 73% participation). Those who attempted suicide before the age of 14 years and repeated suicidal acts between ages 14 and 15 years had worser prognostic profiles than incident cases between ages 14 and 15 years. Male attempters had better psychiatric prognosis than female attempters. Attempters were more likely to have contacted child protection services but not mental health services. Clinicians need to be aware of long-term pervasive outcomes of adolescent suicidality.