Aging with health: aging in place strategies of a Portuguese population aged 65 years or older

OBJECTIVE

To identify the strategies developed by people in the aging process to keep living in their own home, despite the weaknesses and difficulties they face.

METHODS

The research was carried out based on a survey of population aged 65 years or older in the Portuguese municipality of Portimão. Data were collected by questionnaire, in 2017, and submitted to statistical and content analysis.

RESULTS

Most respondents own their household, where they feel safe and satisfied, and they show awareness and concern about the changes they have to make in their home to stay there. In addition to housing and livability conditions, health, economic resources, social network, and available services play a major role in the community.

CONCLUSIONS

We identified several strategies used by older adults to stay in their households as they age and the ways they mobilize their available resources, as well as constraints of aging in place.

Stories told by plants on graveyards in Northern Angola

Background

Worldwide, different traditions of symbolic statements in graveyards can be found. However, studies on sub-Saharan Africa are rare. For BaKongo cemeteries, it is only known that they traditionally do not exhibit plants for decoration purposes. Our study wanted to inspect the influence of Portuguese culture due to the long shared colonial past.

Methods

During 2015 and 2019, plant use in 87 graveyards in 13 municipalities of the province Uíge was documented. Five expert interviews with the village eldest in five municipalities completed the data collection.

Results

While 24% of the graveyards didn´t have any planting, 27 plant species were found in the remaining ones, including a high percentage of alien species (59%), mainly from the Americas. The most abundant plant species are Euphorbia tirucalli (23%) and Agave sisalana (22%). With increasing distance from the city Uíge (especially towards the Democratic Republic of the Congo), the utilization of living plants in cemeteries is decreasing except along the road. In most of the cases, just one plant species per gravesite was found.

Conclusions

This unexpected high number of plants might be interpreted as a strong evidence of outside influence. Cultural symbols of the BaKongo cosmology and Christianism appear to coexist or coalesce. Furthermore, plants are used as a marker for graveyards. Modern influences like the use of concrete in proximity to urban areas indicate a certain wealth.

ISTAP classification for skin tears: Validation for Brazilian Portuguese

The objective of this study was to evaluate interobserver reliability and the concurrent criterion validity of the adapted version of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System to Brazilian Portuguese. For the evaluation of interobserver reliability using the photograph database, 36 nurses classified 30 skin tears (STs) into three groups, according to its definitions (adapted version). For the evaluation through clinical application, 23 nurses classified 12 STs present in 8 thoracic and cardiovascular postoperative patients at a tertiary hospital in Sao Paulo, Brazil. For the data collection of patients, an enterostomal therapist nurse classified the ST found by simultaneously using the adapted ISTAP version and the Skin Tear Audit Research (STAR) Classification System to test the concurrent criterion validity. The average of 17.83 correct answers (SD = 5.03) resulted from 1080 photograph observations, with Fleiss κ = 0.279 (reasonable concordance level). The interobserver reliability in the clinical application resulted in a global correct answer percentage of 76.7% in 85 observations. The concurrent criterion validity was attested by the total correlation (r = 1) between ISTAP and STAR. The ISTAP classification for ST is a reliable instrument and also valid in Brazil, making it another option to be used in clinical practice.

Enhancing patient safety and access to care to populations at risk of exclusion: the example of the Portuguese-speaking migrant community in South London

N/A.

Molecular Epidemiology of HIV-1 Infected Migrants Followed up in Portugal: Trends between 2001-2017

Migration is associated with HIV-1 vulnerability. Objectives: To identify long-term trends in HIV-1 molecular epidemiology and antiretroviral drug resistance (ARV) among migrants followed up in Portugal Methods: 5177 patients were included between 2001 and 2017. Rega, Scuel, Comet, and jPHMM algorithms were used for subtyping. Transmitted drug resistance (TDR) and Acquired drug resistance (ADR) were defined as the presence of surveillance drug resistance mutations (SDRMs) and as mutations of the IAS-USA 2015 algorithm, respectively. Statistical analyses were performed. Results: HIV-1 subtypes infecting migrants were consistent with the ones prevailing in their countries of origin. Over time, overall TDR significantly increased and specifically for Non-nucleoside reverse transcriptase inhibitor (NNRTIs) and Nucleoside reverse transcriptase inhibitor (NRTIs). TDR was higher in patients from Mozambique. Country of origin Mozambique and subtype B were independently associated with TDR. Overall, ADR significantly decreased over time and specifically for NRTIs and Protease Inhibitors (PIs). Age, subtype B, and viral load were independently associated with ADR. Conclusions: HIV-1 molecular epidemiology in migrants suggests high levels of connectivity with their country of origin. The increasing levels of TDR in migrants could indicate an increase also in their countries of origin, where more efficient surveillance should occur.

Cross-Cultural Adaptation and Face Validity of the Functional Mobility Assessment into Brazilian Portuguese

Introduction. The Functional Mobility Assessment (FMA) measures satisfaction with mobility devices in daily life. However, in Brazil, there is a lack of instruments which measure functional mobility.

OBJECTIVE

We aim to report the cross-cultural adaptation process and face validity of the FMA for use in Brazil.

METHODS

Two international guidelines were used in the cross-cultural adaptation process. Two independent translators translated the instrument from English to Brazilian Portuguese, and the two versions were reconciled. Two different translators back translated this reconciled version, and an expert committee analysed the resulting synthesis. For face validity, the FMA was applied with 24 participants, divided into two groups, users with disabilities (n = 12) and occupational therapy students (n = 12) and occupational therapy students (.

RESULTS

The cross-cultural adaptation of the FMA was concluded, and its face validity presented that both groups understood most or completely all instrument items.

CONCLUSION

The Brazilian version of FMA is now available in Brazilian Portuguese and has face validation. Further studies should test its psychometric properties.

School-Class Co-Ethnic and Immigrant Density and Current Smoking among Immigrant Adolescents

Although the school-class is known to be an important setting for adolescent risk behavior, little is known about how the ethnic composition of a school-class impacts substance use among pupils with a migration background. Moreover, the few existing studies do not distinguish between co-ethnic density (i.e., the share of immigrants belonging to one’s own ethnic group) and immigrant density (the share of all immigrants). This is all the more surprising since a high co-ethnic density can be expected to protect against substance use by increasing levels of social support and decreasing acculturative stress, whereas a high immigrant density can be expected to do the opposite by facilitating inter-ethnic conflict and identity threat. This study analyses how co-ethnic density and immigrant density are correlated with smoking among pupils of Portuguese origin in Luxembourg. A multi-level analysis is used to analyze data from the Luxembourg Health Behavior in School-Aged Children study (N = 4268 pupils from 283 classes). High levels of co-ethnic density reduced current smoking. In contrast, high levels of immigrant density increased it. Thus, in research on the health of migrants, the distinction between co-ethnic density and immigrant density should be taken into account, as both may have opposite effects.

Translation, Cross-Cultural Adaptation and Linguistic Validation of the FACE-Q Questionnaire for Brazilian Portuguese

BACKGROUND

Patient-reported outcomes measurement instruments (PRO) are a good way to measure results after aesthetic procedures. FACE-Q is a systematized and standardized PRO tool and was not available in Portuguese.

METHODS

This cross-sectional study included four stages: translation of FACE-Q, backtranslation, testing in patients who underwent facial aesthetic procedures and review of the questionnaires between September and December, 2018. Guidelines merging WHO and ISPOR's rules were followed.

RESULTS

Translation was conducted by two translators, resulting in two versions, translation A and translation B, which were reconciled to generate the first Portuguese version. Reconciliation showed inconsistencies between TA and TB in 63% (n = 222) of the 353 questions, which were solved by maintaining TA in 25% of cases (n = 87), TB in 27% and a new version in 11% (n = 40) of the questions. Backtranslation showed written differences with the original FACE-Q in 64 (22.7%) of the 353 question, but only one case of semantic difference, which was corrected resulting in production of the second Portuguese version. Seven patients with a mean age of 35.8 years were interviewed to assess the difficulty in understanding the questionnaires. Four patients had no or minor difficulties understanding the questionnaire, and the other three had difficulties and suggested changes that led to a third Portuguese version. The third version was reviewed for grammar and spelling resulting in the final Portuguese version.

CONCLUSION

A Brazilian Portuguese version of the FACE-Q questionnaire was obtained maintaining equivalency with the source instrument. This will allow cross-cultural research and comparison of results between different studies.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evolution and Analysis of Cultural and Cognitive Factors Related With Domestic Violence Against Women

Despite the occurrence of encouraging political and social changes in the past few years, many beliefs about women's role in intimate relationships persist, influencing their response to domestic violence (DV). This study aims to analyze the influence of recent policies against DV in Portugal, concerning particularly intimate partner violence against women and their perceptions about the victimization process. Two samples of women ( n = 126 each) reporting an aggressive act allegedly perpetrated by the current or former male partner were interviewed with a hiatus of 5 years (before and after some most relevant policy updates). Results suggest a positive influence of the recent policies against DV. Many significant and encouraging changes were found in the more recent women sample (S2) relatively to the first sample (S1) regarding their information, awareness, perceptions, and attitudes toward DV. They seem to show less tolerance and endurance to DV, placing responsibility on the offender, as well as seem more empowered to report. In S2, there was a decrease in the acceptance of violent behaviors as normal and of reasons to explain violence; the fears, shame, and helplessness about DV; the elapsed time between the beginning of the abuse and its report; and the prevalence of more severe types of physical abuse. In S2, there was an increase on the acknowledgment of DV as a crime, the number of reports in cases without cohabitation, the report of psychological abuses, and the feeling of safety and assurance while reporting.

Relationship between ADD1 Gly460Trp gene polymorphism and essential hypertension in Madeira Island

Essential hypertension (EH) is a complex disease in which physiological, environmental, and genetic factors are involved in its genesis. The genetic variant of the alpha-adducin gene (ADD1) has been described as a risk factor for EH, but with controversial results.The objective of this study was to evaluate the association of ADD1 (Gly460Trp) gene polymorphism with the EH risk in a population from Madeira Island.A case-control study with 1614 individuals of Caucasian origin was performed, including 817 individuals with EH and 797 controls. Cases and controls were matched for sex and age, by frequency-matching method. All participants collected blood for biochemical and genotypic analysis for the Gly460Trp polymorphism. We further investigated which variables were independently associated to EH, and, consequently, analyzed their interactions.In our study, we found a significant association between the ADD1 gene polymorphism and EH (odds ratio 2.484, P = .01). This association remained statistically significant after the multivariate analysis (odds ratio 2.548, P = .02).The ADD1 Gly460Trp gene polymorphism is significantly and independently associated with EH risk in our population. The knowledge of genetic polymorphisms associated with EH is of paramount importance because it leads to a better understanding of the etiology and pathophysiology of this pathology.

The Reactive-Proactive Aggression Questionnaire: Validation Among a Portuguese Sample of Incarcerated Juvenile Delinquents

The aim of the present study was to examine the psychometric properties of the Reactive-Proactive Aggression Questionnaire (RPQ) among a forensic sample of incarcerated male juvenile offenders ( N = 221). The Portuguese version of the RPQ demonstrated promising psychometric properties, namely, in terms of factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity that generally justifies its use among this population. Statistically significant associations were found with conduct disorder, age of criminal onset, age of first problem with the law, crime seriousness, physical violence use in committing crimes, alcohol use, cannabis use, cocaine/heroin use, and having unprotected sex. The findings provide additional support for the extension of the RPQ across different cultures, ethnic groups, and samples.

Portuguese American gay men in southeastern Massachusetts: cultural scripts and risk for HIV

In this study, we examined the lived experiences of an understudied subgroup, Portuguese American gay men, within the context of sexual script theory. We employed a phenomenological study design with eight men to provide a more in-depth analysis of their sociocultural sexual behaviours. Recruitment was conducted through word of mouth and a snowball approach beginning with two well-known HIV education and prevention outreach centres in southeastern Massachusetts. In this study, the sexual scripts of the participants were conceptualised within the three domains of cultural, interpersonal and intrapsychic scripts. Our findings suggest the three scripts are constantly interacting and informing one another. This ongoing negotiation influences the way our participants position their sexuality within the broader context of their everyday life within the US Portuguese community. Participants script their sexuality while they navigate multiple but separate entities within their culture, their religion and their families. Learning from these experiences could have important implications for the development of HIV prevention programmes for specific subgroups of men who have sex with men.

Difficulties of Portuguese Patients Following Acute Myocardial Infarction: Predictors of Readmissions and Unchanged Lifestyles

PURPOSE

Myocardial infarction can occur due to known risk factors and lifestyle choices. The difficulties that patients experience after discharge can lead to readmission and nonadherence to lifestyle change. The purpose of this study was to analyze the difficulties experienced by patients after hospitalization due to myocardial infarction and to identify the predictors of readmission and unchanged lifestyles.

METHODS

The study used a mixed-methods design across 106 patients who had experienced a first episode of acute myocardial infarction. The data were collected from two patient interviews and the patients' medical records. A logistic regression was used to predict unchanged lifestyle and readmission.

RESULTS

In the first interview, 74.5% of the patients reported receiving information prior to discharge. Six months after discharge, 80.2% mentioned that they had changed their lifestyles, but only 59.4% reported that their health had improved, and 75.5% continued to have concerns regarding their health. Patients described difficulties with regard to psychological problems, family dynamics, professional issues, problems with managing cardiovascular symptoms, and complications associated with hospital interventions. A follow-up assessment revealed that 12.3% of patients had been readmitted for cardiovascular disease.

CONCLUSIONS

The analysis revealed significant predictors of readmission amongst patients with hypertension and three-vessel disease. Specifically, the number of people in the household, per capita income, and a lack of information/education provided at discharge as well as problems related to mental health after discharge predicted unchanged lifestyle. An educational program might be advantageous to clarify doubts and involve patients in their own disease management.

Portuguese Lexical Clusters and CVC Sequences in Speech Perception and Production

This paper investigates similarities between lexical consonant clusters and CVC sequences differing in the presence or absence of a lexical vowel in speech perception and production in two Portuguese varieties. The frequent high vowel deletion in the European variety (EP) and the realization of intervening vocalic elements between lexical clusters in Brazilian Portuguese (BP) may minimize the contrast between lexical clusters and CVC sequences in the two Portuguese varieties. In order to test this hypothesis we present a perception experiment with 72 participants and a physiological analysis of 3-dimensional movement data from 5 EP and 4 BP speakers. The perceptual results confirmed a gradual confusion of lexical clusters and CVC sequences in EP, which corresponded roughly to the gradient consonantal overlap found in production.

From Reduction to Apocope: Final Poststressed Vowel Devoicing in Brazilian Portuguese

This is a study of final poststressed vowel devoicing following /s/ in Brazilian Portuguese. We contradict the literature describing it as deletion by arguing, first, that the vowel is not deleted, but overlapped and devoiced by the /s/, and, second, that gradient reduction with devoicing may lead to apocope diachronically. The following results support our view: (1) partially devoiced vowels are centralized; (2) centralization is inversely proportional to duration; (3) total devoicing is accompanied by lowering of the /s/ centroid; (4) the /s/ noise seems to be lengthened when the vowel is totally devoiced; (5) aerodynamic tests reveal that lengthened /s/ has a final vowel-like portion, too short to be voiced; (6) lengthened /s/ favors vowel recovery in perceptual tests. This seems to be a likely path from reduction to devoicing to listener-based apocope.

Prevalence and management of cardiovascular risk factors in Portuguese living in Portugal and Portuguese who migrated to Switzerland

BACKGROUND

Information regarding the health status of migrants compared to subjects who remain in the country of origin is scarce. We compared the levels and management of the main cardiovascular risk factors between Portuguese living in Porto (Portugal) and Portuguese migrants living in Lausanne (Switzerland).

METHODS

Cross-sectional studies conducted in Porto (EPIPorto, 1999 to 2003, n = 1150) and Lausanne (CoLaus, 2003 to 2006, n = 388) among subjects aged 35-65 years. Educational level, medical history and time since migration were collected using structured questionnaires. Body mass index, blood pressure, cholesterol and glucose levels were measured using standardized procedures.

RESULTS

Portuguese living in Lausanne were younger, more frequently male and had lower education than Portuguese living in Porto. After multivariate adjustment using Poisson regression, no differences were found between Portuguese living in Porto or in Lausanne: prevalence rate ratio (PRR) and (95% confidence interval) for Portuguese living in Lausanne relative to Portuguese living in Porto: 0.92 (0.71 - 1.18) for current smoking; 0.78 (0.59 - 1.04) for obesity; 0.81 (0.62 - 1.05) for abdominal obesity; 0.82 (0.64 - 1.06) for hypertension; 0.88 (0.75 - 1.04) for hypercholesterolemia and 0.92 (0.49 - 1.73) for diabetes. Treatment and control rates for hypercholesterolemia were higher among Portuguese living in Lausanne: PRR = 1.91 (1.15 - 3.19) and 3.98 (1.59 - 9.99) for treatment and control, respectively. Conversely, no differences were found regarding hypertension treatment and control rates: PRR = 0.98 (0.66 - 1.46) and 0.97 (0.49 - 1.91), respectively, and for treatment rates of diabetes: PRR = 1.51 (0.70 - 3.25).

CONCLUSIONS

Portuguese living in Lausanne, Switzerland, present a similar cardiovascular risk profile but tend to be better managed regarding hypercholesterolemia than Portuguese living in Porto, Portugal.

Specific language impairment in language-minority children from low-income families

BACKGROUND

Recent evidence suggests that specific language impairment (SLI) might be secondary to general cognitive processing limitations in the domain of executive functioning. Previous research has focused almost exclusively on monolingual children with SLI and offers little evidence-based guidance on executive functioning in bilingual children with SLI. Studying bilinguals with SLI is important, especially in the light of increasing evidence that bilingualism can bring advantages in certain domains of executive functioning.

AIMS

To determine whether executive functioning represents an area of difficulty for bilingual language-minority children with SLI and, if so, which specific executive processes are affected.

METHODS & PROCEDURES

This cross-cultural research was conducted with bilingual children from Luxembourg and monolingual children from Portugal who all had Portuguese as their first language. The data from 81 eight-year-olds from the following three groups were analysed: (1) 15 Portuguese-Luxembourgish bilinguals from Luxembourg with an SLI diagnosis; (2) 33 typically developing Portuguese-Luxembourgish bilinguals from Luxembourg; and (3) 33 typically developing Portuguese-speaking monolinguals from Portugal. Groups were matched on first language, ethnicity, chronological age and socioeconomic status, and they did not differ in nonverbal intelligence. Children completed a battery of tests tapping: expressive and receptive vocabulary, syntactic comprehension, verbal and visuospatial working memory, selective attention and interference suppression.

OUTCOMES & RESULTS

The bilingual SLI group performed equally well compared with their typically developing peers on measures of visuospatial working memory, but had lower scores than both control groups on tasks of verbal working memory. On measures of selective attention and interference suppression, typically developing children who were bilingual outperformed their monolingual counterparts. For selective attention, performance of the bilingual SLI group did not differ significantly from the controls. For interference suppression the bilingual SLI group performed significantly less well than typically developing bilinguals but not monolinguals.

CONCLUSIONS & IMPLICATIONS

This research provides further support to the position that SLI is not a language-specific disorder. The study indicates that although bilingual children with SLI do not demonstrate the same advantages in selective attention and interference suppression as typically developing bilinguals, they do not lag behind typically developing monolinguals in these domains of executive functioning. This finding raises the possibility that bilingualism might represent a protective factor against some of the cognitive limitations that are associated with SLI in monolinguals.

Does ethnicity play a role in the dosing of warfarin in Hawai'i?

Warfarin is the most common anticoagulant prescribed and its metabolism has been linked to two specific genes, CYP2C9 and VKORC1. This study analyzed 113 patients from 4 different ethnic backgrounds (Asian, Native Hawaiian, Portuguese, and Caucasian) and investigated the association between the mean daily dose of warfarin and ethnicity. Caucasian patients required the highest mean daily dose of warfarin 4.4 mg/day while Asian patients required the lowest mean daily dose of warfarin 2.5 mg/day. Portuguese patients and Native Hawaiian patients required mean of 3.8 mg/day. All three groups required a significantly lower dose than Caucasians. When adjusted for weight in kilograms, Native Hawaiian patients required a dose of 4.3 × 10(-2) mg/kg, Portuguese 4.4 × 10(-2) mg/kg and Asians 4.0 × 10(-2) mg/kg. These three populations had similar mean milligrams/kilogram dose requirements while Caucasians required a significantly higher dose of 5.3 × 10(-2) mg/kg. This data suggests that ethnicity should be taken into consideration when dosing warfarin.

Heterosexual Seduction in the Urban Night Context: Behaviors and Meanings

This article presents an anthropological analysis of heterosexual seduction behaviors of men and women (from 18 to 65 years old, with varying civil status) who attended nightclubs located in the movida areas of Lisbon, Portugal. These behaviors were analyzed according to structure versus communitas theories. Nighttime seduction behaviors were observed and recorded in a field diary, and in-depth semistructured interviews with 60 men and 60 women were conducted. Interviews were analyzed using the thematic content analysis model. Results suggested that the communitas domain was evinced in the various seduction strategies. These courtship behaviors tended to follow a specific pattern: nonverbal seduction, visual seduction, verbal seduction, and acting-consisting of caresses, touches, and kisses. When this escalation process evoked positive responses, it generally culminated in the complete synchrony of movements between the two bodies. The seduction process encompassed both masculine and feminine initiatives: Women engaged primarily in nonverbal and visual seduction, while men appeared to orchestrate verbal courtship and acting. However, sometimes men and women did not want to seduce or be seduced because they were married (especially women) or were with their partners (especially young men) and did not want to endanger the structure domain.

The acceptability of ending a patient's life: a France-Portugal-Spain comparison

The views of French, Portuguese, and Spanish people on end-of-life decisions were compared. Two hundred seventy-seven adults from Barcelona, Oporto, and Toulouse judged the acceptability of life-ending procedures in 42 scenarios composed of all combinations of 3 factors: the patient's age (30 or 80 years), the patient's life expectancy (days, weeks, or months), and the type of procedure (suicide, suicide assisted by the physician, euthanasia by the physician at the request of a suffering patient, euthanasia of a comatose patient at the family's request, euthanasia of a comatose patient as stipulated in the patient's advance directives, euthanasia of a comatose patient without advance directions and without a request from the family, or euthanasia of a suffering patient without a request from the patient). In all 3 countries, the type of procedure had the major effect. The 4 procedures implemented by the patient or at the patient's request were, on average, considered acceptable. The 2 procedures not implemented at the patient's request were considered unacceptable. Euthanasia of a comatose patient at the request of the family was judged mildly acceptable. The attitudes of the people in Toulouse, Oporto, and Barcelona concerning the acceptability of ending a patient's life have now largely converged, although Spanish participants were statistically significantly more accepting than French and Portuguese participants.

Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study

BACKGROUND

Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the U.S.A., limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.

METHOD

Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.

RESULTS

The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the U.K., where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59–4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event.

CONCLUSIONS

These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Retention in mental health care of Portuguese-speaking patients

We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.

BTNL2 gene polymorphism associations with susceptibility and phenotype expression in sarcoidosis

A functional polymorphism within butyrophilin-like 2 (BTNL2) gene has been described as a potential risk factor for sarcoidosis. The association between chronicity and the rs2076530 SNP A allele has also been reported. This study evaluates the BTNL2 rs2076530 G/A allele associations with sarcoidosis susceptibility and disease evolution in a Portuguese cohort of patients. A case-control study of 151 patients and 150 controls was performed. Allele frequencies were compared with Chi-square test in a univariate analysis and with logistic regression in a multivariate analysis. BTNL2 rs206530 A allele frequencies were significantly higher in sarcoidosis with no linkage disequilibrium with HLA-DRB1 alleles, except in the subgroup of patients with Löfgren syndrome where the determinant allele was HLA-DRB1*03. The A allele was also increased in those with isolated thoracic disease, with no differences regarding radiological stages or disease evolution. HLA-DRB1*03, besides the association with Löfgren syndrome was significantly related with disease resolution. Our data confirms the association of BTNL2 rs2076530 A allele with sarcoidosis susceptibility in a Portuguese population. We found independent genetic risk factors in clinically distinct disease phenotypes: BTNL2 rs2076530 A allele in patients without Löfgren syndrome or with isolated thoracic disease, and HLA-DRB1*03 in Löfgren syndrome or disease resolution.

Comparing vowel perception and production in Spanish and Portuguese: European versus Latin American dialects

Recent acoustic descriptions have shown that Spanish and Portuguese vowels are produced differently in Europe and Latin America. The present study investigates whether comparable between-variety differences exist in vowel perception. Spanish, Peruvian, Portuguese, and Brazilian listeners were tested in a vowel identification task with stimuli sampled from the whole vowel space. The mean perceived first (F1) and second formant (F2) of every vowel category were compared across varieties. For both languages, perception exhibited the same between-variety differences as production for F1 but not F2, which suggests correspondence between produced F1 and perceived vowel height but not between F2 and frontness.

Social support for breast cancer management among Portuguese-speaking immigrant women

Breast cancer is one of the most commonly diagnosed types of cancer among women in Canada. Much health sciences research has examined this topic. The importance of formal and informal social support in managing breast cancer has received particular attention, but research with immigrant women has been limited. This article presents the findings of an applied ethnographic study conducted in Toronto, Canada, with 12 Portuguese-speaking women from Brazil, Portugal, and Angola about their need for, access to, and use of social support in the management of breast cancer. The key findings pertain to cancer-related fears and stigma that restrict access to and use of informal social support, barriers to obtaining formal social support, and women's resilience in the context of limited informal and formal social support. Implications for healthcare providers are presented at micro, meso, and macro levels.

Negative health care experiences of immigrant patients: a qualitative study

BACKGROUND

Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients.

METHODS

Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment.

RESULTS

Respondents reported negative events in relation to: 1) inadequate information exchange with care providers; 2) different expectations between respondents and care providers about medical procedures; 3) experienced prejudicial behavior on the part of care providers.

CONCLUSIONS

We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.

The Zimba, the Portuguese, and other cannibals in late sixteenth-century Southeast Africa

This article argues that Portuguese accounts of cannibalism in sixteenth-century southeast Africa reflect important but mostly unrecognised elements of the region's political and cultural history. The article analyses descriptions of the Zimba cannibals in Ethiopia Oriental, written by the Portuguese priest Joo dos Santos. Dos Santos's evidence figures significantly in scholarship for this period, and while many historians include his colourful descriptions of cannibalism, none has taken them seriously, largely dismissing them as a product of European myth-making. In focusing on the question of cannibalism, the article asks not whether the Zimba ate human flesh, nor why they might have, but how dos Santos came to believe that they did. Early modern European cultural outlooks had a role in producing such accounts, but the argument here focuses on how claims of cannibalism reflected African, rather than European, perspectives. Such claims were a vernacular expression of beliefs about, and critiques of, political power in the threatening and unsettled political environment of the time. In transmitting descriptions of cannibalism from African informants, dos Santos acted as an unwitting vehicle for this vernacular critique, conveying its meaning quite imperfectly to his readers.

Port wine landscape: railroads, phylloxera, and agricultural science

It is easy to understand why regions that produce very fine goods such as port wine tend to conceal technological and scientific inputs and praise the uniqueness of the terroir. This paper suggests that, during the last decades of the nineteenth century, viticulture in the Douro region of Portugal was as much a product of soil, local farming traditions, and individual entrepreneurship as it was of modern state science and national politics for agricultural improvement. the unprecedented public projects of building a railroad and fighting phylloxera permanently changed the land of port wine. Moreover, those engineering practices of rationalization, simplification, and standardization that were inscribed on Douro's landscape proved essential for the Portuguese experience of modernization and nation-building.

[The journal "Broteria," Jesuit botanists and Gonçalo Sampaio. Exchange of plants and ideas, and the development of botany in Portugal]

The journal Broteria has covered a long path, since its foundation in 1902 until the mid 20's, when it stands as one of the best journals of natural history and a voice of the renewal of the natural sciences in Portugal. Broteria's success was due, mainly, to the remarkable qualities of its founders and main editors: their working capacity, intellectual standards and perseverance as well as the ability to establish a network of naturalists who sent them biological collections from remote regions and the ability to adapt to exile, while continuing to work and focusing their studies on the natural history of the exile country. The maintenance, in regular functioning, of their schools, and the opening to the collaboration of non Jesuit naturalists, such as the botanists from Oporto, also contributed to the success of Broteria.

Prevalence of symptoms of eczema in Latin America: results of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3

BACKGROUND

The aim of the International Study of Asthma and Allergies in Childhood (ISAAC) was to evaluate the prevalence of symptoms of eczema among children living in different parts of Latin America. Data were from centers that participated in ISAAC Phase 3.

METHODS

This was a cross-sectional questionnaire survey of 93,851 schoolchildren (6 to 7 years old) from 35 centers in 14 Latin American countries and 165,917 adolescents (13 to 14 years old) from 56 centers in 17 Latin American countries.

RESULTS

The mean prevalence of current flexural eczema in schoolchildren was 11.3%, ranging from 3.2% in Ciudad Victoria (Mexico) to 25.0% in Barranquilla (Colombia). For adolescents, the prevalence varied from 3.4% in Santo André (Brazil) to 30.2% in Barranquilla (mean prevalence, 10.6%). The mean prevalence of current symptoms of severe eczema among schoolchildren was 1.5%, ranging from 0.3% in Ciudad Victoria, Toluca, and Cuernavaca (Mexico) to 4.9% in La Habana (Cuba). For adolescents, the mean prevalence was 1.4%, ranging from 0.1% in Mexicali Valley (Mexico) to 4.2% in Santa Cruz (Bolivia). These prevalence values are among the highest observed during ISAAC Phase 3. In general, the prevalence of current symptoms of eczema was higher among the Spanish-speaking centers for both schoolchildren and adolescents.

CONCLUSION

Environmental risk factors must be evaluated in order to identify potential causes for the differences observed, even in centers from the same country.

[Hygiene and health preservation in the Luso-Brazilian medicine of the 18th century]

The present article analyzes the problematic of hygiene in the Luso-Brazilian medicine during the second half of 18th century. The chosen context to analysis is related to the changes of medical thought in Portugal along the period related to the appropriation of medical theories that circulated around the Enlightenment Europe. Besides, this paper approaches the ideas presented in medicine treatises of that time related to body care and health conservation, calling attention to the central role of hygiene along that period.

Predictors of mental health among adolescents from immigrant families in Portugal

The aims of this study were to investigate the degree of mental health problems among adolescents with immigrant background in Portugal and the factors that may predict mental health problems. The study sample consisted of 755 immigrant adolescents from seven ethnocultural groups (Cape Verdeans, Angolans, Indians, Mozambicans, East Timorese, Sao Tomese, and Guineans) and 320 native Portuguese adolescents. Generally, most respondents did not report major psychological adjustment problems. Adolescents from immigrant families reported fewer mental health problems than their native Portuguese counterparts, and girls reported more mental health problems than did boys. Predictive factors-sociodemographic, intercultural contact, and psychosocial adjustment variables-were significantly linked to youths' mental health. Major predictors of poor psychological adjustment were perceived discrimination, social difficulties, and behavioral problems. As expected, different factors explained the psychological adaptation of adolescents by gender. Implications of the study for counselors are discussed.

Portuguese immigrant families: the impact of acculturation

Portuguese immigrants to North America represent a large ethnic group with unique family therapy needs. The present study investigates acculturation and the family lives of Portuguese (Azorean) immigrants in Canada. Methods of analytic induction and constant comparison from grounded theory were used to examine transcripts of interviews with 21 Azorean immigrant women and 28 Azorean immigrant men. A model emerged wherein (a) immigration and acculturation act as stressors on the family unit, as described by the categories Process of Change and Family Relationships; (b) family members adopt generation- and gender-specific acculturative strategies, as illustrated by the categories Duas Culturas (Two Cultures) and Falando Portuges (Speaking Portuguese); and (c) as family members acculturate, discords arise and are resolved according to the cultural traits different members have adopted. The categories Discord Resolution and Preocupação (Preoccupations) illustrate this last dynamic. Implications for family therapy with immigrant families include an indication for community-level interventions, emphasis on confidentiality, awareness of acculturation stress and different acculturative strategies within the family, and aiding the family in the negotiation and integration of a new bicultural reality.

Early childhood caries and access to dental care among children of Portuguese-speaking immigrants in the city of Toronto

OBJECTIVE

To determine the influence of accessibility of dental services and other factors on the development of early childhood caries (ECC) among Toronto children 48 months of age or younger with at least one Portuguese-speaking immigrant parent.

METHODS

This population-based case-control study involved 52 ECC cases and 52 controls (i.e., without ECC) identified from community centres, churches and drop-in centres by a process of network sampling. Caries status (dmft/s) was assessed by clinical examination. Access to dental care and risk factors for ECC were determined through a structured interview with the Portuguese-speaking parent.

RESULTS

Forty (77%) of the children with ECC but only 28 (54%) of controls had never visited a dentist. Thirty (58%) mothers of children with ECC but only 13 (25%) mothers of controls had not visited a dentist in the previous year. Bivariate analyses revealed that low family income, no family dentist, no dental insurance, breastfeeding, increased frequency of daily snacks and low parental knowledge about harmful child feeding habits were associated with ECC. Non-European-born parents and parents who had immigrated in their 20s or at an older age were 2 to 4 times more likely to have a child with ECC than European parents and those who had immigrated at a younger age. Lack of insurance, no family dentist and frequency of snacks were factors remaining in the final logistic regression model for ECC.

CONCLUSIONS

The strongest predictors of ECC in this immigrant population, after adjustment for frequent snack consumption, were lack of dental care and lack of dental insurance. These findings support targeting resources to the prevention of ECC in children of new immigrants, who appear to experience barriers to accessing private dental care and who are exposed to many of the determinants of oral disease.

Comparisons of the incidence and pathological characteristics of prostate cancer between Chinese and Portuguese in Macau

BACKGROUND

Aging of population in Macau has become a serious problem and we are diagnosing more and more patients with prostate cancer. To investigate the effect of ethnicity and environment on incidence of prostate carcinoma, we compared the difference of biopsy and postoperative pathology of prostate between indigenous Chinese (Chinese) and Chinese of Portuguese descent (Portuguese) with elevated serologic prostate specific antigen (PSA) and incidence of prostate carcinoma in Macau.

METHODS

Between 1999 and 2006, prostate biopsy was performed in a random sample of 462 patients with elevated serologic PSA who, on followup, were diagnosed in this hospital with benign prostate hyperplasia. Of these, 416 were indigenous Chinese, 46 Portuguese. Based on demographic statistics by Macau government for 2005, we compared differences in incidences of prostate carcinoma, positive rate of random prostate biopsy in patients with elevated serologic PSA, factors related to serological PSA and pathological grade and stage between both ethnic groups.

RESULTS

Prostate carcinoma was diagnosed on biopsy in 178 cases. Positive biopsies of prostate carcinoma were present in 160 Chinese with positive rate of 38.5% and in 18 Portuguese with 39.1%. For patients diagnosed with prostate carcinoma, there was no significant difference in age, incidence, grade of cancerous cells, stage of the disease, incidence of inflammation of prostatic tissues or prostatic intraepithelial neoplasia (PIN) related to elevated PSA between the groups (All P>0.05).

CONCLUSIONS

There was no significant difference in incidence or characteristics of prostate carcinoma between people of Portuguese and Chinese descent in Macau based on our limited data. Long term residence in the same environment may be associated with the incidence and progression of prostate carcinoma in Portuguese living in Macau, but further rigorous epidemiological investigation and analysis of risk factors about prostate carcinoma are needed to corroborate this conclusion.

[Diagnosis of familial amyloid polyneuropathy type I in Argentina]

Familial amyloid polyneuropathy (FAP) is an autosomal dominant inherited disease, characterized by systemic deposition of amyloid fibrils in various tissues, especially in peripheral nerves, being a variant of transthyretin (TTR) the principal component of amyloid fibrils. TTR is a normal plasma protein (previously called prealbumin) that functions as a transport protein binding tiroxine and retinol. Among many mutations that have been found in the TTR gene, the variant with a single amino acid substitution of methionine for valine at position 30 (TTR Val30Met) is the responsible of the Portuguese-type Familial Amyloidotic Polyneuropathy (FAP Type I). Interest in this pathology has arisen in Argentina because of the finding of an endemic area where a group of Portuguese immigrant families is localized. Since liver transplantation is a widely accepted treatment because it results in the disappearance of variant transthyretin from plasma, an early detection of the altered gene is essential. Thus, the objective of the present work was to optimize a methodology to detect the Val30Met mutation introducing modifications into techniques that were previously developed. The simple method here described is useful to confirm the diagnosis of the potential disease and, therefore, make it possible for patients to gain access to early liver transplantation.

[The people of the black waters: the Amazon caboclo of the Negro river]

The article constructs a historically contextualized description of the people who live along the Negro river, a Brazilian affluent in the Amazon basin. Drawing on information about the daily social experience of the participants from the dawn of the twentieth century through the mid-1990s, the processes by which the population and communities took shape are identified. On the Negro river, contact between Brazilian society and the autochthonous, catechized indigenous groups living there was determinant in shaping the territory's caboclo identity. Starting in the last quarter of the nineteenth century, this nomenclature took root and entered the popular lexicon. Extractivist activities played a major role in spreading the term, within a context where the predominant social relations derived from the 'cultura do barracão'.

Exchanged identities in a complex multiple homicide case. Identification and cause of death

We report a multiple homicide in Angola involving six Portuguese citizens. Immediately after the crime, four bodies were retrieved from the homicide site. Forensic autopsies were allegedly performed by local doctors and three bodies were transferred to Portugal, where they were buried with no extra expertise, presumably identified only by the examinations carried out in Angola. The two remaining bodies, presumably from sub-adults, were only discovered 1 year later. At that time, some bone samples of these two corpses were sent to Portugal. A multidisciplinary team of the National Institute of Legal Medicine (NILM) in Portugal, including forensic anthropologist and pathologists, and forensic geneticist, found out that the bodies were previously misidentified. In fact, the anthropological and genetic examinations on the remains of the two persons showed that they did not belong to a child and an adolescent but instead to two adult victims, at least one of them was supposed to be buried in Portugal since 1 year. The verification of this misunderstanding led to a series of exhumations, of the three victims previously buried in Portugal. In all, the identities were reconstructed and the cause of death could be established in four of them. A multiplicity of severe traumatic cranial injuries were detected, which were, undoubtedly due to a violent death.

Population history and infrequent mutations: how old is a rare mutation? GUCY2D as a worked example

The mosaic pattern of haplotypes observed around a single mutation results from one or several founder events. The difficulties involved in calculating the age of the variant are greatly reduced by assuming a single event, but this simplification may bias analysis of the genealogy of the mutation. However, if it is assumed that more than one founder event occurred, the number of genealogies is very large and the likelihood of every possible tree could not be realistically calculated. A multipoint approach is required, given the number of independent variables needed to describe a complex bifurcating genealogy. Starting from the observation that a limited number of parameters is needed for calculation of the simplest models of bifurcating genealogies, we show that the probability density of a two-ancestor model genealogy can be simply described as an algebraic function in a closed form, two coalescence times being calculated simultaneously without compromising accuracy. Implementation in a Bayesian framework is facilitated by the simplicity of the function, which describes the reciprocal relationship between the region of complete linkage disequilibrium and the branch length of the tree. We illustrate the use of haplotype information about allele-sharing decay around a mutation as a genetic clock, using data for two GUCY2D mutations in Mediterranean populations.

Bicultural identity among economical migrants from three south European countries living in Switzerland. Adaptation and validation of a new psychometric instrument

BACKGROUND

Acculturation is one of the determinants of mental health among immigrants. Evaluating adaptation to the host culture is insufficient, since immigrants will develop various degrees of bi- or multicultural identity. However, mental health professionals lack simple and easy to use instruments to guide them with bicultural identity evaluation in their practice. Our aim was to develop such an instrument to be used for clinical purposes among economical migrants from three South European countries living in Geneva, Switzerland.

METHODS

We adapted from existing instruments a 24 item bi-dimensional scale to assess involvement in both culture of origin and host culture. The study included 93 immigrant adults from three south European countries (Italy, Portugal and Spain). Thirty-eight patients were recruited in an outpatient treatment program for alcohol-related problems and 55 participants were hospital employees.

RESULTS

The questionnaire was rated as easy or rather easy by 97.8% of participants. Median time to complete it was 5 minutes. The instrument allowed discriminating between patients and healthy subjects, with scores for Swiss culture significantly higher among hospital workers. The subscales related to culture of origin and host culture displayed adequate internal consistency (Cronbach's alpha 0.77 and 0.73 respectively).

CONCLUSION

It is possible to assist clinicians' assessment of cultural identity of Italian, Portuguese and Spanish economical immigrants in Switzerland with a single and easy to use instrument.

Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes

OBJECTIVE

To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period.

DESIGN

The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence.

RESULTS

Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months.

CONCLUSIONS

Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.

Gene flow in the Iberian Peninsula determined from Y-chromosome STR loci

In this work, seven multiallelic short-tandem repeat (STR) loci from the nonrecombining region of the human Y-chromosome (DYS19, DYS389 I, DYS389 II, DYS390, DYS391, DYS392, and DYS393) were typed in a sample of residents in the Basque Country (RBAS). In all, 40 different Y-STR haplotypic combinations were identified, resulting in a value of haplotypic diversity of 0.979. Y-STR data compiled from previous works were used for studying Y-chromosome diversity in the Iberian Peninsula and for assessing the effects of migratory movements on the genetic background of the population living currently in territories traditionally occupied by native (autochthonous) Basques. An analysis of the spatial distribution of allelic frequencies of the Y-STRs revealed a geographic pattern characterized by variation gradients (frequency clines) oriented for the most part in the direction southwest-northeast. Accordingly, a neighbor-joining analysis showed a relative polarization between populations located in the northeast and center of the Iberian Peninsula, and the rest of the samples considered. The study sample (RBAS) occupied an intermediate position in the population tree between the autochthonous Basques (BASQ) and the remaining samples. Interestingly, the RBAS collection only showed genetic heterogeneity with that of native Basques (PhiST = 0.013, P < 0.05). Estimates of admixture proportions in the gene pool of RBAS indicated a high level of hybridization with Basque (56%) and non-Basque (44%) genes, which could explain the genetic differentiation observed between BASQ and RBAS.

CFTR gene analysis in Latin American CF patients: heterogeneous origin and distribution of mutations across the continent

BACKGROUND

Cystic Fibrosis (CF) is the most prevalent Mendelian disorder in European populations. Despite the fact that many Latin American countries have a predominant population of European-descent, CF has remained an unknown entity until recently. Argentina and Brazil have detected the first patients around three decades ago, but in most countries this disease has remained poorly documented. Recently, other countries started publishing their results.

METHODS

We present a compilation and statistical analysis of the data obtained in 10 countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Uruguay and Venezuela), with a total of 4354 unrelated CF chromosomes studied.

RESULTS

The results show a wide distribution of 89 different mutations, with a maximum coverage of 62.8% of CF chromosomes/alleles in the patient's sample. Most of these mutations are frequent in Spain, Italy, and Portugal, consistent with the origin of the European settlers. A few African mutations are also present in those countries which were part of the slave trade. New mutations were also found, possibly originating in America.

CONCLUSION

The profile of mutations in the CFTR gene, which reflects the heterogeneity of its inhabitants, shows the complexity of the molecular diagnosis of CF mutations in most of the Latin American countries.

Cross-cultural perspectives on research participation and informed consent

This study examined Portuguese Canadian and Caribbean Canadian immigrants' perceptions of health research and informed consent procedures. Six focus groups (three in each cultural group) involving 42 participants and two individual interviews were conducted. The focus groups began with a general question about health research. This was followed by three short role-plays between the moderator and the assistant. The role-plays involved a fictional health research study in which a patient is approached for recruitment, is read a consent form, and is asked to sign. The role-plays stopped at key moments at which time focus group participants were asked questions about their understanding and their perceptions. Focus group transcripts were coded in QSR NUDIST software using open coding and then compared across cultural groups. Six overriding themes emerged: two were common in both the Portuguese and Caribbean transcripts, one emphasized the importance of trust and mistrust, and the other highlighted the need and desire for more information about health research. However, these themes were expressed somewhat differently in the two groups. In addition, there were four overriding themes that were specific to only one cultural group. In the Portuguese groups, there was an overwhelming positive regard for the research process and an emphasis on verbal as opposed to written information. The Caribbean participants qualified their participation in research studies and repeatedly raised images of invasive research.

Portuguese immigrant women's perspectives on wife abuse: a cross-generational comparison

This descriptive study seeks to understand what first and second generation Portuguese women believe about wife abuse and what actions they believe are appropriate for an abused wife. Eighty first generation and 54 second generation women participated. The researcher read the questionnaire items aloud in one-on-one meetings. Overall, participants defined wife abuse broadly, did not approve of wife abuse, were most likely to believe that women should seek external help, and did not hold strong patriarchal beliefs. However, a number of generational differences were found. Second generation women were more likely to label an abusive behavior as abuse, and first generation women were more likely to approve of abuse, endorse indirect or traditional options to deal with wife abuse, and hold stronger patriarchal beliefs. The study's implications for research and practice within Portuguese communities are discussed.