RESUMEN
In the late 1990s, Sri Lanka had a record rate of suicide deaths. Since then, deaths have decreased dramatically due to the restriction of lethal agrochemicals. The number of nonfatal suicidal acts, however, remains extraordinarily high. A disproportionate number of these cases are adolescents and young adults-mainly girls and young women. This paper offers a close look at adolescent girls in rural Sri Lanka who had engaged in nonfatal suicidal acts. We carried out interviews with daughters and mothers while the girls were receiving medical care following a suicidal act. Drawing from these interviews, we describe the circumstances leading to girls' suicidal acts, the responses and moral judgments made by adult family members, and the reputational and social consequences of these acts. Few girls intended to die; none had previously undertaken a suicidal act, and none gave evidence of "mental illness". In many cases, girls' suicidal acts were triggered by acute family conflicts, often concerning situations that were seen to compromise the girl's sexual respectability and the honor of her family.
Asunto(s)
Trastornos Mentales , Suicidio , Humanos , Adolescente , Adulto Joven , Femenino , Masculino , Ideación Suicida , Sri Lanka , Identidad de GéneroRESUMEN
BACKGROUND: Coping strategies play a vital role in cancer management and has been an integral part in the recovery process of cancer patients worldwide. Coping refers to specific efforts; both behavioral and psychological, that diminishes stresses emerged in cancer patients. This study evaluated the psychometric properties of the Sinhalese version of the Coping Orientation to Problems Experienced Inventory (S-BC) which was developed based on the Brief COPE scale for cancer patients in Sri Lanka. METHODS: The original Brief COPE is a self-administered tool with 28 items designed to measure coping methods used by people in stressful life events. It consisted of statements related to adaptive and maladaptive coping strategies. Forty patients with cancer who were registered at the Oncology ward, Teaching Hospital, Galle, Sri Lanka were included in the study. A cross-cultural adaptation of the Brief COPE was done using WHO guidelines. Reliability of the S-BC was assessed using test-retest and internal consistency procedures. The construct validity of the tool was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent and discriminant validity of the S-BC was tested using World Health Organization-Quality of Life-Brief scale (WHOQOL-BREF) and Centre for Epidemiological Studies-Depression scale (CES-D). RESULTS: The mean (± SD) age of the sample was 61(± 12) years, and 52.5% (n = 21) of the participants were men. Eighty percent (n = 32) of the participants were more than one year of treatment from diagnosing as a cancer patient. The test-retest reliability of the S-BC was 0.66, and the internal consistency of the S-BC was good (Cronbach's alpha - 0.819). Both EFA and CFA revealed a structure comprised of seven factors. Such factors were Avoidance/Behavioral disengagement, Religious faith/Acceptance, Seeking support, Planning, Substance use/Venting, Self-blame and Active/positive coping. The scores of the adaptive coping of the S-BC was negatively and the scores of the maladaptive coping of the S-BC was positively correlated with the CES-D score. The scores of the adaptive coping of the S-BC was positively correlated with the total score of the WHOQOL-BREF questionnaire indicating the S-BC's convergent and discriminant validity properties. CONCLUSION: The Sinhalese version of the Brief COPE is found to be a valid and a reliable measure to assess coping strategies used by patients with cancer in Sri Lanka.
Asunto(s)
Neoplasias , Calidad de Vida , Adaptación Psicológica , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Sri Lanka , Encuestas y CuestionariosRESUMEN
BACKGROUND: The early introduction of clinical material is a recognised strategy in medical education. The University of Ruhana Medical School, where a traditional curriculum is followed, offers students pre-clinical subjects without clinical exposure during their first and second years. INNOVATION: Clinical materials in the form of videos were introduced to first-year students. In the videos, patients and their relatives described the diseases and related problems. Students were instructed to identify the problems encountered by patients and relatives. Each video was followed by a discussion of the problems identified by the students. The medical, social and economic problems encountered by patients and relatives were emphasised during post-video discussions. A lecture was conducted linking the contents of the videos to subsequent lectures. The aim of this study is to investigate whether combining teaching preclinical material with a video presentation of relevant clinical cases facilitates the interest and understanding of students. IMPLICATIONS: Quantitative data were collected using a questionnaire, whereas qualitative data were collected using focus group discussions. Quantitative data showed that students appreciated the video, had 'better' knowledge acquisition and a 'better' understanding of problems encountered by patients. Qualitative analysis highlighted the following themes: increased interest; enhanced understanding; relevance of basic knowledge to clinical practice; orientation to profession; and personalising theories. The introduction of patients in the form of videos helped students to understand the relevance of subject material for clinical practice, increased their interest and facilitated a better understanding of the subject material. Therefore, it seems video is a feasible medium to introduce clinical materials to first-year students who follow a traditional curriculum in a resource-limited environment.