Study design, baseline patient characteristics and intervention in a cross-cultural framework: results from the ADORE study

OBJECTIVE : To describe the methodology and to present the baseline findings of the Attention-deficit/hyperactivity Disorder Observational Research in Europe (ADORE) study, the primary objective of which is to describe the relationship between treatment regimen prescribed and quality of life of children with ADHD in actual practice. METHODS : In this 2-year prospective observational study, data on diagnosis, prescribed treatment and outcomes of ADHD were collected at seven time points by paediatricians and child psychiatrists on 1,573 children recruited in 10 European countries. The data presented here from the 1,478 patients included in the analyses describe the baseline condition, initial treatment regimen prescribed and quality of life of families with children with ADHD. RESULTS : Patients had a mean age of 9.0 years (SD 2.5) and 84% were male. Physicians diagnoses were made using DSM-IV (43 %), ICD-10 (32%) and both DSM-IV and ICD-10 (12 %). Mean age of awareness of a problem was 5.1 years, suggesting an average delay of approximately 4 years between awareness and diagnosis of ADHD. Baseline ADHD rating scale scores (physicianrated) indicated moderate to severe ADHD. Parent-rated SDQ scores were in agreement and suggested significant levels of co-existing problems. CGI-S, CGAS and CHIPCE scores also indicated significant impairment. Patients were offered the following treatments after the initial assessment: pharmacotherapy (25 %), psychotherapy (19 %), combination of pharmacotherapy and psychotherapy (25 %), other therapy (10 %) and no treatment (21 %). CONCLUSION : The ADORE study shows that ADHD is similarly recognised across 10 European countries and that the children are significantly impaired across a wide range of domains. In this respect, they resemble children described in previous ADHD samples.

Narratives and landscapes : their capacity to serve indigenous knowledge interests

The thesis is a culmination of my research which drew on tyangi wedi tjan Rak Mak Mak Marranunggu and Marrithiel knowledge systems. These awa mirr spiritual knowledge systems have guided our Pilu for millennium and have powerful spiritual affiliation to the land and our continued presences. The understandings of the spiritual connectedness and our practices of relatedness have drawn on Pulitj, our deep awa mirr spiritual philosophy that nourishes us on our country. This philosophy gave us our voice and our presence to act in our own ways of knowing and being on the landscapes created by the Western bureaucratic systems of higher education in Australia to bring forth our Tyikim knowledge systems to serve our own educational interests. From this spiritual ‘Puliyana kunun’ philosophical position the thesis examines colonising constructions of Tyikim peoples, Tyikim knowledge systems in education, Tyikim research and access to higher education for Tyikim students. From the research, it is argued that the paradigm, within which the enclave-derived approach to Indigenous higher education is located, is compatible with the normalising imperialistic ideology of higher education. The analysis of the Mirrwana/Wurrkama participatory action research project, central to the research, supported an argument for the Mirrwana/Wurrkama model of Indigenous higher education. Further analysis identified five key pedagogical principles embedded within this new model as metaphorically equivalent to wilan~bu of the pelangu. The thesis identifies the elements of the spirituality of the narrative exposed in the research-in-action through the “Marri kubin mi thit wa!”. This is a new paradigm for Tyikim participation in higher education within which the Mirrwana/Wurrkama model is located. Finally, the thesis identifies the scope for Tyikim knowledge use in the construction of contemporary ‘bureaucratic and institutionalised’ higher education ngun nimbil thit thit teaching and learning experiences of Tyikim for the advancement of Tyikim interests. Here the tyangi yigin tjan spiritual concepts of narrative and landscape are drawn upon both awa mirr metaphorically and in marri kubin mi thit wa Tyikim pedagogical practice.

Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants : Guidelines for Strengthening the Reporting of Menopause and Aging (STROMA) studies

This paper reviews the methods used in cross-cultural studies of menopausal symptoms with the goal of formulating recommendations to facilitate comparisons of menopausal symptoms across cultures. It provides an overview of existing approaches and serves to introduce four separate reviews of vasomotor, psychological, somatic, and sexual symptoms at midlife. Building on an earlier review of cross-cultural studies of menopause covering time periods until 2004, these reviews are based on searches of Medline, PsycINFO, CINAHL and Google Scholar for English-language articles published from 2004 to 2010 using the terms “cross cultural comparison” and “menopause.” Two major criteria were used: a study had to include more than one culture, country, or ethnic group and to have asked about actual menopausal symptom experience. We found considerable variation across studies in age ranges, symptom lists, reference period for symptom recall, variables included in multivariate analyses, and the measurement of factors (e.g., menopausal status and hormonal factors, demographic, anthropometric, mental/physical health, and lifestyle measures) that influence vasomotor, psychological, somatic and sexual symptoms. Based on these reviews, we make recommendations for future research regarding age range, symptom lists, reference/recall periods, and measurement of menopausal status. Recommendations specific to the cross-cultural study of vasomotor, psychological, somatic, and sexual symptoms are found in the four reviews that follow this introduction.

Cross-cultural learning experiences in architectural education

This qualitative study looks at the joint output of 20 architecture students from 2 different countries during their short respective Study Tours to each other’s country to discern the effect of cross-cultural experiences on their learning. This paper uses the students’ joint design efforts and reflective writings to investigate the outcome of this cross-cultural educational exchange. Their joint design efforts resulted in the making of small built structures, drawings and collaborative design proposals for an urban setting. In addition, a short questionnaire and personal interviews were also used as methods to gain insight into their experience and to use as a comparative study. The question is also raised in this paper of whether spontaneous friendship among students is integral to long term learning in a cross-cultural context in comparison to pre-designed learning objectives on the part of the educators. This paper also initiates the dialogue of the extent of cultural influences and universal ideas on collaborative architectural design. With increasing joint design ventures between architectural firms in different countries, there is interest in how collaborative design can be understood in a cross-cultural context. This paper examines short term cross cultural experiences and its contribution to architectural education.

Cross cultural perspectives of teachers : a study in three countries

In a shrinking world where globalization has blurred the boundaries across nation states and cultural divides, limitations on intercultural communication can readily give rise to glib generalizations and lack of understanding of diversity. Acknowledging the key role of teachers in shaping the views of future generations, this paper reports on the first stage of a research study on the intercultural understanding of teachers in Australia, Japan, and Thailand. Overall, the teacher participants had diverse cross-cultural experience, differing both in extent and nature of the contact. The methodology used a common survey instrument, except for its language of presentation. However, instead of using a traditional comparative approach to contrast responses of the three target groups, the study asked teachers to provide their perceptions of prevailing world views of people in their own AND the other two countries. The reciprocal nature of the observations provides a powerful methodology to explore perceived intercultural similarities and differences. The article also considers problems associated with response set in investigations of this kind. Three scales are considered — change through intervention, symbolic inner self, and independent thought and action — and the data reveal some similarities but also some striking differences in perceptions across countries. The differences signal a lack of intercultural understanding which is being explored further in a second, qualitative stage of the research. The findings indicate the need for increasing shared programs, exchanges and other opportunities for reciprocal relations that foster genuine dialogue, partnership and intercultural understanding between countries.

Methods used in cross-cultural comparisons of psychological symptoms and their determinants

This paper is the second in a series of reviews of cross-cultural studies of menopausal symptoms. The goal of this review is to compare and contrast methods which have been previously utilized in Cross-Cultural Midlife Women's Health Studies with a view to (1) identifying the challenges in measurement across cultures in psychological symptoms and (2) suggesting a set of unified questions and tools that can be used in future research in this area. This review also aims to examine the determinants of psychological symptoms and how those determinants were measured. The review included eight studies that explicitly compared symptoms in different countries or different ethnic groups in the same country and included: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and the Women's International Study of Health and Sexuality (WISHeS). This review concludes that mental morbidity does affect vasomotor symptom prevalence across cultures and therefore should be measured. Based on the review of these eight studies it is recommended that the following items be included when measuring psychological symptoms across cultures, feeling tense or nervous, sleeping difficulty, difficulty in concentrating, depressed and irritability along with the CES-D Scale, and the Perceived Stress Scale. The measurement of these symptoms will provide an evidence based approach when forming any future menopause symptom list and allow for comparisons across studies.

Methods used in cross-cultural comparisons of sexual symptoms and their determinants

This is the fourth in a series of reviews of cross-cultural studies of menopausal symptoms. The purpose of this review is to examine methods used in cross-cultural comparisons of sexual symptoms among women at midlife, and to examine the determinants of sexual symptoms and how those determinants were measured. The goal of this review is to make recommendations that will improve cross-cultural comparisons in the future. The review included nine studies that explicitly examined symptoms in different countries or different ethnic groups in the same country and included: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and Women's International Study of Health and Sexuality (WISHeS). Although methods used for assessing sexual symptoms across cultures differed between studies, statistically significant differences were reported. Cross-cultural differences in sexual symptoms exist, and should be measured by including the following symptoms: loss of interest in sex, vaginal dryness, and the Females Sexual Function Index which covers desire, arousal, lubrication, orgasm, satisfaction, and pain on intercourse. The measurement of these symptoms will provide an evidence-based approach when forming any future menopause symptom list and allow for comparisons across studies.

Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants

Methodological differences among studies of vasomotor symptoms limit rigorous comparison or systematic review. Vasomotor symptoms generally include hot flushes and night sweats although other associated symptoms exist. Prevalence rates vary between and within populations, but different studies collect data on frequency, bothersomeness, and/or severity using different outcome measures and scales, making comparisons difficult. We reviewed only cross-cultural studies of menopausal symptoms that explicitly examined symptoms in general populations of women in different countries or different ethnic groups in the same country. This resulted in the inclusion of nine studies: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and Women's International Study of Health and Sexuality (WISHeS). These studies highlight the methodological challenges involved in conducting multi-population studies, particularly when languages differ, but also highlight the importance of performing multivariate and factor analyses. Significant cultural differences in one or more vasomotor symptoms were observed in 8 of 9 studies, and symptoms were influenced by the following determinants: menopausal status, hormones (and variance), age (or actually, the square of age, age2), BMI, depression, anxiety, poor physical health, perceived stress, lifestyle factors (hormone therapy use, smoking and exposure to passive smoke), and acculturation (in immigrant populations). Recommendations are made to improve methodological rigor and facilitate comparisons in future cross-cultural menopause studies.

Methods used in cross-cultural comparisons of somatic symptoms and their determinants

This paper is the third in a series of reviews of cross-cultural studies of symptoms at midlife. The goal of this review is to examine methods used previously in cross-cultural studies of menopause and women's health at midlife to (1) identify challenges in the measurement of somatic symptoms across cultures and (2) recommend questions and tools that can be used in future research. This review also aims to examine the determinants of somatic symptoms. The review concludes that methods used for assessing somatic symptoms differ across studies. Somatic symptoms, particularly, aches, pain, and fatigue have a high prevalence. Statistically significant differences were seen in the prevalence of somatic symptoms across cultures. Based on the number of studies that demonstrated cross-cultural differences in symptom prevalence, we recommend that the following symptoms be included in future studies of symptoms at midlife: headaches, aches/pain, palpitations, dizziness, fatigue, breathing difficulties, numbness or tingling, and gastrointestinal difficulties. We also recommend that objective measures of physical function be administered when possible to supplement subjective self-evaluation.

Overseas Chinese as expatriate managers in China: is their recruitment a solution to cross-cultural management problems for multinationals operating in China?

This paper examines the issue of diversity in Chinese identity and how it impacts on the operations of multinationals in China who recruit Overseas Chinese to handle cross-cultural issues. China’s rapid economic development and entry into the World Trade Organization in 2001 made her a formidable player in the global economy and direct foreign investment surged. Yet it is acknowledged that for the foreign investor in China, cross-cultural issues create difficulty at every level, from the interpersonal level relating to communication and negotiation, to the organizational level relating to decision making, human resource management practices, corporate legal institutions and liaison with government institutions. Western multinationals have considered the advantages of posting Overseas Chinese from Southeast Asian countries, Taiwan and Hong Kong to their China operations as a solution to cross-cultural management issues. But has this policy been successful? In terms of language expertise this would seem to be a good strategy, yet organizational case material contradicts this in reality. Overseas Chinese, while sharing some elements of Chinese culture with mainland Chinese, the Confucian heritage and other aspects such as language and diet, nevertheless have different world views and values and behave differently from mainland Chinese in areas critical to business management. As a survival strategy, Overseas Chinese have often developed dual identities which operate simultaneously. For political and historical reasons, many of them have had to adapt to the local culture of their country of citizenship or even hide their own ethnicity in order to survive. On the other hand, the mainland Chinese are different in that their behaviour has only had to be Chinese, but overlaid with this has been the experience of participating in a communist political environment for decades, which has left its mark on mainland Chinese culture. On the basis of their different historical experiences, in the current business environment in China, cultural confusion, difficulty and conflict may occur for the Overseas Chinese.

This paper focuses attention on the subtle cultural differences between the Overseas Chinese and mainland Chinese in an organizational context. This problem has yet to be researched in depth within international business and international management studies. It provides evidence that Overseas Chinese are not often favoured by the local Chinese. It gives insights on how to manage the local Chinese for foreign multinationals operating in China.

Traditions of science : cross-cultural perspectives : essays in honour of B.V. Subbarayappa

Contributed articles

The dual technique model within case study approaches to cross-cultural management research in China

This paper advocates the effectiveness of a dual technique model of interviewing, which combines narrative and depth interview techniques, within the case study method in a cross-cultural management research setting, an Australian MNC operating in China. The case study is acknowledged to be a highly appropriate method for gaining insight into the complicated area of cross-cultural management enquiry in order to generate new theories. In this context, we propose a model which combines the narrative and the depth interview techniques in the interview process, and have illustrated its usefulness with material drawn from the China-Australia cross-cultural research interface.

After establishing the rationale for the model, the discussion focuses on the practicalities of applying it in interviews, in relation to the preparation, warm-up and trust building phases, and in the exercise of personal interviewing skills in cross-cultural research, in this case, the advantage of the interviewer being bilingual.