bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacologic Response to a Diagnosis of Late-Life Depression: A Population Study in Quebec
Authors: Sewitch Maida J , Blais Régis , Rahme Elham , Galarneau Sophie , Bexton Brian
Published: January 2017

Objective:

To identify predictors of receiving psychoactive medication and receiving recommended first-line pharmacotherapy in individuals with newly diagnosed late-life depression.

Methods:

We undertook a retrospective database cohort study of 5258 beneficiaries of the Quebec provincial health insurance plan between 1999 and 2002. Subjects were aged 65 to 84 years and diagnosed with depression by primary care physicians or psychiatrists between October 2000 and March 2001; they had no depression diagnosis in the previous year. We defined receipt of psychoactive medication as having a pharmacy claim in the year following the depression diagnosis. We determined receipt of recommended first-line pharmacotherapy from the first psychoactive medication dispensed following diagnosis and defined it accordingly; we defined first-line pharmacotherapy according to the 2001 Canadian Psychiatric Association guidelines. We used multivariate generalized estimating equations models to identify the determinants of the 2 outcomes.

Results:

A total of 4421 (84.1%) patients received psychoactive medication following diagnosis; 2623 (59.3%) patients had not received antidepressants in the previous year. Of these, 1310 (49.9%) received recommended first-line pharmacotherapy. Independent predictors of receiving psychoactive medication were female sex, depression not otherwise specified (NOS), increasing comorbidity, and living in rural areas. Independent predictors of receiving recommended first-line pharmacotherapy were male sex, depression NOS, receiving medication in the month following diagnosis, and having the same physician diagnosing and treating the patient.

Conclusion:

Male sex and continuity of care predicted that patients had the recommended medication dispensed.
Does Mindfulness Meditation Improve Anxiety and Mood Symptoms? A Review of the Controlled Research
Authors: Toneatto Tony , Nguyen Linda
Published: January 2017

Objective:

To review the impact of mindfulness-based stress reduction (MBSR) on symptoms of anxiety and depression in a range of clinical populations.

Method:

Our review included any study that was published in a peer-reviewed journal, used a control group, and reported outcomes related to changes in depression and anxiety. We extracted the following key variables from each of the 15 studies identified: anxiety or depression outcomes after the MBSR program, measurement of compliance with MBSR instructions, type of control group included, type of clinical population studied, and length of follow-up. We also summarized modifications to the MBSR program.

Results:

Measures of depression and anxiety were included as outcome variables for a broad range of medical and emotional disorders. Evidence for a beneficial effect of MBSR on depression and anxiety was equivocal. When active control groups were used, MBSR did not show an effect on depression and anxiety. Adherence to the MBSR program was infrequently assessed. Where it was assessed, the relation between practising mindfulness and changes in depression and anxiety was equivocal.

Conclusions:

MBSR does not have a reliable effect on depression and anxiety.
Psychometric Properties of the Dominic Interactive in a Large French Sample
Authors: Shojaei Taraneh , Wazana Ashley , Pitrou Isabelle , Gilbert Fabien , Bergeron Lise , Valla Jean-Pierre , Kovess-Masfety Viviane
Published: January 2017

Objectives:

To examine the psychometric properties of the Dominic Interactive (DI) in school-aged children in a different cultural environment than Quebec.

Methods:

In a large French region, 100 schools and 25 children (aged 6 to 11 years) per school were randomly selected. Data were collected using self-administered questionnaires to children (DI), parents (sociodemographic characteristics, mental health services use), and teachers (child school achievement). DI psychometric properties were assessed by examining: the distribution of each DI diagnosis; comorbidity between diagnoses; alpha cœfficients measuring internal consistency; and correlates of psychopathologies with sociodemographic status and health care services use. Estimates of DI properties were compared with those from a sample of community children in Quebec.

Results:

Complete data were available for 1274 children (54.4%). The internal consistency of each DI diagnosis of the French version was reasonable, with Cronbach's alpha cœfficients ranging from 0.62 to 0.89. The psychometric properties and comorbidity were consistent with the version from Quebec.

Conclusions:

The satisfactory psychometric properties of the DI along with other demonstrated advantages of this instrument (children enjoy the activity, parents approve of it, and it is cost-effective) and its cultural adaptability support the consideration of the DI for epidemiologic studies in diverse cultures.
Risk Factors for Conduct Disorder and Delinquency: Key Findings from Longitudinal Studies
Authors: Murray Joseph , Farrington David P
Published: January 2017

Conduct disorder (CD) and delinquency are behavioural problems involving violation of major rules, societal norms, and laws. The prevalence of CD and delinquency peaks in mid-to-late adolescence. Both show considerable continuity over time. The most important studies of CD and delinquency have prospective longitudinal designs, large community samples, repeated personal interviews, measures of many possible risk factors, and both self-reports and official measures of antisocial behaviour. The most important risk factors that predict CD and delinquency include impulsiveness, low IQ and low school achievement, poor parental supervision, punitive or erratic parental discipline, cold parental attitude, child physical abuse, parental conflict, disrupted families, antisocial parents, large family size, low family income, antisocial peers, high delinquency rate schools, and high crime neighbourhoods. However, for many risk factors, it is not known whether they have causal effects. Future research should examine changes in risk factors and changes in CD and delinquency to identify the risk factors that are causes and those that are merely markers of other risk mechanisms.
A Controlled Before-and-after Evaluation of a Mobile Crisis Partnership between Mental Health and Police Services in Nova Scotia
Authors: Kisely Stephen , Campbell Leslie Anne , Peddle Sarah , Hare Susan , Pyche Mary , Spicer Don , Moore Bill
Published: January 2017

Objectives:

Police are often the front-line response to people experiencing mental health crises. This study examined the impact of an integrated mobile crisis team formed in partnership between mental health services, municipal police, and emergency health services. The service offered short-term crisis management, with mobile interventions being attended by a plainclothes police officer and a mental health professional.

Methods:

We used a mixed-methods design encompassing: a controlled before-and-after quantitative comparison of the intervention area with a control area without access to such a service, for 1 year before and 2 years after program implementation; and qualitative assessments of the views of service recipients, families, police officers, and health staff at baseline and 2 years afterward.

Results:

The integrated service resulted in increased use by people in crisis, families, and service partners (for example, from 464 to 1666 service recipients per year). Despite increased service use, time spent on-scene and call-to-door time were reduced. At year 2, the time spent on-scene by police (136 minutes) was significantly lower than in the control area (165 minutes) (Student t test = 3.4, df = 1649, P < 0.001). After adjusting for confounders, people seen by the integrated team ( n = 295) showed greater engagement than control subjects as measured by outpatient contacts (b = 1.3, χ2 = 92.7, df=1, P< 0.001). The service data findings were supported by the qualitative results of focus groups and interviews.

Conclusions:

Partnerships between the police department and mental health system can improve collaboration, efficiency, and the treatment of people with mental illness.
The Developmental Psychopathology of Perinatal Depression: Implications for Psychosocial Treatment Development and Delivery in Pregnancy
Authors: Goodman Sherryl H , Dimidjian Sona
Published: January 2017

Taking a developmental psychopathology perspective, our objective was to identify ways in which psychosocial treatment of depression during pregnancy may be enhanced. We first consider the state of evidence on psychosocial interventions for antenatal depression, next define key developmental psychopathology concepts that are relevant to antenatal depression, and finally discuss implications for clinical practice and research. We found a limited, but promising, evidence base for effective psychosocial interventions for depression during pregnancy. Examining antenatal depression from a developmental psychopathology perspective revealed suggestions for improving treatment. A developmental psychopathology perspective suggests that treatment of depression during pregnancy may be improved by attention to the continuum of depression, from subclinical to severe major depressive disorder; personalized care based on individual women's pattern of risk and resilience factors and correlated risks; consideration of the potential benefits of treating the couple's relationship, the mother's qualities of parenting, and infants' and children's mental health needs; and, including a detailed understanding of the developmental pathways to antenatal depression for each patient in treatment planning.
The Distribution of Mental Health Service Costs for Depression in the Alberta Population
Authors: Slomp Mel , Jacobs Philip , Ohinmaa Arto , Bland Roger , Block Ray , Dewa Carolyn S , Wang Carina
Published: January 2017

Objectives:

In Canada, most mental health services are embedded in the public health care system. Little is known of the cost distribution within the mental health population. Our study aims to estimate the depression care costs of patients with a depression diagnosis, ranking them by the increasing total depression health care costs.

Methods:

For fiscal year 2007/08, we extracted administrative health care records from across the continuum, including physicians, outpatient services, and hospitals. Using a unique patient identifier, all service costs were merged for each person. Costs were summed by service categories and then divided by the served population into 10 equal-size groups. Further, we divided costs in the top decile into 10 percentile groups.

Results:

There were 208 167 people (5.9% of Albertans) who had at least 1 health care visit for depression. The total cost for depression treatment services was $114.5 million, an average $550 per treated person. In the first 9 deciles, most costs were for general practitioners. By the ninth decile, cost per person was about $400. Within the tenth decile, costs increased regularly, and in the top 1 percentile (1 % of patients) there was an increase of cost per patient to $25 826 from $5792 in the previous percentile.

Conclusion:

Per person costs were highly skewed. Until the ninth decile, the cost increased slowly, consisting of mainly physician costs. In the last decile, costs increased substantially, mainly because of hospitalizations. Thus both primary care and specialist care play key roles.
Gene—Environment Interactions in Major Depressive Disorder
Authors: Klengel Torsten , Binder Elisabeth B
Published: January 2017

Family, twin, and epidemiologic studies have suggested that both genes and environment are important risk factors for the development of major depressive disorder (MDD). In the absence of consistent and strong main genetic effects, numerous studies have supported gene–environment interactions in this disorder. While the impact of negative environmental factors, such as early life stress, traumatic experiences, and negative life events have been established as risk factors, they are not sufficient to predict MDD. This article will review evidence suggesting that genetic variants moderate the effects of adversities on the development of MDD, with a focus on the importance of careful characterization of the stressful life events as well as systemic and molecular mechanisms that potentially mediate these gene–environment interactions.

Les études sur les familles, les jumeaux et l'épidémiologie suggèrent que les gènes et l'environnement sont d'importants facteurs de risque du développement d'un trouble dépressif majeur (TDM). En l'absence de grands effets génétiques cohérents et marqués, nombre d'études soutiennent des interactions gène–environnement dans ce trouble. Bien que l'effet de facteurs environnementaux négatifs, comme le stress en début de vie, les expériences traumatiques et les événements négatifs de la vie ait été établi comme facteur de risque, il ne suffit pas à prédire le TDM. Cet article examine les données probantes qui suggèrent que les variantes génétiques modèrent les effets de l'adversité sur le développement du TDM, et met l'accent sur l'importance de la caractérisation prudente des événements stressants de la vie ainsi que des mécanismes systémiques et moléculaires qui assistent potentiellement ces interactions gène–environnement.
Clinical and Sociodemographic Characteristics Associated with Suicidal Ideation in Depressed Outpatients
Authors: Trivedi Madhukar H , Morris David W , Wisniewski Stephen R , Nierenberg Andrew A , Gaynes Bradley N , Kurian Benji T , Warden Diane , Stegman Diane , Shores-Wilson Kathy , Rush A John
Published: January 2017

Objective:

To identify clinical and sociodemographic characteristics associated with suicidal ideation (SI) among patients seeking care for depression in routine primary and psychiatric care settings.

Methods:

We examined data from 4041 treatment-seeking outpatients with major depressive disorder (MDD) to compare baseline sociodemographic and clinical characteristics of those with and without SI, and the presence or absence of baseline depressive symptoms and psychiatric comorbidities in those with SI.

Results:

SI was significantly ( P < 0.01) associated with numerous sociodemographic characteristics (that is, lower level of education, Caucasian or African American, male, unemployed, and treated in psychiatric care) and clinical features (that is, previous suicide attempt, younger age of MDD onset, greater baseline depressive symptom severity, greater number of depressive symptoms, and presence of agoraphobia and [or] generalized anxiety disorder). Elevated levels of SI at baseline were associated with decreased remission rates.

Conclusions:

Consistent with past findings, increased rates of SI were associated with greater depressive symptom severity as well as other features suggestive of severity of illness. Our results confirm previous findings of associations between SI and panic and (or) phobic symptoms and anxiety, but did not confirm previous findings of an association between SI and alcohol or drug use and (or) dependence. While selective serotonin reuptake inhibitor monotherapy appeared significantly helpful in reducing SI during the course of treatment, the presence of SI at baseline was found to be a associated with decreased treatment response, with patients reporting SI at the start of treatment being less likely to achieve remission.

Clinical Trial Registration Number:

Sequenced Treatment Alternatives to Relieve Depression, NCT00021528.
A Review and Retrospective Analysis of Mental Health Services Provided after the September 11 Attacks
Authors: Pandya Anand
Published: January 2017

Objective:

Various mental health services were provided in New York City in the response to the September 11 attacks. This article describes these services and the subsequent research in disaster psychiatry to identify recommended practices for future disasters.

Method:

A PubMed search identified 198 articles since the 9/11 attacks that included “New York City,” and either “9/11” or “disaster,” and either “psychiatry” or “mental health.” The abstracts of all of these articles were reviewed to identify articles that described clinical services and those articles were then reviewed in detail. Additional reports on 9/11-related services were identified through book chapters.

Results:

Acute services included debriefings and other single-time outreach interventions. Postacute phase interventions included community outreach with the goal of addressing normative psychological sequelae, multisession interventions based on evidence-based treatments, and hospital-based psychiatric services provided in the context of general health screenings for response workers.

Conclusions:

Many programs integrated medical and nonmedical services. The professional literature in the decade since this disaster has shifted recommended practices away from psychological debriefings in the acute phase to the implementation of psychological first aid (PFA). Many of the acute 9/11-related services actually closely resembled PFA. In the postacute phase, resources need to be made available for more resource-intensive psychiatric treatment for the fraction of survivors who develop psychiatric illness.
Assessing Children's Disaster Reactions and Mental Health Needs: Screening and Clinical Evaluation
Authors: Pfefferbaum Betty , North Carol S
Published: January 2017

Objective:

To present a framework for assessing children's disaster reactions and mental health needs.

Methods:

We reviewed the relevant literature and clinical experience to identify information on assessment approaches in children and to construct an assessment framework based on disaster exposure.

Results:

Child disaster mental health assessment includes 2 components—screening and clinical evaluation—but these have not been fully explicated or distinguished in the literature. Screening can be used to assess large numbers of children across exposure groups. Clinical evaluation is appropriate for children who are directly exposed to a disaster, for those whose family members and (or) close associates are directly exposed, and for those who are identified through screening as being at risk for psychiatric disturbance. Clinical evaluation includes a full diagnostic assessment (posttraumatic stress disorder and other disorders) with the goals of identifying psychopathology, determining the need for clinical care, and guiding intervention planning and referral. Children with psychiatric conditions should be referred to treatment, while those with psychological distress but without psychiatric illness may benefit from psychosocial interventions.

Conclusions:

Screening is appropriate to identify children at risk for psychiatric disturbance who will need further evaluation to determine diagnosis. Screening should not be used to dictate treatment decisions. Children who screen positive for psychiatric risk should receive a full clinical evaluation. Children determined to be suffering from psychiatric disorders should receive, or be referred for, formal treatment. Children without psychiatric disorders may benefit from psychosocial interventions.
Implementing Panic-Focused Psychodynamic Psychotherapy into Clinical Practice
Authors: Beutel Manfred E , Scheurich Vera , Knebel Achim , Michal Matthias , Wiltink Jörg , Graf-Morgenstern Mechthild , Tschan Regine , Milrod Barbara , Wellek Stefan , Subic-Wrana Claudia
Published: January 2017

Objective:

To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany.

Method:

German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre- and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale.

Results:

Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1 % and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre- to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively.

Conclusions:

PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy. (Clinical Trial Registration Number: German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245)
High Positive Psychiatrie Screening Rates in an Urban Homeless Population
Authors: Ganesh Aravind , Campbell David J T , Hurley Janette , Patten Scott
Published: January 2017

Objective:

To carry out a preliminary assessment of the use of a psychiatric screening tool in an urban homeless population, and to estimate the potential prevalence of undiagnosed and (or) unmanaged mental illness in this population.

Methods:

Participants ( n = 166) were recruited from the Calgary Drop-in and Rehab Centre to complete a questionnaire containing 6 modules screening for common psychiatric disorders. Summary statistics were used in the analysis.

Results:

Only 12 respondents (7%) screened negative on each of the 6 modules. The screening process determined that 60.2% of the sample ( n = 100) had probable mental illness but reported no history of psychiatric diagnosis or treatment.

Conclusions:

A straightforward application of screening (in which screen-positive subjects are referred for assessment) would be difficult in this population as most will screen positive. The results highlight the tremendous burden of psychiatric symptoms in this population.
Les centres de jour pédopsychiatriques pour la clientèle des 0–12 ans au Québec
Authors: Smolla Nicole , Lebel Alain
Published: January 2017

Objectif:

La recension répertorie les Centres de jour pédopsychiatriques au Québec, estime leur capacité d'accueil et les décrit selon l'âge d'admission, les psychopathologies traitées et l'implication parentale demandée.

Méthode:

Affiliés à des hôpitaux, les 26 programmes sélectionnés évaluent et traitent des enfants de 0 à 12 ans selon une formule d'hospitalisation de jour. Une entrevue semi-structurée porte sur l'organisation, le fonctionnement clinique et la recherche.

Résultats:

La capacité d'accueil moyenne est de 18 enfants (de 4 à 40), et de 454 enfants au total. Le nombre de places accordées au préscolaire est comparable au scolaire. Peu de programmes se consacrent aux troubles envahissants du développement; le tiers traitent les troubles de comportement ou affectifs. Les plus nombreux reçoivent une clientèle «mixte». La majorité des programmes sont éclectiques et cherchent à promouvoir l'implication parentale sans la forcer.

Conclusions:

La discussion tient compte des diverses influences théoriques, de la controverse entourant les critères de regroupement et de l'implication parentale, ainsi que de la spécificité du mandat pédopsychiatrique.
The Prevalence of Mental Disorders in the Elderly in Edmonton: A Community Survey Using GMS-AGECAT
Authors: Newman Stephen C , Bland Roger C , Orn Helene T
Published: January 2017

Objective:

To estimate the current prevalence rate of Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) disorders in the elderly population in Edmonton, Alberta. To compare the prevalence rate of GMS-AGECAT depression with the prevalence rate of Diagnostic Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders (DIS-DSM-III) major depression based on an earlier survey in Edmonton.

Method:

A sample of 1119 community residents age 65 years and over was selected using the provincial health insurance database. Data on mental disorders were collected using the Geriatric Mental State questionnaire, and diagnoses were made with the Automated Geriatric Examination for Computer Assisted Taxonomy computer program. Prevalence rates, standard errors, and logistic regression coefficients were estimated using software designed to analyze survey data.

Results:

The prevalence rates of GMS-AGECAT depression and organic disorder were 11.2% and 2.9% respectively. For depression there was a statistically significant difference in the prevalence rates for males (7.3%) and females (14.1%) (P = 0.003), and for organic disorder there was a statistically significant increasing trend across age-groups for females (P < 0.0001). The prevalence rate of GMS-AGECAT depression in Edmonton is comparable to rates reported from several European studies but is much higher than the 6-month prevalence rate of DIS-DSM-III major depression of 1.2% based on an earlier Edmonton survey.

Conclusions:

GMS-AGECAT depression is a depressive syndrome that has a larger prevalence rate than DIS-DSM-III major depression. Community surveys that measure only the prevalence rate of DSM-III major depression may be missing clinically significant cases of geriatric depression.
Therapy for Vaginismus: In Vivo versus In Vitro Desensitization
Authors: Schnyder Ulrich , Schnyder-Lüthi Christine , Ballinari Pietro , Blaser Andreas
Published: January 2017

Objective:

To verify the effectiveness of desensitization exercises with dilators in the treatment of vaginismus, while comparing 2 therapeutic variations with differing instruction procedures (“in vivo” versus “in vitro”) during the desensitization exercises.

Method:

A consecutive random sample of 44 female outpatients in sexual therapy were divided into groups for either treatment on a random basis. All patients were treated until the symptoms abated on the basis of a structured therapy program. The stability of the therapeutic success was verified through follow-up interviews.

Results:

Forty-three (97.2%) of the patients were able to have sexual intercourse after an average of 6.3 therapeutic sessions. One-third reported an increase in their sexual desire. Thirty-four of 39 patients (87.2%) would be prepared to repeat the therapy. There were no significant differences in the success and the required number of consultations for the cure between the 2 groups investigated.

Conclusions:

Desensitization through exercises with dilators is an effective method for treating vaginismus. The choice of instruction procedure can be left to the patient.
Hospital Days in Clozapine-Treated Patients
Authors: Dickson Ruth A , Dalby J Thomas , Williams Richard , Warden Sarah J
Published: January 2017

Objective:

To examine inpatient hospital days used by a group of patients with treatment-resistant schizophrenia for 3 years before and 3 years after clozapine initiation.

Method:

A retrospective chart review of 26 consecutive admissions to an outpatient clozapine clinic was conducted for a 6-year period. The total number of hospital days was recorded.

Results:

Patients separated into 3 groups: those who used clozapine for 3 uninterrupted years (N = 11, 42.3%), those who interrupted but resumed clozapine and continued on to 3 years (N = 4, 15.4%), and those who abandoned clozapine treatment (N = 11, 42.3%). Only the group that was continuously on clozapine showed a decline in percentage of inpatient days during the 3-year follow-up period. Three of the 11 patients who discontinued clozapine died during the posttreatment period: 2 suicides and 1 “death by misadventure.”

Conclusions:

Continuous clozapine treatment significantly reduces days in hospital; this reduction was sustained throughout 3 years ‘follow-up. While the sample size is small, all patients were tracked over a 6-year period, and both drug continuers and dropouts were followed. The reduction in inpatient days may be lost if patients stop and then restart clozapine. For patients who do not respond to or abandon trials of clozapine, there is an urgent need to develop more effective treatment strategies.
Computer Aids to Mental Health Care
Authors: Marks Isaac
Published: January 2017

Computer systems are being used increasingly to aid the assessment and self-treatment of mental health problems in adults. Systems vary hugely in the extent to which they meet all patients ' assessment and therapy needs and save clinicians ' time. Hardly any single system 1) performs every task required from initial screening to the end of follow-up, 2) works 100% independently of contact with a clinician or technician, and 3) is widely available and supported. Most systems use desk- or laptop computers. Some now use palmtop (hand-held) computers. A few employ computerized phone interviews (interactive voice response), usually from home. Virtual reality as a tool is embryonic. Computer aids save time in screening and outcome-tracking in a wide variety of problems. Computer aids to treatment have had promising outcomes in phobic, anxiety, panic, and obsessive-compulsive disorders, nonsuicidal depression, obesity, and smoking cessation. Some systems are installed in a few places as part of everyday clinical care. A growing number should soon be robust enough to ease the lives of many patients, practitioners, and researchers if use of the systems is carefully integrated into normal clinical practice.
Prevalence of DSM-IV Disorders in Children and Adolescents with Asthma versus Diabetes
Authors: Vila G , Nollet-Clemençon C , Vera M , Robert JJ , de Blic J , Jouvent R , Mouren-Simeoni MC , Scheinmann P
Published: January 2017

Objective:

To evaluate the relationships between asthma and type and incidence of psychiatric problems in a pediatric population.

Methods:

A series of 93 children and adolescents with asthma presenting during a 1-year period to a pediatric pneumology and allergy service was studied. Their psychopathological problems were compared with those of 93 children with insulin-dependent diabetes mellitus (IDDM). Various questionnaires were completed by the patients: the Child Depression Inventory (CDI), the State-Trait Anxiety Inventory for Children (STAIC), and the Coopersmith Self-Esteem Inventory (SEI). Their parents were administered the Child Behavior Checklist (CBCL). The patients were examined using the revised Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-R).

Results:

There were more symptoms in the asthma group than in the IDDM group, as indicated by total CBCL scores, internalization and externalization CBCL subscores, and the STAIC scores. Asthma was often associated with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorders. We found 30 anxiety disorders, 5 affective disorders, and 6 disruptive behaviour disorders. Asthmatic children did not seem to be more depressed than the IDDM group, and their self-esteem, overall, was good. However, the asthma subgroup presenting with psychiatric disorders had poorer self-esteem and social competence. Adolescents did not seem to suffer more psychiatric disturbances than did younger patients. Girls did not suffer more psychiatric disturbances than did boys.

Conclusion:

Asthma appears to be associated both with higher overall incidence of psychiatric problems than in IDDM and with particular categories of psychiatric problems. In particular, the problems include anxiety disorders, internalizing symptoms, and disruptive behaviours.
Prevalence of Personality Disorders among Clients in Treatment for Addiction
Authors: Nadeau Louise , Landry Michel , Racine Stéphane
Published: January 2017

This study determined the prevalence of personality disorders among clients in treatment for addiction; this prevalence was compared with those found in similar studies and in clinical samples of individuals suffering from other Axis I disorders. Our sample comprised 255 subjects. The first edition of the Millon Clinical Multiaxial Inventory (MCMI) was used. Only 11.8% of the subjects did not score over 84 on any of the 11 Axis II scales. Over one-half had a score of 84 or higher on the passive-aggressive and dependent-personality scales. The mean number of scales in the 84+ category was 2.68. Comparisons show that this sample was more severe in most cases.
An Exploration of the Psychometric Properties of the French Version of the Positive and Negative Syndrome Scale
Authors: Lançon C , Aghababian V , Llorca PM , Bernard D , Auquier P
Published: January 2017

The psychometric properties of the French version of the Positive and Negative Syndrome Scale (PANSS) were studied in a population of 85 patients diagnosed with schizophrenia in accordance with Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. The results of the study of the properties (internal consistency and principal-component analysis) of the initial structure with 3 scales (positive, negative, and general psychopathology) led us to investigate other factorial structures. We thus isolated a 5-factor structure (negative, hostility, positive, disorganization, and anxiety), explaining 54.7% of the total variance. The internal consistency of the 5 factors isolated was good (0.79, negative factor; 0.71, hostility factor; 0.77, positive factor; 0.66, disorganization factor; and 0.61, anxiety factor). The 3-subscale structure of the PANSS is discussed.
Between Inclusion and Fairness
Authors: Boyadjieva Pepka , Ilieva-Trichkova Petya
Published: January 2017

The article claims that equity is an indispensable dimension of the widening of access to adult education. Building on the understanding of social justice in adult education as a complex phenomenon, two indicators are developed: an index of inclusion and an index of fairness in participation in adult education. The article analyses social justice separately in formal and nonformal education for two social groups—people with low and high education. Using data from the Adult Education Survey from 2007 and 2011 for 25 countries, it is shown that in most of the countries, there are signs of improvement in the fairness aspect of social justice as a result of a decrease in the overrepresentation of people with high education and in the underrepresentation of people with low education. However, the inclusion of people with low education in adult education remains considerable lower in comparison with the inclusion of people with high education.
Wine Components Inhibit Cholera Toxin-Induced Intestinal Secretion in Rats
Authors: Roberts Pamela R. , Zaloga Stacey J. , Burney J. D. , Zaloga Gary P.
Published: January 2017

Gut bacterial toxins contribute to many diseases, including diarrhea. Cholera represents a life-threatening form of enterotoxin-induced diarrhea caused by infection with the bacterium Vibrio cholerae. Diarrhea results from the prosecretory actions of a bacterial enterotoxin. The aim of this study was to identify dietary compounds that antagonize the intestinal secretory actions of cholera toxin and which might be useful in diarrhea prevention and treatment. Rat small intestine (jejunum) was ligated in vivo and separate segments of small bowel were randomly injected with various dietary compounds in the presence and absence of cholera toxin. The secretory response to cholera toxin was assessed by measuring the amount of fluid secreted into the bowel segments. Compared to controls, red wine and wine components significantly inhibited the small intestinal secretory response to cholera toxin. Grape juice, ethanol (12%), and World Health Organization rehydration fluid had lesser antisecretory effects. These novel results demonstrate that nonethanol components of wine possess antisecretory effects. These substances may be useful in treating gut enterotoxin-mediated diseases such as cholera.
Hierarchical Decline of the Initiative and Performance of Complex Activities of Daily Living in Dementia
Authors: Giebel Clarissa M. , Sutcliffe Caroline , Challis David
Published: January 2017

Objectives:

While basic activities of daily living hierarchically decline in dementia, little is known about the decline of individual instrumental activities of daily living (IADLs). The objective of this study was to assess initiative and performance deficits in IADLs in dementia.

Methods:

A total of 581 carers completed the revised Interview for Deterioration in Daily Living Activities in Dementia 2 to rate their relative’s everyday functioning.

Results:

Initiating and performing IADLs deteriorated hierarchically, while people with dementia were consistently most impaired in initiating using the computer and managing finances. Initiating preparing a cold or hot meal and managing finances were more impaired than their performance, whereas performing maintaining an active social life for example were more impaired than their initiative.

Conclusion:

Findings can help identify the severity of dementia by understanding deficits in initiative and performance. This study has implications for the development of targeted interventions depending on the stage of dementia.
Withholding and Withdrawing Artificial Nutrition and Hydration: An Ethical Dilemma
Authors: Stevens Carolyn W.
Published: January 2017

Advances in technology have created and led to many ethical dilemmas within health care delivery. Due to these advances, ambulatory care nurses must be prepared to promote open communication with patients, families, and caregivers in facing life decisions. Familiarity with current literature on the issue of withholding/withdrawal artificial nutrition and hydration, staff development, and educational programs are methods ambulatory care nurses can utilize to promote comprehensive health care planning for older adults.
Developing a Triage Telephone Program for Home Health Care Agencies
Authors: Pursley-Crotteau Suzanne , Bentley Gayle W.
Published: January 2017

In the current managed care environment, innovative strategies for patient care will be the hallmarks for effective utilization of services. Protocol-based telephone triage is an effective way to clinically intervene. It is currently used successfully in a variety of patient care settings. Home health care agencies need to be proactive and to incorporate a telephone triage system into their after-hours programs to meet patient needs with appropriate services. Three key elements—structural, process, and outcome standards—are discussed as critical to the development and implementation of such a program.
Utilization of Home Health Care Services by Elderly Patients with Heart Failure
Authors: Moulton Patricia J. , McGrane Amy M. , Beck Theresa L. , Holland Nancy L. , Christopher Mary Ann
Published: January 2017

Heart failure is one of the most common reasons for admission to home health care among older adults Patients with heart failure present complex challenges for home health care agency staff, given the chronic yet variable nature of the disease and the importance of behavioral factors in long-term management of heart failure. The purpose of this study was to examine the patterns of health service utilization and outcomes of home care among elderly home care patients with heart failure. The sample included 104 patients with a primary or secondary diagnosis of heart failure admitted to a large Medicare-certified home care agency. Finding from the study revealed that subjects received an average of 11 skilled nursing visits over a 37-day period. Twelve percent of the subjects were rehospitalized before their home care treatment plans were completed. Although the percentage of patients rehospitalized in this study was relatively low, additional research is needed that will investigate the relationship between home care nurses' interventions and the patient outcomes associated with these interventions.
Farmer cooperatives and the changing agri-food system in China
Authors: Yang Huan , Vernooy Ronnie , Leeuwis Cees
Published: January 2017

Consumer concerns are leading to changes in China’s food markets and demands for higher quality food. In this article, we explore the role of farmer cooperatives in China in linking farmers with high-quality food markets. We consider food quality a social construct and farmer cooperatives key players in the ‘quality battlefield’. Using a case study approach, we investigate the everyday practices of three farmer cooperatives. We show that farmer cooperatives are capable of establishing or joining quality food networks, but the benefits are often limited because of their weak position or instability of the network. Building strong alliances with other network actors is difficult because of cooperatives’ limited communication capacity and lack of economic and social capital. Our findings suggest that policies that support farmer cooperative capacity building at the micro level could improve the performance of smallholder farmers and their cooperatives in the expanding domestic quality food market.
A Public Management Approach to the NHS
Authors: Gunn Lewis
Published: January 2017

This paper considers a public management perspective on management in the public sector. It begins by setting out two contrasting perspectives, those of business management and of public administration. It contends that the present Conservative government has strongly backed a business management approach to the public sector, with the emphasis being placed on the ‘Five Es’ of economy, efficiency, effectiveness, excellence and enterprise. However, it notes the relative neglect of effectiveness in favour of a rather narrow and short-term concern with economy and efficiency. The paper considers the public administration approach which emphasises the normative differences between the public and private sectors. The paper concludes with an examination of the emerging public management perspective which aims to combine the instrumental insights of business or generic management with the normative orientation of public administration.
Association of Ownership and System Affiliation with the Financial Performance of Rehabilitation Hospitals
Authors: McCue M. J. , Thompson J. M.
Published: January 2017

This study used a cross-sectional design in which regression models were used to test the association of ownership and system affiliation of private rehabilitation hospitals with profit, revenue and expense measures. The study also examined the association of ownership and system affiliation with other choice variables. The study found that new for-profit rehabilitation hospitals had higher revenues and expenses than older non-profit rehabilitation hospitals. In addition, new for-profit hospitals charged more for their ancillary services and treated more of their patients on an inpatient basis. Study findings show higher revenues and expenses per adjusted discharge for new for-profit facilities. Given the cost-based system of reimbursement for Medicare, there appears to be a strong incentive for new for-profits to maximize costs.
Cohort, Gender and Practice Organization: Examining the Bounds of Collaborative Medicine among Newly Established Female and Male Family Physicians in Ontario
Authors: Williams A. P. , Woodward C. A. , Ferrier B. , Cohen M.
Published: January 2017

This paper analyzes data from a 1993 survey of 395 newly established female and male family physicians in Ontario, Canada, to examine the relationship between practice organization and gender. Previous research suggests that younger physicians, particularly women, tend to enter group practice. Compared to solo practice, groups may offer more predictable incomes, more manageable workloads, peer collaboration and review, and economies of scale. Further, female physicians in groups may develop distinctive styles of collaborative medicine. The results show that a majority of physicians in our cohort are in private community-based group practice. However, while many groups share premises, staff and expenses, and many have common charts and practice guidelines, only a minority incorporate regular meetings to discuss business or patient care, have shared care of hospitalized patients, or audits of physicians' practices. Few gender differences are observed in private group practice: although women physicians attract larger proportions of female patients than do their male colleagues, women and men organize their groups in similar ways and have similarly strong patient-centred attitudes.
The Cardiac Waiting Game: Are Patients Prioritized on the Basis of Clinical Need?
Authors: Langham S. , Soljak M. , Keogh B. , Gill M. , Thorogood M. , Normand C.
Published: January 2017

Waiting lists for coronary artery bypass grafting (CABG) have been a recurring problem for many hospitals, putting pressure on hospitals to manage waiting lists more effectively. In this study, we audited the records of 1594 patients who had coronary artery bypass surgery in 1992 and 1993 in three London hospitals, to assess their waiting time experience. Patients' actual waiting times were compared with an appropriate waiting time defined using an adapted version of a Canadian urgency scoring system. Influence of other factors (sex, age, smoking, hypertension, diabetes and obesity) on actual waiting time was assessed. A comparison of patients' actual waiting times with an appropriate waiting time, defined by the urgency score, showed that only 38% were treated within the appropriate period. Thirty-four per cent were treated earlier than their ischaemic risk indicated, and 28% with high ischaemic risk were delayed. Actual waiting time was associated with a patient's sex and smoking status but not with the other factors studied. The current system of prioritizing patients awaiting CABG is not concordant with a measure of appropriate waiting time. This could have arisen due to a number of factors, including the contracting process, waiting list initiatives, and methods of waiting list administration and patient pressures. The use of a standard method for prioritizing patients would enable a more appropriate use of resources.
Using Collectively-Derived Standards to Evaluate Individual Performance: A Cautionary Note on Clinical Practice Guidelines
Authors: Long M.J. , Lescoe-Long M.
Published: January 2017

The purpose of this work is to demonstrate the problem of evaluating an individual physician's performance relative to practice guidelines which have typically been derived from group consensus or some measure of central tendency. It is argued that when evaluated against a set of criteria derived at the macro-level, an individual physician's performance may justifiably vary due to the patient characteristics or the evolving process of care. It is also argued that it is not necessarily true that costs are reduced when practice variation is reduced. The results indicate that there are cost reduction in areas not targeted by the guidelines, suggesting a possible ‘spillover effect’ due to the increased vigilance in monitoring provider performance. The results also provide some evidence of increased costs following a reduction in variation. Caution should be exercised when evaluating individual physician performance relative to guidelines established at the aggregate level. Acceptable individual physician performance should be judged within the upper and lower boundaries of the implicit distribution of physicians' performances from which the established guidelines generated.
Neuropsychological and Psychiatric Changes following Treatment of ARC Patients with Zidovudine
Authors: Riccio Massimo , Burgess Adrian , Hawkins David , Wilson Barbara , Thompson Christopher
Published: January 2017

Six homosexual men with a diagnosis of acquired immunodeficiency syndrome (AIDS)-related complex (ARC- CDC IVA/C2) were assessed with a series of neuropsychological and psychiatric tests prior to commencing treatment with zidovudine and again after 5–6 months. Significant improvements were seen in cognitive functioning, mental state and physical health at the second assessment.