bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparative Perspective on Forensic Psychiatry in Canada and England
Authors: Christopher M. Green , Naismith Laurence J. 
Published: July 2017

ABSTRACT: An outline is presented of the development and practice of forensic psychiatry, including relevant legal aspects, in Canada, in comparison to the English system. It is written by two English-trained psychiatrists, who have provided forensic services in both Canada and England. Canadian forensic psychiatry is portrayed as having a greater medico-legal emphasis than at present in England, with a continuing dependence on the insanity verdict for seriously mentally disordered offenders. Canadian forensic psychiatric institutions are often attached to the correctional system, whereas in England they are under the Department of Health. Within this framework, the article elaborates upon clinical and medico-legal differences.
Interim Hospital Order — A Regional Secure Unit experience
Authors: Kaul A 
Published: July 2017

The Mental Health Act, 1983, provides certain new provisions for the disposal of mentally disordered offenders, including the Interim Hospital Order. This Order allows the appropriateness of an eventual Hospital Order to be assessed. However, there is a wide variation in the use of the Interim Hospital Order. This paper examines the use of this Order in the Trent Regional Secure Unit, where it seems to have been used principally to assess the treatability of patients under the category of psychopathic disorder.
4. Are a Blood Alcohol Concentration of 256mg/dl and Minimal Signs of Impairment Reliable Indications of Alcohol Dependence?
Authors: Jones A W 
Published: July 2017

This article describes a drink-driving scenario where a woman was apprehended for driving under the influence (DUI) with a blood alcohol concentration (BAC) of 256mg/dl1 The correctness of this result was vigorously challenged by a medical expert witness for the defence, who was actually a specialist in alcohol diseases. Despite reanalysis to confirm the BAC as well as a DNA profile to prove the identity of the blood specimen, the woman was acquitted of the charge of drunk driving by the lower court. However, she was subsequently found guilty in the High Court of Appeals with a unanimous decision and sentenced to four weeks imprisonment. This case report illustrates some of the problems surrounding the use of expert medical evidence by the defence to challenge the validity of the prosecution evidence based solely on a suspect's BAC. In situations such as these, an expert witness should be called by the prosecution to clarify and, if necessary, rebut medical and/or scientific opinions that might mislead the court and influence the outcome of the trial.
Prediction of venous wound healing with laser speckle imaging
Authors: van Vuuren Timme MAJ , Van Zandvoort Carina , Doganci Suat , Zwiers Ineke , tenCate-Hoek Arina J , Kurstjens Ralph LM , Wittens Cees HA 
Published: July 2017

Introduction Laser speckle imaging is used for noninvasive assessment of blood flow of cutaneous wounds. The aim of this study was to assess if laser speckle imaging can be used as a predictor of venous ulcer healing. Methods After generating the flux speckle images, three regions of interest (ROI) were identified to measure the flow. Sensitivity, specificity, negative predictive value, and positive predictive value for ulcer healing were calculated. Results In total, 17 limbs were included. A sensitivity of 92.3%, specificity of 75.0%, PPV of 80.0%, and NPV 75.0% were found in predicting wound healing based on laser speckle images. Mean flux values were lowest in the center (ROI I) and showed an increase at the wound edge (ROI II, p = 0.03). Conclusion Laser speckle imaging shows acceptable sensitivity and specificity rates in predicting venous ulcer healing. The wound edge proved to be the best probability for the prediction of wound healing.
Olanzapine Use in the Elderly: A Retrospective Analysis
Authors: Solomons Kevin , Geiger Odie 
Published: July 2017

Objective: To evaluate the efficacy and safety of olanzapine in a hospitalized geriatric population that had previously failed to respond to, or tolerate, numerous trials with other antipsychotic medications. Method: A retrospective chart analysis was conducted on 58 elderly patients with psychotic symptoms who were given a trial on olanzapine. Data was collected regarding patients 'psychiatric diagnoses, duration of illness, duration of hospitalization, prior response to psychotropic therapies, concomitant psychotropic agents, side effects, and clinically determined changes over time. Results: Results indicated that 60.3% of this refractory group of patients improved on olanzapine. Side effects were reported for 38% of the patients, with delirium, extrapyramidal symptoms (EPS), and drowsiness or lethargy being the most common. Conclusions: The reported level of improvement in this group of refractory elderly psychotic patients indicates that olanzapine can make an important contribution to the mental health of elderly patients with similar characteristics.
Understanding Immigrants' Reluctance to Use Mental Health Services: A Qualitative Study from Montreal
Authors: Whitley Rob , Kirmayer Laurence J , Groleau Danielle 
Published: July 2017

Objective: Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms. Method: Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services. Results: Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine. Conclusion: The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore.
The Lay Concept of Conduct Disorder: Do Nonprofessionals Use Syndromal Symptoms or Internal Dysfunction to Distinguish Disorder from Delinquency?
Authors: Wakefield Jerome C , Kirk Stuart A , Pottick Kathleen J , Hsieh Derek K , Tian Xin 
Published: July 2017

Background: Conduct disorder (CD) must be distinguished from nondisordered delinquent behaviour to avoid false positives, especially when diagnosing youth from difficult environments. However, the nature of this distinction remains controversial. The DSM-IV observes that its own syndromal CD diagnostic criteria conflict with its definition of mental disorder, which requires that symptoms be considered a manifestation of internal dysfunction to warrant disorder diagnosis. Previous research indicates that professional judgments tend to be guided by the dysfunction requirement, not syndromal symptoms alone. However, there are almost no data on lay conceptualizations. Thus it remains unknown whether judgments about CD are anchored in a broadly shared understanding of mental disorder that provides a basis for professional–lay consensus. Objective: The present study tests which conception of CD, syndromal-symptoms or dysfunction-requirement, corresponds most closely to lay judgments of disorder or nondisorder and compares lay and professional judgments. We hypothesized that lay disorder judgments, like professional judgments, tend to presuppose the dysfunction requirement. Method: Three lay samples (nonclinical social workers, nonpsychiatric nurses, and undergraduates) rated their agreement that youths described in clinical vignettes have a mental disorder. All vignettes satisfied DSM-IV CD diagnostic criteria. Vignettes were varied to present syndromal symptoms only, symptoms suggesting internal dysfunction, and symptoms resulting from reactions to negative circumstances, without dysfunction. Results: All lay samples attributed disorder more often to youths whose symptoms suggested internal dysfunction than to youths with similar symptoms but without a likely dysfunction. Conclusions: The dysfunction requirement appears to reflect a widely shared lay and professional concept of disorder.
Factors Explaining Career Satisfaction among Psychiatrists and Surgeons in Canada
Authors: Lepnurm Rein , Dobson Roy , Backman Allen , Keegan David 
Published: July 2017

Background: The career satisfaction of specialists is affected by many variables ranging from family responsibilities, stress, the quality of services and facilities available to patients, professional rewards, and how the work is organized. Objective: To articulate models that explain a substantial portion of the variance associated with career satisfaction among surgeons and psychiatrists in Canada. Methods: Of 4958 eligible physicians across Canada, 2810 (56.7%) completed a 12-page survey between January and March 2004, following which the responding 148 surgeons and 231 psychiatrists were selected for this study. We checked response bias and found it was negligible. Hierarchical regression analysis was used to record cumulative R2, Standardized beta, and significance levels as each predictor was entered. We applied weighting factors to reflect the actual physician population in Canada. Results: The models explained 90.4% of the variance in career satisfaction for surgeons and 81.0% of the variance in career satisfaction for psychiatrists. The explanatory variables consisted of distress and coping, role in community activities, access to and quality of health care services, intrinsic and extrinsic rewards, workload, and organizational structure. Conclusions: The study demonstrated that variance associated with career satisfaction can be explained using various factors reported directly by physicians. The study also confirmed that relative differences in the importance of these factors do occur among specialties. Surgeons prefer to delegate more responsibility in the management of their practices on an informal basis, whereas psychiatrists prefer to be more involved in the management of their practices and use more formal structures.
The Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception, and Altruistic Acceptance of Risk
Authors: Wu Ping , Fang Yunyun , Guan Zhiqiang , Fan Bin , Kong Junhui , Yao Zhongling , Liu Xinhua , Fuller Cordelia J , Susser Ezra , Lu Jin , Hoven Christina W 
Published: July 2017

Objective: We examined the psychological impact of the 2003 outbreak of severe acute respiratory syndrome (SARS) on hospital employees in Beijing, China. Methods: In 2006, randomly selected employees ( n = 549) of a hospital in Beijing were surveyed concerning their exposure to the 2003 SARS outbreak, and the ways in which the outbreak had affected their mental health. Results: About 10% of the respondents had experienced high levels of posttraumatic stress (PTS) symptoms since the SARS outbreak. Respondents who had been quarantined, or worked in high-risk locations such as SARS wards, or had friends or close relatives who contracted SARS, were 2 to 3 times more likely to have high PTS symptom levels, than those without these exposures. Respondents' perceptions of SARS-related risks were significantly positively associated with PTS symptom levels and partially mediated the effects of exposure. Altruistic acceptance of work-related risks was negatively related to PTS levels. Conclusions: The psychological impact of stressful events related to an infectious disease outbreak may be mediated by peoples' perceptions of those events; altruism may help to protect some health care workers against these negative impacts.
Use of Administrative Data for the Surveillance of Mental Disorders in 5 Provinces
Authors: Kisely Stephen , Lin Elizabeth , Lesage Alain , Gilbert Charles , Smith Mark , Campbell Leslie Anne , Vasiliadis Helen-Maria 
Published: July 2017

Objective: To evaluate the usefulness of administrative data for the surveillance of mental illness in Canada using databases in the following 5 provinces: British Columbia, Ontario, Quebec, Nova Scotia, and Alberta. Method: We used a population-based record-linkage analysis with data from physician billings, hospital discharge abstracts, and community-based clinics. The following diagnostic codes from the International Classification of Diseases, Ninth Edition, were used to define cases: 290 to 319, inclusive. Results: The prevalence of treated psychiatric disorder was similar in Nova Scotia, British Columbia, Alberta, and Ontario at about 15%. The prevalence for Quebec was slightly lower at 12%. Findings from the provinces showed remarkable consistency across age and sex, despite variations in data coding. Women tended to show a higher prevalence overall of treated mental disorders than men. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increasing again after age 70 years. Conclusions: Provincial and territorial administrative data can provide a useful, reliable, and economical source of information for the surveillance of treated mental disorders. Such a surveillance system can provide longitudinal data at little cost to support health service provision and planning.
The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 4: Criminal Recidivism
Authors: Charette Yanick , Crocker Anne G , Seto Michael C , Salem Leila , Nicholls Tonia L , Caulet Malijai 
Published: July 2017

Objective: To examine criminal recidivism rates of a large sample of people found not criminally responsible on account of mental disorder (NCRMD) in Canada's 3 most populous provinces, British Columbia, Ontario, and Quebec. Public concern about the dangerousness of people found NCRMD has been fed by media attention on high-profile cases. However, little research is available on the rate of reoffending among people found NCRMD across Canadian provinces. Method: Using data from the National Trajectory Project, this study examined 1800 men and women in British Columbia ( n = 222), Ontario ( n = 484), and Quebec ( n = 1094) who were found NCRMD between May 2000 and April 2005 and followed until December 2008. Results: Recidivism was relatively low after 3 years (17%). There were interprovincial differences after controlling for number of prior criminal offences, diagnosis, seriousness of the index offence, and supervision by the review boards. British Columbia (10%) and Ontario (9%) were similar, whereas Quebec had almost twice the recidivism (22%). People who had committed severe violent index offences were less likely to reoffend than those who had committed less severe offences. People from the sample were less likely to reoffend when under the purview of review boards, across all 3 provinces. Conclusion: The results of this study, along with other research on processing differences, suggest systemic differences in the trajectories and outcomes of persons found NCRMD need to be better understood to guide national policies and practices.
Explicit and Implicit Attitudes of Canadian Psychiatrists toward People with Mental Illness
Authors: Dabby Layla , Tranulis Constantin , Kirmayer Laurence J 
Published: July 2017

Objective: People with mental illness suffer stigma and discrimination across various contexts, including the health care setting, and clinicians' attitudes play an important role in perpetuating stigma. Effective stigma-reduction interventions for physicians require a better understanding of explicit (that is, conscious and controllable) and implicit (that is, subconscious and automatic) forms of bias, and of predictors and moderators of stigma. Methods: Members of a Canadian university psychiatry department and of the Canadian Psychiatric Association (CPA) were invited to participate in a web-based study consisting of 2 measures of explicit attitudes, the Social Distance Scale (SDS) and the Opening Minds Scale for Health Care Providers (OMS-HC), and 1 measure of implicit attitudes, the Implicit Association Test (IAT). Results: Thirty-five psychiatry residents and 68 psychiatrists completed the study (response rates of 12.1% for the university sample and 3.3% for the CPA sample). Participants desired greater social distance from the vignette patient with schizophrenia. Mean IAT scores, although negative, did not reach the threshold for a meaningful effect size. Patient contact positively predicted IAT scores, while age, sex, and level of training (resident, compared with psychiatrist) did not. Neither patient contact nor implicit attitudes predicted SDS or OMS-HC scores. Conclusion: Psychiatrists did not differ from psychiatry residents on any measures of explicit or implicit attitudes toward mental illness. Explicit attitudes toward people with mental illness were relatively negative; implicit attitudes were neither negative nor positive; and implicit and explicit attitudes were not correlated. Greater patient contact predicted more positive implicit attitudes, but did not predict explicit attitudes.
A Randomized Controlled Trial of Employer Matching of Employees’ Monetary Contributions to Deposit Contracts to Promote Weight Loss
Authors: Kullgren Jeffrey T. , Troxel Andrea B. , Loewenstein George , Norton Laurie A. , Gatto Dana , Tao Yuanyuan , Zhu Jingsan , Schofield Heather , Shea Judy A. , Asch David A. , Pellathy Thomas , Driggers Jay , Volpp Kevin G. 
Published: July 2017

Purpose: To test whether employer matching of employees’ monetary contributions increases employees’ (1) participation in deposit contracts to promote weight loss and (2) weight loss. Design: A 36-week randomized trial. Setting: Large employer in the northeast United States. Participants: One hundred thirty-two obese employees. Interventions: Over 24 weeks, participants were asked to lose 24 pounds and randomized to monthly weigh-ins or daily weigh-ins with monthly opportunities to deposit $1 to $3 per day that was not matched, matched 1:1, or matched 2:1. Deposits and matched funds were returned to participants for each day they were below their goal weight. Measures: Rates of making ≥1 deposit, weight loss at 24 weeks (primary outcome), and 36 weeks. Analysis: Deposit rates were compared using χ2 tests. Weight loss was compared using t tests. Results: Among participants eligible to make deposits, 29% made ≥1 deposit and matching did not increase participation. At 24 weeks, control participants gained an average of 1.0 pound, whereas 1:1 match participants lost an average of 5.3 pounds ( P = .005). After 36 weeks, control participants gained an average of 2.1 pounds, whereas no match participants lost an average of 5.1 pounds ( P = .008). Conclusion: Participation in deposit contracts to promote weight loss was low, and matching deposits did not increase participation. For deposit contracts to impact population health, ongoing participation will need to be higher.
Improving Healthy Eating and the Bottom Line
Authors: Patsch Amy J. , Smith Jennifer Howard , Liebert Mina L. , Behrens Timothy K. , Charles Tami 
Published: July 2017

Purpose: To evaluate the impact of a health-promoting price intervention on food sales and profit. Design: Nonrandomized evaluation study. Setting: Two hospital cafeterias. Participants: Hospital employees (2800) were the priority population. Intervention: During baseline phase, healthy versions of existing unhealthy items were introduced. The intervention phase included marketing and price incentives/disincentives for healthy and unhealthy items, with a 35% price differential. Measures: Average and proportional change in sales and impact on financial outcomes were assessed. Analysis: Two-way factorial analyses of variance and two-proportion Z-score tests were run to assess change in sales. Independent samples t tests were used to test for changes in profit. Results: Significant impact was demonstrated on all burger sales in the desired direction during intervention ( P < .001). Most notably, the average weekly turkey burger sales at Penrose Hospital (PH) increased 13-fold (10.85-145.59) and became the majority of the market share (51.8%, P < .001). For salads, significant interaction between phase and food type was found at St. Francis Medical Center (SFMC) ( P = .002) but not at PH ( P = .304). Healthy PH salads were popular at baseline and intervention, comprising the majority of the market share throughout the entire study (68.4%-70.2%, respectively, P = .238). Cafeteria gross sales and burger profit ( P < .001) increased at both cafeterias. Conclusion: Incentivizing consumers through price interventions changed hospital cafeteria food sales in the desired direction while improving the bottom line.
Equity in nursing care: A grounded theory study
Authors: Rooddehghan Zahra , ParsaYekta Zohreh , Nasrabadi Alireza N 
Published: July 2017

Background: Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health. Objectives: This study was conducted to explain the process of the realization of equity in nursing care. Research design: This qualitative study uses Glaser’s approach to grounded theory. Participants and research context: Sample selection began with convenience sampling and continued with purposive sampling. A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the “Six C’s” coding family of Glaser. Ethical considerations: The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects. Findings: According to the findings, participants’ main concern in providing equitable care is the rationing of nursing care. The identification of participants’ main concern led to the emergence of the core category of the study, that is, “nurses’ domination.” The other categories revolving around the core category were conceptualized according to the six C’s coding family: “nurses being dominated,” “nurses’ ineffective power in the health system,” “low attention to equitable care in health system,” “lack of clarity in measuring equitable care,” “the health structure’s inconsistency with equity,” and “the inefficiency of the care system.” Conclusion: There is a mutual relationship between providing fair care and nurses’ perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded.