bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinicians’ versus caregivers’ ratings of burden in patients with schizophrenia and bipolar disorder
Authors: Grover Sandeep , Chakrabarti Subho , Ghormode Deepak , Dutt Alakananda , Kate Natasha , Kulhara Parmanand 
Published: June 2013

Background: Only a few studies have evaluated the similarities and differences between clinicians’ and caregivers’ rating of burden of caring for a person with chronic mental illness. Aim: To compare clinician-rated and caregiver-rated burden in a population of patients with either schizophrenia or bipolar disorder, using two different scales to measure caregiver burden. Methodology: Caregivers of patients with schizophrenia ( n = 65) or bipolar disorder ( n = 57) completed the Hindi version of the Involvement Evaluation Questionnaire (Hindi-IEQ) by themselves. Clinicians rated the burden on the Family Burden Interview Schedule (FBI) based on semi-structured interview with the same caregivers. Results: Both total objective and subjective burden on the FBI (clinician ratings) demonstrated significant positive correlations with the total Hindi-IEQ (caregiver ratings) scores. Most areas of burden on the FBI correlated positively with the tension and the worrying-urging II subscales, as well as the total Hindi-IEQ scores. According to clinicians, a significantly higher percentage of caregivers of patients with schizophrenia were experiencing a moderate to severe degree of subjective burden; objective burden in this group was also significantly higher in the domains of effect on the mental health of caregivers. Contrastingly, caregivers of patients with bipolar disorder judged burden to be higher in this group than schizophrenia. Conclusions: There were many areas of agreement as well as some significant discrepancies between clinicians’ and caregivers’ assessment of burden in this population of patients. This suggests that a comprehensive evaluation of burden should include assessments by both clinicians and caregivers of patients.
Stigma and discrimination against people with schizophrenia related to medical services
Authors: Harangozo J , Reneses B , Brohan E , Sebes J , Csukly G , López-Ibor JJ , Sartorius N , Rose D , Thornicroft G 
Published: June 2013

Objective: To investigate whether people with schizophrenia experience discrimination when using health care services. Methods: A cross-sectional survey in 27 countries in centres affiliated to the INDIGO Research Network, using face-to-face interviews with 777 participants with schizophrenia (62% male and 38% female). We analysed the data related to health issues, including health care, disrespect of mental health staff, and also personal privacy, safety and security, starting a family, pregnancy and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC), which consists of 36 items comprising three sub-scales: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Results: More than 17% of patients experienced discrimination when treated for physical health care problems. More than 38% of participants felt disrespected by mental health staff, with higher ratings in the post-communist countries. Conclusions: Mental health service providers have a key role in decreasing stigma in their provision of health care, and by doing more against stigmatizing and discriminating practices on the therapeutic and organizational level. This will require a change of attitudes and practices among mental and physical health care staff.
Mapping accountability: core concept and subtypes
Authors: Lindberg Staffan I 
Published: June 2013

The recent surge in popularity of ‘accountability’ in public administration and international development seems in part divorced from centuries of conceptual and empirical work done in related disciplines of finance and accounting, and in political science. This article brings together the core meaning of accountability as used in hundreds of previous works, and seeks to bring order to the litany of subtypes in this literature. An organizing scheme with three dimensions (source of control, strength of control, and direction of relationship) captures all the existing varying types of accountability. The resulting typology also clarifies that varying subtypes have not only different actors and characteristics, but also seek to uphold varying values and are facing different challenges. These have important implications both for research and the (im-)possibility of translating findings from one subtype field to another; as well as practical implications for the policy world. Points for practitioners Accountability has several different forms depending on the actors (e.g. citizens–politicians; politicians–bureaucrats; or judges–citizens). These types of accountability seek to protect different values, and are accompanied by varying challenges. Yet, everything is not accountability: it is but one of many possible ways to constrain the (mis-)use of power. This article clarifies the core idea of accountability. It then depicts the full range of subtypes with their different characteristics and problems. This can function as a guide for policy makers and practitioners when seeking to address weaknesses in accountability of varying actors based on acknowledging their differences.
Accountability in Central and Eastern Europe: concept and reality
Authors: Veselý Arnošt 
Published: June 2013

This article deals with accountability in EU new member states (the EU-10). First, the different meanings of the concept of accountability are reviewed. Second, accountability in the EU-10 is analysed in terms of three theoretical perspectives (accountability deficits, overloads and traps). Then the specificity of the accountability regime in the EU-10 is discussed as well as its possible explanations. It is argued that the accountability regime in the EU-10 is characterized by discrepancy between the formal existence of many accountability mechanisms and their actual performance (‘sleeping accountability’). This might be explained by the context in which accountability mechanisms are embedded (the high level of corruption, clientelism, low level of trust), frequent changes in political representation and public administration and the lack of knowledgeable and impartial accountees. The article concludes with implications for empirical comparative research and theory-building. Points for practitioners Accountability is one of the most important public administration concepts, but its empirical investigation is underdeveloped, especially in Central and Eastern European countries. Empirical research must be led by propositions that have practical relevance. Three such propositions – the accountability deficit, overload and asymmetry – are suggested. This includes considering the broader contexts in which accountability is embedded, analysing accountability relations over time, and carefully distinguishing between de jure and de facto accountability.
Reshaping public accountability: hospital reforms in Germany, Norway and Denmark
Authors: Mattei Paola , Mitra Mahima , Vrangbæk Karsten , Neby Simon , Byrkjeflot Haldor 
Published: June 2013

The article contributes to the literature on multi-level welfare governance and public accountability in the context of recent European hospital reforms. Focusing on the changing dynamics between regional and central governance of hospitals in Germany, Norway and Denmark, we raise concerns about the reshaping of traditional public accountability mechanisms. We argue that, triggered by growing financial pressures, corporatization and professionalization have increasingly removed decision-making power from regional political bodies in hospital funding and planning. National governments have tightened their control over the overall trajectory of their hospital systems, but have also shifted significant responsibility downwards to the hospital level. This has reshaped public accountability relationships towards more managerial or professional types embedded within multi-level forms of governance. Points for practitioners Our study may be taken to suggest that if reforms are responses to policy pressures, the accompanying changes in accountability relationships and arrangements in turn contribute to altering the pressures and constraints that form the context for administrative, managerial and professional work. As reforms in Norwegian, Danish and German healthcare contribute to corporatization, centralization and economization, there is reason to expect that what officials are held accountable for, and how, is also likely to change and to accentuate the span between policy aims and actual managerial and professional performance.
Between supply and demand: the limits to participatory development in South Africa
Authors: Tapscott Chris , Thompson Lisa 
Published: June 2013

Much of the focus in the literature on participatory development has been on the demand side and on the extent to which citizens succeed in pressuring the state to deliver basic services. Less attention has been focused on the supply side of participatory development, namely on how state institutions give effect to development policies. Post-Apartheid South Africa is replete with policies and legislation supporting participatory processes and yet in practice this has seldom lived up to the ideals espoused. This article examines the delivery of public housing in poor communities in three municipalities in South Africa and argues that there is a mismatch between how the formulators of policy understand participation and how it is interpreted by beneficiary communities and local officials. It concludes that considerably more attention needs to be focused on why officials fail to translate national policies into action if participatory democracy is to attain any legitimacy in the population at large. Points for practitioners Effective citizen engagement in decision-making processes is the key factor in participatory development programmes. Enabling legislation and policy is essential to the process but it is not sufficient to ensure participation. The design of participatory programmes will thus need to take into account the capacity of communities to organize themselves and will need to factor in the means and time to develop their ability to engage effectively. Officials managing participatory development projects need to undergo formal training so that they understand that the manner in which beneficiaries participate is as important the actual activities in which they are involved.
Accountability of immigration administration: comparing crises in Norway, Denmark and Germany
Authors: Reichersdorfer Johannes , Christensen Tom , Vrangbæk Karsten 
Published: June 2013

Accountability can be conceptualized as institutionalized mechanisms obliging actors to explain their conduct to different forums, which can pose questions and impose sanctions. This article analyses different ‘crises’ in immigration policies in Norway, Denmark and Germany along a descriptive framework of five different accountability types: political, administrative, legal, professional and social accountability. The exchanges of information, debate and their consequences between an actor and a forum are crucial to understanding how political-administrative action is carried out in critical situations. First, accountability dynamics emphasize conventional norms and values regarding policy change and, second, formal political responsibility does not necessarily lead to political consequences such as minister resignations in cases of misbehaviour. Consequences strongly depend on how accountability dynamics take place. Points for practitioners Political and administrative leaders as well as civil servants are faced with several demands from the wider public and from internal or external peers. There is a relationship between actors and forums that is important in understanding how public administration works. This relationship can be described as accountability dynamics. In cases of crises, these dynamics can overcome or sustain daily administrative practices and routines. Our accountability framework offers a systematic scheme to recognize five accountability relations which should be considered during reorganization processes or policy changing initiatives.
Interventional based study to reduce child mortality in rural Uganda
Authors: Jones Rebecca , Kantono Edith Birungi 
Published: June 2013

Background: Reducing child mortality is a WHO Millennium Development Goal. Child mortality rate in Uganda in 2009 was 128. In a rural hospital observations on the paediatric ward were being performed infrequently. Methods: Introduction of regular observation Hourly, two hourly or 4 hourly observation on sick children Training of nurses I interpretation of observations. The number of admissions, discharges and deaths was calculated during two six month periods and mortality rates calculated. Results: Mortality decreased from 6.9% (34 deaths from 496 admissions) to 4% (27 deaths from 706 admissions). This is statistically significant (p-value 0.023). The demographics, cause of death and length of stay remained similar in both groups. Conclusions: The simple intervention of regular nursing observation in children with associated training of nurses has resulted in a statistically significant reduction in child mortality rates in a rural hospital in Uganda.
Predictors of Dislocation and Revision After Shoulder Stabilization in Ontario, Canada, From 2003 to 2008
Authors: Wasserstein David , Dwyer Tim , Veillette Christian , Gandhi Rajiv , Chahal Jaskarndip , Mahomed Nizar , Ogilvie-Harris Darrell 
Published: June 2013

Background: Factors contributing to recurrent dislocation, revision stabilization, and complications requiring reoperation after an initial shoulder stabilization procedure for instability have not been evaluated on a population level. Purpose: (1) To define the rate of ipsilateral revision stabilization, contralateral primary stabilization, postoperative dislocation, and complications after primary shoulder stabilization in a population cohort. (2) To understand which risk factors among patient, surgical, and provider factors influence these outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: All residents of Ontario, Canada, aged 16 to 60 years undergoing primary shoulder stabilization between July 2003 and December 2008 were identified from billing and hospital databases. Separate Cox proportional hazards survivorship models were built for the outcomes revision stabilization and postoperative physician-documented shoulder relocation (minimum 2-year follow-up). Model covariates included patient demographics (age, sex, preoperative dislocations), provider characteristics (surgeon volume, hospital academic status), and type of surgery (open, arthroscopic). The frequency and risk factors for contralateral stabilization were identified. Results: A total of 5904 patients (80.6% male; median age, 29 years) were identified. Arthroscopic stabilization was used in ~60% of cases in 2003, increasing to ~80% in 2008. The rates of postoperative dislocation were 6.9%, revision stabilization 4%, and contralateral primary stabilization 3.9%. Patients aged younger than 20 years had a 7.7% revision rate (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.7-4.2; P < .0001) and a 12.6% rate of postoperative physician-documented dislocation (HR, 2.4; 95% CI, 1.8-3.4; P < .0001), compared with 2.8% and 5.5%, respectively, in patients 29 years old (median cohort age). Patients with 3 or more preoperative dislocations in Ontario had an increased risk of revision (HR, 2.1; 95% CI, 1.5-3.0; P < .0001) and postoperative dislocation (HR, 10.6; 95% CI, 8.1-14.0; P < .0001). Revision was more common after arthroscopic (4.3%) compared with open (3.5%) stabilization (HR, 1.4; 95% CI, 1.02-1.98; P = .04). No provider factor was predictive, including surgeon volume. Reoperation rate for complications not related to recurrent instability was 0.23% (infection, 0.07%; manipulation under anesthesia, 0.15%). Conclusion: The risks of revision stabilization and postoperative (either shoulder) dislocation were most influenced by young age (<20 years) and having had 3 or more preoperative dislocations. Complications requiring surgery are rare.
Protective effect of Dalbergia sissoo Roxb. ex DC. (family: Fabaceae) leaves against experimentally induced diarrhoea and peristalsis in mice
Authors: Chandra Phool , Sachan Neetu , Pal Dilipkumar 
Published: June 2013

Ethnopharmacological relevance: Dalbergia sissoo Roxb. ex DC. (family: Fabaceae; Indian Rosewood), is used in India, especially in rural communities by traditional medicine practitioners to treat diarrhoea. However, scientific evidence does not exist in any literature to substantiate the claim of therapeutic success of the plant species in diarrhoea. Aim: To study the protective effect of ethanol extract from D. sissoo Roxb. ex DC. leaves (EDSL) against experimentally induced diarrhoea and peristalsis in mice. Materials and Methods: Castor oil-induced diarrhoea and magnesium sulphate (MgSO4)-induced diarrhoea tests were used to assess the antidiarrhoeal activity of D. sissoo. Gastrointestinal tract transit of charcoal meal test and barium sulphate milk was used to assess the peristalsis activity of the extract, while the acute toxicity study and determination of total phenolics and total flavonoids were carried out using well-established protocols and methods. Results: The EDSL significantly reduced faecal output in castor oil-induced and MgSO4-induced diarrhoea and also significantly reduced the number of diarrhoeal episodes. D. sissoo significantly delayed the onset of diarrhoea induced by both castor oil and MgSO4 and comparable to loperamide, a standard antidiarrhoeal drug. Both D. sissoo and atropine sulphate significantly reduced the peristalsis activity of charcoal meal and barium sulphate milk in mice. The preliminary phytochemical analysis of EDSL revealed the presence of carbohydrates, phenolics, glycosides, and flavonoids. The median lethal dose of EDSL was greater than 2000 mg/kg (orally (p.o.)). Conclusion: The data obtained indicate that the EDSL has antidiarrhoeal and antiperistalsis activities and thus supports its traditional use. The data also show that the plant material given p.o. may be safe and/or non-toxic in mice.
Sleep Disturbance Correlates With White Matter Hyperintensity in Patients With Subcortical Ischemic Vascular Dementia
Authors: Cheng Chun-Yu , Tsai Chia-Fen , Wang Shuu-Jiun , Hsu Chung-Yao , Fuh Jong-Ling 
Published: June 2013

Background: Subcortical ischemic vascular dementia (SIVD) caused by small-artery disease, and hypoperfusion is a major cause of vascular cognitive impairment. Little is known about the relationship between sleep disturbance and white matter hyperintensity (WMH). We investigated the association between sleep disturbance and WMH, measured by magnetic resonance imaging (MRI), in patients with SIVD. Methods: Patients with SIVD recruited from our outpatient clinic completed the Sleep Disturbance Symptom Questionnaire (SDSQ) and Geriatric Depression Scale-short form (GDS-S) and underwent brain MRI. Total SDSQ scores were calculated by summing frequency ratings of the instrument’s 20 items. We graded WMH on brain MR images using a visual rating scale ranging from 0 (barely detectable) to 9 (extensive changes). Results: We enrolled 72 patients (31 men, 41 women; mean age, 75.9 ± 7.9 years) with SIVD. The SDSQ scores were positively correlated with WMH grading ( r = .337, P = .001) and tended to be associated with higher GDS-S scores ( r = .268, P = .022). Patients with diabetes mellitus tended to display higher mean WMH severity than those without diabetes (4.2 vs 3.3, P = .022). After controlling for confounding factors, the multivariate regression model showed that WMH severity was significantly associated with sleep disturbance ( P = .002). Conclusions: This study showed that manifestations of sleep disturbance were significantly associated with WMH severity, with most symptoms related to daytime hypersomnolence. Disruption of the frontal–subcortical neuronal circuit might play a role in sleep disturbance in patients with SIVD.
No excess of mitochondrial DNA deletions within muscle in progressive multiple sclerosis
Authors: Campbell Graham R , Reeve Amy K , Ziabreva Iryna , Reynolds Richard , Turnbull Doug M , Mahad Don J 
Published: June 2013

Background: Mitochondrial dysfunction is an established feature of multiple sclerosis (MS). We recently described high levels of mitochondrial DNA (mtDNA) deletions within respiratory enzyme-deficient (lacking mitochondrial respiratory chain complex IV with intact complex II) neurons and choroid plexus epithelial cells in progressive MS. Objectives: The objective of this paper is to determine whether respiratory enzyme deficiency and mtDNA deletions in MS were in excess of age-related changes within muscle, which, like neurons, are post-mitotic cells that frequently harbour mtDNA deletions with ageing and in disease. Methods: In progressive MS cases ( n=17), known to harbour an excess of mtDNA deletions in the central nervous system (CNS), and controls ( n=15), we studied muscle (paraspinal) and explored mitochondria in single fibres. Histochemistry, immunohistochemistry, laser microdissection, real-time polymerase chain reaction (PCR), long-range PCR and sequencing were used to resolve the single muscle fibres. Results: The percentage of respiratory enzyme-deficient muscle fibres, mtDNA deletion level and percentage of muscle fibres harbouring high levels of mtDNA deletions were not significantly different in MS compared with controls. Conclusion: Our findings do not provide support to the existence of a diffuse mitochondrial abnormality involving multiple systems in MS. Understanding the cause(s) of the CNS mitochondrial dysfunction in progressive MS remains a research priority.
Interest in medical therapy for celiac disease
Authors: Tennyson Christina A. , Simpson Suzanne , Lebwohl Benjamin , Lewis Suzanne , Green Peter H. R. 
Published: June 2013

Objectives: A gluten-free diet is the treatment for celiac disease, but pharmaceutical agents are being developed. The level of interest amongst patients in using a medication to treat celiac disease is unknown. This study examined the level of interest amongst patients in medication to treat celiac disease. Methods: A questionnaire was distributed to celiac disease patients and data were collected on demographics, presentation, and interest in medication. Three validated celiac disease-specific instruments were incorporated: Celiac Disease Associated Quality of Life, the Celiac Symptom Index, and the Celiac Dietary Adherence Test. Results: Responses were received from 365 individuals with biopsy-proven celiac disease. Respondents were 78% ( n = 276) female, 48% ( n = 170) over 50 years of age, and experienced a classical (diarrhea predominant) presentation in 44% ( n = 154). Of the 339 individuals answering the question regarding use of a medication to treat celiac disease, 66% were interested. Interest was greatest in older individuals (71% >50 years of age versus 60% <50 years of age, p = 0.0415), men (78% men versus 62% women, p = 0.0083), frequent restaurant customers (76% versus 58%, p = 0.0006), those dissatisfied with their weight (73% versus 51%, p = 0.0003) and those concerned with the cost of a gluten-free diet (77% versus 64%, p = 0.0176). Length of time since diagnosis, education, presentation, and symptoms with gluten exposure did not demonstrate any effect. Interest in medication was associated with a worse quality of life (CD-QOL 69.4 versus 80.1, p < 0.0001). Conclusions: Most individuals with celiac disease are interested in using a medication. Interest was highest among men, older individuals, frequent restaurant customers, individuals dissatisfied with their weight or concerned with the cost of a gluten-free diet, and those with a worse quality of life.