Technology in Education: What Teachers Should Know

ERIC Educational Resources Information Center

De Bruyckere, Pedro; Kirschner, Paul A.; Hulshof, Casper D.

2016-01-01

Educators often have the feeling that they are finding it harder and harder to reach their students. That is why they are so feverishly interested in smartboards or learning platforms or anything new on the market that might help. Every new tool seems like a possible solution, although sometimes educators really don't know what the problem is or…

Children of Mothers with Mental Ilness: Attachment, Emotional and Behavioural Problems

ERIC Educational Resources Information Center

Cunningham, Judi; Harris, Gillian; Vostanis, Panos; Oyebode, Femi; Blissett, Jackie

2004-01-01

This study describes the pattern of emotional and behavioural difficulties of children whose mothers have mental illness, and explores the relationship between children's behavioural and emotional difficulties and maternal perceptions of attachment. Thirteen mothers previously admitted to psychiatric hospital for mental illness completed a measure…

Social Difficulties As Risk and Maintaining Factors in Anorexia Nervosa: A Mixed-Method Investigation.

PubMed

Cardi, Valentina; Mallorqui-Bague, Núria; Albano, Gaia; Monteleone, Alessio Maria; Fernandez-Aranda, Fernando; Treasure, Janet

2018-01-01

Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients' perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.

Premorbid and illness-related social difficulties in eating disorders: an overview of the literature and treatment developments.

PubMed

Cardi, Valentina; Tchanturia, Kate; Treasure, Janet

2018-01-17

Social difficulties in eating disorders can manifest as predisposing traits and premorbid difficulties, and/or as consequences of the illness. Objective The aim of this paper is to briefly review the evidence for social problems in people with eating disorders and to consider the literature on treatments that target these features. Method A narrative review of the literature was conducted. Results People with eating disorders often manifest traits, such as shyness, increased tendency to submissiveness and social comparison, and problems with peer relationships before illness onset. Further social difficulties occur as the illness develops, including impaired social cognition and increased threat sensitivity. All relationships with family, peers and therapists are compromised by these effects. Thus, social difficulties are both risk and maintaining factors of eating disorders and are suitable targets for interventions. Several forms of generic treatments (e.g. interpersonal psychotherapy, cognitive analytic therapy, focal psychodynamic therapy) have an interpersonal focus and show some efficacy. Guided self-management based on the cognitive interpersonal model of the illness and directed to both individuals and support persons have been found to improve outcomes for all parties. Adjunctive treatments that focus on specific social difficulties, such as Cognitive Remediation and Emotion Skills Training and Cognitive Bias Modification have been shown to have promise. Conclusion More work is needed to establish whether these approaches can improve on the rather disappointing outcomes that are attained by currently used treatments for eating disorders. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

JPRS Report, East Europe

DTIC Science & Technology

1988-12-14

situation in the world healthier, particularly for the program to liquidate nuclear arms and other types of weapons of mass destruction. During the...make preparations for extensive discussions with the aim of radically reducing tactical nuclear weapons, armed forces, and conventional weap- ons...liquidat- ing two classes of nuclear arms as a historic step which will create preconditions for limiting the feverish arms race and for better

Enter the iPad (or Not?)

ERIC Educational Resources Information Center

Waters, John K.

2010-01-01

Few computing devices have sparked the burning gizmo lust ignited by the iPad. Apple's latest entry into the tablet PC market didn't generate much heat when it was first unveiled in January, but by April 3, the day of the official release, feverish customers were mobbing Apple stores. The company claims to have sold 300,000 iPads by midnight on…

Drivers for inappropriate fever management in children: a systematic review.

PubMed

Kelly, M; McCarthy, S; O'Sullivan, R; Shiely, F; Larkin, P; Brenner, M; Sahm, L J

2016-08-01

Background Fever is one of the most common childhood symptoms and accounts for numerous consultations with healthcare practitioners. It causes much anxiety amongst parents as many struggle with managing a feverish child and find it difficult to assess fever severity. Over- and under-dosing of antipyretics has been reported. Aim of the review The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children. Method A systematic search was conducted in ten bibliographic databases from database inception to June 2014. Citation lists of studies and consultation with experts were used as secondary sources to identify further relevant studies. Titles and abstracts were screened for inclusion according to pre-defined inclusion and exclusion criteria. Quantitative studies using a questionnaire were analysed using narrative synthesis. Qualitative studies with a semi-structured interview or focus group methodology were analysed thematically. Results Of the 1565 studies which were screened for inclusion in the review, the final review comprised of 14 studies (three qualitative and 11 quantitative). Three categories emerged from the narrative synthesis of quantitative studies: (i) parental practices; (ii) knowledge; (iii) expectations and information seeking. A further three analytical themes emerged from the qualitative studies: (i) control; (ii) impact on family; (iii) experiences. Conclusion Our review identifies the multifaceted nature of the factors which impact on how parents manage fever and febrile illness in children. A coherent approach to the management of fever and febrile illness needs to be implemented so a consistent message is communicated to parents. Healthcare professionals including pharmacists regularly advise parents on fever management. Information given to parents needs to be timely, consistent and accurate so that inappropriate fever management is reduced or eliminated. This review is a necessary foundation for further research in this area.

Information needs, care difficulties, and coping strategies in families of people with mental illness

PubMed Central

Sabanciogullari, Selma; Tel, Havva

2015-01-01

Objective: To determine information needs, care difficulties, and coping mechanisms of family members of people with mental illness. Methods: In this descriptive cross-sectional study, the study sample consisted of the families of 134 patients who were treated in the Psychiatric Unit of Cumhuriyet University Training and Research Hospital in Sivas, Turkey between January and May 2011. Data was collected by a questionnaire and analysed descriptively, and by chi-square testing. Results: It was determined that 79.1% of family members were knowledgeable of the patients’ illness. It was found that they experienced difficulties in communicating with the patient, and in ensuring drug compliance and anger management and that they used psychological and social coping strategies. Conclusion: Our results indicate that access to medical information on its own is not sufficient for carers of people with mental illness, and the necessity of developing positive attitudes when dealing with the illness and its symptoms. We recommend that nurses and other health professionals offer long term support and consultation programs to family members. PMID:25864067

The natural history of community-acquired common colds symptoms assessed over 4-years.

PubMed

Witek, Theodore J; Ramsey, David L; Carr, Andrew N; Riker, Donald K

2015-03-01

The common cold is the most frequently experienced infection among humans, but limited data exist to characterize the onset, duration, severity and intersection of symptoms in community-acquired colds. A more complete understanding of the symptom frequency and burden in naturally occurring colds is needed. We characterized common cold symptoms from 226 cold episodes experienced by 104 male or female subjects. Subjects were enrolled in the work environment in an attempt to start symptom evaluation (frequency and severity) at the earliest sign of their cold. We also assessed the symptom that had the greatest impact on the subject by asking them to identify their single most bothersome symptom. Symptom reporting started within 24 hours of cold onset for most subjects. Sore throat was a harbinger of the illness but was accompanied by multiple symptoms, including nasal congestion, runny nose and headache. Cough was not usually the most frequent symptom, but was present throughout the cold, becoming most bothersome later in the cold. Nasal congestion, pain (eg, sore throat, headache, muscle pains) or feverishness and secretory symptoms (eg, runny nose, sneezing), and even cough, were simultaneously experienced with high incidence over the first 4 days of illness. The single most bothersome symptom was sore throat on day 1, followed by nasal congestion on days 2-5 and cough on days 6 and 7. There is substantial overlap in the appearance of common cold symptoms over the first several days of the common cold. Nasal congestion, secretory and pain symptoms frequently occur together, with cough being somewhat less prominent, but quite bothersome when present. These data establish the typical symptomatology of a common cold and provide a foundation for the rational treatment of cold symptoms typically experienced by cold sufferers.

Hometown Hospitals: The Weakest Link? Bioterrorism Readiness in America’s Rural Hospitals

DTIC Science & Technology

2004-06-01

prophylaxis , and treatment. Eventually both public health and medical care systems were required to dispense antibiotics to an estimated 32,000...dispatched to the scene over 17 days in chaotic and feverish attempts to rescue and facilitate subsequent medical and surgical interventions to save...delivery of tertiary procedures for life-threatening diseases, hospitals face the quandary of terrorism preparedness and response with limited budgets

Australasian haematologist referral patterns to palliative care: lack of consensus on when and why.

PubMed

Auret, K; Bulsara, C; Joske, D

2003-12-01

Patients with haematological malignancies are not referred to palliative care services as frequently as those with solid cancers (non-haematological malignancies). The present study surveyed haematologists in Australia and New Zealand. We aimed to record theoretical referral times, identify problems with referral to palliative care and clarify elements used to decide whether a patient was "terminally ill". A questionnaire based on the case-histories of three patients (with acute leukaemia, lymphoma or multiple myeloma) was distributed at the Haematology Society of Australia and New Zealand Congress 2000, Perth, Australia. Each case was divided into stages by transitional points in the illness to include issues or prognostic variables that may stimulate referral to palliative care. Questions were asked about: (i) referral-triggers, (ii) problems previously experienced, (iii) definition of when the patient was "terminally ill", (iv) prognostication difficulties and (v) communication about prognosis. The response rate was 11%, which may represent up to 32% of Australian specialists. Eighty per cent had access to all types of palliative care services and refer for symptom control, regardless of illness stage. Twenty-nine per cent had experienced difficulties in referring. There was a variation as to exactly when referral would occur and when each case was considered "terminally ill". Reasons for early or later referral were explored. Prognostication difficulties were common. In theory there is a willingness to refer to palliative care, however this has yet to be translated to day-to-day practice. This may be due to prognostication difficulties, logistical factors and medical concerns. Models of referral are suggested for further study.

Addressing Mental Illness Stigma in the Psychology Classroom

ERIC Educational Resources Information Center

Maranzan, K. Amanda

2016-01-01

A number of initiatives are aimed at reducing mental illness stigma, yet stigma remains a problem in the general population. A focus on stigma reduction with students is particularly relevant, as students often hold negative attitudes toward mental illness, have regular contact with persons experiencing mental health difficulties, and because…

Clinical Management of Ebola Virus Disease in the United States and Europe.

PubMed

Uyeki, Timothy M; Mehta, Aneesh K; Davey, Richard T; Liddell, Allison M; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R; Evans, Laura; Hewlett, Angela L; Brantsaeter, Arne B; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie

2016-02-18

Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

The effects of individual factors and school environment on mental health and prejudiced attitudes among Norwegian adolescents.

PubMed

Andersson, Helle Wessel; Bjørngaard, Johan Håkon; Kaspersen, Silje Lill; Wang, Catharina E A; Skre, Ingunn; Dahl, Thomas

2010-05-01

The aim was to examine the prevalence of mental health difficulties and prejudices toward mental illness among adolescents, and to analyze possible school and school class effects on these issues. The sample comprised 4,046 pupils (16-19 years) in 257 school classes from 45 Norwegian upper secondary schools. The estimated response rate among the pupils was about 96%. Self-reported mental health difficulties were measured with a four-item scale that covered emotional and behavioral difficulties. Prejudiced attitudes toward mental illness were assessed using a nine-item scale. Multilevel regression analysis was used to estimate the contribution of factors at the individual level, and at the school and class levels. Most of the variance in self-reported mental health difficulties and prejudices was accounted for by individual level factors (92-94%). However, there were statistically significant school and class level effects (P < 0.01), confounded by socioeconomic factors. Mental health difficulties were commonly reported, more often by females than males (P < 0.01). Difficulties with emotions and attention were the two main problem areas, with definite to severe difficulties being reported by 19 and 21% of the females, and by 9 and 16% of the males, respectively. Prejudices were reported more often by males than females (P < 0.01). Both self-reported mental health difficulties and prejudiced attitudes were related to educational program, living situation, and parental education (P < 0.01). The relatively high prevalences of mental health difficulties and prejudiced attitudes toward mental illness among adolescents indicate a need for effective mental health intervention programs. Targeted intervention strategies should be considered when there is evidence of a high number of risk factors in schools and school classes. Furthermore, the gender differences found in self-reported mental health difficulties and prejudices suggest a need for gender-differentiated programs.

Dragon Operations: Hostage Rescues in the Congo, 1964-1965 (Leavenworth Papers, Number 14)

DTIC Science & Technology

1988-01-01

lying in the street. 28 The corpse of Dr. Carlson 103 Off-loading medical supplies and food at Stanley.ville The paras’ assembly of the survivors was...attempted to care for the refugees- providing food , water, and shelter from rebel fire-Strobaugh and the · Belgians worked feverishly to get them safely...Georges Ledant, Colonel e.r. Belgian Army, interviews with the author, Ville Franche , France, 9 January 1986: Vandewalle interviews; and Janssens

Impact of Parental Severe Mental Illness: Ethical and Clinical Issues for Counselors

ERIC Educational Resources Information Center

Spiegelhoff, Sarah F.; Ahia, C. Emmanuel

2011-01-01

This article draws attention to the issue of parental severe mental illness and the ethical and clinical implications for counselors who work with this population. Parents with mental illness face a multitude of life challenges including, but not limited to, parenting difficulties, medication and hospitalization, custody and placement of their…

Learning Together 1: an educational model for training GPs, paediatricians: initial findings.

PubMed

Macaulay, Chloe; Spicer, John; Riches, Wendy; Lakhanpaul, Monica

2017-01-01

Learning Together is primarily an educational intervention, where paediatric registrars [SpRs] and General Practice (GP) registrars [GPSTs] see children together in a primary care setting. Over a six month period in 2013/2014, 44 learning pairs were set up mainly in North East and Central London. Proof of concept for the model at scale was achieved. Reported learning demonstrated: clinical learning themes of new knowledge, skill and communication skills; and collaborative themes of ongoing collaboration, satisfaction with team working and change in attitudes. These themes were identified in both sets of trainees. The self-reported learning is backed up by the results of a retrospective notes review of four common conditions based on NICE guidelines; constipation, asthma, feverish illness and eczema (CAFE). Guidance adherence improved from 57% before the intervention in solo GP training consultations to 72% during the joint clinic intervention (p < 0.01). After the intervention when the GP registrars returned to normal consultations, guidance adherence was 77% compared to before the intervention (p < 0.01). In addition 99% of the parents, who handed in feedback forms or took part in interviews, reported a good experience of care, and 87% reported increased confidence to manage their children's health following the consultation. A second, linked article examines the cost utility of Learning Together in its South London extension.

An illness in the family: Dr. Maude Abbott and her sister, Alice Abbott.

PubMed

Brookes, Barbara

2011-01-01

This paper explores Maude Abbott's internationally significant career in medicine and her parallel commitment to caring for her sister, Alice Abbott. An examination of Abbott's life reveals the difficulties faced by an ambitious Canadian woman in medicine from the 1890s to the 1920s; difficulties compounded by caring for a sister with a mental illness. The Abbott archive suggests that it was far more difficult for a woman doctor to make the kind of sharp distinction between public and private life that might be expected of professional men.

Recognizing dying in terminal illness.

PubMed

Taylor, Paul M; Johnson, Miriam

2011-08-01

Recognizing dying in terminally ill patients is a complex clinical skill. This article outlines the approach to the decision, common difficulties encountered in patients with both malignant and non-malignant disease, and a simple approach to considering the question 'Is this patient dying?'

Coping simultaneously with 2 stressors: immigrants with ovarian cancer.

PubMed

Mizrahi, Ilana; Kaplan, Giora; Milshtein, Ellen; Reshef, Batia Piki; Baruch, Gilad Ben

2008-01-01

The dual adjustment to being a cancer patient and an immigrant involves major changes in life and might be a severe experience. This study set out to describe the experience of women who have come to Israel from the former Soviet Union and are coping with ovarian cancer. It focused on illness narratives as presented by 8 patients with cancer at stage III. Our findings indicated that the dual process might have different implications according to the meaning attributed by the patient to the illness situation. Viewing the illness as one more burden among other difficulties, such as language barrier, was a prism through which patients experienced their vulnerability in coping with the illness. Alongside a helplessness pattern, we found indications of interviewees' perceiving advantages in their status as immigrant cancer patients, by dealing with that problem alongside other difficulties. They showed a "fighting spirit" in coping with the illness. Immigration can have a moderating effect on patients' experiences, and the 2 stressors do not necessarily accumulate. Our findings indicate that patients' meaning to the illness experience was a "litmus test," which indicated the way patients would describe their coping stages. This may have potential as a clinical marker of psychological vulnerability.

The stigma of mental illness in children and adolescents: A systematic review.

PubMed

Kaushik, Anya; Kostaki, Evgenia; Kyriakopoulos, Marinos

2016-09-30

One in ten children and adolescents suffer with mental health difficulties at any given time, yet less than one third seek treatment. Untreated mental illness predisposes to longstanding individual difficulties and presents a great public health burden. Large scale initiatives to reduce stigmatization of mental illness, identified as a key deterrent to treatment, have been disappointing. This indicates the need for a clearer understanding of the stigmatizing processes faced by young people, so that more effective interventions are employed. A systematic review of the literature, assessing public stigma and self-stigma (i.e. internalized public stigma) specifically in children and adolescents with mental health difficulties (YP-MHD), was conducted. Forty-two studies were identified, confirming that stigmatization of YP-MHD is a universal and disabling problem, present amongst both children and adults. There was some variation by diagnosis and gender, and stigmatization was for the most part unaffected by labelling. Self-stigmatization led to more secrecy and an avoidance of interventions. The findings confirm that stigmatization of mental illness is poorly understood due to a lack of research and methodological discrepancies between existing studies. Implications for the findings are discussed, and suggestions made for future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Causes of homelessness prevalence: Relationship between homelessness and disability.

PubMed

Nishio, Akihiro; Horita, Ryo; Sado, Tadahiro; Mizutani, Seiko; Watanabe, Takahiro; Uehara, Ryosuke; Yamamoto, Mayumi

2017-03-01

Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system. The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results. Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability. Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

Nurse Education and Professional Work: Transition Problems?

ERIC Educational Resources Information Center

Kapborg, Inez D.; Fischbein, Siv

1998-01-01

Eight nursing students kept diaries during their transition from school to professional work. Common problems included management of paperwork, heavy workload, difficulty feeling relaxed when off duty, difficulty in determining what to delegate and when to call for doctors, and tending to seriously ill patients. (SK)

Language Universals and Misidentification: A Two-Way Street

ERIC Educational Resources Information Center

Berent, Iris; Lennertz, Tracy; Balaban, Evan

2012-01-01

Certain ill-formed phonological structures are systematically under-represented across languages and misidentified by human listeners. It is currently unclear whether this results from grammatical phonological knowledge that actively recodes ill-formed structures, or from difficulty with their phonetic encoding. To examine this question, we gauge…

View of Mission Control Center during the Apollo 13 emergency return

NASA Image and Video Library

1970-04-16

S70-35368 (16 April 1970) --- Overall view showing some of the feverish activity in the Mission Operations Control Room (MOCR) of the Mission Control Center (MCC) during the final 24 hours of the problem-plagued Apollo 13 mission. Here, flight controllers and several NASA/MSC officials confer at the flight director's console. When this picture was made, the Apollo 13 lunar landing had already been canceled, and the Apollo 13 crewmembers were in trans-Earth trajectory attempting to bring their crippled spacecraft back home.

The feasibility and acceptability of questionnaires and accelerometry for measuring physical activity and sedentary behaviour in adults with mental illness.

PubMed

Chapman, Justin J; Fraser, Sarah J; Brown, Wendy J; Burton, Nicola W

2015-01-01

Adults with mental illness may have difficulties with data collection methods such as questionnaires and accelerometry. To assess the utility of questionnaires and accelerometry for assessing physical activity (PA) and sedentary behaviour (SB) in non-institutionalised adults with mental illness. Participants were recruited from outpatient clinics and community organisations. Participants completed PA and SB questionnaires, wore accelerometers for 7 d, and rated the ease/difficulty of completing study components. Recruitment numbers, adherence, and ease/difficulty ratings were examined. Ease/difficulty ratings were compared between study components, and between participants by distress level. One hundred forty-two participants completed the questionnaires; they found it easier to report PA than reclining time (p = 0.017), and reclining time than sitting time (p < 0.001). Participants with high distress found it more difficult to report sitting time and PA than participants with low distress (p < 0.017). Ninety-nine participants (70%) completed the accelerometry; the majority (88%) met the minimum wear-time criteria. They found it easier to wear the monitor during the day than while sleeping (p < 0.001), and easier to complete accelerometry than questionnaires (p < 0.001). Accelerometry was more feasible for assessing SB than questionnaires. Questionnaires were feasible for assessing PA, but less acceptable for people experiencing high distress.

Emotion dysregulation in hypochondriasis and depression.

PubMed

Bailer, Josef; Witthöft, Michael; Erkic, Maja; Mier, Daniela

2017-11-01

The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis. Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions. Copyright © 2017 John Wiley & Sons, Ltd.

A Review of Measles

ERIC Educational Resources Information Center

Dardis, Melissa R.

2012-01-01

Measles, once a common childhood illness that many older school nurses could recognize without difficulty, needs review again after reemerging from Europe and other continents. A highly contagious disease, which has been referenced since the seventh century, the virus can cause serious illness and death, despite the fact that it is vaccine…

Factors affecting health seeking behavior for common childhood illnesses in Yemen

PubMed Central

Webair, Hana Hasan; Bin-Gouth, Abdulla Salim

2013-01-01

Introduction Appropriate medical care seeking could prevent a significant number of child deaths and complications due to ill health. This study aims to determine factors affecting health seeking behavior (HSB) for childhood illnesses, thereby improving child survival. Methods A cross sectional study was carried out from January 11 to April 2, 2012. A total of 212 caretakers of children under the age of 5 years participated. Caretakers who visited the vaccination unit in the Shehair Health Center during the study period and had a child with a history of diarrhea, fever, cough, and/or difficulty of breathing during the last 14 days were included. The data were collected by interviewing caretakers and the answers were reported in pretested structured questionnaires. Results Medical care was sought for about half of the sick children (n=109, 51.42%). Seeking medical care was frequently initiated for illnesses that did not improve or worsened. The major reasons for not seeking medical care were “illness was mild” (n=40, 38.83%) and “illness is not for medical treatment” (n=32, 31.07%). The caretakers sought medical care significantly more when they had a higher level of school education (POR [prevalence odds ratio] 5.85, 95% CI [confidence interval]: 2.34–14.61), when the illness was perceived as severe (POR 5.39, 95% CI: 2.81–10.33), and when the child had difficulty of breathing (POR 2.93, 95% CI: 1.10–7.80). Conclusion For the preventable childhood illnesses with existing interventions, appropriate HSB prevalence is low. Symptom type, caretakers’ education, and perception of illness severity are the predictors of HSB. Educational improvement of the mothers, introduction of community based integrated management of childhood illness, and in-depth research are imperative to improve mothers’ HSB. PMID:24187490

Messy Problems and Lay Audiences: Teaching Critical Thinking within the Finance Curriculum

ERIC Educational Resources Information Center

Carrithers, David; Ling, Teresa; Bean, John C.

2008-01-01

This article investigates the critical thinking difficulties of finance majors when asked to address ill-structured finance problems. The authors build on previous research in which they asked students to analyze an ill-structured investment problem and recommend a course of action. The results revealed numerous critical thinking weaknesses,…

Representing health and illness: thoughts for the 21st century.

PubMed

Gilman, Sander L

2011-06-01

The on-going discussion about a new empiricism in the study of the medical humanities has lead to a misapprehension about the problems attendant to representing health and illness. The difficulty in understanding the politics of health and illness as well as the concomitant new aestheticism that has arisen concerning its representation demands a rethinking of these categories in the 21st century. Obesity can provide a model for the importance of this problem today.

Psychosocial Difficulties Experienced by People Diagnosed with Schizophrenia--Barriers to Social Inclusion

ERIC Educational Resources Information Center

Anczewska, Marta; Switaj, Piotr; Roszczynskamichta, Joanna; Chrostek, Anna; Charzynska, Katarzyna

2013-01-01

Schizophrenia as mental illness is defined in terms of diagnostic criteria which do not include the full range of psychosocial difficulties that shape the lived experience of persons with this diagnosis and affect their quality of life. The biopsychosocial approach found in the World Health Organization's International Classification of…

An Investigation of Lebanese G7-12 Students' Misconceptions and Difficulties in Genetics and Their Genetics Literacy

ERIC Educational Resources Information Center

Osman, Enja; BouJaoude, Saouma; Hamdan, Hiba

2017-01-01

Lebanese educators claim that middle and secondary school students exhibit poor understanding of genetics due to misconceptions and difficulties that hinder progression in conceptual understanding of major genetics concepts and phenomena across different grade levels. They attributed these problems to Lebanon's ill-structured genetics curriculum…

Association of physicians' illness perception of fibromyalgia with frustration and resistance to accepting patients: a cross-sectional study.

PubMed

Homma, Mieko; Ishikawa, Hirono; Kiuchi, Takahiro

2016-04-01

The aim of this study was to elucidate whether physicians' illness perceptions correlate with their frustration or resistance to accepting patients with fibromyalgia (FM). In this cross-sectional postal survey, questionnaires were sent to member physicians of the Japan College of Rheumatology and Japan Rheumatism Foundation. Measures collected included the Brief Illness Perception Questionnaire with Causal Attribution, the Illness Invalidation Inventory, and the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). Multiple logistic regression was performed to examine associations between the DDPRQ-10 and resistance to accepting patients with FM for treatment. We analyzed data from 233 physicians who had experience in consulting with patients with FM. Only 44.2 % answered that they wanted to accept additional patients with FM. Physicians' frustration was associated with difficulty controlling symptoms, patients' emotional responses, and causal attribution of FM to patient internal factors. Conversely, lower levels of frustration were associated with causal attributions to biological factors and uncontrollable external factors. However, the "difficult patient" perception did not correlate with resistance to accepting patients with FM. Difficulty controlling symptoms with treatment was the one factor common to both physicians' frustration and resistance to accepting patients with FM. Physicians may hesitate to accept patients with FM not because of the stigmatic image of the "difficult patient," but instead because of the difficulty in controlling the symptoms of FM. Thus, to improve the quality of consultation, physicians must continuously receive new information about the treatments and causes of FM.

Employment status and work-related difficulties among family members of terminally ill patients compared with the general population.

PubMed

Kim, Seon Young; Chang, Yoon-Jung; Do, Young Rok; Kim, Sam Yong; Park, Sang Yoon; Jeong, Hyun Sik; Kang, Jung Hun; Kim, Si-Yung; Ro, Jung Sil; Lee, Jung Lim; Lee, Woo Jin; Park, Sook Ryun; Yun, Young Ho

2013-01-01

Although caregiving to patients with terminal illness is known to be a stressful burden to family members, little attention has been focused on work-related problems. We aimed to investigate employment status and work-related difficulties of family caregivers of terminal cancer patients, comparing with the general population. Using structured questionnaires, we assessed family caregivers of 481 cancer patients determined by physicians to be terminally ill, from 11 university hospitals and the National Cancer Center in Korea. Among 381 family caregivers of terminal cancer patients (response rate, 87.6%), 169 (43.9%) were not working before cancer diagnosis, but currently 233 (63.7%) were not working. Compared with the general population (36.5%), the percentage of not working among the family caregivers was higher (OR = 2.39; 95% CI= 1.73-3.29). A major reason for not working was to provide assistance to the patients (71.6%). 40.6% of those who continued working and 32.3% of those who not working family members reported extreme fatigue. Caregivers of old age, those who were female, those with a lower household income, and those caring for patients with a low performance status were not working at a more significant rate. Family caregivers of terminal cancer patients suffer job loss and severe work-related difficulties, probably due to caregiving itself and to fatigue. We need to develop supportive programs to overcome the burden of caregivers of the terminally ill.

Experiences of primary health care nurses in implementing integrated management of childhood illnesses strategy at selected clinics of Limpopo Province.

PubMed

Vhuromu, E N; Davhana-Maselesele, M

2009-09-01

Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO) and United Nation Children's Fund (UNICEF) came up with Integrated Management of Childhood illnesses (IMCI) strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS) in Limpopo Province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch 's method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.

Chronic Physical Illness and Mental Health in Children. Results from a Large-Scale Population Study

ERIC Educational Resources Information Center

Hysing, Mari; Elgen, Irene; Gillberg, Christopher; Lie, Stein Atle; Lundervold, Astri J.

2007-01-01

Background: The aim of the present study was to evaluate the sensitivity and specificity of the Strengths and Difficulties Questionnaire (SDQ) in detecting emotional and behavioural problems among children with chronic illness (CI). Methods: Parents and teachers of a population of primary school children in Norway (n = 9430) completed a…

Fear of Death, Mortality Communication, and Psychological Distress among Secular and Religiously Observant Family Caregivers of Terminal Cancer Patients

ERIC Educational Resources Information Center

Bachner, Yaacov G.; O'Rourke, Norm; Carmel, Sara

2011-01-01

Previous research suggests that caregivers and terminally ill patients face substantial difficulties discussing illness and death. Existing research, however, has focused primarily on the experience of patients. The current study compared responses as well as the relative strength of association between mortality communication, fear of death, and…

Racism and Mental Health: An Exploration of the Racist's Illness and the Victim's Health.

ERIC Educational Resources Information Center

Bowser, Benjamin P.

The field of mental health has had difficulty in developing an adequate conceptualization of racism as a mental health problem. Based on conventional classifications of mental illness, racism might be described as a functional disorder. The racist, however, appears quite normal except for a paranoid disorder in the area of racial relations. The…

Differential Outcomes of Adolescents with Chronically Ill and Healthy Parents

ERIC Educational Resources Information Center

Sieh, Dominik Sebastian; Visser-Meily, Johanna Maria Augusta; Meijer, Anne Marie

2013-01-01

Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically ill parent and 112 adolescents from 68 families…

Respite Care. Briefing Paper. Interim Update.

ERIC Educational Resources Information Center

Ambler, Lana; Kupper, Lisa, Ed.

The challenges that families face in caring for a child with a disability or a chronic illness are reviewed in this report on respite care. A parent's narrative describes the difficulties in providing around-the-clock care to a child with a chronic illness. The benefits of respite care are outlined as follows: gives the family peace of mind,…

Home Health Care for Chronically Ill Children: Hearing before the Committee on Labor and Human Resources, United States Senate, Ninety-Ninth Congress, First Session on Examining the Needs for Pediatric Home Care for Children with Long-Term Illnesses and Disabilities.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

The proceedings of the 1985 hearing address issues in pediatric home care for children with long-term illnesses and disabilities. Statements of parents center on extreme expenses of home care and the difficulties of finding financial aid. Additional testimony is offered by representatives of home health care agencies, physicians involved in care…

The Feasibility of Using Questionnaires and Accelerometers to Measure Physical Activity and Sedentary Behavior Among Inpatient Adults With Mental Illness.

PubMed

Fraser, Sarah J; Chapman, Justin J; Brown, Wendy J; Whiteford, Harvey A; Burton, Nicola W

2016-05-01

The aim of this study was to assess the feasibility of using questionnaires and accelerometers to measure physical activity and sedentary behavior among inpatient adults with mental illness. Participants completed a physical activity and sitting time questionnaire and wore an accelerometer for 7 consecutive days. Feasibility was assessed in terms of participant engagement, self-reported ease/ difficulty of completing study components, extreme self-report data values and adherence to accelerometer wear time criteria. Ease/difficulty ratings were examined by level of distress. 177 inpatients were invited to the study, 101 completed the questionnaires and 36 provided valid accelerometry data. Participants found it more difficult to complete sitting time and physical activity questionnaires than to wear the accelerometer during waking hours (z = 3.787, P < .001; z = 2.824, P = .005 respectively). No significant differences were found in ease/ difficulty ratings by level of distress for any of the study components. Extreme values for self-reported sitting time were identified in 27% of participants. Inpatient adults with mental illness can engage with self-report and objective methods of measuring physical activity and sedentary behavior. They were initially less willing to participate in objective measurement, which may however be more feasible than self-report measures.

Critical illness polyneuropathy and myopathy: a systematic review

PubMed Central

Zhou, Chunkui; Wu, Limin; Ni, Fengming; Ji, Wei; Wu, Jiang; Zhang, Hongliang

2014-01-01

Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles, respectively. Clinically, they manifest as limb and respiratory muscle weakness. Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation. Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event. Substantial progress has been made lately in the understanding of the pathophysiology of critical illness polyneuropathy and myopathy. Clinical and ancillary test results should be carefully interpreted to differentiate critical illness polyneuropathy/myopathy from similar weaknesses in this patient population. The present review is aimed at providing the latest knowledge concerning the pathophysiology of critical illness polyneuropathy/myopathy along with relevant clinical, diagnostic, differentiating, and treatment information for this debilitating neurological disease. PMID:25206749

Sickness behavior in feverish children is independent of the severity of fever. An observational, multicenter study.

PubMed

Corrard, François; Copin, Christian; Wollner, Alain; Elbez, Annie; Derkx, Véronique; Bechet, Stéphane; Levy, Corinne; Boucherat, Michel; Cohen, Robert

2017-01-01

Behavioral changes in a febrile child are usually considered to stem from the fever. We studied sickness behavior (SB) in terms of its clinical components and its relation to fever. This observational, multicenter study included children aged 6 months to 3 years who were either febrile (fever ≥12 hours, ≥ 39°C and ≥38°C at inclusion) or non-febrile and well. The child had to have been awake for the 2 hours preceding the consultation and cared for by the parent who brought him/her to the doctor. SB was evaluated according to 6 parameters over this 2-hour period: time spent playing, distance covered, time spent seeking comfort, time spent whining or crying, time spent in a state of irritation or of anger, most distorted facial expression. Two parameters were assessed for the 24-hour period preceding the consultation: time spent sleeping and appetite. The parent reported the degree of change in these parameters compared with the usual situation, using rating scales. 200 febrile children (most with nonspecific upper respiratory infections) and 200 non-febrile children were included. The mean values of the 8 parameters differed significantly (p<0.001) between the 2 groups and were independent of the height of fever at inclusion in the febrile children. In the study conditions, paracetamol failed to improve SB when the child was still feverish. The 8 parameters suggested that SB and fever are two independent manifestations that are activated simultaneously during an infection. This independence is in harmony with recommendations to treat the discomfort of SB and not the fever.

Comparison of Self- and Proxy Report of Mental Health Symptoms in People with Intellectual Disabilities

ERIC Educational Resources Information Center

Scott, Haleigh M.; Havercamp, Susan M.

2018-01-01

Mental illness, and its assessment and treatment, is a concern for caregivers and professionals working with people with intellectual disability (ID), as well as a cause of distress and disability for people with ID. Research in this area is hindered by difficulties associated with recognizing symptoms of mental illness and tracking their changes.…

A Virtual Learning Environment for the Continuation of Education and Its Relationship with the Mental Well-Being of Chronically Ill Adolescents

ERIC Educational Resources Information Center

Zhu, Chang; Van Winkel, Lies

2016-01-01

Research has shown that the continuation of education by chronically ill adolescents is an important way to avoid social isolation, psychosocial problems and the accumulation of learning difficulties. In this light, virtual learning environments (VLEs), which connect sick adolescents to their schools, play an important role in ensuring that the…

Reserve-building activities attenuate treatment burden in chronic illness: The mediating role of appraisal and social support

PubMed Central

Schwartz, Carolyn E; Zhang, Jie; Michael, Wesley; Eton, David T; Rapkin, Bruce D

2018-01-01

This study examines the importance of four psychosocial factors—personality, cognitive appraisal of quality of life, social support, and current reserve-building—in predicting treatment burden in chronically ill patients. Chronically ill patients (n = 446) completed web-based measures. Structural equation modeling was used to investigate psychosocial factors predicting treatment burden. Reserve-building activities indirectly reduced treatment burden by: (1) reducing health worries appraisals, (2) reducing financial difficulties, (3) increasing calm and peaceful appraisals, and (4) increasing perceived social support. These findings point to key behaviors that chronically ill people can use to attenuate their treatment burden. PMID:29785278

Exploration of Friendship Experiences, before and after Illness Onset in Females with Anorexia Nervosa: A Qualitative Study

PubMed Central

Lawrence, Vanessa; Fleming, Caroline; Tchanturia, Kate

2016-01-01

Background Difficulties with social relationships have been implicated in both the development and maintenance of Anorexia Nervosa (AN) but the friendship experiences of individuals with AN have not been explored in depth. Method Ten adults with AN took part in a semi-structured interview about their friendship experiences both before and since the onset of their illness. Results Five principle themes were identified through thematic analysis: Social Concern; Impact of AN; Social Connectedness; Inflexibility and Preferred Social Activity. Difficulties with friendship were present prior to the onset of AN in all cases, with participants experiencing anxiety in relation to various aspects of their friendships. Participants described mixed experiences of how their AN has affected their friendships but most participants described having less contact with their friends since becoming unwell. Conclusion This research highlights the role that social difficulties may play in the development of AN, whilst also emphasising the importance of addressing problems with friendship in the course of inpatient treatment. PMID:27676072

[The personal digital assistant: A tool for supporting mental health rehabilitation].

PubMed

Charbonneau, Karine; Lalande, Mélissa; Briand, Catherine

2015-10-01

People living with mental illness may manifest cognitive and social-emotional difficulties leading to several challenges in their daily lives. Using technological aids may help to compensate for some of these difficulties. The objective of this study was to document the effects and issues of the use of mobile technology applications (apps) with people with mental illness during the rehabilitation process. Using an exploratory qualitative evaluative approach, 12 participants were engaged in ongoing brief interviews in which they discussed their use of a variety of apps that met their rehabilitation needs. A thematic analysis (descriptive interpretive) was used to uncover the effects and issues of the integration of apps in participants' daily life. The apps helped participants to overcome their cognitive difficulties, facilitated the management of their daily tasks and socialization, and prevented boredom. However, several issues related to the context, the technology, and the person need to be considered. The findings prompt one to consider the therapist's role in the integration of personal digital assistants in psychosocial rehabilitation.

Visual difficulty and employment status in the world.

PubMed

Harrabi, Hanen; Aubin, Marie-Josee; Zunzunegui, Maria Victoria; Haddad, Slim; Freeman, Ellen E

2014-01-01

Using a world-wide, population-based dataset, we sought to examine the relationship between visual difficulty and employment status. The World Health Survey was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design. Far vision was assessed by asking about the level of difficulty in seeing and recognizing a person you know across the road (i.e. from a distance of about 20 meters). Responses included none, mild, moderate, severe, or extreme/unable. Participants were asked about their current job, and if they were not working, the reason why (unable to find job, ill health, homemaker, studies, unpaid work, other). The occupation in the last 12 months was obtained. Multinomial regression was used accounting for the complex survey design. Of those who wanted to work, 79% of those with severe visual difficulty and 64% of those with extreme visual difficulty were actually working. People who had moderate, severe, or extreme visual difficulty had a higher odds of not working due to an inability to find a job and of not working due to ill health after adjusting for demographic and health factors (P<0.05). As the major causes of visual impairment in the world are uncorrected refractive error and cataract, countries are losing a great deal of labor productivity by failing to provide for the vision health needs of their citizens and failing to help them integrate into the workforce.

How Patients With Schizophrenia Use the Internet: Qualitative Study

PubMed Central

Sibitz, Ingrid; Unger, Annemarie; Amering, Michaela

2010-01-01

Background The Internet is an important source of health information for people with psychiatric conditions. Little is known about the way patients with schizophrenia use the Internet when it comes to issues related to their illness. Data on their specific needs, difficulties, and the consequences related to Internet use are lacking. Objective Our objective was to investigate the nature and subjective consequences of health-related Internet use among patients with schizophrenia. Methods In all, 26 individual semistructured interviews were conducted and analyzed qualitatively in groups of 4 until theoretical saturation was achieved. Results Study results suggest that the Internet is an influential source of illness-related information for patients with schizophrenia. Many aspects of their behavior around the Internet resemble those of individuals not afflicted by mental illness. Importantly, problems specific to patients with schizophrenia were stimulus overflow, an inability to deal with the abundance of information, difficulties with concentration, lack of energy, paranoid ideas, symptom provocation, and the need to distance themselves from illness-related topics as part of the recovery process. Internet information was subjectively perceived as having the potential to significantly change patients’ attitudes toward medication and their relationships with doctors. Conclusions These findings provide insight into how individuals with schizophrenia handle illness-related Internet information. The data could contribute to the continuous development of Internet-based interventions and offer novel approaches to optimizing traditional treatment options. PMID:21169176

The description of physical signs of illness in photographs by physicians with abnormal colour vision.

PubMed

Campbell, John L; Spalding, J Anthony B; Mir, Fraz A

2004-07-01

Physicians with congenital colour vision deficiency (CCVD) have reported difficulties recognising certain physical signs of illness, for example, jaundice, red rashes and pallor, and interpreting coloured charts, diagrams and slide projections. However, there has been little study of the effects of CCVD on the performance of medical practitioners. The aim of this study was to look for evidence of the effect of CCVD on the ability of physicians to recognise and describe physical signs of illness that have colour as either the main or an important feature. Twenty-three general practitioners with CCVD were shown 11 colour photographs depicting colour signs of illness and were asked to describe the signs they saw and rate their confidence in making their descriptions. Their responses were compared to those of 23 age-matched general practitioners with normal colour vision. General practitioners with CCVD compared to those with normal colour vision had less ability and confidence in detecting physical signs in the photographs and naming the colours. The results of this study support other evidence that physicians with CCVD have difficulties detecting some colour signs of illness and naming the colours. Because of the use of photographs the extent of the problem in clinical practice is unknown but medical practitioners with CCVD should be aware of the possibility of failing to detect or correctly assess physical signs that are characterised by colour.

Final technical report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Richman, M.

1996-08-01

Granular flows of nearly elastic, identical spheres down bumpy inclines are described. A numerical technique is developed to overcome the difficulties associated with the ill-defined `tops` of these flows.

Sedation and Analgesia in Transportation of Acutely and Critically Ill Patients.

PubMed

Johnston, Dawn; Franklin, Kevin; Rigby, Paul; Bergman, Karen; Davidson, Scott B

2016-06-01

Transportation of acutely or critically ill patients is a challenge for health care providers. Among the difficulties that providers face is the balance between adequate sedation and analgesia for the transportation event and maintaining acceptable respiratory and physiologic parameters of the patient. This article describes common challenges in providing sedation and analgesia during various phases of transport. Copyright © 2016 Elsevier Inc. All rights reserved.

A Cross Cultural Comparison of Disability and Symptomatology Associated with CFS.

PubMed

Zdunek, Maria; Jason, Leonard A; Evans, Meredyth; Jantke, Rachel; Newton, Julia L

Few studies have compared symptomatology and functional differences experienced by patients with chronic fatigue syndrome (CFS) across cultures. The current study compared patients with CFS from the United States (US) to those from the United Kingdom (UK) across areas of functioning, symptomatology, and illness onset characteristics. Individuals in each sample met criteria for CFS as defined by Fukuda et al. (1994). These samples were compared on two measures of disability and impairment, the DePaul Symptom Questionnarie (DSQ) and the Medical outcomes study 36-item short-form health survey (SF-36). Results revealed that the UK sample was significantly more impaired in terms of mental health and role emotional functioning, as well as specific symptoms of pain, neurocognitive difficulties, and immune manifestations. In addition, the UK sample was more likely to be working rather than on disability. Individuals in the US sample reported more difficulties falling asleep, more frequently reported experiencing a sudden illness onset (within 24 hours), and more often reported that the cause of illness was primarily due to physical causes. These findings suggest that there may be important differences in illness characteristics across individuals with CFS in the US and the UK, and this has implications for the comparability of research findings across these two countries.

Poverty, social stress & mental health.

PubMed

Kuruvilla, A; Jacob, K S

2007-10-01

While there is increasing evidence of an association between poor mental health and the experience of poverty and deprivation, the relationship is complex. We discuss the epidemiological data on mental illness among the different socio-economic groups, look at the cause -effect debate on poverty and mental illness and the nature of mental distress and disorders related to poverty. Issues related to individual versus area-based poverty, relative poverty and the impact of poverty on woman's and child mental health are presented. This review also addresses factors associated with poverty and the difficulties in the measurement of mental health and illness and levels/impact of poverty.

Strengths and difficulties in children with cochlear implants--comparing self-reports with reports from parents and teachers.

PubMed

Anmyr, Lena; Larsson, Kjerstin; Olsson, Mariann; Freijd, Anders

2012-08-01

The aim was to explore and compare how children with cochlear implants, their parents, and their teachers perceive the children's mental health in terms of emotional and behavioral strengths and difficulties. The self-report, parents', and teachers' versions of the Strengths and Difficulties Questionnaire (SDQ) were used to assess the mental health of 22 children with cochlear implants. The children's assessments were then compared to the parents' and 17 teachers' assessments. The data were analyzed using the SPSS software package. Total difficulties (p=.000), emotional symptoms (p=.000), and conduct problems (p=.007) were greater according to the children than according to parents and teachers. Younger children (9 years, n=12) reported more emotional symptoms than older children (12 and 15 years, n=10). Almost a quarter of the children rated themselves in a way indicating mental ill-health. Parents and teachers each indicated mental ill-health for one child. Children with cochlear implants express greater concerns about their mental health than their parents and teachers do. This is important knowledge for adults in families, schools, and health care in order to support these children and offer treatment when needed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[Burden of relatives and their expectations towards psychiatric institutions. A review of the literature and own results].

PubMed

Schmid, R; Spiessl, H; Vukovich, A; Cording, C

2003-03-01

This article aimed to provide an overview regarding the burden of relatives of mentally ill patients and their expectations towards psychiatric institutions. The literature was selected from Medline covering the years 1996 - 2002. 342 articles were reviewed, 145 of which were described in this review. The burden of relatives are manifold and can be classified into the following categories: time spent on caring, financial difficulties, occupational restrictions, detrimental effects on relatives own physical and psychological well-being, reduction in leisure activities, negative effects on social relationships, experiences of discrimination and refusal, deficiencies in information about illness, feelings of not being taken seriously, insufficient service support, long distance to mental health service, emotional burdens of caregivers and difficulties with the patients behaviour. The expectations of the relatives mainly refer to the categories "relationship between staff and relatives", "information about illness" and "establishing of institutions required". The various burdens of relatives and their expectations towards psychiatric services point to necessary improvements of mental health services in the sense of a consumer-oriented psychiatric care.

School Experiences of Siblings of Children with Chronic Illness: A Systematic Literature Review.

PubMed

Gan, Lucy L; Lum, Alistair; Wakefield, Claire E; Nandakumar, Beeshman; Fardell, Joanna E

Siblings of children with chronic illness have unique experiences that can affect their school functioning, such that they may miss ongoing periods of school, experience difficulties with schoolwork or experience changes in their peer and teacher interactions. This review provides an overview of these siblings' school experiences. Six databases (Medline, PsychINFO, CINAHL, ERIC, Embase and The Cochrane Library) were systematically searched for studies examining the school experiences and peer relationships of siblings of children with chronic illness, as well as school-based interventions for these siblings. Studies were included if they were published in or after 2000 and were published in English. We identified 2137 articles upon initial search. From these, we identified 28 eligible studies examining the school experiences of >1470 siblings of children with chronic illness. Three key themes were identified throughout the reviewed articles. The literature described 1) the psychological impact on siblings at school; 2) decreases in school attendance and academic functioning, and; 3) changes or perceived differences in peer and teacher interactions. Siblings value teacher and peer support, and this support may contribute to better sibling school functioning. Many siblings are socially resilient, yet overlooked, members of the family who may present with psychological, academic and peer related difficulties at school following diagnosis of a brother or sister with chronic illness. Future research is needed to further delineate the sibling school experience to better facilitate the development of targeted sibling support interventions within the school environment. Copyright © 2016 Elsevier Inc. All rights reserved.

Creating the final conversations scale: a measure of end-of-life relational communication with terminally ill individuals.

PubMed

Generous, Mark Alan; Keeley, Maureen P

2014-01-01

Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the "Final Conversations Scale" was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality/religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness/death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale.

[THE NEED FOR HELP OF FAMILY CAREGIVERS OF PERSONS WITH MENTAL ILLNESS IN A UNIQUE SERVICE FOR FAMILIES AT THE BEER SHEVA MENTAL HEALTH CENTER].

PubMed

Shalev, Anat; Shor, Ron

2016-12-01

Limited research attention has been given to the needs of family caregivers of persons with mental illness in psychiatric hospitals despite the stressors and difficulties they experience. In light of the recognition of the significance of helping family caregivers, a new model of consultation and support centers for family caregivers, called Meital, has been developed. To examine the needs of family caregivers who receive help in Meital, at the Beer Sheva Mental Health Center. Eighty-five family caregivers participated in the research. They completed a structured questionnaire constructed for this research two weeks after they started receiving services from Meital. The questionnaire included four areas of needs for help. These areas examined the extent of the need for help with respect to each of the items in the instrument. The mean of the extent of need for help of the items in the 'information and knowledge' subscale was the highest. Average to high means of the items of the subscales were found in the subscales relating to 'difficulties stemming from the impact of the situation of the person with mental illness on the function of the family caregiver receiving help,' 'on the function of other family members' and 'difficulties coping with the person with mental illness.' The mean of the items of the subscale 'relationships with professionals and informal systems' was the lowest. An examination of the items within the subscales indicated that items relating to the 'impact of the situation of the person with mental illness on the family caregiver who receives help' were ranked higher than the items relating to the 'impact on the function of other family caregivers.' Items relating to 'relationships with professionals' were ranked higher than items relating to 'relationships with informal systems.' This research emphasizes the importance of implementing the family-centered approach, the basis of the Meital Model, in psychiatric institutions. The focus of this approach is on the need for help of family caregivers beyond the help needed for them to function as a resource of help for the ill person. The findings also illuminate the importance of making information and knowledge accessible for family caregivers.

Growing up with an ill parent: An examination of family characteristics and parental illness features.

PubMed

Stoeckel, Maggie; Weissbrod, Carol

2015-12-01

Existing literature suggests that the children of ill parents are vulnerable to a variety of psychosocial difficulties such as depression and anxiety. The purpose of the current study is to investigate the impact of family characteristics (parental involvement, familial support, stress experienced as a result of parental illness) and parental illness features (severity, duration, recovery status, frequency of symptoms, course) on the psychosocial functioning (depression, anxiety, life satisfaction) of late adolescents who have grown up with an ill parent but no longer live with their parents. Participants were 71 college students with a parent who experienced a chronic medical condition while they were growing up. Participants provided information regarding family characteristics, parental illness features, and the impact of parental illness. Impact of parental illness was assessed using the Impact of Illness Scale. Participants also completed measures of depression, anxiety, and life satisfaction. Participants' reported impact of parent illness was positively correlated with participant depression and anxiety. Several family characteristics and parental illness features were significantly associated with participant psychosocial functioning. In particular, lower parental involvement was correlated with greater participant depression and anxiety, as well as lower life satisfaction. These findings extend our understanding of the impact of parental illness on late adolescents' psychosocial functioning. Results could have clinical applications for psychosocial interventions in children and families coping with chronic illness. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

A review of measles.

PubMed

Dardis, Melissa R

2012-02-01

Measles, once a common childhood illness that many older school nurses could recognize without difficulty, needs review again after reemerging from Europe and other continents. A highly contagious disease, which has been referenced since the seventh century, the virus can cause serious illness and death, despite the fact that it is vaccine preventable. School nurses are wise to review the pathogenesis, occurrences, incubation, and communicability as well as methods to diagnose and treat measles in order to prevent an outbreak.

Energy Requirements in Critically Ill Patients.

PubMed

Ndahimana, Didace; Kim, Eun-Kyung

2018-04-01

During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.

Illness and the disruption of autobiography: accounting for the complex effect of awareness in schizophrenia.

PubMed

Lysaker, Paul H; Buck, Kelly D

2007-09-01

Interventions for individuals with schizophrenia often involve helping clients become more aware of their condition so they can make informed decisions about their treatment and recovery. Yet the effect of awareness or admission of schizophrenia has remained elusive. Empirical research has found that awareness of illness is essential for people to make informed decisions about the future, to free themselves from blame for difficulties linked with illness, and to form and sustain bonds with others. However, this awareness has also been linked to depressed mood, lower self-esteem, and a diminished sense of well-being. In this article, we review the evidence and suggest that the effect of awareness on well-being may be mitigated by the meaning clients assign to their illness and whether it disrupts their life story. Evidence linking clients' internalized, stigmatizing beliefs about illness with demoralization is presented, and clinical implications are discussed.

Mentally ill persons in the criminal justice system: some perspectives.

PubMed

Lamb, H Richard; Weinberger, Linda E; Gross, Bruce H

2004-01-01

There is an increasing number of severely mentally ill persons in the criminal justice system. This article first discusses the criminalization of persons with severe mental illness and its causes, the role of the police and mental health, and the treatment of mentally ill offenders and its difficulties. The authors then offer recommendations to reduce criminalization by increased coordination between police and mental health professionals, to increase mental health training for police officers, to enhance mental health services after arrest, and to develop more and better community treatment of mentally ill offenders. The necessary components of such treatment are having a treatment philosophy of both theory and practice; having clear goals of treatment; establishing a close liaison between treatment staff and the justice system; understanding the need for structure; having a focus on managing violence; and appreciating the crucial role of case management, appropriate living arrangements, and the role of family members.

African American Elders' Serious Illness Experiences: Narratives of "God Did," "God Will," and "Life Is Better".

PubMed

Coats, Heather; Crist, Janice D; Berger, Ann; Sternberg, Esther; Rosenfeld, Anne G

2017-04-01

The foundation of culturally sensitive patient-centered palliative care is formed from one's social, spiritual, psychological, and physical experiences of serious illness. The purpose of this study was to describe categories and patterns of psychological, social, and spiritual healing from the perspectives of aging seriously ill African American (AA) elders. Using narrative analysis methodology, 13 open-ended interviews were collected. Three main patterns were "prior experiences," "I changed," and "across past, present experiences and future expectations." Themes were categorized within each pattern: been through it . . . made me strong, I thought about . . . others, went down little hills . . . got me down, I grew stronger, changed priorities, do things I never would have done, quit doing, God did and will take care of me, close-knit relationships, and life is better. "Faith" in God helped the aging seriously ill AA elders "overcome things," whether their current illness or other life difficulties.

Illness perceptions in adolescents with a psychiatric diagnosis in Pakistan

PubMed Central

Imran, Nazish; Azeem, Muhammad Waqar; Chaudhry, Mansoor R.; Butt, Zeeshan

2015-01-01

Aims and method To assess adolescents' perceptions of their psychiatric illness and the role of various demographic factors in a Pakistani setting. Adolescents with various psychiatric diagnoses were interviewed using a structured questionnaire including the Illness Perceptions Questionnaire–Revised (IPQ-R). Results Fifty-two adolescents with various psychiatric illnesses were interviewed; their mean age was 12.7 years and the majority (67%) were female. Males had significantly higher scores on timeline and emotional representation (P<0.05), suggesting strongly held beliefs about chronicity of their illness and anger and worry about their condition. Adolescents' own emotional state, stress, family problems and bad luck were endorsed by participants as some of the causal factors in their mental illness. Clinical implications Despite the importance of early intervention in psychiatric problems, engaging youth in the treatment process in Pakistan remains difficult. Better understanding of how adolescents perceive their psychiatric difficulties may play a significant role in developing culturally sensitive interventions and better utilisation of services. PMID:26755949

Illness perceptions in adolescents with a psychiatric diagnosis in Pakistan.

PubMed

Imran, Nazish; Azeem, Muhammad Waqar; Chaudhry, Mansoor R; Butt, Zeeshan

2015-08-01

Aims and method To assess adolescents' perceptions of their psychiatric illness and the role of various demographic factors in a Pakistani setting. Adolescents with various psychiatric diagnoses were interviewed using a structured questionnaire including the Illness Perceptions Questionnaire-Revised (IPQ-R). Results Fifty-two adolescents with various psychiatric illnesses were interviewed; their mean age was 12.7 years and the majority (67%) were female. Males had significantly higher scores on timeline and emotional representation (P<0.05), suggesting strongly held beliefs about chronicity of their illness and anger and worry about their condition. Adolescents' own emotional state, stress, family problems and bad luck were endorsed by participants as some of the causal factors in their mental illness. Clinical implications Despite the importance of early intervention in psychiatric problems, engaging youth in the treatment process in Pakistan remains difficult. Better understanding of how adolescents perceive their psychiatric difficulties may play a significant role in developing culturally sensitive interventions and better utilisation of services.

Modeling Periodic Impulsive Effects on Online TV Series Diffusion.

PubMed

Fu, Peihua; Zhu, Anding; Fang, Qiwen; Wang, Xi

Online broadcasting substantially affects the production, distribution, and profit of TV series. In addition, online word-of-mouth significantly affects the diffusion of TV series. Because on-demand streaming rates are the most important factor that influences the earnings of online video suppliers, streaming statistics and forecasting trends are valuable. In this paper, we investigate the effects of periodic impulsive stimulation and pre-launch promotion on on-demand streaming dynamics. We consider imbalanced audience feverish distribution using an impulsive susceptible-infected-removed(SIR)-like model. In addition, we perform a correlation analysis of online buzz volume based on Baidu Index data. We propose a PI-SIR model to evolve audience dynamics and translate them into on-demand streaming fluctuations, which can be observed and comprehended by online video suppliers. Six South Korean TV series datasets are used to test the model. We develop a coarse-to-fine two-step fitting scheme to estimate the model parameters, first by fitting inter-period accumulation and then by fitting inner-period feverish distribution. We find that audience members display similar viewing habits. That is, they seek new episodes every update day but fade away. This outcome means that impulsive intensity plays a crucial role in on-demand streaming diffusion. In addition, the initial audience size and online buzz are significant factors. On-demand streaming fluctuation is highly correlated with online buzz fluctuation. To stimulate audience attention and interpersonal diffusion, it is worthwhile to invest in promotion near update days. Strong pre-launch promotion is also a good marketing tool to improve overall performance. It is not advisable for online video providers to promote several popular TV series on the same update day. Inter-period accumulation is a feasible forecasting tool to predict the future trend of the on-demand streaming amount. The buzz in public social communities also represents a highly correlated analysis tool to evaluate the advertising value of TV series.

Modeling Periodic Impulsive Effects on Online TV Series Diffusion

PubMed Central

Fang, Qiwen; Wang, Xi

2016-01-01

Background Online broadcasting substantially affects the production, distribution, and profit of TV series. In addition, online word-of-mouth significantly affects the diffusion of TV series. Because on-demand streaming rates are the most important factor that influences the earnings of online video suppliers, streaming statistics and forecasting trends are valuable. In this paper, we investigate the effects of periodic impulsive stimulation and pre-launch promotion on on-demand streaming dynamics. We consider imbalanced audience feverish distribution using an impulsive susceptible-infected-removed(SIR)-like model. In addition, we perform a correlation analysis of online buzz volume based on Baidu Index data. Methods We propose a PI-SIR model to evolve audience dynamics and translate them into on-demand streaming fluctuations, which can be observed and comprehended by online video suppliers. Six South Korean TV series datasets are used to test the model. We develop a coarse-to-fine two-step fitting scheme to estimate the model parameters, first by fitting inter-period accumulation and then by fitting inner-period feverish distribution. Results We find that audience members display similar viewing habits. That is, they seek new episodes every update day but fade away. This outcome means that impulsive intensity plays a crucial role in on-demand streaming diffusion. In addition, the initial audience size and online buzz are significant factors. On-demand streaming fluctuation is highly correlated with online buzz fluctuation. Conclusion To stimulate audience attention and interpersonal diffusion, it is worthwhile to invest in promotion near update days. Strong pre-launch promotion is also a good marketing tool to improve overall performance. It is not advisable for online video providers to promote several popular TV series on the same update day. Inter-period accumulation is a feasible forecasting tool to predict the future trend of the on-demand streaming amount. The buzz in public social communities also represents a highly correlated analysis tool to evaluate the advertising value of TV series. PMID:27669520

Choosing a Career in Psychiatry

MedlinePlus

... medical and surgical patients who may have psychiatric problems or who have difficulty coping with their illness. Because modern psychiatry places special emphasis on the relationship between mind and body, students pay special attention to issues of stress and ...

Ethics and the compensation of immigrant workers for work-related injuries and illnesses.

PubMed

Gravel, Sylvie; Vissandjée, Bilkis; Lippel, Katherine; Brodeur, Jean-Marc; Patry, Louis; Champagne, François

2010-10-01

This paper examines the compensation process for work-related injuries and illnesses by assessing the trajectories of a sample of immigrant and non-immigrant workers (n = 104) in Montreal. Workers were interviewed to analyze the complexity associated with the compensation process. Experts specialized in compensation issues assessed the difficulty of the interviewees' compensation process. Immigrant workers faced greater difficulties with medical, legal, and administrative issues than non-immigrants did. While immigrant workers' claim forms tended to be written more often by employers or friends (58% vs. 8%), the claims were still more often contested by employers (64% vs. 24%). Immigrant workers were less likely to obtain a precise diagnosis (64% vs. 42%) and upon returning to work were more likely to face sub-optimal conditions. Such results throw into relief issues of ethics and equity in host societies that are building their economy with migrant workers.

Distress associated with patients' symptoms and depression in a sample of Mexican caregivers of individuals with MS.

PubMed

Lehan, Tara; Arango-Lasprilla, Juan Carlos; Macias, Miguel Ángel; Aguayo, Adriana; Villaseñor, Teresita

2012-11-01

The objectives of this quantitative correlational study were to: (a) determine the frequency and level of distress associated with patients' symptoms as reported by caregivers of individuals with multiple sclerosis (MS), (b) determine the prevalence of depression in these caregivers, and (c) examine the relationship between these caregivers' total symptom distress and depression after controlling for patient, caregiver, and illness characteristics. In this quantitative correlational study, data from 79 caregivers of individuals with MS in Mexico were analyzed. The patient symptoms with the highest average level of distress for caregivers were depression, difficulty talking, difficulty hearing, becoming upset easily, and upsetting other people. Patient symptoms with the lowest average level of distress for caregivers included difficulty learning, seizures, trouble reading, difficulty eating, and difficulty writing. Forty percent of the caregivers met the criteria for probable major depressive disorder. Results of a multivariate regression analysis showed that caregiver total symptom distress was significantly related to caregiver depression, after controlling for patient marital status, caregiver gender, caregiver relationship to patient, caregiver current employment, and months spent caregiving. These findings have implications for MS patients and caregivers as well as larger society, as depression in caregivers often results in the institutionalization of individuals with chronic illnesses and disabilities, which is costly for both individuals and society. In addition, there might be increased expenditures associated with the caregivers' own declining health. For these reasons, it is important to develop a better understanding of its risk factors to identify caregivers who might benefit from intervention. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Burdens and difficulties experienced by caregivers of children and adolescents with schizophrenia-spectrum disorders: a qualitative study.

PubMed

Knock, Jane; Kline, Emily; Schiffman, Jason; Maynard, Ashley; Reeves, Gloria

2011-11-01

The purpose of this qualitative study was to investigate the burdens and difficulties associated with the experience of caring for youth with schizophrenia-spectrum disorders. Ten caregivers participated in a modified version of the Knowledge about Schizophrenia Illness interview. The most common areas of general difficulties reported by caregivers were emotional burdens and the everyday practical demands and sacrifices required in caring for their dependents. RESULTS also suggested high levels of burden for caregivers concerning difficulties with mental health services. Additional work is needed to learn more about the challenges that caregivers of youth with schizophrenia-spectrum disorders are facing, as well as to develop empirically based strategies for helping these caregivers and their dependents. © 2011 Blackwell Publishing Asia Pty Ltd.

To Your Health: NLM update transcript - Improving the international response to infectious illness

MedlinePlus

... international responses to the bird flu, Ebola, and Zika viruses are a byproduct of how public health ... in 2009, Ebola in 2014-15, and the Zika virus in 2015-16 suggest similar operational difficulties ...

Early onset anorexia nervosa.

PubMed Central

Fosson, A; Knibbs, J; Bryant-Waugh, R; Lask, B

1987-01-01

This paper describes 48 children, aged 14 years or less, who met diagnostic criteria for anorexia nervosa modified from Morgan and Russell. The characteristics of the sample (13 boys and 35 girls) are described along with features of the illness, associated family characteristics, treatment in hospital, and a brief description of treatment. Difficulties in diagnosis are addressed, with reference in particular to the high incidence of depression in this group. Finally, the importance and difficulty of close paediatric/psychiatric liaison in diagnosis and treatment is emphasised. PMID:3548600

Robust penalty method for structural synthesis

NASA Technical Reports Server (NTRS)

Kamat, M. P.

1983-01-01

The Sequential Unconstrained Minimization Technique (SUMT) offers an easy way of solving nonlinearly constrained problems. However, this algorithm frequently suffers from the need to minimize an ill-conditioned penalty function. An ill-conditioned minimization problem can be solved very effectively by posing the problem as one of integrating a system of stiff differential equations utilizing concepts from singular perturbation theory. This paper evaluates the robustness and the reliability of such a singular perturbation based SUMT algorithm on two different problems of structural optimization of widely separated scales. The report concludes that whereas conventional SUMT can be bogged down by frequent ill-conditioning, especially in large scale problems, the singular perturbation SUMT has no such difficulty in converging to very accurate solutions.

Challenges in managing a mother with a dual diagnosis of peripartum cardiomyopathy and paranoid schizophrenia - a case report.

PubMed

Weerasundera, Rajiv; Yogaratnam, Jegan

2013-01-01

Psychotic illness has a low incidence in the puerperal period. Peripartum cardiomyopathy as a complication of pregnancy is also rare. We report a case where the above two conditions occurred simultaneously in a patient and posed significant difficulties in the clinical management. She was diagnosed as having paranoid schizophrenia and peripartum cardiomyopathy. Many of the antipsychotics were contraindicated, and electroconvulsive therapy could not be administered due to the added risks involved with regard to anesthesia. She was therefore managed with clonazepam and olanzapine. This case highlights the challenges in a patient with a psychiatric illness presenting with comorbid physical illness. Copyright © 2013 Elsevier Inc. All rights reserved.

Public Policy and Mental Illnesses: Jimmy Carter's Presidential Commission on Mental Health

PubMed Central

Grob, Gerald N

2005-01-01

President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short-lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created. PMID:16201999

What I did on my summer vacation

NASA Astrophysics Data System (ADS)

Hotinski, Roberta

Imagine learning on Monday morning that you had to write an article on an area of science you knew little about. Now imagine that the article had to be finished by Thursday morning, in print by Friday, and scrutinized by millions on the following Monday morning. If you felt a rush of adrenaline reading that scenario, then you have a sense of my fellowship experience this summer. Instead of scaling mountains or feverishly experimenting in the lab, I explored a strange new frontier: the world of science journalism. I spent ten weeks immersed in the tumult and fervor of a news organization, and now have a new appreciation for the art of science communication as well as a new sympathy for science writers that would benefit any researcher.

Narratives by Japanese mothers with chronic mental illness in the Tokyo metropolitan area: their feelings toward their children and perceptions of their children's feelings.

PubMed

Ueno, Rie; Kamibeppu, Kiyoko

2008-07-01

Women with mental illness generally have normal fertility rates. Mothers with mental illness think that their children are important for their lives but also experience difficulties in relating to their children. Therefore, it is important to understand the mothers' perception of what experiences influence them or their parenting practices in relationships with their children. We conducted narrative interviews with 20 Japanese mothers who were being treated for either schizophrenia or mood disorders. The data were analyzed using the Modified Grounded Theory Approach. For the mothers, their feelings toward their children and their perception of their children's feelings toward them or their illness influenced the mothers and their parenting practices. Implications for support are discussed and directions for future research are presented.

The explanatory models of depression in low income countries: listening to women in India.

PubMed

Pereira, Bernadette; Andrew, Gracy; Pednekar, Sulochana; Pai, Reshma; Pelto, Pertti; Patel, Vikram

2007-09-01

Women, and persons facing social and economic disadvantage, are at greater risk for depressive disorders. Our objective was to describe the explanatory models of illness in depressed women, in particular, their idioms of distress, and their views of their social circumstances and how this related to their illness. We carried out a qualitative investigation nested in a population based cohort study of women's mental and reproductive health in Goa, India. We purposively sampled women who were ever-married and who had been found to be suffering from a depressive disorder on the basis of a structured diagnostic interview. In-depth interviews were carried out about six months apart exploring stressors in women's lives, a typical day in their recent lives, and their illness narratives (idioms of distress, causal models, impact of illness, help-seeking). 35 women consented to participate in the study, 28 completing both interviews. Women gave expression to their problems primarily through somatic complaints, typically a variety of body aches, autonomic symptoms, gynecological symptoms and sleep problems. There was frequent mention of overall "weakness" and tiredness. Economic difficulties and difficulties with interpersonal relationships (particularly related to marital relationships) were the most common causal models. However, women rarely considered biomedical concepts, for example, the notion that they may suffer from an illness or that their complaints were due to a biochemical disturbance in the brain. Despite the lack of a biomedical concept, most of the participants had sought medical help, typically for reproductive and somatic complaints. We recommend the use of somatic idioms as the defining clinical features, and a broader, psychosocial model for understanding the aetiology and conceptualization of the clinical syndrome of depression for public health interventions and mental health promotion in the Indian context.

Continuum beliefs and stigmatising beliefs about mental illness: results from an Asian community survey

PubMed Central

Subramaniam, Mythily; Abdin, Edimansyah; Picco, Louisa; Shahwan, Shazana; Jeyagurunathan, Anitha; Vaingankar, Janhavi Ajit; Chong, Siow Ann

2017-01-01

Objectives To establish the prevalence and correlates of continuum beliefs for five mental illnesses in a multiethnic population and to explore its association with stigma. Design A community-based, cross-sectional study. Setting A national study in a multiethnic Asian country. Participants A comprehensive study of 3006 Singapore residents (Singapore citizens and permanent residents) aged 18–65 years who were living in Singapore at the time of the survey. Outcome measures Parameters assessed included belief in a continuum of symptom experience, stigma dimensions and causal beliefs in mental illness. Statistical analyses included descriptive statistics and multiple linear regression (MLR). Results About half of the population indicated agreement with a continuum of symptoms for depression (57.9%) and dementia (46.8%), whereas only about one in three respondents agreed with it for alcohol abuse (35.6%), schizophrenia (32.7%) and obsessive–compulsive disorder (OCD) (36.8%). MLR analyses revealed that students (β=0.28; 95% CI 0.05 to 0.50; p=0.018) and those who were unemployed (β=0.60; 95% CI 0.26 to 0.95; p=0.001) (vs employed) as well as those who had previous contact with people with mental illness (β = 0.31; 95% CI 0.18 to 0.45; p<0.001) and believed stress, family arguments, difficulties at work or financial difficulties to be a cause for mental illness (β=0.43; 95% CI 0.13 to 0.73; p=0.005) were associated with a higher belief in a continuum of symptom experience. Continuum beliefs were related to lower desire for social distance in alcohol abuse, OCD and schizophrenia; however, they were associated with higher scores on ‘weak-not-sick’ stigma dimension in dementia and schizophrenia. Conclusions Perceiving that a person with a mental illness is similar to themselves may reduce social distancing by the public. Thus, the approach may lend itself well to public education aimed at reducing stigma. PMID:28381420

Why do children lack the flexibility to innovate tools?

PubMed

Cutting, Nicola; Apperly, Ian A; Beck, Sarah R

2011-08-01

Despite being proficient tool users, young children have surprising difficulty in innovating tools (making novel tools to solve problems). Two experiments found that 4- to 7-year-olds had difficulty on two tool innovation problems and explored reasons for this inflexibility. Experiment 1 (N=51) showed that children's performance was unaffected by the need to switch away from previously correct strategies. Experiment 2 (N=92) suggested that children's difficulty could not easily be explained by task pragmatics or permission issues. Both experiments found evidence that some children perseverated on a single incorrect strategy, but such perseveration was insufficient to explain children's tendency not to innovate tools. We suggest that children's difficulty lies not with switching, task pragmatics, or behavioral perseveration but rather with solving the fundamentally "ill-structured" nature of tool innovation problems. Copyright © 2011 Elsevier Inc. All rights reserved.

Breaking bad news: communication around parental multiple sclerosis with children.

PubMed

Paliokosta, Elena; Diareme, Stavroula; Kolaitis, Gerasimos; Ferentinos, Spyros; Lympinaki, Eirini; Tsiantis, John; Romer, George; Karageorgiou, Clementine; Tsiantis, Alkis; Anasontzi, Sofia; Tsalamanios, Emmanuel

2009-03-01

This study investigates the relation of communication around parental multiple sclerosis (MS) to family dysfunction and mental health problems of the children in Greek families. Fifty-six families with a parent with MS were studied regarding emotional well-being of children, parental depression, family functioning, and illness' related impairment, correlated to the amount of information about parental illness provided to children. Significant differences were found in three dimensions of child psychopathology on maternal scores of Child Behavior Checklist, between children who had partial information about parental illness and the other two groups of children who had explicit or no information at all. Differences were also observed in children's scores on (Youth Self Report) social problems between the same groups. The finding that children who had only partial information about their parents' illness presented more problems, illustrates the importance of "how, what, and how much" of information is communicated to children. Clinical implications are discussed in terms of the families' difficulties with communicating parental illness with their children and possible need for professional support.

The Couples' Illness Communication Scale (CICS): development and evaluation of a brief measure assessing illness-related couple communication.

PubMed

Arden-Close, Emily; Moss-Morris, Rona; Dennison, Laura; Bayne, Louise; Gidron, Yori

2010-09-01

When one member of a couple has a chronic illness, communication about the illness is important for both patient and partner well-being. This study aimed to develop and test a brief self-report measure of illness-related couple communication. A combination of correlations and multiple regression were used to assess the internal consistency and validity of the Couples' Illness Communication Scale (CICS). A scale to provide insight into both patient and partner illness communication was developed. The CICS was then tested on patients with ovarian cancer (N=123) and their partners (N=101), as well as patients with early stage multiple sclerosis (MS) who had stable partnerships (N=64). The CICS demonstrated good acceptability, internal consistency, convergent validity (correlations with general couple communication and marital adjustment), construct validity (correlations with intrusive thoughts, social/family well-being, emotional impact of the illness, and psychological distress), and test-retest reliability. The CICS meets the majority of psychometric criteria for assessment measures in both a life-threatening illness (ovarian cancer) and a chronic progressive disease (MS). Further research is required to understand its suitability for use in other populations. Adoption of the CICS into couple-related research will improve understanding of the role of illness-related communication in adjustment to illness. Use of this short, simple tool in a clinical setting can provide a springboard for addressing difficulties with illness-related couple communication and could aid decision making for referrals to couple counselling.

Nicotine Withdrawal, Relapse of Mental Illness, or Medication Side-Effect? Implementing a Monitoring Tool for People With Mental Illness Into Quitline Counseling.

PubMed

Segan, Catherine J; Baker, Amanda L; Turner, Alyna; Williams, Jill M

2017-01-01

Smokers with mental illness and their health care providers are often concerned that smoking cessation will worsen mental health. Smokers with mental illness tend to be more nicotine-dependent and experience more severe symptoms of nicotine withdrawal, some of which are difficult to distinguish from psychiatric symptoms. In addition, smoking cessation can increase the blood levels and hence side effects of some psychotropic medications. Improved monitoring of nicotine withdrawal and medication side effects may help distinguish temporary withdrawal symptoms from psychiatric symptoms and facilitate targeted treatment to help smokers with mental illness manage the acute phase of nicotine withdrawal. The aim of this research was to examine the acceptability and feasibility to quitline counselors of implementing structured assessments of nicotine withdrawal and common medication side effects in people with mental illness who are quitting smoking using a telephone smoking cessation service. Monitoring involves administering (once pre-cessation and at each contact post-cessation) (1) the Minnesota Nicotine Withdrawal Scale, assessing eight symptoms: anger, anxiety, depression, cravings, difficulty concentrating, increased appetite, insomnia, and restlessness and (2) an adverse side effects checklist of 5 to 10 symptoms, for example, dry mouth and increased thirst. Following a 1-day update training in mental health, quitline counselors were asked to offer these assessments to callers disclosing mental illness in addition to usual counseling. Group interviews with counselors were conducted 2 months later to examine implementation barriers and benefits. Barriers included awkwardness in integrating a new structured practice into counseling, difficulty in limiting some callers to only the content of new items, and initial anxieties about how to respond to changes in some symptoms. Benefits included the ability to provide objective feedback on changes in symptoms, as this identified early benefits of quitting, provided reassurance for clients, and provided an opportunity for early intervention where symptoms worsened. Structured monitoring of withdrawal symptoms and medication side effects was able to be integrated into the quitline's counseling and was valued by counselors and clients. Given evidence of its benefits in this limited pilot study, we recommend it be considered for larger-scale adoption by quitlines.

[Acceptance of patients with mental illness: a family perspective].

PubMed

Vicente, Jéssica Batistela; Mariano, Pamela Patrícia; Buriola, Aline Aparecida; Paiano, Marcelle; Waidman, Maria Angélica Pagliarini; Marcon, Sonia Silva

2013-06-01

The aim of this descriptive and qualitative study is to analyse how acceptance of mental illness is perceived by family members of the patient and the surrounding community. This study was conducted with the help of 10 families of patients with mental disorders admitted to the psychiatric emergency unit of the Municipal Hospital of Maringá, state of Parana, Brazil. Data were collected from October to December 2010, in open interviews and submitted to thematic content analysis, resulting in three categories: "Care, a constant requirement", "Living with a patient with mental illness: a whirlwind of emotions", "A wall constructed with stigma and prejudgement: the need for deconstruction". The conclusion is that an understanding of the disease is vital for acceptance of the illness itself and of the patient, and that healthcare professionals must remain close to the family to provide support, answer queries related to the disease, and help the family to face the difficulties of everyday life.

Canada's Compassionate Care Benefit: views of family caregivers in chronic illness.

PubMed

Williams, Allison; Crooks, Valorie A; Stajduhar, Kelli I; Allan, Diane; Cohen, S Robin

2006-09-01

Based on a pilot evaluation of Canada's recently introduced Compassionate Care Benefit (CCB), the purpose of this paper is to highlight the experiences of family caregivers caring for people with non-malignant advanced chronic illness. Using Patton's (1997) utilization-focused evaluation approach, 25 telephone interviews were conducted with three groups of family caregivers: those who had successfully applied for the CCB; those who were unsuccessful in their applications; those who had never applied for the benefit. The CCB has a number of limitations, particularly for caregivers of patients diagnosed with non-malignant advanced chronic illness. The central limitations are: difficulties associated with accurate prognostication; limited definition of "family member"; insufficient length of the funding period. By modelling similar programmes internationally, such as those in Sweden, Norway, and the Netherlands, Canada would likely find the CCB to have greater relevance and accessibility to Canadian caregivers, particularly those caring for people with non-malignant advanced chronic illness.

The Impact of Neonatal Illness on Nutritional Requirements—One Size Does Not Fit All

PubMed Central

Ramel, Sara E.; Brown, Laura D.

2015-01-01

Sick neonates are at high risk for growth failure and poorer neurodevelopment than their healthy counterparts. The etiology of postnatal growth failure in sick infants is likely multi-factorial and includes undernutrition due to the difficulty of feeding them during their illness and instability. Illness also itself induces fundamental changes in cellular metabolism that appear to significantly alter nutritional demand and nutrient handling. Inflammation and physiologic stress play a large role in inducing the catabolic state characteristic of the critically ill newborn infant. Inflammatory and stress responses are critical short-term adaptations to promote survival, but are not conducive to promoting long-term growth and development. Conditions such as sepsis, surgery, necrotizing enterocolitis, chronic lung disease and intrauterine growth restriction and their treatments are characterized by altered energy, protein and micronutrient metabolism that result in nutritional requirements that are different from those of the healthy, growing term or preterm infant. PMID:25722954

'Him bid sona sel': psychiatry in the Anglo-Saxon Leechbooks.

PubMed

Pell, Christopher

2011-12-01

Classical Greek and Roman writers documented the diagnosis and treatment of psychiatric illness in ancient times. Following the fall of the Western Roman Empire however, we find little writing on the topic in early Medieval Europe. Yet in Britain, medical texts survived and were complemented by local traditions and treatments. This article explores the best-known Anglo-Saxon medical texts, the Leechbooks and Lacnunga, for evidence of psychiatric illness and the treatments employed by physicians in the tenth century. The difficulties encountered when working with sources translated from Old English and speculations about the supernatural aetiology ascribed to these illnesses are detailed. The efficacy of the leechdoms (treatments) described are also investigated for both their placebo and potential pharmacological effects.

Pediatric Solid Organ Transplant Recipients: Transition to Home and Chronic Illness Care

PubMed Central

Lerret, Stacee M; Weiss, Marianne; Stendahl, Gail; Chapman, Shelley; Menendez, Jerome; Williams, Laurel; Nadler, Michelle; Neighbors, Katie; Amsden, Katie; Cao, Yumei; Nugent, Melodee; Alonso, Estella; Simpson, Pippa

2014-01-01

Pediatric solid organ transplant recipients are medically fragile and present with complex care issues requiring high-level management at home. Parents of hospitalized children have reported inadequate preparation for discharge, resulting in problems transitioning from hospital to home and independently self-managing their child’s complex care needs. The aim of this study was to investigate factors associated with the transition from hospital to home and chronic illness care for parents of heart, kidney, liver, lung, or multivisceral recipients. Fifty-one parents from five pediatric transplant centers completed questionnaires on the day of hospital discharge and telephone interviews at 3-week, 3-month, and 6-months following discharge from the hospital. Care coordination (p = .02) and quality of discharge teaching (p < .01) was significantly associated with parent readiness for discharge. Readiness for hospital discharge was subsequently significantly associated with post-discharge coping difficulty (p = .02) at 3-weeks, adherence with medication administration (p = .03) at 3-months, and post-discharge coping difficulty (p = .04) and family management (p = .02) at 6-months post-discharge. The results underscore the important aspect of education and care coordination in preparing patients and families to successfully self-manage after hospital discharge. Assessing parental readiness for hospital discharge is another critical component for identifying risk of difficulties in managing post-discharge care. PMID:25425201

Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions

PubMed Central

Sharma, Ratika; Wigginton, Britta; Meurk, Carla; Ford, Pauline; Gartner, Coral E.

2016-01-01

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes. PMID:28025516

Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions.

PubMed

Sharma, Ratika; Wigginton, Britta; Meurk, Carla; Ford, Pauline; Gartner, Coral E

2016-12-22

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.

Working as a doctor when chronically ill or disabled: comments made by doctors responding to UK surveys.

PubMed

Smith, Fay; Goldacre, Michael J; Lambert, Trevor W

2016-07-01

To report a qualitative study of themes doctors raised spontaneously, in a large-scale prospective cohort study covering many aspects of their medical careers, when referring to their own chronic illness or disability. Questionnaire survey. UK. Questionnaires were sent one, five and 10 years after graduation to 44,539 doctors who qualified between 1993 and 2012 in the UK: 38,613 questionnaires were returned and 11,859 respondents provided comments made by doctors about their training or work. The comments of 123 doctors about their own chronic illness or disability. Main themes raised included poor support for doctors with chronic illness or disability, delays in and changes to careers (either planned ahead or imposed), the impact of pressure at work, difficulties returning to work after illness, limitations on career choices and inadequate careers advice for doctors with chronic illness or disabilities. More needs to be done to ensure that doctors with chronic illness or disability receive appropriate support. Occupational health guidance should be monitored closely, with more support for ill doctors including adjustments to the job, help if needed with morale and mental health, and advice on career options. Further studies should establish the prevalence of long-term health conditions among doctors.

[Diagnostic categories and gender: two examples in contemporary Spanish medicine, chlorosis and neurasthenia (1877-1936)].

PubMed

Bernabeu-Mestre, Josep; Santos, Ana Paula Cid; Pellicer, Josep Xavier Esplugues; Galiana-Sánchez, María Eugenia

2008-01-01

Chlorosis and Neurasthenia are two classical examples of pathological dissociations and the difficulties involved in approaching their diagnosis using scientific-naturalistic criteria. In the realm of those difficulties, the study examines the androcentric viewpoint and the ideological perspective of Contemporary Spanish Medicine when addressing the feminine nature and women's pathologies. Moreover, based on the similarities with present-day pain and fatigue syndromes, the study underlines the need to review the clinical approach to these illnesses by attempting to overcome the existing biomedical limitations.

Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges.

PubMed Central

Brockman, B

1999-01-01

Food refusal occurs for a variety of reasons. It may be used as a political tool, as a method of exercising control over others, at either the individual, family or societal level, or as a method of self-harm, and occasionally it indicates possible mental illness. This article examines the motivation behind hunger strikes in prisoners. It describes the psychiatrist's role in assessment and management of prisoners by referring to case examples. The paper discusses the assessment of an individual's competence to commit suicide by starvation, legal restraints to intervention, practical difficulties and associated ethical dilemmas. Anecdotal evidence suggests that most prisoners who refuse food are motivated by the desire to achieve an end rather than killing themselves, and that hunger-strike secondary to mental illness is uncommon. Although rarely required, the psychiatrist may have an important contribution to make in the management of practical and ethical difficulties. PMID:10635497

Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges.

PubMed

Brockman, B

1999-12-01

Food refusal occurs for a variety of reasons. It may be used as a political tool, as a method of exercising control over others, at either the individual, family or societal level, or as a method of self-harm, and occasionally it indicates possible mental illness. This article examines the motivation behind hunger strikes in prisoners. It describes the psychiatrist's role in assessment and management of prisoners by referring to case examples. The paper discusses the assessment of an individual's competence to commit suicide by starvation, legal restraints to intervention, practical difficulties and associated ethical dilemmas. Anecdotal evidence suggests that most prisoners who refuse food are motivated by the desire to achieve an end rather than killing themselves, and that hunger-strike secondary to mental illness is uncommon. Although rarely required, the psychiatrist may have an important contribution to make in the management of practical and ethical difficulties.

[Dissociation (conversion) - malingering - antisocial personality disorder: differential diagnostic reflection on the basis of a case study].

PubMed

Rothuber, Helfried; Mitterauer, Bernhard

2011-01-01

In this case report we refer to the big challenge of making a diagnosis in a deliberate malingering in the field of mental disorders. We specifically describe the difficulty regarding the differentiation between a conversion disorder and malingering of a serial delinquent. For such a person avoiding criminal persecution is one of the most frequent reason to deceitfully simulate a mental illness. In this field, symptoms of conversion disorders exceed the average; furthermore, a great number of organic-neurological illnesses may appear to be very similar to a conversion disorder or in many cases a neurological disorder can actually be detected in the course of a somatic examination. A further obstacle for the differential diagnosis can be seen in the difficulty to discern it from factitious disorders. However, it is quite possible to discern the deliberate malingering of a mental disorder from a conversion disorder by means of the diligent diagnosis of a competent and experienced doctor/assessor who specialises.

Recurrent zoonotic transmission of Nipah virus into humans, Bangladesh, 2001-2007.

PubMed

Luby, Stephen P; Hossain, M Jahangir; Gurley, Emily S; Ahmed, Be Nazir; Banu, Shakila; Khan, Salah Uddin; Homaira, Nusrat; Rota, Paul A; Rollin, Pierre E; Comer, James A; Kenah, Eben; Ksiazek, Thomas G; Rahman, Mahmudur

2009-08-01

Human Nipah outbreaks recur in a specific region and time of year in Bangladesh. Fruit bats are the reservoir host for Nipah virus. We identified 23 introductions of Nipah virus into human populations in central and northwestern Bangladesh from 2001 through 2007. Ten introductions affected multiple persons (median 10). Illness onset occurred from December through May but not every year. We identified 122 cases of human Nipah infection. The mean age of case-patients was 27 years; 87 (71%) died. In 62 (51%) Nipah virus-infected patients, illness developed 5-15 days after close contact with another Nipah case-patient. Nine (7%) Nipah case-patients transmitted virus to others. Nipah case-patients who had difficulty breathing were more likely than those without respiratory difficulty to transmit Nipah (12% vs. 0%, p = 0.03). Although a small minority of infected patients transmit Nipah virus, more than half of identified cases result from person-to-person transmission. Interventions to prevent virus transmission from bats to humans and from person to person are needed.

Cultural and Organizational Aspects of Application of the Americans with Disabilities Act to Persons with Psychiatric Disabilities

PubMed Central

Mechanic, David

1998-01-01

The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodation for persons with psychiatric disabilities. Most persons with a history of mental disorder work productively and do not require accommodation. Many persons with serious mental illness need accommodation but are conscientious and productive workers. Difficulties inherent in the Equal Employment Opportunity Commission (EEOC) guidelines are those of differentiating aspects of mental disorder from work-related conduct and the potential for manipulative persons to use the Act to excuse inappropriate behavior and ask for accommodation. A further problem is the potential for discouraging employers from hiring persons with mental illness because of the perceived difficulty of terminating them should their work prove unsatisfactory. If the ADA is to be effective, it must be seen as only one step in a larger process involving public education, effective mediation, meaningful assistance for employers, and wise implementation decisions that account appropriately for the social context. PMID:9510898

Cultural and organizational aspects of application of the Americans with Disabilities Act to persons with psychiatric disabilities.

PubMed

Mechanic, D

1998-01-01

The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodation for persons with psychiatric disabilities. Most persons with a history of mental disorder work productively and do not require accommodation. Many persons with serious mental illness need accommodation but are conscientious and productive workers. Difficulties inherent in the Equal Employment Opportunity Commission (EEOC) guidelines are those of differentiating aspects of mental disorder from work-related conduct and the potential for manipulative persons to use the Act to excuse inappropriate behavior and ask for accommodation. A further problem is the potential for discouraging employers from hiring persons with mental illness because of the perceived difficulty of terminating them should their work prove unsatisfactory. If the ADA is to be effective, it must be seen as only one step in a larger process involving public education, effective mediation, meaningful assistance for employers, and wise implementation decisions that account appropriately for the social context.

Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey.

PubMed

Oflaz, Serap; Guveli, Hulya; Kalelioglu, Tevfik; Akyazı, Senem; Yıldızhan, Eren; Kılıc, Kasım Candas; Basyigit, Sehnaz; Ozdemiroglu, Filiz; Akyuz, Fatma; Gokce, Esra; Bag, Sevda; Kurt, Erhan; Oral, Esat Timucin

2015-06-01

Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance. Copyright © 2015 Elsevier B.V. All rights reserved.

Normotensive cardiomyopathy and malignant hypertension in phaeochromocytoma

PubMed Central

Shapiro, L. M.; Trethowan, N.; Singh, S. P.

1982-01-01

A patient with two different presentations of phaeochromocytoma is described. She initially presented with normal blood pressure and heart failure following a prolonged feverish prodrome. A provisional diagnosis of myocarditis or early congestive cardiomyopathy was made and she improved with digoxin and diuretics. Eighteen months later, after a period of normotension free from heart failure, she developed malignant hypertension with recurrence of heart failure. A phaeochromocytoma was surgically removed, with return to normal of blood pressure and cardiac status. It would seem that the initial presentation of the phaeochromocytoma was a catecholamine-induced myocarditis without hypertension and this resolved with the subsequent development of malignant hypertension. The possible mechanisms responsible for this are discussed and it is concluded that phaeochromocytoma should be considered in patients who have heart failure and persistent features of myocarditis. PMID:7100023

Nuclear proliferation: Will the Soviet Union's collapse spawn a new arms race

DOE Office of Scientific and Technical Information (OSTI.GOV)

Griffin, R.D.

Almost 30 years ago, in the midst of the US-Soviet arms race, President John F. Kennedy warned of the danger of nuclear proliferation. Ironically, now that the Cold War is over, the prospect has become a reality. The collapse of the Soviet Union may have calmed fears of a nuclear Armageddon, but it has aroused new concerns about the spread of nuclear weapons. More than a dozen nations either have or are feverishly trying to develop nuclear arsenals, including Third World nations riven by religious and territorial disputes. If the world fails to contain the spread of nuclear-weapons technology, themore » balance of power that kept relative peace during the four decades of the Cold War may be displaced by a balance of terror.« less

Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study

PubMed Central

Worth, Allison; Irshad, Tasneem; Bhopal, Raj; Brown, Duncan; Lawton, Julia; Grant, Elizabeth; Murray, Scott; Kendall, Marilyn; Adam, James; Gardee, Rafik

2009-01-01

Objectives To examine the care experiences of South Asian Sikh and Muslim patients in Scotland with life limiting illness and their families and to understand the reasons for any difficulties with access to services and how these might be overcome. Design Prospective, longitudinal, qualitative design using in-depth interviews. Setting Central Scotland. Participants 25 purposively selected South Asian Sikh and Muslim patients, 18 family carers, and 20 key health professionals. Results 92 interviews took place. Most services struggled to deliver responsive, culturally appropriate care. Barriers to accessing effective end of life care included resource constrained services; institutional and, occasionally, personal racial and religious discrimination; limited awareness and understanding among South Asian people of the role of hospices; and difficulty discussing death. The most vulnerable patients, including recent migrants and those with poor English language skills, with no family advocate, and dying of non-malignant diseases were at particularly high risk of inadequate care. Conclusions Despite a robust Scottish diversity policy, services for South Asian Sikh and Muslim patients with life limiting illness were wanting in many key areas. Active case management of the most vulnerable patients and carers, and “real time” support, from where professionals can obtain advice specific to an individual patient and family, are the approaches most likely to instigate noticeable improvements in access to high quality end of life care. Improving access to palliative care for all, particularly those with non-malignant illnesses, as well as focusing on the specific needs of ethnic minority groups, is required. PMID:19190015

Illness perception, help-seeking attitudes, and knowledge related to obsessive-compulsive disorder across different ethnic groups: a community survey.

PubMed

Fernández de la Cruz, Lorena; Kolvenbach, Sarah; Vidal-Ribas, Pablo; Jassi, Amita; Llorens, Marta; Patel, Natasha; Weinman, John; Hatch, Stephani L; Bhugra, Dinesh; Mataix-Cols, David

2016-03-01

Despite similar prevalence rates across ethnicities, ethnic minorities with obsessive-compulsive disorder (OCD) are under-represented in research and clinical settings. The reasons for this disproportion have been sparsely studied. We explored potential differences in illness perception, help-seeking attitudes, illness knowledge, and causal attributions that could help explain the lower uptake of treatment for OCD amongst ethnic minorities. Two-hundred and ninety-three parents (139 White British, 61 Black African, 46 Black Caribbean, and 47 Indian) were recruited from the general population in South-East London, UK. Using a text vignette methodology, participants completed a survey including questions on illness perception, help-seeking attitudes, OCD knowledge, and causal attributions. The groups did not differ in socio-demographic characteristics and family history of OCD. White British parents perceived that the OCD difficulties would have more negative impact on their children and that treatment would be more helpful, compared to the ethnic minorities; the largest differences were observed between White British and Indian parents. Ethnic minorities were more prone to say that would seek help from their religious communities. Black African parents were more in favor of not seeking help for the described difficulties and, in general, perceived more treatment barriers. White British parents seemed to be better informed about OCD than ethnic minority parents. The results offer some plausible explanations for the large inequalities in access to services amongst ethnic minorities with OCD. Clinicians and policy-makers need to be aware of these socio-cultural factors when designing strategies to encourage help-seeking behaviors in these populations.

Consequences of Psychotherapy Clients' Mental Health Ideology.

ERIC Educational Resources Information Center

Milling, Len; Kirsch, Irving

Current theoretical approaches to understanding emotional difficulties are dominated by the medical model of mental illness, which assumes that emotional dysfunction can be viewed the same way as physical dysfunction. To examine the relationship between psychotherapy clients' beliefs about the medical model of psychotherapy and their behavior…

Prenatal and Early Life Risk Factors of Schizophrenia

ERIC Educational Resources Information Center

Lattari, Fallon; Dragowski, Eliza A.

2011-01-01

Childhood-onset schizophrenia is an exceedingly rare mental illness whose complex, multifaceted behavioral presentation can disrupt child development and raise diagnostic and treatment difficulties for attending clinicians. The disorder, affecting one in 30,000 children, shares the same diagnostic criteria and symptoms as its adult counterpart,…

Intelligence and Neuropsychological Aptitude Testing of U.S. Air Force MQ-1 Predator Pilot Training Candidates

DTIC Science & Technology

2012-11-01

of cognitive difficulties (e.g., memory, attention, reasoning, information processing) stemming from a head injury, medical illness (e.g., bacterial ... meningitis ), developmental disorder (e.g., attention deficit and hyperactivity, learning disorder), or emotional problems (e.g., depression, anxiety

Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya.

PubMed

Hooft, Anneka M; Ripp, Kelsey; Ndenga, Bryson; Mutuku, Francis; Vu, David; Baltzell, Kimberly; Masese, Linnet N; Vulule, John; Mukoko, Dunstan; LaBeaud, A Desiree

2017-09-20

Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya. A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes. The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing, especially haemograms and bacterial cultures. Clinicians discussed the use of counseling and education to improve community understanding of febrile illness in order to decrease preventable deaths in children. Results of this study suggest that since malarial testing has become more widespread, clinicians working in resource-poor environments still face difficulty when evaluating a child with fever, especially when malaria testing is negative. Improving access to additional diagnostics, continuing medical education, and ongoing evaluation and revision of clinical guidelines may lead to more consistent management of febrile illness by providers, and may potentially decrease prescription of unnecessary antibiotics. Additional interventions at the community level may also have an important role in managing febrile illness, however, more studies are needed to identify targets for intervention at both the clinic and community levels.

Stigmatization of mental illness among Nigerian schoolchildren.

PubMed

Ronzoni, Pablo; Dogra, Nisha; Omigbodun, Olayinka; Bella, Tolulope; Atitola, Olayinka

2010-09-01

Despite the fact that about 10% of children experience mental health problems, they tend to hold negative views about mental illness. The objective of this study was to investigate the views of Nigerian schoolchildren towards individuals with mental illness or mental health problems. A cross-sectional design was used. Junior and senior secondary schoolchildren from rural and urban southwest Nigeria were asked: 'What sorts of words or phrases might you use to describe someone who experiences mental health problems?' The responses were tabulated, grouped and interpreted by qualitative thematic analysis. Of 164 students, 132 (80.5%) responded to the question. Six major themes emerged from the answers. The most popular descriptions were 'derogatory terms' (33%). This was followed by 'abnormal appearance and behaviour' (29.6%); 'don't know' answers (13.6%); 'physical illness and disability' (13.6%); 'negative emotional states' (6.8%); and 'language and communication difficulties' (3.4%). The results suggest that, similar to findings elsewhere, stigmatization of mental illness is highly prevalent among Nigerian children. This may be underpinned by lack of knowledge regarding mental health problems and/or fuelled by the media. Educational interventions and encouraging contact with mentally ill persons could play a role in reducing stigma among schoolchildren.

'Betwixt and between'; liminality in recovery stories from people with myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).

PubMed

Brown, Brian; Huszar, Kate; Chapman, Rosemary

2017-06-01

This paper explores experiences of 16 people claiming to have recovered from Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) using the concept of liminality. Liminality describes the status of those falling between socially recognised and medically sanctioned categories, and illuminates both the experience of illness and the process of recovery from ME/CFS. The liminality experienced during illness was akin to that described by Turner with a degree of communitas among sufferers. As recovery progressed, participants stressed the percentage to which they had improved, and compared themselves with peers and themselves prior to the illness. Recovery did not mean transition into a post-liminal phase, but involved a new liminality, characterised by straddling boundaries between illness and wellness. Participants continued strategies such as rest, pacing and meditation. This second liminal state included difficulty in communicating the experience convincingly, and estrangement from the ME/CFS community. Thus, recoverees moved from the liminality of illness to a second, and less legible state of sustained liminality in recovery, described as having one foot in the ill world, one foot in the well world. This suggests that more needs to be understood about the recovery experience to assist those making the transition toward wellness. © 2017 Foundation for the Sociology of Health & Illness.

Absenteeism, Educational Plans, and Anxiety among Children with Incontinence and Their Parents

ERIC Educational Resources Information Center

Filce, Hollie G.; LaVergne, Leslie

2015-01-01

Background: Children with incontinence have more absenteeism, poorer academic performance, and potential social difficulties during the school years. These children and their parents are at risk for illness-related anxiety. Whereas educational plans are designed to remediate educational, medical, and social-emotional barriers at school, little…

Tips for Research Recruitment: The Views of Sexual Minority Youth

ERIC Educational Resources Information Center

Lucassen, Mathijs F. G.; Fleming, Theresa M.; Merry, Sally N.

2017-01-01

Researchers often experience difficulties recruiting hard-to-reach populations. This is especially so for studies involving those who have been historically stigmatized, such as individuals who challenge heteronormative expectations or people who experience mental ill health. The authors aimed to obtain the views of sexual minority adolescents (n…

Napoleon Dynamite: Asperger's Disorder or Geek NOS?

ERIC Educational Resources Information Center

Levin, Hope W.; Schlozman, Steven

2006-01-01

Napoleon Dynamite, the quirky hit film from 2004, is a fascinating portrayal of a teenager with social difficulties. The character Napoleon provokes intriguing diagnostic questions in distinguishing between mental illness and the spectrum of normal behavior. He demonstrates several symptoms of Asperger's disorder, yet he also challenges the notion…

Attitudes and Experiences of Death Workshop Attendees

ERIC Educational Resources Information Center

Kubler-Ross, Elisabeth; Worden, J. William

1977-01-01

Attendees at workshops and lectures were asked to complete a questionnaire which assessed the following: 1) First death experience, 2) Present conceptualization of death, 3) Anticipated reactions to a personal terminal illness, 4) Resources in managing one's own death, and 5) Difficulties experienced in working with dying persons. (Author)

Wind Turbines Make Waves: Why Some Residents near Wind Turbines Become Ill

ERIC Educational Resources Information Center

Havas, Magda; Colling, David

2011-01-01

People who live near wind turbines complain of symptoms that include some combination of the following: difficulty sleeping, fatigue, depression, irritability, aggressiveness, cognitive dysfunction, chest pain/pressure, headaches, joint pain, skin irritations, nausea, dizziness, tinnitus, and stress. These symptoms have been attributed to the…

An Inventory on Rotational Kinematics of a Particle: Unravelling Misconceptions and Pitfalls in Reasoning

ERIC Educational Resources Information Center

Mashood, K. K.; Singh, Vijay A.

2012-01-01

Student difficulties regarding the angular velocity ([image omitted]) and angular acceleration ([image omitted]) of a particle have remained relatively unexplored in contrast to their linear counterparts. We present an inventory comprising multiple choice questions aimed at probing misconceptions and eliciting ill-suited reasoning patterns. The…

The Economics of Comparable Worth.

ERIC Educational Resources Information Center

Killingsworth, Mark R.

This document concludes that the basic difficulty with comparable worth is that it is an ill-conceived solution to a serious problem and that alternative policies, such as equal employment opportunity legislation or application of antitrust laws, provide means of addressing employment discrimination that are both more effective and less likely to…

Outcomes of a care coordinated service model for persons with severe and persistent mental illness: A qualitative study.

PubMed

Isaacs, Anton N; Sutton, Keith; Dalziel, Kim; Maybery, Darryl

2017-02-01

Owing to difficulties faced by individuals with severe and persistent mental illness (SPMI) in accessing multiple services, the Australian Government trialed a care coordinated service model called the Partners in Recovery (PIR) initiative. A total of 45 stakeholders in Gippsland were asked what difference the initiative had made. The PIR initiative benefited not only clients and carers but also service providers. It addressed an unmet need in service delivery for individuals with SPMI. The PIR initiative has filled a gap in delivery of care for individuals with SPMI in Gippsland.

Young onset Parkinson's disease. Practical management of medical issues.

PubMed

Calne, Susan M; Kumar, Ajit

2008-01-01

Young Onset Parkinson's disease (YOPD) is defined as Parkinson's disease diagnosed between the ages of 21 and 40 years. Problems faced by this group are different from those faced by older subjects because they face decades with the illness. This article reviews current literature and offers suggestions for intervention when appropriate and practical suggestions in the areas of drug treatment, rehabilitation, nutrition, sexuality, pregnancy, menstruation and menopause. The suggestions are not exclusively restricted to the management of YOPD, but emphasis is placed on items where people with YOPD have either had particular difficulties or where they can proactively self-manage their illness.

African American Elders’ Serious Illness Experiences: Narratives of “God Did,” “God Will,” and “Life Is Better”

PubMed Central

Coats, Heather; Crist, Janice D.; Berger, Ann; Sternberg, Esther; Rosenfeld, Anne G.

2017-01-01

The foundation of culturally sensitive patient-centered palliative care is formed from one’s social, spiritual, psychological, and physical experiences of serious illness. The purpose of this study was to describe categories and patterns of psychological, social, and spiritual healing from the perspectives of aging seriously ill African American (AA) elders. Using narrative analysis methodology, 13 open-ended interviews were collected. Three main patterns were “prior experiences,” “I changed,” and “across past, present experiences and future expectations.” Themes were categorized within each pattern: been through it … made me strong, I thought about … others, went down little hills … got me down, I grew stronger, changed priorities, do things I never would have done, quit doing, God did and will take care of me, close-knit relationships, and life is better. “Faith” in God helped the aging seriously ill AA elders “overcome things,” whether their current illness or other life difficulties. PMID:26701962

Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine

PubMed Central

2013-01-01

Background Fever is an extremely common occurrence in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that parents have too many misconceptions and conflicting information about fever management. The aim of this study was to identify parents’ beliefs and practices regarding childhood fever management. Methods We conducted a cross-sectional survey among parents whose children were enrolled and presented for health care at primary health care clinics in the Nablus region of Palestine. Data were collected using structured questionnaire interviews with parents. The questionnaire consisted of ‘yes/no’ responses and multiple-response questions. Descriptive statistics were used. Results Overall, 402 parents were interviewed. All parents believed that fever could cause at least one harmful effect if left untreated. The harmful effects most frequently reported by parents were brain damage (38.1%), dehydration (15.7%), and other organs damage such as liver and kidney damage (14.2%). The study showed that 65.4% of parents would recognise fever by only touching the child, 31.6% would measure the temperature and 3.0% would assess temperature by touching and measuring the child. Antipyretic was preferred to be used by 34.8% of parents, while 49.8% stated that they preferred cold sponges, and 3.2% stated that they preferred homeopathic methods to treat fever. The most common factors influencing frequency of medication administration included physician’s instruction (61.7%), the degree of elevated temperature (14.9%) and instructions on the medication leaflet (13.7%). Of the participant parents, 53.2% believed antipyretics used to reduce fever were harmful. Parents reported the most harmful outcomes from these antipyretics to be allergic reactions (20.9%), effects on the stomach (16.9%), kidney damage (16.2%) and overdose (11.4%). Conclusions Parents were anxious when dealing with a feverish child, which resulted in incorrect or inappropriate practices. Parents require reliable evidence-based information about the care of feverish children. These results indicate a need to develop and evaluate educational programs in our setting that will provide parents with education on fever and fever management. PMID:23622106

Understanding Interpersonal Function in Psychiatric Illness Through Multiplayer Economic Games

PubMed Central

2014-01-01

Interpersonal factors play significant roles in the onset, maintenance, and remission of psychiatric conditions. In the current major diagnostic classification systems for psychiatric disorders, some conditions are defined by the presence of impairments in social interaction or maintaining interpersonal relationships; these include autism, social phobia, and the personality disorders. Other psychopathologies confer significant difficulties in the social domain, including major depression, posttraumatic stress disorder, and psychotic disorders. Still other mental health conditions, including substance abuse and eating disorders, seem to be exacerbated or triggered in part by the influence of social peers. For each of these and other psychiatric conditions, the extent and quality of social support is a strong determinant of outcome such that high social support predicts symptom improvement and remission. Despite the central role of interpersonal factors in psychiatric illness, the neurobiology of social impairments remains largely unexplored, in part due to difficulties eliciting and quantifying interpersonal processes in a parametric manner. Recent advances in functional neuroimaging, combined with multiplayer exchange games drawn from behavioral economics, and computational/quantitative approaches more generally, provide a fitting paradigm within which to study interpersonal function and dysfunction in psychiatric conditions. In this review, we outline the importance of interpersonal factors in psychiatric illness and discuss ways in which neuroeconomics provides a tractable framework within which to examine the neurobiology of social dysfunction. PMID:22579510

Modality-specific alterations in the perception of emotional stimuli in Bipolar Disorder compared to Healthy Controls and Major Depressive Disorder

PubMed Central

Vederman, Aaron C.; Weisenbach, Sara L.; Rapport, Lisa J.; Leon, Hadia M.; Haase, Brennan D.; Franti, Lindsay M.; Schallmo, Michael-Paul; Saunders, Erika F.H.; Kamali, Masoud M.; Zubieta, Jon-Kar; Langenecker, Scott A.; McInnis, Melvin G.

2013-01-01

Objectives Affect identification accuracy paradigms have increasingly been utilized to understand psychiatric illness including Bipolar Disorder (BD) and Major Depressive Disorder (MDD). This investigation focused on perceptual accuracy in affect identification in both visual and auditory domains among patients with BD, relative to Healthy Controls (HC) and patients with MDD. Demographic and clinical variables, in addition to medications were also investigated. Methods The visual Facial Emotion Perception Test (FEPT) and auditory Emotional Perception Test (EPT) were administered to adults with BD (n = 119) and MDD (n = 78) as well as HC (n = 66). Results Performance on the FEPT was significantly stronger than on the EPT irrespective of group. Performance on the EPT did not significantly differentiate the groups. On the FEPT, BD samples had the greatest difficulty relative to HC in identification of sad and fearful faces. BD participants also had greater difficulty identifying sad faces relative to MDD participants though not after controlling for severity of illness factors. For the BD (but not MDD) sample several clinical variables were also correlated with FEPT performance. Conclusions The findings suggest that disruptions in identification of negative emotions such as sadness and fear may be a characteristic trait of BD. However, this effect may be moderated by greater illness severity found in our BD sample. PMID:21683948

Mothering disrupted by illness: a narrative synthesis of qualitative research.

PubMed

Vallido, Tamara; Wilkes, Lesley; Carter, Bernie; Jackson, Debra

2010-07-01

This paper is a report of a literature review of qualitative empirical research investigating women's experiences of mothering disrupted by illness. As a primary identity, motherhood is endangered by illness. Illness can interfere with a woman's ability to mother her child/children. Healthcare professionals regularly fail to acknowledge a woman's dual identities of mother and patient. CINAHL, Medline, PsychInfo, Scopus and Sociological abstracts were searched 1980-2009. A narrative synthesis was used, with quality appraisal guided by the Critical Appraisal Skills Programme method. Concepts were analysed thematically, explicating common experiences of women disrupted in their mothering by illness. This allowed for both descriptive and narrative synthesis to occur. Thirteen papers were included in the final review. Themes identified were: mechanism of disruption; reframing the mother role; protecting the children; experiencing guilt or shame; problems with healthcare professionals; and living to mother, mothering to live. Women disrupted in their mothering by illness view themselves as a mother first and a patient second. Women found themselves unsupported in their mothering role by healthcare professionals, and this may have left them reluctant to broach difficulties they had relinquishing mothering duties when ill. Nurses are well-positioned to support women in illness by acknowledging the importance of their identity as mothers, offering them opportunities to discuss how illness is disrupting their ability to mother, providing support to help them negotiate the social/emotional distress experienced when mothering is disrupted and, where necessary, referring them to other members of the healthcare team, such as social workers.

Patient participation in mental healthcare: when is it difficult? A qualitative study of users and providers in a mental health hospital in Norway.

PubMed

Solbjør, Marit; Rise, Marit By; Westerlund, Heidi; Steinsbekk, Aslak

2013-03-01

In western countries, patient participation is requested in policies on mental health services. Participation is built on ideas of democracy and individual responsibility. Mental illness has, however, been characterized by its irrational features. To investigate mental health service users' and providers' views on patient participation during episodes of mental illness. Qualitative interview study with 20 users and 25 staff from a mental health hospital in central Norway. Both users and professionals saw poor illness phases as an obstacle to patient participation. Lack of insight, lack of verbal ability and difficulty cooperating made participation difficult. During such phases, patient participation was redefined. There was a shift in responsibility where professionals took charge through strategies of providing information, motivating patients and reducing choices. Respect and dignity were maintained and not redefined. In poor phases of mental illness, patient participation was redefined and weighed against what was perceived to be the patient's best interest.

Prisons: the psychiatric institution of last resort?

PubMed

Huxter, M J

2013-10-01

The World Health Organization declared in 1948 that the enjoyment of the highest individual attainment of health for any person is a fundamental human right. Australia, the U.K. and the United States all legally ratified this declaration as becoming signatories to their founding treatise with the United Nations. Despite this, there are many conspicuous examples of inequities of public health as found within these nations. One of the more disparate and outrageous examples of inequities in public health has been an insidious trend towards criminalizing mental illness, and the largely unjust treatment of many mentally ill persons. This change has resulted in untold numbers of mentally ill persons being over-represented within the criminal justice system, experiencing higher morbidity, co-morbidity and mortality rates, and having difficulty in surviving in a society frequently dealing with their illness in a persecutory manner. Questions must be raised: that although over the passage of time medical science and technology has changed, but has western societies' attitudes to health equity kept pace? © 2012 John Wiley & Sons Ltd.

An analysis of the stressors and coping strategies of Chinese adults with a partner admitted to an intensive care unit in Hong Kong: an exploratory study.

PubMed

Chan, Keung-Sum; Twinn, Sheila

2007-01-01

The aim of this study was to identify the major stressors affecting Chinese adults whose partner had been admitted to an intensive care unit and to understand the major coping strategies employed to manage such stressors. Recently a greater number of patients of higher acuity have been admitted to intensive care units and survive lengthy illnesses of an unpredictable course. Such critical illnesses have been identified as a major life event to family members of these patients. Little is known, however, about the stressors and coping mechanisms of Chinese adults whose critically ill partner is admitted to an intensive care unit. An exploratory qualitative design was selected to achieve the aims of the study. A purposive sample of 10 Chinese adults with a partner in an intensive care unit of a regional general hospital in Hong Kong participated in tape-recorded semi-structured interviews. Content analysis was employed to analyse the translated interviews. Categories of stressors included uncertainty, difficulties in communication, changes in roles and responsibilities, difficulties in decision making, financial strain as well as changes in relationships. Analysis identified a range of coping strategies which included seeking information, seeking support, reliance on cultural beliefs and practices, turning to religious beliefs, maintaining hope and acceptance of illness. The findings demonstrate the importance of cultural beliefs and practices in determining the coping mechanisms employed to manage the stressors identified by this sample of Chinese adults. Such findings indicate the use of both internal and external coping strategies in order to maintain equilibrium in the family. Implications for nursing practice highlight the significance of seeking information throughout the critical period and also culturally appropriate support from healthcare professionals.

The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review

PubMed Central

Hudson, Briony F; Oostendorp, Linda JM; Candy, Bridget; Vickerstaff, Victoria; Jones, Louise; Lakhanpaul, Monica; Bluebond-Langner, Myra; Stone, Paddy

2016-01-01

Background: Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. Aim: To explore how children and young people (aged 0–25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. Design: Systematic review. Data sources: MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. Results: A total of 215 studies – 152 qualitative, 54 quantitative and 9 mixed methods – were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants’ perceptions of potential burdens. Conclusion: All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment. PMID:27609607

Functional illness in primary care: dysfunction versus disease

PubMed Central

Williams, Nefyn; Wilkinson, Clare; Stott, Nigel; Menkes, David B

2008-01-01

Background The Biopsychosocial Model aims to integrate the biological, psychological and social components of illness, but integration is difficult in practice, particularly when patients consult with medically unexplained physical symptoms or functional illness. Discussion This Biopsychosocial Model was developed from General Systems Theory, which describes nature as a dynamic order of interacting parts and processes, from molecular to societal. Despite such conceptual progress, the biological, psychological, social and spiritual components of illness are seldom managed as an integrated whole in conventional medical practice. This is because the biomedical model can be easier to use, clinicians often have difficulty relinquishing a disease-centred approach to diagnosis, and either dismiss illness when pathology has been excluded, or explain all undifferentiated illness in terms of psychosocial factors. By contrast, traditional and complementary treatment systems describe reversible functional disturbances, and appear better at integrating the different components of illness. Conventional medicine retains the advantage of scientific method and an expanding evidence base, but needs to more effectively integrate psychosocial factors into assessment and management, notably of 'functional' illness. As an aid to integration, pathology characterised by structural change in tissues and organs is contrasted with dysfunction arising from disordered physiology or psychology that may occur independent of pathological change. Summary We propose a classification of illness that includes orthogonal dimensions of pathology and dysfunction to support a broadly based clinical approach to patients; adoption of which may lead to fewer inappropriate investigations and secondary care referrals and greater use of cognitive behavioural techniques, particularly when managing functional illness. PMID:18482442

Design, Development and Testing of Airplanes for Mars Exploration

NASA Technical Reports Server (NTRS)

Hall, David W.

2004-01-01

The opportunity for a piggyback mission to Mars aboard an Ariane 5 rocket in the early spring of 1999 set off feverish design activity at several NASA centers. This report describes the contract work done by faculty, students, and consultants at the California Polytechnic State University in San Luis Obispo California (Cal poly/SLO) to support the NASA/Ames design, construction and test efforts to develop a simple and robust Mars Flyer configuration capable of performing a practical science mission on Mars. The first sections will address the conceptual design of a workable Mars Flyer configuration which started in the spring and summer of 1999. The following sections will focus on construction and flight test of two full-scale vehicles. The final section will reflect on the overall effort and make recommendations for future work.

Kikuchi-Fujimoto disease: an unusual association with acute renal failure.

PubMed

Silva, Amanda Feliciano da; Focaccia, Roberto; Oliveira, Allan Constantino de; Sementilli, Angelo; Reis, Gelvana Flávio Barreto

2010-01-01

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE), infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone.

Stress and Distress in Migration: Problems and Resources of Turkish Women in Denmark.

ERIC Educational Resources Information Center

Mirdal, Gretty M.

1984-01-01

Seventy-two Turkish female immigrants reported problems created by the difficulty of adjusting to Danish culture and society, unemployment and overwork, isolation from other Turks, and sex role changes. Many interviewees reported stress-related illnesses, but overall the Turkish women were strong, resourceful, and determined to solve their…

Treating the Sleep Disorders of Childhood: Current Practice in the United Kingdom

ERIC Educational Resources Information Center

Bartlet, L. B.

2006-01-01

Sleep disorders are common in childhood. Their prevalence is especially high in the presence of disability or chronic illness. They cause considerable stress to the children themselves and to their parents. Sleep deprivation leads to daytime behavioral problems and educational difficulties. In assessing sleep problems thorough history taking is…

Primal Barrier Methods for Linear Programming

DTIC Science & Technology

1989-06-01

A Theoretical Bound Concerning the difficulties introduced by an ill-conditioned H- 1, Dikin [Dik67] and Stewart [Stew87] show for a full-rank A...Dik67] I. I. Dikin (1967). Iterative solution of problems of linear and quadratic pro- gramming, Doklady Akademii Nauk SSSR, Tom 174, No. 4. [Fia79] A. V

Illnesses and Other Causes of Unexpected Absences from Work During Residency Training.

ERIC Educational Resources Information Center

Parker, Ruth M.; And Others

1987-01-01

Unexpected absences from work among residents cause scheduling difficulties and stress among residents. University of Rochester internal medicine and pediatric residents recorded the days they had been absent from work and provided their opinions regarding the stress these absences caused and the effectiveness for the sick-call system. (Author/MLW)

Attendance, Achievement and Participation: Young Carers' Experiences of School in Australia

ERIC Educational Resources Information Center

Moore, Tim; McArthur, Morag; Morrow, Ros

2009-01-01

Schools play an important part in the lives of children and young people who have caring responsibilities for a family member with an illness, disability, alcohol or other drug problem or mental health condition but many of these "young carers" report difficulty in attending, achieving and participating in education. This qualitative…

Recurrent Zoonotic Transmission of Nipah Virus into Humans, Bangladesh, 2001–2007

PubMed Central

Hossain, M. Jahangir; Gurley, Emily S.; Ahmed, Be-Nazir; Banu, Shakila; Khan, Salah Uddin; Homaira, Nusrat; Rota, Paul A.; Rollin, Pierre E.; Comer, James A.; Kenah, Eben; Ksiazek, Thomas G.; Rahman, Mahmudur

2009-01-01

Human Nipah outbreaks recur in a specific region and time of year in Bangladesh. Fruit bats are the reservoir host for Nipah virus. We identified 23 introductions of Nipah virus into human populations in central and northwestern Bangladesh from 2001 through 2007. Ten introductions affected multiple persons (median 10). Illness onset occurred from December through May but not every year. We identified 122 cases of human Nipah infection. The mean age of case-patients was 27 years; 87 (71%) died. In 62 (51%) Nipah virus–infected patients, illness developed 5–15 days after close contact with another Nipah case-patient. Nine (7%) Nipah case-patients transmitted virus to others. Nipah case-patients who had difficulty breathing were more likely than those without respiratory difficulty to transmit Nipah (12% vs. 0%, p = 0.03). Although a small minority of infected patients transmit Nipah virus, more than half of identified cases result from person-to-person transmission. Interventions to prevent virus transmission from bats to humans and from person to person are needed. PMID:19751584

Health anxiety and attentional bias: the time course of vigilance and avoidance in light of pictorial illness information.

PubMed

Jasper, Fabian; Witthöft, Michael

2011-12-01

Cognitive-behavioral models of health anxiety stress the importance of selective attention not only towards internal but also towards external health threat related stimuli. Yet, little is known about the time course of this attentional bias. The current study investigates threat related attentional bias in participants with varying degrees of health anxiety. Attentional bias was assessed using a visual dot-probe task with health-threat and neutral pictures at two exposure durations, 175ms and 500ms. A baseline condition was added to the dot-probe task to dissociate indices of vigilance towards threat and difficulties to disengage from threat. Substantial positive correlations of health anxiety, anxiety sensitivity, and absorption with difficulties to disengage from threat were detected at 500ms exposure time. At an early stage (i.e., at 175ms exposure time), we found significant positive correlations of health anxiety and absorption with orientation towards threat. Results suggest a vigilance avoidance pattern of selective attention associated with pictorial illness related stimuli in health anxiety. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Families Affected by Parental Illness - What Obstacles Prevent them from Claiming Help and how Could their Supply Situation be Improved?].

PubMed

Kühnis, Romana; Müller-Luzi, Seraina; Schröder, Martin; Schmid, Marc

2016-01-01

Families Affected by Parental Illness - What Obstacles Prevent them from Claiming Help and how Could their Supply Situation be Improved? Current studies describe families affected by parental mental illness as a high-risk group. Although, interventions and programs were developed, the supply situation is still insufficient. In terms of a triangulation method, the present qualitative research with problem-centered semi-structured interviews stands in addition to the results of a quantitative study. This research investigates, which factors influence the claim of help and how the supply situation could be improved. 14 mothers and fathers in inpatient psychiatric treatment were interviewed. For instance is there a small awareness level of low-threshold services, parents also talk about different fears towards helpers or financial difficulty which prevent them from seeking help.

Voices of Native Hawaiian kupuna (elders) living with chronic illness: "knowing who I am".

PubMed

Davis, ReNel

2010-07-01

Health disparities among Native Hawaiian kupuna (elders) continues to be a major health issue. The purpose of this study was to explore the meanings, experiences and perceptions of care of Native Hawaiian kupuna in Hawaii who live with chronic illness. A qualitative design was used with in-depth interviews conducted with 15 Native Hawaiian kupuna and five Native Hawaiian health care providers. Study themes that emerged were the importance of knowing and respecting the Hawaiian culture, the difficulties of living in two worlds, knowing how to speak from the heart, and the need to learn from each other. Findings revealed that integrating knowledge and understanding of Hawaiian cultural values and perspectives are essential in designing culturally competent approaches that promote the health and well-being of Native Hawaiian kupuna with chronic illnesses.

Nurses' professional stigma and attitudes towards postpartum women with severe mental illness.

PubMed

Ordan, Revital; Shor, Ron; Liebergall-Wischnitzer, Michal; Noble, Lawrence; Noble, Anita

2018-04-01

To examine professional stigma and attitudes of parenthood towards postpartum women with severe mental illness and the association between postpartum nurses' attitudes and nursing interventions that promote motherhood. Stigma and attitudes towards parenthood of women with severe mental illness may influence nurses' clinical practices. Cross-sectional, mixed methods. The Stigma among Health Professionals towards People with Severe Mental Illness, Attitudes towards Parenthood among People with Severe Mental Illness and Nursing Interventions that Promote Becoming a Mother Questionnaires were used in the study, as well as qualitative analysis. Sixty-one postpartum nurses participated in the study. Increased stigma was associated with an increase in negative attitudes towards parenthood among people with severe mental illness, in general, and towards their parenthood skills, in particular. Postpartum nurses reported a decrease in nursing interventions and a therapeutic nurse-client relationship that fosters mother's empowerment. Themes that emerged from the qualitative analysis were postpartum nurse's perceptions of inadequacy, difficulty of postpartum nurses taking responsibility for managing women with severe mental illness and a paternalistic approach to these women, rather than empowerment, regarding infant care. Nurses providing care to postpartum women with severe mental illness and their infants may provide fewer routine postpartum interventions due to professional stigma and negative attitudes concerning parenting skills. Nurses should provide individualised, tailored care that allows women with severe mental illness to become a mother to the best of her ability. Not all women with severe mental illness are capable of caring for themselves and/or their baby. Nurses should provide individualised, tailored care that allows the women with severe mental illness to become a mother to the best of her ability. © 2017 John Wiley & Sons Ltd.

Human-centric predictive model of task difficulty for human-in-the-loop control tasks

PubMed Central

Majewicz Fey, Ann

2018-01-01

Quantitatively measuring the difficulty of a manipulation task in human-in-the-loop control systems is ill-defined. Currently, systems are typically evaluated through task-specific performance measures and post-experiment user surveys; however, these methods do not capture the real-time experience of human users. In this study, we propose to analyze and predict the difficulty of a bivariate pointing task, with a haptic device interface, using human-centric measurement data in terms of cognition, physical effort, and motion kinematics. Noninvasive sensors were used to record the multimodal response of human user for 14 subjects performing the task. A data-driven approach for predicting task difficulty was implemented based on several task-independent metrics. We compare four possible models for predicting task difficulty to evaluated the roles of the various types of metrics, including: (I) a movement time model, (II) a fusion model using both physiological and kinematic metrics, (III) a model only with kinematic metrics, and (IV) a model only with physiological metrics. The results show significant correlation between task difficulty and the user sensorimotor response. The fusion model, integrating user physiology and motion kinematics, provided the best estimate of task difficulty (R2 = 0.927), followed by a model using only kinematic metrics (R2 = 0.921). Both models were better predictors of task difficulty than the movement time model (R2 = 0.847), derived from Fitt’s law, a well studied difficulty model for human psychomotor control. PMID:29621301

Child behaviour problems and childhood illness: development of the Eczema Behaviour Checklist.

PubMed

Mitchell, A E; Morawska, A; Fraser, J A; Sillar, K

2017-01-01

Children with atopic dermatitis are at increased risk of both general behaviour problems, and those specific to the condition and its treatment. This can hamper the ability of parents to carry out treatment and manage the condition effectively. To date, there is no published instrument available to assess child behaviour difficulties in the context of atopic dermatitis management. Our aim was to develop a reliable and valid instrument to assess atopic dermatitis-specific child behaviour problems, and parents' self-efficacy (confidence) for managing these behaviours. The Eczema Behaviour Checklist (EBC) was developed as a 25-item questionnaire to measure (i) extent of behaviour problems (EBC Extent scale), and (ii) parents' self-efficacy for managing behaviour problems (EBC Confidence scale), in the context of child atopic dermatitis management. A community-based sample of 292 parents completed the EBC, measures of general behaviour difficulties, self-efficacy with atopic dermatitis management and use of dysfunctional parenting strategies. There was satisfactory internal consistency and construct validity for EBC Extent and Confidence scales. There was a negative correlation between atopic dermatitis-specific behaviour problems and parents' self-efficacy for dealing with behaviours (r = -.53, p < .001). Factor analyses revealed a three-factor structure for both scales: (i) treatment-related behaviours; (ii) symptom-related behaviours; and (iii) behaviours related to impact of the illness. Variation in parents' self-efficacy for managing their child's atopic dermatitis was explained by intensity of illness-specific child behaviour problems and parents' self-efficacy for dealing with the behaviours. The new measure of atopic dermatitis-specific child behaviour problems was a stronger predictor of parents' self-efficacy for managing their child's condition than was the measure of general child behaviour difficulties. Results provide preliminary evidence of reliability and validity of the EBC, which has potential for use in clinical and research settings, and warrant further psychometric evaluation. © 2016 John Wiley & Sons Ltd.

Health inequalities in later life in a social democratic welfare state.

PubMed

Dahl, E; Birkelund, G E

1997-03-01

The paper examines inequalities in mental health and "serious" illness, i.e. illness with significant consequences, among 964 men and women aged 65 and over in Norway. The aim is to analyse the extent to which the assumed class differentials in ill health in later life are accounted for by current socioeconomic circumstances and social and economic conditions during upbringing. Multiple logistic regression analyses suggest that the bivariate relationship between previous class location and present health condition among elderly men remains or may be attributed to current income. For women, their previous class location is not significantly related to either health outcome. However, women's current income and present economic difficulties are significantly related to both health measures in the expected direction. In addition, serious illness is related to long-standing illness in childhood, and poorer mental health is associated with economic hardship in childhood and dissension in the family of upbringing. For neither sex was father's social class during upbringing an important predictor of ill health. It is concluded that health inequalities in later life may, at least to some extent, be attributed to the "legacy of the past", and that the social democratic welfare state has not succeeded in eradicating health inequalities despite its egalitarian age pension policy.

Living as a couple with anorexia nervosa: A dyadic interpretative phenomenological analysis.

PubMed

Antoine, Pascal; Flinois, Bérengère; Doba, Karyn; Nandrino, Jean-Louis; Dodin, Vincent; Hendrickx, Marion

2016-10-01

This study examined the difficulties couples face in relation to anorexia nervosa. Using interpretative phenomenological analysis, five couples in which one of the partners lives with anorexia nervosa were interviewed separately. The findings are conceptualized into three areas: first, the encounter 'at the crossroads between remission and relapse'; second, the way that 'anorexia reveals itself'; and finally, the way the 'ménage à trois' works, including the illness fully as part of the couple. Psychotherapists should take into account the context of the couple and the complex interaction between the couple and the illness to support both partners' development of appropriate responses.

Work-related mental ill-health and 'stress' in the UK (2002-05).

PubMed

Carder, Melanie; Turner, Susan; McNamee, Roseanne; Agius, Raymond

2009-12-01

There is concern about the frequency of work-related mental ill-health and 'stress' within the UK. To provide a measure of the incidence of work-related mental ill-health reported by specialist psychiatrists and occupational physicians to UK voluntary reporting schemes during the period 2002-05. Additionally, an investigation of determinants, notably factors identified by reporters as precipitants in cases of work-related mental ill-health was undertaken. The study used data collected by The Health and Occupation Reporting Network (THOR) from 2002 to 2005. Cases were analysed by age, gender, industry and precipitating event. Estimated annual average incidence rates and 95% confidence intervals of work-related mental ill-health diagnoses reported to THOR between 2002 and 2005 by psychiatrists were 89 (78, 101) per million and by occupational physicians were 1589 (1443, 1735) per million. For both groups of reporters, anxiety and depression continued to make up the largest proportion of diagnoses. The majority of cases were attributed to factors such as workload and difficulties with other workers. There was some suggestion that the type of factors associated with the mental ill-health case reports varied between industrial sectors. Work-related anxiety and depression and stress continue to constitute a significant proportion of all work-related mental ill-health diagnoses in the UK, with workload and interpersonal relationships reported as significant risk factors. Further investigations may determine whether guidance for employers and employees on work-related mental ill-health would benefit from being more industry specific.

Chronically ill rural women: self-identified management problems and solutions.

PubMed

Cudney, Shirley; Sullivan, Therese; Winters, Charlene A; Paul, Lynn; Oriet, Pat

2005-03-01

To add to the knowledge base of illness management of chronically ill, rural women by describing the self-identified problems and solutions reported by women participants in the online health-education segment of the Women to Women (WTW) computer outreach project. WTW is a research-based computer intervention providing health education and online peer support for rural women with chronic diseases. Messages posted to the online chat room were examined to determine the women's self-management problems and solutions. The self-identified problems were: (1) difficulties in carrying through on self-management programmes; (2) negative fears and feelings; (3) poor communication with care providers; and (4) disturbed relationships with family and friends. The self-identified solutions to these problems included problem-solving techniques that were tailored to the rural lifestyle. Although not all problems were 'solvable', they could be 'lived with' if the women's prescriptions for self-management were used. Glimpses into the women's day-to-day experiences of living with chronic illness gleaned from the interactive health-education discussions will give health professionals insights into the women's efforts to manage their illnesses. The data provide health professionals with information to heighten their sensitivity to their clients' day-to-day care and educational needs.

Approaches to involuntary admission of the mentally ill in the People’s Republic of China: Changes in legislation from 2002 to 2012

PubMed Central

Shao, Y; Xie, B

2015-01-01

Because a systematic analysis of laws on involuntary admission of the mentally ill in China does not exist, this paper explored the trajectory of the legislation on involuntary admission of the mentally ill in China; the social and cultural factors underlying these changes are also discussed. By describing and analyzing the differences or similarities of current legal frameworks and procedures for involuntary admission of the mentally ill across the seven local mental health regulations and the National Mental Health Act, one can see a trajectory of gradually more stringent legislation for involuntary admission during the past 10 years of China. The compromise, reversals, and circuitous paths during the legislation process reflect the difficulty the government faces in balancing the benefits between society and individuals, and explores the transformation of the mode of mental health services. The approach in the 2012 National Mental Health Act, despite some weaknesses, is an important step to standardize the diverse practices in involuntary admission of the mentally ill in China. Further research on the influence of the National Act on mental health services is clearly needed. PMID:25770277

Employment outcomes among African Americans and Whites with mental illness.

PubMed

Lukyanova, Valentina V; Balcazar, Fabricio E; Oberoi, Ashmeet K; Suarez-Balcazar, Yolanda

2014-01-01

People with mental illness often experience major difficulties in finding and maintaining sustainable employment. African Americans with mental illness have additional challenges to secure a job, as reflected in their significantly lower employment rates compared to Whites. To examine the factors that contribute to racial disparities in employment outcomes for African-American and White Vocational Rehabilitation (VR) consumers with mental illness. This study used VR data from a Midwestern state that included 2,122 African American and 4,284 White participants who reported mental illness in their VR records. Logistic regression analyses were conducted. African Americans had significantly more closures after referral and were closed as non-rehabilitated more often than Whites. Logistic regressions indicated that African Americans are less likely to be employed compared to Whites. The regression also found differences by gender (females more likely to find jobs than males) and age (middle age consumers [36 to 50] were more likely to find jobs than younger consumers [18 to 35]). Case expenditures between $1,000 and $4,999 were significantly lower for African Americans. VR agencies need to remain vigilant of potential discrepancies in service delivery among consumers from various ethnic groups and work hard to assure as much equality as possible.

[Self-perception of cancer patients on the relationship existing between their nutritional status, their feeding status, and their illness].

PubMed

Gómez Candela, C; Marín Caro, M M; Benítez Cruz, S; Loria Kohen, V; García Huerta, M; Lourenço Nogueira, T; Villarino Sanz, M; Castillo Rabaneda, R; Zamora Auñón, P

2008-01-01

Knowing the opinion of oncologic patients about the importance they give to their feeding, the difficulties they have with feeding, their body image, weight, and ponderal changes, the relationship between their feeding and their illness, the relationship between their physical activity and their mood and health is essential to look for nutritional therapeutic interventions leading to improvement of quality of life and, in general, the feeling of well being. Thus, it is paramount to know the patients' opinion of these issues. We passed a questionnaire to 131 patients. The patients were recruited from the Day-Hospital of the Medical Oncology and Radiotherapeutic Oncology Departments, and from the Hospitalization Department of Medical Oncology. In the questionnaire, we asked in a simple manner about the importance the patients give to all these issues. This is a 20-item questionnaire, divided into six parts: 1. Vital statistics; 2) perception about the disease and its relationship with feeding; 3) Perception of the relationship between physical activity and mood with feeding; 4) Nutritional therapies prescribed to the patients and their perception on its effect on the disease progression; 5) Current difficulties with feeding; 6) Demand of nutritional care. The patients mean age was 57 +/- 13 years. 45% were males, and the remaining females. 81% life in an urban area, and only 14% in a rural area. The educational level was categorized in 5 groups: without education, basic education, elementary school, high school, or college studies. 28% had basic education, and 19% college studies, and only 8% had no education at all. Their occupation was also categorized in five groups: home-keeping, student, unemployed, employed, and retired. 33% were employed, 29% retired, and 34% were home-keepers. Most of the patients (74%) are aware of their illness and perceive it as severe or very much severe. Most of these patients worry about their body image, weight, and ponderal changes, and they relate them with their feeding status. 74% find a relationship between their nutritional status and their physical activity, and 73% relate it with their mood. At least half of the patients perceive their mood as being low. Although 47% manifested having some difficulty for feeding, only 34% had received some information about their diet, 26% had consumed nutritional supplements, and 81% still consumed their diet without any change. The most common difficulties for feeding were decreased appetite (38%), early satiety (32%), and nausea (20%). The nutritional intervention most commonly required by the patients was general and specific nutritional education to alleviate the symptoms associated to oncologic therapies. Most of the patients are aware of the severity of their illness and care about their body image, weight, and ponderal changes, which they associate with their nutrition. Most of the patients find a close relationship between their nutritional status, their physical activity and their mood. More than half of the patients manifest having some difficulty feeding, but only one third of the population has received information about their diet some time. It is clearly shown that oncologic patients need different effective nutritional intervention measures contributing to improve their feeling of well being.

Complete mental health in adult siblings of those with a chronic illness or disability.

PubMed

Hallion, Madeleine; Taylor, Amanda; Roberts, Rachel

2018-02-01

Sibling relationships have lifelong significance and childhood chronic illness and disability can have considerable impacts on healthy siblings, influencing development into adulthood. Research has not yet assessed well-being in this population using measures of both mental health and mental illness. Thus, this study assessed well-being in a comprehensive manner using the complete mental health (CMH) model. Participants (N = 144) included both adult siblings of those with chronic illness or disability and adults with healthy siblings. Measures of positive social, psychological and emotional well-being were used to assess mental health and a measure of depression, anxiety, and stress was used to assess mental illness. A high proportion of participants, both with and without siblings with a chronic illness or disability, were experiencing symptoms of mental illness, accompanied by high wellbeing. This indicates that many participants fit into the struggling category of the CMH model. The present research highlights the need for early intervention services to ensure that siblings of those with a chronic illness or disability are well supported in developing strengths, as well as managing difficulties. Results also indicate that targeting students in mental health promotion is important to encourage participation in services. Implications for rehabilitation Siblings of those with a chronic illness or disability need to be included in assessments in order to understand the experience of the family unit. It is important for families and clinicians to be aware of the needs of healthy siblings and encourage them to interact with support services in order to maximise and maintain well-being. Skills-based support could be beneficial, particularly for providing caregivers with strategies to meet the needs of both their child with a chronic illness or disability and their healthy children.

Social Reasoning Skills in Adults with Down Syndrome: The Role of Language, Executive Functions and Socio-Emotional Behaviour

ERIC Educational Resources Information Center

Hippolyte, L.; Iglesias, K.; Van der Linden, M.; Barisnikov, K.

2010-01-01

Background: Although the prevalence of mental illness and behaviour problems is lower in adults with Down syndrome (DS) than in other populations with intellectual disabilities, they do present emotional and relational problems, as well as social integration difficulties. However, studies reporting on specific competences known to be central in…

Whose Voice Is It Anyway? Hushing and Hearing "Voices" in Speech and Language Therapy Interactions with People with Chronic Schizophrenia

ERIC Educational Resources Information Center

Walsh, Irene P.

2008-01-01

Background: Some people with schizophrenia are considered to have communication difficulties because of concomitant language impairment and/or because of suppressed or "unusual" communication skills due to the often-chronic nature and manifestation of the illness process. Conversations with a person with schizophrenia pose many pragmatic…

Effects of Race and Precipitating Event on Suicide versus Nonsuicide Death Classification in a College Sample

ERIC Educational Resources Information Center

Walker, Rheeda L.; Flowers, Kelci C.

2011-01-01

Race group differences in suicide death classification in a sample of 109 Black and White university students were examined. Participants were randomly assigned to read three vignettes for which the vignette subjects' race (only) varied. The vignettes each described a circumstance (terminal illness, academic failure, or relationship difficulties)…

Assessment of Diverse Biological Indicators in Gulf War Illness: Are They Replicable Are They Related

DTIC Science & Technology

2015-10-01

that includes physical and neuropsychological evaluations, neuroimaging (MRI, fMRI , DTI), adrenal function tests, and diverse immune, inflammatory...characterized by a profile of concurrent symptoms that typically includes persistent headaches, memory and cognitive difficulties, widespread pain, unexplained...includes physical examinations, neuroimaging (MRI volumetric assessments, fMRI , diffusion tensor imaging), neuropsychological evaluations, assessment

Critical Transport: A Serious Game to Teach the Recommendations for the Transport of Critically Ill Patients

ERIC Educational Resources Information Center

Ribeiro, Claudia; Antunes, Tiago; Pereira, João; Monteiro, Micaela

2014-01-01

At present, medical knowledge is experiencing an exponential growth. This results in serious difficulties to healthcare professionals in keeping up to date. At the same time, medical education is mostly taught using traditional learning methodologies, not always the most efficient. Recently however, there has been a significant increase in the use…

Compassion in the workplace? Discrimination against an employee with cancer.

PubMed

2006-12-01

Rachel is a designer based in the UK. In the following account, she describes the experiences of her colleague Jack, designer and studio manager, during his battles with colon cancer and with his employers. The article raises the issues of difficulties faced in the workplace by patients with cancer and other life-threatening illnesses.

Comprehensive Sex Education and Academic Success: Effective Programs Foster Student Achievement. The Facts

ERIC Educational Resources Information Center

Bridges, Emily; Alford, Sue

2010-01-01

Several recent studies have shown that healthy teens generally do better in school than their less healthy peers. Teens may have little control over some factors--such as chronic illness--that may contribute to their poor health and difficulties in school. However, when armed with accurate information and skills, teens can eliminate or minimize…

Assessing human risk of illness with West Nile virus mosquito surveillance data to improve public health preparedness

USDA-ARS?s Scientific Manuscript database

Surveillance for West Nile virus (WNV) and other mosquito-borne pathogens involves costly and time-consuming collection and testing of mosquito samples. One difficulty faced by public health personnel is how to interpret mosquito data relative to human risk, thus leading to a failure to fully exploi...

A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis.

PubMed

Harris, Sarah; Gilbert, Matthew; Beasant, Lucy; Linney, Catherine; Broughton, Jessica; Crawley, Esther

2017-01-01

An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. Semi-structured interviews were conducted with adolescents (aged 12-17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible.

A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis

PubMed Central

Harris, Sarah; Gilbert, Matthew; Beasant, Lucy; Linney, Catherine; Broughton, Jessica; Crawley, Esther

2016-01-01

Background: An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. Methods: Semi-structured interviews were conducted with adolescents (aged 12–17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. Results: Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. Conclusions: If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible. PMID:27215228

Culture, science and the changing nature of fibromyalgia.

PubMed

Wolfe, Frederick; Walitt, Brian

2013-12-01

Fibromyalgia is a common but contested illness. Its definition and content have changed repeatedly in the 110 years of its existence. The most important change was the requirement for multiple tender points and extensive pain that arose in the 1980s, features that were not required previously. By 2010, a second shift occurred that excluded tender points, allowed less extensive pain, and placed reliance on patient-reported somatic symptoms and cognitive difficulties ('fibro fog') that had never been part of past definitions or content. Fibromyalgia is closely allied with and often indistinguishable from neurasthenia, a disorder of the late 19th and early 20th centuries that lost favour when it was perceived as being a psychological illness. Fibromyalgia's status as a 'real disease', rather than a psychocultural illness, is buttressed by social forces that include support from official criteria, patient and professional organizations, pharmaceutical companies, disability access, and the legal and academic communities.

Gender and schizophrenia.

PubMed

Strkalj Ivezić, Sladana; John, Nada

2009-09-01

In accordance with the predominant view on the neurobiology of schizophrenia, most of the research on the differences in the illness between men and women has been studied on the basis of sex difference as a biological category rather than on the basis of gender as a psychosocial category. There are gender- identity difficulties observed in schizophrenia. Problems associated with gender can be a major source of instability and vulnerability during the development of the first and later psychotic episodes. There is a need for future research to view sex difference through gender perspectives. Findings from a gender study may have utility for the development of differential treatment interventions for men and women and may improve the outcome of the illness in general. The study of the complex role of gender in illness processes is an important research direction that would enhance our understanding of the heterogeneity in the manifestation and subjective experience of schizophrenia.

Roles of community helpers in using the Medicare Part D benefit

PubMed Central

Hensley, Melissa A.

2013-01-01

Objectives To examine the experiences of low-income Part D beneficiaries with mental illness and their use of community helpers to access prescription medicines. Methods Individual semi-structured interviews were conducted with 26 Medicare beneficiaries with mental illness in community settings. The transcripts were analyzed for content related to community help-seeking and attitudes toward family and professional helpers. Results Medicare Part D beneficiaries with mental illness used the assistance of community helpers extensively. Pharmacists, nurses, community mental health case managers, and family members assisted beneficiaries with understanding their benefit plans and interpreting paperwork from plans and government agencies. Community helpers also assisted with tasks related to medication adherence. Mental health consumers appreciated the help that they received from family members and professionals. Conclusion This group of Medicare beneficiaries would have experienced difficulty in using their benefits and obtaining their medication without considerable help from professionals and family members in the community. PMID:21317520

A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists.

PubMed

Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey; Essock, Susan; Riano, Nicholas S; Shumway, Martha; Newcomer, John W; Dilley, James W; Schillinger, Dean

2017-11-28

We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.

Treatment of Psychosomatic Disorders

PubMed Central

Wittkower, E. D.

1964-01-01

Goals, potentialities and limitations of treatment of psychosomatic disorders are reviewed. Removal of a disturbing psychosomatic symptom may be all that can be accomplished. The bulk of patients suffering from psychosomatic disorders should be treated by physicians other than psychiatrists. Difficulties arise, owing to differences in approach, when treatment is carried out by a general physician as well as a psychiatrist. In appraising the prospects of treatment, the age on examination, intelligence, duration of illness, degree of insight, nature of illness, environmental stress and personality structure of the patients should be considered. Psychiatric measures which have been employed include: electroconvulsive therapy, psychotropic drugs, hypnosis, drug abreaction, group therapy, supportive psychotherapy and psychoanalysis. Psychoanalysis provides the best understanding of the psychodynamics of psychosomatic illness but is, for a variety of reasons, applicable only to a small number of patients. Alternations and removal of disturbing symptoms can be accomplished by the other therapeutic means. PMID:14146853

[Psychiatric patients, dialysis, kidney transplant: case report and discussion].

PubMed

Melamed, Yuval; Klein, Osnat; Bzura, Georgina; Finkel, Boris; Bleich, Avi; Bernheim, Jack

2005-05-01

Psychiatric patients' coping capacity with various life situations is limited due to their mental illness. This difficulty is even more pronounced when dealing with severe physical conditions such as kidney failure, the need for dialysis and kidney transplant. In the past, similar to patients who suffered from additional physical conditions, patients with major psychiatric disorders, long-term psychotic illness such as schizophrenia, were not considered candidates for dialysis treatment. Although these attitudes have changed, there is still concern that psychiatric patients would find it difficult to cooperate with the long-term treatment required following kidney transplant, and that lack of careful adherence to medication regimens could lead to rejection of the implant. This article describes five mentally ill individuals who suffer from terminal kidney failure, and illustrates the dilemma associated with dialysis and kidney transplant in psychiatric patients. Close cooperation between the psychiatric staff and the nephrology team can lead to the hoped for outcomes.

The Dubai Community Psychiatric Survey. IV. Life events, chronic difficulties and psychiatric morbidity.

PubMed

Bebbington, P; Hamdi, E; Ghubash, R

1998-10-01

The relationship between life events, chronic social difficulties and psychiatric morbidity was investigated in 297 women selected at random as part of the Dubai Community Psychiatric Survey. The PSE-ID-CATEGO system was used to identify psychiatric cases, based on an Index of Definition level of 5 or more. Life events in the 6-month period prior to illness or interview were elicited through the Life Events and Difficulties Schedule. Chronic difficulties were explored through direct questioning based on a list of possible problems. The study demonstrates a significant excess of marked and moderately threatening life events in acute cases of psychiatric disorder (50%) compared to chronic cases (16.7%) and non-cases (27.9%). The association was particularly marked for events in the 3-month period before the onset. Around 33% of psychiatric morbidity may be attributed to marked and moderately threatening life events. Rates for mild events were similar in the three groups of subjects. Subjects experiencing chronic social difficulties included a significantly higher proportion of cases (33.3%) than those who did not experience such difficulties (9.1%). The effect of chronic social difficulties was more pronounced than, and independent of, the effects of life events. There were no interactions between life events and vulnerability factors in their effect on psychiatric morbidity, although numbers were small. The results suggest that the overall influence of life events and chronic difficulties on psychiatric morbidity is commensurate with that in Western societies, despite the different coping traditions of Islam.

[Herpetic encephalitis: a clinical case].

PubMed

Dryhant, L P; Sereda, V H; Kushpiĭ, O V; Tkachenko, V V; Kravchuk, N A; Inhula, N I; Sizina, A V; Sachko, Iu Iu; Andrusenko, A S; Tytenko, Iu I; Babirad, A M

2012-01-01

An example of diagnostics and treatment of patient is in-process made with herpetic encephalitis. It is well-proven in researches, that a herpetic encephalitis is 11.5% among sharp encephalitises. Morbidity is sporadic, some researchers specify on an increase its spring. An infection can be passed tiny and pin a way. Seasonal vibrations are not incident to the herpetic encephalitis. Two peaks of morbidity are on 5-30 years and age more senior 50 years. More than in 95% cases the virus of simple herpes of type serves as an exciter of herpetic encephalitis 1. A characteristic triad of herpetic encephalitis is the sharp feverish beginning, development of cramps of dzheksonovskogo type and violation of consciousness, developing usually after a brief respirator infection. Sometimes sudden development of cramps and loss of consciousness is preceded a fever. Example of such development of disease is made an in our work.

Confirmed viral meningitis with normal CSF findings.

PubMed

Dawood, Naghum; Desjobert, Edouard; Lumley, Janine; Webster, Daniel; Jacobs, Michael

2014-07-17

An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism. On admission, blood tests showed a mild lymphopenia, with a normal C reactive protein and white cell count. Chest X-ray and CT of the head were normal. Cerebrospinal fluid (CSF) microscopy was normal. CSF protein and glucose were in the normal range. MRI of the head and cerebral angiography were also normal. Subsequent molecular testing of CSF detected enterovirus RNA by reverse transcriptase PCR. The patient's clinical syndrome correlated with her virological diagnosis and no other cause of her symptoms was found. Her symptoms were self-limiting and improved with supportive management. This case illustrates an important example of viral central nervous system infection presenting clinically as meningitis but with normal CSF microscopy. 2014 BMJ Publishing Group Ltd.

What Physical Health Means to Me: Perspectives of People with Mental Illness.

PubMed

Happell, Brenda; Ewart, Stephanie B; Platania-Phung, Chris; Bocking, Julia; Scholz, Brett; Stanton, Robert

2016-12-01

There are significant inequalities in physical health and life expectancy between people with and without a mental illness. Understanding perspectives of people with mental illness on personal meanings of physical health is essential to ensuring health services are aligned with consumer understandings, needs, and values. A qualitative exploratory study was undertaken involving focus groups with 31 consumers in The Australian Capital Territory, Australia. Participants were asked: "What does physical health mean to you?" Thematic analysis was applied to interview transcripts. Five themes are discussed, representing different emphases in the meaning of physical health: (1) physical and mental are interconnected, (2) absence of disease, (3) moving the body, (4) struggling for healthy diet, and (5) functioning and participation. Physical pain was a difficulty that arose across these themes. Mental health consumers see physical health as always connected with well-being. Nurses would benefit from been informed by consumer understandings of physical health. In addition, there should be more attention to quality of life measures of people with mental illness as these are more congruent with consumer perspectives on physical health than biomedical measures.

'Health is wealth and wealth is health'--perceptions of health and ill-health among female sex workers in Savannakhet, Laos.

PubMed

Phrasisombath, Ketkesone; Thomsen, Sarah; Sychareun, Vanphanom; Faxelid, Elisabeth

2013-01-02

Female sex workers (FSWs) are vulnerable to sexually transmitted infections (STIs) and other types of health problems and they also encounter socio-economic difficulties. Efforts to develop effective health intervention programs for FSWs have been hampered by a lack of information on why FSWs do not seek or delay seeking treatment for STIs. To further understand their reasons, our study applied a qualitative approach to explore perceptions of health and ill-health among FSWs in Savannakhet province in Laos. Fifteen in-depth interviews were conducted with FSWs in Savannakhet province. Latent content analysis was used for analysis. Sex workers' definitions of health and wealth are intertwined. Thus, good health was described as strongly related to wealth, and wealth was needed in order to be healthy. This is explained in two sub-themes: health is necessary for work and income and ill-health creates social and economic vulnerability. Female sex workers' beliefs and perceptions about health and ill-health were dominated by their economic need, which in turn was influenced by expectations and demands from their families.

Junior doctors' experiences of personal illness: a qualitative study.

PubMed

Fox, Fiona E; Doran, Natasha J; Rodham, Karen J; Taylor, Gordon J; Harris, Michael F; O'Connor, Michael

2011-12-01

Professional status and working arrangements can inhibit doctors from acknowledging and seeking care for their own ill health. Research identifies that a culture of immunity to illness within the medical profession takes root during training. What happens when trainee doctors become unwell during their formative period of education and training? What support do they receive and how do they perceive that the experience of ill health affects their training trajectory? These research questions were developed by a multidisciplinary team of researchers and health professionals, who adopted a qualitative approach to investigate the experiences of personal illness among trainees in their Foundation Programme (FP) years. Semi-structured interviews were conducted with eight FP trainees from the Severn Deanery in southwest England who had experienced significant illness. Interpretative phenomenological analysis was used to conduct and analyse the interviews, resulting in a comprehensive list of master themes. This paper reports an interpretative analysis of the themes of Support, Illness Experience, Crossing the Line, Medical Culture, Stigma and Disclosure. Ineffective communication within the medical education and employment system underpins many of the difficulties encountered by trainees who are unwell. Coping style plays a key role in predicting how trainees experience support during and after their illness, although this may be influenced by their particular diagnoses. The barriers to disclosure of their illnesses are discussed within the context of mobilising and maintaining support. Concern about the impact of missing training as a result of ill health appears to be significant in the transmitting of an ethos of invulnerability within the medical culture. Suggestions to improve support procedures for trainees who are unwell include the provision of greater flexibility within the rotation system along with independent pastoral support. Promoting the importance of disclosing significant illness as early as possible might go some way towards challenging the culture of invulnerability to illness that prevails among doctors. © Blackwell Publishing Ltd 2011.

Providing Support to Relatives and Friends Managing Both Chronic Physical Illness and Depression: the Views of a National Sample of U.S. Adults

PubMed Central

Janevic, Mary; Rosland, Ann-Marie; Wiitala, Wyndy; Connell, Cathleen M; Piette, John D.

2012-01-01

Objective To describe how comorbid depression in chronically ill adults affects the willingness of their family and friends to provide them with illness management support. Methods We identified a national sample of U.S. adults (n=1027), all of whom had a close relative or friend with a chronic physical illness. We examined whether respondents were less willing to help their relatives/friends with disease management when they reported that these relatives/friends were also diagnosed with depression. Results In multivariate models, the odds of respondents being willing to provide disease-management support doubled when the relative/friend was depressed (adjusted odds ratio (AOR) = 1.99; 95% C.I=1.31, 3.02). Respondents were willing to perform an equal number of illness support tasks for relatives/friends with and without depression. However, respondents reported 30% more difficulties discussing health issues (incidence rate ratio (IRR)=1.30; 95% C.I=1.11,1.53), and 44% more barriers to providing support (IRR=1.44; 95% C.I=1.18, 1.75) to depressed relatives/friends. Conclusion U.S. adults are more willing to provide disease-management support for chronically ill relatives/friends with depression. However, helping depressed relatives/friends is also more challenging. Practice implications By providing resources for potential supporters, health providers could mobilize an important source of disease-management support for patients with chronic illness and depression. PMID:22748757

"It's not that straightforward": when family support is challenging for mothers living with mental illness.

PubMed

Perera, Dinali N; Short, Liz; Fernbacher, Sabin

2014-09-01

Mental health service providers often have limited or problematic understanding of parents' support needs or experiences and family relationships. Moreover, the impact of family life and relationships for mothers with mental illness, and whether these relationships are experienced as positive or negative, have been largely underinvestigated. This article aims to increase understanding about the complexity of family relationships and support for mothers. Findings may be useful for services when considering family involvement, and for how to better meet the needs of mothers with mental illness and support their recovery. Semistructured interviews were conducted with 8 mothers with mental illness and 11 mental health service providers. This article presents a grounded theory analysis of the complexity of family relationships and support for mothers with mental illness. Family relationships of mothers with mental illness can be complex, potentially difficult, and challenging. Problems in relationships with partners and families, and experiences of abuse, can have harmful consequences on parenting, on mothers' and children's well-being, and on the support mothers receive. This project highlights a need to recognize and work with positive aspects and difficulties in family relationships as part of mental health service provision. Policies can be reviewed to increase the likelihood that mental health care will combine family-sensitive practice with practice that acknowledges difficult family relationships and experiences of family violence in order to maximize support to mothers with mental illness and their children. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Age at Onset of Bipolar Disorder Related to Parental and Grandparental Illness Burden.

PubMed

Post, Robert M; Altshuler, Lori L; Kupka, Ralph; McElroy, Susan L; Frye, Mark A; Rowe, Michael; Grunze, Heinz; Suppes, Trisha; Keck, Paul E; Leverich, Gabriele S; Nolen, Willem A

2016-10-01

The age at onset of bipolar disorder varies greatly in different countries and continents. The association between load of family history of psychiatric illness and age at onset has not been adequately explored. 979 outpatients with bipolar disorder (from 4 sites in the United States and 3 in the Netherlands and Germany) gave informed consent and completed a questionnaire about their demographics, age at onset of illness, and family history of unipolar and bipolar disorder, alcohol and substance abuse comorbidity, suicide attempts, and "other" illnesses in their parents, 4 grandparents, and any offspring. We examined how the parental and grandparental burden of these illnesses related to the age at onset of the patients' bipolar disorder. The burden of family psychiatric history was strongly related to an earlier age at onset of illness in both US and European patients (F₃,₉₀₆ = 35.42, P < .0001). However, compared to the Europeans, patients in the United States had both more family history of most difficulties and notably earlier age at onset. Earlier age at onset was associated with a greater illness burden in the patient's offspring (t₅₆₈ = 4.1, P < .0001). More parental and grandparental psychiatric illness was associated with an earlier age at onset of bipolar disorder, which is earlier in the United States compared with Europe and is strongly related to a poor long-term prognosis. This apparent polygenic contribution to early onset deserves further study and therapeutic attempts at ameliorating the transgenerational impact. © Copyright 2016 Physicians Postgraduate Press, Inc.

Psychiatric emergencies.

PubMed

Schorr, S J; Richardson, D

1995-06-01

Psychiatric emergencies can arise during pregnancy and the puerperium. When faced with a gravida presenting with the symptoms of an acute psychiatric illness, the obstetrician must consider the possibilities of organic disorders and substance abuse before initiating psychotropic therapy with the consulting psychiatrist. Generally, patients with psychiatric illness have difficulty caring for themselves and hospitalization may be indicated at least initially. Emotional support, a quiet environment, and psychotherapy are often the most important aspects of treatment. Suicide gestures should always be taken seriously. Immediate psychiatric consultation is imperative. Finally, anyone caring for pregnant women should be aware of the possibility of domestic violence. Pregnant women are unlikely to volunteer information about an abusive situation. Detection hinges on willingness of the physician to ask probing questions.

Normal-pressure hydrocephalus and the saga of the treatable dementias

DOE Office of Scientific and Technical Information (OSTI.GOV)

Friedland, R.P.

1989-11-10

A case study of a 74-year-old woman is presented which illustrates the difficulty of understanding dementing illnesses. A diagnosis of normal-pressure hydrocephalus (NPH) was made because of the development of abnormal gait, with urinary incontinence and severe, diffuse, white matter lesions on the MRI scan. Computed tomographic, MRI scans and positron emission tomographic images of glucose use are presented. The treatable dementias are a large, multifaceted group of illnesses, of which NPH is one. The author proposes a new term for this disorder commonly known as NPH because the problem with the term normal-pressure hydrocephalus is that the cerebrospinal fluidmore » pressure is not always normal in the disease.« less

Hypochondriacal Concerns: Management Through Understanding

PubMed Central

Holder-Perkins, Vicenzio; Wise, Thomas N.; Williams, Darren E.

2000-01-01

The medically unexplained complaint is often a symptom of hypochondriacal concerns. Patients with hypochondriasis may be managed with either naive realism or consideration of morbid categorization or via dimensional assessment of illness beliefs and behaviors. Naive realism will foster focus somatization and promote regression as well as lead to needless tests and treatments. Attention to categorical entities such a major depression or anxiety disorders will alert the clinician to comorbid psychiatric disorders that respond to traditional psychiatric treatments. Finally, by assessing the domains of illness behaviors such as disease conviction, beliefs in organic versus psychological causes, and denial, the clinician can document and then confront abnormal cognitive schema that revolve around somatic concerns that are a proxy for psychosocial difficulties. PMID:15014644

Methodological update in Medicina Intensiva.

PubMed

García Garmendia, J L

2018-04-01

Research in the critically ill is complex by the heterogeneity of patients, the difficulties to achieve representative sample sizes and the number of variables simultaneously involved. However, the quantity and quality of records is high as well as the relevance of the variables used, such as survival. The methodological tools have evolved to offering new perspectives and analysis models that allow extracting relevant information from the data that accompanies the critically ill patient. The need for training in methodology and interpretation of results is an important challenge for the intensivists who wish to be updated on the research developments and clinical advances in Intensive Medicine. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Psychiatric and physical sequelae of childhood physical and sexual abuse and forced sexual trauma among individuals with serious mental illness.

PubMed

Subica, Andrew M

2013-10-01

Trauma and posttraumatic stress disorder (PTSD) frequently co-occur with serious mental illness, yet the unique mental and physical health influences of childhood physical abuse (CPA), childhood sexual abuse (CSA), and forced sexual trauma on individuals with serious mental illness remain unevaluated. The present study of 172 individuals with serious mental illness investigated the adverse effects of CPA, CSA, and forced sexual trauma on severity of PTSD and depression, and overall mental and physical health functioning. Data analysis consisted of chi-square tests, independent t tests, bivariate odds ratios, and linear regressions. Prevalence of CPA (44.8%), CSA (29.1%), and forced sexual trauma (33.1%) were elevated, and nearly one third of participants (31.4%) reported clinical PTSD. Participants exposed to CSA or forced sexual trauma evidenced bivariate ORs ranging from 4.13 to 7.02 for PTSD, 2.44 to 2.50 for major depression, and 2.14 to 2.31 for serious physical illness/disability. Sexual trauma exposure associated with heightened PTSD and depression, and reduced mental and physical health functioning, with CSA uniquely predicting PTSD, depression, and physical health difficulties. CPA less significantly affected these clinical domains. Sexual traumas have profound negative effects on mental and physical health outcomes among individuals with serious mental illness; increased screening and treatment of sexual traumas is needed. Copyright © 2013 International Society for Traumatic Stress Studies.

Detainee Health Care: Essential Element of Stability Operations

DTIC Science & Technology

2012-03-22

reported a lack of proper medical equipment to treat older chronically ill detainees.57 Physicians reported difficulties in transferring detainees...ascertains detainees’ baseline health and identifies medical needs which require immediate attention or chronic conditions for ongoing care, referral to a...an in- patient or out-patient basis. Long standing chronic injuries are common among detainees-these include injuries from gunshot wounds, shrapnel

Estimating the Illuminant Color from the Shading of a Smooth Surface

DTIC Science & Technology

1988-08-01

OV 69 is OSSO1LEtTE UNCLASS IF IED SECURITY CLASSIFICATION OPV THIS PACE (9%@n Dae. ill’ft~h Block 20 continued Light reflection from a surface is...perceive qualitatively the scene illuminant quite well. Even w ,cn we have difficulty judging the "true" color of a piece of fabrics under certain indoor

Intranasal Insulin: A Novel Treatment for Gulf War Multisymptom Illness

DTIC Science & Technology

2016-10-01

unexplained health symptoms; common among them were attention and memory difficulties, fatigue, joint pain, headaches, gastrointestinal complaints...slowing of response speed that affects mental flexibility across multiple cognitive domains (memory, attention , visuospatial functions) especially...Krengel and Sullivan, 2008; Toomey et al., 2009; Chao et al., 2011). Recent studies also have suggested that the response inhibition deficits shown in

Using Cognitive Load Theory to Interpret Student Difficulties with a Problem-Based Learning Approach to Engineering Education: A Case Study

ERIC Educational Resources Information Center

Peters, Michael

2015-01-01

This article reports on an investigation with first year undergraduate Product Design and Management students within a School of Engineering and Applied Science. The students at the time of this investigation had studied fundamental engineering science and mathematics for one semester. The students were given an open ended, ill-formed problem…

Change management - recommendations for successful electronic medical records implementation.

PubMed

Shoolin, J S

2010-01-01

Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician's attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management.

A feasibility study of a 3-D finite element solution scheme for aeroengine duct acoustics

NASA Technical Reports Server (NTRS)

Abrahamson, A. L.

1980-01-01

The advantage from development of a 3-D model of aeroengine duct acoustics is the ability to analyze axial and circumferential liner segmentation simultaneously. The feasibility of a 3-D duct acoustics model was investigated using Galerkin or least squares element formulations combined with Gaussian elimination, successive over-relaxation, or conjugate gradient solution algorithms on conventional scalar computers and on a vector machine. A least squares element formulation combined with a conjugate gradient solver on a CDC Star vector computer initially appeared to have great promise, but severe difficulties were encountered with matrix ill-conditioning. These difficulties in conditioning rendered this technique impractical for realistic problems.

Being a Forensic Psychiatrist in India: Responsibilities, Difficulties, and Criticalities.

PubMed

Malathesh, B C; Das, Soumitra

2017-01-01

Forensic psychiatry is in its infancy in India. There is a clear module or a well-structured training in the country except for recently opened few courses. Lack of trainer in the field might lead to compromised state when one has to take decision between the well-being of a person versus society. Starting from social contexts, such as marriage and mental illness, to the interpretation of criminal mind, there is a multitude of situations where forensic psychiatrist has a handful of jobs which suffer due to lack of infrastructure. In this article, we delineate the importance of a forensic psychiatrist in different civil as well as legal scenarios and difficulties often faced while handling it.

Mental Health Literacy Content for Children of Parents with a Mental Illness: Thematic Analysis of a Literature Review

PubMed Central

Riebschleger, Joanne; Grové, Christine; Cavanaugh, Daniel

2017-01-01

Millions of children have a parent with a mental illness (COPMI). These children are at higher risk of acquiring behavioural, developmental and emotional difficulties. Most children, including COPMI, have low levels of mental health literacy (MHL), meaning they do not have accurate, non-stigmatized information. There is limited knowledge about what kind of MHL content should be delivered to children. The aim of this exploratory study is to identify the knowledge content needed for general population children and COPMI to increase their MHL. A second aim is to explore content for emerging children’s MHL scales. Researchers created and analyzed a literature review database. Thematic analysis yielded five main mental health knowledge themes for children: (1) attaining an overview of mental illness and recovery; (2) reducing mental health stigma; (3) building developmental resiliencies; (4) increasing help-seeking capacities; and (5) identifying risk factors for mental illness. COPMI appeared to need the same kind of MHL knowledge content, but with extra family-contextual content such as dealing with stigma experiences, managing stress, and communicating about parental mental illness. There is a need for MHL programs, validated scales, and research on what works for prevention and early intervention with COPMI children. PMID:29072587

Psychometric properties of the parent́s perception uncertainty in illness scale, spanish version.

PubMed

Suarez-Acuña, C E; Carvajal-Carrascal, G; Serrano-Gómez, M E

2018-03-27

To analyze the psychometric properties of the Parents' Perception of Uncertainty in Illness Scale, parents/children, adapted to Spanish. A descriptive methodological study involving the translation into Spanish of the Parents' Perception of Uncertainty in Illness Scale, parents/children, and analysis of their face validity, content validity, construct validity and internal consistency. The original version of the scale in English was translated into Spanish, and approved by its author. Six face validity items with comprehension difficulty were reported; which were reviewed and adapted, keeping its structure. The global content validity index with expert appraisal was 0.94. In the exploratory analysis of factors, 3 dimensions were identified: ambiguity and lack of information, unpredictability and lack of clarity, with a KMO=0.846, which accumulated 91.5% of the explained variance. The internal consistency of the scale yielded a Cronbach alpha of 0.86 demonstrating a good level of correlation between items. The Spanish version of "Parent's Perception of Uncertainty in Illness Scale" is a valid and reliable tool that can be used to determine the level of uncertainty of parents facing the illness of their children. Copyright © 2018 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Computerized physical activity training for persons with severe mental illness - experiences from a communal supported housing project.

PubMed

Gyllensten, Amanda Lundvik; Forsberg, Karl-Anton

2017-11-01

To study the effectiveness of Exergames in communal psychiatry for persons with severe mental illness, a randomized cluster study was performed. The hypothesis was to increase physical activity habits to improve somatic health. To identify factors promoting or impeding the use of the Exergames. Assessments of BMI, blood pressure, physical fitness, SF36, GAF and social interactions were studied at baseline and 10 months. An integrated methods design using content analysis of focus group interviews was integrated with a statistical analysis. Forty-three persons were randomized to the intervention and 30 to the control group. The qualitative interviews included 18 users, 11 staffs and one technical assistant. There were no significant between-group changes in physical activity behaviours or somatic health parameters after 10 months. Only 5% of the intervention group made systematic use of the intervention. Technological difficulties and staff attitudes were found to be barriers. The Exergames were perceived as technically complicated. The staff did not see playing TV games as important and negative attitudes were found. Exergames was not a successful intervention to increase physical activity behaviours in persons with severe mental illness in the community. Exergames and motivation for physical activity in this group is problematic. Implications for rehabilitation There are difficulties to change passive physical activity habits for persons with severe mental illness, living in sheltered housing conditions in the community due to negative symptoms with depression, low motivation and bad self -confidence. An exergame intervention was not successful in this group of persons. No somatic health benefits were found. Simple physical activities and offering different choices meeting different user needs should be offered. Ensuring user and staff engagement, good technical knowledge and good monitoring is a need for a successful intervention, if Exergames are offered as an alternative physical activity.

Patient perceptions about illness self-management in ANCA-associated small vessel vasculitis.

PubMed

Thorpe, C T; DeVellis, R F; Blalock, S J; Hogan, S L; Lewis, M A; DeVellis, B M

2008-06-01

To characterize patient perceptions, related to eight self-management behaviours relevant for adults with ANCA-associated small vessel vasculitis (ANCA-SVV), and to determine if these perceptions were associated with performance of each behaviour. Adults with ANCA-SVV (n = 202) completed a self-administered questionnaire that assessed eight self-management behaviours (adherence to recommendations for medication, health service use, diet, exercise, infection avoidance and symptom monitoring; prompt reporting of symptoms and side effects; and adjusting activities in response to symptoms), perceptions about these behaviours, socio-demographics, clinical factors and social desirability bias. Descriptive statistics were generated to characterize patients' perceptions about difficulty of, importance of, and specific barriers to performing each behaviour. Regression analyses explored whether these variables were associated with performing each behaviour, controlling for potential confounders. With few exceptions, higher perceived importance and lower perceived difficulty of each behaviour were associated with more frequent performance of the behaviour. For each behaviour, several specific barriers were frequently endorsed by patients and a number of these were associated with lower levels of self-management. This study reveals that patient perceptions about the illness and its treatment influence ANCA-SVV self-management. Perceived barriers to medication, health services, diet and exercise adherence were similar to those in other illnesses. This study also provides insight into barriers experienced by patients in performing behaviours (infection avoidance, symptom monitoring, reporting symptoms and side-effects and adjusting activities) not often previously studied. How the identification of these barriers can help inform future interventions for ANCA-SVV patients is to be discussed.

What, if anything, is specific about having a rare disorder? Patients’ judgements on being ill and being rare

PubMed Central

Huyard, Caroline

2009-01-01

Abstract Background  Growing efforts are made to improve the situation of persons with rare diseases, but the specific nature of these disorders remains unclear. Objectives  To establish (1) to what extent people with rare disorders think that their disease’s rarity causes particular difficulties, (2) to what extent these difficulties relate to other causes than rarity (i.e. other characteristics of the disease or other components of the illness experience), (3) to what extent the rarity of the disease may relate to components of patients’ experience other than those that are traditionally addressed (i.e. personal or daily life aspects). Methods  Semi‐structured interviews with 29 patients and 15 parents of children with one of six rare diseases (cystic fibrosis, fragile X syndrome, Wilson’s disease, mastocytosis, locked‐in syndrome and a sixth syndrome). The interviews were conducted in France. The analysis draws on French pragmatic sociology and focuses on the participants’ judgements of their experience. Findings  The participants considered as normal and acceptable a range of situations that are often viewed as specific to rare disorders and unfair. This rather positive evaluation was conditional on some specific moral criteria being met. The participants attributed the cause of their difficulties to the failure of health professionals to meet these criteria. In the participants’ experience, disease‐related associations play a key role and rarity seems to contribute to making them especially important. Conclusions  Patients’ experience would be considerably improved if health professionals more often fulfilled their moral expectations, especially regarding diagnosis disclosure and information. (250 words) PMID:19840131

38 CFR 20.702 - Rule 702. Scheduling and notice of hearings conducted by the Board of Veterans' Appeals in...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., whichever is earlier. The request must be in writing, but the grounds for the request need not be stated..., but are not limited to, illness of the appellant and/or representative, difficulty in obtaining... writing and must explain why a new hearing date is necessary. If good cause is shown, the hearing will be...

38 CFR 20.702 - Rule 702. Scheduling and notice of hearings conducted by the Board of Veterans' Appeals in...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., whichever is earlier. The request must be in writing, but the grounds for the request need not be stated..., but are not limited to, illness of the appellant and/or representative, difficulty in obtaining... writing and must explain why a new hearing date is necessary. If good cause is shown, the hearing will be...

38 CFR 20.702 - Rule 702. Scheduling and notice of hearings conducted by the Board of Veterans' Appeals in...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., whichever is earlier. The request must be in writing, but the grounds for the request need not be stated..., but are not limited to, illness of the appellant and/or representative, difficulty in obtaining... writing and must explain why a new hearing date is necessary. If good cause is shown, the hearing will be...

38 CFR 20.702 - Rule 702. Scheduling and notice of hearings conducted by the Board of Veterans' Appeals in...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., whichever is earlier. The request must be in writing, but the grounds for the request need not be stated..., but are not limited to, illness of the appellant and/or representative, difficulty in obtaining... writing and must explain why a new hearing date is necessary. If good cause is shown, the hearing will be...

38 CFR 20.702 - Rule 702. Scheduling and notice of hearings conducted by the Board of Veterans' Appeals in...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., whichever is earlier. The request must be in writing, but the grounds for the request need not be stated..., but are not limited to, illness of the appellant and/or representative, difficulty in obtaining... writing and must explain why a new hearing date is necessary. If good cause is shown, the hearing will be...

Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care.

PubMed

Jimenez, Daniel E; Bartels, Stephen J; Cardenas, Veronica; Alegría, Margarita

2013-10-01

The current study applies the perceived stigma framework to identify differences in attitudes toward mental health and mental health treatment among various racial/ethnic minority older adults with common mental health problems including depression, anxiety disorders, or at-risk alcohol use. Specifically, this study examines to what extent race/ethnicity is associated with differences in (1) perceived stigma of mental illness and (2) perceived stigma for different mental health treatment options. Analyses were conducted using baseline data collected from participants who completed the SAMHSA Mental Health and Alcohol Abuse Stigma Assessment, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multisite randomized trial for older adults (65+ years) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1247 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. African-Americans and Latinos expressed greater comfort in speaking to primary care physicians or mental health professionals concerning mental illness compared with non-Latino Whites. Asian-Americans and Latinos expressed greater shame and embarrassment about having a mental illness than non-Latino Whites. Asian-Americans expressed greater difficulty in seeking or engaging in mental health treatment. Racial/ethnic differences exist among older adults with mental illness with respect to stigmatizing attitudes toward mental illness and mental health treatment. Results of this study could help researchers and clinicians educate racial/ethnic minority older adults about mental illness and engage them in much needed mental health services. Copyright © 2013 John Wiley & Sons, Ltd.

Stigmatizing Attitudes towards Mental Illness among Racial/Ethnic Older Adults in Primary Care

PubMed Central

Jimenez, Daniel E.; Bartels, Stephen J.; Cardenas, Veronica; Alegría, Margarita

2013-01-01

Objective The current study applies the perceived stigma framework to identify differences in attitudes toward mental health and mental health treatment among various racial/ethnic minority older adults with common mental health problems including depression, anxiety disorders, or at-risk alcohol use. Specifically, this study examines to what extent race/ethnicity is associated with differences in: (1) perceived stigma of mental illness; and (2) perceived stigma for different mental health treatment options. Methods Analyses were conducted using baseline data collected from participants who completed the SAMHSA Mental Health and Alcohol Abuse Stigma Assessment, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1247 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. Results African-Americans and Latinos expressed greater comfort in speaking to primary care physicians or mental health professionals concerning mental illness compared to non-Latino Whites. Asian-Americans and Latinos expressed greater shame and embarrassment about having a mental illness than non-Latino Whites. Asian-Americans expressed greater difficulty in seeking or engaging in mental health treatment. Conclusions Racial/ethnic differences exist among older adults with mental illness with respect to stigmatizing attitudes towards mental illness and mental health treatment. Results of this study could help researchers and clinicians educate racial/ethnic minority older adults about mental illness and engage them in much needed mental health services. PMID:23361866

Insomnia: Zolpidem Extended-Release for the Treatment of Sleep Induction and Sleep Maintenance Symptoms

PubMed Central

Doghramji, Paul P.

2007-01-01

Insomnia impairs daytime functioning or causes clinically significant daytime distress. The consequences of insomnia, if left untreated, may contribute to the risks of developing additional serious conditions, such as psychiatric illness, cardiovascular disease, or metabolic issues. Furthermore, some comorbidities associated with insomnia may be bidirectional in their causality because psychiatric and other medical problems can increase the risk for insomnia. Regardless of the serious consequences of inadequately treated insomnia, clinicians often do not inquire into their patients' sleep habits, and patients, in turn, are not forthcoming with details of their sleep difficulties. The continuing education of physicians and patients with regard to insomnia and currently available therapies for the treatment of insomnia is, therefore, essential. Insomnia may present as either a difficulty falling asleep, difficulty maintaining sleep, or waking too early without being able to return to sleep. Furthermore, these symptoms often change over time in an unpredictable manner. Therefore, when considering a sleep medication, one with efficacy for the treatment of multiple insomnia symptoms is recommended. A modified-release formulation of zolpidem, zolpidem extended-release, has been approved for the treatment of insomnia characterized by both difficulty in falling asleep and maintaining sleep. Here, we review studies supporting the use of zolpidem extended-release in the treatment of sleep-onset and sleep maintenance difficulties. PMID:17435620

Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study.

PubMed

Gullbrå, Frøydis; Smith-Sivertsen, Tone; Rortveit, Guri; Anderssen, Norman; Hafting, Marit

2016-11-08

Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.

Psychopathology in pediatric epilepsy: role of antiepileptic drugs.

PubMed

Caplan, Rochelle

2012-01-01

Children with epilepsy are usually treated with antiepileptic drugs (AEDS). Some AEDs adversely affect behavior in susceptible children. Since psychiatric comorbidity is prevalent in pediatric epilepsy, this paper attempts to disentangle these AED side effects from the psychopathology associated with this illness. It first outlines the clinical and methodological problems involved in determining if AEDs contribute to the behavior and emotional problems of children with epilepsy. It then presents research evidence for and against the role AEDs play in the psychopathology of children with epilepsy, and outlines how future studies might investigate this problem. A brief description of how to clinically separate out AED effects from the complex illness-related and psychosocial factors that contribute to the behavior difficulties of children with epilepsy concludes the paper.

The chronically ill grandparent in minority multigenerational family households: problems and solutions from three points of view.

PubMed

Banks, J; Cameron, W; Montague, M; Toliver, J; Hobbs, S; Peterson, L; Williams, R

1989-01-01

The Interactional Model of Family Systems was used as a basis for exploring the problems of the chronically ill grandparent from three points of view: the elder family member, the adult child, and the grandchild. A descriptive correlational study was utilized to collect data on a purposive sample of 10 minority families recruited from the Montgomery County Council of the National Council of Negro Women, personal contacts of the investigators, and referrals from a family physician who treats the chronically ill elder members. Data was obtained on the family environment, perceived support, physical health, and a variety of open-ended items dealing with specific difficulties and coping strategies. Findings identified ambivalent feelings, contradictory statements, and some dissatisfaction about their relations with other family members, not feeling needed, not having enough to do and feeling lonely. This information can be useful in designing and implementing a counseling intervention model for groups of multigenerational families who have similar situations and needs.

Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq.

PubMed

Browne, Tess; Hull, Lisa; Horn, Oded; Jones, Margaret; Murphy, Dominic; Fear, Nicola T; Greenberg, Neil; French, Claire; Rona, Roberto J; Wessely, Simon; Hotopf, Matthew

2007-06-01

Deployment to the 2003 Iraq War was associated with ill health in reserve armed forces personnel. To investigate reasons for the excess of ill health in reservists. UK personnel who were deployed to the 2003 Iraq War completed a health survey about experiences on deployment to Iraq. Health status was measured using self-report of common mental disorders, post-traumatic stress disorder (PTSD), fatigue, physical symptoms and well-being. Reservists were older and of higher rank than the regular forces. They reported higher exposure to traumatic experiences, lower unit cohesion, more problems adjusting to homecoming and lower marital satisfaction. Most health outcomes could be explained by role, experience of traumatic events or unit cohesion in theatre. PTSD symptoms were the one exception and were paradoxically most powerfully affected by differences in problems at home rather than events in Iraq. The increased ill-health of reservists appears to be due to experiences on deployment and difficulties with homecoming.

Contrasting beliefs about screening for mental disorders among UK military personnel returning from deployment to Afghanistan.

PubMed

Keeling, M; Knight, T; Sharp, D; Fertout, M; Greenberg, N; Chesnokov, M; Rona, R J

2012-12-01

The objective of the study was to elicit beliefs and experiences of the value of a screening programme for mental illness among UK military personnel. Three months after returning from Afghanistan 21 army personnel participated in a qualitative study about mental health screening. One-to-one interviews were conducted and recorded. Data-driven thematic analysis was used. Researchers identified master themes represented by extracts of text from the 21 complete transcripts. Participants made positive remarks on the advantages of screening. Noted barriers to seeking help included: unwillingness to receive advice, a wish to deal with any problems themselves and a belief that military personnel should be strong enough to cope with any difficulties. Participants believed that overcoming barriers to participating in screening and seeking help would be best achieved by making screening compulsory. Although respondents were positive about a screening programme for mental illness, the barriers to seeking help for mental illness appear deep rooted and reinforced by the value ascribed to hardiness.

Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists.

PubMed

Rosenberg, Leah B; Greenwald, Jeff; Caponi, Bartho; Doshi, Ami; Epstein, Howard; Frank, Jeff; Lindenberger, Elizabeth; Marzano, Nick; Mills, Lynnea M; Razzak, Rab; Risser, James; Anderson, Wendy G

2017-09-01

To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.

The views and experiences of severely mentally ill mothers--a qualitative study.

PubMed

Diaz-Caneja, Angeles; Johnson, Sonia

2004-06-01

The majority of women with severe mental illness are mothers. Little is known about their experiences and the extent to which their needs are met. Semi-structured interviews were carried out with 22 women with schizophrenia, bipolar affective disorder or severe depression with psychotic symptoms in Inner London. Participants' experiences, views about services and needs for support in parenting were discussed. Interviews were transcribed verbatim and qualitative thematic analysis carried out. Most participants who looked after their children described motherhood as rewarding and central to their lives. However, they described the demands associated with parenting and at the same time coping with severe mental illness as considerable, and some feared that their children would be adversely affected by their illnesses. Parenting responsibilities created practical impediments to engaging with mental health services. Fear of losing custody or access to children dominated interactions with mental health and social services, making most participants reluctant to disclose difficulties in parenting to professionals. A widespread assumption that mentally ill women are inherently poor parents, regardless of the facts of individual cases, was described, and stigma was seen as affecting children as well as mothers. Services were perceived as offering little continuing support in relation to parenting, intervening only in crises. Little attention has so far been paid in research and service development to the fact that the majority of mentally ill women are mothers. Strategies for assessing and meeting the resulting unmet needs should be developed and evaluated.

Assessing movement quality in persons with severe mental illness - Reliability and validity of the Body Awareness Scale Movement Quality and Experience.

PubMed

Hedlund, Lena; Gyllensten, Amanda Lundvik; Waldegren, Tomas; Hansson, Lars

2016-05-01

Motor disturbances and disturbed self-recognition are common features that affect mobility in persons with schizophrenia spectrum disorder and bipolar disorder. Physiotherapists in Scandinavia assess and treat movement difficulties in persons with severe mental illness. The Body Awareness Scale Movement Quality and Experience (BAS MQ-E) is a new and shortened version of the commonly used Body Awareness Scale-Health (BAS-H). The purpose of this study was to investigate the inter-rater reliability and the concurrent validity of BAS MQ-E in persons with severe mental illness. The concurrent validity was examined by investigating the relationships between neurological soft signs, alexithymia, fatigue, anxiety, and mastery. Sixty-two persons with severe mental illness participated in the study. The results showed a satisfactory inter-rater reliability (n = 53) and a concurrent validity (n = 62) with neurological soft signs, especially cognitive and perceptual based signs. There was also a concurrent validity linked to physical fatigue and aspects of alexithymia. The scores of BAS MQ-E were in general higher for persons with schizophrenia compared to persons with other diagnoses within the schizophrenia spectrum disorders and bipolar disorder. The clinical implications are presented in the discussion.

Role conflicts of physicians and their family members: rules but no rulebook

PubMed Central

Chen, Frederick M; Feudtner, Chris; Rhodes, Lorna A; Green, Larry A

2001-01-01

Objectives To elucidate the difficulties physicians have when a family member becomes ill and to elicit their underlying causes. Design Using a key informant technique, we solicited chairs of family medicine departments for their experiences with the health care provided to seriously ill family members. We then conducted in-depth, semistructured telephone interviews that were then transcribed, coded, and labeled for themes. Subjects 8 senior family physicians whose parents had experienced a serious illness within the past 5 years. All of the subjects reflected on experiences stemming from their fathers' illness. Results These physicians faced competing expectations: at an internal level, those of their ideal role in their family and their ideal professional identity; and at an external level, those originating from other family members and from other physicians. Reconciling these conflicting expectations was made more difficult by what they deemed to be suboptimal circumstances of the modern health care system. Conclusions Conflicting rules of appropriate conduct, compounded by the inadequacies of modern health care, make the role of physician-family member especially challenging. The medical profession needs a clearer, more trenchant understanding of this role. PMID:11577049

‘Health is wealth and wealth is health’ – perceptions of health and ill-health among female sex workers in Savannakhet, Laos

PubMed Central

Phrasisombath, Ketkesone; Thomsen, Sarah; Sychareun, Vanphanom; Faxelid, Elisabeth

2013-01-01

Background Female sex workers (FSWs) are vulnerable to sexually transmitted infections (STIs) and other types of health problems and they also encounter socio-economic difficulties. Efforts to develop effective health intervention programs for FSWs have been hampered by a lack of information on why FSWs do not seek or delay seeking treatment for STIs. To further understand their reasons, our study applied a qualitative approach to explore perceptions of health and ill-health among FSWs in Savannakhet province in Laos. Methods Fifteen in-depth interviews were conducted with FSWs in Savannakhet province. Latent content analysis was used for analysis. Results Sex workers’ definitions of health and wealth are intertwined. Thus, good health was described as strongly related to wealth, and wealth was needed in order to be healthy. This is explained in two sub-themes: health is necessary for work and income and ill-health creates social and economic vulnerability. Conclusions Female sex workers’ beliefs and perceptions about health and ill-health were dominated by their economic need, which in turn was influenced by expectations and demands from their families. PMID:23336614

Neutral theory, microbial practice: challenges in bacterial population genetics.

PubMed

Rocha, Eduardo P C

2018-04-19

Kimura's outstanding contributions to population genetics included many elegant theoretical results on the vagaries of alleles in populations. Once polymorphism data showed extensive variation in natural populations, these results led naturally to the Neutral Theory. In this article, I'll depart from some of these results to focus on four major open problems in microbial population genetics with direct implications to the study of molecular evolution: the lack of neutral polymorphism, the modeling of genetic exchanges, the population genetics of ill-defined populations, and the difficulty of untangling selection and demography in the light of the previous issues. Whilst studies in population genetics usually focus on single nucleotide polymorphism and allelic recombination, ignoring even small indels, a large fraction of genetic diversification in Bacteria results from horizontal gene transfer. Ignoring this fact defeats the purpose of population genetics: to characterize the genetic variation in populations and their adaptive effects. I'll argue that, following on Kimura's life work, one may need to develop new approaches to study microbes that reproduce asexually but are able to engage in gene exchanges with very distantly related organisms in a context where random sampling is often unachievable, populations are ill-defined, genetic linkage is strong, and random drift is rare.

Change Management – Recommendations for Successful Electronic Medical Records Implementation

PubMed Central

Shoolin, J.S.

2010-01-01

Summary Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician’s attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management. PMID:23616842

Children and adolescents living with diabetes and celiac disease.

PubMed

Brancaglioni, Bianca de Cássia Alvarez; Rodrigues, Grasiele Caroline; Damião, Elaine Buchhorn Cintra; Queiroz, Márcia Silva; Nery, Márcia

2016-03-01

Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.

[Immunization status of risk newborns and difficulties experienced by mothers].

PubMed

Lopes, Edilene Gianelli; Martins, Christine Baccarat de Godoy; Lima, Fernanda Cristina Aguiar; Gaíva, Maria Aparecida Munhoz

2013-01-01

Among newborns at risk, immunization becomes relevant due to its preventive characteristic. The research aimed to analyze the vaccination status of newborns at risk of Cuiabá-MT, as well as satisfaction and difficulties of mothers regarding immunization. This is descriptive study, quantitative, with 113 newborns at risk, selected by the Statement of Live Birth: 25.7% had delayed immunization, being the lack of vaccine at the Health Unit (50.0%) the reason most often reported. Of the children with delayed immunization, 65.5% had more than one vaccine late, 100% had weight less than expected, 75.9% were accompanied in their growth and development by the Health Unit, 69.0% had an episode of illness in the six first months of life, 41.4% of mothers were under 18 years. The mothers reported more difficulties to the immunization service. We emphasize the importance of strategies to improve the quality of care, structure of health services, reception and professional preparation.

Measuring cancer-specific child adjustment difficulties: Development and validation of the Children's Oncology Child Adjustment Scale (ChOCs).

PubMed

Burke, Kylie; McCarthy, Maria; Lowe, Cherie; Sanders, Matthew R; Lloyd, Erin; Bowden, Madeleine; Williams, Lauren

2017-03-01

Childhood cancer is associated with child adjustment difficulties including, eating and sleep disturbance, and emotional and other behavioral difficulties. However, there is a lack of validated instruments to measure the specific child adjustment issues associated with pediatric cancer treatments. The aim of this study was to develop and evaluate the reliability and validity of a parent-reported, child adjustment scale. One hundred thirty-two parents from two pediatric oncology centers who had children (aged 2-10 years) diagnosed with cancer completed the newly developed measure and additional measures of child behavior, sleep, diet, and quality of life. Children were more than 4 weeks postdiagnosis and less than 12 months postactive treatment. Factor structure, internal consistency, and construct (convergent) validity analyses were conducted. Principal component analysis revealed five distinct and theoretically coherent factors: Sleep Difficulties, Impact of Child's Illness, Eating Difficulties, Hospital-Related Behavior Difficulties, and General Behavior Difficulties. The final 25-item measure, the Children's Oncology Child Adjustment Scale (ChOCs), demonstrated good internal consistency (α = 0.79-0.91). Validity of the ChOCs was demonstrated by significant correlations between the subscales and measures of corresponding constructs. The ChOCs provides a new measure of child adjustment difficulties designed specifically for pediatric oncology. Preliminary analyses indicate strong theoretical and psychometric properties. Future studies are required to further examine reliability and validity of the scale, including test-retest reliability, discriminant validity, as well as change sensitivity and generalizability across different oncology samples and ages of children. The ChOCs shows promise as a measure of child adjustment relevant for oncology clinical settings and research purposes. © 2016 Wiley Periodicals, Inc.

'The singing hospital'--integrated group therapy in the Black mentally ill.

PubMed

Benjamin, B

1983-06-04

Integrated group therapy was originally introduced at Sterkfontein Hospital in 1957, and reintroduced 6 years ago in an effort to overcome difficulties in communication with approximately 100 Black male and female mental hospital patients. This therapy consisted mainly of song and dance activation, sociodrama, psychodrama and behavioural modification methods. These techniques are flexible, and can be carried out by proxy therapists working with doctors and psychologists.

The development of tool manufacture in humans: what helps young children make innovative tools?

PubMed Central

Chappell, Jackie; Cutting, Nicola; Apperly, Ian A.; Beck, Sarah R.

2013-01-01

We know that even young children are proficient tool users, but until recently, little was known about how they make tools. Here, we will explore the concepts underlying tool making, and the kinds of information and putative cognitive abilities required for children to manufacture novel tools. We will review the evidence for novel tool manufacture from the comparative literature and present a growing body of data from children suggesting that innovation of the solution to a problem by making a tool is a much more challenging task than previously thought. Children's difficulty with these kinds of tasks does not seem to be explained by perseveration with unmodified tools, difficulty with switching to alternative strategies, task pragmatics or issues with permission. Rather, making novel tools (without having seen an example of the required tool within the context of the task) appears to be hard, because it is an example of an ‘ill-structured problem’. In this type of ill-structured problem, the starting conditions and end goal are known, but the transformations and/or actions required to get from one to the other are not specified. We will discuss the implications of these findings for understanding the development of problem-solving in humans and other animals. PMID:24101620

Absenteeism, educational plans, and anxiety among children with incontinence and their parents.

PubMed

Filce, Hollie G; LaVergne, Leslie

2015-04-01

Children with incontinence have more absenteeism, poorer academic performance, and potential social difficulties during the school years. These children and their parents are at risk for illness-related anxiety. Whereas educational plans are designed to remediate educational, medical, and social-emotional barriers at school, little research has explored the relationship among absenteeism, educational plans, and anxiety for this population. Eighty-three families provided demographic information and completed either the Revised Children's Manifest Anxiety Scale Second Edition (RCMAS-2) or the Adult Manifest Anxiety Scale (AMAS-A). A multiple regression analysis was conducted to determine the relationships among these variables. Children with chronic illness resulting in incontinence had greater than expected rates of absenteeism. A high level of absenteeism was a significant predictor of parental anxiety, but not child anxiety. Over one third reported having no plan in place to support the child's needs at school. However, when a plan was present, it had no impact on child or parental anxiety. Absenteeism contributes to familial anxiety and educational difficulties. Despite the potential for educational plans to support these children at school, these plans are underutilized for children with incontinence. This population requires more attention to their academic and social-emotional well-being at school. © 2015, American School Health Association.

[End of life care difficulties in intensive care units. The nurses' perspective].

PubMed

Velarde-García, Juan Francisco; Luengo-González, Raquel; González-Hervías, Raquel; González-Cervantes, Sergio; Álvarez-Embarba, Beatriz; Palacios-Ceña, Domingo

To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Adherence to Integrated Management of Childhood Illnesses Guideline in Treating South Sudanese Children with Cough or Difficulty in Breathing

PubMed Central

Anyigu, Stanley; Ndungutse, David

2017-01-01

Background Pneumonia substantially kills children aged 2–59 months in South Sudan. However, information on health workers adherence to Integrated Management of Childhood Illnesses (IMCI) guideline in treating children with cough/difficulty in breathing remains scarce. This study assessed factors associated with adherence to IMCI guideline in Aweil East County, South Sudan. Methods This cross-sectional study involved 232 health workers from 36 health facilities. Data collected using structured questionnaire and checklist was double-entered in EpiData and analyzed with STATA at 5% significance level using logistic regression. Results Respondents mean age was 32.41 ± 7.0 years, 154 (66.4%) were males, 104 (44.8%) reached secondary education, and 190 (81.9%) had certificate. 23 (9.9%, 95% CI: 6.4–14.5) adhered to IMCI guideline. Holding diploma (adjusted odds ratio (AOR) = 6.97; 95% Confidence Interval (CI): 1.82–26.67; P = 0.005), shorter time to follow guideline steps (AOR = 12.0; 95% CI: 2.73–61.66; P < 0.001), and nondifficult use (AOR = 27.7; 95% CI: 5.40–142.25; P < 0.001) were associated with adherence. Conclusion Adherence was low. Academic qualifications, guideline complexity, and availability of IMCI drugs were associated factors. PMID:29075300

The development of tool manufacture in humans: what helps young children make innovative tools?

PubMed

Chappell, Jackie; Cutting, Nicola; Apperly, Ian A; Beck, Sarah R

2013-11-19

We know that even young children are proficient tool users, but until recently, little was known about how they make tools. Here, we will explore the concepts underlying tool making, and the kinds of information and putative cognitive abilities required for children to manufacture novel tools. We will review the evidence for novel tool manufacture from the comparative literature and present a growing body of data from children suggesting that innovation of the solution to a problem by making a tool is a much more challenging task than previously thought. Children's difficulty with these kinds of tasks does not seem to be explained by perseveration with unmodified tools, difficulty with switching to alternative strategies, task pragmatics or issues with permission. Rather, making novel tools (without having seen an example of the required tool within the context of the task) appears to be hard, because it is an example of an 'ill-structured problem'. In this type of ill-structured problem, the starting conditions and end goal are known, but the transformations and/or actions required to get from one to the other are not specified. We will discuss the implications of these findings for understanding the development of problem-solving in humans and other animals.

Cancer in working-age is not associated with childhood adversities.

PubMed

Korpimäki, Sonja K; Sumanen, Markku P T; Sillanmäki, Lauri H; Mattila, Kari J

2010-05-01

Early life events are studied as potential causes of cancer. The objective here was to study childhood adversities in the etiology of cancer. The material comprised a population based random sample of 25 898 individuals among the Finnish working-aged population. In 1998 they were requested through six questions in a postal questionnaire to recall their childhood adversities. The cases consisted of people with cancer diagnosed 2000-2006 and registered in the Finnish Cancer Registry (n = 384). The rest of the sample consisted of cancer-free controls. The most common adversities were prolonged financial difficulties, serious conflicts in the family and someone in the family having been seriously or chronically ill. The cancer patients reported more prolonged financial difficulties and someone seriously or chronically ill in the family. They reported less parental divorce than the controls. The associations were not statistically significant after adjusting for age, sex, education, and health behaviour. Nor was there a significant difference in the total number of childhood adversities between the study group and the controls. On the whole, these cancer patients had not experienced more childhood adversities than the controls. According to our findings, there is no cause to attribute development of cancer in working age to childhood adversities. This information may also give relief to other family members.

Not 'going there': limits to the professionalisation of our emotional lives.

PubMed

Brownlie, Julie

2011-01-01

This article takes as its starting point the thesis that there has been a shift towards emotional openness in Anglo-American societies and that, as a result, we are increasingly at ease with talking to professionals, those who are trained to listen, when faced with difficulties in our emotional lives. Such assumptions are implicit, if unexamined, in recent mental health policy in the UK. Drawing on findings from the first British general population study of views and experiences of emotional support, it is argued that, while there has indeed been a cultural acceptance of the notion that it is good to talk, this has not translated into a retreat into professionalised spaces. How, then, can we understand these limits or, to draw on a popular idiom, why do people choose not to 'go there'? To begin to answer these questions, four areas are explored: the persistence and significance of non talk-based. responses to emotional difficulties, the constraints of and on emotions talk, evidence for an emergent vulnerable self in need of professional intervention and wider cultural beliefs about need, privacy and the role of strangers. © 2010 The Author. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

A Measure of Suffering in relation to Anxiety and Quality of Life in IBS Patients: Preliminary Results.

PubMed

Pletikosić Tončić, Sanda; Tkalčić, Mladenka

2017-01-01

Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder with a severe impact on quality of life (QoL). We explored the relationship of a visual measure of suffering, the PRISM-RII, with quality of life (QoL) and anxiety measures in IBS patients. Participants were 44 IBS patients who completed several questionnaires and kept a symptom diary for two weeks. The measures used were PRISM-RII (self-illness separation (SIS); illness perception measure (IPM)); IBS-36 (IBS health related QoL); SF-36 (physical and mental health related QoL); State-Trait Anxiety Inventory (STAI-T); Visceral Sensitivity Index (VSI; GI-specific anxiety); and a symptom diary. SIS was negatively correlated to VSI, while IPM was negatively correlated to SIS and the physical component of SF-36 and positively to VSI and symptom severity. We found significant differences between participants who perceive their illness as small and those who perceive it as medium in SIS, symptom severity, VSI, and the mental component of SF-36. Participants, who perceived their illness as small, represented their illness as more distant, showed lower average symptom severity, and had lower GI-specific anxiety and higher QoL. The results indicate that IPM and SIS can be useful in discriminating patients with more prominent psychological difficulties and QoL impairment.

Meeting unmet needs of families of persons with mental illness: evaluation of a family peer support helpline.

PubMed

Shor, Ron; Birnbaum, Menachem

2012-08-01

Family members of persons with mental illness experience multiple stressors stemming from the burdens of caring for the ill family member. A potential source of help for this population is a family peer support helpline. Knowledge, however, is lacking about the types of help offered in such a service and its benefit for this population. In a study conducted in Israel, 800 calls made by family members of persons with mental illness to a family peer support helpline were analyzed utilizing an instrument developed for the family peers' evaluation of the calls. In addition, researchers conducted 77 follow-up interviews with callers who agreed to be interviewed. The findings indicate the importance of the life experience, flexibility and anonymity of the family peers in providing types of help that are complementary to the help provided by formal services. The most frequent categories of support provided were emotional support, information and advice. This help could assist family members of persons with mental illness with their care-giving role, as well as provide them with an alternative source of help if they experience difficulties with professionals. It could also serve as a catalyst in encouraging them to establish and maintain contact with the formal mental health services. Recognizing and supporting the contribution of a family peer support helpline would encourage its development within the range of services available for this population.

Illness Symptoms Experienced by Children Exposed to Benzene After a Flaring Incident at the BP Refinery Facility in Texas City.

PubMed

D'Andrea, Mark A; Reddy, G Kesava

2016-10-01

Objective To evaluate the illness symptoms experienced by children who were exposed to benzene following a flaring incident at the BP refinery in Texas City, Texas. Methods A total of 641 children, aged <17 years, exposed to benzene were included. Using medical charts, data on the children's illness symptoms as well as the serum levels of β-2-microglobulin and the amount of urinary excretion of phenol were reviewed and analyzed. Results A total of 1790 illness symptoms were reported in 641 children exposed to benzene. Upper respiratory symptoms were the most (67%) frequently reported, followed by neurological symptoms (57%), diarrhea (25%), and cough (24%). Logistic regression analysis indicated that neurological symptoms (R(2) = 0.75), chest pain (R(2) = 0.64), joint pain (R(2) = 0.57), and vision difficulty (R(2) = 0.54) were positively associated with increasing age. β-2-Microglobulin levels were significantly higher in children <5 years compared with those >5 year (P = .04). Conversely, urinary phenol levels were significantly lower in children <5 years compared with those >5 years (P = .00). Conclusion Together, these findings reveal that children exposed to benzene experience a range of illness symptoms and an altered profile of urinary phenol indicating their vulnerability to potentially increased health complications. © The Author(s) 2016.

[DGPPN compass of participation for vocational integration of persons with mental illnesses].

PubMed

Stengler, K; Rauschenbach, J; Riedel-Heller, S G; Becker, T; Steinhart, I; Gerlinger, G; Hauth, I

2016-11-01

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.

Supporting a friend, housemate or partner with mental health difficulties: The student experience.

PubMed

Byrom, Nicola C

2017-07-14

When experiencing mental health difficulties, university students turn to their friends for support. This study assessed the consequences of caregiving among a university sample, identifying predictors of caregiving burden among students. A total of 79 students with experience of supporting a friend with mental health difficulties were recruited through a UK student mental health charity to complete an online survey. Alongside qualitative data, the online survey used the Experience of Caregiving Inventory and the Involvement Evaluation Questionnaire as measures of the consequences of caregiving. Students supporting friends, housemates or partners were found to experience significant consequences of caregiving. Frequency of face-to-face contact and duration of illness predicted more negative consequences of caregiving, but these relationships were not straightforward. The presence and intensity of professional support did not influence the experience of caregiving. The study suggests that the impact of supporting friends with mental health difficulties is not insubstantial for students. Broadening the network of informal social support may help improve the experience for students supporting a friend, but currently, contact with professional services appears to have a limited effect. © 2017 John Wiley & Sons Australia, Ltd.

An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study

PubMed Central

Patel, Krisna; Tchanturia, Kate; Harrison, Amy

2016-01-01

Previous research indicates adults with eating disorders (EDs) report smaller social networks, and difficulties with social functioning, alongside demonstrating difficulties recognising and regulating emotions in social contexts. Concurrently, those recovered from the illness have discussed the vital role offered by social support and interaction in their recovery. To date, little is known about the social skills and social networks of adolescents with EDs and this study aimed to conduct focus groups to explore the social functioning of 17 inpatients aged 12–17. Data were analysed using thematic analysis and six core themes were identified: group belonging, self-monitoring, social sensitivity, impact of hospitalisation, limited coping strategies and strategies for service provision. Key areas for service provision were: management of anxiety, development and/or maintenance of a social network and development of inter and intrapersonal skills. The most salient finding was that adolescents with EDs reported social difficulties which appeared to persist over and above those typically experienced at this point in the lifespan and therefore a key area for future focus is the development of appropriate coping strategies and solutions to deal with these reported difficulties. PMID:27458808

Taking the Perspective of the Other Contributes to Awareness of Illness in Schizophrenia

PubMed Central

Langdon, Robyn; Ward, Philip

2009-01-01

Two approaches dominate research on the lack of awareness of illness that characterizes schizophrenia. The “deficit” approach uses standardized neuropsychological batteries to identify the neural underpinnings of intact insight; the “nondeficit” approach investigates the psychological defense mechanisms that motivate denial of illness. We adopt, instead, a cognitive neuropsychological approach to model the cognitive processes which underpin insight and which might be either damaged (because of neuropathology) or not used (because of motivational forces). We conceive of these processes in terms of a metacognitive capacity “to see ourselves as others see us.” We predict that a general difficulty with adopting other mental perspectives (with “seeing the world as others do”), indexed by performance deficits on theory of mind (ToM) tasks, will impair insight in schizophrenia. Thirty schizophrenic patients (also assessed for insight) and 26 healthy controls completed a battery of ToM tasks which varied presentation modality, response mode and instruction type (picture sequencing, joke appreciation and story comprehension tasks). While patients performed more poorly than controls on all ToM tasks, impairment in patients was not concordant across tasks. ToM scores from the picture sequencing and joke appreciation tasks, and not the story comprehension task, intercorrelated significantly in patients and predicted insight. Findings support the view that insight relies upon a cognitive capacity to adopt the other perspective, which, if intact, contributes to the metacognitive capacity to reflect upon “one's own” mental health from the other perspective. Findings also suggest that the nature of perspective-taking difficulty which disrupts insight in schizophrenia is best revealed using ToM tasks with “indirect” instructions. PMID:18495647

Elementary School-Based Influenza Vaccination: Evaluating Impact on Respiratory Illness Absenteeism and Laboratory-Confirmed Influenza

PubMed Central

Kjos, Sonia A.; Irving, Stephanie A.; Meece, Jennifer K.; Belongia, Edward A.

2013-01-01

Background Studies of influenza vaccine effectiveness in schools have assessed all-cause absenteeism rather than laboratory-confirmed influenza. We conducted an observational pilot study to identify absences due to respiratory illness and laboratory-confirmed influenza in schools with and without school-based vaccination. Methods A local public health agency initiated school-based influenza vaccination in two Wisconsin elementary schools during October 2010 (exposed schools); two nearby schools served as a comparison group (non-exposed schools). Absences due to fever or cough illness were monitored for 12 weeks. During the 4 weeks of peak influenza activity, parents of absent children with fever/cough illness were contacted and offered influenza testing. Results Parental consent for sharing absenteeism data was obtained for 937 (57%) of 1,640 students. Fifty-two percent and 28%, respectively, of all students in exposed and non-exposed schools were vaccinated. Absences due to fever or cough illness were significantly lower in the exposed schools during seven of 12 surveillance weeks. Twenty-seven percent of students at exposed schools and 39% at unexposed schools had one or more days of absence due to fever/cough illness (p<0.0001). There was no significant difference in the proportion of students absent for other reasons (p = 0.23). During the 4 week period of influenza testing, respiratory samples were obtained for 68 (42%) of 163 episodes of absence due to fever or cough illness. Influenza was detected in 6 students; 3 attended exposed schools. Conclusions Detection of laboratory-confirmed influenza in schools was challenging due to multiple consent requirements, difficulty obtaining samples from absent children, and a mild influenza season. School-based influenza vaccination was associated with reduced absenteeism due to fever or cough illness, but not absenteeism for other reasons. Although nonspecific, absence due to fever or cough illness may be a useful surrogate endpoint in school-based studies if identification of laboratory confirmed influenza is not feasible. PMID:23991071

The power gap: freedom, power and mental illness.

PubMed

Kelly, Brendan D

2006-10-01

Up to one in four individuals in the US meet the diagnostic criteria for a mental illness in any given year and a significant proportion have severe or recurring illnesses (e.g. schizophrenia). Despite this prevalence, mental health services remain poorly funded, mental illness remains misunderstood and individuals with recurring illness are constrained to live lives characterized by isolation, under-employment, stigma and denial of rights. Here I examine the idea that this situation is attributable, at least in part, to the ways in which the freedom and power of the mentally ill are undermined by a range of factors, including: (i) dispersion of political power amongst interest groups, which, combined with the relatively wide distribution of the 'interest' of mental illness, has the paradoxical result that mental health interest groups do not command political power proportional to the number affected; (ii) systematic exclusion of the mentally ill from full participation in civic, social and political life (structural violence), resulting in a lack of emphasis on mental health on political agendas and the exclusion of certain policy options as possible responses and (iii) difficulties the mentally ill may experience recognizing or articulating their own needs the absence of effective health-care systems, and the absence of knowledge about alternative systems. I argue that the enhancement of individual agency is central to efforts to address this power gap, including: (i) rights-based approaches, involving the enhancement of national mental health legislation, improvement of advocacy, empowerment and guardianship processes and development of governance, accountability and quality procedures in mental health services; (ii) approaches based on enhancing direct political participation, including voter-registration programmes and development of larger, more effective interest groups and (iii) additional approaches, including increasing accountability throughout services, recognizing the effects of socio-political change on the context of care and adapting the concept of 'soft power' to strengthen advocacy programmes.

Illuminating the clinical significance of alexithymia subtypes: A cluster analysis of alexithymic traits and psychiatric symptoms.

PubMed

Kajanoja, J; Scheinin, N M; Karlsson, L; Karlsson, H; Karukivi, M

2017-06-01

Alexithymia is a personality construct involving difficulties identifying and verbalizing feelings, and an externally oriented thinking style. There is preliminary evidence for alexithymia subtypes that may carry different risk profiles for psychiatric illness. The aim of this study was to gain support for the existence of alexithymia subtypes and further characterize their clinical relevance. To identify possible subtypes, a cluster analysis was conducted for individuals with high alexithymic traits (N=113). Current depressive and anxiety symptoms, self-reported psychiatric medical history, and self-reported early life adversity were compared between subtypes. The cluster analysis was replicated with the low (N=2471) and moderate (N=290) alexithymia groups. We identified two alexithymia subtypes. Compared to type A, type B alexithymia was associated with higher levels of difficulties in identifying feelings, and was more strongly associated with current depressive (Cohen's d=0.77, p<0.001) and anxiety symptoms (Cohen's d=0.82, p<0.001), and self-reported early life adversity (Cohen's d 0.42, p=0.048). Compared to type A, type B alexithymia was also associated with a higher prevalence of self-reported diagnosis of major depressive- (30.2% vs. 8.3%) and anxiety disorder (18.9% vs. 3.3%). The results of this study support the hypothesis of alexithymia subtypes, and add support to the growing evidence showing that alexithymia is likely a heterogeneous and dimensional phenomenon. The subtype (type B) with most pronounced difficulties in identifying feelings may be associated with a higher risk for psychiatric illness compared to type A alexithymia, and may exhibit a more severe history of early life adversity. Copyright © 2017 Elsevier Inc. All rights reserved.

Family context in muscular dystrophies: psychosocial aspects and social integration.

PubMed

Magliano, Lorenza; Politano, Luisa

2016-10-01

Muscular dystrophies (MDs) are degenerative diseases which may led to marked functional impairment and reduced life expectancy. Being caregivers of a loved one with MD may be both a rewarding and a demanding experience that may have relevant impact on the quality of life of the whole family. In this short review we summarize the main findings of the first survey on family context in MD in Italy. The study was carried out on 502 key-relatives of patients suffering from Duchenne, Becker, or Limb-Girdle MD, aged between 4 and 25 years, and attending one of 8 participating Centers, all over 2012. The results revealed that practical difficulties were mainly related to relatives' involvement in helping the patient in moving and in relative's constraints of leisure activities. Furthermore, feelings of loss and perception of patient's condition as having negative effects on the family life were the psychological consequences more frequently complained. However, despite the difficulties, 88% of the key-relatives acknowledged the caregiving as a positive experience. In fact 94% of the respondents stated they could rely on friends in case of own physical illness, and 88% in case of psychological stress. Burden was found higher among relatives of patients with lower functional autonomy and longer duration of illness, and among relatives with lower professional and social support. Conversely, the positive aspects of the caregiving were more frequently acknowledged by those who received higher level of professional help and psychological social support. These results reveal that the caregiving experience has a positive impact on key-relatives quality of life despite the practical demands, and that the support of professionals is essential to help families in identifying the benefits of this experience without denying its difficulties.

Workplace Accommodation for Persons With IBD: What Is Needed and What Is Accessed.

PubMed

Chhibba, Tarun; Walker, John R; Sexton, Kathryn; Restall, Gayle; Ivekovic, Melony; Shafer, Leigh Ann; Singh, Harminder; Targownik, Laura E; Bernstein, Charles N

2017-10-01

People with inflammatory bowel disease (IBD) often experience periods of illness that interfere with their ability to work. We aimed to understand the need for workplace accommodation during periods of acute illness among persons IBD. Participants were recruited from the population-based University of Manitoba Research Registry and received a survey including questions assessing experiences with workplace accommodations. Data were analyzed using descriptive statistics and multivariate logistic regression modelling. A total of 1143 individuals responded to the survey (46% response rate), of whom 881 had experienced IBD symptoms in the workplace and were included in the analysis. The mean age was 48.3 years (standard deviation, 10.9); 61% were female. Mean IBD duration was 20.6 years (standard deviation, 10.5). Most respondents (73%) described IBD symptoms experienced in the workplace as severe to very severe. The most commonly required accommodations were time to go to medical appointments during working hours (81%), easy access to a toilet (71%), and a chance to take a break when not feeling well (54%). Most accommodations were arranged informally or through a supervisor. The accommodations required were very or somewhat easy to arrange about half the time. Being female, having high symptom severity, and high level of current distress were associated with a need for more accommodations, difficulty implementing accommodations, and not asking for needed accommodations. This study provides important information as to the types of accommodations that are necessary, common practices arranging for these, and level of difficulty arranging accommodations. Furthermore, characteristics associated with greater need for accommodation, reluctance to ask for them, and difficulty in arranging them were identified. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Measuring stigma in children receiving mental health treatment: Validation of the Paediatric Self-Stigmatization Scale (PaedS).

PubMed

Kaushik, A; Papachristou, E; Dima, D; Fewings, S; Kostaki, E; Ploubidis, G B; Kyriakopoulos, M

2017-06-01

Research on the impact of stigma associated with mental illness in children is scarce. Considering the known negative effects of stigma associated with mental illness in adults, it is crucial to explore the stigma experienced by children who access mental health treatment. However, no scale measuring self-stigmatization in younger children is available to date. This study aimed to develop and validate such a scale, the Paediatric Self-Stigmatization Scale (PaedS). A total of 156 children (119 receiving outpatient and 37 receiving inpatient treatment), aged 8-12 years, completed the PaedS, the Self-Perception Profile for Children and the Pediatric Quality of Life Inventory (PedsQL - Child Report, ages 8-12). In addition, parents completed the PedsQL (Parent Report for Children, ages 8-12), the Strengths and Difficulties Questionnaire (SDQ) and a modified subscale of the PaedS measuring the children's rejection by others due to their mental health difficulties. A confirmatory factor analysis showed that a four-factor structure, comprising Societal Devaluation, Personal Rejection, Self-Stigma and Secrecy scales, had excellent fit to the data (CFI=0.95; TLI=0.95; RMSEA=0.05). Child-reported PaedS scores were positively correlated with parental-reported PaedS scores and negatively with PedsQL, the SDQ, and 5 out of 6 subscales of the Self-Perception Profile for Children, suggesting adequate convergent validity (all P-values<0.05). The PaedS is a valid instrument, which is hoped to advance the understanding of self-stigmatization in children with mental health difficulties and contribute to its prevention. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

'Better medicines for children' within the Integrated Management of Childhood Illness framework: a qualitative inquiry in Uganda.

PubMed

Nsabagasani, Xavier; Ogwal-Okeng, Japer; Hansen, Ebba Holme; Mbonye, Anthony; Muyinda, Herbert; Ssengooba, Freddie

2016-01-01

The Integrated Management of Childhood Illnesses is the main approach for treating children in more than 100 low income countries worldwide. In 2007, the World Health Assembly urged countries to integrate 'better medicines for children' into their essential medicines lists and treatment guidelines. WHO regularly provides generic algorithms for IMCI and publishes the Model Essential Medicines List with child-friendly medicines based on new evidence for member countries to adopt. However, the status of 'better medicines for children' within the Integrated Management of Childhood Illnesses approach in Uganda has not been studied. Qualitative interviews were conducted with: two officials from the ministry of health; two district health officials and, 22 health workers from public health facilities. Interview transcripts were manually analyzed for manifest and latent content. Child-appropriate dosage formulations were not included in the package for the Integrated Management of Childhood Illnesses and ministry officials attributed this to resource constraints and lack of initial guidance from the World Health Organization. Underfunding reportedly undercut efforts to: orient health workers; do support supervision and update treatment guidelines to reflect 'better medicines for children'. Health workers reported difficulties in administering tablets and capsules to under-five children and that's why they preferred liquid oral dosage formulations, suppositories and injections. The IMCI strategy in Uganda was not revised to reflect child-appropriate dosage formulations - a missed opportunity for improving the quality of management of childhood illnesses. Funding was an obstacle to the integration of child-appropriate dosage formulations. Ministry of health should prioritize funding for the Integrated Management of Childhood Illnesses and revising the Essential Medicines and Health Supplies List of Uganda, the Uganda Clinical Guidelines and, the Treatment Charts for the Integrated Management of Childhood Illnesses to reflect child-appropriate dosage formulations.

Serious Illness Conversations in ESRD

PubMed Central

Bernacki, Rachelle E.; Block, Susan D.

2017-01-01

Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 65 years old experience higher rates of hospitalization, intensive care unit admission, procedures, and death in hospital than patients with cancer or heart failure, while using hospice services less. This high intensity of care is often inconsistent with the wishes of patients on dialysis but persists due to failure to explore or discuss patient goals, values, and preferences in the context of their serious illness. Fewer than 10% of patients on dialysis report having had a conversation about goals, values, and preferences with their nephrologist, although nearly 90% report wanting this conversation. Many nephrologists shy away from these conversations, because they do not wish to upset their patients, feel that there is too much uncertainty in their ability to predict prognosis, are insecure in their skills at broaching the topic, or have difficulty incorporating the conversations into their clinical workflow. In multiple studies, timely discussions about serious illness care goals, however, have been associated with enhanced goal-consistent care, improved quality of life, and positive family outcomes without an increase in patient distress or anxiety. In this special feature article, we will (1) identify the barriers to serious illness conversations in the dialysis population, (2) review best practices in and specific approaches to conducting serious illness conversations, and (3) offer solutions to overcome barriers as well as practical advice, including specific language and tools, to implement serious illness conversations in the dialysis population. PMID:28031417

Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients.

PubMed

Turon, Marc; Fernandez-Gonzalo, Sol; Jodar, Mercè; Gomà, Gemma; Montanya, Jaume; Hernando, David; Bailón, Raquel; de Haro, Candelaria; Gomez-Simon, Victor; Lopez-Aguilar, Josefina; Magrans, Rudys; Martinez-Perez, Melcior; Oliva, Joan Carles; Blanch, Lluís

2017-12-01

Growing evidence suggests that critical illness often results in significant long-term neurocognitive impairments in one-third of survivors. Although these neurocognitive impairments are long-lasting and devastating for survivors, rehabilitation rarely occurs during or after critical illness. Our aim is to describe an early neurocognitive stimulation intervention based on virtual reality for patients who are critically ill and to present the results of a proof-of-concept study testing the feasibility, safety, and suitability of this intervention. Twenty critically ill adult patients undergoing or having undergone mechanical ventilation for ≥24 h received daily 20-min neurocognitive stimulation sessions when awake and alert during their ICU stay. The difficulty of the exercises included in the sessions progressively increased over successive sessions. Physiological data were recorded before, during, and after each session. Safety was assessed through heart rate, peripheral oxygen saturation, and respiratory rate. Heart rate variability analysis, an indirect measure of autonomic activity sensitive to cognitive demands, was used to assess the efficacy of the exercises in stimulating attention and working memory. Patients successfully completed the sessions on most days. No sessions were stopped early for safety concerns, and no adverse events occurred. Heart rate variability analysis showed that the exercises stimulated attention and working memory. Critically ill patients considered the sessions enjoyable and relaxing without being overly fatiguing. The results in this proof-of-concept study suggest that a virtual-reality-based neurocognitive intervention is feasible, safe, and tolerable, stimulating cognitive functions and satisfying critically ill patients. Future studies will evaluate the impact of interventions on neurocognitive outcomes. Trial registration Clinical trials.gov identifier: NCT02078206.

Acute quadriplegic myopathy with loss of thick (myosin) filaments following heart transplantation.

PubMed

Perea, M; Picón, M; Miró, O; Orús, J; Roig, E; Grau, J M

2001-10-01

Acute quadriplegic myopathy with loss of thick (myosin) filaments (AQM-LTF) is an acute toxic myopathy observed in critically ill patients and is characterized by proximal or diffuse weakness of extremities and difficulty in weaning from mechanical ventilation. In recent years, this myopathy has been described in transplanted patients, although only 5 cases have been reported following heart transplantation. We present 3 new cases and review the previous literature. We conclude that the clinical picture and outcome of AQM-LTF in heart-transplanted patients do not differ from those observed in other critically ill patients (transplanted and non-transplanted). Therefore, because AQM-LTF is often clinically suspected muscle biopsy should be quickly performed to confirm the diagnosis so that physical therapy may begin as soon as possible.

Success requires seizing opportunities.

PubMed

Melum, M M

1987-01-01

The well-trained group of professionals had worked hard at the business they knew well. Their efforts had paid off--they were highly respected for their quality; their business grew; they had a close, trusting relationship with their customers; and they had the satisfaction of running their business as they alone knew to be best. As they looked ahead, they saw the personal security of a bright, safe future, of more of the same success. Then, slowly at first but building steadily to a feverish pace, their business and their lives were uprooted and torn apart in an all-encompassing economic and social earthquake. Now, with a force the professionals could hardly believe, let alone keep track of, the very definition of their business was changing, the trusting relationship with customers began to break down as massive numbers of new and different competitors vied for their business, many new players began to control how they ran their business, and security vanished into a confusion of competition, entrepreneurship, and risk.

Dynamic phosphorylation of Ebola virus VP30 in NP-induced inclusion bodies.

PubMed

Lier, Clemens; Becker, Stephan; Biedenkopf, Nadine

2017-12-01

Zaire Ebolavirus (EBOV) causes a severe feverish disease with high case fatality rates. Transcription of EBOV is dependent on the activity of the nucleocapsid protein VP30 which represents an essential viral transcription factor. Activity of VP30 is regulated via phosphorylation at six N-terminal serine residues. Recent data demonstrated that dynamic phosphorylation and dephosphorylation of serine residue 29 is essential for transcriptional support activity of VP30. To analyze the spatio/temporal dynamics of VP30 phosphorylation, we generated a peptide antibody recognizing specifically VP30 phosphorylated at serine 29. Using this antibody we could demonstrate that (i) the majority of VP30 molecules in EBOV-infected cells is dephosphorylated at the crucial position serine 29, (ii) both, VP30 phosphorylation and dephosphorylation take place in viral inclusion bodies that are induced by the nucleoprotein NP and (iii) NP influences the phosphorylation state of VP30. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of an e-supported illness management and recovery programme for consumers with severe mental illness using intervention mapping, and design of an early cluster randomized controlled trial.

PubMed

Beentjes, Titus A A; van Gaal, Betsie G I; Goossens, Peter J J; Schoonhoven, Lisette

2016-01-19

E-mental health is a promising medium to keep mental health affordable and accessible. For consumers with severe mental illness the evidence of the effectiveness of e-health is limited. A number of difficulties and barriers have to be addressed concerning e-health for consumers with severe mental illness. One possible solution might be to blend e-health with face-to-face delivery of a recovery-oriented treatment, like the Illness Management & Recovery (IMR) programme. This paper describes the development of an e-health application for the IMR programme and the design of an early clustered randomized controlled trial. We developed the e-IMR intervention according to the six-step protocol of Intervention Mapping. Consumers joined the development group to address important and relevant issues for the target group. Decisions during the six-step development process were based on qualitative evaluations of the Illness Management & Recovery programme, structured interviews, discussion in the development group, and literature reviews on qualitative papers concerning consumers with severe mental illness, theoretical models, behavioural change techniques, and telemedicine for consumers with severe mental illness. The aim of the e-IMR intervention is to help consumers with severe mental illness to involve others, manage achieving goals, and prevent relapse. The e-IMR intervention consists of face-to-face delivery of the Illness Management & Recovery programme and an e-health application containing peer-testimonials on videos, follow up on goals and coping strategies, monitoring symptoms, solving problems, and communication opportunities. We designed an early cluster randomized controlled trial that will evaluate the e-IMR intervention. In the control condition the Illness Management & Recovery programme is provided. The main effect-study parameters are: illness management, recovery, psychiatric symptoms severity, self-management, quality of life, and general health. The process of the IMR program will be evaluated on fidelity and feasibility in semi-structured interviews with participants and trainers. Intervention Mapping provided a systematic procedure for the development of this e-health intervention for consumers with severe mental illness and the preparation of an early randomized controlled trial. The trial is registered in the Dutch Trial Register: NTR4772 .

Paediatric chronic illness and educational failure: the role of emotional and behavioural problems.

PubMed

Layte, Richard; McCrory, Cathal

2013-08-01

Chronic illness in childhood is associated with worse educational outcomes. The association is usually explained via lowered cognitive development, decreased readiness to learn and school absence. However, this paper examines whether worse psychological adjustment may also play a role. We use data from the Growing Up in Ireland study, a cohort study, which collected data on 8,568 nine-year-old children through the Irish national school system using a two-stage sampling method. Maximum likelihood path analytic models are used to assess the direct effect of child chronic illness on reading and maths test scores and the mediating role of emotional and behavioural problems. In unadjusted analyses, children with a mental and behavioural condition scored 14.5 % points less on reading tests and 16.9 % points less on maths tests than their healthy peers. Children with non-mental and behavioural conditions scored 3 % points less on both tests, a significant difference. Mental and behavioural (OR, 9.58) and other chronic conditions (OR, 1.61) were significantly more likely to have 'high' levels of difficulties on the SDQ. Path analysis models showed that the association between chronic illness and educational test scores was completely mediated by emotional and behavioural problems controlling for school absence and bullying by peers. Child and adolescent chronic illness can have significant effects on educational development and a long-lasting impact on future life-chances. The psychological adjustment of the child is important in mediating the effect of chronic illness on educational outcomes. Interventions should target this developmental pathway.

Open communication with terminally ill cancer patients about illness and death: a comparison between spouses of Ashkenazi and Sephardi ethnic origins.

PubMed

Bachner, Yaacov G; Yosef-Sela, Nili; Carmel, Sara

2014-01-01

Studies document that caregivers face severe difficulties in communicating with their loved ones about both illness and death. To date, a paucity of studies has examined caregiver-patient communication at the end of life within the context of ethnic origin. This study compares the level of open communication between caregivers from 2 ethnic groups and examines the contribution of different caregiver characteristics and situational variables to the explanation of open communication. A total of 77 spouse caregivers of terminally ill cancer patients (comprising 41 Jews of Sephardi origin and 36 Jews of Ashkenazi origin) participated in the study. The questionnaire included measures of caregiver communication, caregiver characteristics (ie, age, gender, education level, optimism, self-efficacy), and situational variables (ie, duration and intensity of care). Spouses of Ashkenazi origin communicated more with their loved ones about illness and death compared with their Sephardi counterparts. Ethnic origin accounted for 16.6% of the explained variance, caregiver characteristics added 20.3%, and situation variables lent a modest contribution of 3.5%. Four variables emerged as significant predictors of caregivers' level of open communication: self-efficacy (β = .33, P < .05), gender (β = .32, P < .01), ethnic origin (β = .25, P <.05), and duration of care (β = .20, P < .05). These findings demonstrate the importance of ethnic origin to caregivers' open communication with terminal cancer patients about illness and death. Moreover, communication level with patients is mostly explained by the caregiver characteristics. Caregiver characteristics should be considered by nurses when developing intervention programs for increasing caregivers' level of open communication with dying patients.

Rat bite fever in a pet lover.

PubMed

Cunningham, B B; Paller, A S; Katz, B Z

1998-02-01

Rat-bite fever is an uncommon bacterial illness resulting from infection with Streptobacillus moniliformis that is often transmitted by the bite of a rat. The cutaneous findings in rat-bite fever are nonspecific but have been described as maculopapular or petechial. We describe a 9-year-old girl with acrally distributed hemorrhagic pustules, fever, and arthralgias. Diagnosis was delayed because of difficulty in identifying the pathologic organism. She was successfully treated with 10 days of ceftriaxone.

Induction of Food Allergy in Mice by Allergen Inhalation

DTIC Science & Technology

2015-10-01

whether and how inhaling egg white can sensitize for the development of egg white food allergy. Despite difficulties related to the complicated pregnancy...and illness of a key researcher, considerable progress has been made: 1) We cannot induce an allergic response to aerosolized egg white, even if...have shown that egg yolk acts as an adjuvant for the development of allergic lung disease tp egg white and induction of food allergy; 3) We have

Rapid optimization of multiple-burn rocket flights.

NASA Technical Reports Server (NTRS)

Brown, K. R.; Harrold, E. F.; Johnson, G. W.

1972-01-01

Different formulations of the fuel optimization problem for multiple burn trajectories are considered. It is shown that certain customary idealizing assumptions lead to an ill-posed optimization problem for which no solution exists. Several ways are discussed for avoiding such difficulties by more realistic problem statements. An iterative solution of the boundary value problem is presented together with efficient coast arc computations, the right end conditions for various orbital missions, and some test results.

Harsh Climates, Poor Transportation, And Irregular Warfare: Logistical Difficulties From Napoleon To The Soviet - Afghan War That Affect Operational Campaigns

DTIC Science & Technology

2014-04-01

confident about having two operational campaigns in the Iberian Peninsula and Russia where the climate , transportation infrastructure, and threats...campaigns in the Iberian Peninsula and Russia exhibited effects of the harsh climates on logistical effectiveness. The climates in the Iberian Peninsula ...decreasing). The Iberian Peninsula climate consists of vast infertile areas with mountains, hills, and dry regions ill-suited for logistically

Prevalence and predictors of difficulty accessing the mouths of intubated critically ill adults to deliver oral care: An observational study.

PubMed

Dale, Craig M; Smith, Orla; Burry, Lisa; Rose, Louise

2018-04-01

Oral care of intubated patients is essential to the prevention of infection and patient discomfort. However, barriers to oral access and delivery of oral care have received little attention. To determine prevalence and predictors of oral access difficulty. A prospective, observational, multi-center study. Four intensive care units in Toronto, Canada. Adult patients orally intubated for ≥48 h. We screened consecutive admissions once a week to identify eligible participants. We observed each patient and asked the patient's nurse about presence or absence of difficulty accessing the mouth to deliver oral care across three categories: (1) visualizing inside the mouth; (2) obtaining patient cooperation, or (3) inserting instruments for delivery of oral care. We asked nurses to identify presence of patient behaviors contributing to oral access difficulty and perceived level of difficulty on a Likert response scale. We examined patient and treatment characteristics associated with extreme difficulty (i.e., difficulty in all 3 categories) using a generalized estimating equation regression model. A total of 428 patients were observed, 58% admitted with a medical diagnosis. More than half (57%) had ≥2 oral devices up to maximum of 4. Oral care difficulty was identified in 83% of patients and rated as moderate to high for 217 (51%). Difficulty concerned visibility (74%), patient cooperation (55%), and space to insert instruments (53%). Patient behaviors contributing difficulty included coughing/gagging (60%), mouth closing (49%), biting (45%) and localizing (27%) during care. Variables associated with extreme difficulty included neurological (OR 1.92, 95% CI 1.42-2.60) or trauma admission (OR 1.83, 95% CI 1.16-2.89), lack of pain assessment or treatment in the 4 h prior to oral care (OR 1.43, 95% CI 1.14-1.80), more oral devices (OR 1.40, 95% CI 1.05-1.87), and duration of intubation (OR 1.05, 95% CI 1.01-1.10). Absence of documented agitation in the 4 h prior to oral care was associated with less difficulty (OR 0.68, 95% CI 0.54-0.86). Oral care is complex and difficulties are experienced in a vast majority of intubated patients. Some difficulties are amenable to correction such as pain management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Stigma associated with PTSD: perceptions of treatment seeking combat veterans.

PubMed

Mittal, Dinesh; Drummond, Karen L; Blevins, Dean; Curran, Geoffrey; Corrigan, Patrick; Sullivan, Greer

2013-06-01

Although stigma associated with serious mental illness, substance abuse disorders, and depression has been studied very little is known about stigma associated with Posttraumatic Stress Disorder (PTSD). This study explored stigma related to PTSD among treatment-seeking Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combat veterans. Sixteen treatment-seeking OEF/OIF veterans with combat-related PTSD participated in focus groups. We used qualitative methods to explore PTSD-related stigma. Common perceived stereotypes of treatment-seeking veterans with PTSD included labels such as "dangerous/violent," or "crazy," and a belief that combat veterans are responsible for having PTSD. Most participants reported avoiding treatment early on to circumvent a label of mental illness. Participants initially reported experiencing some degree of self-stigma; however, following engagement in treatment they predominantly resisted these stereotypes. Although most participants considered combat-related PTSD as less stigmatizing than other mental illnesses, they reported difficulties with reintegration. Such challenges likely stem from both PTSD symptoms and veterans' perceptions of how the public views them. Most reported that fellow combat veterans best understood them. Awareness of public stereotypes impacts help seeking at least early in the course of illness. Peer-based outreach and therapy groups may help veterans engage in treatment early and resist stigma. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Barriers to continuity in the pathway toward occupational engagement among ethnic minorities with mental illness.

PubMed

Pooremamali, Parvin; Morville, Anne-Le; Eklund, Mona

2017-07-01

Ethnic minorities have particular needs and difficulties in terms of support for meaningful occupations, lack of access to and use of occupation-based rehabilitation services. They are not established in the labour market and are seldom in paid employment. This study aimed to investigate how mentally ill ethnic minority clients experience, feel and think about participation in occupation-based rehabilitation, and potential barriers they might encounter. Nine participants experiencing mental illness and receiving occupation-based rehabilitation were interviewed. Grounded theory methods were used in order to collect and analyze data. One core category, "barriers for a continuous path towards enriched and meaningful occupation" described the participants' experiences of a variety of barriers related to personal, occupational and system factors that hindered participation in occupation-based rehabilitation and influenced their need for occupational development and growth. The core category was composed of; personal-related barriers, occupational-related barriers, and system-related barriers as well as six related sub-categories. These barriers interacted continually across time and space in ways that increased the participants' sense of occupational deprivation and alienation. The findings also suggested that the issues of paid employment for ethnic minorities with mental illness should feature on the agenda of local, regional and state politicians and professionals involved in occupational rehabilitation.

Self-treatment of malaria in a rural area of western Kenya.

PubMed Central

Ruebush, T. K.; Kern, M. K.; Campbell, C. C.; Oloo, A. J.

1995-01-01

Reported are the results of a study of residents' knowledge about malaria and antimalarial drugs and of their treatment-seeking behaviour in a rural area of western Kenya. The study subjects were generally well-informed about the symptoms of the disease. Malaria was perceived as a relatively mild illness, much less severe than acquired immunodeficiency syndrome (AIDS), measles, difficulty in breathing, and diarrhoea. Self-treatment was extremely common: of 138 episodes of febrile illness, 60% were treated at home with herbal remedies or medicines purchased at local shops, and only 18% received treatment at a health centre or hospital; no treatment was sought by the remainder. Commercially available chloroquine preparations were perceived as more effective than either antipyretics or herbal remedies for the treatment of malaria, and injections were regarded as more effective than oral medications. 4-Amino-quinolines were used to treat 58% of febrile illnesses but in only 12% of the cases was a curative dose of > or = 25 mg/kg body weight employed. Even attendance at a health centre did not ensure adequate treatment because of the common practice of sharing medication among family members. Greatly increased attention should be paid to the role of home treatment of malaria when policies are being developed for the management of febrile illnesses in sub-Saharan Africa. PMID:7743595

Impact of a family-oriented rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children.

PubMed

Besier, T; Hölling, H; Schlack, R; West, C; Goldbeck, L

2010-09-01

To evaluate the impact of a family-oriented inpatient rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children and to assess the association between these problems and quality of life. A total of 259 healthy children (4-16 years, M = 8.6 years, SD = 3.3) with a chronically ill sibling were enrolled in the study. Parents filled in the Strengths and Difficulties Questionnaire, while the children answered a self-report quality of life instrument (LQ-KID) at the time of admission and discharge from the clinic and at a 6-month follow-up. Comparisons were performed with a matched control group from the German general population (n= 777). Significant behavioural or emotional symptoms were found in 30.5% of the healthy siblings, the relative risk of having elevated scores being 2.2 compared with the control group. Symptoms were inversely correlated with quality of life (r=-0.42). During the inpatient rehabilitation, symptoms decreased significantly to a normal level. Similarly, quality of life significantly improved, except in the dimension family relations. Family-oriented inpatient rehabilitation is a promising approach to improve the mental health of children with a chronically ill sibling.

Personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment in Queensland, Australia.

PubMed

Gladman, Beverley; Waghorn, Geoff

2016-02-15

High non-participation in the labour force and unemployment remain challenging for adults with serious mental illness. This study examined the personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment. The aim was to increase understanding of personal experiences of employment and how these experiences can be used to inform the assistance provided in support of clients' competitive employment goals. Qualitative data from a two-year period were thematically analysed from one participating site in a multi-site trial of employment services integrated with public funded community mental health treatment and care. Both positive and negative themes arose. Positive themes included: Aspirations for a better life, receiving feedback on good job performance, employment displacing preoccupation with illness, and employment improving self-esteem and reducing financial stress. Negative themes included stigma experiences, stress, and health difficulties. Both positive and negative experiences did not depend on type of employment service assistance nor key client characteristics such as age, sex, and diagnostic category. Despite its many benefits, employment can also increase the risk of negative personal experiences. These findings suggest that employment service providers could do more to assist people who commence employment, to reduce the risk of negative personal experiences and to enhance the benefits of competitive employment.

Correlates of Mental Illness and Health Categories among Older Adults in China: An Empirical Study Based on the Two Continua Model.

PubMed

Jiang, Nan; Lu, Nan

2018-04-30

Keyes' two continua model is a useful concept in which mental health and mental illness exist on two separate axes. Based on this model, this study examined the prevalence and correlates of three mental health categories among older adults in China. Cross-sectional data were derived from Wave 1 of the Study on Global AGEing and Adult Health. Participants were categorized into complete mental health (CMH), complete mental illness (CMI), and moderate mental health (MMH) groups. Multinomial logistic regressions were used. The prevalence of CMH, CMI, and MMH in China was 18%, 16%, and 66%, respectively. Being female, unmarried, younger, and feeling unhealthy were more likely to result in placement in the CMI category. Employment, education, and cognitive function were identified as important protective factors of CMH. Age, income, urban or rural residence, and physical function difficulty were associated with all three categories. We demonstrated the utility of the two continua model in identifying mental health needs in Chinese contexts. The findings suggest that future policy reforms and clinical interventions should establish a more comprehensive mental health category as a screening tool nationwide. The promotion of social engagement could play an important role in treating mental illness and improving positive mental health.

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study.

PubMed

Kaite, Charis P; Karanikola, Maria N; Vouzavali, Foteini J D; Koutroubas, Anna; Merkouris, Anastasios; Papathanassoglou, Elizabeth D E

2016-10-06

Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way. A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews. Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants. The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.

A SIMPLE FRAILTY QUESTIONNAIRE (FRAIL) PREDICTS OUTCOMES IN MIDDLE AGED AFRICAN AMERICANS

PubMed Central

MORLEY, J.E.; MALMSTROM, T.K.; MILLER, D.K.

2015-01-01

Objective To validate the FRAIL scale. Design Longitudinal study. Setting Community. Participants Representative sample of African Americans age 49 to 65 years at onset of study. Measurements The 5-item FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight), at baseline and activities of daily living (ADLs), instrumental activities of daily living (IADLs), mortality, short physical performance battery (SPPB), gait speed, one-leg stand, grip strength and injurious falls at baseline and 9 years. Blood tests for CRP, SIL6R, STNFR1, STNFR2 and 25 (OH) vitamin D at baseline. Results Cross-sectionally the FRAIL scale correlated significantly with IADL difficulties, SPPB, grip strength and one-leg stand among participants with no baseline ADL difficulties (N=703) and those outcomes plus gait speed in those with no baseline ADL dependencies (N=883). TNFR1 was increased in pre-frail and frail subjects and CRP in some subgroups. Longitudinally (N=423 with no baseline ADL difficulties or N=528 with no baseline ADL dependencies), and adjusted for the baseline value for each outcome, being pre-frail at baseline significantly predicted future ADL difficulties, worse one-leg stand scores, and mortality in both groups, plus IADL difficulties in the dependence-excluded group. Being frail at baseline significantly predicted future ADL difficulties, IADL difficulties, and mortality in both groups, plus worse SPPB in the dependence-excluded group. Conclusion This study has validated the FRAIL scale in a late middle-aged African American population. This simple 5-question scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality. PMID:22836700

Supportive and palliative care for patients with chronic mental illness including dementia.

PubMed

Lloyd-Williams, Mari; Abba, Katharine; Crowther, Jacqueline

2014-09-01

People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life. Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.

Closed-Loop Neuromodulation Systems: Next-Generation Treatments for Psychiatric Illness

PubMed Central

Lo, Meng-Chen; Widge, Alik S.

2017-01-01

Despite deep brain stimulation’s positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient’s electrical brain activity. These interventions may provide more precise and patient-specific treatments. In this article, we first introduce the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders. We discuss the strengths and limitations of these devices in the context of psychiatric illness. We then describe emerging technologies to address these limitations, including pre-clinical developments such as wireless deep neurostimulation and genetically targeted neuromodulation. Finally, we discuss ongoing challenges and limitations for closed-loop psychiatric brain stimulation development, most notably the difficulty of identifying meaningful biomarkers for titration. We consider this in the recently-released Research Domain Criteria (RDoC) framework and describe how neuromodulation and RDoC are jointly very well suited to address the problem of treatment-resistant illness. PMID:28523978

[Specifics of working with chronic mentally ill patients in Specialised Social Help Services--experiences in training and supervision meetings].

PubMed

Paszko, Jolanta; Wnek, Beata; Załuska, Maria

2004-01-01

Information was presented on the development and efficiency of The Specialised Psychiatric Social Help Services for the mentally ill in Poland. It took into consideration the specifics of this work and formal requirements for special training of the staff. The experiences of the 3.5 years of work of the specialised services in the Warszawa Targówek district (October 1997 - June 2001) were discussed. Organisational solutions and basic data about clients and staff and establishments and experiences coming from training and supervision meetings were discussed. Problems and difficulties most often experienced by the staff workers at their work with chronic mentally ill patients were described. Consideration was put from one side on the big rotation of the staff and from the other on the need of the extension of the theoretical and practical knowledge as well as of supervision and support was often mentioned in the questionnaire. A need of elaborating the programme of training and professional courses for workers of the specialised psychiatric social help services was also pointed out.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

PubMed

Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

2016-02-01

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

Beliefs about health and illness and health-related behavior among urban women with gestational diabetes mellitus in the south east of China.

PubMed

Ge, Li; Albin, Björn; Hadziabdic, Emina; Hjelm, Katarina; Rask, Mikael

2016-11-01

The incidence of gestational diabetes among Chinese women is 4.3%. No study has previously been conducted about beliefs and health-related behavior among urban Chinese women with this disease. This article aims to explore beliefs about health and illness and health-related behavior among women in this group in a Chinese sociocultural context. A qualitative exploratory study was conducted and semistructured individual interviews (n = 15) were processed by content analysis. Beliefs about health and illness among these women were foremost attributed to the individual, social, and natural worlds. They feared the negative influence of gestational diabetes, but some of them believed in "letting nature take its course" and "living in the present." Their care-seeking behavior varied between the professional, popular, and folk sectors. They sought a balance between following professionals' advice and avoiding practical difficulties. The beliefs and health-related behavior among them were influenced by Chinese culture, which can sometimes but not always reduce the effect of the disease. © The Author(s) 2015.

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

PubMed Central

BROCKINGTON, IAN; CHANDRA, PRABHA; DUBOWITZ, HOWARD; JONES, DAVID; MOUSSA, SUAAD; NAKKU, JULIET; QUADROS FERRE, ISABEL

2011-01-01

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide. PMID:21633678

Alcohol-Use Disorders in the Critically Ill Patient

PubMed Central

Jones, Drew G.; Sessler, Curtis N.; Zilberberg, Marya D.; Weaver, Michael F.

2010-01-01

Alcohol abuse and dependence, referred to as alcohol-use disorders (AUDs), affect 76.3 million people worldwide and account for 1.8 million deaths per year. AUDs affect 18.3 million Americans (7.3% of the population), and up to 40% of hospitalized patients have AUDs. This review discusses the development and progression of critical illness in patients with AUDs. In contrast to acute intoxication, AUDs have been linked to increased severity of illness in a number of studies. In particular, surgical patients with AUDs experience higher rates of postoperative hemorrhage, cardiac complications, sepsis, and need for repeat surgery. Outcomes from trauma are worse for patients with chronic alcohol abuse, whereas burn patients who are acutely intoxicated may not have worse outcomes. AUDs are linked to not only a higher likelihood of community-acquired pneumonia and sepsis but also a higher severity of illness and higher rates of nosocomial pneumonia and sepsis. The management of sedation in patients with AUDs may be particularly challenging because of the increased need for sedatives and opioids and the difficulty in diagnosing withdrawal syndrome. The health-care provider also must be watchful for the development of dangerous agitation and violence, as these problems are not uncommonly seen in hospital ICUs. Despite studies showing that up to 40% of hospitalized patients have AUDs, relatively few guidelines exist on the specific management of the critically ill patient with AUDs. AUDs are underdiagnosed, and a first step to improving patient outcomes may lie in systematically and accurately identifying AUDs. PMID:20923804

How patients and clinicians make meaning of physical suffering in mental health evaluations.

PubMed

Carson, Nicholas J; Katz, Arlene M; Alegría, Margarita

2016-10-01

Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such "comorbidity" can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient-provider communication. The recordings of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient-provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors. © The Author(s) 2016.

Prenatal docosahexaenoic acid supplementation and infant morbidity: randomized controlled trial.

PubMed

Imhoff-Kunsch, Beth; Stein, Aryeh D; Martorell, Reynaldo; Parra-Cabrera, Socorro; Romieu, Isabelle; Ramakrishnan, Usha

2011-09-01

Long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of maternal DHA supplementation on infant morbidity is unknown. We investigated the effects of prenatal DHA supplementation on infant morbidity. In a double-blind randomized controlled trial conducted in Mexico, pregnant women received daily supplementation with 400 mg of DHA or placebo from 18 to 22 weeks' gestation through parturition. In infants aged 1, 3, and 6 months, caregivers reported the occurrence of common illness symptoms in the preceding 15 days. Data were available at 1, 3, and 6 months for 849, 834, and 834 infants, respectively. The occurrence of specific illness symptoms did not differ between groups; however, the occurrence of a combined measure of cold symptoms was lower in the DHA group at 1 month (OR: 0.76; 95% CI: 0.58-1.00). At 1 month, the DHA group experienced 26%, 15%, and 30% shorter duration of cough, phlegm, and wheezing, respectively, but 22% longer duration of rash (all P ≤ .01). At 3 months, infants in the DHA group spent 14% less time ill (P < .0001). At 6 months, infants in the DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and "other illness," respectively, but 74% longer duration of vomiting (all P < .05). DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months.

Hypochondriasis: difficulties in diagnosis and management.

PubMed

Webb, W L

1979-01-01

The hypochondriacal patient presents numerous frustrations for the physician. The typical hypochondriac is a middle-aged person dominated by a preoccupation with bodily symptoms. Bereavement, serious life failures, and severe blows to self-esteem put patients at high risk for somatization. Hypochondrisis has been cited as a symptom of masked depression, early paranoid schizophrenia, and dementia and/or delirium. A careful diagnostic work-up with attention to any correctable psychiatric illness sets the stage for regularly scheduled, long-term supportive therapy.

[Neurophysiology and neuropsychology of recognition confabulation in hospitalized schizophrenic patients].

PubMed

Salazar Fraile, J; Tabarés Seisdedos, R; Selva Vera, G; Balanzá Martínez, V; Leal Cercós, C; Vilela Soler, C; Vallet Mas, M

1998-01-01

Recognition confabulation was studied in 16 schizoprhenic patients and 16 normal controls. Half of the schizophrenics presented recognition confabulation, while the remaining 8 and 16 controls did not. This type of confabulation was associated to attentional deficiency, difficulties in perceptual follow-up and perceptive changes. These test satisfactorily discriminated confabulating schizoprhenics and both ill and healthy non-confabulating subjects. The possible mechanisms underlying this type of confabulation are discussed, in relation to the deficiences observed.

Psychosocial Well-being of Siblings of Adolescents with Anorexia Nervosa.

PubMed

van Langenberg, Tanja; Sawyer, Susan M; Le Grange, Daniel; Hughes, Elizabeth K

2016-11-01

Anorexia nervosa (AN) is often first diagnosed in the adolescent years. The treatment with the greatest evidence during this time is family-based treatment (FBT). In FBT, siblings are expected to attend treatment sessions; however, sibling well-being during this time has not been well researched. This study aimed to explore sibling well-being when the ill child was initially diagnosed with AN and after FBT had been completed. Eighty-five parents and 55 siblings of adolescents with AN completed the Strengths and Difficulties Questionnaire at diagnosis. In addition, 88 parents and 46 siblings completed the Strengths and Difficulties Questionnaire after finishing treatment. Mothers and fathers reported siblings to have lower levels of conduct problems in comparison with population norms. Mothers also reported lower levels of prosocial behaviours. Siblings reported higher levels of emotional difficulties and hyperactivity in comparison with their peers. There were no differences in reported psychosocial well-being of siblings between diagnosis and following FBT. Siblings of adolescents with AN have poorer psychosocial adjustment than their peers, both before and after FBT. Clinicians and parents are encouraged to be aware of sibling difficulties and seek additional support if required. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Adverse social circumstances and depression in people of Pakistani origin in the UK.

PubMed

Husain, N; Creed, F; Tomenson, B

1997-11-01

The social origins of depression in people of Pakistani origin in the UK are not fully understood; they may not be the same as for the indigenous White population. Patients attending a GP's surgery were screened with the Personal Health Questionnaire to detect depressive illness, which was confirmed using the Psychiatric Assessment Schedule; the estimated prevalence of major depression was 42%. Forty-four people with depression and 33 non-depressed comparison subjects were successfully interviewed using the Life Event and Difficulty Schedule, either in Urdu or English. Seventy-five per cent of the sample were Pakistani born; 57% of cases and 33% of non-cases spoke English with difficulty. Seventy-five per cent of the cases and 36% of the non-cases had experienced an independent severe event and/or a major difficulty (P = 0.0015). Difficulties associated with depression were most commonly in the marital, health and housing categories; overt racial harassment and discrimination were rare. This is a preliminary study because of the small sample of GP attenders. The somatic presentation of depression in this population is clear. Acceptable forms of social support and help with marital, housing and employment problems will be needed to help relieve the depression in this population.

Women's experiences of becoming a mother after prolonged labour.

PubMed

Nystedt, Astrid; Högberg, Ulf; Lundman, Berit

2008-08-01

This paper is a report of a study to explore women's experiences of becoming a mother after prolonged labour. The negativity associated with a complicated labour such as prolonged labour can lead to a struggle to become a healthy mother and could restrict the process of becoming a mother. Interviews were conducted in 2004 with 10 mothers who had been through a prolonged labour with assisted vaginal or caesarean delivery 1-3 months previously. Thematic content analysis was used. Three themes were formulated, describing women's experiences as fumbling in the dark, struggling for motherhood and achieving confidence in being a mother. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like 'fumbling in the dark'. Women experienced bodily fatigue, accompanied by feelings of illness and detachment from the child. Having the child when in this condition entailed a struggle to become a mother. In spite of these experiences and the desire to achieve confidence in being a mother, the reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged interaction and relationship with the child, and contributed to their adaptation to motherhood. Women experiencing prolonged labour may be comparable with the experience of and recovery from illness, which could contribute to difficulties transitioning to motherhood and limit a woman's ability to be emotionally available for the child.

Social attribution in anorexia nervosa.

PubMed

Oldershaw, Anna; DeJong, Hannah; Hambrook, David; Schmidt, Ulrike

2018-05-01

People with anorexia nervosa (AN) report socioemotional difficulties; however, measurement has been criticised for lacking ecological validity and the state or trait nature of difficulties remains unclear. Participants (n = 122) were recruited across 3 groups: people who are currently ill with AN (n = 40); people who recovered (RecAN, n = 18); healthy-control participants (n = 64). Participants completed clinical questionnaires and the Social Attribution Task. The Social Attribution Task involves describing an animation of moving shapes, scored for number of propositions offered, accuracy, and social relevance. Groups were compared cross-sectionally. Those with current AN were assessed prepsychological and postpsychological treatments. People with AN provided fewer propositions than other groups and fewer salient social attributions than healthy-control participants. Those who recovered scored intermediately and not significantly different from either group. Following treatment, people with AN demonstrated (nonsignificant) improvements, and no significance between group differences were observed. Findings suggest difficulties for people with AN in providing spontaneous social narrative and in identifying social salience. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

Using Rapid Indicators for Enterococcus to Assess the Risk of Illness after Exposure to Urban Runoff Contaminated Marine Water

PubMed Central

Colford, John M.; Schiff, Kenneth C.; Griffith, John F.; Yau, Vince; Arnold, Benjamin F.; Wright, Catherine C.; Gruber, Joshua S.; Wade, Timothy J.; Burns, Susan; Hayes, Jacqueline; McGee, Charles; Gold, Mark; Cao, Yiping; Noble, Rachel T.; Haugland, Richard; Weisberg, Stephen B.

2012-01-01

Background Traditional fecal indicator bacteria (FIB) measurement is too slow (>18 hr) for timely swimmer warnings. Objectives Assess relationship of rapid indicator methods (qPCR) to illness at a marine-beach impacted by urban-runoff. Methods We measured baseline and two-week health in 9525 individuals visiting Doheny Beach 2007-08. Illness rates were compared (swimmers vs. non-swimmers). FIB measured by traditional (Enterococcus spp. by EPA Method 1600 or Enterolert™, fecal coliforms, total coliforms) and three rapid qPCR assays for Enterococcus spp. (Taqman, Scorpion-1, Scorpion-2) were compared to health. Primary bacterial source was a creek flowing untreated into ocean; the creek did not reach the ocean when a sand berm formed. This provided a natural experiment for examining FIB-health relationships under varying conditions. Results We observed significant increases in diarrhea (OR1.90, 95% CI 1.29-2.80 for swallowing water) and other outcomes in swimmers compared to non-swimmers. Exposure (body immersion, head immersion, swallowed water) was associated with increasing risk of gastrointestinal illness (GI). Daily GI incidence patterns were different: swimmers (2-day peak ) and non-swimmers (no peak). With berm-open, we observed associations between GI and traditional and rapid methods for Enterococcus; fewer associations occurred when berm status was not considered. Conclusions We found increased risk of GI at this urban-runoff beach. When FIB source flowed freely (berm-open), several traditional and rapid indicators were related to illness. When FIB source was weak (berm-closed) fewer illness-associations were seen. These different relationships under different conditions at a single beach demonstrate the difficulties using these indicators to predict health risk. PMID:22356828

The association of an inability to form and maintain close relationships due to a medical condition with anxiety and depressive disorders.

PubMed

Simning, Adam; Seplaki, Christopher L; Conwell, Yeates

2016-03-15

While low social support is a risk factor for mental illness, anxiety and depression's relationship with social impairment specifically resulting from a medical condition is poorly understood. We hypothesize that when a medical illness makes it difficult for people to form and maintain close relationships with others, they will be at increased risk for anxiety and depression. Two nationally representative surveys, the National Comorbidity Survey-Replication and National Latino and Asian American Study, included 6805 adults with at least one medical illness and information on social impairment attributed to a medical condition. The Composite International Diagnostic Interview evaluated a 12-month history of anxiety and depressive disorders. 8.2% of our sample had at least moderate difficulty in forming and maintaining close relationships due to a medical condition. In bivariate analyses, younger age, Latino ethnicity, less education, worse financial status, more chronic illnesses, physical health and discomfort, and problems with mobility, home management, and self-care were associated with this social impairment. In multivariable analyses accounting for possible confounders, there was a dose-dependent relationship between social impairment and the prevalence of anxiety and depression. Data are cross-sectional and our analyses are therefore unable to determine cause-and-effect relationships. Among adults with one or more medical conditions, social impairment attributed to medical illness was associated with a significantly greater odds of anxiety and depression. Further clarification of this relationship could inform more targeted, personalized interventions to prevent and/or alleviate mental illness in those with chronic medical conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

Cultural and linguistic barriers to mental health service access: the deaf consumer's perspective.

PubMed

Steinberg, A G; Sullivan, V J; Loew, R C

1998-07-01

The authors investigated knowledge, attitudes, and beliefs about mental illness and providers held by a group of deaf adults. The American Sign Language interviews of 54 deaf adults were analyzed. Recurrent themes included mistrust of providers, communication difficulty as a primary cause of mental health problems, profound concern with communication in therapy, and widespread ignorance about how to obtain services. Deaf consumers' views need due consideration in service delivery planning. Outreach regarding existing programs is essential.

The Effectiveness of Neural Therapy in Patients With Bell’s Palsy

PubMed Central

Yavuz, Ferdi; Kelle, Bayram; Balaban, Birol

2016-01-01

This report describes the case of a 42-y-old man with a type of facial nerve palsy of the lower motor neurons (LMNs) on the right side, who was treated with neural therapy. After exposure to cold weather, the patient had suddenly developed difficulty in closing his right eye and a deviation to the left in the angle of his mouth. He had no previous medical illness and had no history of trauma, smoking, alcohol intake, or blood transfusion. PMID:27547166

Contemporary Management of Disorders of Male Orgasm and Ejaculation.

PubMed

Althof, Stanley E; McMahon, Chris G

2016-07-01

Ejaculatory disorders lie along a conceptual continuum with premature ejaculation anchoring one end, normal ejaculation in the center, and difficulties with delayed or anejaculation at the opposite end. Retrograde ejaculation, painful ejaculation, and postorgasmic illness syndrome can occur at any point on the continuum. This manuscript defines the ejaculatory dysfunctions, reviews the anatomy and physiology of orgasm and ejaculation, and summarizes the pharmacological, psychological, and combined treatment approaches to ejaculatory dysfunctions. Copyright © 2016 Elsevier Inc. All rights reserved.

Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care.

PubMed

Björk Brämberg, Elisabeth; Torgerson, Jarl; Norman Kjellström, Anna; Welin, Peder; Rusner, Marie

2018-01-09

Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.

Using Freire's Participatory Educational Method to Understand the Experience of Living With Chronic Illness in the Current Age of Globalization.

PubMed

Camargo Plazas, Maria del Pilar; Cameron, Brenda L

2015-06-01

Many approaches and efforts have been used to better understand chronic diseases worldwide. Yet, little is known about the meaning of living with chronic illness under the pressures of globalization and neoliberal ideologies. Through Freire's participatory educational method, this article presents an innovative approach to understanding the multiple dimensions of living with chronic illness. In this way, we hope to use an innovative approach to address the impact of globalization on the daily life of chronically ill people and thus expand to the body of knowledge on nursing. This article uses Freire's participatory educational method to understand the multiple dimensions of living with chronic illness. This qualitative study follows an interpretive inquiry approach and uses a critical hermeneutic phenomenological method and critical research methodologies. Five participants were recruited for this participatory educational activity. Data collection methods included digitally recorded semistructured individual interviews and a Freire's participatory educational method session. Data analysis included a thematic analysis. Participants reported lacking adequate access to healthcare services because of insurance policies; a general perception that they were an unwanted burden on the healthcare system; and a general lack of government support, advocacy, and political interest. This research activity assisted participants to gain a new critical perspective about the condition of others with chronic diseases and thus provided an enlightening opportunity to learn about the illnesses and experiences of others and to realize that others experienced the same oppression from the healthcare system. Participants became agents of change within their own families and communities. Chronic diseases cause many economic and social consequences in their victims. These findings urge us to move from merely acknowledging the difficulties of people who live with chronic illness in an age of globalization to taking the actions necessary to bring about healthcare, social, and political reform through a process of conscientization and mutual transformation.

Can ill-structured problems reveal beliefs about medical knowledge and knowing? A focus-group approach

PubMed Central

Roex, Ann; Clarebout, Geraldine; Dory, Valerie; Degryse, Jan

2009-01-01

Background Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. In several non-medical domains, EB have been found to contribute to the way individuals reason when faced with ill-structured problems (i.e. problems with no clear-cut, right or wrong solutions). Such problems are very common in medical practice. Determining whether EB are also influential in reasoning processes with regard to medical issues to which there is no straightforward answer, could have implications for medical education. This study focused on 2 research questions: 1. Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? and 2. What are the views of general practice trainees and trainers about knowledge and how do they justify knowing? Methods 2 focus groups of trainees (n = 18) were convened on 3 occasions during their 1st year of postgraduate GP training. 2 groups of GP trainers (n = 11) met on one occasion. Based on the methodology of the Reflective Judgement Interview (RJI), participants were asked to comment on 11 ill-structured problems. The sessions were audio taped and transcribed and an adapted version of the RJI scoring rules was used to assess the trainees' reasoning about ill-structured problems. Results Participants made a number of statements illustrating their EB and their importance in clinical reasoning. The level of EB varied widely form one meeting to another and depending on the problem addressed. Overall, the EB expressed by trainees did not differ from those of trainers except on a particular ill-structured problem regarding shoulder pain. Conclusion The use of focus groups has entailed some difficulties in the interpretation of the results, but a number of preliminary conclusions can be drawn. Ill-structured medical problems can be used to elicit EB. Most trainees and trainers displayed pre-reflective and quasi-reflective EB. The way trainees and doctors view and justify knowledge are likely to be involved in medical reasoning processes. PMID:19775425

Mother's perceptions of child mental health problems and services: A cross sectional study from Lahore.

PubMed

Imran, Nazish; Ashraf, Sania; Shoukat, Rabia; Pervez, Muhammad Ijaz

2016-01-01

To assess the perceptions of mothers regarding child mental health problems, its causes, preferred treatment options, and to determine whom they would consult, if their child had a psychiatric illness. Following informed consent, a questionnaire covering perceptions regarding various aspects of child mental illness was used for data collection from mothers. They were asked to identify the symptoms and behaviours they considered psychopathological in children, which treatments they would prefer, where they would turn for help with a mentally ill child, and their understanding of the causes of child psychiatric disorders in addition to ways to increase awareness of child psychiatric issues in the society. Ninety one mothers participated in the study. They equally perceived emotional, behavioural and cognitive symptoms as suggestive of mental ill health in childhood. Mothers perceived multiple causes of child mental health problems, including family problems, economic difficulties, social adversity and possession by evil spirits. A substantial proportion preferred medication, recitation of Holy Quran and psychotherapy as the preferred treatment options. Overall, mothers preferred consulting health professionals than religious scholars and faith healers. They were keen for steps to increase mental health awareness within their society. Despite different cultural perspective, mothers exhibit good understanding of symptoms of child mental health issues and appear open to various services and treatment options. Understanding parental perceptions and expectations from child psychiatric services are crucial in increasing families' engagement in treatment.

Function in job seekers with mental illness and drug and alcohol problems who access community based disability employment services.

PubMed

Matthews, Lynda R; Harris, Lynne M; Jaworski, Alison; Alam, Ashraful; Bozdag, Gokcen

2013-03-01

This study identified functioning, health, and social needs in jobseekers with mental disorders independently assessed as having capacity to work and referred to disability employment services. Differences in function between jobseekers with mental illness alone and with additional drug and alcohol problems were examined with view to identifying interventions for vocational rehabilitation. A convenience sample of 116 jobseekers completed BASIS-32, CANSAS, AUDIT, DAST-10 and 6 items from the EXIT interview and were divided into two groups: mental illness only, and additional drug and alcohol issues (AUDIT total score >8 and/or DAST total score >3). Analysis of variance was used to determine group differences. Jobseekers reported low-moderate problems with function. Over 40% of the sample reported unresolved psychological distress, physical health needs, and social/daytime activity needs. Thirty-five jobseekers (30%) had additional drug and alcohol problems and reported significantly greater difficulty with impulsive/addictive behavior and poorer memory and executive function than the mental illness only group. No significant differences were identified in past work functioning. Screening all job seekers for psychological, physical, and social needs to identify suitable treatment and rehabilitation strategies and providing interventions that improve emotional regulation and executive function for job seekers with additional drug and alcohol problems may improve employability of job seekers accessing disability employment services.

A study of the performance of patients with frontal lobe lesions in a financial planning task.

PubMed

Goel, V; Grafman, J; Tajik, J; Gana, S; Danto, D

1997-10-01

It has long been argued that patients with lesions in the prefrontal cortex have difficulties in decision making and problem solving in real-world, ill-structured situations, particularly problem types involving planning and look-ahead components. Recently, several researchers have questioned our ability to capture and characterize these deficits adequately using just the standard neuropsychological test batteries, and have called for tests that reflect real-world task requirements more accurately. We present data from 10 patients with focal lesions to the prefrontal cortex and 10 normal control subjects engaged in a real-world financial planning task. We also introduce a theoretical framework and methodology developed in the cognitive science literature for quantifying and analysing the complex data generated by problem-solving tasks. Our findings indicate that patient performance is impoverished at a global level but not at the local level. Patients have difficulty in organizing and structuring their problem space. Once they begin problem solving, they have difficulty in allocating adequate effort to each problem-solving phase. Patients also have difficulty dealing with the fact that there are no right or wrong answers nor official termination points in real-world planning problems. They also find it problematic to generate their own feedback. They invariably terminate the session before the details are fleshed out and all the goals satisfied. Finally, patients do not take full advantage of the fact that constraints on real-world problems are negotiable. However, it is not necessary to postulate a 'planning' deficit. It is possible to understand the patients' difficulties in real world planning tasks in terms of the following four accepted deficits: inadequate access to 'structured event complexes', difficulty in generalizing from particulars, failure to shift between 'mental sets', and poor judgment regarding adequacy and completeness of a plan.

A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions

PubMed Central

2011-01-01

Background This paper analyses the relationship between public perceptions of access to general practitioners (GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores the different dimensions associated with facility access and accessibility. Methods Data on difficulties experienced in accessing health services, respondent health status and car ownership were collected through an attitudes survey. Road distances to the nearest service were calculated for each respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial non-stationarity in the results. Results Respondent long term illness, reported bad health and non-car ownership were found to be significant predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global relationships indicating locations where the predictive strength of the independent variables was higher or lower than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not. Conclusions Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed how these relationships were varied across the study area. This study demonstrates that the notion of access is a multi-dimensional concept, whose composition varies with location, according to the facility being considered and the health and socio-economic status of the individual concerned. PMID:21787394

A qualitative study of doctors' and nurses' barriers to communicating with seriously ill patients about their dependent children.

PubMed

Dencker, Annemarie; Rix, Bo Andreassen; Bøge, Per; Tjørnhøj-Thomsen, Tine

2017-12-01

Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional difficulty later in life and depend on adult support to minimize these consequences. Patients suffer anxiety about supporting their children during their illness. Because of their potentially pivotal role in supporting patients in enabling parent-child communication, we examined HP's structural and emotional barriers to communicating with patients about their children. The study was based on 49 semi-structured, in-depth interviews with doctors and nurses working with haematology, gynaecological cancer, and neurointensive care. Both interviews and analysis addressed emotional and structural barriers, drawing on the theoretical framework of Maturana's domains. The study found structural barriers (eg, lack of space in the medical recording system, professional code, time pressure, and lack of training) and emotional barriers (eg, the painful nature of the situation and the perceived need of keeping professional distance). We found that emotional barriers tended to grow when structural barriers were not addressed. Our study indicates (1) the need to use templates and manual procedures to gather and process information about children in medical records; (2) the need for managerial backing for addressing children of seriously ill patients and time spent on it; and (3) the need for future HP training programmes to include how to implement procedures and how to address all barriers. Copyright © 2017 John Wiley & Sons, Ltd.

Visual integration dysfunction in schizophrenia arises by the first psychotic episode and worsens with illness duration.

PubMed

Keane, Brian P; Paterno, Danielle; Kastner, Sabine; Silverstein, Steven M

2016-05-01

Visual integration dysfunction characterizes schizophrenia, but prior studies have not yet established whether the problem arises by the first psychotic episode or worsens with illness duration. To investigate the issue, we compared chronic schizophrenia patients (SZs), first episode psychosis patients (FEs), and well-matched healthy controls on a brief but sensitive psychophysical task in which subjects attempted to locate an integrated shape embedded in noise. Task difficulty depended on the number of noise elements co-presented with the shape. For half of the experiment, the entire display was scaled down in size to produce a high spatial frequency (HSF) condition, which has been shown to worsen patient integration deficits. Catch trials-in which the circular target appeared without noise-were also added so as to confirm that subjects were paying adequate attention. We found that controls integrated contours under noisier conditions than FEs, who, in turn, integrated better than SZs. These differences, which were at times large in magnitude (d = 1.7), clearly emerged only for HSF displays. Catch trial accuracy was above 95% for each group and could not explain the foregoing differences. Prolonged illness duration predicted poorer HSF integration across patients, but age had little effect on controls, indicating that the former factor was driving the effect in patients. Taken together, a brief psychophysical task efficiently demonstrates large visual integration impairments in schizophrenia. The deficit arises by the first psychotic episode, worsens with illness duration, and may serve as a biomarker of illness progression. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Prenatal Docosahexaenoic Acid Supplementation and Infant Morbidity: Randomized Controlled Trial

PubMed Central

Imhoff-Kunsch, Beth; Stein, Aryeh D.; Martorell, Reynaldo; Parra-Cabrera, Socorro; Romieu, Isabelle

2011-01-01

OBJECTIVE: Long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of maternal DHA supplementation on infant morbidity is unknown. We investigated the effects of prenatal DHA supplementation on infant morbidity. METHODS: In a double-blind randomized controlled trial conducted in Mexico, pregnant women received daily supplementation with 400 mg of DHA or placebo from 18 to 22 weeks' gestation through parturition. In infants aged 1, 3, and 6 months, caregivers reported the occurrence of common illness symptoms in the preceding 15 days. RESULTS: Data were available at 1, 3, and 6 months for 849, 834, and 834 infants, respectively. The occurrence of specific illness symptoms did not differ between groups; however, the occurrence of a combined measure of cold symptoms was lower in the DHA group at 1 month (OR: 0.76; 95% CI: 0.58–1.00). At 1 month, the DHA group experienced 26%, 15%, and 30% shorter duration of cough, phlegm, and wheezing, respectively, but 22% longer duration of rash (all P ≤ .01). At 3 months, infants in the DHA group spent 14% less time ill (P < .0001). At 6 months, infants in the DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and “other illness,” respectively, but 74% longer duration of vomiting (all P < .05). CONCLUSIONS: DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months. PMID:21807696

Do the parent-child relationship and parenting behaviors differ between families with a child with and without chronic illness? A meta-analysis.

PubMed

Pinquart, Martin

2013-08-01

The present meta-analysis compared the quality of the parent-child relationship as well as parenting behaviors and styles of families with a child with chronic physical illness with families of healthy children or test norms. Empirical studies were identified with the help of electronic databases and cross-referencing. Based on 325 included studies, random-effects meta-analysis was performed. Although most effect sizes were small or very small, the parent-child relationship tended to be less positive if a child had a chronic physical illness (g = -.16 standard deviation units). In addition, lower levels of parental responsiveness (emotional warmth; g = -.22) as well as higher levels of demandingness (control, monitoring; g = .18) and overprotection (g = .39) were observed in these families. However, effect sizes were heterogeneous and only significant for a limited number of diseases. There was also some evidence for higher levels of authoritarian (g = .24) and neglectful parenting (g = .51) as well as lower levels of authoritative parenting compared with families with healthy children (g = -.13). Effect sizes varied, in part, by length of illness, child age, rater, assessment method, and target of comparison. We conclude that most families with a child with chronic physical illness adapt well with regard to the parent-child relationship and parenting behaviors/styles. Nonetheless, some families of children with specific diseases-such as epilepsy, hearing impairment, and asthma-may have difficulties finding appropriate levels of protective behaviors, control, and parental warmth and building positive mutual relationships between parents and children.

On the place of fuzzy health in medical theory.

PubMed

Nordenfelt, L

2000-10-01

This commentary on Sadegh-Zadeh's article 'Fuzzy health, illness and disease,' has its focus on the philosophical background for applying fuzzy logic to medical theory. I concentrate on four issues. First, I contest some of Sadegh-Zadeh's statements on the present state of the theory of medicine, in particular with regard to assumptions ascribed to contemporary theorists. Second, I consider Sadegh-Zadeh's interesting idea that a person can have a disease to varying degrees, from not having it at all to having it completely. I argue that there are difficulties pertaining to the definition of particular diseases, which obstruct the application of this idea. The following two points concern medical semantics and principles for definition in general. I take issue with Sadegh-Zadeh's description of the correct procedure for definition. I also contest his unconditional proposal for a social definition of health, illness and disease.

Living with breast cancer: the influence of rurality on women's suffering and resilience. a postmodern feminist inquiry.

PubMed

Rogers-Clark, Cath

This paper focuses on rural living as a dimension of women's experiences of living through breast cancer. The findings presented emanate from a feminist narrative research project that examined the experiences of rural women from south-west Queensland who were long-term survivors of breast cancer. This project aimed to listen, report and interpret rural women's stories of resilience in surviving breast cancer and moving on with their lives. The participants reported that there were both positive and negative aspects of living in a rural setting, especially when ill. Eight of the nine participants, however, felt strongly that the positive aspects of rural living outweighed the difficulties. This suggests that rurality in the context of health and illness must be considered as a multifaceted dimension, with resources to support cancer survivors building on the existing strengths in rural communities.

Heat-related symptoms in sugarcane harvesters.

PubMed

Crowe, Jennifer; Nilsson, Maria; Kjellstrom, Tord; Wesseling, Catharina

2015-05-01

Exposure to heat stress is a documented risk for Central American sugarcane harvesters. However, little is known about heat-related illness in this population. This study examined the frequency of heat-related health effects among harvesters (n = 106) exposed to occupational heat stress compared to non-harvesters (n = 63). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories. Heat and dehydration symptoms (headache, tachycardia, muscle cramps, fever, nausea, difficulty breathing, dizziness, swelling of hands/feet, and dysuria) were experienced at least once per week significantly more frequently among harvesters. Percentages of workers reporting heat and dehydration symptoms increased in accordance with increasing heat exposure categories. A large percentage of harvesters are experiencing heat illness throughout the harvest demonstrating an urgent need for improved workplace practices, particularly in light of climate change and the epidemic of chronic kidney disease prevalent in this population. © 2015 Wiley Periodicals, Inc.

Financial Victimization of Adults With Severe Mental Illness

PubMed Central

Claycomb, Meredith; Black, Anne C.; Wilber, Charles; Brocke, Sophy; Lazar, Christina M.; Rosen, Marc I.

2014-01-01

Objective People with severe mental illness are vulnerable to having other people directly take or misappropriate their disability payments. This study investigated the prevalence of different types of financial victimization and the client characteristics associated with being financially victimized. Methods Adults (N=122) receiving inpatient or intensive outpatient psychiatric treatment who received Social Security disability payments completed assessments about money management and victimization. A path model was used to estimate the association of victimization with participant characteristics. Results Seventy percent of participants experienced at least one type of financial victimization in the preceding 28 days; 35% ran out of money because of victimization. Victimization was significantly associated with being younger, having had more psychiatric hospitalizations, having more recent alcohol use, and, most robustly, having problems managing money (β=.52, p<.01). Conclusions Financial victimization of disability recipients in acute care settings is common and more likely among people with recent substance use and difficulty managing their funds. PMID:24026837

Personality disorders at the interface of psychiatry and the law: legal use and clinical classification

PubMed Central

Johnson, Sally C.; Elbogen, Eric B.

2013-01-01

Personality disorders have a complex relationship with the law that in many ways reflects their complexity within the clinical and research communities. This paper addresses expert testimony about personality disorders, outlines how personality disorders are assessed in forensic cases, and describes how personality disorders are viewed in different legal contexts. Reasons are identified why personality disorders are not generally accepted as significant mental illness within the legal system, including high incidence of personality dysfunction in criminal populations, frequent comorbidity of personality disorders making it difficult to determine direct causation, and difficulty determining where on a continuum personality traits should be defined as illness (or not). In summary, the legal system, to a significant degree, mirrors the clinical conception of personality disorders as not severe mental diseases or defects, not likely to change, and most often, under volitional control. PMID:24174894

Contingent workers: Workers' compensation data analysis strategies and limitations.

PubMed

Foley, Michael; Ruser, John; Shor, Glenn; Shuford, Harry; Sygnatur, Eric

2014-07-01

The growth of the contingent workforce presents many challenges in the occupational safety and health arena. State and federal laws impose obligations and rights on employees and employers, but contingent work raises issues regarding responsibilities to maintain a safe workplace and difficulties in collecting and reporting data on injuries and illnesses. Contingent work may involve uncertainty about the length of employment, control over the labor process, degree of regulatory, or statutory protections, and access to benefits under workers' compensation. The paper highlights differences in regulatory protections and benefits among various types of contingent workers and how these different arrangements affect safety incentives. It discusses challenges caused by contingent work for accurate data reporting in existing injury and illness surveillance and benefit programs, differences between categories of contingent work in their coverage in various data sources, and opportunities for overcoming obstacles to effectively using workers' compensation data. © 2014 Wiley Periodicals, Inc.

A relational approach to health practices: towards transcending the agency-structure divide.

PubMed

Veenstra, Gerry; Burnett, Patrick John

2014-02-01

Many health scholars find that Pierre Bourdieu's theory of practice leaves too little room for individual agency. We contend that, by virtue of its relational, field-theoretic underpinnings, the idea of leaving room for agency in Bourdieu's theory of practice is misguided. With agency manifested in interactions and social structures consisting of relations built upon relations, the stark distinction between agency and structure inherent to substantialist thinking is undermined, even dissolved, in a relational field-theoretic context. We also contend that, when treated as relationally bound phenomena, Bourdieu's notions of habitus, doxa, capital and field illuminate creative, adaptive and future-looking practices. We conclude by discussing difficulties inherent to implementing a relational theory of practice in health promotion and public health. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Personality disorders at the interface of psychiatry and the law: legal use and clinical classification.

PubMed

Johnson, Sally C; Elbogen, Eric B

2013-06-01

Personality disorders have a complex relationship with the law that in many ways reflects their complexity within the clinical and research communities. This paper addresses expert testimony about personality disorders, outlines how personality disorders are assessed in forensic cases, and describes how personality disorders are viewed in different legal contexts. Reasons are identified why personality disorders are not generally accepted as significant mental illness within the legal system, including high incidence of personality dysfunction in criminal populations, frequent comorbidity of personality disorders making it difficult to determine direct causation, and difficulty determining where on a continuum personality traits should be defined as illness (or not). In summary, the legal system, to a significant degree, mirrors the clinical conception of personality disorders as not severe mental diseases or defects, not likely to change, and most often, under volitional control.

Risk factors for common mental disorders in women. Population-based longitudinal study.

PubMed

Patel, Vikram; Kirkwood, Betty R; Pednekar, Sulochana; Weiss, Helen; Mabey, David

2006-12-01

The determinants of common mental disorders in women have not been described in longitudinal studies from a low-income country. Population-based cohort study of 2494 women aged 18 to 50 years, in India. The Revised Clinical Interview Schedule was used for the detection of common mental disorders. There were 39 incident cases of common mental disorder in 2166 participants eligible for analysis (12-month rate 1.8%, 95% CI 1.3-2.4%). The following baseline factors were independently associated with the risk for common mental disorder: poverty (low income and having difficulty making ends meet); being married as compared with being single; use of tobacco; experiencing abnormal vaginal discharge; reporting a chronic physical illness; and having higher psychological symptom scores at baseline. Programmes to reduce the burden of common mental disorder in women should target poorer women, women with chronic physical illness and who have gynaecological symptoms, and women who use tobacco.

"Coffee Stands": a vocational rehabilitation project in the community for people coping with mental disorders.

PubMed

Katz, Noomi; Gilad Izhaky, Smadar; Ziv, Ornit; Revach, Anat

2013-01-01

The "Coffee Stands" project was developed to provide a work place where individuals with long term mental illness can receive job training within the community. It is similar to a supported employment program, except that it does not provide individual job placement services. The objective of the study was to describe the participants who worked at the "coffee stands", with respect to their participation in occupations, functional cognition, executive functions and awareness, perception of their quality of life (QoL), satisfaction and self esteem. Moreover, the study aimed at examining whether changes occurred in these variables during the 6-month period in which participants worked at the coffee stands. Participants included 44 people with chronic mental illness; 27 men and 17 women, mean age 43.43 (SD = 9.02); mean years of education 11.81 (SD = 1.83); mean age of illness onset 27.72 (SD = 11.12) and mean number of hospitalizations 3.27 (SD = 2.64). All signed an informed consent to participate in the study. A battery of eight instruments measuring the various variables was administered at two points in time; at the beginning of the work at the coffee stands and 6 months later. Indicated that the training was successful and that participants were able to maintain an average 3 hours of work daily, demonstrating an improvement in their perception of their ability to work. In the area of planning, they needed structure, suggesting some difficulties in executive functions, but they seemed to be aware of their difficulties. After 6 months, participants showed improvements in health related measures of QoL and satisfaction, but not in self esteem. The findings strengthen the premise that people coping with an emotional disorder place great importance on working, are able to work and derive satisfaction from their work.

[Burnout syndrome. Legal medicine: analysis and evaluation INAIL protection in cases of suicide induced by burnout within the helping professions].

PubMed

Carlini, Luigi; Fidenzi, Luca; Gualtieri, Giacomo; Nucci, Giulia; Fagiolini, Andrea; Coluccia, Anna; Gabbrielli, Mario

2016-01-01

After a survey of the definition and etiopathogenesis of burnout syndrome (BOS) carried out with the support of the most reliable available literature on the subject, the essay focuses on clinical evaluation (psychometric identification and quantification) of burn-out. In accordance with Circular 71/2003 of INAIL, it is assumed to be essential both legally and scientifically knowledge that the syndrome of burnout, knowledge, which involves an analysis of the case conducted with objective strictness and critical sensibility. It is carried out by collecting data on work history, physiological history, remote and proximal pathological history and performing a physical examination including neuro-psychiatric and psycho-diagnostic tests surveys. Only after the ascertainment of an effective existence of a psychiatric syndrome related to burnout phenomenon indeed, it will be possible (and necessary) to quantify the period of illness and the potential temporary biological damage or, more rarely, a permanent one. Given the difficulty of applying the forensic methodology to BOS (among which: the evaluation of the previous state of the person, the assessment of the causal link, the difficulties of nosographic of mental illness, the near impossibility of adequate prognostic evaluation, the difficulty to identify suitable criteria for establishing the importance and nature of limitations of daily living), in order to quantify the damage as objective as possible, it will be necessary to: 1) reconstruct the previous mental state of the subject; 2) assess the psychopathological condition following the event which the action of recognition focuses on; 3) express the clinical severity graduation judgment of the framework as well as a prognosis regarding the mental disorder found. The second part of the analysis focuses on the relationship between BOS and "helping profession"; specific attention is paid, in this section of work, to the analysis of the relationship between a typical BOS work-related stress and suicide.

Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project

PubMed Central

2010-01-01

Background Mental ill health, especially depression, is recognised as an important health concern, potentially with greater impact in rural communities. This paper reports on a project, Coach the Coach, in which Australian rural football clubs were the setting and football coaches the leaders in providing greater mental health awareness and capacity to support early help seeking behaviour among young males experiencing mental health difficulties, especially depression. Coaches and other football club leaders were provided with Mental Health First Aid (MHFA) training. Method Pre-post measures of the ability of those club leaders undertaking mental health training to recognise depression and schizophrenia and of their knowledge of evidence supported treatment options, and confidence in responding to mental health difficulties were obtained using a questionnaire. This was supplemented by focus group interviews. Pre-post questionnaire data from players in participating football clubs was used to investigate attitudes to depression, treatment options and ability to recognise depression from a clinical scenario. Key project stakeholders were also interviewed. Results Club leaders (n = 36) who were trained in MHFA and club players (n = 275) who were not trained, participated in this evaluation. More than 50% of club leaders who undertook the training showed increased capacity to recognise mental illness and 66% reported increased confidence to respond to mental health difficulties in others. They reported that this training built upon their existing skills, fulfilled their perceived social responsibilities and empowered them. Indirect benefit to club players from this approach seemed limited as minimal changes in attitudes were reported by players. Key stakeholders regarded the project as valuable. Conclusions Rural football clubs appear to be appropriate social structures to promote rural mental health awareness. Club leaders, including many coaches, benefit from MHFA training, reporting increased skills and confidence. Benefit to club players from this approach was less obvious. However, the generally positive findings of this study suggest further research in this area is desirable. PMID:20482809

Losses related to everyday occupations for adults affected by mental illness.

PubMed

Baker, Amy Elizabeth Zanker; Procter, Nicholas Gerard

2014-07-01

This paper presents findings from a larger study that explored losses from mental illness. Losses associated with occupations--a key theme from this participatory action research study--are the focus of this paper. Semi-structured in-depth interviews were carried out with 16 people who had been diagnosed with a mental illness and attended a community mental health centre. Interviews were transcribed verbatim and thematically analysed, guided by processes proposed by Dey. Numerous losses influenced participants' ability to initiate or engage in daily occupations. Some losses perpetuated further loss, at times with profound consequences, such as the loss of a house following a loss of work. Engaging in chosen occupations was often described as a longer-term goal or something participants did infrequently, due to losses such as motivation, energy, or normal sleeping patterns. The desire to work and participate in everyday occupations was emphasized and its benefits highlighted, despite previous difficulties. Implications for occupational therapists include the importance of exploring, validating, and responding to losses when these are shared, and being aware of and striving to support people experiencing losses in the areas of work, motivation, sleep patterns, and energy, which were perceived as especially challenging for participants in this study.

Perceptions of biopsychosocial services needs among older adults with severe mental illness: met and unmet needs.

PubMed

Cummings, Sherry M; Cassie, Kimberly McClure

2008-05-01

This study sought to identify the psychiatric, physical, and social services needs experienced by older adults with severe mental illness (SMI) and to examine factors influencing their experience of need and service provision adequacy. Seventy-five older adults with SMI were recruited from a community mental health center to participate in the study. The typical client experienced a need for care in 10 areas, with the greatest needs occurring in the areas of psychological pain, physical illness, social contacts, looking after the home, and daily activities. The total number of unmet needs ranged from zero to 10, with the typical client having an average of 2.3 unmet needs (SD = 2.4). The highest proportions of unmet needs were in the areas of social contact, benefits, sight or hearing difficulties, and intimate relationships. Linear hierarchical regression analyses revealed that clients with lower income, greater impairments in independent daily living skills, and higher levels of depression experienced increased needs for care. Older clients who lived in private homes or apartments had higher levels of depression, and those who required assistance in the areas of intimate relationships and benefits experienced higher levels of unmet needs. Research and practice implications are discussed.

Decision-making capacity should not be decisive in emergencies.

PubMed

Hubbeling, Dieneke

2014-05-01

Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures.

Family options for parents with mental illnesses: a developmental, mixed methods pilot study.

PubMed

Nicholson, Joanne; Albert, Karen; Gershenson, Bernice; Williams, Valerie; Biebel, Kathleen

2009-01-01

The objective of this paper is to provide a description of Family Options, a rehabilitation intervention for parents with serious mental illnesses and their children focusing on recovery and resilience, and to report the findings from a pilot study at 6-months post-enrollment for participating mothers. A developmental design, and mixed quantitative and qualitative methods facilitate an in-depth understanding of Family Options and its impact on parents early in the implementation process. Participating families faced significant challenges, including long-term mental health conditions in adults, and emotional and behavioral difficulties in children. Data from mothers (n = 22) demonstrate significant improvements in well-being, functioning, and supports and resources at 6 months post-enrollment in Family Options. Mothers report help from Family Options staff consistent with the intervention as conceptualized, and high levels of satisfaction with the intervention as delivered. Innovative study design and analytic strategies are required to build the evidence base and promote rapid dissemination of effective interventions. Findings from this study will assist purveyors in refining the intervention, and will lay the groundwork for further replication and testing to build the evidence base for parents with serious mental illnesses and their families.

Differences in sleep quality and health-related quality of life in young adults with allergies and asthma and their healthy peers.

PubMed

Molzon, Elizabeth S; Bonner, Margaret S; Hullmann, Stephanie E; Ramsey, Rachelle R; Suorsa, Kristina I; Chaney, John M; Mullins, Larry L

2013-01-01

The current study examined the relationship between sleep quality and health-related quality of life (HRQOL). Participants were 501 undergraduate students with allergies (167), asthma + allergies (167), or with no history of a chronic illness (167) completed study measures from August 2011 to April 2012. The undergraduate students completed questionnaires online as part of a larger study of psychosocial adjustment of young adults. Young adults with allergies and asthma + allergies reported significantly worse sleep quality and HRQOL than healthy peers. Additionally, those with allergies and asthma + allergies had significantly more sleep disturbances and used sleeping medication significantly more often in the previous month than healthy peers. These results highlight concerns regarding quality of life and sleep problems in an often-overlooked population. Importantly, sleep difficulties can result in difficulties in daily living and impairment in academic functioning.

Online self-management interventions for chronically ill patients: cognitive impairment and technology issues.

PubMed

Archer, Norm; Keshavjee, Karim; Demers, Catherine; Lee, Ryan

2014-04-01

As the fraction of the population with chronic diseases continues to grow, methods and/or technologies must be found to help the chronically ill to take more responsibility to self-manage their illnesses. Internet based and/or mobile support for disease self-management interventions have often proved effective, but patients with chronic illnesses may have co-occurring cognitive impairment, making it more difficult for them to cope with technologies. Many older patients are also not familiar with technologies or they may have cognitive disabilities or dementia that reduce their ability to self-manage their healthcare. On-line solutions to the needs of chronically ill patients must be investigated and acted upon with care in an integrated manner, since resources invested in these solutions will be lost if patients do not adopt and continue to use them successfully. To review the capabilities of online and mobile support for self-management of chronic illnesses, and the impacts that age and disease-related issues have on these interventions, including cognitive impairment and lack of access or familiarity with Internet or mobile technologies. This study includes a review of the co-occurrence of cognitive impairment with chronic diseases, and discusses how cognitive impairment, dyadic caregiver patient support, patient efficacy with technology, and smart home technologies can impact the effectiveness and sustainability of online support for disease self-management. Disease self-management interventions (SMIs) using online patient centered support can often enable patients to manage their own chronic illnesses. However, our findings show that cognitive impairment often co-occurs in patients with chronic disease. This, along with age-related increases in multiple chronic illnesses and lack of technology efficacy, can be obstacles to Internet and mobile support for chronic disease self-management. Patients with chronic diseases may have greater than expected difficulties in using Internet and mobile technologies for disease self-management, often due to cognitive impairment or unfamiliarity with technology. Approaches to dealing with such barriers include suitable integration of solutions involving patient-caregiver dyads, better design of online applications, careful attention to technology adoption and sustainability, and smart home technologies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Intellectual Functioning in In-Patients with Substance Use Disorders: Preliminary Results from a Clinical Mediation Study of Factors Contributing to IQ Variance.

PubMed

Braatveit, Kirsten J; Torsheim, Torbjørn; Hove, Oddbjørn

2018-01-01

To investigate the direct effect of different childhood difficulties on adult intelligence coefficient (IQ) and their possible indirect effect through the mediating pathways of education and severity substance use. Ninety in-patients aged 19-64. The participants had abstained from substance use for at least 6 weeks and had different substance use profiles. Substance use disorder (SUD) and psychiatric illnesses were diagnosed according to the International Classification of Diseases 10th edition criteria. IQ was measured with the Wechsler Adult Intelligence Scale, 4th edition. Childhood difficulties, severity of substance use and level of education were assessed through a self-report questionnaire. Mean full scale IQ for the studied population was 87.3. Learning and attention deficit/hyperactivity difficulties in childhood were directly related to adult IQ. Education had a mediating effect between childhood learning difficulties/conduct problems and the verbal comprehension index. There was no significant difference in IQ due to the specific substance used or severity of substance use. IQ variance in in-treatment individuals with SUD was related to childhood functioning alone or through the mediator of education. Substance-related factors did not contribute to IQ variance. The results fit a normal theory of IQ development with commonly known risk factors and no disturbing effect of substance use. © 2018 S. Karger AG, Basel.

U.S. Congress playing budgetary endgame

NASA Astrophysics Data System (ADS)

Carlowicz, Mike

With fiscal year 1997 (FY '97) set to begin on October 1, the U.S. Congress was poised to fund most American science programs and agencies at or above the levels of funding appropriated in the tumultuous FY '96. Seeking to avert a drawn-out budget debate during an election year, congressional leaders were working feverishly in the last week of September to write appropriations bills that would be acceptable—though not necessarily satisfying—to both Congress and the Clinton Administration.On September 24, the U.S. House of Representatives and the Senate approved the conference report of H.R. 3666, the appropriations bill that provides funding for the departments of Veterans Affairs, Housing and Urban Development, and the Independent Agencies. The conference report of this VA-HUD bill provides $84.7 billion in spending for the affected agencies, including NASA, the Environmental Protection Agency (EPA), and the National Science Foundation (NSF). The conference report was weighted heavily toward the preferences of the Senate, where moderates and pragmatists were stressing compromise and pushing for appropriations bills that President Clinton would be likely to sign.

[Efficiency and specificity of the KAT-test for rapid diagnosis of falciparum malaria].

PubMed

Cong, Le Dinh; Sergiev, V P; Rabinovich, S A; Nhah, Doan Hanh; Huong, Nguyen Van; Morozov, E N; Kukina, I V; Thinh, Ta Thi; Maksakovskaia, E V; Dao, Le Minh; Chalyĭ, V F; To, Dang Thi; Fandeev, V A; Hoa, Ngo Viet; Due, Nguyen Thi

2002-01-01

A new rapid KAT Quick Malaria test for the diagnosis of falciparum malaria, which is based on the detection of a monoclonal antibody-antigen complex of malaria parasites, has been worked out by the KAT Medical CC in South Africa. The efficiency and specificity of the KAT test were compared with those of the microscopic method and with the ICT test for rapid diagnosis of P. falciparum and P. vivax. The polymerase chain reaction was used as a control test. Testing for malaria was performed on 98 blood samples from feverish patients in Vietnam and Tadjikistan and among the persons who had returned to Moscow from endemic regions. The efficiency of the KAT test for falciparum-malaria was found to be 100% versus 90.5% with ICT. The absence of cross-reactions with P. vivax and the presence of pseudopositive results of the KAT test for fever cases of non-malaria origin indicate its high specificity. There was no correlation between the rate of test line colouring and the level of parasitemia. The KAT test yielded positive results only when gametocytes were found in blood specimens.

[Pyelonephritis with massive renal tissue necrosis in child with urinary tract malformation--a case report].

PubMed

Pawlak-Bratkowska, Monika; Finke, Daria; Olejniczak, Dariusz; Midel, Anna; Tkaczyk, Marcin

2009-04-01

The aim of the case report is presentation of unusual and heavy clinical course of pyelonephritis with renal tissue necrosis in a child with urinary tract malformation. Nine month old girl was admitted to hospital in heavy clinical status due to pyelonephritis--urosepsis. It was complicated by acute renal insufficiency. Patient was treated by broad-spectrum antibiotics and parenteral nutrition. She was feverish for 14 days. Computed tomography done in order to exclude abdominal abscess showed massive renal tissue necrosis of on both sides. Antibiotic treatment was successful after 6 weeks. Urological evaluation revealed bilateral vesico-ureteral refluxes grade IV. Scintigraphy showed multiple scars. Patient was treated Deflux injections (twice). We noted 5 urinary tract recurrences despite antibiotic profilaxis. GFR of 75 ml/min/1.73 m2 was estimated at age of 16 m. Immunodeficiency or malignancy as background of clinical course were excluded. The case we describe presents severe clinical course of pyelonephritis due to complex urinary tract malformation that is to be considered despite based on modern publications "sparing" strategies of diagnosis and profilaxis in urinary tract malformations.

Promoting recovery via an integrated model of care to deliver a bed-based, mental health prevention and recovery centre.

PubMed

Lee, Stuart J; Collister, Laura; Stafrace, Simon; Crowther, Elizabeth; Kroschel, Jon; Kulkarni, Jayashri

2014-10-01

This research was conducted in order to explore the experience of care and outcomes for people entering a bed-based step-up/step-down Prevention and Recovery Centre (PARC). An audit of files for PARC participants in 2010 collected demographic (age, gender, and marital, housing, employment and education/training status) and clinical measures (length of stay, entry and exit outcome measures, psychiatric hospital use). Participants were also invited to a feedback group to discuss their PARC experience. In 2010, 118 people entered PARC. Most were single and unemployed and 35% were in temporary housing or homeless. In the six months following PARC exit, participants spent significantly less time in psychiatric hospital than in the six months prior to entry (p<0.001). Significant reductions in clinician-rated difficulties were documented at exit (p<0.001). For 40 episodes of care with self-report measures at entry and exit, significant reductions in difficulties with relating to self/others (p=0.004), daily living/role functioning (p=0.006), and depression/anxiety (p=0.019) were seen. Twelve participants attended a feedback group. Positive aspects of PARC included: supportive and caring staff; help with practical issues or community access; therapeutic activities and learning about health; and socialization opportunities. A step-up/step-down PARC can facilitate recovery for people with mental illness through promoting independence and illness self-management. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Interactions with parents and friends among chronically ill children: examining social networks.

PubMed

Herzer, Michele; Umfress, Kris; Aljadeff, Gabriel; Ghai, Kanika; Zakowski, Sandra G

2009-12-01

Children with medical conditions often experience a combination of positive and negative social interactions with parents and friends. Adult research examining cross-domain buffering effects has documented that supportive social ties can make up for shortcomings in other social relationships. This study examined whether negative effects of strained relationships with loved ones can be buffered when children feel supported by individuals in different support networks (i.e., cross-domain buffering effects). Children with Type I diabetes (n = 56), chronic asthma (n = 54), and cystic fibrosis (n = 17) completed questionnaires during an outpatient hospital visit that assessed perceptions of support and strain from parents and friends, quality of life, self-concept, and emotional/behavioral difficulties. Parental strain was conceptualized as parental overprotection and parental rejection. Hierarchical regression analyses showed that friend support buffered the adverse effects of parental strain on child quality of life, self-concept, and emotional/behavioral difficulties. Interestingly, parental support did not buffer the negative effects of experiencing strained relationships with friends; only main effects on outcome were found. These findings partially support our hypotheses of cross-domain buffering. In this study, friendships were a protective factor for children who experienced strained relationships with parents. In contrast, although parent support had a direct impact on child outcome, it did not make up for feeling rejected by friends. Because close relationships are often strained during medical stressors, findings underscore the importance of promoting social connectedness in chronically ill children to maximize opportunities for experiencing positive social relationships.

Guided self-help for mental health disorders in children and young people with chronic neurological conditions: A qualitative evaluation.

PubMed

Bennett, Sophie D; Coughtrey, Anna E; Heyman, Isobel; Greally, Suzanna; Clarkson, Harriet; Bhattacharyya, Tuhina; Lewis, Corah; Varadkar, Sophia; Shafran, Roz

2018-03-09

Children with neurological conditions such as epilepsy are at high risk of developing mental health disorders. Guided self-help can be used to increase access to psychological therapies. When developing and evaluating interventions, it is important to obtain the views of service-users about their acceptability. A telephone-guided self-help intervention was used to treat common mental health difficulties in children and young people with neurological conditions. The intervention was not adapted in content to account for chronic illness. This study therefore reports on qualitative interviews with participants to determine the acceptability of the intervention. Semi-structured interviews were conducted with 27 participants (25 parents and 2 young people) who had undertaken a telephone-delivered guided self-help intervention for common mental health difficulties in the context of a paediatric neurological condition. Transcripts were analysed thematically using the framework approach. Thirteen themes were extracted, organised into three main domains, which covered: the practicalities of telephone guided self-help treatment; the outcomes of the intervention; and the extent to which adaptation was needed for chronic illness. Most families found the intervention helpful in working towards their specific goals and noticed changes for the child and/or parents and family. Participants had a positive experience of the intervention and the majority of parents found the standard intervention with individualised goals sufficient to meet the young person's mental health needs. Copyright © 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Self-reported peer victimization and child mental health: results of a cross-sectional survey among French primary school children.

PubMed

Shojaei, Taraneh; Wazana, Ashley; Pitrou, Isabelle; Gilbert, Fabien; Kovess, Viviane

2009-08-01

To estimate the prevalence of peer victimization among primary school-aged children, to identify mental health and social correlates, and to assess health care services use. One hundred schools and 25 children (6-11 years old) per school were randomly selected in a large French region. Data were collected using standardized self-administered questionnaires to parents (Strengths and Difficulties Questionnaire) and children (Dominic Interactive). Three drawings depicting situations of victimization were added to the 91 standard questions of the Dominic Interactive. The categories of victimization considered were as follows: bullied, assaulted not scared, and scared not assaulted (categories mutually exclusive). Complete data were available for 1,274 children (54.4%). The prevalence of bullied children, assaulted not scared, and scared not assaulted was 21.0%, 19.6%, and 19.7%, respectively. Bullied children were characterized by their vulnerability: young age (6-8 yr) and chronic illness. The main correlates were self-reported symptoms of anxiety, major depressive disorder, and parent-reported peer relationship difficulties. Victimization was not associated with higher access to mental health services (odds ratio = 1.0; 95% confidence interval = 0.5-2.1). Except for children who suffered chronic illness, access to physicians was less frequent for bullied children (odds ratio = 0.3; 95% confidence interval = 0.2-0.7). Peer victimization was frequent in schools, even in primary schools. Our findings highlight the need for public health interventions in schools and the role of physicians in detecting children at risk.

Predictors and course of vocational status, income, and quality of life in people with severe mental illness: a naturalistic study.

PubMed

Nordt, Carlos; Müller, Brigitte; Rössler, Wulf; Lauber, Christoph

2007-10-01

Due to high unemployment rates, people with mental illness are at risk of poverty and are deprived of the social and psychological functions of work, such as the provision of social support, structuring of time, and self-esteem, with a negative effect on their perceived quality of life (QoL). Two distinct processes are held responsible for the low work force participation of people with mental illness: 'Social underachievement' and 'social decline'. Social underachievement signifies that, due to early illness onset, the educational attainment of people with mental illness is low and entry to the labor market fails. Social decline, on the other hand, describes the loss of competitive employment after illness onset, followed by prolonged periods of unemployment and difficulties to re-enter the labor market. This study examines how social underachievement and decline are reflected in the course of vocational status, income, and QoL of people with severe mental illness in the years after a psychiatric admission in a naturalistic longitudinal design. A total of 176 participants diagnosed with schizophrenia or affective disorders were interviewed during an index hospitalization in two large psychiatric hospitals in Zurich. Follow-up interviews were conducted 12 and 30 months after. Random coefficient models (multilevel models) were used to examine simultaneously the predictors and course of the variables of interest. A low number of psychiatric hospitalizations, a higher educational degree, a diagnosis of schizophrenia, and years of work experience predicted a higher vocational status. Vocational status decreased in first-admission participants with prolonged hospitalizations during the follow-up period. Income did not change over time and was positively influenced by a higher age of illness onset, competitive employment, higher education, and not having had a longer hospitalization recently. Subjective QoL significantly improved and was rated higher by people with any kind of employment than by participants without a job. Participants with an affective disorder, those with few hospitalizations but a recent inpatient stay of longer duration, showed lower QoL. Including employment issues early in treatment is especially important for people with an early illness onset and those with more severe forms of psychiatric disorder. A life course perspective enhances the understanding of patients' vocational potential and needs for support.

Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature.

PubMed

Salim, Imtiaz; Al Suwaidi, Jassim; Ghadban, Wissam; Alkilani, Hani; Salam, Amar M

2013-04-01

Fasting during the month of Ramadan is a religious obligation that is practiced by millions of people around the world yet there is no clear scientific consensus on its effects on cardiovascular disease. This study was performed to inform physicians as well as patients of evidence based recommendations on this subject. The study was undertaken to assess: (1) any alteration in the incidence of acute cardiac illness during Ramadan fasting; (2) whether fasting during the month of Ramadan alters the clinical status of patients with stable cardiac disease; and (3) the impact of Ramadan fasting on cardiovascular risk factors in normal subjects, in patients with stable cardiac disease, metabolic syndrome, dyslipidemia, type 2 diabetes and systemic hypertension. Systematic review of the literature. A Medline search of the English literature published between January 1980 and September 2012. The incidence of acute cardiac illness during Ramadan fasting was similar to non-fasting days, although the timing of symptom onset may be different, with significant increase in events during the period of 'breaking fast' when compared to non-fasting days. The majority of patients with stable cardiac illness can undergo Ramadan fasting without any clinical deterioration. Body mass index, lipid profile, and blood pressure showed significant improvement in normal healthy subjects, patients with stable cardiac illness, metabolic syndrome, dyslipidemia and hypertension during Ramadan fasting. The lipid profile of diabetic patients deteriorated significantly during Ramadan fasting. Ramadan fasting is not associated with any change in incidence of acute cardiac illness and the majority of cardiac patients can fast without any difficulty. Improvement in lipid profile, especially 30% to 40% increment in high-density lipoprotein, as reported in some studies, appear promising. Diabetic patients should be carefully monitored during Ramadan fasting.

The impact of a short-term cohousing initiative among schizophrenia patients, high school students, and their social context: A qualitative case study

PubMed Central

2018-01-01

Background A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. The aim of this study was to describe the experience of patients with schizophrenia, high school students, and their social context, participating in a short-term cohousing initiative. Methods A qualitative case-study approach was implemented. Patients with schizophrenia from the San Juan de Dios Psychiatric Hospital, female students from Almen High School, and participants from their social context (parents, hospital staff, and teachers) were included, using purposeful sampling. Data were collected from 51 participants (15 patients, nine students, 11 hospital staff, six teachers, 10 parents) via non-participant observation, focus groups, informal interviews, researchers’ field notes and patients’ personal diaries and letters. A thematic analysis was performed. Results The themes identified included a) learning to live together: students and patients participate and learn together; b) the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c) change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d) a trial and an opportunity: patients test their ability to live outside the hospital; e) discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures. Conclusions Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. These results may be used for the development of cohousing programs in controlled environments. PMID:29324773

Gulf War illness: an overview of events, most prevalent health outcomes, exposures, and clues as to pathogenesis.

PubMed

Kerr, Kathleen J

2015-01-01

During or very soon after the 1990-1991 Persian Gulf War, veterans of the conflict began to report symptoms of illness. Common complaints included combinations of cognitive difficulties, fatigue, myalgia, rashes, dyspnea, insomnia, gastrointestinal symptoms and sensitivity to odors. Gradually in the USA, and later in the UK, France, Canada, Denmark and Australia, governments implemented medical assessment programs and epidemiologic studies to determine the scope of what was popularly referred to as "the Gulf War syndrome". Attention was drawn to numerous potentially toxic deployment-related exposures that appeared to vary by country of deployment, by location within the theater, by unit, and by personal job types. Identifying a single toxicant cause was considered unlikely and it was recognized that outcomes were influenced by genetic variability in xenobiotic metabolism. Derived from primary papers and key reports by the Research Advisory Committee on Gulf War Veterans' Illnesses and the Institute of Medicine, a brief overview is presented of war related events, symptoms and diagnostic criteria for Gulf War illness (GWV), some international differences, the various war-related exposures and key epidemiologic studies. Possible exposure interactions and pathophysiologic mechanisms are discussed. Exposures to pyridostigmine bromide, pesticides, sarin and mustard gas or combinations thereof were most associated with GWI, especially in some genotype subgroups. The resultant oxidant stress and background exposome must be assumed to have played a role. Gulf War (GW) exposures and their potential toxic effects should be considered in the context of the human genome, the human exposome and resultant oxidant stress to better characterize this unique environmentally-linked illness and, ultimately, provide a rationale for more effective interventions and future prevention efforts.

The impact of a short-term cohousing initiative among schizophrenia patients, high school students, and their social context: A qualitative case study.

PubMed

Palacios-Ceña, Domingo; Martín-Tejedor, Emilio Andrés; Elías-Elispuru, Ana; Garate-Samaniego, Amaia; Pérez-Corrales, Jorge; García-García, Elena

2018-01-01

A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. The aim of this study was to describe the experience of patients with schizophrenia, high school students, and their social context, participating in a short-term cohousing initiative. A qualitative case-study approach was implemented. Patients with schizophrenia from the San Juan de Dios Psychiatric Hospital, female students from Almen High School, and participants from their social context (parents, hospital staff, and teachers) were included, using purposeful sampling. Data were collected from 51 participants (15 patients, nine students, 11 hospital staff, six teachers, 10 parents) via non-participant observation, focus groups, informal interviews, researchers' field notes and patients' personal diaries and letters. A thematic analysis was performed. The themes identified included a) learning to live together: students and patients participate and learn together; b) the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c) change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d) a trial and an opportunity: patients test their ability to live outside the hospital; e) discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures. Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. These results may be used for the development of cohousing programs in controlled environments.

Gardner-Diamond syndrome: Difficulties in the management of patients with unexplained medical symptoms

PubMed Central

Meeder, Robert; Bannister, Susan

2006-01-01

The case of an adolescent girl who presented with unexplained bruising is reported. Subsequent investigations failed to elucidate an organic etiology. The diagnosis of Gardner-Diamond syndrome – a syndrome of predictable bruising preceded by pain and warmth at the bruise site, often associated with physical or psychosocial stress – was made. In the present report, the authors use their experience with this rare syndrome to highlight some important ethical and practical considerations with regard to investigation, treatment and communication in illnesses with unexplained medical symptoms. PMID:19030312

[Psychological problems of thalassemic subjects].

PubMed

Guasco, G; La Mantia, A; Cuniolo, A

1987-01-01

Analysis of psychological problems of the thalassemic subject shown with these following tests: Der Baumtest, drawing of the human figure. Moreover, we made meetings with all boys and their parents during their stay in the day-hospital. These tests have shown subjective conflicts (fear and uncertainty of future due to illness felt as aggression and fault, depressive moods and loneliness, problems of communication, hope in a magic recovery opposite to the constant discomfort of the therapeutic dependence) and relational conflicts (ambivalence towards parents, difficulties in becoming a part of the social and school environment).

Sensitivity to emotional ill health

NASA Technical Reports Server (NTRS)

Felton, J. S.

1969-01-01

The services of mental specialists, such as psychologists, psychiatrists, or psychiatric social workers are required to assure maximum human performance in Government facilities. Contemporary mental health programming covers emotionally generated problems at operational sites to complete disclaiming of the existence of such difficulties among workers. Frequent taking of sick leave or annual leave when work seems demanding or when a promotion does not materialize, chronic or repeated tardiness, requests for frequent transfers, work over-loading, accidental injuries, and alcoholism are all forms of stress responses and indicate a need for emotional counselling.

The role of stigma and uncertainty in moderating the effect of procedural justice on cooperation and resistance in police encounters with persons with mental illnesses.

PubMed

Watson, Amy C; Angell, Beth

2013-01-01

Within social psychology, procedural justice theory has been used to understand variations in compliance with legal authorities such as police. Thus, it may help explain variation in cooperation and compliance in encounters between police officers and people with serious mental illness (SMI), which are often fraught with difficulty and risk. In this paper, we examine the extent to which perceptions of procedural justice among persons with SMI are associated with self-reported levels of cooperation and resistance in encounters with police. We also examine stigma and encounter type as potential moderators of the procedural justice effect. 154 persons with serious mental illness who reported a police contact within the past year were interviewed using the newly developed Police Contact Experience Survey (PCES), which includes questions about the characteristics of the contact, perceived procedural justice (PPJ) and degree of cooperation and resistance. Participants also completed the Link Perceived Devaluation and Discrimination Scale (PDS). Findings suggest that greater PPJ is associated with more cooperation and less resistance. The effect on cooperation, however, is moderated by both perceived stigma and the type of encounter. The direct effect of perceived stigma (PDS) on cooperation was unexpected, with higher perceived stigma associated with greater cooperation. Findings underline the importance of both procedurally just treatment in police interactions with vulnerable individuals and further efforts to reduce the stigma of mental illness.

The role of stigma and uncertainty in moderating the effect of procedural justice on cooperation and resistance in police encounters with persons with mental illnesses

PubMed Central

Watson, Amy C; Angell, Beth

2014-01-01

Within social psychology, procedural justice theory has been used to understand variations in compliance with legal authorities such as police. Thus, it may help explain variation in cooperation and compliance in encounters between police officers and people with serious mental illness (SMI), which are often fraught with difficulty and risk. In this paper, we examine the extent to which perceptions of procedural justice among persons with SMI are associated with self-reported levels of cooperation and resistance in encounters with police. We also examine stigma and encounter type as potential moderators of the procedural justice effect. 154 persons with serious mental illness who reported a police contact within the past year were interviewed using the newly developed Police Contact Experience Survey (PCES), which includes questions about the characteristics of the contact, perceived procedural justice (PPJ) and degree of cooperation and resistance. Participants also completed the Link Perceived Devaluation and Discrimination Scale (PDS). Findings suggest that greater PPJ is associated with more cooperation and less resistance. The effect on cooperation, however, is moderated by both perceived stigma and the type of encounter. The direct effect of perceived stigma (PDS) on cooperation was unexpected, with higher perceived stigma associated with greater cooperation. Findings underline the importance of both procedurally just treatment in police interactions with vulnerable individuals and further efforts to reduce the stigma of mental illness. PMID:24920876

How patients understand depression associated with chronic physical disease – a systematic review

PubMed Central

2012-01-01

Background Clinicians are encouraged to screen people with chronic physical illness for depression. Screening alone may not improve outcomes, especially if the process is incompatible with patient beliefs. The aim of this research is to understand people’s beliefs about depression, particularly in the presence of chronic physical disease. Methods A mixed method systematic review involving a thematic analysis of qualitative studies and quantitative studies of beliefs held by people with current depressive symptoms. MEDLINE, EMBASE, PSYCHINFO, CINAHL, BIOSIS, Web of Science, The Cochrane Library, UKCRN portfolio, National Research Register Archive, Clinicaltrials.gov and OpenSIGLE were searched from database inception to 31st December 2010. A narrative synthesis of qualitative and quantitative data, based initially upon illness representations and extended to include other themes not compatible with that framework. Results A range of clinically relevant beliefs was identified from 65 studies including the difficulty in labeling depression, complex causal factors instead of the biological model, the roles of different treatments and negative views about the consequences of depression. We found other important themes less related to ideas about illness: the existence of a self-sustaining ‘depression spiral’; depression as an existential state; the ambiguous status of suicidal thinking; and the role of stigma and blame in depression. Conclusions Approaches to detection of depression in physical illness need to be receptive to the range of beliefs held by patients. Patient beliefs have implications for engagement with depression screening. PMID:22640234

Mother’s perceptions of child mental health problems and services: A cross sectional study from Lahore

PubMed Central

Imran, Nazish; Ashraf, Sania; Shoukat, Rabia; Pervez, Muhammad Ijaz

2016-01-01

Objective: To assess the perceptions of mothers regarding child mental health problems, its causes, preferred treatment options, and to determine whom they would consult, if their child had a psychiatric illness. Methods: Following informed consent, a questionnaire covering perceptions regarding various aspects of child mental illness was used for data collection from mothers. They were asked to identify the symptoms and behaviours they considered psychopathological in children, which treatments they would prefer, where they would turn for help with a mentally ill child, and their understanding of the causes of child psychiatric disorders in addition to ways to increase awareness of child psychiatric issues in the society. Results: Ninety one mothers participated in the study. They equally perceived emotional, behavioural and cognitive symptoms as suggestive of mental ill health in childhood. Mothers perceived multiple causes of child mental health problems, including family problems, economic difficulties, social adversity and possession by evil spirits. A substantial proportion preferred medication, recitation of Holy Quran and psychotherapy as the preferred treatment options. Overall, mothers preferred consulting health professionals than religious scholars and faith healers. They were keen for steps to increase mental health awareness within their society. Conclusion: Despite different cultural perspective, mothers exhibit good understanding of symptoms of child mental health issues and appear open to various services and treatment options. Understanding parental perceptions and expectations from child psychiatric services are crucial in increasing families’ engagement in treatment. PMID:27375732

Clinical cardiac regenerative studies in children.

PubMed

Pavo, Imre J; Michel-Behnke, Ina

2017-02-26

Although the incidence of pediatric heart failure is low, the mortality is relatively high, with severe clinical symptoms requiring repeated hospitalization or intensive care treatment in the surviving patients. Cardiac biopsy specimens have revealed a higher number of resident human cardiac progenitor cells, with greater proliferation and differentiation capacity, in the neonatal period as compared with adults, demonstrating the regeneration potential of the young heart, with rising interest in cardiac regeneration therapy in critically ill pediatric patients. We review here the available literature data, searching the MEDLINE, Google Scholar and EMBASE database for completed, and www.clinicaltrials.gov homepage for ongoing studies involving pediatric cardiac regeneration reports. Because of difficulties conducting randomized blinded clinical trials in pediatric patients, mostly case reports or cohort studies with a limited number of individuals have been published in the field of pediatric regenerative cardiology. The majority of pediatric autologous cell transplantations into the cardiac tissue have been performed in critically ill children with severe or terminal heart failure. Congenital heart disease, myocarditis, and idiopathic hypertrophic or dilated cardiomyopathy leading to congestive heart failure are some possible areas of interest for pediatric cardiac regeneration therapy. Autologous bone marrow mononuclear cells, progenitor cells, or cardiospheres have been applied either intracoronary or percutaneously intramyocardially in severely ill children, leading to a reported clinical benefit of cell-based cardiac therapies. In conclusion, compassionate use of autologous stem cell administration has led to at least short-term improvement in heart function and clinical stability in the majority of the critically ill pediatric patients.

Conceptions of health, illness and treatment of patients who use homeopathy in Santos, Brazil.

PubMed

Patriani Justo, C M; Dé Andrea Gomes, Mara H

2008-01-01

To investigate the conceptions of health and illness, the reasons for seeking homeopathy and continuing treatment, compliance and the meaning of the relationship between religiosity and health for patients who adhere to homeopathy. A qualitative study of 20 adult patients in Santos (Brazil) treated by homeopaths in the public and private sector for at least 2 years. Semi-structured interviews, organized by predefined thematic categories, the content of the interviews was analyzed. The conceptions of health and illness of the interviewed patients are related to the idea of vital balance/imbalance mediated by body-mind interaction. Dissatisfaction with conventional treatment, family influence and suggestions of others were the reasons for seeking homeopathic treatment. Patients continued homeopathic treatment due to positive therapeutic results, cure without being aggressive to the organism, the holistic integrated approach, the preventive nature of the treatment and low prices of medicine. For these patients, the availability of homeopathy in the public health sector extends the possibility of access. The need for a wider dissemination of homeopathy and the difficulties in following the prescription are the main problems involved in continuing treatment. Faith is an important component. We found a correlation between the conceptions of health and illness and the principles of homeopathy, assimilated through a strong bond between patients and the homeopathic practitioners. To investigate the beliefs, values and meanings that patients attribute to homeopathy helps to understand subjective aspects that may interfere with treatment compliance.

An internet-based survey in Japan concerning social distance and stigmatization toward the mentally ill among doctors, nurses, pharmacists, and the general public.

PubMed

Fujii, Tomoo; Hanya, Manako; Kishi, Masanori; Kondo, Yuki; Cates, Marshall E; Kamei, Hiroyuki

2018-05-28

Stigma associated with psychiatric disorders tends to be manifested as negative attitudes or behavior toward the mentally ill. It has negative influences, such as leading to difficulty in establishing trust-based relationships and interfering with medical treatment. In order to reduce such stigma, it is necessary to clarify its extent and characteristics in healthcare professionals. Considering this, an Internet-based questionnaire survey was conducted, involving doctors (n = 186), nurses (n = 161), and pharmacists (n = 192) in comparison with the general public (n = 331), and using the Whatley Social Distance Scale (WSDS) and Index of Attitudes toward the Mentally Ill (IATM) as stigma-related indices. Median total WSDS scores and interquartile range were as follows: doctors: 15.5(12.0-18.0), nurses: 14.0(12.0-16.5), pharmacists: 15.0(13.0-17.0), and the general public: 16.0(13.0-18.0). Similarly, median IATM scores were as follows: doctors: 39.0(36.0-42.0), nurses: 39.0(37.0-43.0), pharmacists: 40.0(36.0-42.0), and the general public: 37.0(33.0-41.0). IATM scores were significantly higher in the professional groups than the general public group. Both healthcare professionals and the general public with prior exposure to mental illness were more favorable attitudes toward the mentally ill. Especially among healthcare professionals, they working in psychiatric departments were more favorable attitudes. These results suggest that the stigma of healthcare professionals toward the mentally ill was shown to have a smaller and relatively favorable attitude than that of the general public. In order to correct the stigma it was suggested that a good contact experience with the patient such as work and training in psychiatry is effective. Copyright © 2018. Published by Elsevier B.V.

Feasibility of the electrolarynx for enabling communication in the chronically critically ill: The EECCHO study.

PubMed

Rose, Louise; Istanboulian, Laura; Smith, Orla M; Silencieux, Soledad; Cuthbertson, Brian H; Amaral, Andre Carlos Kajdacsy-Balla; Fraser, Ian; Grey, Joanne; Dale, Craig

2018-06-12

To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators. We included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction. Interviews explored barriers/facilitators. We recruited 24 participants (Jan2015-Dec2016). Mean (SD) intelligibility was 45%(18%) words correct: 57%(21%) when facing. Mean comprehension difficulty was 6.4(2.0) overall, indicating moderate difficulty (5.5(2.5) scored visualizing). Mean EES was 2.9(1.0) (3 = improved lip-reading through recognizable sounds). Anxiety decreased from median 3.8 to 2.0 (P = .007). Communication was rated easier (median 15 vs 12, P = .04) whereas satisfaction remained similar (P = .06). Facilitators included device friendliness, patient independence, and word intelligibility. Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility. The electrolarynx may aid intelligible speech for some tracheostomized patients if the communication partner can visualize the users face, and reduce anxiety and make patient perceived communication easier. Copyright © 2018 Elsevier Inc. All rights reserved.

Employment status, difficulties at work and quality of life in inflammatory bowel disease patients.

PubMed

De Boer, Angela G E M; Bennebroek Evertsz', Floor; Stokkers, Pieter C; Bockting, Claudia L; Sanderman, Robert; Hommes, Daniel W; Sprangers, Mirjam A G; Frings-Dresen, Monique H W

2016-10-01

To assess employment status, difficulties at work and sick leave in inflammatory bowel disease (IBD) patients and their relation with sociodemographic and clinical factors, quality of life (QoL), and anxiety and depression. IBD patients attending an IBD outpatients' clinic received self-report questionnaires on employment status, IBD-related difficulties at work and sick leave (Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness), sociodemographic factors, QoL (Inflammatory Bowel Disease Questionnaire and 12-item Short-form Health Survey) and anxiety and depression (Hospital Anxiety and Depression Scale). Disease activity was assessed by their gastroenterologist. Associations between paid employment and sick leave with sociodemographic and clinical factors, QoL and anxiety and depression were assessed by regression analyses. In total, 202 IBD patients of working age, with a mean age of 41 years, participated; 63% had Crohn's disease and 37% had ulcerative colitis, and 57% were women and 19% had active disease. In all, 123 (61%) patients were in paid employment, of whom 31 (25%) were on sick leave, whereas 46 (23%) received a disability pension. Concentration problems (72%), low working pace (78%) and delayed work production (50%) were the most prevalent IBD-related work difficulties. IBD patients without paid employment were older and more often women, with active disease, lower QoL and higher anxiety and depression rates. Sick leave was associated with lower QoL and higher anxiety and depression rates. More than half of IBD patients were in paid employment, whereas almost a quarter was receiving a disability pension. A large majority experienced work difficulties. Having no paid employment was associated with poorer QoL and more anxiety and depression symptomatology.

Theory of mind difficulties in patients with alcohol dependence: beyond the prefrontal cortex dysfunction hypothesis.

PubMed

Maurage, François; de Timary, Philippe; Tecco, Juan Martin; Lechantre, Stéphane; Samson, Dana

2015-06-01

Previous studies have shown that alcohol-dependent (AD) individuals have difficulties inferring other people's emotion, understanding humor, and detecting a faux pas. This study aimed at further understanding the nature of such "Theory of Mind" (ToM) difficulties. A total of 34 recently detoxified AD and 34 paired controls were compared based on 2 nonverbal and video-based false belief tasks. These tasks were designed to identify 3 different types of deficits: (i) a deficit in dealing with the general task demands, (ii) a selective deficit in self-perspective inhibition, and (iii) a deficit in tracking the other person's mental state. (i) and (ii) are compatible with the hypothesis of a prefrontal cortex dysfunction being at the origin of AD individuals' social difficulties, while (iii) would suggest the possible contribution of a dysfunction of the temporo-parietal junction in explaining the social difficulties. Group analyses highlighted that AD individuals performed worse on the 2 false belief tasks than controls. Individual analyses showed, however, that just under half of the AD individuals were impaired compared to controls. Moreover, most of the AD individuals who were impaired showed a deficit in tracking the other person's belief. This deficit was linked to disease-related factors such as illness duration, average alcohol consumption, and craving but not to general reasoning abilities, depression, anxiety, or demographic variables. Just under half of the AD individuals tested showed a ToM deficit, and in most cases, the deficit concerned the tracking of other people's mental states. Such a type of deficit has previously been associated with lesions to the temporo-parietal brain areas, indicating that a prefrontal cortex dysfunction may not be the sole origin of the social cognition deficits observed in alcohol dependence. Copyright © 2015 by the Research Society on Alcoholism.

Examination of arthritis-related work place activity limitations and intermittent disability over four-and-a-half years and its relationship to job modifications and outcomes.

PubMed

Gignac, Monique A M; Cao, Xingshan; Tang, Kenneth; Beaton, Dorcas E

2011-07-01

To examine the type, degree, and episodic nature of arthritis-related work place activity limitations and the consistency of the relationship of activity limitations to job modifications and work place outcomes. Using an interviewer-administered structured questionnaire, individuals with osteoarthritis (OA) or inflammatory arthritis (IA) were interviewed at 4 time points, 18 months apart. At baseline, all participants (n = 490; 381 women, 109 men) were employed. Respondents were recruited using community advertising and from rheumatology and rehabilitation clinics. The Workplace Activity Limitations Scale (WALS) assessed arthritis-related disability with job tasks. Job modifications/accommodations (e.g., scheduling changes), work place outcomes (e.g., absenteeism), demographics, illness, and work context were also measured. Repeated cross-sectional logistic regressions examined levels of WALS disability with job modifications and outcomes at each time point. Similar levels of activity limitations were found comparing OA and IA with fewer difficulties with global aspects of work (e.g., scheduling) than with specific tasks (e.g., working with hands). Three-quarters of the participants had episodic or intermittent WALS difficulty over time. Medium and high levels of work place activity limitations were significantly associated with job modifications, and high WALS difficulty was consistently related to negative work outcomes. Many individuals with arthritis report some difficulty with work place activities. However, these difficulties are often intermittent and may not result in changes to work productivity until they are consistently high. This is important for designing work place interventions and for employers, insurers, and the government to understand to avoid viewing individuals with arthritis as a permanent drain on work place and health resources. Copyright © 2011 by the American College of Rheumatology.

Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results

PubMed Central

Koenig, Harold G.

2012-01-01

This paper (1) reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2) discusses research on the relationship between religion and depression-induced physiological changes, (3) describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a) overcome physical and religious barriers to CBT and (b) compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4) presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed. The ultimate goal is to determine if a psychotherapy delivered remotely that integrates patients' religious resources improves depression more quickly than a therapy that ignores them, and whether religious CBT is more effective than conventional CBT in reversing depression-induced physiological changes. PMID:22778932

Investigating self-esteem in individuals with schizophrenia: relevance of the Self-Esteem Rating Scale-Short Form.

PubMed

Lecomte, Tania; Corbière, Marc; Laisné, François

2006-06-30

Studies investigating self-esteem in individuals with severe mental illness, either as a treatment goal, outcome or correlate to other variables, have increased over the past few years. One of the main difficulties in assessing self-esteem is the assessment itself, often measuring global and stable self-esteem as in the Rosenberg Self-Esteem Scale, or requiring extensive training and long interviews. The present article aims at demonstrating the relevance of the French and English versions of the Self-Esteem Rating Scale-Short Form with individuals with severe mental illness. The instrument's reliability and validity were investigated in a sample of 250 French Canadian college students, 247 British college students and three samples of English- or French-speaking individuals with severe mental illness (N=254, N=150 and N=171). Confirmatory factor analysis revealed that a shorter version of the instrument (20 items), with a positive and a negative self-esteem factor, had a great validity for all the samples studied. The Self-Esteem Rating Scale-Short Form, with its positive and negative self-esteem subscales, appears to be a valid and reliable self-esteem measure for individuals with mental health problems. Limitations of this study and future directions are discussed.

Physical activity and mental disorders: a case-control study on attitudes, preferences and perceived barriers in Italy.

PubMed

Carpiniello, Bernardo; Primavera, Diego; Pilu, Alessandra; Vaccargiu, Nicola; Pinna, Federica

2013-12-01

Mentally ill people experience greater difficulty than the general population in exercising regularly. We aimed to evaluate attitudes displayed and barriers perceived towards physical activity in a sample of psychiatric patients. A total of 138 (M = 48, F = 90) patients attending a community mental health centre were compared with a control group made up of 138 subjects not affected by mental disorders matched for gender, mean age and education. Both groups underwent a self-administered questionnaire. Patients reported a more sedentary lifestyle in terms of weekly physical activities and daily hours of exercise; their body mass index (BMI) was significantly higher compared with the BMI of controls (p < 0.002); the mentally ill more frequently reported tiredness (p < 0.001), scarce motivation (p < 0.001) and the illness itself (p = 0.01) as barriers to physical activity; moreover, stating how feeling sad or "distressed" reduced their propensity to physical exercise (p = 0.002). A higher number of patients (p < 0.0001) reported little or no motivation for physical activity, and the experiencing of scarce enjoyment (p < 0.001). A series of barriers may limit regular physical activity in subjects affected by mental disorders; these barriers should be taken into account and appropriately addressed.

Everyday ethics and help-seeking in early rheumatoid arthritis

PubMed Central

Townsend, A.; Adam, P.; Cox, S.M.; Li, L.C.

2018-01-01

Background Sociological understandings of chronic illness have revealed tensions and complexities around help-seeking. Although ethics underpins healthcare, its application in the area of chronic illness is limited. Here we apply an ethical framework to interview accounts and identify ethical challenges in the early rheumatoid arthritis (RA) experience. Methods In-depth interviews were conducted with eight participants who had been diagnosed with RA in the 12 months prior to recruitment. Applying the concepts of autonomous decision-making and procedural justice highlighted ethical concerns which arose throughout the help-seeking process. Analysis was based on the constant-comparison approach. Results Individuals described decision-making, illness actions and the medical encounter. The process was complicated by inadequate knowledge about symptoms, common-sense understandings about the GP appointment, difficulties concerning access to specialists, and patient–practitioner interactions. Autonomous decision-making and procedural justice were compromised. The accounts revealed contradictions between the policy ideals of active self-management, patient-centred care and shared decision-making, and the everyday experiences of individuals. Conclusions For ethical healthcare there is a need for: public knowledge about early RA symptoms; more effective patient–practitioner communication; and increased support during the wait between primary and secondary care. Healthcare facilities and the government may consider different models to deliver services to people requiring rheumatology consults. PMID:20610465

The potential role of nano- and micro-technology in the management of critical illnesses.

PubMed

Sadikot, Ruxana T

2014-11-20

In recent years nanomedicine has become an attractive concept for the targeted delivery of therapeutic and diagnostic compounds to injured or inflamed organs. Nanoscale drug delivery systems have the ability to improve the pharmacokinetics and increase the biodistribution of therapeutic agents to target organs, thereby resulting in improved efficacy and reduced drug toxicity. These systems are exploited for therapeutic purposes to carry the drug in the body in a controlled manner from the site of administration to the therapeutic target. The mortality in many of the critical illnesses such as sepsis and acute respiratory distress syndrome continues to remain high despite of an increased understanding of the molecular pathogenesis of these diseases. Several promising targets that have been identified as potential therapies for these devastating diseases have been limited because of difficulty with delivery systems. In particular, delivery of peptides, proteins, and miRNAs to the lung is an ongoing challenge. Hence, it is an attractive strategy to test potential targets by employing nanotechnology. Here some of the novel nanomedicine approaches that have been proposed and studied in recent years to facilitate the delivery of therapeutic agents in the setting of critical illnesses such as acute respiratory distress syndrome, sepsis and ventilator associated pneumonia are reviewed. Published by Elsevier B.V.

Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

PubMed Central

Hyphantis, Thomas; Almyroudi, Augustina; Paika, Vassiliki; Goulia, Panagiota; Arvanitakis, Konstantinos

2009-01-01

Based on the psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles’ heel” has come to mean a person’s principal weakness), we aimed to assess whether “narcissistic rage” has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ “omnipotence” and HDHQ “extraverted hostility”. Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a “normal” mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an “Achilles’ Heel” for patients with long-term physical illness. These findings may have important clinical implications. PMID:19936167

Recovery from adolescent anorexia nervosa and associations with diurnal patterns of salivary stress hormones: a case report.

PubMed

Oskis, Andrea; Loveday, Catherine; Hucklebridge, Frank; Wood, David; Clow, Angela

2012-01-01

In the neurodevelopment of adolescent anorexia nervosa (AN), dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is proposed to be a central component. Furthermore, a therapeutic milieu focusing on affect regulation can contribute much to treatment, given the emotional processing difficulties associated with this disorder. Studies of HPA axis function following such specialist treatments for adolescent AN, however, are rare. This study describes the diurnal pattern of HPA axis activation, including the cortisol awakening response (CAR), in a 16-year-old female diagnosed with AN both during illness and at clinical recovery following milieu therapy with a focus on affect regulation. Specialised single-case study statistics were used to assess whether the patient's data were significantly different from the healthy "norm" at illness and recovery. During illness, her measure of affective problems was outside of the normal range and cortisol and DHEA secretory profiles were significantly elevated across the diurnal period. However, at recovery both her affective state and HPA axis function became comparable to healthy controls. This case study suggests that salivary markers of HPA axis function can be feasibly incorporated into the clinical regime within a specialist adolescent AN residential service and could be used by clinicians to monitor prognosis and interventions.

Insight and psychopathology in never-treated schizophrenia.

PubMed

Tirupati, Srinivasan; Padmavati, Raman; Thara, Rangaswamy; McCreadie, Robin G

2007-01-01

Insight is a feature of schizophrenia related to psychopathology, which could be modified by treatment. The real relationship will be more evident in the never-treated state. This study compared insight and its relationship to psychopathology in 143 never-treated patients with chronic schizophrenia with 183 treated patients. The treated patients had not received any structured intervention for improvement of insight. The item on insight and judgment from the Positive and Negative Syndrome Scale for schizophrenia was used as a measure of insight. Never-treated patients were more ill and poorer in insight than the TT group. Sex, age, duration of illness, negative symptoms related to insight only in the TT group. Positive symptoms score correlated with insight in both the groups, but negative symptoms correlated with insight only among the treated patients. Delusions, uncooperativeness, and poor attention predicted 27% of variation in the level of insight in the never-treated, whereas age; duration of illness; and symptoms of emotional withdrawal, difficulty in abstract thinking, and uncooperativeness predicted 30.3% of variation in insight of the TT group. The observed differences between the never-treated and treated subjects were due to influence of treatment on the association between insight and psychopathology. A subgroup of patients with a treatment-resistant trait of negative symptoms associated with poor insight was hypothesized.

Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.

PubMed

Pascual, Juan C; Córcoles, David; Castaño, Juan; Ginés, Jose M; Gurrea, Alfredo; Martín-Santos, Rocio; Garcia-Ribera, Carlos; Pérez, Victor; Bulbena, Antonio

2007-09-01

This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units. A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score. Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction. Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.

Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making.

PubMed

LeBlanc, Thomas W; Fish, Laura J; Bloom, Catherine T; El-Jawahri, Areej; Davis, Debra M; Locke, Susan C; Steinhauser, Karen E; Pollak, Kathryn I

2017-12-01

Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with diagnosis and treatment decision-making to identify areas for improvement. We recruited hospitalized patients with AML to participate in semi-structured qualitative interviews about their experiences being diagnosed with AML, receiving information, and making a treatment decision. Interviews were conducted during their hospitalization for induction chemotherapy. We analyzed data by using a constant comparison approach. Thirty-two patients completed an interview. Four main themes emerged: (a) shock and suddenness, (b) difficulty processing information, (c) poor communication, and (d) uncertainty. Patients frequently described their diagnosis as shocking. They also felt that the amount of information was too great and too difficult to process, which negatively impacted their understanding. Patients frequently described a lack of emotional support from clinicians and described uncertainty about their prognosis, the number and nature of available treatments, and what to expect from treatment. Acute myeloid leukemia poses a sudden, emotionally challenging, information-laden situation, where little time is available to make important decisions. This results in difficulty processing information and is sometimes complicated by a lack of emotive communication from clinicians. Results indicate a need for targeted interventions to improve AML patients' understanding of illness and treatment options and to address their traumatic experiences around diagnosis. Copyright © 2016 John Wiley & Sons, Ltd.

Changes in extreme events and the potential impacts on human health.

PubMed

Bell, Jesse E; Brown, Claudia Langford; Conlon, Kathryn; Herring, Stephanie; Kunkel, Kenneth E; Lawrimore, Jay; Luber, George; Schreck, Carl; Smith, Adam; Uejio, Christopher

2018-04-01

Extreme weather and climate-related events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, dust storms, flooding rains, coastal flooding, storm surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden. More information is needed about the impacts of climate change on public health and economies to effectively plan for and adapt to climate change. This paper describes some of the ways extreme events are changing and provides examples of the potential impacts on human health and infrastructure. It also identifies key research gaps to be addressed to improve the resilience of public health to extreme events in the future. Extreme weather and climate events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, flooding rains, coastal flooding, surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden.

The Influence of Social Interaction and Physical Health on the Association Between Hearing and Depression With Age and Gender

PubMed Central

Seeto, Mark

2017-01-01

Recent epidemiological data suggest the relation between hearing difficulty and depression is more evident in younger and middle-aged populations than in older adults. There are also suggestions that the relation may be more evident in specific subgroups; that is, other factors may influence a relationship between hearing and depression in different subgroups. Using cross-sectional data from the UK Biobank on 134,357 community-dwelling people and structural equation modelling, this study examined the potential mediating influence of social isolation and unemployment and the confounding influence of physical illness and cardiovascular conditions on the relation between a latent hearing variable and both a latent depressive episodes variable and a latent depressive symptoms variable. The models were stratified by age (40s, 50s, and 60s) and gender and further controlled for physical illness and professional support in associations involving social isolation and unemployment. The latent hearing variable was primarily defined by reported hearing difficulty in noise. For all subgroups, poor hearing was significantly related to both more depressive episodes and more depressive symptoms. In all models, the direct and generally small association exceeded the indirect associations via physical health and social interaction. Significant (depressive episodes) and near significant (depressive symptoms) higher direct associations were estimated for males in their 40s and 50s than for males in their 60s. There was at each age-group no significant difference in estimated associations across gender. Irrespective of the temporal order of variables, findings suggest that audiological services should facilitate psychosocial counselling. PMID:28752806

The Influence of Social Interaction and Physical Health on the Association Between Hearing and Depression With Age and Gender.

PubMed

Keidser, Gitte; Seeto, Mark

2017-01-01

Recent epidemiological data suggest the relation between hearing difficulty and depression is more evident in younger and middle-aged populations than in older adults. There are also suggestions that the relation may be more evident in specific subgroups; that is, other factors may influence a relationship between hearing and depression in different subgroups. Using cross-sectional data from the UK Biobank on 134,357 community-dwelling people and structural equation modelling, this study examined the potential mediating influence of social isolation and unemployment and the confounding influence of physical illness and cardiovascular conditions on the relation between a latent hearing variable and both a latent depressive episodes variable and a latent depressive symptoms variable. The models were stratified by age (40s, 50s, and 60s) and gender and further controlled for physical illness and professional support in associations involving social isolation and unemployment. The latent hearing variable was primarily defined by reported hearing difficulty in noise. For all subgroups, poor hearing was significantly related to both more depressive episodes and more depressive symptoms. In all models, the direct and generally small association exceeded the indirect associations via physical health and social interaction. Significant (depressive episodes) and near significant (depressive symptoms) higher direct associations were estimated for males in their 40s and 50s than for males in their 60s. There was at each age-group no significant difference in estimated associations across gender. Irrespective of the temporal order of variables, findings suggest that audiological services should facilitate psychosocial counselling.

Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi State, south east Nigeria.

PubMed

Oyibo, P G

2011-09-01

Each year, 100 million people are impoverished globally as a result of expenditure on health. To assess the constraints and implications of out-of-pocket payment for health services among government employees in Abakaliki, Ebonyi State, south east Nigeria. This was a cross-sectional descriptive study. The study instrument was a pre-tested, semi-structured self administered questionnaire. Over half of the respondents (62.8 %) reported a history of illness in their household in the preceding four weeks before the study. Sixty-nine percent of these respondents relied on out-of-pocket payment in order to pay for health services at the moment of seeking medical treatment for themselves or their dependants; while 28.4 % and 2.6 % relied on a pre-payment package (National Health Insurance Scheme) and borrowed money respectively to pay for health services at the moment of seeking medical treatment for themselves or their dependants. The vast majority of respondents (63.6 %) who relied on out-of-pocket payment reported their difficulties in accessing quality health care services as a result of financial hardship at the moment of seeking medical treatment. Most of them (47.7 %) resolved to self medication, while 28.4 %, 17.1 % and 6.8 % of them delayed seeking health care, patronized herbalists and ignored their illness respectively. This study brings to the fore the fact that most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services via paying for them out-of-pocket.

The relationship between cognitive dysfunction and coping abilities in schizophrenia.

PubMed

Wilder-Willis, Kelly E; Shear, Paula K; Steffen, John J; Borkin, Joyce

2002-06-01

Cognitive dysfunction is a core feature of schizophrenia [Psychiatr. Clin. North Am., 16 (1993) 295; Psychopharmacology: The fourth generation of progress, Raven Press, New York (1995) 1171; Clinical Neuropsychology, Oxford University Press, New York (1993) 449] and is related to psychosocial functioning in this population [Am. J. Psychiatry, 153 (1996) 321]. It is unclear whether cognitive dysfunction is related to specific areas of functioning in schizophrenia, such as coping abilities. Individuals with schizophrenia have deficient coping skills, which may contribute to their difficulties dealing with stressors [Am. J. Orthopsychiatry, 62 (1992) 117; J. Abnorm. Psychol., 82 (1986) 189]. The current study examined the relationship between coping abilities and cognitive dysfunction in a community sample of individuals with schizophrenia. It was hypothesized that executive dysfunction and mnemonic impairments would be positively related to deficiencies in active coping efforts involving problem solving and self-initiation (e.g. advocating for oneself and others with mental illness and becoming involved in meaningful activities, such as work), independent of the contributions of the general intellectual deficits associated with the disorder and psychiatric symptoms. The results indicated that both executive dysfunction and mnemonic impairments were related to decreased usage of active coping mechanisms after controlling for general intellectual deficits. Further, recognition memory made independent contributions to the prediction of coping involving action and help seeking after controlling for the effects of negative symptoms. These findings suggest that individuals with schizophrenia may be less flexible in their use of coping strategies, which may in turn contribute to their difficulties in coping with mental illness and its consequences.

Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.

PubMed

Díaz, Magda C; Ospina-Tascón, Gustavo A; Salazar C, Blanca C

2014-02-01

Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

Impact of illness and its treatment on workplace costs: regulatory and measurement issues.

PubMed

Greenberg, P E; Birnbaum, H G; Kessler, R C; Morgan, M; Stang, P

2001-01-01

In an attempt to document a broader spectrum of the benefits of their pharmaceutical products, drug companies increasingly seek to include productivity claims in their promotional campaigns. We describe the existing regulatory framework of the Food and Drug Administration (FDA) for considering productivity claims, distinguishing between the traditional "substantial evidence" standard and the "competent and reliable scientific evidence" standard. But the notion of competent and reliable scientific evidence may itself be problematic, even when it is the appropriate regulatory standard, because there exists no consistent measurement approach across diseases, workplaces, jobs, and worker capabilities that is widely accepted in this emerging area of health outcomes research. We examine the various measurement approaches that have been used to quantify the impact of illness and its treatment on workplace productivity, and we describe some of the shortcomings associated with each alternative. This discussion highlights the possible difficulties faced by the FDA in reviewing productivity-based promotional claims. Finally, we suggest possible strategies for furthering this field of investigation.

Clinical and personality profiles and survival in patients with COPD.

PubMed

Ashutosh, K; Haldipur, C; Boucher, M L

1997-01-01

To assess the relationship of personality and clinical characteristics with survival in patients with advanced chronic obstructive pulmonary disease (COPD). Prospective double-blind study. Outpatient clinic of a teaching Veterans Affairs Hospital in central New York. PATIENT PARTICIPATION: Sixteen male patients (mean age, 62.2 +/- 2.5 years) with severe COPD INTERVENTIONS: Patients were administered Minnesota Multiphasic Personality Inventory (MMPI) test; their clinical features were recorded from hospital records at the time of admission into the study. All were followed up for 4 years after the initial assessment or until their death. The nine survivors and seven nonsurvivors were similar in age, pulmonary function test (PFT) results, oxygenation, number of medications, or concomitant illnesses. However, the nonsurvivors had higher MMPI and clinical illness scores compared with the survivors (p < 0.01 and < 0.05, respectively). The 4-year mortality in male veterans with severe COPD is influenced by overall psychological distress and difficulty in coping with their disease, which seem to be important prognostic indicators irrespective of PFT results or oxygenation.

Factors Associated with Money Mismanagement Among Adults with Severe Mental Illness and Substance Abuse.

PubMed

Moore, Brent A; Black, Anne C; Rosen, Marc I

2016-08-01

People with severe mental illness often have substantial problems with money mismanagement such as losing or lending money to other people and making impulsive or unnecessary purchases, including drugs and alcohol. Money mismanagement in turn affects patients' health and social functioning, and can lead to homelessness and other harm. This cross-sectional study evaluated demographic and clinical predictors of money mismanagement among SSI/SSDI recipients. SSI/SSDI beneficiaries ( N = 95) with recent cocaine use initiating a clinical trial were assessed at intake with demographic, cognitive, psychiatric, social/family, substance abuse, and financial measures. In multivariate regression analyses, psychiatric functioning and drug dependence diagnosis were independent predictors of self-reported money mismanagement. Even within individuals whom all had recently used cocaine, those with drug dependence and those with more psychiatric symptomatology had more difficulty managing their funds. Future studies might determine whether people who reduce their drug use and psychiatric symptomatology go on to better manage their funds.

How do homeless adults change their lives after completing an intensive job-skills program? A prospective study.

PubMed

Gray, Heather M; Nelson, Sarah E; Shaffer, Howard J; Stebbins, Patricia; Farina, Andrea Ryan

2017-09-01

Among people experiencing homelessness, difficulty securing housing is often compounded by concurrent challenges including unemployment, chronic illness, criminal justice involvement, and victimization. The Moving Ahead Program (MAP) is a vocational rehabilitation program that seeks to help adults facing these challenges to secure competitive employment. We prospectively studied how MAP graduates (N = 97) changed from the beginning of MAP to about six months after graduation. We observed a variety of positive outcomes not just in employment and housing but also in health, substance use, and criminal justice involvement. However, these gains were not universal; for instance, participants were less likely to report positive outcomes at follow-up if they started MAP with a serious mental illness, made relatively small gains in work skills, or did not seek mental health treatment during the six months after they completed MAP. These findings might encourage program staff to devote additional resources toward supporting at-risk students.

Identifying new diseases and their causes: the dilemma of illnesses in Gulf War veterans.

PubMed

Gardner, John W; Gibbons, Robert V; Hooper, Tomoko I; Cunnion, Stephen O; Kroenke, Kurt; Gackstetter, Gary D

2003-03-01

Since the Gulf War, investigation continues of symptoms and illnesses among its veterans. Yet, identifying a specific "Gulf War Syndrome" remains elusive. With new disease entities, causal associations are relatively easily established when the condition is serious, verifiable, and has excess disease rates in specific groups. In common conditions, many excess cases are required to establish association with a specific exposure. Establishing causality in syndromes with variable symptoms is difficult because specific diagnostic algorithms must be established before causal factors can be properly investigated. Searching for an environmental cause is futile in the absence of an operational disease case definition. Common subjective symptoms (without objective physical or laboratory findings) account for over one-half of all medical outpatient visits, yet these symptoms lack an identified physical cause at least one-third of the time. Our medical care system has difficulty dealing with disorders where there is no identified anatomic abnormality or documented metabolic/physiological dysfunction.

[Integrated management of childhood illness (IMCI) in the practice of nurses graduated from USP].

PubMed

Higuchi, Cinthia Hiroko; Fujimori, Elizabeth; Cursino, Emília Gallindo; Chiesa, Anna Maria; Veríssimo, Maria de la O Ramallo; de Mello, Débora Falleiros

2011-06-01

This is a description of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). This is a case study of qualitative approach. The data were collected through focus groups and analyzed using thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was apart of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown by co-workers and institutional obstacles. In spite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the educational video, expansion of the practice, integration of courses and optimization of content and workload were suggested for improving the teaching of IMCI at the undergraduate level.

Workplace social networks and their relationship with job outcomes and other employment characteristics for people with severe mental illness

PubMed Central

Rollins, Angela L.; Bond, Gary R.; Jones, Amanda M.; Kukla, Marina; Collins, Linda A.

2013-01-01

Clients with severe mental illness (SMI) often struggle in their efforts to maintain employment. One cause of early job terminations is interpersonal difficulties in the workplace. This study explored workplace social networks and their relationship with job outcomes and other employment characteristics for people with SMI. Results indicated that clients generally had positive experiences with both supervisors and coworkers. Contrary to our hypothesis, employment model was not associated with better workplace network characteristics. Also contrary to our hypothesis, clients employed in group placements did not differ in workplace network characteristics from those in competitive employment settings. Workplace network characteristics were robustly correlated with job satisfaction, but not strongly related to hourly wages or overall job tenure. Job tenure at the time of the workplace network assessment did show a few modest negative correlations with supervisor and coworker support, indicating declining perceived social network support with increasing job tenure. Study limitations and future directions for research using this methodology are discussed. PMID:24013773

Issues in the conduct of therapeutic trials in palliative care: an Australian perspective.

PubMed

Maddocks, Ian

2002-01-01

Palliative care has been slow to demonstrate that its common interventions are supported by high levels of evidence. There are multiple reasons for this--historical and cultural, as well as the recognised difficulties of conducting studies in dying persons. There are problems in isolating the effect of a single intervention from the many other changing dimensions which attend the progress of terminal illness, and problems also in defining particular outcomes free from the contaminating effect of other simultaneous changes in a patient's situation. Sickness is an interaction between disease and patient, and science sits more comfortably with the study of disease than with the understanding of the patient. Nevertheless, the therapies commonly employed for symptom management in individuals with advanced and terminal illness deserve more rigorous investigation to establish their efficacy. In Australia, new levels of government support for research have stimulated a closer examination of principles and practical guidelines for the conduct of research in this area of healthcare.

Non-infant adoption from care: lessons for safeguarding children.

PubMed

Rees, C A; Selwyn, J

2009-07-01

To explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. A cohort of 130 children was identified for whom adoption was recommended in 1991-1996 at a mean age of 5.7 years (range 3-11). All were in local authority care for child protection reasons. information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent-Child Communication Scale were completed. All but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty-six per cent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty-seven per cent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional 'phoniness' and rejection affected closeness. At follow-up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty-eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional responsibilities in supporting it need to be acknowledged and adequately resourced. Dysfunctional hypothalamus-pituitary-adrenal axis programming may contribute to persisting difficulties. Supporting substitute care should be considered integral to safeguarding children.

Impact of the economic downturn on nursing schools.

PubMed

Terry, Allison J; Whitman, Marilyn V

2011-01-01

The challenges posed by the economic downturn on baccalaureate nursing schools in the southeast as it relates to their perceptions of changes in the number of applicants, acceptance rates, employer recruitment efforts, and student clinical and job placement were explored. Responses from deans and program directors indicated nursing schools are experiencing negative effects of the economic downturn in the form of graduates having difficulty finding employment, decreased recruitment efforts from prospective employers, difficulty locating clinical placements for students, and no change in faculty applicants despite an increase in undergraduate student applicants as well as graduate student applicants. These multiple factors combined could signal the death knell for programs that are ill-prepared to deal with such a crisis. Programs need to be aggressive in their efforts to draw health care recruiters as well as qualified faculty applicants to their campuses. Nursing schools must be able to clearly show why their graduates are superior to other programs' graduates when competing for both highly qualified faculty applicants and prospective student employers.

Age-Associated Differences in Cognitive Performance in Older Community Dwelling Schizophrenia Patients: Differential Sensitivity of Clinical Neuropsychological and Experimental Information Processing Tests

PubMed Central

Bowie, Christopher R.; Reichenberg, Abraham; McClure, Margaret M.; Leung, Winnie L.; Harvey, Philip D.

2008-01-01

Cognitive dysfunction is a common feature of schizophrenia and deficits are present before the onset of psychosis, and are moderate to severe by the time of the first episode. Controversy exists over the course of cognitive dysfunction after the first episode. This study examined age-associated differences in performance on clinical neuropsychological (NP) and information processing tasks in a sample of geriatric community living schizophrenia patients (n=172). Compared to healthy control subjects (n=70), people with schizophrenia did not differ on NP tests across age groups but showed evidence for age-associated cognitive worsening on the more complex components of an information-processing test. Age-related changes in cognitive function in schizophrenia may be a function of both the course of illness and the processing demands of the cognitive measure of interest. Tests with fixed difficulty, such as clinical NP tests, may differ in their sensitivity from tests for which parametric difficulty manipulations can be performed. PMID:18053687

Potential problems of detecting and treating psychosis in the White House. Potential psychosis in the White House.

PubMed

Gambill, J

1980-01-01

Numerous books and articles have described the emotional difficulties suffered by President Nixon and how they influenced functioning in the White House and other branches of government during his presidency. I am not able to ascertain whether Nixon was temporarily psychotic; but the reported emotional turmoil suggests he may have been at high risk for committing suicide or developing a psychosis. This article analyzes the reactions of numerous people to the questionably irrational behaviour of Richard Nixon. Examples of psychiatric risks in other Presidents, presidential candidates, and public figures are also discussed. The potential difficulties in detecting and treating severe psychiatric illness in Presidents and other public figures should not prevent us from taking action now to minimize future risks. It is recommended that future Presidents appoint a psychiatrist, at least on a part-time basis, as one of their personal physicians in order to increase Presidential access to psychiatric evaluation and treatment.

Aging affects the balance of neural entrainment and top-down neural modulation in the listening brain

PubMed Central

Henry, Molly J.; Herrmann, Björn; Kunke, Dunja; Obleser, Jonas

2017-01-01

Healthy aging is accompanied by listening difficulties, including decreased speech comprehension, that stem from an ill-understood combination of sensory and cognitive changes. Here, we use electroencephalography to demonstrate that auditory neural oscillations of older adults entrain less firmly and less flexibly to speech-paced (∼3 Hz) rhythms than younger adults’ during attentive listening. These neural entrainment effects are distinct in magnitude and origin from the neural response to sound per se. Non-entrained parieto-occipital alpha (8–12 Hz) oscillations are enhanced in young adults, but suppressed in older participants, during attentive listening. Entrained neural phase and task-induced alpha amplitude exert opposite, complementary effects on listening performance: higher alpha amplitude is associated with reduced entrainment-driven behavioural performance modulation. Thus, alpha amplitude as a task-driven, neuro-modulatory signal can counteract the behavioural corollaries of neural entrainment. Balancing these two neural strategies may present new paths for intervention in age-related listening difficulties. PMID:28654081

I Collect Therefore I am--Autonoetic Consciousness and Hoarding in Asperger Syndrome.

PubMed

Skirrow, Paul; Jackson, Paul; Perry, Ewan; Hare, Dougal Julian

2015-01-01

A growing number of studies have highlighted impairments in the ability of individuals with autism spectrum disorders to recall specific, personally experienced material. These difficulties have been related to underlying problems with autonoetic consciousness, namely the subjective awareness of one's own existence in subjective time. The current paper describes the manifestation of these difficulties in three individuals diagnosed with Asperger syndrome. For the people described, lifelong collecting and hoarding behaviours appeared to serve the function of constituting and maintaining aspects of their sense of self, particularly the sense of continuity and agency over time. On the basis of this clinical information and previous research into self-related processes in people with autism spectrum disorders, an initial model of collecting and hoarding behaviours amongst individuals with Asperger syndrome was formulated. The implications of this formulation for both clinical practice and future research are discussed. People with Asperger syndrome can have problems in developing a functional sense of self. Collecting and hoarding behaviour by people with Asperger syndrome may reflect such underlying difficulties in their sense of self rather than being symptoms of comorbid mental illness. Interventions need to take account of the function of such behaviours rather than solely regarding them as discrete pathological signs. Copyright © 2014 John Wiley & Sons, Ltd.

Impact of childhood cancer on parents' relationships: an integrative review.

PubMed

da Silva, Fernanda Machado; Jacob, Eufemia; Nascimento, Lucila Castanheira

2010-09-01

The diagnosis of cancer and the treatment decisions associated with it may cause uncertainty, stress, and anxiety among parents. Emotional tensions can affect parents' relationships during the trajectory of the child's cancer illness. We conducted an integrative review to examine the evidence related to the effects of childhood cancer on parents' relationships. An integrative literature search of studies published between 1997 and 2009 was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychology Information (PsycINFO), PubMed, Scopus, CUIDEN, and Latin American and Caribbean Health Science Literature (LILACS). The key words used were neoplasms, child, marriage, spouses, family relations, and nursing. Articles were reviewed if the (a) topic addressed parents' relationships during childhood cancer; (b) participants were mothers, fathers, or both; (c) design was either qualitative or quantitative; (d) language was English, Portuguese, or Spanish; (e) date of publication was between January 1997 and October 2009; and (f) abstract was available. Fourteen articles met the search criteria and were reviewed using Cooper's framework for integrative reviews. Four themes emerged: (a) changes in the parents' relationship during the trajectory of the child's illness; (b) difficulty in communication between couples; (c) gender differences in parental stress and coping; and (d) role changes. Findings revealed positive and negative changes in parents' relationships, communication, stress, and roles. Nurses need to assess the impact of cancer diagnosis and treatments on parent relationships, offer support and encouragement, and allow expression of feelings. Future research is needed to develop and test interventions that increase parents' potentials and strengthen relationships during the challenging trajectory of their children's cancer and treatment. The multiple sources of stress and uncertainty associated with a child's cancer diagnosis and treatment affect parents' relationships. Difficulties in communication appear frequently in parents' relationship. Our findings may guide healthcare professionals in identifying parents at risk for developing conflicts, communication problems, and lack of alignment between parents that could interfere with providing optimal care for their child with cancer. Healthcare professionals may promote dialogue and encourage parents to express their feelings, seek mutual support, and establish a partnership in dealing with the child's illness.

Housing First: exploring participants' early support needs.

PubMed

Stergiopoulos, Vicky; Gozdzik, Agnes; O'Campo, Patricia; Holtby, Alixandra R; Jeyaratnam, Jeyagobi; Tsemberis, Sam

2014-04-13

Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants' early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrollment in a Canadian field trial of Housing First. The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis. The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrollment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support. Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs. Current Controlled Trials ISRCTN42520374.

Housing First: exploring participants’ early support needs

PubMed Central

2014-01-01

Background Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants’ early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First. Methods The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis. Results The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support. Conclusions Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs. Trial registration Current Controlled Trials ISRCTN42520374 PMID:24725374

Qualitative interview study of parents' perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care.

PubMed

Halls, Amy; Van't Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M

2017-09-15

To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care. Qualitative semistructured interview study. UK primary care. 23 parents of children aged 6 months to 10 years presenting with LRTI in primary care. Thematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI. Four major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor's attention. Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic recommendation or delayed antibiotic recommendation is made. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Challenges in conducting psychiatry studies in India

PubMed Central

Kharawala, Saifuddin; Dalal, Jeroze

2011-01-01

A large number of psychiatry studies are conducted in India. Psychiatry studies are complex and present unique challenges in the Indian setting. Ethical issues pertaining to the risk of worsening of illness, use of placebo and validity of informed consents are commonly faced. Site selection can be difficult due to the relative paucity of ICH-GCP (International Conference on Harmonisation - Good Clinical Practice) trained psychiatry investigators in India. Recruitment can be challenging due to issues such as strict eligibility criteria, (lack of) availability of caregiver, illness-related considerations, etc. Assessment of the consent capacity of patients is not simple, while structured assessments are not commonly employed. As the illness fluctuates, the consent capacity may change, thus requiring continued assessment of consent capacity. Study patients run the risk of worsening of illness and suicide due to exposure to inactive treatments; this risk is counterbalanced by use of appropriate study designs, as well as the indirect psychotherapeutic support received. Psychiatry studies are associated with a high placebo response. This necessitates conduct of placebo-controlled studies despite the attendant difficulties. Also, the high placebo response is often the cause of failed trials. Rating scales are essential for assessment of drug response. Some rating instruments as well as some rater training procedures may not be suitable for the Indian setting. Technological advancements may increase the procedural complexity but improve the quality of ratings. Psychiatry studies present monitors and auditors with unique scenarios too. Utilization of psychiatry specific training and expertise is recommended to ensure successful conduct of these studies in India. PMID:21584176

Why do Families of Sick Newborns Accept Hospital Care? A Community-Based Cohort Study in Karachi, Pakistan

PubMed Central

Owais, Aatekah; Sultana, Shazia; Stein, Aryeh D.; Bashir, Nasira H.; Awaldad, Razia; Zaidi, Anita K M

2011-01-01

Objective Sick young infants are at high risk of mortality in developing countries but families often decline hospital referral. Our objective was to identify the predictors of acceptance of referral for hospital care among families of severely ill newborns and infants <59 days old in three low-income communities of Karachi, Pakistan. Study design A cohort of 541 newborns and infants referred from home by community health workers doing household surveillance, and diagnosed with a serious illness at local community clinics between January 1 and December 31, 2007, was followed-up within 1 month of referral to the public hospital. Results Only 24% of families accepted hospital referral. Major reasons for refusal were financial difficulties (67%) and father/elder denying permission (65%). Religious/cultural beliefs were cited by 20% of families. Referral acceptance was higher with recognition of severity of the illness by mother (OR=12.7; 95% CI=4.6–35.2), family’s ability to speak the dominant language at hospital (OR=2.0; 95% CI=1.3–3.1), presence of grunting in the infant (OR=3.3; 95% CI=1.2–9.0), and infant temperature <35.5°C (OR=4.1; 95% CI=2.3–7.4). No gender differential was observed. Conclusion Refusal of hospital referral for sick young infants is very common. Interventions that encourage appropriate care seeking, as well as community-based management of young infant illnesses when referral is not feasible are needed to improve neonatal survival in low-income countries. PMID:21273989

Arthritis symptoms, the work environment, and the future: measuring perceived job strain among employed persons with arthritis.

PubMed

Gignac, Monique A M; Sutton, Deborah; Badley, Elizabeth M

2007-06-15

To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it. Study participants were 292 employed individuals with osteoarthritis or inflammatory arthritis. Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, coworker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data. A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain. The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals' lives.

Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients' last year of life.

PubMed

Tang, Siew Tzuh; Chang, Wen-Cheng; Chen, Jen-Shi; Chou, Wen-Chi; Hsieh, Chia-Hsun; Chen, Chen H

2016-04-01

Whether prognostic awareness benefits terminally ill cancer patients' psychological-existential well-being and quality of life (QOL) is unclear because of lack of well-controlled longitudinal studies. This study longitudinally evaluated the associations of accurate prognostic awareness and prognostic acceptance with psychological distress, existential suffering, and QOL while comprehensively controlling for confounders in Taiwanese terminally ill cancer patients' last year of life. A convenience sample of 325 cancer patients was followed until death. Psychological distress and existential suffering were assessed by severe anxiety and depressive symptoms and high self-perceived sense of burden to others, respectively. Dichotomized and continuous (QOL) outcome variables were evaluated by multivariate logistic and linear regression modeling with the generalized estimating equation, respectively. Accurate prognostic awareness was not associated with the likelihood of severe anxiety or depressive symptoms but significantly increased the likelihood of high self-perceived sense of burden to others and was associated with poorer QOL in participants' last year of life. Participants who knew and highly accepted their prognosis were significantly less likely to experience severe anxiety symptoms than those who were unaware of or knew their prognosis but had difficulty accepting it. Knowing one's poor prognosis and confronting one's impending death without full acceptance and adequate professional psycho-spiritual support may harm more than benefit terminally ill cancer patients' psychological state, existential well-being, and QOL. These findings highlight the importance of tailoring psycho-spiritual support to cancer patients' psychological and existential needs when prognostic information is disclosed. Copyright © 2015 John Wiley & Sons, Ltd.

Communication with children about a parent's advanced cancer and measures of parental anxiety and depression: a cross-sectional mixed-methods study.

PubMed

Hailey, Claire E; Yopp, Justin M; Deal, Allison M; Mayer, Deborah K; Hanson, Laura C; Grunfeld, Gili; Rosenstein, Donald L; Park, Eliza M

2018-01-01

Parents with advanced cancer are faced with difficult decision-making about communication about their illness with their children. The objectives of this study were to describe how parents communicated with their children about advanced cancer and to explore associations between communication and parental depression and anxiety. This was a cross-sectional, mixed-methods study of 42 patients with stage IV solid tumor malignancies who had at least one child less than 18 years of age. Participants completed a semi-structured interview and the Hospital Anxiety and Depression Scale (HADS). We used multiple linear regression to evaluate the association between extent of communication and HADS Anxiety and Depression scores. Interview data were analyzed using standard qualitative content and thematic techniques and triangulated with survey data. Higher HADS Anxiety scores, but not HADS Depression scores, were cross-sectionally associated with greater extent of parental communication (p = 0.003), even when controlling for performance status and children's ages. In qualitative analyses, parents who acknowledged the terminal nature of their illness or experienced higher symptom burden were more likely to report that they also communicated more extensively with children. A third of parents (n = 14, 33%) described difficulty with illness-related communication with their children. In this pilot study, parents with advanced cancer who reported more illness-related communication with their children also reported more symptoms of general anxiety. Future interventions should address psychological distress relevant to parenting and further assess how parental communication may be linked to parental mood symptoms.

Psychological adjustment to IDDM: 10-year follow-up of an onset cohort of child and adolescent patients.

PubMed

Jacobson, A M; Hauser, S T; Willett, J B; Wolfsdorf, J I; Dvorak, R; Herman, L; de Groot, M

1997-05-01

To evaluate the psychological adjustment of young adults with IDDM in comparison with similarly aged individuals without chronic illness. An onset cohort of young adults (n = 57), ages 19-26 years, who have been followed over a 10-year period since diagnosis, was compared with a similarly aged group of young adults identified at the time of a moderately severe, acute illness (n = 54) and followed over the same 10-year period. The groups were assessed at 10-year follow-up in terms of 1) sociodemographic indices (e.g., schooling, employment, delinquent activities, drug use), 2) psychiatric symptoms, and 3) perceived competence. In addition, IDDM patients were examined for longitudinal change in adjustment to diabetes. The groups differed only minimally in terms of sociodemographic indices, with similar rates of high school graduation, post-high school education, employment, and drug use. The IDDM group reported fewer criminal convictions and fewer non-diabetes-related illness episodes than the comparison group. There were no differences in psychiatric symptoms. However, IDDM patients reported lower perceived competence, with specific differences found on the global self-worth, sociability, physical appearance, being an adequate provider, and humor subscales. The IDDM patients reported improving adjustment to their diabetes over the course of the 10-year follow-up. Overall, the young adults with IDDM appeared to be as psychologically well adjusted as the young adults without a chronic illness. There were, however, indications of lower self-esteem in the IDDM patients that could either portend or predispose them to risk for future depression or other difficulties in adaptation.

Correlates of competitive versus noncompetitive employment among adults with psychotic disorders.

PubMed

Waghorn, Geoffrey; Saha, Sukankta; McGrath, John J

2014-04-01

Studies of the demographic and clinical correlates of employment activity have proven useful for identifying employment assistance needs among people with severe and persistent mental illness. However, the results of prior studies remain unclear, and most reviews of prior studies have not differentiated competitive from noncompetitive employment. This study attempted to clarify the relative strength and consistency of correlates of competitive versus noncompetitive employment. Data were drawn from a population-based survey of Australian adults with psychotic disorders between March and December 2010. Demographic, clinical, and employment assistance correlates of competitive and noncompetitive employment were compared. The sample comprised 1,825 participants who agreed to face-to-face interviews. A total of 408 (22.3%) participants were employed in the previous four weeks, 330 (18.1%) in competitive employment and 78 (4.3%) in noncompetitive employment. Those in competitive employment were more likely to be female and aged 18-34, to have a partner, to have received formal vocational training or education after high school, and to have no literacy difficulties. Better global functioning, shorter illness duration, less severe course of illness, and affective versus nonaffective psychosis were associated with a greater likelihood of competitive employment. Those using Australian government employment services were less likely to be in competitive employment, suggesting a service provider preference for noncompetitive employment. Four times as many employees were in competitive employment than in noncompetitive employment. The negative relationship between employment assistance and competitive employment highlights the urgent need to improve the effectiveness of Australian employment services for people with severe mental illnesses.

A creative arts intervention for children with diabetes. Part 2: evaluation.

PubMed

Basso, Robert V J; Pelech, William James

2008-12-01

In Part 1 of this article (published in the October 2008 issue), we discussed the importance of using creative arts skits as an expressive technique for children with Type 1, or juvenile, diabetes. This creative arts intervention offers children the opportunity to decipher emotional difficulties through symbolic play in a secure atmosphere. Analysis of feelings following the skits encourages children to share concerns about their illnesses as well as self-concept issues. In Part 2, we use the case study method to demonstrate the benefits of creative arts skits for children with diabetes.

Rethinking the Psychogenic Model of Complex Regional Pain Syndrome: Somatoform Disorders and Complex Regional Pain Syndrome

PubMed Central

Hill, Renee J.; Chopra, Pradeep; Richardi, Toni

2012-01-01

Abstract Explaining the etiology of Complex Regional Pain Syndrome (CRPS) from the psychogenic model is exceedingly unsophisticated, because neurocognitive deficits, neuroanatomical abnormalities, and distortions in cognitive mapping are features of CRPS pathology. More importantly, many people who have developed CRPS have no history of mental illness. The psychogenic model offers comfort to physicians and mental health practitioners (MHPs) who have difficulty understanding pain maintained by newly uncovered neuro inflammatory processes. With increased education about CRPS through a biopsychosocial perspective, both physicians and MHPs can better diagnose, treat, and manage CRPS symptomatology. PMID:24223338

Notes on nervios: a disorder of menopause.

PubMed

Barnett, E A

1989-01-01

The condition of nerves among women in the small Peruvian town of Puente Piedre is described. Both nervios (a symptom) and Nervios (a disorder) describe a woman's difficulty with nerves. In Puente Piedre, the identification of an anxiety condition among women depends only on the women's age. Younger women with anxiety symptoms are diagnosed as nervios, a temporary condition ascribed to a single episode of high blood pressure. Menopausal women with similar symptoms, on the other hand, are thought to have a specific disorder, Nervios. In Puente Piedre, Nervios clearly is a folk illness limited to women of menopausal age.

Clinical ethics case report: questionable capacity and the guidance of living wills.

PubMed

VanderWalde, Ari

2011-01-01

After falling from a roof, an older man lost neurological function below his face. In two days, the patient regained consciousness, but it was unclear whether he could communicate his preferences, whether due to injuries or difficulties with language. His family believed he could communicate with them, and that he was capable of making treatment decisions. The staff did not think to contact the hospital's largely inactive ethics consultation service for assistance, and instead looked to the patient's living will for guidance, even though the patient was not terminally ill, and his lack of capacity had not been determined.

That very interesting dance in the Baltimore Canyon

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stuart, A.

1978-09-11

Pointing out that offshore oil and gas has been a marginal proposition until now--the only consistent moneymaker being the Federal government as leaser--it is hard to understand the feverish spasms that have swept the stock market for months, at the slightest hint of a discovery in Baltimore Canyon. Despite the dismal returns vs. risks up to the present, most of the oil industry believes it must continue offshore if it wants to stay in the oil and gas business. Most of these oil men widely share the belief that most of the large fields that remain to be discovered aremore » in frontier areas of the continential shelf; and one ''big elephant'' discovered can easily erase a string of losses. Still another reason to keep playing is an astonishing advance in exploration technology known as ''bright spots''. Finally, oil men are lured into the offshore arena by a subtle mixture of perceived necessity, an innate if somewhat battered spirit of optimism, and an unabashed fascination with the game itself--the latter, little understood outside the industry according to Dick Palmer, Texaco's top exploration man, but ''a very interesting dance''.« less

Causes and differentials of childhood mortality in Iraq

PubMed Central

Awqati, Naira A; Ali, Mohamed M; Al-Ward, Nada J; Majeed, Faiza A; Salman, Khawla; Al-Alak, Mahdi; Al-Gasseer, Naeema

2009-01-01

Background Limited information is available in Iraq regarding the causes of under-five mortality. The vital registration system is deficient in its coverage, particularly from rural areas where access to health services is limited and most deaths occur at home, i.e. outside the health system, and hence the cause of death goes unreported. Knowledge of patterns and trends in causes of under-five mortality is essential for decision-makers in assessing programmatic needs, prioritizing interventions, and monitoring progress. The aim of this study was to identify causes of under-five children deaths using a simplified verbal autopsy questionnaire. The objective was to define the leading symptoms and cause of death among Iraqi children from all regions of Iraq during 1994–1999. Methods To determine the cause structure of child deaths, a simplified verbal autopsy questionnaire was used in interviews conducted in the Iraqi Child & Maternal Mortality Survey (ICMMS) 1999 national sample. All the mothers/caregivers of the deceased children were asked open-ended questions about the symptoms within the two weeks preceding death; they could mention more than one symptom. Results The leading cause of death among under-five children was found to be childhood illnesses in 81.2%, followed by sudden death in 8.9% and accidents in 3.3%. Among under-five children dying of illnesses, cough and difficulty in breathing were the main symptoms preceding death in 34.0%, followed by diarrhea in 24.4%. Among neonates the leading cause was cough/and or difficulty in breathing in 42.3%, followed by sudden death in 11.9%, congenital abnormalities in 10.3% and prematurity in 10.2%. Diarrhea was the leading cause of death among infants in 49.8%, followed by cough and/or difficulty in breathing in 26.6%. Among children 12–59 months diarrhea was the leading cause of death in 43.4%, followed by accidents, injuries, and poisoning in 19.3%, then cough/difficulty in breathing in 14.8%. Conclusion In Iraq Under-five child mortality is one of the highest in the Middle East region; deaths during the neonatal period accounted for more than half of under-five children deaths highlighting an urgent need to introduce health interventions to improve essential neonatal care. Priority needs to be given to the prevention, early and effective treatment of neonatal conditions, diarrheal diseases, acute respiratory infections, and accidents. This study points to the need for further standardized assessments of under-5 mortality in Iraq. PMID:19545410

Malnutrition among Cognitively Intact, non-Critically Ill Older Adults in the Emergency Department

PubMed Central

Pereira, Greg F.; Bulik, Cynthia M.; Weaver, Mark A.; Holland, Wesley C.; Platts-Mills, Timothy F.

2014-01-01

Objectives We estimate the prevalence of malnutrition among older patients presenting to an emergency department (ED) in the southeastern United States and identify subgroups at increased risk. Methods We conducted a cross-sectional study with random time block sampling of cognitively intact patients aged 65 years and older. Nutrition was assessed using the Mini Nutritional Assessment Short-Form (0–14 scale) with malnutrition defined as a score of 7 or less and at-risk for malnutrition defined as a score of 8–11. The presence of depressive symptoms was defined as a Center for Epidemiological Studies Depression-10 score of 4 or more (0–10 scale). Results Among 138 older adults, 16% (95% Confidence Interval [CI], 10%–22%) were malnourished and 60% (95% CI, 52%–69%) were either malnourished or at-risk for malnutrition. Seventeen of the 22 malnourished patients (77%) denied previously being diagnosed with malnutrition. The prevalence of malnutrition was not appreciably different between males and females, across levels of patient education, or between those living in urban and rural areas. However, the prevalence of malnutrition was higher among patients with depressive symptoms 52%, those residing in assisted living 50%, those with difficulty eating 38%, and those reporting difficulty buying groceries 33%. Conclusion Among a random sample of cognitively intact older ED patients, more than half were malnourished or at-risk for malnutrition, and the majority of malnourished patients had not previously been diagnosed. Higher rates of malnutrition among those with depression, difficulty eating, and difficulty buying groceries suggest the need to explore multifaceted interventions. PMID:25129819

Increased risk of respiratory illness associated with kerosene fuel use among women and children in urban Bangalore, India.

PubMed

Choi, Jae-Young; Baumgartner, Jill; Harnden, Sarah; Alexander, Bruce H; Town, Robert J; D'Souza, George; Ramachandran, Gurumurthy

2015-02-01

Kerosene is a widely used cooking and lighting fuel in developing countries. The potential respiratory health effects of cooking with kerosene relative to cooking with cleaner fuels such as liquefied petroleum gas (LPG) have not been well characterised. We sampled 600 households from six urban neighbourhoods in Bangalore, India. Each household's primary cook, usually the woman of the house, was interviewed to collect information on current domestic fuel use and whether there was any presence of respiratory symptoms or illness in her or in the children in the household. Our analysis was limited to 547 adult females (ages 18-85) and 845 children (ages 0-17) in households exclusively cooking with either kerosene or LPG. We investigated the associations between kerosene use and the likelihood of having respiratory symptoms or illness using multivariate logistic regression models. Among adult women, cooking with kerosene was associated with cough (OR=1.88; 95% CI 1.19 to 2.99), bronchitis (OR=1.54; 95% CI 1.00 to 2.37), phlegm (OR=1.51; 95% CI 0.98 to 2.33) and chest illness (OR=1.61; 95% CI 1.02 to 2.53), relative to cooking with LPG in the multivariate models. Among children, living in a household cooking with kerosene was associated with bronchitis (OR=1.91; 95% CI 1.17 to 3.13), phlegm (OR=2.020; 95% CI 1.29 to 3.74) and chest illness (OR=1.70; 95% CI 0.99 to 2.90) after adjusting for other covariates. We also found associations between kerosene use and wheezing, difficulty breathing and asthma in adults and cough and wheezing in children, though these associations were not statistically significant. Women and children in households cooking with kerosene were more likely to have respiratory symptoms and illnesses compared with those in households cooking with LPG. Transitioning from kerosene to LPG for cooking may improve respiratory health among adult women and children in this population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey

PubMed Central

Wandera, Stephen O.; Ntozi, James; Kwagala, Betty

2014-01-01

Background Nationally representative evidence on the burden and determinants of disability among older people in sub-Saharan Africa in general, and Uganda in particular, is limited. Objective The aim of this study was to estimate the prevalence and investigate the correlates of disability among older people in Uganda. Design We conducted secondary analysis of data from a sample of 2,382 older persons from the Uganda National Household Survey. Disability was operationalized as either: 1) having a lot of difficulty on any one question; 2) being unable to perform on any one question; or, 3) having some difficulty with two of the six domains. We used frequency distributions for description, chi-square tests for initial associations, and multivariable logistic regressions to assess the associations. Results A third of the older population was disabled. Among all older persons, disability was associated with advancement in age (OR=4.91, 95% CI: 3.38–7.13), rural residence (0.56, 0.37–0.85), living alone (1.56, 1.07–2.27), separated or divorced (1.96, 1.31–2.94) or widowed (1.86, 1.32–2.61) marital status, households’ dependence on remittances (1.48, 1.10–1.98), ill health (2.48, 1.95–3.15), and non-communicable diseases (NCDs) (1.81, 0.80–2.33). Gender was not associated with disability among older persons. Conclusions Disability was associated with advancement in age, rural residence, living alone, divorced/separated/widowed marital status, dependence on remittances, ill health, and NCDs. Interventions to improve health and functioning of older people need to focus on addressing social inequalities and on the early preventive interventions and management of NCDs in old age in Uganda. PMID:25413721

Did poor eyesight influence Goya's late works? Medicine and art history in search for an interpretation of Goya's late paintings.

PubMed

Pérez-Trullén, José M; Ascaso, Francisco J; Auría, María J

2018-04-15

The aim of this article is to 'determine' the scope of Goya's eyesight difficulties and assess the extent to which those difficulties might explain his style of painting in the last years of his life. We analyse the correspondence and late works of the Aragonese painter Francisco de Goya y Lucientes (1746-1828), who has been admired for his use of colour, his energetic loose brushstrokes, his disregard for details and his bold compositions, as well as for his different artistic styles throughout his life. The evolution of Goya's style of painting in his later works seems to have been the consequence of an eyesight condition, probably age-related cataracts at an advanced stage. The faded dark backgrounds, which become blurred with the silhouette of the person portrayed, could indicate a certain degree of eye strain. This can be traced in all these works, but is especially evident in the unfinished portrait of Pío de Molina (1827-1828), as well as in the portraits of Mariano Goya, the artist's grandson (1827), and Jacques Galos (1826). It has been considered that the late and isolated Goya's sight problems were a belated consequence of his severe illness of 1792. Nevertheless, in our opinion, this is a simplistic explanation and, given the painter's age, it is logical to presume that their cause could be age-related lens opacities. This article argues that medicine may become a subsidiary science to art history, as it can provide empirical evidence of the way painters' illnesses may have a strong impact on their artworks. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Bringing it all back home: Understanding the medical difficulties encountered by newly released prisoners in New Orleans, Louisiana - a qualitative study.

PubMed

Vail, William Lee; Niyogi, Anjali; Henderson, Norris; Wennerstrom, Ashley

2017-07-01

Formerly incarcerated persons (FIPs) face a disproportionate risk of death and serious illness in the immediate post-release period. Therefore, it is a critical time to initiate community-based care for chronic illnesses and behavioural disorders. Little is known about the unique transitional health and social support needs of FIPs in Louisiana, which has the highest incarceration rate in the world. As the average age of prisoners in the United States rises, the release of older prisoners with chronic conditions will become increasingly common. The aim of this study was to explore the healthcare experiences of FIPs in Louisiana in order to inform delivery of services tailored to this population. This research was done in partnership with a community organisation that advocates for restoration of voting rights to FIPs and helps newly released individuals transition back into society. This organisation identified FIPs in the Greater New Orleans area, and from January to May 2015, we conducted 24 semi-structured, in-person, audio-recorded interviews at the community organisation's transitional living facility. The interviews assessed FIPs' experiences with and barriers to receiving healthcare during and after incarceration. These discussions also explored FIPs' desires for services and attitudes towards health and healthcare. Interviews were transcribed and independently coded by two researchers. Interviewees reported negative experiences with healthcare during incarceration, and limited health guidance during the pre-release process. Post-release concerns included lack of insurance, difficulty accessing care and medication, and interest in learning about healthy lifestyles. Results suggest a need for a formalised system of transitional healthcare for FIPs. Findings are being used to inform a pilot transitional care clinic in New Orleans, Louisiana. © 2017 John Wiley & Sons Ltd.

Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents--a theoretical model.

PubMed

Berlin, Anita; Hylander, Ingrid; Törnkvist, Lena

2008-03-01

According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained. The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses. Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes. Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.

Effects of gender and executive function on visuospatial working memory in adult obsessive-compulsive disorder.

PubMed

Martoni, Riccardo Maria; Salgari, Giulia; Galimberti, Elisa; Cavallini, Maria Cristina; O'Neill, Joseph

2015-12-01

Visuospatial working memory (VSWM) is the ability of the brain to transiently store and manipulate visual information. VSWM deficiencies have been reported in obsessive-compulsive disorder (OCD), but not consistently, perhaps due to variability in task design and clinical patient factors. To explore this variability, this study assessed effects of the design factors task difficulty and executive organizational strategy and of the clinical factors gender, OCD symptom dimension, and duration of illness on VSWM in OCD. The CANTAB spatial working memory, spatial recognition memory, delayed matching to sample, and stop signal tasks were administered to 42 adult OCD patients and 42 age- and sex-matched healthy controls. Aims were to detect a possible VSWM deficit in the OCD sample, to evaluate influences of the above task and patient factors, to determine the specificity of the deficit to the visuospatial subdomain, and to examine effects of sustained attention as potential neurocognitive confound. We confirmed previous findings of a VSWM deficit in OCD that was more severe for greater memory load (task difficulty) and that was affected by task strategy (executive function). We failed to demonstrate significant deficits in neighboring or confounding neurocognitive subdomains (visual object recognition or visual object short-term memory, sustained attention). Notably, the VSWM deficit was only significant for female patients, adding to evidence for sexual dimorphism in OCD. Again as in prior work, more severe OCD symptoms in the symmetry dimension (but no other dimension) significantly negatively impacted VSWM. Duration of illness had no significant effect on VSWM. VSWM deficits in OCD appear more severe with higher task load and may be mediated through poor task strategy. Such deficits may present mainly in female patients and in (male and female) patients with symmetry symptoms.

Effectiveness of therapeutic conversation intervention among caregivers of people with eating disorders: quasi-experimental design.

PubMed

Gisladottir, Margret; Treasure, Janet; Svavarsdottir, Erla Kolbrun

2017-03-01

The aim of this study was to evaluate the effectiveness of therapeutic conversation intervention in group and caregiver sessions on the supporting role of caregivers. Caregivers of people with eating disorders are known to suffer major difficulties and are in great need of support. Unhelpful parental support strategies can delay the recovery of an individual with an eating disorder. Skill training interventions can equip parents with skills, guidance and techniques by helping them to be a support person and making them one of the most important links in the treatment process. The therapeutic conversation intervention consisted of five group and caregiver sessions and three booster sessions. The Calgary Family Assessment and Calgary Family Intervention Models, the Illness Beliefs Model and the New Maudsley Method were used as theoretical frameworks. The content of the intervention consisted of work on difficult behaviours, feelings and helpful strategies. The participants (n = 58) included primary and secondary caregivers of 12- to 24-year-old patients with eating disorders. Eight caregivers dropped out of treatment. This study had a quasi-experimental design with one pre- and two post-test measures. Between 90-96% of caregivers rated the therapeutic conversation intervention as supportive. Furthermore, the study revealed significant differences in caregiver emotional and cognitive support, illness beliefs, disruptive behaviour and quality of life, negative aspects of care giving demands and caregiver and patient behavioural difficulties after the intervention and/or at follow-up. Therapeutic conversation intervention with caregivers in group and private sessions proved to be beneficial. This outcome provides information for healthcare professionals on how they can help primary caregivers in their supporting role, which can, in turn, improve services in healthcare centres and psychiatric hospitals. © 2016 John Wiley & Sons Ltd.

Consultation and illness behaviour in response to symptoms: a comparison of models from different disciplinary frameworks and suggestions for future research directions.

PubMed

Wyke, Sally; Adamson, Joy; Dixon, Diane; Hunt, Kate

2013-06-01

We all get ill and social scientific interest in how we respond - the study of illness behaviour - continues unabated. Existing models are useful, but have been developed and applied within disciplinary silos, resulting in wasted intellectual and empirical effort and an absence of accumulation of knowledge across disciplines. We present a critical review and detailed comparison of three process models of response to symptoms: the Illness Action Model, the Common Sense Model of the Self-Regulation of Health and Illness and the Network Episode Model. We suggest an integrated framework in which symptoms, responses and actions are simultaneously interpreted and evaluated in the light of accumulated knowledge and through interactions. Evaluation may be subconscious and is influenced by the extent to which the symptoms impose themselves, expectations of outcomes, the resources available and understanding of symptoms' salience and possible outcomes. Actions taken are part of a process of problem solving through which both individuals and their immediate social network seek to (re)achieve 'normality'. Response is also influenced by social structure (directly and indirectly), cultural expectations of health, the meaning of symptoms, and access to and understandings of the legitimate use of services. Changes in knowledge, in embodied state and in emotions can all be directly influential at any point. We do not underestimate the difficulty of operationalising an integrated framework at different levels of analysis. Attempts to do so will require us to move easily between disciplinary understandings to conduct prospective, longitudinal, research that uses novel methodologies to investigate response to symptoms in the context of affective as well as cognitive responses and interactions within social networks. While challenging such an approach would facilitate accumulation of knowledge across disciplines and enable movement beyond description to change in individual and organisational responses. Copyright © 2013 Elsevier Ltd. All rights reserved.

'Sometimes it feels as if the world goes on without me': adolescents' experiences of living with chronic fatigue syndrome.

PubMed

Winger, Anette; Ekstedt, Mirjam; Wyller, Vegard B; Helseth, Sølvi

2014-09-01

To explore the experience of being an adolescent with chronic fatigue syndrome. Despite ample research, chronic fatigue syndrome is still poorly understood, and there are still controversies related to the illness. Adolescents with chronic fatigue syndrome are often unable to attend school and lose social relations with friends. The challenges they face will affect their quality of life. A qualitative, phenomenological hermeneutical design. Six boys and twelve girls, aged 12-18, were interviewed, emphasising their own experiences living with chronic fatigue syndrome. Analyses were performed using a phenomenological hermeneutical method. The core theme, 'Sometimes it feels as if the world goes on without me', encompasses the feelings an adolescent living with chronic fatigue syndrome might have about life. The core theme was supported by four subthemes: 'On the side of life--locked in and shut out'; 'the body, the illness and me'; 'if the illness is not visible to others, does it exist?'; and 'handling life while hoping for a better future'. The subthemes reflect the experience of social isolation, their own and others' understanding of the illness and hope for the future. Not being able to be with friends, or attend school, made the adolescents feel different and forgotten. They felt alienated in their own bodies and were struggling to be visible to themselves and to their surroundings. Spending less time with friends and more time with their parents constituted a threat to independence and development. Yet they managed to envision a better future despite all the difficulties. To provide effective support and constructive relations to adolescents with chronic fatigue syndrome, all health professions involved need insight from the persons who are themselves ill. Health centres could function as resource centres for patients and healthcare professionals. © 2013 John Wiley & Sons Ltd.

The experience of critically ill children: A phenomenological study of discomfort and comfort.

PubMed

Carnevale, Franco A; Gaudreault, Josée

2013-01-01

Emerging evidence indicates that critically ill children are particularly at risk for incurring significant psychological harm. Little is known about these children's actual experiences. The aim of the study was to examine children's experience of critical illness. The research question was: What are a critically ill child's sources of discomfort and comfort? Interpretive phenomenology was selected as the study's method. Children's accounts were examined to identify what they considered meaningful, in terms of their experienced discomfort and comfort. Data sources included formal and informal interviews with child-participants, drawings provided by some participants, and field-notes documenting observed non-verbal data. Twelve children were enrolled in the study, ranging from 3 to 17years of age; including four girls and eight boys. Although all participants were able to discuss the discomfort and comfort they experienced, they reported difficulties in remembering part or most of their experience. Some participants characterized their Pediatric Intensive Care Unit stay quite favourably or as "not that bad", while some described their experience unfavourably. Diverse types of discomforts were reported, including fears and worries, hurt and pain, invasive interventions, missing significant people, noise, food or eating problems, boredom, physical symptoms, as well as four additional discomforts reported by individual participants. Several sources of comfort were described, including parents, visitors and friends, hospital staff (principally nurses), stuffed animal/favourite blanket, entertainment and play, food, selected medical interventions, thinking of going home, being able to walk or run, sleep, waking up, gifts, along with two other comforts reported by individual participants. Embodiment and a tension between aloneness and being with were identified as the principal phenomena underlying these children's experiences. The findings complement existing knowledge regarding the psychological impact of critical illness by highlighting how children regard specific phenomena as discomforting or comforting. This sheds light on future directions for practice and research development in pediatric critical care.

Psychosocial aspects of induced abortion.

PubMed

Stotland, N L

1997-09-01

US anti-abortion groups have used misinformation on the long-term psychological impact of induced abortion to advance their position. This article reviews the available research evidence on the definition, history, cultural context, and emotional and psychiatric sequelae of induced abortion. Notable has been a confusion of normative, transient reactions to unintended pregnancy and abortion (e.g., guilt, depression, anxiety) with serious mental disorders. Studies of the psychiatric aspects of abortion have been limited by methodological problems such as the impossibility of randomly assigning women to study and control groups, resistance to follow-up, and confounding variables. Among the factors that may impact on an unintended pregnancy and the decision to abort are ongoing or past psychiatric illness, poverty, social chaos, youth and immaturity, abandonment issues, ongoing domestic responsibilities, rape and incest, domestic violence, religion, and contraceptive failure. Among the risk factors for postabortion psychosocial difficulties are previous or concurrent psychiatric illness, coercion to abort, genetic or medical indications, lack of social supports, ambivalence, and increasing length of gestation. Overall, the literature indicates that serious psychiatric illness is at least 8 times more common among postpartum than among postabortion women. Abortion center staff should acknowledge that the termination of a pregnancy may be experienced as a loss even when it is a voluntary choice. Referrals should be offered to women who show great emotional distress, have had several previous abortions, or request psychiatric consultation.

Mental illness and parenthood: being a parent in secure psychiatric care.

PubMed

Parrott, Fiona R; Macinnes, Douglas L; Parrott, Janet

2015-12-10

Research into parenting and mental illness seldom includes forensic mental health service users, despite its relevance to therapeutic, family work and risk management. This study aimed to understand the experiences of parents and the variety of parenting roles maintained during admission to a secure forensic hospital. Narrative interviews with 18 parents (eight mothers and 10 fathers) at an English medium security hospital were analysed thematically, using the framework approach. The proportion of patients who are parents and their contact patterns with their children were estimated from records. About a quarter of men and 38% of women were parents. Parenthood was of central importance to their emotional life, spanning experiences of loss, shame and failed expectations, joy, responsibility and hope. Fewer fathers maintained contact with their children than mothers yet fatherhood remained a vital aspect of men's identities, with impact on their self-esteem. Parenting during lengthy admissions--while constrained and dependent on professional support and surveillance--ranged from sending gifts and money to visits and phone calls. Offending was seen as a particularly shameful aspect of admission, contributing to distancing from the children and difficulty explaining detention to them. Such complex experiences call for multidisciplinary knowledge and skills. Provision of focused therapy, as well as appropriate visiting spaces, creative approaches to contact time and support for patients in explaining their mental illness and detention to their children are recommended. Copyright © 2015 John Wiley & Sons, Ltd.

The significance of services in a psychiatric hospital for family members of persons with mental illness.

PubMed

Shor, Ron; Shalev, Anat

2015-03-01

Hospitalization of persons with mental illness may cause their family members to experience multiple stressors that stem from the hospitalization as well as from the duties of helping him or her. However, providing support services in psychiatric hospitals for family members has received only limited attention. To change this situation, mental health professionals in a psychiatric hospital in Israel developed an innovative family-centered practice model, the Family Members' Support and Consultation (FMSC) service center. We examined the significance to family members of the services they received from the FMSC service center in a study that included 20 caregivers. Ten participated in 2 focus groups of 5 participants each; 10 were interviewed personally. We implemented a thematic analysis to analyze the data. According to the participants, the staff of the FMSC service center provided support services that helped them cope with the stressors and difficulties they experienced within the context of the psychiatric hospital. The participants emphasized the significance of the immediacy and accessibility of support provided, as well as the positive effects of systemic interventions aimed at changing the relationships between family members and systems in the psychiatric hospital. Our findings show the importance of integrating a service that focuses on the needs of family members of persons with mental illness within a psychiatric hospital. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Exploration of experiences in therapeutic groups for patients with severe mental illness: development of the Ferrara group experiences scale (FE- GES).

PubMed

Caruso, Rosangela; Grassi, Luigi; Biancosino, Bruno; Marmai, Luciana; Bonatti, Luciano; Moscara, Maria; Rigatelli, Marco; Carr, Catherine; Priebe, Stefan

2013-10-01

Group therapies are routinely provided for patients with severe mental illness. The factors important to the group experience of patients are still poorly understood and are rarely measured. To support further research and practice, we aimed to develop a questionnaire that captures how patients experience groups within a community mental health context. An initial pool of 39 items was conceptually generated to assess different aspects of group experiences. Items were completed by 166 patients with severe mental illness attending group therapies in community mental health services in Italy. Patients with different psychiatric diagnoses who attended at least 5 group sessions were included. An exploratory factor analysis was used to identify different dimensions of group experiences and to reduce the number of items for each dimension. The resulting questionnaire has five subscales: 1) sharing of emotions and experiences, 2) cognitive improvement, 3) group learning, 4) difficulties in open expression and 5) relationships. Each subscale has 4 items. The scale and sub-scales have good internal consistency. The Ferrara Group Experiences Scale is conceptually derived and assesses dimensions of group experience that are theoretically and practically relevant. It is brief, easy to use and has good psychometric properties. After further validation, the scale may be used for research into patient experiences across different group therapy modalities and for evaluation in routine care.

Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services

PubMed Central

2012-01-01

Background The study attempted to explore the quality of life (QoL) of Chinese caregivers with mentally ill relatives. It also aimed to examine the differential roles of caregiving burdens, caregiver characteristics, and satisfaction with psychiatric services in caregivers' QoL. Methods 276 caregivers with relatives attending community psychiatric facilities in Hong Kong were invited to fill out a questionnaire. One sample t-tests were conducted to compare the results of this study with that of other Chinese populations in Hong Kong, Taiwan, and mainland China. A hierarchical regression analysis was performed to examine the relative influence of different factors on caregivers' QoL. Results Our sample of caregivers had significantly lower QoL scores than other Chinese populations. Results also suggest that Chinese caregivers who had chronic illness, younger in age, a lower education level, experienced more difficulties in handling negative symptoms, and were more dissatisfied with mental health services had poorer quality of life. Indeed, caregiver characteristics displayed a much stronger association with caregivers' QoL than did caregiving burdens and satisfaction with psychiatric services. Conclusions This study supports the strong association of caregiver characteristics and the QoL of caregivers and establishes the nature of the relationship between satisfaction with mental health services and caregiver QoL. Implications for future research and practice are discussed. PMID:22289443

Motivations, aims and communication around advance directives: a mixed-methods study into the perspective of their owners and the influence of a current illness.

PubMed

van Wijmen, Matthijs P S; Pasman, H Roeline W; Widdershoven, Guy A M; Onwuteaka-Philipsen, Bregje D

2014-06-01

What are motivations of owners of an advance directive (AD) to draft an AD, what do they aim for with their AD and do they communicate about their AD? Written questionnaires were sent to a cohort of people owning different types of ADs (n=5768). A purposive sample of people suffering from an illness was selected from the cohort for an in-depth interview (n=29). About half of our population had no direct motivation to draft their AD. Most mentioned motivation for the other half was an illness of a family member or friend. Many different and specific aims for drafting an AD were mentioned. An often mentioned more general aim in people with different ADs was to prevent unnecessary lengthening of life or treatment (14-16%). Most respondents communicated about having an AD with close-ones (63-88%) and with their GP (65-79%). In the interviews people gave vivid examples of experiences of what they hoped to prevent at the end of life. Some mentioned difficulties foreseeing the future and gave examples of response shift. ADs can give directions to caregivers about what people want at the end of life. ADs have to be discussed in detail by their owners and caregivers, since owners often have specific aims with their AD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.

PubMed

Shao, Amani Flexson; Rambaud-Althaus, Clotilde; Swai, Ndeniria; Kahama-Maro, Judith; Genton, Blaise; D'Acremont, Valerie; Pfeiffer, Constanze

2015-04-02

The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker's perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified. In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient's trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices. The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.

British Asian families and the use of child and adolescent mental health services: a qualitative study of a hard to reach group.

PubMed

Bradby, Hannah; Varyani, Maya; Oglethorpe, Rachel; Raine, Wendy; White, Ishbel; Helen, Minnis

2007-12-01

We explored attitudes to and experiences of Child and Adolescent Mental Health Services (CAMHS) among families of South Asian origin who are underrepresented as service-users in an area of a Scottish city with a high concentration of people of South Asian origin. Six community focus groups were conducted, followed by semi-structured interviews with families who had used CAMHS and with CAMHS professionals involved in those families' cases. Lastly, parents of children who had problems usually referred to CAMHS but who had not used the service were interviewed. Qualitative analysis of transcripts and notes was undertaken using thematic and logical methods. Participants consisted of 35 adults who identified themselves as Asian and had children; 7 parents and/or the young service users him-herself; 7 health care professionals involved in the young person's care plus 5 carers of 6 young people who had not been referred to CAMHS, despite having suitable problems. Focus groups identified the stigma of mental illness and the fear of gossip as strong disincentives to use CAMHS. Families who had been in contact with CAMHS sought to minimise the stigma they suffered by emphasising that mental illness was not madness and could be cured. Families whose children had complex emotional and behavioural problems said that discrimination by health, education and social care professionals exacerbated their child's difficulties. Families of children with severe and enduring mental illness described tolerating culturally inappropriate services. Fear of gossip about children's 'madness' constituted a major barrier to service use for Asian families in this city. Given the widespread nature of the concern over the stigma of children's mental illness, it should be considered in designing culturally competent services for children's mental health.

Feasibility of conducting prospective observational research on critically ill, dying patients in the intensive care unit.

PubMed

van Beinum, Amanda; Hornby, Laura; Dhanani, Sonny; Ward, Roxanne; Chambers-Evans, Jane; Menon, Kusum

2017-01-01

Studying patients during the end of life is important, as it has the potential to lead to improvements in care for the dying. For patients who die after a controlled withdrawal of life-sustaining therapies in the intensive care unit, information about the natural history of death and the process of removing life support has additionally led to advances in practice for deceased organ donation. However, this unique population of severely critically ill and imminently dying patients has been difficult to study, largely due to assumptions made by research teams and ethics boards alike about the logistical difficulties of obtaining consent and completing research procedures before or during the process of withdrawal of life-sustaining therapies. In this paper, we describe the ethics substudy of the first prospective observational research study in Canada to obtain consent and collect clinical data on patients during the process of withdrawal of life-sustaining therapies in the intensive care unit. We describe in detail the process of protocol development, review by five institutional research ethics boards and bedside staff satisfaction with the study. We conclude that prospective research on a critically ill and imminently dying population is feasible and can be conducted in an ethical manner. Further information is needed about the experiences and motivations of families and substitute decision makers who provide consent for research on critically ill intensive care unit patients at the end of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Understanding childhood asthma in focus groups: perspectives from mothers of different ethnic backgrounds

PubMed Central

Cane, Rachel; Pao, Caroline; McKenzie, Sheila

2001-01-01

Background Diagnosing childhood asthma is dependent upon parental symptom reporting but there are problems in the use of words and terms. The purpose of this study was to describe and compare understandings of childhood 'asthma' by mothers from three different ethnic backgrounds who have no personal experience of diagnosing asthma. A better understanding of parents' perceptions of an illness by clinicians should improve communication and management of the illness. Method Sixty-six mothers living in east London describing their ethnic backgrounds as Bangladeshi, white English and black Caribbean were recruited to 9 focus groups. Discussion was semi-structured. Three sessions were conducted with each ethnic group. Mothers were shown a video clip of a boy with audible wheeze and cough and then addressed 6 questions. Sessions were recorded and transcribed verbatim. Responses were compared within and between ethnic groups. Results Each session, and ethnic group overall, developed a particular orientation to the discussion. Some mothers described the problem using single signs, while others imitated the sound or made comparisons to other illnesses. Hereditary factors were recognised by some, although all groups were concerned with environmental triggers. Responses about what to do included 'normal illness' strategies, use of health services and calls for complementary treatment. All groups were concerned about using medication every day. Expectations about the quality of life were varied, with recognition that restrictions may be based on parental beliefs about asthma, rather than asthma itself. Conclusion Information from these focus groups suggests mothers know a great deal about childhood asthma even though they have no personal experience of it. Knowledge of how mothers from these ethnic backgrounds perceive asthma may facilitate doctor – patient communication with parents of children experiencing breathing difficulties. PMID:11667951

Psychosocial adjustment in siblings of young people with Duchenne muscular dystrophy.

PubMed

Read, Joy; Kinali, Maria; Muntoni, Francesco; Garralda, M Elena

2010-07-01

Duchenne muscular dystrophy (DMD) is a progressive, impairing, life-limiting disorder of childhood. Little is known about how siblings adapt to this. The aim of this study is to document psychosocial adjustment in siblings of patients with DMD. Healthy siblings (11-18 years old) of young people with DMD attending a specialist paediatric centre and their parent/main carer took part. Parents, siblings and teachers completed a battery of questionnaires: (i) to assess psychiatric risk the Strengths and Difficulties Questionnaire (SDQ), General Health Questionnaire (GHQ), Hospital Anxiety and Depression Scale (HADS); (ii) to measure general wellbeing: SF-36; (iii) to document DMD illness disability: Functional Disability Inventory (FDI); (iv) to assess family function and life stresses for the unaffected sibling: Family Assessment Device (FAD), Family Burden Interview Schedule and Life Events Checklist. Forty six/77 eligible siblings (24 females/22 males); (mean age 14 years (SD 2.3)) took part. Although their mean psychological functioning and wellbeing questionnaire scores were comparable to normative data, there was a trend for more siblings scoring at high-risk for psychological (mainly emotional) problems. Weak/moderate associations with psychological symptoms in siblings varied according to informant and included the following factors: closeness in age to the affected sibling; older sibling age; extent of wheelchair use, burden of illness on family interactions, and siblings reporting high impact of illness on their lives. Psychological symptoms were also associated with less sibling involvement in patient care, with broader psychosocial and family disadvantage and with life stresses. Siblings have an increased risk for emotional problems, which appears influenced by specific illness factors. Copyright (c) 2009 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Written pain neuroscience education in fibromyalgia: a multicenter randomized controlled trial.

PubMed

van Ittersum, Miriam W; van Wilgen, C Paul; van der Schans, Cees P; Lambrecht, Luc; Groothoff, Johan W; Nijs, Jo

2014-11-01

Mounting evidence supports the use of face-to-face pain neuroscience education for the treatment of chronic pain patients. This study aimed at examining whether written education about pain neuroscience improves illness perceptions, catastrophizing, and health status in patients with fibromyalgia. A double-blind, multicenter randomized controlled clinical trial with 6-month follow-up was conducted. Patients with FM (n = 114) that consented to participate were randomly allocated to receive either written pain neuroscience education or written relaxation training. Written pain neuroscience education comprised of a booklet with pain neuroscience education plus a telephone call to clarify any difficulties; the relaxation group received a booklet with relaxation education and a telephone call. The revised illness perception questionnaire, Pain Catastrophizing Scale, and fibromyalgia impact questionnaire were used as outcome measures. Both patients and assessors were blinded. Repeated-measures analyses with last observation carried forward principle were performed. Cohen's d effect sizes (ES) were calculated for all within-group changes and between-group differences. The results reveal that written pain neuroscience education does not change the impact of FM on daily life, catastrophizing, or perceived symptoms of patients with FM. Compared with written relaxation training, written pain neuroscience education improved beliefs in a chronic timeline of FM (P = 0.03; ES = 0.50), but it does not impact upon other domains of illness perceptions. Compared with written relaxation training, written pain neuroscience education slightly improved illness perceptions of patients with FM, but it did not impart clinically meaningful effects on pain, catastrophizing, or the impact of FM on daily life. Face-to-face sessions of pain neuroscience education are required to change inappropriate cognitions and perceived health in patients with FM. © 2013 World Institute of Pain.

Good-parent beliefs of parents of seriously ill children.

PubMed

Feudtner, Chris; Walter, Jennifer K; Faerber, Jennifer A; Hill, Douglas L; Carroll, Karen W; Mollen, Cynthia J; Miller, Victoria A; Morrison, Wynne E; Munson, David; Kang, Tammy I; Hinds, Pamela S

2015-01-01

Parents' beliefs about what they need to do to be a good parent when their children are seriously ill influence their medical decisions, and better understanding of these beliefs may improve decision support. To assess parents' perceptions regarding the relative importance of 12 good-parent attributes. A cross-sectional, discrete-choice experiment was conducted at a children's hospital. Participants included 200 parents of children with serious illness. Ratings of 12 good-parent attributes, with subsequent use of latent class analysis to identify groups of parents with similar ratings of attributes, and ascertainment of whether membership in a particular group was associated with demographic or clinical characteristics. The highest-ranked good-parent attribute was making sure that my child feels loved, followed by focusing on my child's health, making informed medical care decisions, and advocating for my child with medical staff. We identified 4 groups of parents with similar patterns of good-parent-attribute ratings, which we labeled as: child feels loved (n=68), child's health (n=56), advocacy and informed (n=55), and spiritual well-being (n=21). Compared with the other groups, the child's health group reported more financial difficulties, was less educated, and had a higher proportion of children with new complex, chronic conditions. Parents endorse a broad range of beliefs that represent what they perceive they should do to be a good parent for their seriously ill child. Common patterns of how parents prioritize these attributes exist, suggesting future research to better understand the origins and development of good-parent beliefs among these parents. More important, engaging parents individually regarding what they perceive to be the core duties they must fulfill to be a good parent may enable more customized and effective decision support.

Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: a narrative review of educational interventions.

PubMed

Yamaguchi, Sosei; Mino, Yoshio; Uddin, Shahir

2011-08-01

There is a need to reduce stigma and increase awareness in order to prevent social exclusion of people with mental illness and to facilitate the use of mental health services in young people. The purpose of this review was to examine the effects of educational interventions to reduce stigmatization and improve awareness of mental health problems among young people. An electronic search using MEDLINE, PsycINFO and Academic Search Complete was carried out for studies that evaluated the effectiveness of educational interventions. Forty eligible studies were identified. There were three types of educational interventions (Educational condition, Video-based Contact condition and Contact condition). Eighteen of 23 studies reported significant improvements in knowledge, 27 of 34 studies yielded significant changes in attitudes towards people with mental illness. Significant effects in social distance were found in 16 of 20 studies. Two of five studies significantly improved young people's awareness of mental illness. However, six studies reported difficulties in maintaining improved knowledge, attitudes and social distance in young people. Furthermore, the majority of studies did not measure the actual behavioral change. From the comparison of the three types of educational interventions, direct contact with people with mental illness (Contact condition) seems to be key in reducing stigmatization, while the components of Education and Video-based contact conditions are still arguable. Despite the demonstration of the positive effects of each educational intervention, their long-term effects are still unclear. Further research needs to involve measuring actual behavioral change and performing a long-term follow up. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

The process of acceptance among rheumatoid arthritis patients in Switzerland: A qualitative study

PubMed Central

Kostova, Zlatina; Caiata-Zufferey, Maria; Schulz, Peter J

2014-01-01

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, painful disease with many injurious psychological effects. Acceptance is an important component of pain management and is associated with improved quality of life, and lower levels of pain and depression. While studies have begun to identify the stages of acceptance, little is known about factors influencing the ease and speed with which patients pass through these stages. OBJECTIVE: To explore the main stages through which RA patients pass and the strategies they adopt to learn to live with the pain, and to identify factors shaping patients’ capacities to achieve acceptance. METHODS: A qualitative study involving 20 semistructured interviews with RA patients in the Italian-speaking region of Switzerland was conducted. Analysis of the data followed the precepts of grounded theory. RESULTS: Although the present study revealed that acceptance is not a smooth or linear process, five main stages in patients’ struggles to accommodate the newly imposed limitations were, nonetheless, identified: naming the illness; realizing the illness; resisting the illness; ‘hitting the bottom’; and integrating the illness. Diagnosis proved to be an especially tortuous stage in the case of RA, and the effects of delayed diagnosis continued to be felt during the subsequent stages. Patients’ understanding of the notion of acceptance and the strategies that they used to achieve it were also explored. CONCLUSIONS: Diagnosis of RA is notoriously difficult. Beyond the clinical difficulties, structural reasons for late diagnosis (symptoms being neglected by patients and medical professionals) were identifed. Delayed diagnosis hindered the acceptance process throughout, and led to more resistant behaviour and to a struggle to achieve the optimal formula for acceptance – accepting the losses of prepain life while still pursuing personal goals. PMID:24527466

A symptom self-rating scale for schizophrenia (4S): psychometric properties, reliability and validity.

PubMed

Lindström, Eva; Jedenius, Erik; Levander, Sten

2009-01-01

The objective of the study was to validate a self-administrated symptom rating scale for use in patients with schizophrenia spectrum disorders by item analysis, exploration of factor structure, and analyses of reliability and validity. Data on 151 patients, initially treated by risperidone, obtained within the framework of a naturalistic Phase IV longitudinal study, were analysed by comparing patient and clinician ratings of symptoms, side-effects and global indices of illness. The Symptom Self-rating Scale for Schizophrenia (4S) is psychometrically adequate (item analysis, internal consistency, factor structure). Side-effect ratings were reliable. Symptom ratings displayed consistent associations with clinicians' ratings of corresponding symptom dimensions, suggesting construct validity. Patients had most difficulties assessing negative symptom items. Patients were well able to assess their own symptoms and drug side-effects. The factor structure of symptom ratings differs between patients and clinicians as well as how they construe global indices of illness. Clinicians focus on psychotic, patients on affective symptoms. Use of symptom self-ratings is one way to improve communication and thereby strengthen the therapeutic alliance and increase treatment adherence.

A Description of the Use of Music Therapy in Consultation-Liaison Psychiatry

PubMed Central

Ries, Rose

2007-01-01

Music therapy is gaining increasing recognition for its benefit in medical settings both for its salutary effects on physiological parameters and on psychological states associated with medical illness. This article discusses the role of a music therapist in consultation-liaison psychiatry, a specialty that provides intervention for medical and surgical patients with concomitant mental health issues. We describe the ways in which music therapy has been integrated into the consultation-liaison psychiatry service at Hahnemann University Hospital, a tertiary care facility and major trauma center in Philadelphia. The referral process and some of the techniques used in music therapy are explained. Anecdotal observations illustrate how a music therapist incorporates the various elements of music as well as the experiences of engaging in music-making to bring about changes in mood and facilitate expression of feelings and social interactions in patients who are having difficulty coping with the effects of illness and hospitalization. These methods have also been observed to have positive effects on the hospital staff by making available a means with which staff can express pressures inherent in direct patient care. PMID:20805929

A study of family carers of people with a life-threatening illness. 2: Implications of the needs assessment.

PubMed

Scott, G

2001-07-01

This is the second of two articles that consider the findings of a Carers' Assessment of Difficulties Index (CADI) (Nolan et al, 1998) delivered in a palliative care context. It analyses the implications of these findings for practitioners concerned with the delivery of palliative care to such carers and their families. The development of support strategies and services addressing their needs are also presented against a backdrop of transactional stress theory. For people new to caring, recommendations for the local service include early intervention through informational support and validation of their emotional responses to caring; for longer-term carers they include assistance with cognitive reappraisal of the stressfulness of caring and regular 'respite' and socializing opportunities. These are taking place in a political climate that finally recognizes the contribution and value of carers (Department of Health, 1999). The research behind these carer identity and recognition initiatives aims to apply the spirit of public recognition and practical wisdom of palliative care expertise by responding sensitively to the specific needs of carers of people with a life-threatening illness.

Psychological support based on positive suggestions in the treatment of a critically ill ICU patient – A case report

PubMed Central

Varga, Zsófia; Fritúz, Gábor

2013-01-01

This case report describes the way psychological support based on positive suggestions (PSBPS) was added to the traditional somatic treatment of an acute pancreatitis 36-year-old male patient. Psychological support based on positive suggestions (PSBPS) is a new adjunct therapeutic tool focused on applying suggestive techniques in medical settings. The suggestive techniques usually applied with critically ill patients are based on a number of pre-prepared scripts like future orientation, reframing, positivity, supporting autonomy, etc., and other, very unique and personalized interventions, which are exemplified with verbatim quotations. We describe the way several problems during treatment of intensive care unit (ICU) patients were solved using suggestive methods: uncooperativeness, difficulties of weaning, building up enteral nutrition, supporting recovery motivation, and so on, which permanently facilitated the patient’s medical state: the elimination of gastrointestinal bleeding, recovery of the skin on the abdomen, etc. Medical effects follow-up data at 10 months show that the patient recovered and soon returned to his original work following discharge. PMID:24381733

Chronic stressors and trauma: prospective influences on the course of bipolar disorder

PubMed Central

Gershon, A.; Johnson, S. L.; Miller, I.

2013-01-01

Background Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients. Method One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments). Results Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance. Conclusions Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress. PMID:23419615

Military nutrition: maintaining health and rebuilding injured tissue.

PubMed

Hill, Neil; Fallowfield, Joanne; Price, Susan; Wilson, Duncan

2011-01-27

Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel.

Away from home: experiences of Mexican American families in pediatric palliative care.

PubMed

Contro, Nancy; Davies, Betty; Larson, Judith; Sourkes, Barbara

2010-01-01

In this study, the authors describe the experiences of Mexican American family members who immigrated to the United States and then experienced the death of a child. Participants described difficulties they encountered crossing the border, leaving the culture of their homeland, and then caring for a seriously ill child. Key themes that characterized their experience of being far from home included a backdrop of poverty, absence of traditional social support, and challenges caring for healthy siblings. Participants made comparisons between health care in Mexico and the United States and assessed the trade-off they made to come to the United States, discussing access to medical care and how they were able to relate to health care providers. Further, participants conveyed how rituals from their home country were important in maintaining connections with the child who died. Based on these themes, clinical implications and strategies that focus on understanding participants' experiences with past traumas, communication and literacy needs, and the challenges of living in poverty--especially with a critically ill child--are needed.

[Bioethics and research into mental health].

PubMed

Braz, Marlene; Schramm, Fermin Roland

2011-04-01

This article discusses research in the field of mental health, examining the ethical is sues involved and the use of Informed Consent. In order to achieve these objectives two main approaches were used: (1) a brief history of the different treatments and research with patients with mental illness or disability; (2) theoretical and conceptual analysis of the main problems concerning the mental health field, namely the notion of vulnerability, responsibility and autonomy and the use of placebo control groups. Two main questions prompted the reflection on whether the patient with a mental disorder can sign an Informed Consent, and whether the use of a placebo is acceptable. The existence of antagonistic and contradictory positions indicates that mental health research is hampered by biases that are difficult to overcome. Ethical investigation that may contribute to the healing of mental disorders should not however be overlooked merely because of the difficulties involved in its implementation. It must be borne in mind that changes occurring in the context of Psychiatric Reform in Brazil are gradually altering archaic concepts about what constitutes mental illness and how this group should be understood and treated.

Self-stigma in women with borderline personality disorder and women with social phobia.

PubMed

Rüsch, Nicolas; Hölzer, Aurelia; Hermann, Christiane; Schramm, Elisabeth; Jacob, Gitta A; Bohus, Martin; Lieb, Klaus; Corrigan, Patrick W

2006-10-01

Little is known about how women with borderline personality disorder (BPD) and women with social phobia react to mental illness stigma. The goal of this study was to assess empirically self-stigma and its correlates in these groups. Self-stigma and related constructs were measured by self-report questionnaires among 60 women with BPD and 30 women with social phobia. Self-stigma was inversely related to self-esteem, self-efficacy, and quality of life and predicted low self-esteem after controlling for depression and shame-proneness. Stereotype awareness was not significantly correlated with self-esteem or quality of life. While there was no difference in stereotype awareness between women with BPD and women with social phobia, women with BPD showed higher self-stigma than women with social phobia. Self-stigma is associated with low self-esteem and other indices of poor psychological well-being. In comparison to women with social phobia, women with BPD suffer from more self-stigma. This may reflect intense labeling processes as being mentally ill due to repeated hospitalizations, frequent interpersonal difficulties, and visible scars.

Family Management Style Framework: a new tool with potential to assess families who have children with brain tumors.

PubMed

Deatrick, Janet A; Thibodeaux, Annaka G; Mooney, Kim; Schmus, Cynthia; Pollack, Rosanna; Davey, Barbara Hieb

2006-01-01

Qualitative studies of families with children who have cancer or other serious illnesses have found that families often come to view their child and their lives as normal. They manage illness-related demands using family management styles that sustain usual patterns of family and child functioning. Few studies have addressed the family management styles of families who express less satisfaction with family and child functioning or who are identified by health care professionals as having difficulty with family functioning. Such families are likely to be overrepresented among those whose children are being treated for brain tumors that entail extremely burdensome treatments as well as a range of unfavorable prognoses and long-term sequelae. In fact, little is known about how these families manage on a day-to-day basis and how the interdisciplinary team can best provide supportive care to optimize their functioning. The purpose of this article is to present the Family Management Styles Framework as a tool that is useful in both clinical practice and research for assessing families who have children with cancer, including those with brain tumors.

Disorganised schizotypy is selectively associated with poorer semantic processing in non-clinical individuals.

PubMed

Tan, Eric Josiah; Rossell, Susan Lee

2017-10-01

The nature and severity of semantic memory (SM) impairments in schizophrenia has been related to symptoms, mainly formal thought disorder (FTD), and other clinical factors like length of illness. Symptom-related studies in schizophrenia are often confounded by clinical factors, for example medication and hospitalisations. We completed a schizotypy analogue study to examine the relationship between SM processing and FTD using an analogue schizotypy score referred to as cognitive disorganisation. Sixty individuals without a history of mental illness (M=22.92, SD=2.70) completed a schizotypy questionnaire and three semantic tasks - naming pictures, category fluency and semantic priming. Only decreasing fluency was associated with increasing cognitive disorganisation scores (p=0.029). In line with the prevailing dyssemantic theories, the results highlight that cognitive disorganisation is associated with some difficulties in SM processes, though not all. The observed differential relationships of SM processes to disorganised schizotypy are discussed in relation to previous work, and in terms of potential developmental trajectories for SM impairment in schizophrenia. Copyright © 2017 Elsevier B.V. All rights reserved.

Military nutrition: maintaining health and rebuilding injured tissue

PubMed Central

Hill, Neil; Fallowfield, Joanne; Price, Susan; Wilson, Duncan

2011-01-01

Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel. PMID:21149358

Chronic stressors and trauma: prospective influences on the course of bipolar disorder.

PubMed

Gershon, A; Johnson, S L; Miller, I

2013-12-01

Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients. One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments). Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance. Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.

National and international response to occupational hazards in the healthcare sector.

PubMed

Froneberg, Brigitte

2006-09-01

The health care sector is one of the largest, most rapidly expanding areas of employment and is increasingly in need of qualified staff especially in the area of nursing. The health care sector is complex and comprises a variety of largely different professions; occupational hazards and exposures differ accordingly. Rates of absenteeism, reported work-related ill-health, and early retirement or departure from professions are comparatively high, especially among the nursing staff. While classical health hazards are addressed by international and national regulations, underlying causes of ill-health and departure from the profession, such as psychological stress, violence, pressing time schedules, and poor work organization are less well heeded. Practical guidance and quality information have become increasingly available from national and international Occupational Safety and Health (OSH) institutions and can be easily accessed through the Internet. They will undoubtedly benefit the profession, but difficulties not related to OSH will warrant political solutions. This presentation provides access to relevant international and European Union (EU) legislation and to valuable information resources for health care workers available from the Internet.

Using drawing tests to explore the multidimensional psychological aspects of children with cancer.

PubMed

Hatano, Yutaka; Yamada, Miwa; Nakagawa, Kanae; Nanri, Hiromi; Kawase, Masatoshi; Fukui, Kenji

2014-10-01

In seeking to understand how life-threatening illness affects children psychologically, projective testing may be beneficial, particularly when attempting to identify psychological problems in younger adolescents. The advantages of projective testing are that it does not depend on patients' verbal ability and is not invasive. Three cancer inpatients from Kyoto Prefectural University of Medicine, aged between 10 and 16 years old, participated in the study. Projective testing was used to measure the depth of participants' distress and included a tree-drawing test, a person-drawing test and a free drawing test. Results from the tree- and person-drawing tests indicated energy loss, anxiety and a sense of emptiness. However, results from the free drawing test suggested that the children had hope and a desire to recover from their illness. The combination of drawing tests in this study may increase the understanding of the internal psychological difficulties faced by children hospitalized with cancer. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A cognitive perspective on medical expertise: theory and implication.

PubMed

Schmidt, H G; Norman, G R; Boshuizen, H P

1990-10-01

A new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the features of prototypical or even actual patients. These cognitive structures, referred to as "illness scripts," contain relatively little knowledge about pathophysiological causes of symptoms and complaints but a wealth of clinically relevant information about disease, its consequences, and the context under which illness develops. By contrast, intermediate-level students without clinical experience typically use pathophysiological, causal models of disease when solving problems. The authors review evidence supporting the theory and discuss its implications for the understanding of five phenomena extensively documented in the clinical-reasoning literature: (1) content specificity in diagnostic performance; (2) typical differences in data-gathering techniques between medical students and physicians; (3) difficulties involved in setting standards; (4) a decline in performance on certain measures of clinical reasoning with increasing expertise; and (5) a paradoxical association between errors and longer response times in visual diagnosis.

A woman with dermatitis and dissociative periods.

PubMed

Wise, T N; Reading, A J

1975-01-01

A nineteen year old female with pustular eczema and dissociative spells is presented. The patient has a three year history of severe dermatitis beginning shortly after her marriage. Central dynamic issues appear to be difficulty separating from her mother and an ambivalent identification with a hostile father. The patient also describes fugue-like episodes which occur with emerging aggressive feelings. Psychological testing supported these hypotheses. The relevant literature describing the correlation between aggression and skin disease is reviewed. A final uniform formulation was tentatively proposed that this patient, in addition to a strong genetic component for atopic dermatitis, had her illness abetted by inability to cope with aggressive affects.

Myalgia Cruris Epidemica: an unusual presentation of dengue fever.

PubMed

Ahmad, Rashidi; Abdul Latiff, Abdul Kursi; Abdul Razak, Salmi

2007-11-01

We describe a 5-year-old girl who had sudden onset difficulty in walking after 3 days of febrile illness. In the emergency department her creatine kinase level was elevated but urine myoglobin was normal. She was diagnosed as having benign acute childhood myositis. Because of poor oral intake and dehydration, she was admitted to the pediatric ward. The next day she had a petechial rash over the antecubital fossa, and dengue IgM back was positive. She was treated conservatively and recovered uneventfully. Despite dengue fever being endemic in Malaysia, this is the first case report of myositis following dengue infection in Malaysia.

Rat Bite Fever and Streptobacillus moniliformis

PubMed Central

Elliott, Sean P.

2007-01-01

Rat bite fever, caused by Streptobacillus moniliformis, is a systemic illness classically characterized by fever, rigors, and polyarthralgias. If left untreated, it carries a mortality rate of 10%. Unfortunately, its nonspecific initial presentation combined with difficulties in culturing its causative organism produces a significant risk of delay or failure in diagnosis. The increasing popularity of rats and other rodents as pets, together with the risk of invasive or fatal disease, demands increased attention to rat bite fever as a potential diagnosis. The clinical and biological features of rat bite fever and Streptobacillus moniliformis are reviewed, providing some distinguishing features to assist the clinician and microbiologist in diagnosis. PMID:17223620

On inconsistency in frictional granular systems

NASA Astrophysics Data System (ADS)

Alart, Pierre; Renouf, Mathieu

2018-04-01

Numerical simulation of granular systems is often based on a discrete element method. The nonsmooth contact dynamics approach can be used to solve a broad range of granular problems, especially involving rigid bodies. However, difficulties could be encountered and hamper successful completion of some simulations. The slow convergence of the nonsmooth solver may sometimes be attributed to an ill-conditioned system, but the convergence may also fail. The prime aim of the present study was to identify situations that hamper the consistency of the mathematical problem to solve. Some simple granular systems were investigated in detail while reviewing and applying the related theoretical results. A practical alternative is briefly analyzed and tested.

Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology.

PubMed

Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A

2010-01-01

Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

Religious coping and cognitive symptoms of depression in elderly medical patients.

PubMed

Koenig, H G; Cohen, H J; Blazer, D G; Kudler, H S; Krishnan, K R; Sibert, T E

1995-01-01

The investigators examined associations between depressive symptom type and religious coping in 832 consecutively admitted older medical inpatients. Cognitive symptoms of depression, but not somatic symptoms, were related to religious coping. Boredom, loss of interest, social withdrawal, feeling downhearted and blue, restlessness, feeling like a failure, feeling hopeless, or feeling that other people were better off were all significantly less common among religious copers. Difficulty initiating new activities was the only somatic symptom related to this coping behavior. Religious coping, a strategy heavily dependent on cognitive processes, is associated with fewer cognitive but not somatic symptoms of depression in medically ill older patients

Schizophrenia: management and family burden.

PubMed

Sebit, M B

2007-01-01

To explore schizophrenia with respect to its management, causes, risk factors as well as the impact it has in families regarding the burden and social networks support. Desk literature reviews. The findings are that patients with schizophrenia typically have great difficulty following a medication regimen, but they also have the greatest potential for benefiting from adherence. As with other chronic diseases that lack a definitive cure, the individual's service/recovery plan must include treatment interventions directed towards decreasing manifestations of the illness, rehabilitative services, enhancing adaptive skills, and social support mobilization aimed at optimizing function and quality of life. Finally, this paper is not exhaustive, but a pointer for further readings.

An Output Approach to Incentive Reimbursement for Hospitals

PubMed Central

Ro, Kong-kyun; Auster, Richard

1969-01-01

A method of incentive reimbursement for health care institutions is described that is designed to stimulate the providers' efficiency. The two main features are: (1) reimbursement based on a weighted average of actual cost and mean cost plus or minus an appropriate number of standard deviations; (2) output defined as episodes of illness given adequate treatment instead of days of hospitalization. It is suggested that despite the operational difficulties involved in a method of payment based on an output approach, the flexibility incorporated into the determination of reimbursement by use of the properties of a normal frequency distribution would make the system workable. PMID:5349002

Learning to attain an advanced level of professional responsibility.

PubMed

Ter Maten-Speksnijder, Ada; Grypdonck, Mieke; Pool, Aart; Meurs, Pauline; Van Staa, AnneLoes

2015-08-01

After graduation, nurse practitioner students are expected to be capable of providing complex, evidence-based nursing care independently, combined with standardized medical care. The students who follow work-study programs have to develop their competencies in a healthcare environment dominated by efficiency policies. This study aims to explore nurse practitioner students' perceptions of their professional responsibility for patient care. This qualitative interpretative study entails a content analysis of 46 reflective case studies written by nurse practitioner students. The students felt responsible for the monitoring of patients' health status, attending to psychosocial problems, emphasizing compliance, and optimizing the family's role as informal caregivers. At the same time, students struggled to understand the complexities of their patients' needs, and they had difficulty applying their knowledge and skills to complex medical, psychological, and social problems. The students' perceptions of their new responsibility were characterized by a strong focus on curative care, while psychosocial components of health and illness concerns were often overlooked. The students experienced difficulties in meeting the criteria of advanced practice nursing described in the Dutch competency framework. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anger in the UK Armed Forces: strong association with mental health, childhood antisocial behavior, and combat role.

PubMed

Rona, Roberto J; Jones, Margaret; Hull, Lisa; MacManus, Deirdre; Fear, Nicola T; Wessely, Simon

2015-01-01

We assessed the strength of the association of several mental health problems, childhood difficulties, and combat role with anger, as well as the contribution of these factors to explain anger assessed by population attributable fraction (PAF). A total of 9885 UK service personnel, some of them deployed to Iraq and Afghanistan, participated in the study. There was a strong or intermediate association between cases and subthreshold cases of symptoms of posttraumatic stress disorder, psychological distress, multiple physical symptoms and alcohol misuse, having a combat role, childhood adversity, and childhood antisocial behavior with anger. The PAF for any mental health problem and combat role and childhood difficulties was 0.64 (95% confidence interval [CI], 0.56-0.70) and increased to 0.77 (95% CI, 0.69-0.83) if subthreshold cases were included. Anger is a frequent component of mental disorders; health care professionals need to be aware of the interference of anger in the management of mental illness and that anger infrequently presents as an isolated phenomenon.

On quantum integrability of the Landau-Lifshitz model

NASA Astrophysics Data System (ADS)

Melikyan, A.; Pinzul, A.

2009-10-01

We investigate the quantum integrability of the Landau-Lifshitz (LL) model and solve the long-standing problem of finding the local quantum Hamiltonian for the arbitrary n-particle sector. The particular difficulty of the LL model quantization, which arises due to the ill-defined operator product, is dealt with by simultaneously regularizing the operator product and constructing the self-adjoint extensions of a very particular structure. The diagonalizibility difficulties of the Hamiltonian of the LL model, due to the highly singular nature of the quantum-mechanical Hamiltonian, are also resolved in our method for the arbitrary n-particle sector. We explicitly demonstrate the consistency of our construction with the quantum inverse scattering method due to Sklyanin [Lett. Math. Phys. 15, 357 (1988)] and give a prescription to systematically construct the general solution, which explains and generalizes the puzzling results of Sklyanin for the particular two-particle sector case. Moreover, we demonstrate the S-matrix factorization and show that it is a consequence of the discontinuity conditions on the functions involved in the construction of the self-adjoint extensions.

Adjustment to the death of a sibling.

PubMed Central

Pettle Michael, S A; Lansdown, R G

1986-01-01

Despite the recent increase in interest in terminally ill children and their families and the post death adjustment of parents, there has been little research examining the adjustment and self concept of surviving siblings in such families. This paper discusses the results of a preliminary descriptive study of 28 children (from 14 families) whose brother or sister had died of cancer between 18 and 30 months previously. Behaviour checklists were completed by parents and teachers and self concept scales administered to the children. A lengthy semistructured interview was carried out, and measures of parental adjustment were gathered. A high percentage of children were found to be exhibiting emotional or behavioural difficulties, or both, and the results indicated that low self esteem was common. Parental and child adjustment were not found to be related inter se, nor did they seem to relate to the child's self esteem. Thus for many children the loss of a sibling might cause long term distress. Further, many children who did not manifest overt difficulties perceived themselves unfavourably in comparison with either their ideal or their dead sibling. PMID:3963872

Work-related Mental Health Surveillance in Brazil: characteristics, difficulties, and challenges.

PubMed

Araújo, Tania Maria; Palma, Tarciso de Figueiredo; Araújo, Natália do Carmo

2017-10-01

This paper addresses the challenges and difficulties in Work-related Mental Health (WMH) Surveillance in Brazil, based on a review of the bibliographic literature. From the compilation of identified academic research, it seeks to foster reflections about the current landscape of surveillance actions, its main obstacles, and possibilities for improvement. A survey of national publications was carried out using Scielo, Lilacs and PUBMED databases from 2002 until 2017. Systematizing the results allows us to group the following themes: Epidemiology of WMH in Brazil; Policies for WMH and VISAT; Work Environment for Mental Health; and, Actions and Interventions in the VISAT and WMH. The surveillance actions are still in the early stages; however, there is an effort to strengthen the RENAST, materialized in the creation of protocols and the promotion of national meetings which reflect the construction of a new surveillance model for worker health. We noted a search for new conceptual models of mental illness, a redefinition of the focus of care, and of intervention approaches highlighting the active role of workers, who are essential players in facing the challenges in this area.

Anxiety and Depressive Symptoms and Medical Illness Among Adults with Anxiety Disorders

PubMed Central

Niles, Andrea N.; Dour, Halina J.; Stanton, Annette L.; Roy-Byrne, Peter P.; Stein, Murray B.; Sullivan, Greer; Sherbourne, Cathy D.; Rose, Raphael D.; Craske, Michelle G.

2014-01-01

Objective Anxiety is linked to a number of medical conditions, yet few studies have examined how symptom severity relates to medical comorbidity. Purpose The current study assessed associations between severity of anxiety and depression and presence of medical conditions in adults diagnosed with anxiety disorders. Method Nine-hundred eighty-nine patients diagnosed with panic, generalized anxiety, social anxiety, and posttraumatic stress disorders reported on the severity of anxiety and depressive symptoms and on diagnoses of 11 medical conditions. Results Severity of anxiety and depressive symptoms was strongly associated with having more medical conditions over and above control variables, and the association was as strong as that between BMI and disease. Odds of having asthma, heart disease, back problems, ulcer, migraine headache and eyesight difficulties also increased as anxiety and depressive symptom severity increased. Anxiety symptoms were independently associated with ulcer, whereas depressive symptoms were independently associated with heart disease, migraine, and eyesight difficulties. Conclusions These findings add to a growing body of research linking anxiety disorders with physical health problems and indicate that anxiety and depressive symptoms deserve greater attention in their association with disease. PMID:25510186

[Practices and interventions related to the work integration of people with a severe mental illness: work outcomes and avenues of research].

PubMed

Pachoud, B; Corbière, M

2014-06-01

Sustained work integration for people with a severe mental illness or handicap psychique in French (e.g., schizophrenia) is an important issue in our society today. Indeed, work is not only an essential factor in people's social integration but is also a stepping-stone toward recovery for this clientele. Well-defined programs and services related to work integration were developed and studied over the last three decades. Although the work integration of people with severe mental illness has been studied extensively in the Anglo-Saxon literature, the impact of these studies on the traditional beliefs and services in France remains uncertain. In terms of the scope of the studies so far, there has been an initial interest lasting over many years to uncover individual characteristics of people with severe mental illness which would best predict job tenure. Since, studies have been increasingly investigating various supports in order to facilitate the work integration process. These supports can be illustrated as direct supports or accommodations offered in the workplace, as needed, particularly when people with severe mental illness choose to disclose their mental disorder in the workplace. This awareness of the impact of the workplace environment on the work integration of people with a severe mental illness increases the need to find solutions and develop environmentally sensitive clinical strategies to overcome difficulties during the work integration. To illustrate this thematic, in this special issue, we have gathered together studies conducted in different countries but who share the focus on work integration of people with a severe mental illness. To reflect the advancement in this domain, this special issue is divided in three parts. The first part consists of the presentation of different types of vocational programs: supported employment programs, social firms, and hybrid models. Supported employment programs are very well documented in the specialised literature and are recognized as an evidence-based practice across the world to help people get competitive employment. Social firms is an another alternative model for facilitating the work integration of people with severe mental illness but has to date scarcely been studied empirically. Other hybrid vocational programs implemented in Québec (Canada) and France and inspired by supported employment programs and social firms' principles, are also described. The second part of this special issue is related to the presentation of two adjunct clinical interventions for helping people with a severe mental illness in their work integration, and more particularly for increasing job tenure: cognitive remediation and group cognitive behavioral therapy. Cognitive remediation was developed to reduce the impact of cognitive deficits, such as memory or attention, in people with a severe mental illness whereas group cognitive behavioral therapy was developed to change the dysfunctional beliefs and behaviours that might hinder job tenure in people receiving supported employment services. Finally, the third part of this special issue presents two papers on the influence of the workplace, of stakeholders from the organization (e.g., employers, supervisors) and of the work environment on the work integration of people with severe mental illness. The first paper discusses disclosure of the mental illness in the workplace and its positive and negative consequences such as receiving work accommodations and experiencing stigma, respectively. In the last paper, psychological processes during the hiring process are presented to better understand the elements related to discrimination and stigma during the work integration of people with severe mental illness. Copyright © 2014. Published by Elsevier Masson SAS.

Student Cognitive Difficulties and Mental Model Development of Complex Earth and Environmental Systems

NASA Astrophysics Data System (ADS)

Sell, K.; Herbert, B.; Schielack, J.

2004-05-01

Students organize scientific knowledge and reason about environmental issues through manipulation of mental models. The nature of the environmental sciences, which are focused on the study of complex, dynamic systems, may present cognitive difficulties to students in their development of authentic, accurate mental models of environmental systems. The inquiry project seeks to develop and assess the coupling of information technology (IT)-based learning with physical models in order to foster rich mental model development of environmental systems in geoscience undergraduate students. The manipulation of multiple representations, the development and testing of conceptual models based on available evidence, and exposure to authentic, complex and ill-constrained problems were the components of investigation utilized to reach the learning goals. Upper-level undergraduate students enrolled in an environmental geology course at Texas A&M University participated in this research which served as a pilot study. Data based on rubric evaluations interpreted by principal component analyses suggest students' understanding of the nature of scientific inquiry is limited and the ability to cross scales and link systems proved problematic. Results categorized into content knowledge and cognition processes where reasoning, critical thinking and cognitive load were driving factors behind difficulties in student learning. Student mental model development revealed multiple misconceptions and lacked complexity and completeness to represent the studied systems. Further, the positive learning impacts of the implemented modules favored the physical model over the IT-based learning projects, likely due to cognitive load issues. This study illustrates the need to better understand student difficulties in solving complex problems when using IT, where the appropriate scaffolding can then be implemented to enhance student learning of the earth system sciences.

Older Adult Experience of Online Diagnosis: Results From a Scenario-Based Think-Aloud Protocol

PubMed Central

2014-01-01

Background Searching for online information to interpret symptoms is an increasingly prevalent activity among patients, even among older adults. As older adults typically have complex health care needs, their risk of misinterpreting symptoms via online self-diagnosis may be greater. However, limited research has been conducted with older adults in the areas of symptom interpretation and human-computer interaction. Objective The intent of the study was to describe the processes that a sample of older adults may use to diagnose symptoms online as well as the processes that predict accurate diagnosis. Methods We conducted a series of “think-aloud” protocols with 79 adults aged 50 years or older. Participants received one of two vignettes that depicted symptoms of illness. Participants talked out loud about their thoughts and actions while attempting to diagnose the symptoms with and without the help of common Internet tools (Google and WebMD’s Symptom Checker). Think-aloud content was categorized using an adapted Q-sort and general inductive approach. We then compared the think-aloud content of participants who were accurate in their diagnosis with those who were not. Results Nineteen descriptive codes were identified from the think-aloud content. The codes touched upon Web navigation, attempts to organize and evaluate online health information, and strategies to diagnose symptoms. Participants most frequently relied on a strategy where they reviewed and then rejected the online diagnoses if they contained additional symptoms than those that were depicted in the vignette. Finally, participants who were inaccurate in their diagnosis reported being confused by the diagnosis task, lacking confidence in their diagnosis, and using their past experiences with illness to guide diagnosis more frequently than those participants who accurately diagnosed the symptoms. Conclusions Older adult participants tended to rely on matching strategies to interpret symptoms, but many still utilized existing medical knowledge and previous illness experiences as a guide for diagnosis. Many participants also had difficulty navigating the Internet tools, which suggests an increased need for navigation aids in Web design. Furthermore, participants who were inaccurate in their diagnosis had more difficulty with the Internet tools and confusion with the task than those who were accurate. Future work in this area may want to utilize additional study design such as eye-tracking to further understand the coordination between Web navigation, online symptom information processing, and diagnostic strategies. PMID:24434479

[Using the subcutaneous approach for symptoms control in a health center].

PubMed

Pascual López, L; Portaceli Armiñana, A; Ros Sáez, A

2001-01-01

To describe the use of the subcutaneous tract for symptoms control in patients those are in phase of palliative treatment of their illness. Observational study. Primary care. Patients seen in a health center, in phase of palliative treatment of their illness, that needed for symptoms control the subcutaneous administration of drugs. Most of the patients were in terminal phase (19), the fundamental cause (17 cases) that justified the use of the subcutaneous tract was the difficulty to take drugs by oral tract in the last days of life, attention on death throes. The infusion continuous through injector type travenol, at an infusion speed of 2 ml/h, it was the most common way of drug administration (19 patients). The drugs and initial average dose most used were: morphine 19 patients dose 100 mg/24 h, hyoscine butylbromide (Buscapina), 13 patients, 60 mg/24 h, haloperidol 12 patients, 4 mg/24 h. The patients death was the main cause that justified the retirement of the continuous infusion (17 people sick), happening in its own home. Symptoms control was good or very good in the most of patients (14). The experience on using the subcutaneous tract for symptoms control in our health center is positive, being the fundamental cause for its use symptoms control in the last days of the patients life. The continuous subcutaneous infusion should be used in primary attention, as an usual technique for the symptoms control in patients that are in phase of palliative treatment of their illness.

Not feeling ready to go home: a qualitative analysis of chronically ill patients' perceptions on care transitions.

PubMed

Verhaegh, Kim J; Jepma, Patricia; Geerlings, Suzanne E; de Rooij, Sophia E; Buurman, Bianca M

2018-06-25

Unplanned hospital readmissions frequently occur and have profound implications for patients. This study explores chronically ill patients' experiences and perceptions of being discharged to home and then acutely readmitted to the hospital to identify the potential impact on future care transition interventions. Twenty-three semistructured interviews were conducted with chronically ill patients who had an unplanned 30-day hospital readmission at a university teaching hospital in the Netherlands. A constructive grounded theory approach was used for data analysis. The core category identified was 'readiness for hospital discharge,' and the categories related to the core category are 'experiencing acute care settings' and 'outlook on the recovery period after hospital discharge.' Patients' readiness for hospital discharge was influenced by the organization of hospital care, patients' involvement in decision-making and preparation for discharge. The experienced difficulties during care transitions might have influenced patients' ability to cope with challenges of recovery and dependency on others. The results demonstrated the importance of assessing patients' readiness for hospital discharge. Health care professionals are recommended to recognize patients and guide them through transitions of care. In addition, employing specifically designated strategies that encourage patient-centered communication and shared decision-making can be vital in improving care transitions and reduce hospital readmissions. We suggest that health care professionals pay attention to the role and capacity of informal caregivers during care transitions and the recovery period after hospital discharge to prevent possible postdischarge problems.

Chronic physical illness and mental health in children. Results from a large-scale population study.

PubMed

Hysing, Mari; Elgen, Irene; Gillberg, Christopher; Lie, Stein Atle; Lundervold, Astri J

2007-08-01

The aim of the present study was to evaluate the sensitivity and specificity of the Strengths and Difficulties Questionnaire (SDQ) in detecting emotional and behavioural problems among children with chronic illness (CI). Parents and teachers of a population of primary school children in Norway (n = 9430) completed a questionnaire including the SDQ, and a question about chronic illness. A total of 74% (n = 7007) of the parents participated. A sub-sample (n = 1040) was given a psychiatric diagnostic evaluation according to the Development and Well-Being Assessment (DAWBA). According to parent reports, 537 (8%) children had a CI. The SDQ revealed an increased risk of emotional and behavioural problems in children with CI as compared with non-CI peers, both among boys (OR = 2.10 CI 95% 1.56-2.83) and girls (OR = 2.11 CI 95% 1.49-2.99). Children with CI also showed an increased risk of psychiatric disorder as assessed by the DAWBA (OR = 1.70 CI 95% 1.04-2.85). Both the sensitivity and specificity of the SDQ in predicting a psychiatric diagnosis were high, even when only information from parents was included. Children with CI in the general population are at increased risk of behavioural and emotional problems and psychiatric disorders. Given its high sensitivity and specificity the SDQ might work well as a screening instrument for behaviour/emotional problems and psychiatric disorder in children with CI.

Recognition of depressive symptoms by physicians.

PubMed

Henriques, Sergio Gonçalves; Fráguas, Renério; Iosifescu, Dan V; Menezes, Paulo Rossi; Lucia, Mara Cristina Souza de; Gattaz, Wagner Farid; Martins, Milton Arruda

2009-01-01

To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4-76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2-99.4%). Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.

Health Care Professionals' Perceptions of Seriously Ill Women.

NASA Astrophysics Data System (ADS)

Hardin, Kimeron Norman

1990-01-01

The research was designed to measure the perceptions of health care professionals toward women with serious illness. Physicians, psychologists and nurses were randomly chosen from lists of licensed practicing professionals and were surveyed. Each respondent read one of four vignettes describing a woman who had received one of four diagnoses: breast cancer, lung cancer, heart attack, or severe burn. The respondents were asked to respond to the Profile of Mood States (POMS) as they perceived the woman had been feeling during the past week. They then answered a series of ten questions about the woman's recovery and about their own anticipated behaviors while interacting with her. Two-way ANOVAs revealed that nurses and psychologists perceived the woman as having more mood disturbance and they saw more need for psychological counseling than physicians, regardless of her diagnosis. Several differences emerged in terms of perceptions of diagnosis. Subjects perceived themselves as being more comfortable around heart attack patients than lung cancer patients, breast cancer patients or burn patients and as having more difficulty talking to a woman with lung cancer than a woman with a heart attack. They also perceived a woman with lung cancer as having poorer chances of survival and they perceived women with more disfiguring disorders, breast cancer and severe burns, as having more sexual adjustment problems than the other diagnostic groups. The results of this survey supports the need for training for health care professionals in recognizing psychological distress in, and appropriately referring, seriously ill women.

Gender differences in food insecurity and morbidity among adolescents in southwest Ethiopia.

PubMed

Belachew, Tefera; Hadley, Craig; Lindstrom, David; Gebremariam, Abebe; Michael, Kifle Wolde; Getachew, Yehenew; Lachat, Carl; Kolsteren, Patrick

2011-02-01

Several studies have shown the adverse health consequences of food insecurity on household members. To what extent this relationship is mediated by gender among adolescents has not been documented. We hypothesized that the health consequences of food insecurity would be more pronounced in girls compared with boys. We used the first-round data from a 5-year longitudinal family survey of 2084 adolescents aged 13 to 17 years from urban, semiurban, and rural areas of southwest Ethiopia. Stratified random sampling was used to select households and adolescents. Multivariable logistic regression was used to compare self-reported morbidity according to food-security status and gender after adjusting for nutritional and socioeconomic covariates. Overall, 29.9% of girls and 19.2% of boys reported illness during the previous 1 month before the survey. Food-insecure girls were twice as likely to report suffering from an illness (P < .01) compared with boys, and the risk of reported illness tripled when girls were food insecure and were part of food-insecure households (P < .01). Girls were 7.4 and 7.0 times more likely to report difficulties with activities because of poor health and having a feeling of tiredness/low energy compared with boys, respectively (P < .001). We report that in a food-insecure situation, gender is an important predictor of an adolescent's self-reported health status. Food-security interventions should consider gender as a key variable to narrow the gap in health between boys and girls.

Factors influencing return to work after illness in France.

PubMed

Pélissier, C; Fontana, L; Chauvin, F

2014-01-01

Few studies have been published about the factors influencing return to work after sickness absence. To identify medical and occupational factors influencing the type of fitness certificate given by occupational physicians before employees return to work after sickness absence. A cross-sectional study was undertaken over 3 months in several health services in France. Workers undergoing a medical examination before returning to work after a period of sickness absence of at least 3 weeks were included. Medical and occupational factors were collected using a questionnaire. The relationship between different factors and certification of fitness was assessed by univariate and multivariate analyses. Among the 402 workers included, 64% were considered fit to return to work. Being older, strenuous work, prolonged sick leave and fear of returning to work appeared to be negative factors influencing the return to a previous job. In contrast, having an education level higher than secondary school, being satisfied at work, perception of very good health and benefitting from satisfactory professional relationships appeared to favour return to work. We developed a predictive score of not being fit to return to work after illness. Our study highlighted the relationship between medical and occupational factors with problems returning to work. The predictive score may be used by occupational physicians as a screening tool to identify those who are likely to have difficulties returning to work after illness, so that their working conditions can be modified to take this into consideration.

High social anxiety and poor quality of life in patients with pulmonary tuberculosis.

PubMed

Kibrisli, Erkan; Bez, Yasin; Yilmaz, Ahmet; Aslanhan, Hamza; Taylan, Mahsuk; Kaya, Halide; Tanrikulu, Abdullah Cetin; Abakay, Ozlem

2015-01-01

Pulmonary tuberculosis (PT) has been previously related with various psychosocial adverse consequences including stigmatization and social isolation.Social anxiety is a psychiatric condition that may be associated with social isolation and fear of social exclusion.To date no study has investigated social anxiety and its impact on quality of life (QoL) among patients with PT. Therefore, we aimed to determine the severity of social anxiety in a group of patients with PT.Among patients who were recently discharged from hospital with the diagnosis of PT 94 patients and 99 healthy control subjects who had similar demographical features have been included in the study. A psychiatrist interviewed all participants and a semistructured interview form, which was prepared by the authors, Liebowitz Social Anxiety Scale (LSAS), and Short Form-36 were administered to them.Patients with PT showed higher levels of performance avoidance and social avoidance than healthy control subjects. They reported lower QoL scores across all dimensions. Among patients women showed higher levels of LSAS subscale scores and total score. Fear of social exclusion was predicted by perceived illness severity and emotional role difficulty. On the other hand, perceived illness severity was predicted by fear of exclusion and sedimentation level.PT patients seem to experience higher levels of social anxiety and associated fear of social exclusion that add to their worse QoL during the earlier months of their disease. Among them fear of social exclusion is related with perceived illness severity.

Disease management programs: barriers and benefits.

PubMed

Magnezi, Racheli; Kaufman, Galit; Ziv, Arnona; Kalter-Leibovici, Ofra; Reuveni, Haim

2013-04-01

The healthcare system in Israel faces difficulties similar to those of most industrialized countries, including limited resources, a growing chronically ill population, and demand for high quality care. Disease management programs (DMPs) for patients with a chronic illness aim to alleviate some of these problems, primarily by improving patient self-management skills and quality of care. This study surveyed the opinions of senior healthcare administrators regarding barriers, benefits, and support for implementing DMPs. Cross-sectional survey. A 21-item questionnaire was self-completed by 87 of 105 (83%) healthcare administrators included in the study. Participants were 65.5% male and 47% physicians, 25.3% nurses, 17.3% administrators, and 10.3% other healthcare professionals. The main perceived benefit of DMPs among all respondents was improving quality of care. Other benefits noted were better contact with patients (81.6%) and better compliance with treatment (75.9%). Efficient long-term utilization of system resources was perceived as a benefit by only 58.6%. The main perceived barriers to implementing DMPs were lack of budgetary resources (69%) and increased time required versus financial compensation received (63.2%). The benefits of DMPs were patient oriented; barriers were perceived as financial and limiting professional autonomy. Information regarding long-term benefits (better patient outcomes) that ultimately provide better value for the system versus short-term barriers (increased costs and expenditures of time without compensation) might encourage the implementation of DMPs in countries faced with a growing population of patients with at least 1 chronic illness.

Work activity in the process of recovery - an interpretive phenomenological analysis of the experiences of people with a schizophrenia spectrum diagnosis.

PubMed

Pańczak, Anna; Pietkiewicz, Igor

2016-01-01

Having the opportunity to work has been found meaningful for individuals suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers. Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA). Having the opportunity to work was significant for participants because it mobilized them and encouraged self-care. G oing to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enables a sense of independence and the ability to develop skills to plan and control their budget. This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psychological support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.

Device-related infections in critically ill patients. Part II: Prevention of ventilator-associated pneumonia and urinary tract infections.

PubMed

Di Filippo, A; De Gaudio, A R

2003-12-01

Device utilization in critically ill patients is responsible for a high risk of complications such as catheter-related bloodstream infections (CRBSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI). In this article we will review the current status of data regarding the prevention of VAP and UTI. The results of the more recent (5 years) randomized controlled trials are reviewed and discussed. General recommendations include staff education and use of a surveillance program with a restrictive antibiotic policy. Adequate time must be allowed for hand washing and barrier precautions must always be used during device manipulation. Specific measures for VAP prevention are: 1) use of multi-use, closed-system suction catheters; 2) no routine change of the breathing circuit; 3) lubrication of the cuff of the endotracheal tube (ET) with a water-soluble gel; 4) maintenance of patient in semi-recumbent position to improve chest physiotherapy in intubated patients. Specific measures for UTI prevention include: 1) use of a catheter-valve instead of a standard drainage system; 2) use of a silver-alloy, hydro gel-coated latex urinary catheter instead of uncoated catheters. Biofilm represents a new variable: the capacity of bacteria to organize a biofilm on a device surface can explain the difficulty in preventing and eradicating an infection in a critically ill patient. More clinical trials are needed to verify the efficacy of prevention measures of ICU infections.

Metabonomics study on the hot syndrome of traditional Chinese medicine by rapid resolution liquid chromatography combined with quadrupole time-of-flight tandem mass spectrometry.

PubMed

Wang, Yang; Ma, Li; Sun, Yi; Yang, Liman; Yue, Hao; Liu, Shuying

2014-07-01

The hot syndrome refers to any feverish conditions during a pathological development, a sub-health phenomenon, and is a potential risk for human health. The metabonomics study on the hot syndrome may provide insight into understanding of its pathology and play a role in the prevention and treatment of its related diseases. In this paper, the rats were dosed with the hot syndrome prescription, ginseng and water. The corresponding urine samples were identified by rapid resolution liquid chromatography combined with quadrupole time-of-flight tandem mass spectrometry. More than 1,000 metabolic compounds from different urine samples could be further differentiated by principal component analysis. As a result, the rat body temperature and weight were recognized as the hot syndrome related factors. Some specific metabolites have been discovered as a pattern of the potential biomarkers for the hot syndrome. The results showed that ginseng cannot cause the hot syndrome in a reasonable dose, but the hot syndrome prescription can. It is suggested that ginseng cannot be used only as a tradition Chinese medicine but also as a nutrient. The work showed metabonomics method is a valuable tool in studying mechanism of the hot syndrome.

[Continuous bladder irrigation following transurethral resection of the prostate (TURP)].

PubMed

Nojiri, Yoshikatsu; Okamura, Kikuo; Kinukawa, Tsuneo; Ozawa, Hideo; Saito, Shiro; Okumura, Kazuhiro; Terai, Akito; Takei, Mineo

2007-09-01

We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot. We analyzed data from 761 patients registered in "a multi-institutional study of TURP clinical pathway" sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed. The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe (4.4% VS 12.9%, p<0.001). There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection. Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.

Immunogenicity and protective efficacy of Semliki forest virus replicon-based DNA vaccines encoding goatpox virus structural proteins

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zheng Min; Guangxi Center for Animal Disease Control and Prevention, Nanning 530001; College of Animal Science and Veterinary Medicine, Jilin University, Changchun 130062

Goatpox, caused by goatpox virus (GTPV), is an acute feverish and contagious disease in goats often associated with high morbidity and high mortality. To resolve potential safety risks and vaccination side effects of existing live attenuated goatpox vaccine (AV41), two Semliki forest virus (SFV) replicon-based bicistronic expression DNA vaccines (pCSm-AAL and pCSm-BAA) which encode GTPV structural proteins corresponding to the Vaccinia virus proteins A27, L1, A33, and B5, respectively, were constructed. Then, theirs ability to induce humoral and cellular response in mice and goats, and protect goats against virulent virus challenge were evaluated. The results showed that, vaccination with pCSm-AALmore » and pCSm-BAA in combination could elicit strong humoral and cellular responses in mice and goats, provide partial protection against viral challenge in goats, and reduce disease symptoms. Additionally, priming vaccination with the above-mentioned DNA vaccines could significantly reduce the goats' side reactions from boosting vaccinations with current live vaccine (AV41), which include skin lesions at the inoculation site and fevers. Data obtained in this study could not only facilitate improvement of the current goatpox vaccination strategy, but also provide valuable guidance to suitable candidates for evaluation and development of orthopoxvirus vaccines.« less

Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory - use of the Chronic Care Model.

PubMed

Si, Damin; Bailie, Ross; Cunningham, Joan; Robinson, Gary; Dowden, Michelle; Stewart, Allison; Connors, Christine; Weeramanthri, Tarun

2008-05-28

Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence - strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages - facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management - promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support - facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design - strengthened by provision of transport for clients to health centres, separate men's and women's clinic rooms, specific roles of primary care team members in relation to chronic illness care, effective teamwork, and functional pathology and pharmacy systems, but weakened by staff shortage (particularly doctors and Aboriginal health workers) and high staff turnover; and 6) clinical information systems - facilitated by wide adoption of computerised information systems, but weakened by the systems' complexity and lack of IT maintenance and upgrade support. Using concrete examples, this study translates the concept of the Chronic Care Model (and associated systems view) into practical application in Australian Indigenous primary care settings. This approach proved to be useful in understanding the quality of primary care systems for prevention and management of chronic illness. Further refinement of the systems should focus on both increasing human and financial resources and improving management practice.

[Immediate prediction of recovery, based on emotional impact of vertigo].

PubMed

Dal-Lago, Andrés H; Ceballos-Lizarraga, Ricardo; Carmona, Sergio

2014-01-01

This work presents deeper studies of comorbidity between anxiety and vestibular pathology. The aim of this work was to comprehend the reasons why patients do not feel «fully recovered» even though the treating professionals discharge them. We studied the features of personality that can favour the continuity of the condition. The questionnaire for measuring the emotional impact of vertigo makes it possible to determine if the patient has a psychological style with a tendency to develop pathological anxiety levels. Anxiety is a subjective characteristic determinant in difficulties with medical treatment. The questionnaire was applied to 198 patients in Argentina and Mexico in parallel. Each pathology was treated by standard medical procedures. The study focused on determining the correlation between «feeling fully recovered or not at the end of treatment» and the questionnaire scores obtained before the approach. In more than 80% of cases, high scores (>15 points) on the questionnaire were correlated with the difficulty presented by the patients for full recovery from the pathology after medical treatment. The objective assessments (duration and intensity of symptoms, time of onset of the disease, etc.) do not exactly predict possible difficulties during treatment of vertigo. Consequently, we consider the patient's subjective assessment of how the vestibular pathology affects him or her to be determinant. That key information allows us to predict the course of the illness and the probability of a full recovery. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Behavioral side effects of pediatric acute lymphoblastic leukemia treatment: the role of parenting strategies.

PubMed

Williams, Lauren K; Lamb, Karen E; McCarthy, Maria C

2014-11-01

Behavioral and emotional difficulties are a recognised side effect of childhood acute lymphoblastic leukemia (ALL) treatment. Modifiable factors, such as parenting strategies, may be an appropriate target for interventions to assist families with managing their child's behavior, potentially leading to improved psychosocial and clinical outcomes. This study examined whether parenting strategies are associated with child behavioral and emotional problems in a pediatric oncology context, with the aim of establishing whether parenting is a potential modifiable target for psychosocial intervention. Participants included 73 parents of children aged 2-6 years who were either (i) in the maintenance phase of treatment for ALL at the Royal Children's Hospital Children's Cancer Centre, Melbourne (N = 43), or (ii) had no major medical history (healthy control group) (N = 30). Participants completed psychometrically validated questionnaires that assessed parenting strategies and child emotional and behavioral problems. Results revealed that the ALL group parents reported higher lax parenting and more spoiling and bribing of their child than the healthy control group. Results from regression models indicated that, after controlling for the significant contribution of illness status and child age on child emotional and behavioral difficulties, parental laxness and parental overprotection were significantly associated with child emotional and behavioral difficulties. Supporting parents to minimise sub-optimal parenting strategies, particularly lax parenting, may offer a fruitful avenue for future research directed toward modifiable factors associated with managing child emotional and behavioral problems in a pediatric oncology context. © 2014 Wiley Periodicals, Inc.

Doubtful descent, dilemma and diagnosis: a case of Kallmann syndrome.

PubMed

Chakraborty, P P; Chowdhury, S R; Mandal, S K; Bandyopadhyay, D

2007-03-01

A 16-year-old boy with a diagnosis of bilateral cryptorchidism was referred for preoperative evaluation. He had diminished hearing and difficulty in vision since birth, with inattentiveness, poor school performance and delayed milestones. He was previously operated on for cleft lip. General survey revealed bilateral short fourth metacarpals and an operative scar mark over the left nostril and upper lip. He had a micropenis, small soft testes with anosmia, and sensory-motor deafness. The hormonal assay was consistent with hypogonadotrophic hypogonadism. Magnetic resonance imaging of the brain and computed tomography cisternography revealed almost hypoplastic olfactory bulb with an ill-defined olfactory tract and sulci, supporting the clinical diagnosis of Kallmann syndrome.

Decision Making and Cognitive Behavioral Flexibility in a OCD Sample: a Study in a Virtual Environment.

PubMed

la Paglia, Filippo; la Cascia, Caterina; Rizzo, Rosalinda; Riva, Giuseppe; la Barbera, Daniele

2015-01-01

Neuropsychological disorders are common in Obsessive-Compulsive Disorder (OCD) patients. Executive functions, verbal fluency and verbal memory, shifting attention from one aspect of stimuli to others, mental flexibility, engaging in executive planning and decision making, are the most involved cognitive domains. We focus on two aspects of neuropsychological function: decision making and cognitive behavioral flexibility, assessed through a virtual version of the Multiple Errand Test (V-MET), developed using the NeuroVR software. Thirty OCD patients were compared with thirty matched control subjects. The results showed the presence of difficulties in OCD patients with tasks where the goal is not clear, the information is incomplete or the parameters are ill-defined.

Care-seeking at patent and proprietary medicine vendors in Nigeria.

PubMed

Prach, Lisa M; Treleaven, Emily; Isiguzo, Chinwoke; Liu, Jenny

2015-06-12

To achieve health development goals, policymakers are increasingly focused on improving primary care in low- and middle-income countries, and private sector drug retailers offer one channel through which basic services may be delivered. In Nigeria, patent and proprietary medicine vendors (PPMVs) serve as a main source of medications, but little is known about their clientele or how care is sought at PPMVs for common illnesses. We explore differences in care-seeking at PPMV shops based on the most commonly reported symptoms. In Kogi and Kwara states, Nigeria, 250 PPMV shop workers and 2,359 customers purchasing drugs were surveyed, and each worker-customer interaction was observed. Multivariate regression analysis was used to assess the association of commonly reported symptoms with care-seeking behavior prior to attending the shop and while interacting with the provider at the shop. Most customers sought care for headache (30.5 %), fever (22.9 %), cough/cold (18.1 %), or diarrhea (8.4 %). Customers with fever were more likely to report being diagnosed by a formally trained person, to have discussed the illness with and be examined by the shop worker, and have more difficulty paying. In contrast, customers with headache symptoms were less likely to experience these outcomes and spent less money purchasing drugs. Those reporting cough or cold symptoms were less likely to have been diagnosed by a formally trained person, waited longer before visiting the PPMV shop, and were more likely to discuss the illness with the shop worker, but were less likely to be examined or to recommend the purchased drug themselves. If a sick child was brought to the shop, a discussion of the illness and an exam were more likely and more money was spent on drugs. Because care-seeking behaviors vary by symptoms and the sick person's age, PPMVs should be trained to treat common illnesses for which customers are unlikely to seek a formal medical consultation. Interventions aimed at improving primary care need to target the places where most people access care, and equip PPMV workers with knowledge and tools to provide basic services.

[Clinical status and outcome biomarkers in schizophrenia: a review for near-infrared spectroscopy studies].

PubMed

Koike, Shinsuke

2013-01-01

Neuroimaging technologies have seen enormous progress during the past two decades, and are now able to provide detailed illustrations of brain structure and activity. As a result, our understanding of the pathophysiology of mental illnesses such as schizophrenia has expanded, and potential clinical applications are becoming apparent. Unlike most physical illnesses, mental illnesses often lack objective markers, and this is one of the reasons why some patients and their family members experience difficulty in understanding symptoms and disabilities. In some cases, this leads to delays in patients seeking treatment, discontinuation of treatment, and relapse. If biological markers can be utilized as aids in differential diagnosis, selection of treatment options, and assessment of severity and treatment response in clinical settings, they may lead to improved treatment quality and clinical outcomes. Near-infrared spectroscopy (NIRS) is a functional neuroimaging technique that may be a candidate for clinical application in psychiatry. Advantages of NIRS include: 1) its non-invasive nature, with no harmful impact resulting from repeated measurement, even in infants; 2) high temporal resolution (> 10 Hz); 3) compact size, enabling easy movement; and 4) no required restraint position: people undergoing testing may take a natural position, such as sitting or standing, and may converse and perform manual tasks during measurement. Previous NIRS studies have revealed different characteristic waveform patterns during verbal fluency tasks among patients with major depression, bipolar disorder, and schizophrenia, which led to government approval in 2009 as an "advanced medical technology to aid in the differential diagnosis of depressive symptoms." This was the first approval in the field of psychiatry in Japan. Future NIRS studies will focus more on clinical applications, and multi-site studies are needed to assess the impact of non-illness factors such as age, sex, and head size, in addition to factors related to illness, including differences in sub-type diagnosis, severity of symptoms, and treatment. It is hoped that findings will support the development of new biomarkers that will facilitate differential diagnosis, better understanding of present conditions and prognosis, and decisions regarding treatment options.

Perceptions of factors associated with weight management in obese adults with schizophrenia.

PubMed

Lundgren, Jennifer D; Rempfer, Melisa V; Lent, Michelle R; Foster, Gary D

2014-12-01

Individuals with serious mental illnesses are at increased risk of obesity, although the behavioral factors contributing to excess weight are not well understood. We report on the eating behavior, physical activity, and body image of obese adults with and without schizophrenia spectrum disorders. Twenty-two obese adults diagnosed with schizophrenia or schizoaffective disorder were compared to demographically matched obese adults without psychiatric diagnoses on their responses to a comprehensive assessment of several psychosocial and behavioral domains relevant to obesity and weight management. The schizophrenia group, compared to controls, reported more difficulty with several eating behaviors that were self-identified as contributing to increased weight. They also reported more enjoyment of physical activity and greater satisfaction with body weight and shape compared to controls. Clinically relevant group differences were identified that should be considered when designing ecologically valid weight management assessments and interventions for individuals diagnosed with serious mental illnesses. Health care providers are encouraged to assess an individual's weight management strengths and barriers through available assessment tools and home visits, as well as offer specific environmental and behavioral changes to manage hunger and modify eating patterns. (c) 2014 APA, all rights reserved.

[Body image and quality of life in women with polycystic ovary syndrome].

PubMed

Micskei, Orsolya; Deli, Tamás; Jakab, Attila; Bugán, Antal

2014-07-06

Polycystic ovary syndrome is the most common endocrine disease in women. Psychic consequences are significant; patients have difficulties to be pregnant and the disease disturbs the quality of life. Due to complications associated with polycystic ovary syndrome, studies on psychological state and disease perception of patients appear to be important. The aim of the authors was to assess how the disease influences quality of life and changes in body image. The authors used the Illness Intrusiveness Ratings Scale, Health-Related-Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome and their own body image questionnaire. 121 women took part in the study. There was a negative correlation between illness intrusiveness and quality of life (r = -0.353) and a positive correlation between body image and quality of life (r = 0.614). A significant difference was observed in body satisfaction between patients who had visible body changes and those who had metabolic disturbances (p<0.05). Overweight patients who lost weight with lifestyle changes had significantly better quality of life (p<0.05). These results appear to be convincing in that in addition to gynecological care, psychotherapy could be offered to patients with polycystic ovary syndrome.

Undergraduate Performance in Solving Ill-Defined Biochemistry Problems

PubMed Central

Sensibaugh, Cheryl A.; Madrid, Nathaniel J.; Choi, Hye-Jeong; Anderson, William L.; Osgood, Marcy P.

2017-01-01

With growing interest in promoting skills related to the scientific process, we studied performance in solving ill-defined problems demonstrated by graduating biochemistry majors at a public, minority-serving university. As adoption of techniques for facilitating the attainment of higher-order learning objectives broadens, so too does the need to appropriately measure and understand student performance. We extended previous validation of the Individual Problem Solving Assessment (IPSA) and administered multiple versions of the IPSA across two semesters of biochemistry courses. A final version was taken by majors just before program exit, and student responses on that version were analyzed both quantitatively and qualitatively. This mixed-methods study quantifies student performance in scientific problem solving, while probing the qualitative nature of unsatisfactory solutions. Of the five domains measured by the IPSA, we found that average graduates were only successful in two areas: evaluating given experimental data to state results and reflecting on performance after the solution to the problem was provided. The primary difficulties in each domain were quite different. The most widespread challenge for students was to design an investigation that rationally aligned with a given hypothesis. We also extend the findings into pedagogical recommendations. PMID:29180350

Does personality influence job acquisition and tenure in people with severe mental illness enrolled in supported employment programs?

PubMed

Fortin, Guillaume; Lecomte, Tania; Corbière, Marc

2017-06-01

When employment difficulties in people with severe mental illness (SMI) occur, it could be partly linked to issues not specific to SMI, such as personality traits or problems. Despite the fact that personality has a marked influence on almost every aspect of work behavior, it has scarcely been investigated in the context of employment for people with SMI. We aimed to evaluate if personality was more predictive than clinical variables of different competitive work outcomes, namely acquisition of competitive employment, delay to acquisition and job tenure. A sample of 82 people with a SMI enrolled in supported employment programs (SEP) was recruited and asked to complete various questionnaires and interviews. Statistical analyses included logistic regressions and survival analyses (Cox regressions). Prior employment, personality problems and negative symptoms are significantly related to acquisition of a competitive employment and to delay to acquisition whereas the conscientiousness personality trait was predictive of job tenure. Our results point out the relevance of personality traits and problems as predictors of work outcomes in people with SMI registered in SEP. Future studies should recruit larger samples and also investigate these links with other factors related to work outcomes.

Late-life depression: its oral health significance.

PubMed

Friedlander, Arthur H; Friedlander, Ida K; Gallas, Mercedes; Velasco, Eugenio

2003-02-01

Late-life depression (LLD) initially occurs after age 65 and is a major public health concern because elderly people who are at high risk constitute an ever-expanding segment of the population. LLD is a mental illness in which mood, thought content, and behavioural patterns are impaired, causing individual distress, compromising social function and impairing self-maintenance skills (e.g. bathing, dressing, hygiene). It is characterised by marked sadness, or a loss of interest or pleasure in daily activities and may be accompanied by weight change, sleep disturbance, fatigue, difficulty concentrating, and high suicide rate. Individuals under treatment for LLD and those whose illness has not been diagnosed or treated often present to the dentist with significant oral disease. LLD is frequently associated with a disinterest in performing oral hygiene, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education programme, the use of artificial salivary products, antiseptic mouthwash, daily fluoride mouthrinse and special precautions when administering local anaesthetics with vasoconstrictors and prescribing analgesics.

Culture and spirituality: essential components of palliative care.

PubMed

Speck, Peter

2016-06-01

Palliative care advocates a holistic, multiprofessional approach to the care of people with life-threatening disease. In addition to the control of physical symptoms attention should also be paid to psychosocial, cultural and spiritual aspects of the patient's experience of illness. Guidance documents and research evidence reflect the complexity of the patient's journey and the need to regularly assess these areas of need over time. Cultural background can shape how patients respond to life-threatening illness, as can the beliefs held by the patients, whether religious or more broadly spiritual. Research evidence shows the importance of identifying and addressing cultural and spiritual aspects of care held by patients, families and staff. These are often neglected in clinical practice due to the focus on biomedical concerns and staff discomfort in engaging with beliefs and culture. Recent studies have highlighted gaps in the research, and some methodological difficulties and indicate many patients welcome healthcare staff enquiring about the importance of their beliefs and culture. Identifying research priorities is necessary to guide future research and strengthen the evidence base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Stress and quality of life among parents of children with congenital heart disease referred for psychological services.

PubMed

Kaugars, Astrida; Shields, Clarissa; Brosig, Cheryl

2018-01-01

The study examined parent stress and health-related quality of life (HRQOL) among families of children with congenital heart disease (CHD) referred for psychological services. Parents of 54 children (85% boys) aged 3 to 13 (M age  = 7.48, SD = 2.38) completed measures to assess parenting stress (Parenting Stress Index - Short Form; Pediatric Inventory for Parents) and the PedsQL Family Impact Module. Medical information was retrieved from medical record review. Half of parents of children with single ventricle anatomy had clinically significant levels of parenting stress. Parents of children with single ventricle anatomy reported more frequent illness-related stress and more difficulty dealing with illness-related stress than parents of children with two ventricle anatomy. Younger gestational age at birth and referral for attention or behavior problems were associated with greater likelihood of parent at-risk psychosocial functioning. Among children referred for psychological services, many parents report significant stress and significant negative impact of the child's medical condition on the family. Results underscore the need to consider assessing parent psychosocial functioning and providing additional support for parents of children with CHD. © 2017 Wiley Periodicals, Inc.

The health impact of childhood trauma: an interdisciplinary review, 1997-2003.

PubMed

Mulvihill, Deanna

2005-01-01

Research has shown a strong relationship between childhood trauma and psychological difficulties in later life; more recent research has indicated that the long-term effects are even greater for physical illness. These long-term effects have highlighted Posttraumatic Stress Disorder (PTSD) as a possible mediator variable. The illnesses identified include, but are not limited to, eating disorders, substance abuse, phobias, multiple personality disorders, irritable bowel syndrome, rheumatoid arthritis, and autoimmune disorders. Childhood trauma is an area of interdisciplinary interest; therefore, a variety of disciplines have been carrying out research in this area. This article is an integrative review of the literature over the last five years across disciplines, including nursing, medicine, psychology, education, social services, and government agencies. The review searched for themes, common constructs, and definitions, plus gaps in the present literature that need to be addressed. Particular attention was paid to measurement tools, and the importance of post traumatic stress disorder. Databases included were Medline, Proquest, Canadian Health Network (CHN), Canadian Business and Current Affairs (CBCA) Education, Educational Resources Information Center (ERIC) Plus, Cumulative Index to Nursing & Allied Health Literature (CINAHL), American Psychological Association Database Information (PsychINFO), and Cochrance.

Qualitative study: the experience and impact of living with Behcet's syndrome.

PubMed

Tai, Vicky; Lindsay, Karen; Sims, Joanne L; McQueen, Fiona M

2017-09-22

Behcet's syndrome is a rare chronic multisystemic vasculitis of unknown aetiology, is unpredictable and can cause life-threatening complications. This qualitative study aims to explore the experiences of patients living with Behcet's syndrome in New Zealand. Eight English-speaking patients participated in in-depth semi-structured interviews about their experiences of living with Behcet's syndrome. Interviews were recorded and transcribed. Data were analysed using a general inductive thematic approach. Five themes related to the experience of Behcet's syndrome emerged from the interviews: diagnosis (diagnostic challenge and closure), impact of disease (pain, fatigue, reduced vision, fear and uncertainty), loneliness and isolation (lack of support and information, invisible illness), acquiring resilience (coping, gaining sense of control, support group) and ongoing interactions with health system (specialist care, primary care, need for multidisciplinary care, doctor-patient relationship). Behcet's syndrome patients experience difficulties in obtaining a timely and correct diagnosis and contend numerous physical and emotional challenges, often experiencing loneliness and isolation. Establishing trusting doctor-patient relationships, allowing timely access to specialist care and recruiting psychosocial supports will help patients better cope with their illness. Diagnosis and management of Behcet's syndrome requires close collaboration and communication among specialists and general practitioners and improved education on Behcet's syndrome.

Quality of life of people with mental health problems: a synthesis of qualitative research

PubMed Central

2012-01-01

Purpose To identify the domains of quality of life important to people with mental health problems. Method A systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis. Results We identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or ‘ill-being’ were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization. Conclusions Generic measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems. PMID:23173689

Parenteral nutrition in the ICU setting: need for a shift in utilization.

PubMed

Oshima, Taku; Hiesmayr, Michael; Pichard, Claude

2016-03-01

The difficulties to feed the patients adequately with enteral nutrition alone have drawn the attention of the clinicians toward the use of parenteral nutrition, although recommendations by the recent guidelines are conflicting. This review focuses on the intrinsic role of parenteral nutrition, its new indication, and modalities of use for the critically ill patients. A recent trial demonstrated that selecting either parenteral nutrition or enteral nutrition for early nutrition has no impact on clinical outcomes. However, it must be acknowledged that the risk of relative overfeeding is greater when using parenteral nutrition and the risk of underfeeding is greater when using enteral nutrition because of gastrointestinal intolerance. Both overfeeding and underfeeding in the critically ill patients are associated with deleterious outcomes. Thus, early and adequate feeding according to the specific energy needs can be recommended as the optimal feeding strategy. Parenteral nutrition can be used to substitute or supplement enteral nutrition, if adequately prescribed. Testing for enteral nutrition tolerance during 2-3 days after ICU admission provides the perfect timing to start parenteral nutrition, if needed. In case of absolute contraindication for enteral nutrition, consider starting parenteral nutrition carefully to avoid overfeeding.

The role of comorbidities in patients' hypertension self-management.

PubMed

Fix, Gemmae M; Cohn, Ellen S; Solomon, Jeffrey L; Cortés, Dharma E; Mueller, Nora; Kressin, Nancy R; Borzecki, Ann; Katz, Lois A; Bokhour, Barbara G

2014-06-01

We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.

The MEDIGATE graphical user interface for entry of physical findings: design principles and implementation. Medical Examination Direct Iconic and Graphic Augmented Text Entry System.

PubMed

Yoder, J W; Schultz, D F; Williams, B T

1998-10-01

The solution to many of the problems of the computer-based recording of the medical record has been elusive, largely due to difficulties in the capture of those data elements that comprise the records of the Present Illness and of the Physical Findings. Reliable input of data has proven to be more complex than originally envisioned by early work in the field. This has led to more research and development into better data collection protocols and easy to use human-computer interfaces as support tools. The Medical Examination Direct Iconic and Graphic Augmented Text Entry System (MEDIGATE System) is a computer enhanced interactive graphic and textual record of the findings from physical examinations designed to provide ease of user input and to support organization and processing of the data characterizing these findings. The primary design objective of the MEDIGATE System is to develop and evaluate different interface designs for recording observations from the physical examination in an attempt to overcome some of the deficiencies in this major component of the individual record of health and illness.