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Findings from London's Mental Health': a service in crisis.

The King's Fund published its second London Commission in July 1997, and had produced a report 'London's Mental Health' in preparation for this, consisting of the most complete account ever published of the present state of the mental health services. They are found to be in a state of crisis, unable to cope with the very high levels of demand seen in the deprived inner city areas. There are now too few beds in the National Health Service to deal with the number of patients who need to be admitted, and too few residential places in the community to take those ready for discharge. The report considers the reasons for the high demand, and finds London to contain the six most socially deprived districts in the country, the highest unemployment rates, and double the number of persons living in single person accommodation. Emergency care is from the Accident and Emergency Departments, and the complete range of community care is not available anywhere. Remedies for these problems include adjustments to the resource allocation formulae, removal of the difficulties preventing new capital building in the public sector, and removing the divide between health and social services.

Health Care Rationing↗

The affordability of a nutritious diet for households on welfare in Toronto.

OBJECTIVES: This study assesses the affordability of a nutritious diet for households in Toronto that are supported by welfare. METHODS: For three hypothetical households, welfare incomes were compared to the monthly costs for food, shelter, and other essential expenditures in Toronto. RESULTS: If households lived in market rental accommodation, average monthly incomes were insufficient to cover expenses for the single-person household and two-parent family, and barely adequate for the single-parent family considered in this study. However, the single-parent family's actual income fell below expenses for six months of the year. For households with children, the relative inadequacy of welfare increased as children grew older. Living in rent-geared-to-income housing afforded substantial financial advantage, but the welfare income of single-person households was still insufficient to meet basic needs. INTERPRETATION: These findings indicate discrepancies between welfare incomes and costs of basic needs, which may explain the vulnerability of welfare recipients to food insecurity.

Budgets↗

Suicide in Scotland 1988-1989. Psychiatric and physical morbidity according to primary care case notes.

BACKGROUND: The aim was to identify the amount of psychiatric and physical morbidity identified in suicide victims prior to death. METHOD: A survey was made of primary care records of Scottish suicide victims in the years 1988 and 1989. RESULTS: Less morbidity was encountered than in previous studies. Single persons and persons from lower socio-economic groups were less likely to have a diagnosis of depression. No association was found between physical and psychiatric morbidity. Depressed single persons and depressed persons from lower socio-economic groups were less likely to receive antidepressants. GPs prescribed lower dosages of antidepressants than psychiatrists. Patients receiving antidepressants were more likely to die by drug overdose. CONCLUSIONS: There are groups in whom depression may be being overlooked and others in whom depression could be treated more vigorously. There are risks in prescribing antidepressants which are potentially fatal in overdose.

Alcoholism↗

First admissions for psychosis in Turku. A time trend study.

Patients over 15 years of age from Turku hospitalized for psychosis for the first time during the years 1949-50, 1959-60 or 1969-70 were investigated. The incidence of hospitalized psychoses (per 100,000 inhabitants) was 115, 136 and 160, respectively. The increase in incidence was greater in women than in men. The incidence remained approximately the same in patients aged 30 to 59, but increased in the younger and older groups. The incidence of functional psychoses increased; in schizophrenia, however, it declined, while in paranoid and effective psychoses it increased. In organic psychoses, the admission frequency of psychoses of old age rose in the 1950's, but declined in some measure in the 1960's. The incidence of psychosis increased for single persons. The ratio of the incidence between single and married persons rose in men, whereas in women it fell. This was particularly pronounced in schizophrenics. The incidence of psychosis was highest in unskilled laborers. The overrepresentation of schizophrenia and paranoid psychoses seemed to have become more pronounced in this occupational group.

Adolescent↗

The reliability of balance tests performed on the kinesthetic ability trainer (KAT 2000).

The Kinesthetic Ability Trainer (KAT 2000) is a balance platform designed for training and functional testing of the neuromuscular control system. Forty healthy and sports-active persons were tested and 1 month later retested to investigate the reliability of the KAT 2000 testing "one-leg static balance" and "two-leg dynamic balance". A significant improvement at retesting on the same day was seen in both tests; furthermore the dynamic test result improved significantly with retesting 1 month later. The data obtained made it possible to calculate the 95% confidence limits for an unchanged test result for a single person and a group of persons. The results show a clear learning effect when the persons are retested, especially in the dynamic test. The KAT 2000 can be used as a tool for testing groups of persons both in short- and long-term studies, but it cannot be used for testing single persons due to the great variance in the test results. Further investigations involving injured persons are needed to determine the range of improvement after intervention.

Adolescent↗

The accuracy and reliability of linear measurements of the ulna for anthropometrical studies in dogs.

This study investigated the accuracy and reliability of measuring the distance between two surface landmarks (the point of the tuber olecrani and the proximal aspect of the stopper pad) as an indication of ulna length in the live dog. It was found that the chosen skin landmarks did correlate well with the length of the ulna bone. The reliability of such measurements was high when performed by a single person, however this fell to unacceptable levels when multiple people were used to make the measurements. It was concluded that if this technique was to be used in studies to serially record the bone length in live growing dogs, then the measurements should be taken by a single person.

Analysis of Variance↗

Is the national nutrition survey in Japan representative of the entire Japanese population?

OBJECTIVE: We examined the representativeness of the sample used in the National Nutrition Survey in Japan (J-NNS). METHODS: The distribution of the J-NNS sample from 1995 to 2000 was compared with that of the national census with respect to gender, age group, place of residence, and number of household members. RESULTS: In the survey sample, as compared with the national census distributions, the proportion of females was 1% to 2% larger, the proportion of individuals who were 20 to 39 y of age was a few percentages smaller, and a slight bias toward rural areas was seen. Among individuals who were 20 to 59 y of age, the proportion of individuals who lived in single-person households was 50% to 66% of that found in the national census. Observed disparities between the sample and the population were minimal except in the case of the proportion of individuals who lived alone. CONCLUSIONS: The sample used in the J-NNS is generally representative of the entire Japanese population with the exception of individuals in single-person households.

Adult↗

Intestinal parasitic diseases in Riyadh, Saudi Arabia: prevalence, sociodemographic and environmental associates.

Our objectives were to assess the prevalence of intestinal parasitic infections in Riyadh and to determine associated sociodemographic and environmental factors. The study was conducted through a household survey. Three health centres were chosen from each of the five Riyadh urban regions and 15 from rural areas. Based on the average family size, a random sample of households were chosen. All household members were asked to participate in the study. Data were collected using a pre-designed questionnaire eliciting data on sociodemographic and environmental factors. A stool specimen of each individual was examined microscopically for the presence of trophozoites and cysts. Six thousand and twelve participants with a mean age of 23.3 +/- 17.4 (median 19 years, 48.6% males) were studied and 32.2% were infected. The infection rate was high in urban areas (33.3%), among children < 12 years (34.4%), non-Saudis (42.2%), single persons (34.9%), illiterate individuals (33.8%), those who obtained drinking water from tankers (36.1%) and those who disposed of sewage in open channels (47.1%). Stratified analysis showed that for Saudis <12 years parasitic infections were significantly higher among tanker users (39.5%) and septic tank users (36.8%). For Saudis> or =12 years low education, water storage and open sewage disposal were statistically associated with parasitic infections (P < 0.05). Among expatriates, infections were high among males (47.6%), urban residents (48.3%), single persons (46.9%), tanker users (39.5%) and septic tank users (78.6%). Multivariate logistic regression analysis showed that age < 12 years, non-Saudi nationalities, educational level below secondary school, tanker as source of water and open sewage disposal were independently associated with high intestinal parasitic infection.

Adolescent↗

Normobaric measurement of arterial oxygen tension in subjects exposed to hyperbaric oxygen.

This study demonstrates the ability of an automated blood gas analyzer (Radiometer ABL 330) operated at atmospheric pressure to measure the arterial oxygen tension (PaO2) of ten healthy volunteers exposed to hyperbaric oxygen (HBO2) up to 3.0 atmospheres absolute. Arterial blood samples were aspirated from subjects compressed in a single-person hyperbaric chamber and were analyzed immediately in the blood gas analyzer. The subjects' values for PaO2 correlated with the calculated alveolar O2 tension (PAO2) (measured PaO2 = 0.827 x PAO2-15.1) (r2 = 0.97). Tonometric experiments indicated a difference between saline and blood PO2 measurements. We therefore derived a correction factor for blood measurements (corrected PaO2 = 0.908 x PAO2-52.4) (r2 = 0.98). These results compared favorably with PaO2 measurements made with blood gas analyzers calibrated inside walk-in hyperbaric chambers. We conclude that the PaO2 of normal subjects exposed to HBO2 can be measured accurately at atmospheric pressure with this automated blood gas analyzer. Prior to this study, hyperbaric PaO2 measurements could only be performed within walk-in chambers. Our observations generalize the normobaric measurement of hyperbaric PaO2 to patients treated in single-person and walk-in chambers.

Adult↗

Anti-black prejudice as a function of exposure to the negative behavior of a single black person.

The authors examined whether the negative behavior of 1 Black male would influence White participants' perceptions of Black Americans and behavior toward another Black person. In Study 1, it was found that participants in the Black-negative condition tended to stereotype Blacks more than participants in the Black-control condition did. It was also found that participants who had observed a negative behavior, whether it was performed by a Black or a White confederate, avoided a subsequently encountered Black person more often than did participants in either the positive condition or the control condition. In a 2nd study, interpersonal interactions with a Black person were minimized only after participants observed the negative behavior of a Black confederate. Study 3 extended the findings of Study 1 by showing that group level stereotypes and the expression of ingroup favoritism resulted from simply overhearing a conversation in which a Black person was alleged to have committed a crime.

Adult↗

Personality characteristics in obesity: relation of MMPI profile and age of onset of obesity to success in weight reduction.

A group of 142 obese subjects was seen in an obesity clinic over a 2-year period. Of these, 116 had assessment of personality factors by the Minnesota Multiphasic Personality Inventory (MMPI), and 71 were followed for periods of 4 to 28 months in order to determine success at weight reduction by means of a conventional dietary regimen. The MMPI profiles of the obese subjects were compared to those of a general medical population of 50,000 patients seen in the Department of Internal Medicine at the Mayo Clinic. Obese male subjects had significantly higher scores on the F and MA scales. Obese female subjects had significantly higher scores on the F, PD, PA, SC, and MA scales, and a significantly lower score on the Q scale than the reference population. Even though these findings show that certain personality traits as measured by the MMPI may occur more frequently in obese persons, the individual MMPI profile codes point out the presence of diverse behavior patterns among obese persons rather than a single personality pattern characteristic of obesity. There were no apparent differences in the success in achieving a loss of 10% or more of initial weight among the male and female obese subjects having normal or abnormal MMPI profiles. Obese subjects having onset of obesity before age 12 years were slightly more successful in weight reduction than those whose obesity began later than this, but the differences were not statistically significant for either the male or female subjects.

Adolescent↗

Hepatitis a molecular epidemiology in the United States, 1996-1997: sources of infection and implications of vaccination policy.

BACKGROUND: The genetic relatedness of hepatitis A virus (HAV) isolates was determined to identify possible infection sources for case patients in the Sentinel Counties Study of Acute Viral Hepatitis. METHODS: A 315-nucleotide segment of the VP1-P2 region of the HAV genome was amplified and sequenced from serum of case patients and analyzed together with risk-factor data. RESULTS: Of 508 HAV-RNA-positive case patients, 449 (88.4%) were interviewed, and 255 (50.1%) reported >/=1 risk factor. Some 123 unique nucleotide sequence patterns (UNSPs) were identified--77 (62.6%) from only 1 case patient and the rest in 2-99 persons. Among international travelers, a single person was more often infected with a single type of UNSP (17/54 [31.5%]), compared with other case patients (48/393 [12.2%]; P<.001). UNSPs from travelers to Mexico (33/37 [89.2%]) clustered with those from Hispanic children (47/49 [95.9%]). Of 119 men who had sex with men, 96 (80.7%) had the same or similar UNSPs, which were also found in 37 men and 10 women with no identified infection source. CONCLUSION: HAV is often transmitted within networks of persons with similar risk factors, which may be the infection source for others in the community.

Acute Disease↗

Similar or disparate brain patterns? The intra-personal EEG variability of three women with multiple personality disorder.

Quantitative EEG was used to assess the intra-personal variability of brain electrical activity for 3 women diagnosed with Multiple Personality Disorder (MPD). Two separate control groups (within-subject and between-subject) were used to test the hypothesis that the intra-personal EEG variability between 2 alters would be less than the interpersonal EEG variability between 2 controls, and similar to the intra-personal EEG variability of a single personality. This hypothesis was partially supported. In general, the 2 EEG records of a MPD subject (alter 1 vs. alter 2) were more different from one another than the 2 EEG records of a single control, but less different from one another than the EEG records of 2 separate controls. Most of the EEG variability between alters involved beta activity in the frontal and temporal lobes.

Adult↗

Rural residence is not a risk factor for frequent mental distress: a behavioral risk factor surveillance survey.

BACKGROUND: Residents of rural areas may be at increased risk of mental health problems. If so, public health programs aimed at preventing poor mental health may have to be customized for delivery to rural areas. The purpose of this study was to examine the relationship between residing in a rural area and frequent mental distress, which is one indicator of poor mental health. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) survey for the state of Texas was the source of information about obesity, demographic characteristics, and frequent mental distress (FMD). FMD was defined as poor self-rated mental health during at least half of the days in the last month. Adjusted odds for FMD were computed for rural and suburban respondents relative to urban respondents. RESULTS: FMD was found to be independently associated with lower education, being younger, being non-Hispanic, being unmarried, and being female. FMD also was associated with being obese or underweight and suburban residence (relative to metro-central city). FMD was not more common among rural respondents than in the metro-central city. CONCLUSION: Rural respondents were not at greater risk of frequent mental distress than urban respondents in this sample. Programs seeking to improve community mental health should target persons with less education and extremes in body weight, along with women and single persons, regardless of whether they live in rural or urban areas.

Adolescent↗

Assessment of sexual behavior, sexual attitudes, and sexual risk in Sweden (1989-2003).

To assess changes in sexual behavior, sexual attitudes, and sexual risk related to HIV, we conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, and 2003 (total N = 13,762). Each sample consisted of 4,000-6,000 subjects aged 16-44 years, stratified by age: 16-17, 18-19, 20-24, 25-34, and 35-44 years. The overall participation rate was 63.8% (for men, 55.9%; for women, 71.9%). The prevalence of three or more sexual partners and casual sexual contacts without the use of a condom was comparatively high for men, for persons aged 16-24 years, single persons with and without a regular partner, and persons living in towns and urban areas. The prevalence of multiple sexual partners and casual sexual contacts increased significantly over time. There was a significant decrease in the proportion of participants who agreed with the statement "Sexual intercourse should only take place in a stable relationship." Personal risk assessments related to HIV did not change significantly over time. The study shows that risky sexual behavior related to HIV/AIDS increased in the Swedish population between 1989 and 2003, and that attitudes concerning casual sexual relations became more permissive.

Adolescent↗

Influence of mental illness on marriage, reproduction, and parenting in a society without psychiatric services.

This survey was undertaken in a peasant society without modern psychiatric services in order to assess marriage, reproduction, and parenting functions among 35 mentally ill persons. Among the mentally ill, single persons had earlier onset of mental illness as compared to those who had ever been married. Those who had married and produced children had a high rate of divorce from their spouses and separation from their children following onset of mental illness. Among 12 parents whose onset of mental illness began when their children were still young, five were not living with their children and the other seven exercised little or no parental supervision. In two families, the psychotic parent had beaten her children severely. One infant died of neglect when a psychotic mother refused to surrender child care to others. Mentally ill subjects 18 years or older were less apt to be married than opium addicts in the same population. Infant mortality was greater among the children of mentally ill than in the general population.

Adolescent↗