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PubMed2000

Promoting the mental health of elderly African Americans: a case illustration.

Promoting mental health in an illness-oriented health care delivery system is challenging. Health promotion from a holistic perspective requires that mental health be viewed as important as physical health. The mental health needs of the elderly are numerous and often not addressed during routine visits for primary health care. Research consistently reports that elderly African Americans are not equal participants in the formal health care system. Consequently, promoting mental health in the African American elderly is a challenge made even more complicated because of this group's limited access to and use of mental health care services. Promoting the health of African Americans confronts many traditional values and practices of health care institutions and mental health practice. Therefore, health care providers must be innovative and creative to facilitate mental health promotion in this population of clients. The authors suggest that the Revised Health Promotion Model can serve as a framework for guiding the mental health care of elderly African Americans. Aspects of the model are particularly relevant for this population. The case of an elderly Black woman is presented as an illustration of ways in which the model may be applied with many cultural nuances.

Black or African American↗
PubMed2001

Aggressive local treatment for screen-detected DCIS results in very low rates of recurrence.

AIMS: To review our institution's practice of treatment of a mammographically detected population of ductal carcinoma in situ (DCIS) patients and to determine the outcome. METHODS: Between April 1989 and March 1994, 304 women with median age 59 years (range 51-65) with DCIS detected on screening mammogram, were treated in the Newcastle General and Royal Victoria Infirmary Hospitals, Newcastle-upon-Tyne, UK. More than half of the women (n=176, 57.8%) decided to have mastectomy. Other treatment options were wide local excision (WLE) with radiotherapy (n=97, 32%) and WLE alone (n=31, 10.2%). All except five received adjuvant hormone treatment. RESULTS: Predominant DCIS was comedo in 122 (42%), followed by cribriform in 87 (30%) and micropapillary in 44 (15%) cases. Grade I was found to be commonest grade (54%) followed by grade II (27%) and grade III (11%). With a median follow-up of 88 months, there were six (2%) recurrences, all of which were in women who were given breast conservation treatment, WLE with radiotherapy (n=1, 1%) and without radiotherapy (n=5, 16.6%). Mastectomy in this series was not associated with any recurrence at all. In three cases the recurrence was invasive, one of who also had distant metastasis. CONCLUSIONS: The findings of this study suggest that in women with DCIS suitable for breast conservation, WLE when combined with radiotherapy is associated with a very low recurrence rate.

Antineoplastic Agents, Hormonal↗
PubMed2002

Dietary recommendations for neutropenic patients.

OBJECTIVES: To describe the development of an evidence-based practice project that will evaluate less restrictive dietary practices and focus on hand washing in adult patients with chemotherapy-induced neutropenia. DATA SOURCES: Guidelines, protocols, and published articles. CONCLUSIONS: There is a lack of scientific basis for food restrictions, a wide variation in policies related to low-microbial diets, and inconsistent compliance with restricted diets. Furthermore, lack of consistent practice has not been related to incidence of infection. IMPLICATIONS FOR NURSING PRACTICE: Evaluation of an evidence-based project such as this can lead to change in practice and institutional policy.

Antineoplastic Agents↗
PubMed2006

Does the context matter? Utilization of sedative drugs in nursing homes--a multilevel analysis.

BACKGROUND: The aim of this study is to assess the utilization of sedative drugs in nursing homes by means of a multilevel approach taking into account individual as well as institutional characteristics. METHODS: A retrospective chart review of the drugs consumed in nursing homes in an urban region of Germany was conducted. Individual characteristics were measured by analyzing nursing home files, by staff assessment and by a structured interview conducted by trained psychologists and physicians. Institutional characteristics were assessed by interviewing the management of each facility and ward and by using a staff questionnaire survey. The sample consisted of 1903 residents from 27 nursing homes with a total of 96 wards. Data analysis was carried out by means of a multilevel analysis, a strategy for analyzing hierarchically structured data. RESULTS: The utilization of sedative drugs (low potency neuroleptics, anxiolytics, hypnotics) in nursing homes is remarkably high. Thus, 33.3 % of the residents used sedative drugs on a regular basis. PRN prescriptions existed for 13.1 % of the residents, 5.3 % had been using sedative medication prescribed as PRN. Results indicate the influence of individual as well as institutional characteristics on residents' sedative drug utilization. In particular, the use of PRN medicine is determined by characteristics of the ward the individuals are living in. CONCLUSION: Methodological implications: The data analysis concerning the drug utilization of residents of nursing homes requires multilevel models and a distinction between regular and PRN medicine. Further research should focus on explaining institutional variance. PRACTICAL IMPLICATIONS: Staff training in nonpharmacological strategies to manage disturbing behavior of residents is required.

Adult↗
PubMed2006

[Social psychiatry in the field of contrasting context between psychiatry and Social Medicine].

OBJECTIVE: There has been a discussion going on that Social Psychiatry has entered a state of crisis in terms of its socio-scientific roots. Little is known, however, about its relationship to Social Medicine. The question is whether Social Psychiatry, having grown apart from Sociology, has also lost its scientific relation to Social Medicine. METHOD: A systematic literature analysis of all works published in "Psychiatrische Praxis" - PP and "Das Gesundheitswesen"--GHW in the years 2004/2005 was done. All works concerning Social Psychiatry were analysed. The same procedure was applied to all abstracts, posters and presentations for the annual meetings of the German Society of Social Medicine and Prevention (DGSMP). RESULTS: 10 % off all articles published in GHW and 97 % in PP address issues of Social Psychiatry. Apart from similarities in terms of their theoretical, practical and institutional background and the research methods applied, there are a number of differences. CONCLUSIONS: Social Psychiatry has not lost its scientific relation to Social Medicine, however, the scientific cooperation between the two needs to be intensified.

Community Psychiatry↗
PubMed1996

[250 years of English psychiatry].

The history of British psychiatry is considered from five main viewpoints: clinical practice, the institutional basis, the legislative basis, lay perspectives of-mental disorder, and European influences. Its philosophical basis can be traced back to the work of the seventeenth-century philosophers. Thomas Hobbes and John Locke. In Scotland, both 'philosophy of mind' and new clinical methods flourished during its Enlightenment; the concept of 'neurosis' was developed by William Cullen. Around 1800, James Prichard's concept of 'moral insanity' became the foundation of modern work on personality disorder and psychopathy. The psychotic illness of King George III, beginning in 1788, led to greater public sympathy for the mentally ill. Attitudes since then have varied, with 'antipsychiatry' becoming very influential in the 1960s. By the mid-eighteenth century, specialised institutions for the mentally ill existed in a number of cities, there were also units attached to charitable general hospitals, but none of these continued after about 1830. The neglect of patients in private madhouses, prisons, and poorhouses led to increasing concern by Parliament, which resulted in the development of public asylums throughout the country. Severe legal restrictions on their activities were modified in 1930 and completely reformed in 1959. From the mid-nineteenth century, French and German influences became increasingly strong, but British universities played no active part in psychiatry until the 1950s. Psycho-analysis did not develop strongly in Britain, where the main contribution was through translation and biography, but some leading analysts came as refugees in the 1930s-as did other psychiatrists from central Europe. Another important influence was that of Adolf Meyer at the Institute of Psychiatry, London, particularly through Sir Aubrey Lewis; physical treatment methods also came to Britain from Europe. In the second half of this century, the most important British developments have been in social psychiatry therapeutic communities, day hospitals, comprehensive district services, psychogeriatrics, etc. Academic psychiatry has also become strong since the 1960s.

England↗
PubMed1978

The medical care of mentally retarded persons in public residential facilities.

Large public residential facilities have traditionally been society's primary service resource for persons with serious mental retardation. Despite current emphasis on restricting admissions and community placement of retarded persons, approximately 175,000 people continue to reside in 230 institutions throughout the United States. This population is vulnerable to a variety of chronic medical disorders that diminish successful adaptation to a more normal life-style, especially when health services are marginal. Institutional medical staffs have been largely isolated from their physician peers, and their patients have not had access to medical care equivalent to that available in the community. We describe the recent affiliation of a teaching hospital with a Massachusetts institution. We suggest that such affiliations would assure better medical care for mentally retarded persons while increasing physicians' knowledge of attendant medical and societal problems.

Adolescent↗
PubMed2002

Dietitians in New South Wales: workforce trends 1984-2000.

Complete surveys of the dietetic workforce in NSW were conducted in 1984 and 1991 and have now been updated with a new survey in 2000. In the nine years since 1991, the total active workforce grew by 48%. Although there were significant improvements in the ratios of hospital dietitians per 100 acute beds (from 0.88 to 1.08) and dietitians per million population (from 69.7 to 96.5), the supply of dietitians does not yet reach recommended levels, especially in rural areas. Other trends were significant increases in the proportion of dietitians employed outside hospitals (to 38% in 2000) and in non-clinical work (50% in 2000), and declines in the number of technical support staff for dietitians.

Allied Health Personnel↗
PubMed1998

Microcephaly with chorioretinal degeneration.

PURPOSE: To describe the ophthalmologic findings and electroretinograms in patients with microcephaly and chorioretinal degeneration. METHODS: We reviewed the hospital records of 20 patients with microcephaly that was not part of a recognizable syndrome prior to initial referral to the institutional consultative practice of one of the authors (RGW). Twelve patients, all from separate families, were diagnosed as having microcephaly with chorioretinopathy. Ten of these patients had ISCEV-standard electroretinograms (ERG). RESULTS: No family history of microcephaly or retinal degeneration was found in any of our patients. Three patients had another family member with mental retardation. Three of the 12 were compatible with the autosomal dominant form of microcephaly with chorioretinopathy (MIM 156590), possibly as a new mutation. Eight patients, who had fundus findings of retinitis pigmentosa, were similar to the autosomal recessive form of microcephaly with chorioretinal degeneration (MIM 251270). The ERGs were moderately to severely subnormal for responses of both rods and cones. The retinal findings varied from no pigmentary changes, pigment clumping and bone spicules, pigmentary granularity, bull's eye maculopathy, choroidal and retinal atrophy, to lacunar depigmentation. Mental retardation was mild to profound. The abnormal findings from MRI/ CT brain scans (8 patients) were cerebellar atrophy (2), agenesis of cerebellar vermis (1), cortical atrophy (1), and pachygyria (1). Dysmorphic features were present in most patients. Chromosome studies were normal, except for one patient with ring chromosome 14. CONCLUSIONS: Although the patients reviewed in this study represent a heterogeneous group of disorders, ocular abnormalities, especially retinal degeneration, are frequent among patients with microcephaly.

Adolescent↗