[The social service function of the Instituto Nacional de Neumologia (1947-1961)].
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The aims of this study were to determine the characteristics and perceived levels of fatigue and the prevalence of depression in children with chronic fatigue syndrome and to assess the effects of illness on schooling and social functioning. Twelve children with chronic fatigue syndrome were compared with a matched group of children with cystic fibrosis and matched healthy controls. Levels of fatigue (fatigue questionnaire), depression (children's depression inventory), and social adjustment (semistructured interview with parents) were compared between groups. Children with chronic fatigue syndrome had significantly higher median scores for physical and mental fatigue and depressive symptomatology than either comparison group and five children scored as depressed on the children's depression inventory. Schooling and social functioning were seriously disrupted. Children with chronic fatigue syndrome reported high levels of fatigue affecting both physical and mental functioning, the association with depression found in adult studies was confirmed, and social adjustment was poor.
OBJECTIVES: To examine the effects of early case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services. DESIGN: Prospective controlled unmatched non-randomised study for up to two years after injury. SETTING: Four district general hospitals and two university teaching hospitals, each with neurosurgical units, in east central, north, and north east London and its environs. SUBJECTS: 126 patients aged 16-60 recruited acutely and sequentially after severe head injury. All received standard rehabilitation services in each of the six hospitals and districts: case management was also provided for the 56 patients admitted to three of the hospitals. MAIN OUTCOME MEASURES: Standard measures of patients' physical and cognitive impairment; disability and handicap; and affective, behavioural, and social functioning and of relatives' affective and social functioning. Relatives' perception of burden; changes in patients' and relatives' housing, financial, vocational, recreational, and medical needs; and ongoing requirements for care and support; and the amount and type of paramedical input provided were assessed with structured questionnaires. RESULTS: For a given severity of injury, case management increased the chance and range of contact with inpatient and outpatient rehabilitation services. However, duration of contact was not increased by case management, and there was no demonstrable improvement in outcome in the case managed group. Any trends were in favour of the control group and could be accounted for by group differences in initial severity of injury. CONCLUSIONS: Widespread introduction of early case management of patients after severe head injury is not supported, and early case management is not a substitute for improvement in provision of skilled and specialist rehabilitation for patients.
Problem and nonproblem drinking, college student sons of alcoholics were compared to problem and nonproblem drinking college student sons of nonalcoholic fathers with respect to cognitive functioning. Problem drinkers performed more poorly on two of the four cognitive tasks, Group Embedded Figures and Symbol-Digit Paired Associates Learning Task, thus supporting earlier findings of cognitive deficits in problem drinking nonalcoholics. Additionally, sons of alcoholics tended to perform more poorly than sons of nonalcoholics on the Group Embedded Figures Test. Cognitive performance was not predicted by any of four measures of impulsive/antisocial personality and behavior-preadult antisocial behavior, childhood behavior problems, sensation seeking, and the MacAndrew Alcoholism Scale. The findings of the research pointed to the importance of considering both drinking and familial alcoholism risk statuses in studies of the cognitive performance of nonalcoholics. Further implications and limitations of the findings are discussed.
OBJECTIVE: To examine recovery status in bulimia nervosa (BN) and its relation to social support and social adjustment. METHOD: Using a cross-sectional design, we administered the modified Social Support Questionnaire and the Social Adjustment Scale-Self-Report (SAS-SR) to 40 women, each of whom was actively bulimic (ABN), was in remission from BN (RBN), or had no history of eating disturbance (comparison). RESULTS: In terms of social support, relative to RBN and comparison subjects, the ABN group had significantly fewer persons in their friendship and kinship networks available to provide emotional support, although the groups were equivalent in number of persons available to provide things and advice. Relative to the comparison group, both bulimic groups were significantly dissatisfied with the quality of emotional support provided by relatives. On the SAS-SR, women in the ABN group displayed the poorest overall social functioning. The RBN group was functioning significantly better than the ABN group, but significantly more poorly than the comparison group. DISCUSSION: Our results suggest that the social functioning of RBN women lies between ABN women and non-eating-disordered women, indicating both gains relative to the active phase and residual deficits.
Prior studies have identified that quality of social functioning is strongly associated with both physical and cognitive recovery from stroke as well as with the existence of depression. This study was undertaken to identify the specific elements of social functioning that are related to depression and impaired recovery and to determine whether these elements are different between acute and chronic periods following stroke. There were 50 patients with acute stroke who were assessed in the hospital and at short-term (3- or 6-month) and long-term (12- or 24-month) follow-up. An impaired relationship with the patient's "closest other" prior to the stroke and limited social activities were both associated with depression immediately after the stroke as well as with depression at long-term follow-up. An impaired relationship with the closest other prior to the stroke was also associated with impaired recovery in activities of daily living and cognitive recovery at long-term follow-up. Fears of economic stability and limited social activity were associated with depression at short-term follow-up whereas loss of job or job satisfaction was associated with depression at long-term follow-up. These findings suggest that during the first few weeks following stroke, social supports and contact are essential needs for patients, whereas during the chronic period, other factors such as financial security, adequacy of living arrangements, and loss of job satisfaction also become important. Future research should examine the effect of enhanced social support on poststroke depression and physical and cognitive recovery.
BACKGROUND: In order to define needs for care of people with severe mental illness, the Camberwell Assessment of Need (CAN) is focused on measuring personal and social functioning. However, previous studies of the CAN have given inconsistent results in terms of what variables are actually being measured. AIMS: To investigate the factor structure of the CAN. METHOD: Assessments of 741 out-patients (mean age 45.5 years, 50% females) with severe mental illness (68% schizophrenia or other psychotic disorder) were used in an exploratory maximum likelihood factor analysis. RESULTS: Support was found for a three-factor model, comprising 13 of the 22 variables in the CAN, with the factors corresponding to functional disability (7 variables), social loneliness (3 variables) and emotional loneliness (3 variables). The remaining variables did not load on any factor. CONCLUSIONS: Exploratory factor analysis revealed three homogeneous dimensions in the CAN that may represent functional disability and two aspects of social health.
In the past, health care was predominantly curative and was directed mostly at the individual. It largely neglected the community and the true object of health services, i.e. to improve the health of the entire population. A comprehensive health service should meet all the health needs of a community and should not be orientated solely towards disease and hospital care. The importance of community participation in the social rehabilitation of individuals recovering from mental or organic diseases is emphasized, and the role of primary health care in helping to relieve pressure on hospital services by caring for more people at the community level should be recognized. In training health personnel greater emphasis needs to be placed on promoting more flexible attitudes of mind to fit professional skills covering all problems confronting the community. The social function of health services should be recognized and accepted in order to ensure that health technology is developed and applied in harmony with this social function.
This study describes a prospective six-month follow-up study of previously hospitalized psychiatric patients. Data are presented on social functioning and symptomatology derived from self-report scales administered to 60 patients. there was significant improvement in both symptomatology and social functioning on follow-up for all groups with the exception of the schizophrenic group, who exhibited little or no change. Residual change scores revealed more than expected change in 71 percent of schizophreniform patients, 70 percent of nondepressed patients, 53 percent of depressed patients, but only 20 percent of schizophrenic patients. These findings suggest that most patients sustain improvement after discharge and that many schizophreniform patients may have good prognoses.
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BACKGROUND: Case management has increasingly been the recommended approach to care for severely mentally ill patients since the number of psychiatric beds has decreased. Despite equivocal results, in the UK and Europe, this approach is becoming accepted policy. We assessed the effect of smaller case loads. METHODS: We randomly assigned 708 psychotic patients in four centres standard case management (355 patients, case load 30-35 per case manager) or intensive case management (353 patients, case load 10-15 per case manager). We measured clinical symptoms and social functioning at baseline, 1 year, and 2 years. The impact of treatment on hospital use was assessed at 2 years by subgroup analyses for Afro-Caribbean and for severely socially disabled patients. Analysis was by intention to treat. FINDINGS: There was no significant decline in overall hospital use among intensive-case-management patients (mean 73.5 vs 73.1 days in those who received standard care [SD 0.4, 95% CI -17.4 to 18.1]), nor were there any significant gains in clinical or social functioning. There was no evidence of differential effect in Afro-Caribbean patients or the most socially disabled patients. INTERPRETATION: In well-coordinated mental-health services, a decline in case load alone does not improve outcome for these patients. Mental-health planners may need to pay more attention to the content of treatment rather than changes in service organisation.
This study examined the association between emotional intelligence (EI), anxiety, depression, and mental, social, and physical health in university students. The sample was made up of 184 university students (38 men and 146 women). El was evaluated by the Trait Meta-Mood Scale (Salovey, Mayer, Goldman, Turvey, and Palfai, 1995), which evaluates the three dimensions (Attention, Clarity, and Mood Repair). Anxiety was evaluated with the Trait Anxiety Questionnaire (Spielberger, Gorsuch, Lushene, Vagg, and Jacobs, 1983) and depression with the Beck Depression Inventory (Beck, Rush, Shaw, and Emery, 1979). Mental, social, and physical health were evaluated with the SF-12 Health Survey (Ware, Kosinski, and Keller, 1996). Results showed that high Emotional Attention was positively and significantly related to high anxiety, depression, and to low levels of Role Emotional, Social Functioning, and Mental Health. However, high levels of emotional Clarity and Mood Repair were related to low levels of anxiety and depression, high Role Physical, Social Functioning, Mental Health, Vitality, and General Health. This study confirmed the predictive value of Attention, Clarity and Mood Repair regarding the levels of anxiety, depression, and areas related to mental, social, and physical health in university students.
The goal of the present study was to explore the relationship between anger and dissociation and their relationship to symptoms of post-trauma pathology. One hundred four female assault victims were assessed prospectively 2, 4, and 12 weeks post-assault. Measures of posttraumatic stress disorder (PTSD) severity, social functioning, anger, and dissociation were obtained at all assessments. Results revealed that differentiation between symptoms that predict later PTSD and impaired social functioning first becomes evident at 4 weeks post-assault. At 4 weeks post-assault, anger expression was predictive of later PTSD severity, whereas dissociation was predictive of poorer later functioning.
Spasmodic dysphonia (SD), a disabling focal dystonia involving the laryngeal musculature, is most commonly treated by the intramuscular injection of botulinum toxin (BTX). Although the treatment is well tolerated and generally produces clinical voice improvement, it has never been statistically shown to alter the patient's perception of voice quality or general health. Declining resources for medical care mandate that treatment outcomes be documented. A prospective analysis of the effects of BTX on the patient's perception of voice and general health was undertaken. The Voice Handicap Index (VHI) and Short Form 36 (SF-36) surveys were administered to patients before treatment and 1 month after. Pretreatment and posttreatment scores were analyzed with a Student's t-test. On the VHI, improvements in the patients' perception of their functional, physical, and emotional voice handicap reached statistical significance (p < or = .0005). On the SF-36, patients had statistically significant improvements in mental health (p < or = .03) and social functioning (p < or = .04). Treatment of SD with BTX significantly lessened the patients' perception of dysphonia. In addition, it improved their social functioning and their perception of their mental health. These outcome measures justify the continued treatment of SD with BTX.
BACKGROUND: The aim was to compare the efficacy of intensive clinical case management (ICM) with standard community care in the management of 'hard to treat' patients with a severe mental illness. METHOD: A randomised controlled trial was carried out in East Lambeth, a deprived area of inner London. Seventy people with psychosis designated as 'hard to treat' by referring teams were included; 35 were randomised to ICM (case load eight patients per worker), and 35 to standard care, which offered follow-up by a community psychiatric nursing service (30 patients per worker). Outcome measures were admissions and hospital bed utilisation; contact with services; symptomatology; social behaviour; social functioning; quality of life; patients' satisfaction with care at 9 and 18 months. RESULTS: There were no differences in patients' symptoms, social behaviour or social functioning. Quality of life was significantly improved in patients receiving ICM at 9 months. Satisfaction with care was significantly greater among case-managed patients. All ICM patients remained in contact with services throughout the study, while six control patients were refusing all contact with services at 18 months. CONCLUSIONS: ICM failed to improve the clinical outcome of 'hard to treat' patients. The service was successful in maintaining contact with patients, was greatly appreciated and had a positive effect on their perceived quality of life.
Substantial reductions in the in-patient census of state hospitals throughout the United States have led to the concentration of large numbers of formerly mentally ill individuals in sheltered living arrangements in local communities. These efforts represent a major change in providing care for the long-term chronic patient. How is the life of this individual affected by community placement? A survey was completed of 499 residents in 234 facilities representing all formerly hospitalized non-retarded mental patients between 18 and 65 years old in California's sheltered care facilities. Results indicate that the social functioning of individuals in the external community is enhanced primarily by the characteristics of the community in which they are placed. In contrast, the social functioning of individuals within the immediate environment of their sheltered living arrangements is most affected by the character of the placement itself. The particular characteristics of communities and facilities found to be most important in addition to the characteristics of the residents which impact on social integration are discussed in the study.
OBJECTIVE: To assess the health-related quality of life (HRQOL) of patients complaining of halitosis at their first visit and at a later time when their complaint had diminished following therapy, using a self-administered questionnaire, the Medical Outcome Study Short Form-36 (SF-36). The aim of this study was to examine the relationship between HRQOL of patients before and after self-reported disappearance of their complaint following oral hygiene improvements for halitosis. SUBJECTS AND METHODS: Seventy patients of our special clinic for halitosis served as subjects. At the first visit, each completed the SF-36 before determination of volatile sulfur compound (VSC) concentration in mouth air. After excluding dropouts, the same measurements were performed for subjects whose self-reported complaint had disappeared following oral hygiene therapy. RESULTS AND DISCUSSION: At the initial visit, SF-36 scale scores for general health, vitality, social functioning, role-emotion, and mental health were significantly lower when compared with the national averages in Japan. For subjects with self-reported disappearance of complaint, only social functioning rose significantly among SF-36 scores at the end of the study. These results suggest that an awareness of improvement in social life could be related to patient's satisfaction with halitosis oral hygiene therapy.
BACKGROUND: Few psychosocial interventions have been developed in China that are suitable for use in the community. AIMS: To evaluate the effectiveness of the Chinese version of the Community Re-Entry Module (CRM; a module of a standardised, structured social skills training programme devised at the University of California, Los Angeles) for patients with schizophrenia compared with standard group psychoeducation. METHOD: Patients with schizophrenia (n=103) were randomly allocated to CRM or psychoeducation groups and followed up for 24 months. Outcome measures included social functioning, psychiatric symptoms, insight, re-employment, relapse and re-hospitalisation rates. RESULTS: The CRM group significantly improved in terms of social functioning, insight and psychiatric symptoms compared with the psychoeducation group; the re-employment rate was significantly higher and relapse and rehospitalisation rates were significantly lower in the CRM group. CONCLUSIONS: The findings support the feasibility and effectiveness of CRM as a psychosocial intervention for Chinese patients with schizophrenia in the community.