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PubMed1979

[Training of personnel for mental health teams].

The mental disorder is a biopsychosocial phenomenon. Starting from this idea, this paper suggests the active participation of every psychiatric professional with the organizated help of community groups, specially trained in mental health matters. A double social function is obtained by this: 1) programmed public training, and 2) practical performance in the assistence field of the same community. In Chile, in general, two social stratus are distinguished; the european culture (middle and upper class) and the popular aboriginal culture (working and rural class). Both have their own pattern about medicine: the european culture, based on the scientific concept, and the popular one based on the magic-religious thoughts. Between them, there exists a barrier. On the one hand, there is not sufficient scientific medical assistence on a national level; on the other hand, the popular medicine is precarious, but more effective in its social function (low cost, availability, absence of bureaucracy, human contact, comprehensible language of medicasters, etc.). The Integral Mental Health Programme objective, in this point, is to join a minimum of the popular medicine sociological structure with the actions of the scientific medicine. Interaction between these will be produced according to the transculturation principles. Patterns for training the 5 levels of the functions delegation are given.

Allied Health Personnel↗
PubMedDate not supplied

Determinants of perceived health in patients with left ventricular dysfunction: a structural modeling analysis.

OBJECTIVE: Few studies have evaluated the determinants of perceived health in patients with chronic illness. The present study was designed to evaluate the role of biomedical, demographic, and psychosocial influences on global subjective health by means of a structural equation modeling approach. METHOD: A conceptual model of perceived health was tested in a subsample of patients (N = 146) from the multicenter Studies of Left Ventricular Dysfunction (SOLVD) trial. Domain-specific quality of life constructs (emotional status, social support, and physical functioning), were assessed by means of multiple indicators. These latent (mediating) variables, along with six single-indicator biomedical and background variables, were modeled as predictors of a composite index of perceived health. RESULTS: A satisfactory fit was obtained for the proposed model, with practical fit indices ranging from .89 to .95. High levels of perceived health were associated with low levels of emotional distress and high levels of physical functioning. Social support was positively correlated with physical functioning and negatively associated with emotional distress. Among the background variables, no direct associations were observed between any of the single-indicator variables and perceived health. Several background variables (eg, age, income, walk-test scores) had indirect effects via associations with the latent variables of physical functioning and emotional distress. CONCLUSIONS: These findings support the use of a structural modeling approach in assessing determinants of perceived health in patients with congestive heart failure. Further research is needed to evaluate the utility of the model in other patient populations.

Activities of Daily Living↗
PubMed1993

Parental risk and resistance factors among children with juvenile rheumatic disease: a four-year predictive study.

Examined the extent to which baseline functioning and parental risk and resistance factors predicted disease-related (functional disability and pain) and psychosocial functioning (social competence and behavior problems) 4 years later among 172 children with juvenile rheumatic disease. The study also examined the extent to which fathers' risk and resistance factors explained patients' adaptation, above and beyond maternal factors. Poorer baseline functioning was a strong risk factor that predicted poorer functioning 4 years later. In addition, parental risk and resistance factors at baseline predicted patients' adjustment after patients' age and baseline functioning were controlled. Mothers' and fathers' personal strain and depressed mood, and fathers' drinking problems, were associated with poorer patient adjustment; mothers' and fathers' social functioning appeared to aid patients' adjustment. Fathers' risk and resistance factors contributed independently from those of mother, to predict patients' outcome.

Adaptation, Psychological↗
PubMed2004

The contribution of social disability to the evaluation of mental disability among PTSD veterans.

BACKGROUND: Israeli veterans who claim for recognition of their mental disability and compensation undergo multi-professional assessments including a detailed psychosocial evaluation. OBJECTIVES: To conduct a systematic evaluation of the social disabilities of veterans with PTSD; to examine the relationships between the various aspects of their social disability and their PTSD symptom severity, on the one hand, and the ratings they receive from psychiatrists determining their overall disability, on the other hand. METHOD: The study was conducted on 120 veterans with PTSD, all filing for compensation. Data was collected by means of semi-structured interviews that were carried out by social workers in ajoint meeting with the veterans and their spouses and that covered marital, parental and social functioning; from the self-report PTSD questionnaire that the veterans filled out; and from the final disability ratings in the veterans' files. RESULTS: Findings showed a disturbing picture of impaired marital, parental and social functioning of veterans with PTSD. In addition, they indicate that both PTSD severity and the psychiatrists' disability ratings were correlated with only a quarter or so of the veterans' specific social disabilities in the areas studied. DISCUSSION: Several explanations for the pattern of correlations between these two assessments are offered. In addition, we highlight the importance of a sensitive and detailed evaluation of social disability as well as recommending the development of practical guidelines for the determination of disability.

Adaptation, Psychological↗
PubMed2006

Cognitive self-therapy for chronic depression and anxiety: a multi-centre randomized controlled study.

BACKGROUND: Non-professional treatment programmes are presumed to relieve the extensive need for care of anxiety and depression disorders. This study investigates the effectiveness of cognitive self- therapy (CST) in the treatment of depression or generalized anxiety disorder. METHOD: Patients (n=151) were randomized to receive CST or treatment as usual (TAU) in a trial lasting for 18 months, measuring symptoms (SCL-90; main outcome), social functions, quality of life and utilization of care. RESULTS: Patients in both conditions improved significantly, but no difference was found between the conditions. Reduction of symptoms, improvement of social functions and medical utilization were maintained at the end of the 18 months. Medical care utilization (therapist contact and hospitalization) was lower for CST than for TAU. No suicides occurred. CONCLUSIONS: Cognitive self-therapy is likely to decrease the need for care of chronic depression and anxiety disorders, but it has not been proven to be more effective than treatment as usual.

Adult↗
PubMed2006

Impact of severe acute respiratory syndrome care on the general health status of healthcare workers in taiwan.

BACKGROUND: The impact of the outbreak of severe acute respiratory syndrome (SARS) was enormous, but few studies have focused on the infectious and general health status of healthcare workers (HCWs) who treated patients with SARS. DESIGN: We prospectively evaluated the general health status of HCWs during the SARS epidemic. The Medical Outcome Study Short-Form 36 Survey was given to all HCWs immediately after caring for patients with SARS and 4 weeks after self-quarantine and off-duty shifts. Tests for detection of SARS coronavirus antibody were performed for HCWs at these 2 time points and for control subjects during the SARS epidemic. SETTING: Tertiary care referral center in Taipei, Taiwan. SUBJECTS: Ninety SARS-care task force members (SARS HCWs) and 82 control subjects. RESULTS: All serum specimens tested negative for SARS antibody. Survey scores for SARS HCWs immediately after care were significantly lower than those for the control group (P<.05 by the t test) in 6 categories. Vitality, social functioning, and mental health immediately after care and vitality and mental health after self-quarantine and off-duty shifts were among the worst subscales. The social functioning, role emotional, and role physical subscales significantly improved after self-quarantine and off-duty shifts (P<.05, by paired t test). The length of contact time (mean number of contact-hours per day) with patients with SARS was associated with some subscales (role emotional, role physical, and mental health) to a mild extent. The total number of contact-hours with symptomatic patients with SARS was a borderline predictor (adjusted R2=0.069; P=.038) of mental health score. CONCLUSIONS: The impact of the SARS outbreak on SARS HCWs was significant in many dimensions of general health. The vitality and mental health status of SARS HCWs 1 month after self-quarantine and off-duty shifts remained inferior to those of the control group.

Adult↗
PubMed1998

Changes in the SF-36 in 12 months in a clinical sample of disadvantaged older adults.

OBJECTIVES: The present study assessed changes in the Medical Outcomes Study 36-item short-form health survey (SF-36) during a 12-month period and examined the relation of those changes to selected baseline characteristics. METHODS: The study was a 12-month follow-up evaluation of 786 disadvantaged adults aged 50 to 99 years old who had participated in a randomized controlled clinical trial in the general medicine outpatient clinics of a major academic medical center. Descriptive and psychometric analyses of changes in the SF-36 scale scores during a 12-month period were performed, and two series of multivariable logistic regressions of increases or decreases greater than one standard error of measurement (SEM) versus stability on selected baseline characteristics were done. Measures were the eight SF-36 scales. RESULTS: Mean baseline scores on the SF-36 scales were substantially below age-specific national norms. Problematic floor and/or ceiling effects were found for the bodily pain, social function, role--physical, and role--emotional scales, consistent with age-specific national norms. Internal consistency was unacceptable for the general health perceptions scale, adequate for the social function scale, and good for all the other SF-36 scales. Improvements greater than one standard error of measurement were found for between one fifth and one third of the patients, and declines greater than one standard error of measurement were found for between one fifth and one third of the patients. Selected baseline characteristics generally were unrelated to either improvements or declines on the SF-36 scales. CONCLUSIONS: The SF-36 scales appear to be sufficiently sensitive for measuring changes in health outcomes during a 1-year period in older patients with debilitating disease. Little of the measured change, however, was predictable.

Adult↗
PubMed1996

An outbreak of Salmonella typhimurium DT104 food poisoning associated with eating beef.

An outbreak of Salmonella typhimurium DT104 infection in Shropshire in May 1995 was identified when four isolates were noted to be from members or supporters of a local football team that had held several social functions in the same week. The subsequent investigation identified 16 people with gastrointestinal symptoms and 12 with microbiologically confirmed infection. The outbreak was complex, associated with several social functions on different days, but infection was associated with eating beef at a public house. A number of errors were detected in the cooking, storage, and handling of the implicated food. The investigation identified beef as the vehicle of infection in this outbreak but was unable to show whether it was the original source of infection or whether cross or manual contamination occurred in the kitchen.

Animals↗
PubMed2005

Health-related quality of life of diabetic foot ulcer patients and their caregivers.

AIMS/HYPOTHESIS: The effect of a foot ulcer on health-related quality of life (HRQoL) of patients with diabetes mellitus and their caregivers is unclear, and was therefore evaluated prospectively in this multicentre study. METHODS: HRQoL according to the 36-item health-related quality of life questionnaire (SF-36) of 294 patients (ulcer duration > or = 4 weeks) and 153 caregivers was analysed at baseline (time-point zero [T0]), once the ulcer was healed or after 20 weeks (time-point 1 [T1]), and 3 months later (time-point 2 [T2]). Patients with severe ischaemia were excluded. RESULTS: The mean age of the patients was 60 years, 72% were male, and time since diagnosis of diabetes was 17 years. Patients reported a low HRQoL on all SF-36 subscales. At T1, HRQoL scores in physical and social functioning were higher in patients with a healed vs a non-healed ulcer (p<0.05). At T2, these differences were larger, with higher scores for physical and social functioning, role physical and the physical summary score (all p<0.05). Within-group analysis revealed that HRQoL improved in different subscales in patients with a healed ulcer and worsened in patients with a persistent ulcer from T0 to T2 (all p<0.05). The caregivers of patients with a persisting ulcer had more emotional difficulties at T2. CONCLUSIONS/INTERPRETATION: Diabetic patients with a healed foot ulcer had a higher HRQoL than patients with a persisting ulcer. Healing of a foot ulcer resulted in a marked improvement of several SF-36 subscales 3 months after healing (from T0 to T2). HRQoL declined progressively when the ulcer did not heal. A diabetic foot ulcer appeared to be a large emotional burden on the patients' caregivers, as well.

Becaplermin↗
PubMed1997

Effect of neurological dysfunction on health-related quality of life in patients with high-grade glioma.

The purpose of the study was to assess health-related quality of life (HQL) in patients with high-grade malignant glioma of the brain. The EORTC core Quality of Life Questionnaire (QLQ-C30) and a Brain Cancer Module (BCM20) were administered at baseline and several weeks later (follow-up) to 105 patients with either recently-diagnosed (n = 41) or recurrent (n = 64) malignant glioma. In addition, the attending neurologists completed a standard neurological examination, a modified Barthel Activities of Daily Living Index (BADLI) and the Karnofsky Performance Scale (KPS). In a preliminary step, the QLQ-C30 was found to have acceptable reliability (internal consistency and test-retest reliability). Newly-diagnosed patients and those with a KPS of 80-100 had significantly better physical, role and cognitive functioning and global quality of life with less fatigue, visual disorder, motor dysfunction, communication deficit, weakness of both legs and trouble controlling the bladder than did those with recurrent disease and those with a KPS of 50-70. Similarly, those capable of independent activities of daily living, as reported on the BADLI, had higher functioning scores and less fatigue than did those who were not independent. Patients with dysphasia, mental confusion or motor deficit on neurological examination reported significantly lower levels of physical, role, cognitive, emotional and social functioning and global quality of life than did patients not having these difficulties. They also had significantly more symptoms. In patients with deteriorating neurological status between baseline and follow-up, there was a marked decline in cognitive, physical, role, emotional and social functioning and global quality of life and an increase in fatigue. Thus, there are significant differences in HQL between patients with newly-diagnosed and recurrent brain cancer and between patients with differing KPS and BADLI scores. In addition, the HQL scores provide details not provided by the KPS and the BADLI. Deterioration in neurological function is accompanied by significant deterioration in a range of HQL domains and in global quality of life.

Adolescent↗
PubMed2002

Achieving gains beyond response.

OBJECTIVE: To review adverse outcomes following response in treatment of depression. METHOD: Review of published literature with particular emphasis on key papers. RESULTS: Moderately high rates of relapse and recurrence are found in naturalistic follow-up studies of depressed patients receiving modern treatment. These are reduced but not abolished in controlled trials by continuation and maintenance treatment with antidepressants. Suicide rates in follow-up studies are much elevated compared with the general population. Social function is impaired and remits more slowly than depressive symptoms. A key outcome is the occurrence of incomplete remission with residual symptoms, which is associated with high relapse rates and impaired social function. CONCLUSION: It is important to achieve complete remission in depression. Elimination of residual symptoms is an important target for full treatment of the depressive episode, in order to avoid later adverse outcomes.

Antidepressive Agents↗
PubMed1991

[Comparison of several screening instruments for dementia].

Both evidences of cognitive and functional impairments are necessary for the diagnosis of dementia. Following instruments: Mini-Mental State Examination (MMSE), Blessed Dementia Scale (BDS) and Hasegawa Dementia Scale (HDS) for cognitive assessment, and Activity of Daily Living (ADL) and Pffefer's Social Function Questionnaire (POD) for function measurement, were used in a survey sample of 5055 aged persons. It was found that the scores of both categories of tests were significantly correlated. The scores of MMSE, BDS and HDS were highly education-related, thus the education-dependent cutoff point should be decided. Among the cognitive assessment scales, MMSE and HDS seems better than BDS, while in functional scales, POD was more suitable for community survey. Sensory and motor disturbances, emotional and health problem were also interfered with both cognitive and daily or social function, it should be taken account in the diagnostic process for dementia.

Activities of Daily Living↗
PubMed2003

Depressive symptoms erode self-esteem in severe mental illness: a three-wave, cross-lagged study.

Vulnerability, scar, and reciprocal-relations models of depressive symptoms and self-esteem were compared among people with severe mental illness (SMI; N=260) participating in a partnership-based intervention study. Assessments were conducted at baseline, midway through the intervention (after 4 months), and at termination (after 9 months). Cross-lagged, structural equation modeling analyses revealed that participants' baseline depressive symptoms predicted a decrease in self-esteem in the first 4 months but not in the subsequent 5 months of participation. Exploratory regression analyses indicated that improved social functioning buffered this deleterious effect of depressive symptoms. These findings, which are consistent with the scar model, highlight the fragile nature of the self and the importance of social functioning in recovery from SMI.

Adult↗
PubMed2006

A pilot study of adjunctive family psychoeducation in adolescent major depression: feasibility and treatment effect.

OBJECTIVE: To obtain preliminary evidence of the feasibility and effectiveness of adjunctive family psychoeducation in adolescent major depressive disorder. METHOD: Participants were from outpatient clinics in Hamilton and London, Ontario. Over 24 months, 41 adolescents ages 13 through 18 years meeting major depressive disorder criteria were recruited (31 in Hamilton, 10 in London). Participants were randomized to usual treatment or usual treatment plus family psychoeducation. Outcome measures were readministered at 2 weeks, mid-treatment, posttreatment, and 3-month follow-up. Intent-to-treat analyses used chi2 and t tests and growth curve analysis. Standardized effects based on growth curve estimates were calculated for continuous outcomes. RESULTS: The London site was withdrawn because of poor participant retention. In Hamilton, no participant missed more than one assessment and there was good family psychoeducation adherence. Compared to controls, participants in the experimental group showed greater improvement in social functioning and adolescent-parent relationships (with medium standardized effect size > 0.5), and parents reported greater satisfaction with treatment. CONCLUSIONS: There were positive treatment effects on family and social functioning processes postulated to mediate the clinical course of major depressive disorder. The study provides support for further evaluation of family psychoeducation in this clinical population.

Adolescent↗
PubMed2004

Treatment of depressed mothers of depressed children: pilot study of feasibility.

Numerous studies have shown that depression is highly familial and impairing and that a history of depression in a parent is the strongest risk factor for depression in a child. Many of the parents in these studies have never received sustained treatment despite histories of recurrent depression. None of the studies have examined the effects of maternal symptom remission on offspring symptom or functioning. We sought to determine the feasibility of treating depressed mothers who brought an offspring for the treatment of depression and to examine the relationship between improved maternal depression and symptomatic improvement and social functioning in their offspring. Nine mothers bringing their offspring for treatment of depression, and who were evaluated and found to be currently depressed, completed a 12-week open trial of interpersonal psychotherapy. Mothers and their depressed offspring were assessed by independent evaluators at weeks 0, 6, and 12 for depressive symptomatology and social functioning. Although the rates of depression were high among the mothers, few eligible mothers agreed to participate. Of the 12 who entered treatment, 9 (75%) completed it. Mothers and offspring improved with regard to depressive symptomatology and global functioning over the course of the trial. Improvement in maternal depression was significantly associated with improvement in offspring functioning but not symptom reduction. Improvement of maternal depression may be associated with improved outcomes in depressed offspring. However, it is difficult to engage depressed mothers in treatment for themselves if they come to the clinic to bring their child for treatment of depression. It may be more feasible to study the effect of improved maternal depression on offspring by sampling depressed mothers coming for their own treatment and then assessing their children over the course of maternal treatment.

Adolescent↗
PubMed1998

Health-related quality of life in men with erectile dysfunction.

OBJECTIVE: To assess health-related quality of life (HRQOL) in men with erectile dysfunction. DESIGN: Descriptive survey with general and disease-specific measures. The instrument contained three established, validated HRQOL measures, a validated comorbidity checklist, and sociodemographics. The RAND 36-Item Health Survey 1.0 (SF-36) was used to assess general HRQOL. Sexual function and sexual bother were assessed using the UCLA Prostate Cancer Index. The marital interaction scale from the Cancer Rehabilitation Evaluation System Short Form (CARES-SF) was used to assess each patient's relationship with his sexual partner. SETTING: Urology clinics at a university medical center and the affiliated Veterans Affairs (VA) Medical Center. PARTICIPANTS: Thirty-five (67%) of 54 consecutive university patients presenting for erectile dysfunction and 22 (42%) of 52 VA patients who were awaiting a previously prescribed vacuum erection device participated. MAIN RESULTS: The university respondents scored slightly lower than population normals in social function, role limitations due to emotional problems, and emotional well-being. The VA respondents scored lower than expected in all eight domains. Scores for the VA population were significantly lower than those for the university population in physical function, role limitations due to physical problems, bodily pain, and social function. A significant correlation was seen between marital interaction and sexual function (r = -.33, p = .01) but not between marital interaction and sexual bother (r = -.15, p = .26) in the total sample. Sexual function also correlated significantly with general health perceptions (r = .34, p = .01), role limitations due to physical problems (r = .29, p = .03), and role limitations due to emotional problems (r = .30, p = .03). Sexual bother did not correlate with any of the general HRQOL domains. Affluent men reported better sexual function (p = .03). CONCLUSIONS: The emotional domains of the SF-36 are associated with more profound impairment than are the physical domains in men with erectile dysfunction. Erectile dysfunction and the bother it causes are discrete domains of HRQOL and distinct from each other in these patients. With increased attention to patient-centered medical outcomes, greater emphasis has been placed on such variables as HRQOL. This should be particularly true for a patient-driven symptom, such as erectile dysfunction.

Comorbidity↗