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PubMed1977

[Medicosocial aspects of epilepsy in Latin America].

This paper justifies the consideration of epilepsy as a social problem and an important public health problem in Latinamerica. It comments on the lack of proper statistical studies and the particular composition of the Latinamerican population where epilepsy has no clear differences according to age, in reference to mortality. It considers the labor structure of the population with low income and exposed to morbility and malnutrition for different causes, making notice that the social problems of epilepsy are by and large going along with the economic deficits and the unequal social system. The article mentions the problem of neonatal anoxia and other perinatal hazards so much influenced by poor hygiene and ignorance, going along with other poorly understood or non existing hygienic prevention problems. Among other points it touches on human and material resources in relation to epilepsy.

Adolescent↗
PubMed1997

The psychological effect of orphanhood: a study of orphans in Rakai district.

This paper examines the psychological effect of orphanhood in a case study of 193 children in Rakai district of Uganda. Studies on orphaned children have not examined the psychological impact. Adopting parents and schools have not provided the emotional support these children often need. Most adopting parents lack information on the problem and are therefore unable to offer emotional support; and school teachers do not know how to identify psychological and social problems and consequently fail to offer individual and group attention. The concept of the locus of control is used to show the relationship between the environment and individuals' assessment of their ability to deal with it and to adjust behaviour. Most orphans risk powerful cumulative and often negative effects as a result of parents' death, thus becoming vulnerable and predisposed to physical and psychological risks. The children were capable of distinguishing between their quality of life when their parents were alive and well, when they became sick, and when they eventually died. Most children lost hope when it became clear that their parents were sick, they also felt sad and helpless. When they were adopted, many of them felt angry and depressed. Children living with widowed fathers and those living on their own were significantly more depressed. These children were also more externally oriented than those who lived with their widowed mothers. Teachers need to be retrained in diagnosing psycho-social problems and given skills to deal with them. Short courses should be organized for guardians and community development workers in problem identification and counselling.

Adaptation, Psychological↗
PubMed1988

Rearranging the deckchairs on the Titanic: failure of an augmented home help scheme after discharge to reduce the length of stay in hospital.

An augmented home help service was set up in the Rhondda Valley in South Wales in order to facilitate discharge from hospital of elderly subjects who were kept in hospital because of mainly social problems. Patients were allocated to the new service or the pre-existing services according to their date of birth. The extra social support did not result in a faster discharge from hospital, nor in any improvement in well-being of the intervention group, largely because the small extra amount of service input was inadequate to ameliorate the extreme physical, mental and social problems experienced by the study group.

Aftercare↗
PubMed2001

Stalking: new constructions of human behaviour.

OBJECTIVE: In the last decade stalking has emerged as a significant social problem, which now constitutes a specific form of criminal offence in most English-speaking nations. This paper examines why stalking has become a major social problem and why it should be of particular concern to mental health professionals. METHOD: Using the extant literature, the history of the emergence of stalking as social, legal and behavioural science discourses is presented. An attempt is made to understand the social and cultural forces which shaped our current understanding of the phenomenon of stalking. RESULTS: Stalking flourishes in a variety of contexts; the social conditions conducive to such behaviour include greater instability in intimate relationships, a culture of blame and entitlement and a growing social anxiety that emphasizes vulnerability to crime and suspicion regarding the intentions of strangers. Stalking is now an established category whose utility is in directing social, legal and health energies to support victims and relieve stalkers of their burden of pursuit. CONCLUSIONS: Stalking is a curious construction born of a range of tensions in contemporary culture but has proved to be a useful label and a useful concept. In part due to the emergence of the concept of stalking, laws are now available to protect, and services increasingly geared to support, the victims of persistent harassment.

Female↗
PubMed2000

Psychosocial sequelae in 29 children with giant congenital melanocytic naevi.

Giant congenital melanocytic naevus (GCMN) may be expected to affect psychosocial functioning of children and their parents due to deviant appearance and painful treatment. To obtain insight into clinical aspects and psychosocial functioning of those suffering from GCMN, 29 children diagnosed with GCMN syndrome or single GCMN received a dermatological examination, were interviewed, and their mothers and teachers completed standardized questionnaires on the child's competence and behavioural/emotional problems and their own adjustment. Social problems were reported for 30% of the patients and behavioural/emotional problems for 25.9%. There was no correlation between visibility of the naevus, treatment or child age and psychological problems. Mothers reported considerable psychosocial burden. It is concluded that children with GCMN are at increased risk of social and behavioural/emotional problems, and mothers suffer considerable psychological impact of their child's condition.

Adaptation, Psychological↗
PubMed1994

Child and parent psychological problems influence child weight control.

This study used path analytic methods to assess the influence of child psychopathology measured using the Child Behavior Checklist and parent psychiatric symptoms measured using the Cornell Medical Index on changes in child percent overweight in obese 8- to 11-year-old children over 2 years (6 months of treatment, 18 months of follow-up) provided family-based behavioral intervention. Path analysis for the 0-6 month change showed the influence of mother and father psychiatric symptoms and child age on child anxiety/depression scores that in turn influenced child percent overweight change during treatment, accounting for 41% of the shared variance. The path analysis for follow-up change showed mother and father psychiatric symptoms influenced child social problems at the first stage, and child social problems influenced child percent overweight change, accounting for 68.5% of the shared variance. These results provide the first demonstration that both parent and child problems may influence the short- and long-term success of obese children who participate in family-based behavioral treatment programs.

Adult↗
PubMed2006

Alcohol Use Disorder Identification Test (AUDIT): what does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample.

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000-01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.

Adolescent↗
PubMed1998

Characteristics of geriatric patients related to early and late readmissions to hospital.

The aim of the study was to evaluate which characteristics of geriatric patients account for readmission to hospital, 6 months after discharge. All patients (203 females, 176 males) consecutively admitted over a two-month period to four acute geriatric care units, located in the cities of Chieti, Perugia, Pescara and Prato, participated in the study. Data that could potentially explain early and late readmissions were collected for each patient. Prevalence of diseases and comorbidity were assessed with the Cumulative Illness Rating Scale (CIRS); physical function by self-report (ADL, IADL) and objective (Stand and Walking Speed) measures; cognitive level by MMSE; and depressive symptoms by the Geriatric Depression Scale (GDS). Information on family and social support were also obtained. After discharge, data on hospital readmissions were collected for six months. For each readmitted patient (cases), medical records were reviewed, and supplementary information was obtained from families and general practitioners. Readmissions were classified as "early" (within the first three months), "late" (within the third and sixth month), and "multiple" (2 or more readmissions irrespective of the period). Patients not readmitted (alive at home) were considered as controls. Systematic differences between centers and between periods of readmissions were evaluated using one-way analyses of variance, and Pearson's chi 2 test. Factors related to early, late, and multiple readmission were identified in multivariate logistic regression models. On univariate analysis, patients readmitted over the first three-month period were sicker than controls (CIRS classes 3-4: 52.1% vs 34.1%), had more social problems or behavioral symptoms, and were more functionally impaired (ADL dependencies 3.3 +/- 0.4 vs 2.1 +/- 0.2). Patients who were readmitted between the third and the sixth month after discharge had a significantly higher CIRS total score (p = 0.006). Patients with multiple readmissions had more severe diseases, and more social problems. On multivariate analysis, early readmission was associated with unsatisfactory social conditions, living alone, severity of diseases and cognitive impairment, while late readmission was associated with comorbidity only. Multiple readmissions were related only to social factors, and to hospital admission before the baseline evaluation. The findings of this study suggest that interventions aimed at improving unfavorable social conditions may reduce the rate of rehospitalization in geriatric patients.

Activities of Daily Living↗
PubMed1995

Impaired social status of growth hormone deficient adults as compared to controls with short or normal stature. Dutch Growth Hormone Working Group.

OBJECTIVES: In adults with growth hormone deficiency (GHD) social problems have been reported, but so far the relative contributions of GHD, additional pituitary deficiencies and short stature have not been distinguished. We therefore compared social data from GHD patients with social data from controls with short or normal stature. Furthermore we investigated whether social problems are caused solely by the deficiency of GH or also by the associated absence of other pituitary hormones. DESIGN: A questionnaire was sent to patients and controls with items on education, profession, income, partner and living situation. PATIENTS: Two hundred and ten GHD patients treated in childhood but not in adulthood with GH (93 isolated GHD (IGHD), 111 patients with multiple pituitary deficiency (MPD)) were compared with 53 short controls (height in childhood < third percentile for population) and 39 normal stature controls. RESULTS: There were no differences between short and normal controls. There were also no differences between IGHD and MPD patients in any of the investigated items. GHD patients did not differ from controls on education level, but scored lower on the profession scale, had a lower income and had a partner less often; if they had a partner they less often had children; also, more of them lived with their parents. CONCLUSION: Since patients with multiple pituitary deficiency did not differ from patients with isolated growth hormone deficiency, this suggests that the lower scores on the social parameters are the result of the growth hormone deficiency itself. Since short stature controls had higher scores than patients with growth hormone deficiency and did not differ from normal stature controls in any of the aspects investigated, it seems unlikely that the problems of the patients with growth hormone deficiency can be attributed to short stature.

Adult↗
PubMed1979

Lost to follow up: a study of nonattendance at a general paediatric outpatient clinic.

50 children defined as persistent outpatient nonattenders were compared with 50 children who regularly attended the same clinics. Several factors were often found in the group of nonattenders: (a) initial referral via casualty without a letter from the family doctor, (b) hospital admission before the first outpatient appointment, (c) recognition of multiple medical problems, and (d) evidence of diffuse social problems affecting the family. 34 of the nonattenders had at least 2 of these factors, compared with only 9 children in the other group. Many of these problems can be identified at the initial consultation, and perhaps other methods of continuing health care should be provided for these children.

Adolescent↗
PubMed2005

Chronic renal diseases as a public health problem: epidemiology, social, and economic implications.

The impact of chronic kidney disease (CKD) on the global burden of diseases is probably underestimated by current methods of evaluation. However, CKD are emerging as a major health problem. First, the costs of renal replacement therapy are excedingly high and are consuming a significant proportion of health care budgets of developed countries, while in developing countries are out of reach. Second, complex interaction are clearly emerging between chronic kidney, cardiovascular disease, and diabetes.

Adult↗
PubMed2004

Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients.

BACKGROUND: Although present findings about frequent users of psychiatric inpatient services vary from study to study, some potentially important predictors of frequent use were extracted. The purpose of this study was to examine the potentially contributory factors of frequent use of psychiatric inpatient services by schizophrenia patients and to test the influence single factors have in an overall model. METHODS: A total of 307 schizophrenia patients were interviewed five times with intervals of 6 months. Data were collected about service receipt and health care costs, strength of primary diagnosis and comorbidities, as well as about patients' needs for care and satisfaction with care. Patients with three or more psychiatric admissions within a 30-month period were defined as frequent users. RESULTS: According to this criterion, 12% of the study population were frequent users. Compared with ordinary users, these patients accounted for significantly higher costs in hospital- and community-based care. Important predictors for frequent use of psychiatric inpatient services were the number of previous hospitalizations and current scores of psychopathology. In addition, a longitudinal analysis showed the importance of social factors for the use of psychiatric inpatient care. Therefore, a number of the frequent users' multiple admissions could also be caused by social problems. CONCLUSIONS: The mental health system should, thus, provide well-directed community-based resources, which give frequent users support to solve their social problems.

Adolescent↗