Community-Based Interventions

This paper explores the potential of community-based, public health-oriented interventions as a tool for reducing the burden of affective disorders on individuals, their families, and communities. The paper reviews the use of community-based interventions with other health-related problems and describes potential applicability for affective disorders such as changing public attitudes, reducing social stigma, facilitating access, or supporting treatment adherence for populations in their community settings. An agenda for developing this field of intervention research is proposed.     

汕头市精神分裂症社区康复疗效分析

目的探讨精神分裂症社区康复的疗效和方法。方法对１２３例精神分裂症２年社区康复的治疗、现病、社会功能、社会影响、复发进行前后比较，并与７９例社区自然状态下精神分裂症对照。结果精神分裂症两年社区康复疗效显著，２年显进率达７３９８％，复发率１７５８％，对照病例则无变化或恶化，显进率２９１１％，复发率４３４８％。结论社区康复对于精神分裂症控制病情，恢复社会功能，防止复发显示明显作用     

Community-Based Study of Lennox-Gastaut Syndrome

Summary: Purpose : Before 1986, the spectrum of childhood epilepsies, including Lennox-Gastaut syndrome (LGS) and Doose syndrome (DS), known collectively as "epilepsia myoclonica astatica", was believed to represent a single disease. More recently, some investigators have considered these syndromes to be parts of a continuum. To clarify these theories, neurobiologic factors of the syndromes were studied to determine which qualities were shared and which were unique.
Methods : A retrospective (1975–985), community-based (Helsinki metropolitan area and the province of Uusimaa) study was designed to seek children with features of LGS and DS. It was assumed that recall bias and the selection of documented history would be similar throughout the group. Ranks of increasing pathology were assigned to different seizure types, EEG results, and drug treatments. A similar procedure was applied to epidemiologic data. Spearman rank-order correlations were calculated to determine which features correlated with LGS and which correlated with less severe epilepsy.
Results : The survey comprised 75 patients with broadly defined LGS. The annual incidence was 2 in 100,000 children aged 0 to 14 years. Prenatal or perinatal abnormalities did not correlate with severity of epilepsy. As compared with the relatively favorable ranks, the severe epilepsy ranks were more often associated with an early onset of epilepsy, an infectious disease at the onset, delayed development before epilepsy, abnormalities in neurologic or neuroradiologic examinations, and a deteriorating course of the condition.
Conclusions : Patients with LGS are more likely than patients with less severe epilepsy to have a younger age at onset of epilepsy, an infection or both, and a deteriorating course of the condition.     

Patient Satisfaction with Community-Based Psychiatric Services

The aim of this study is to establish the satisfaction of patients with community-based psychiatric services, developed in the context of Italian psychiatric reform. The Verona Services Satisfaction Scale (VSSS-54) was used to measure satisfaction among 229 patients cared for by the Desio Department of Mental Health. Patients were gene rally satisfied (23 percent of the patients were unsatisfied), but in some dimensions (“Information” and “Relatives’ involvement”) they reported a low level of satisfaction. In the regression models, the sociodemographic, diagnostic, and service utilization variables explained only a low percentage of the satisfaction variance. Continuity of care and satisfaction with psychiatric services do not seem to be related; satisfaction does not predict the number of admissions to a psychiatric ward in the year after evaluation. The conclusion of the study is that satisfaction is a useful indicator in monitoring quality of care: by analyzing different dimensions of satisfaction, we can focus professionals on patients’ needs and expectation and modify the services accordingly.     

不宁腿综合征与认知障碍的前瞻性研究:基于社区的5年纵向队列研究

目的探讨不宁腿综合征(RLS/WED)与认知功能减退间的关系。方法这是一项基于上海黄浦区五里桥社区≥50岁人群的前瞻性研究。首先于2009年,使用中国版简易精神状态检查量表(MMSE-C)对该社区中222例RLS/WED患者(基于2003版诊断标准制定的量表筛查)和1669例无RLS/WED患者进行认知功能评定,通过问卷调查和病案回顾的方法收集混杂因素信息,建立基线标准,5年后(2014年)随访该人群的认知功能(MMSE-C)。通过Logistic regression方法分析RLS/WED人群与认知功能减退的相关性。结果仅调整年龄和性别后,RLS/WED对认知能力减退有保护作用(OR=0.68, 95%CI:0.46~0.99,P=0.04)。然而,继续调整其他混杂因素(包括性别、年龄、职业、教育状况、糖尿病、高血压、鼾症、失眠、吸烟和饮酒、体重指数、载脂蛋白Eε4、抑郁、头部创伤史、全身麻醉史、冠状动脉疾病史、脑梗死、脑出血史)后,RLS/WED和认知能力减退无显著相关性(OR=0.64, 95%CI:0.40~1.04,P=0.07)。结论基于社区随访5年的前瞻性研究未发现RLS与认知功能减退有相关性。     

A computer-based interactive game to train persons with cognitive impairments to perform recycling tasks independently

This study assessed the possibility of training three people with cognitive impairments using a computer-based interactive game. A game was designed to provide task prompts in recycling scenarios, identify incorrect task steps on the fly, and help users learn to make corrections. Based on a multiple baseline design, the data showed that the three participants considerably increased their target response, which improved their vocational job skills during the intervention phases and enabled them to maintain the acquired job skills after intervention. The practical and developmental implications of the results are discussed.     

Community-Based Study of Mortality in Children with Epilepsy

Summary: Summary: We used the records of a statewide pediatric mortality surveillance system to determine mortality rates and causes of death in children with epilepsy. Of the 1,095 children aged 1–14 years who died in the state of Victoria during the study period 1985–1989,93 had a history of epilepsy. Six children (6%) had primary epilepsy, and 87 (94%) had secondary epilepsy. Death was (a) directly attributable to epilepsy in 20 (22%), including 11 with sudden unexplained death, (b) not directly attributable to epilepsy in 59 (63%), and (c) of undetermined cause in 14 (15%). No classifiable death occurred as a direct result of status epilepticus. The average annual mortality rates for children with epilepsy were (a) death from all causes, 30.6 in 10,000 [95% confidence interval (CI) 19.7, 47.51, and (b) death attributable to epilepsy, 6.6 in 10,000 (95% CI 3.7, 11.8). Relative to the all-cause mortality rate in children without epilepsy, the all-cause mortality rate ratios were (a) all children with epilepsy, 13.2 (95% CI 8.5, 20.7); (b) primary epilepsy, 1.1 (95% CI 0.5, 2.6); and (c) secondary epilepsy, 49.7 (95% CI 31.7, 77.9). The mortality rate ratios for secondary epilepsy relative to primary epilepsy were (a) death from all causes, 43.5 (95% CI 19.0, 99.5); and (b) death attributable to epilepsy, 9.0 (95% CI 3.3, 24.8). Epilepsy appeared on the death certificate of only 11 of 20 (55%) children whose deaths were attributable to epilepsy. We conclude that (a) there was an increased risk of death during childhood in children with epilepsy; (b) the risk of death was greatest for children with secondary epilepsy; (c) potentially preventable, epilepsy-related deaths occurred in children with primary epilepsy; (d) sudden unexplained death accounted for at least 12% of deaths; and (e) death certification was deficient with respect to recording of epilepsy.     

Psychosocial Mediators of Two Community-Based Physical Activity Programs

Background

Previous findings are inconclusive regarding the mediators of physical activity behavior change.

Purpose

To test self-efficacy and social support as mediators of Active Choices, a telephone-delivered physical activity intervention, and Active Living Every Day, a group-based physical activity intervention, implemented with midlife and older adults in community settings.

Methods

MacKinnon's product of coefficients was used to examine social support and self-efficacy as mediators of change in physical activity. The proportion of the total effect mediated was calculated. Each model controlled for age, gender, race (white vs. non-white), body mass index (BMI), and education (high school graduate or less vs. at least some college).

Results

Increases in self-efficacy mediated increases in physical activity among Active Choices (n?=?709) and Active Living Every Day (n?=?849) participants. For Active Living Every Day, increases in social support also mediated increases in physical activity in single mediator models.

Conclusions

Increasing self-efficacy and social support may help increase physical activity levels in older adults.     

Efficiency Evaluation of Community-Based Youth Services in Virginia

This study investigates the efficiency of community-based youth services in the Commonwealth of Virginia using data envelopment analysis (DEA). Efficiency was calculated based on resources available, the demand of services, and the service units produced. Results demonstrated the extent of inefficiency in community-based youth programs and how much efficiency can be improved relative to comparison with peer groups. The differences between large and small communities, urban and rural communities, and rich and poor communities were analyzed. There was no significant difference between each type for all three categories.     

Predicting the Cost of Community-Based Psychiatric Rehabilitation Services

Abstract

Managed behavioral healthcare emphasizes cost containment, necessitating an understanding about the reasonable expected costs of services. The purpose of this study was to design a statistical model aimed at predicting the cost of community-based psychiatric rehabilitation services from selected consumer variables. The model was constructed on a sample of 159 people with severe and persistent mental illness and cross-validated with a sample of 163 participants. The prediction model demonstrated a statistically significant but moderate relationship to the cost of psychiatric rehabilitation services, implying that other types of variables may be better predictors. Implications for theory, practice and policy were discussed.     

Community-Based Prevention for Suicide in Elderly by Depression Screening and Follow-Up

The aim of the study was to evaluate the outcome of a community-based prevention program against suicides among the elderly aged 65 and over in the Japanese rural town of Joboji (population 7,010), using a quasi-experimental design with two neighboring control areas. During the 10-year implementation of the program based on strategies including screening for depression, follow up with mental health care or psychiatric treatment and health education on depression, the relative risks estimated by the age-adjusted odds ratios for both males and females were reduced to almost one quarter more than a regional historical trend, with a better response to education for females than for males. A community-based management for later-life depression with mental health care supported by the psychiatric treatment can be effective against suicide among the elderly for both males and females.     

Community-Based Treatment for Youth with Co- and Multimorbid Disruptive Behavior Disorders

Little is known about the types of psychotherapeutic practices delivered to youth with comorbid and multimorbid diagnoses in community settings. The present study, based on therapists’ self-reported practices with 569 youth diagnosed with a disruptive behavior disorder (ODD or CD), examined whether specific therapeutic practice applications varied as a function of the number and type of comorbid disorders. While type of comorbid disorder (AD/HD or internalizing) did not predict therapists’ practices, youth with more than two diagnoses (multimorbid) received treatment characterized by a more diverse set and a higher dosage of practices.     

Trajectory of fatigue severity in natalizumab treated multiple sclerosis patients

Fatigue is one of the most debilitating symptoms in multiple sclerosis (MS). The aim of this study was to observe the severity of MS associated fatigue in a community-based sample of natalizumab (ntz) treated patients over one year. In 48 relapsing remitting MS patients (mean age = 38.3 years) fatigue was longitudinally measured with the Modified Fatigue Impact Scale (MFIS) at two time points. The primary analysis of differences in MFIS was performed using non-parametric Wilcoxon test for dependent variables. Mean total MFIS Score increased significantly from 32.6 ± 20.9 to 49.1 ± 20.0 over the observation period of 12 months (p < 0.001). 83% of patients remained clinically disease activity free (no relapse, no progression in the Expanded Disability Status Scale, EDSS) over the observation period of one year. Age, gender, disease duration, spinal involvement, Gd-enhancement, depressive symptoms and EDSS had no influence on fatigue levels as measured with MFIS. Severity of fatigue symptoms during ntz treatment might increase despite very low disease activity.     

Comorbidities in a community sample of narcolepsy

Study objectiveTo assess comorbidities in a community-based cohort of narcolepsy.MethodsA 2000–2014 community-based narcolepsy cohort was identified in Olmsted County, Minnesota. Records were reviewed by a certified sleep specialist for accuracy of diagnosis, and comorbidities were extracted and analyzed. Comorbidities in narcolepsy subjects, both at diagnosis and upon follow-up, were compared with those in unaffected and age- and sex-matched cohort using conditional logistic regression.ResultsAt diagnosis, there was increased association of narcolepsy with anxiety (OR 4.56, 95% CI 1.99–10.44), thyroid disease (3.07, 1.19–7.90), hypertension (2.69, 1.22–5.93), and hyperlipidemia (2.49, 1.05–5.92). At the end of the prolonged observation period of 9.9 years (SD 7.27 years), there was increased association of narcolepsy with peripheral neuropathy (11.21, 1.16–108.11), non-migrainous headache (6.00, 1.73–20.83), glucose intolerance (2.39, 1.05–5.45), and automobile-related trauma (2.43, 1.08–5.45). Persistently increased both at diagnosis and after a prolonged observation period were associations of narcolepsy with obstructive sleep apnea (OSA) (69.25, 9.26–517.99 decreasing to 13.55, 5.08–36.14), chronic low back pain (5.46, 2.46–12.11 to 2.58, 1.39–4.77), depression (4.88, 2.45–9.73 to 3.79, 2.12–6.79), psychiatric disorders in general (4.73, 2.49–9.01 to 3.40, 1.94–5.98), endocrinopathies (4.15, 1.81–9.56 to 2.45, 1.33–4.49), and obesity (2.27, 1.13–4.56 to 2.07, 1.15–3.7).ConclusionsIn this community-based study of narcolepsy comorbidities, both at diagnosis and after prolonged follow-up, persistent comorbidities were revealed, including OSA, chronic low back pain, psychiatric disorders in general, endocrinopathies, and obesity. The comprehensive management of narcolepsy requires monitoring for and managing these important associated health conditions.     

Outcome from a Community-based Smoking Cessation Program for Persons with Serious Mental Illness

Six and 12-month outcomes are reported on 79 mentally ill persons attending either a 4- or 8-session community-based smoking cessation group. Quit rates at post, 3-, 6-, and 12-month follow-ups were 16, 19, 16, and 19%, respectively, with no significant effect of program length. These success rates are comparable to outcomes reported following group-based treatment with mentally healthy smokers. The majority of quitters used nicotine replacement therapy. Psychotropic medication dosages did not vary over time in quitters or non-quitters. No reductions in smoking were observed among non-quitters. Quitting smoking had no untoward effects on symptoms of mental illness or general functioning.     

Mortality in Autism: A Prospective Longitudinal Community-Based Study

The purposes of the present study were to establish the mortality rate in a representative group of individuals (n = 120) born in the years 1962–1984, diagnosed with autism/atypical autism in childhood and followed up at young adult age (≥18 years of age), and examine the risk factors and causes of death. The study group, which constituted a total population sample of children with these diagnoses, were followed up in Swedish registers. Nine (7.5%) of the 120 individuals with autism had died at the time of follow-up, a rate 5.6 times higher than expected. The mortality rate was significantly higher among the females. Associated medical disorders (including epilepsy with cognitive impairment) and accidents accounted for most of the deaths, and it was not possible to determine whether autism “per se” actually carries an increased mortality risk.     

Community-Based Mental Health Service Utilization Among Low-Income Latina Immigrants

Latina immigrants may be at increased risk for mental illnesses, but have less access to and seek mental health services less often than Black and White counterparts. Guided by the Andersen Behavioral Model of service utilization, the current study employed a medical chart review to elucidate factors associated with use of mental health services at a community health center. Of the clients referred for mental health services, only 36% followed through on the referral. Older age, use of case management services, and depressive symptomatology were predictors of attending mental health services. These findings have implications for community health and mental health providers.     

北京城市卒中社区康复及危险因素自我管理效果分析

目的应用以引导式教育为内容的康复治疗和危险因素自我管理措施,评价其对促进卒中患者卒中知识知晓、行为改善及功能恢复的作用。方法在北京市东城区选择两个社区分别作为干预社区与对照社区,结合现代康复理念、引导式教育、危险因素自我管理,先后对干预社区109例患者开展3个月的卒中康复治疗及6个月危险因素自我管理干预。通过卒中患者自身治疗和干预前、后比较以及与对照社区110例患者比较,评价干预效果。结果经3个月康复治疗后,干预社区卒中患者简化的Fugl-Meyer运动功能量表评分从57.0(30.0,81.5)分提高到70.5(40.5,92.0)分(P0.001);Barthel指数评分从90(65,95)分提高到95(75,100)分(P0.001);社会功能活动问卷评分从(11.6±8.3)分降低到(10.1±8.4)分(P=0.001)。经过6个月自我管理,干预社区卒中患者对危险因素(P0.001)、预警知识(P0.001)和康复技能知晓(P0.001)以及血糖控制(P=0.033)和坚持康复治疗情况(P0.001)均显著高于对照社区卒中患者。结论社区卒中康复及危险因素自我管理干预,可以提高卒中相关知识知晓、改善行为习惯和功能恢复。     

基于社区人群的性别与颈动脉粥样硬化斑块内出血关系的研究

目的 探讨性别与通过HR-MRI诊断颅外颈动脉粥样硬化斑块内出血之间的关系。 方法 在清华大学社区人群中进行横断面调查，通过现场调查问卷获得人口统计学、既往史、行为 生活方式、实验室检查结果等信息，根据HR-MRI对颅外颈动脉粥样硬化斑块内出血进行判读，分为 斑块内出血组和无斑块内出血组。采用多因素Logistic回归分析探讨性别与斑块内出血之间的关系。 结果 本研究共纳入246例有颈动脉粥样硬化斑块的研究对象，男性105例（42.7%），平均年龄 （64.8±11.5）岁，其中12例（4.88%）有斑块内出血。与无斑块内出血组相比，斑块内出血组男性较多 （83.3% vs 40.6%，P =0.004），高血压病史（91.7% vs 43.2%，P =0.001）和糖尿病病史（50.0% vs 12.4%，P <0.001）的比例较高；空腹血糖[（6.30±1.63）mmol/L vs（5.00±0.99）mmol/L，P <0.001] 的水平较高。多因素Logistic回归分析发现，男性是颅外颈动脉粥样硬化斑块内出血的独立危险因素 （OR 7.68，95%CI 1.10～53.81，P =0.040）。 结论 男性可能是颅外颈动脉粥样硬化斑块内出血的危险因素。