The Meaning of Community Rehabilitation for Schizophrenia Patients in Israel

In the year 2000, a law was passed in Israel, known as the Law for Community Rehabilitation of the Mentally Disabled. The Community Rehabilitation Law was intended to provide a “package of services” that will allow people who suffer from mental illness and were hospitalized, to return to their community. This research, by using qualitative research methods, tried to understand and explore the meaning of rehabilitation and return to the community under the new legislative setting from the viewpoint and experiences of the participants themselves. Fifteen schizophrenic patients were interviewed in this research. All the participants were institutionalized in the past and released for rehabilitation in the community under Israel’s new act. The data were collected after all interviews were recorded and analyzed. The qualitative data analysis exposed a continuous process of four conceptual categories: (1) Viewing institutionalization as transformation from the “normal” to the “abnormal”; (2) Viewing institutionalization as a process moving from the “abnormal” back to the “normal”; (3) Viewing the return to the community as “re-birth”; and finally, (4) Viewing community-based rehabilitation as reality, which enables normality alongside mental illness. This research presents a theoretical model that provides the meanings and experiences of the participants as a continuity, in which the whole process of moving from the community to the institution and back to the community is represented as one continuous process integrated in each other. Within this continuing process, the community-based rehabilitation legislation serves as a key component, well-integrated within the whole continuum that allows people with mental illness to return to “normality” within the community.     

Community psychiatry in border settlements in Israel

Summary An analysis of our work during two years in a community mental health clinic serving a small town and an agricultural area near the northern border of Israel was presented. The clinic was staffed by a team of psychiatrists, psychologists and social workers who came to the area for one and a half days every week from a university psychiatric hospital in the center of the country. Only the nurse was a resident of the clinic was an attempt to provide a border population with expert psychiatric services which had previously been lacking, while maintaining a close connection with the central psychiatric hospital. All this was done on a relatively low budget. In spite of the difficult working conditions, an ambulatory team, travelling to the place and serving a wide area which was often under emergency conditions, was able to do effective work. A total number of 485 patients was seen during the two years, only 60 of whom were hospitalised, and very few were referred for private psychotherapy.The success of the clinic's operation can be explained by appropriate initial classification of referrals, concentration on short term therapy, close cooperation between the team members and effective interaction with the relevant agencies in the community. The clinic handled patients from two population groups (the town of Kiryat Shmona and the villages of the area), which differed considerably from demographic, social and therapeutic points of view.     

The Impact of Psychiatric Comorbidity on General Hospital Length of Stay

Medical inpatients often suffer from comorbid psychiatric illness, which has been shown in previous studies to be associated with longer hospital stays. The present analysis used a large representative dataset to examine the impact of patient demographic and clinical characteristics on the relationship between psychiatric comorbidity and hospital length of stay. Analyses showed the existence of a psychiatric comorbidity predicted longer hospital stays for medical inpatients. However, in comparison to previous research, this effect was attenuated in this sample. Patients with mental disorders who were elderly, on Medicare, and those with schizophrenia or mood disorders were especially at risk for slightly longer lengths of stay.     

The Effect of the Implementation of the Rehabilitation of the Mentally Disabled in the Community Law in Israel on the Pattern of Psychiatric Hospitalizations

In 2001 the Rehabilitation of the Mentally Disabled in the Community Law was implemented in Israel, defining a basket of rehabilitation services to which the mentally disabled are entitled. The objectives of the present study were to examine the effect of being placed in a rehabilitation program after discharge from a psychiatric hospitalization on the probability of rehospitalization and on the length of the following hospitalization if it occurred. Anonymized data were extracted from two registers of the Ministry of Health: the Rehabilitation Register and the Israeli Psychiatric Case Register, whose data were merged. The study population consisted of all the discharges from a psychiatric hospital during 2001-8. There were three study groups (those admitted to hostels, supportive housing, and vocational rehabilitation) and two control groups (those referred to rehabilitation and did not implement the referral and a matched control group of potential candidates for rehabilitation). Kaplan-Meyer survival and Cox analysis were performed on the data. The results showed that the probability to stay in the community after discharge was higher in all the study groups compared to those who were referred but did not reach the rehabilitation system and to the matched control group of potential candidates. Moreover, if the patients were rehospitalized, the probability of a short duration of the next inpatient episode was higher among all the study groups compared to the control groups. The results emphasize the beneficial effect on the pattern of psychiatric hospitalization of the legislation regarding national rehabilitation services for the mentally disabled.     

Community mental health and the State Hospital

Summary Creedmoor State Hospital is the major psychiatric facility for the borough of Queens, a community of 2. 2 million people in the City of New York. The hospital had 5 600 patients on the in-patient roles, when in 1969, it was divided into four sections, three relating to specific geographic areas of the borough and one for chronically and acutely medically ill patients who had been admitted originally for social or psychiatric reasions. Hospital personnel developed a group process approach for in-patients and to a large extent, followed their own patients after discharge. Two years later there were 3 500 patients in the hospital and 3 000 in out-patient clinics for discharged patients and their families, and for other patients in the community. The problems of the state hospital and its historical origins have been described. Emphasis was given to the theoretical approach to the solution utilizing reference group theory, and defining the resocialization of the patients by means of a small group approach was outlined. The small reference group was described as the primary unit of treatment. The geographic unitization of the hospital, its clinical programs, its method of allocating priorities for maintenance of the physical plant, and employee relations were described.Some results of the programs were noted briefly in terms of population transfer from inhospital o community clinics and to other facilities in the borough. Issues such as community education, problems of medical and surgical illness, and political problems were considered. — It appears that when considering the development of a community program for a large institution, it is essential to have component parts of the hospital relate to various segments of the community while concurrently embarking upon community educational procedures and assuring appropriate medical care from other health delivery service organizations. A sense of group identity both for patients and staff is essential to the success of the program, in addition to any basic medical and social skills which must be brought to the program or taught to staff. The group process approach becomes even all the more important in terms of the large numbers of people to be treated, as does the utilization and recognition of the role of non-degreed mental health workers in this program.This work was done when the author was Director of Creedmoor State Hospital, Queens Village, New York.     

卒中急救护士对急性缺血性卒中救治效率的影响

目的 探索优化急性缺血性卒中急诊诊疗流程,在预检台设置卒中护士作为第一反应者并贯穿整个 溶栓和血管内取栓绿色通道对治疗效率的影响。 方法 回顾性分析上海长海医院脑血管病中心2016年4月1日-2017年3月31日溶栓和（或）血管内治 疗的急性缺血性卒中病例208例。根据有无卒中护士的参与分为有卒中护士组（43例）和无卒中护士 组（165例）。比较两组各治疗环节的延误时间：进门到用药时间（door-to-needle,DTN）、进门至影像学 检查时间（door-to-imaging,DTI）、影像学检查至用药时间（imaging-to-needle,ITN）、影像学检查至股动 脉穿刺时间（i magi ng-to-puncture,ITP）、进门至股动脉穿刺时间（door-to-puncture,DTP）、到院至治疗 达标率（DTN≤60 min、DTP≤90 min）和出院时及发病3个月预后良好[改良Rankin量表（modified Rankin Scale,mRS）≤2分]的比例。 结果 较无护士组,有卒中护士组DTN中位数由39 mi n缩短至27 mi n（Z =-5.422,P＜0.001）;DTP 中位数由105 mi n缩短至68 mi n（Z =-2.707,P =0.007）;I TN中位数由21 mi n缩短至8 mi n（Z =-5.981,P ＜0.001）;I TP中位数由78.5 mi n缩短至45 mi n（P =0.013）。有护士组和无护士组DTN达标率分别为 97.67%和90.97%（P＜0.001）,DTP达标率分别为100%和35.62%（P＜0.001）。出院时和发病3个月有 卒中护士组mRS评分≤2分比例显著高于无卒中护士组（62.79% vs 49.09%;69.77% vs 50.91%,均 P＜0.001）。 结论 急诊预检台设置卒中护士作为第一反应者并贯穿整个急性缺血性卒中溶栓或血管内治疗绿 色通道可以显著缩短急性缺血性卒中患者的DTN时间和ITP时间,提高到院至治疗达标率,改善患者 的预后。     

From PTSD to "national trauma": the case of the Israel Trauma Center for Victims of Terror and War

Since its establishment in 1998, NATAL, "The Israel Trauma Center for Victims of Terror and War," has been propagating the notion of national trauma as a comprehensive category of suffering related to the Israeli-Palestinian conflict. Against the shifting perceptions of PTSD in Israel, we explore recent undertakings of NATAL's experts to naturalize trauma among "pre-clinical" populations of Israeli Defense Force (IDF) veterans. The experts' attempts to de-politicize the suffering of the veterans are constrained by the fact that in their clinical ideology, the apolitical language of the therapeutic is aligned with a somber national pathos that strikes a collective cord of common Jewish fate and identity. This alignment may account for the Israeli public's acceptance of NATAL's agenda, despite its subversive connotations.     

高血压前期对社区中老年人群颈动脉内中膜厚度的影响

目的 探讨高血压前期对社区中老年人群颈动脉内中膜厚度（intima-media thickness,IMT）的影响。方法 对942名46～75岁广州社区居民进行问卷调查、体格检查、血生化检查和双侧颈动脉超声检查,根据JNC-7的血压分类标准,比较正常血压（normotension,NT）、高血压前期（prehypertension,Pre‑-HT）和高血压（hypertension,HT）3亚组人群颈总动脉、分叉部、颈内动脉以及平均IMT大小。结果 Pre‑-HT和HT均与高龄、男性、肥胖、血脂异常、吸烟等危险因素相关。Pre‑-HT人群颈动脉各段及平均IMT均比NT人群明显增厚（P<0.001）。控制相关危险因素后,Pre‑-HT人群平均IMT和颈总动脉IMT比NT人群明显增厚（P<0.05）,而颈动脉分叉部IMT和颈内动脉IMT增厚未达到统计学意义（P=0.082,0.133）。HT人群颈总动脉、分叉部IMT及平均IMT均比NT、Pre‑-HT人群明显增厚（P均<0.05）。结论 处于高血压前期的中老年人群已存在较明显的靶器官损害——颈动脉内中膜增厚。     

Parental Coping with Developmental Disorders in Adolescents within the Ultraorthodox Jewish Community in Israel

This preliminary study compares the coping strategies used by 100 ultraorthodox Jewish parents and 100 secular Jewish parents for dealing with adolescent children with developmental disorders. The parents completed two questionnaires on the sense of stress-related personal growth and the sense of coherence. The ultraorthodox parents reported a higher sense of growth and a higher sense of coherence than the secular parents. In addition, there were associations found between demographic characteristics. Gender differences between mothers and fathers in the sense of growth and community differences between ultraorthodox fathers and secular fathers in the sense of coherence are discussed. The study highlights the uniqueness of the religious point of view in dealing with adolescent children with developmental disorders.     

Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data

ObjectiveSeveral studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. MethodsWe respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. “Off-hour hospital presentation” was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox''s proportional hazard model. ResultsIn subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106–1.400; HR, 1.402; 95% CI, 1.124–1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. ConclusionThis study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.