Community living assessment for persons with severe and persistent mental illness

Psychiatric rehabilitation has been hampered by the absence of reliable and valid instruments to assess functional skills of persons with severe and persistent mental illness. This article describes the development of the Community Living Assessment Scale (CLAS), which was designed specifically to assess daily living skills of those with mental illness who live in community residences. The scale was found to have good test-retest, split-half, and interrater reliability. Comparison of clients with nonclients revealed significant differences on eight of nine scales. Scale scores were not found to be predictive of type of residential placement; however, many of the scales correlated significantly with perceived level of independence and general well-being 2 years after assessment. The CLAS is recommended as an assessment instrument for use in psychiatric rehabilitation programs and for research with populations with severe and persistent mental illness.     

广东省翁源县妇女孕期抑郁水平及影响因素的调查分析

目的调查广东省翁源县妇女孕期抑郁的水平并分析其影响因素,为孕期心理保健提供重要依据。方法采用单纯随机抽样的方法,抽取在广东省翁源县妇幼保健院住院分娩的产妇进行问卷调查。结果 206名调查对象中,抑郁量表平均得分为（40.75±9.42）分,孕期抑郁症的患病率为14.56%。多因素分析表明,年龄≥35岁、家庭人均收入〈2000元/月、主观支持得分低的孕妇孕期抑郁水平高。结论年龄、家庭经济状况、主观支持情况对妇女孕期抑郁水平有影响,应有针对性地开展心理卫生健康教育和心理咨询工作。     

人工流产术后再次意外妊娠原因及影响因素的分析

目的分析人工流产术后再次意外妊娠的原因以及相关影响因素。方法2010年5月至2013年5月在我院进行人工流产手术的患者4000例,选取人工流产术后再次意外妊娠的1723例患者为观察组,在未发生意外妊娠的患者中随机选取1723例为对照组,对观察组和对照组产妇中年龄小于19岁、农村户口、月收入在2000元以下、产妇高中以下文化程度、未婚同居、性伴侣在2个以上和首次性行为在17岁以下人数进行观察。结果4000例人组产妇当中,发生再次意外妊娠的产妇所占比例为43．08％（1723／4000）;X^2检验和Logistic回归分析均显示年龄小于19岁、农村户口、月收入在2000元以下、产妇高中以下文化程度、未婚同居、性伴侣在2个以上和首次性行为在17岁以下是人工流产术后的危险因素。结论年龄低、文化程度低、收入低和性观念开放是人工流产术后再次意外妊娠发生的关键因素。     

Risk factors for infections with Norovirus gastrointestinal illness in Switzerland

Viral infections, particularly those caused by noroviruses (NV, genus Norovirus), are the most common cause of community-acquired gastroenteritis in Europe, with respect to both endemic and epidemic occurrence. For the first time, a general practitioner-based case-control study was performed between July 2001 and July 2003 in the German-speaking part of Switzerland in order to identify risk factors for sporadic NV infections. The consumption of different foodstuffs and of bottled mineral water did not show any significant association with the risk of NV gastroenteritis, nor was there any significant effect of individual ABO histo-blood group or household size on the incidence of NV gastroenteritis. The findings are consistent with person-to-person transmission as the most important route of transmission for community-acquired, sporadic NV infection, in that 39% of all patients reported they had had contact with ill persons before their illness. The fact that 33% reported contact with ill persons, mainly within family groups, after their own illness suggested that a substantial proportion of patients were part of family mini-outbreaks.     

Resilience factors in families living with people with mental illnesses

In South Africa, a substantial burden is placed on families living with people with mental illnesses. The aim of this study was to identify resilience factors in families living in an underprivileged area, caring for people with mental illnesses. Data was obtained from family representatives (N=34) using semistructured interviews and a set of seven self‐report, quantitative questionnaires during the course of a once‐off interview. The results of the qualitative analysis show that the most commonly cited resilience factors are religion and spirituality, and personal characteristics of individual family members. Both these factors were cited by 67.6% of the participants. The results of the Spearman correlations showed that the factor that displayed the strongest relationship with family adaptation was the quality of communication in the family unit. © 2009 Wiley Periodicals, Inc.     

Angiogenic imbalance and plasma lipid alterations in women with preeclampsia from a developing country

Background: An imbalance between anti-angiogenic factors (e.g. soluble vascular endothelial growth factor receptor-1 (s-FLT1) and soluble endoglin (s-Eng)) and pro-angiogenic factors (e.g. placental growth factor (PlGF)) as well as increased oxidized low-density lipoprotein (ox-LDL) concentrations have been associated with preeclampsia (PE). Risk factors associated with the development of PE, however, are known to be different between developed and developing countries. The aim of the study was to determine the levels of s-FLT1, s-Eng, PIGF, and ox-LDL in women with PE from a developing country. Methods: A multi-center case–control study was conducted. One hundred and forty three women with PE were matched by age and parity with 143 healthy pregnant women without cardiovascular or endocrine diseases. Before delivery, blood samples were taken and serum was stored until analysis. Results: Women with PE had lower concentrations of PIGF (p < 0.0001) and higher concentrations of s-Eng (p = 0.001) than healthy pregnant women. There were no differences between the groups regarding ox-LDL or s-FLT1. Women with early onset PE had higher s-FLT1 concentrations (p = 0.0004) and lower PIGF concentrations (p < 0.0001) than their healthy pregnant controls. Women with late onset PE had higher concentrations of s-Eng (p = 0.005). Women with severe PE had higher concentrations of s-Eng (p = 0.0008) and ox-LDL (p = 0.01), and lower concentrations of PIGF (p < 0.0001). Conclusions: Women with PE from a developing country demonstrated an angiogenic imbalance and an increased rate of LDL oxidation. Findings from this study support the theory that PE is a multifactorial disease, and understanding differences in these subpopulations may provide a better target to approach future therapies.     

Risk factors for cardiovascular disease in women

Management of women's health seldom includes cardiovascular disease (CVD) prevention in spite of CVD being the most common cause of death in females being even more common than cancer, HIV/AIDS, malaria and tuberculosis combined. According to the World Heart Federation, CVD is indisputably the most serious, neglected health problem for women in both the developing and the developed worlds. A possible reason may be that CVD has traditionally been perceived as a ‘man's illness’. Since 6 out of 10 deaths from CVD can be prevented, it is of utmost importance that there is more general awareness about CVD in women. The most important factors for developing CVD are dyslipidaemia, hypertension, smoking, stress, diabetes, obesity (especially abdominal fat distribution), physical inactivity, poor eating habits and possibly excessive alcohol intake. Some unique risk factors for CVD exist in women; of which older age at presentation is a major one as they are more likely to suffer from co-morbidities such as diabetes and hypertension.     

Risk factors for illness severity in patients with COVID-19 pneumonia: a prospective cohort study

Background: Although COVID-19 pneumonia is spreading internationally, knowledge regarding the factors associated with the illness severity of patients remains limited. We aimed to identify the factors associated with the disease severity of patients with COVID-19 pneumonia induced by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Methods: We prospectively enrolled a single-center case series of adult patients with COVID-19 admitted to the Infectious Disease Hospital of Jining, Jining City, Shandong Province, China, from January 24 to March 1, 2020. Demographics, clinical characteristics, and laboratory findings were compared to investigate the risk factors related with the disease severity of COVID-19 pneumonia patients.Results: We included a total of 78 patients with COVID-19 pneumonia, of whom 6 had the severe type. As compared to a moderately ill cohort, our analysis showed that shortness of breath, fatigue, longer days from illness onset to diagnosis confirmed, neutrophil percentages > 70%, neutrophil counts > 6.3 × 10⁹/L, lymphocyte percentages < 20%, lymphocyte counts < 1.0 × 10⁹/L, platelet < 100 × 10⁹/L, C-reactive protein (CRP) > 10 mg/L, neutrophil to platelet ratio (NPR) > 2.3, neutrophil to lymphocyte ratio (NLR) > 3.9, aspartate aminotransferase (AST) > 40 U/L, albumin < 40 g/L, lactate dehydrogenase (LDH) > 245 U/L, and glucose > 6.1 mmol/L were predictors of disease severity in COVID-19 pneumonia. In the sex-, age-, and comorbid illness-matched case-control study, neutrophil percentages > 70%, neutrophil counts > 6.3 × 10⁹/L, lymphocyte percentages < 20%, NPR > 2.3, NLR > 3.9, albumin < 40 g/L, and LDH > 245 U/L remained associated with the early detection and identification of severe patients.Conclusion: We demonstrated that neutrophil percentages > 70%, neutrophil counts > 6.3 × 10⁹/L, lymphocyte percentages < 20%, NPR > 2.3, NLR > 3.9, albumin < 40 g/L, and LDH > 245 U/L might predict the severity of illness in patients with COVID-19 pneumonia.     

A problem-orientated approach to management of mental illness in developing countries

A new problem-orientated method has been developed to identify the appropriate management of mental illnesses in cross-cultural primary care settings. It is designed to be used by intermediate level health workers in outpatient clinics in many different developing countries. The research undertaken to develop and evaluate this new method is described, and its implications for improving the quality of mental health care are discussed.     

Risk factors for depressive symptoms during pregnancy

The present study examined risk factors for depression during pregnancy in a very large population sample. Two research questions have been addressed: first, the association between demographic factors and past negative obstetrical outcomes on depression severity scores, and second, the differences in these factors between women recruited at a university medical center and maternal health centers (MHC). The study included more than 5,000 pregnant women attending regular appointments at the University Obstetrics and Gynecology Clinic or at several MHCs in Eastern Iowa. Participants completed a Beck depression inventory (BDI) and a demographic questionnaire. We performed a statistical analysis on the association between risk factors and depression severity scores. Regression analysis revealed that week of pregnancy, site of recruitment, years of education, income, marital status, employment, and number of miscarriages and stillbirths were significant predictors of total BDI score. Compared to their university counterparts, participants at MHCs had more depressive symptoms, were younger, mostly single, and had lower socioeconomic status and more past negative obstetrical outcomes. Our study can inform providers about some of the risk factors during depression screening in pregnancy to increase diagnostic vigilance and tailor the level of prenatal care accordingly.     

Risk factors for depressive symptoms in adolescent pregnancy in a late-teen subsample

Depression in adolescent pregnancy is common but underrecognized and can be associated with negative medical outcomes. This brief report examines the relationship between depressive symptoms and various demographic and obstetrical risk factors, as well as the use of antidepressants in pregnant adolescents of late teenage years. Data were derived from a relatively large sample (506 women) recruited from university-based and community mental health centers in Iowa. A cross-sectional analysis did not reveal significant statistical associations between the risk factors and depressive symptoms (Beck Depression Inventory). Antidepressant use was very low (3.7 %), and adolescents with higher depression scores were more likely to take medications. In conclusion, screening for depression in pregnant adolescents should be universal, regardless of demographic and obstetrical risk factors, and promptly addressed.     

Risk factors for breast cancer in women with proliferative breast disease

To assess the importance of various risk factors for breast cancer in women with benign proliferative breast lesions, we reevaluated 10,366 consecutive breast biopsies performed in women who had presented at three Nashville hospitals. The median duration of follow-up was 17 years for 3303 women, 1925 of whom had proliferative disease. This sample contained 84.4 per cent of the patients originally selected for follow-up. Women having proliferative disease without atypical hyperplasia had a risk of cancer that was 1.9 times the risk in women with nonproliferative lesions (95 per cent confidence interval, 1.2 to 2.9). The risk in women with atypical hyperplasia (atypia) was 5.3 times that in women with nonproliferative lesions (95 per cent confidence interval, 3.1 to 8.8). A family history of breast cancer had little effect on the risk in women with nonproliferative lesions. However, the risk in women with atypia and a family history of breast cancer was 11 times that in women who had nonproliferative lesions without a family history (95 per cent confidence interval, 5.5 to 24). Calcification elevated the cancer risk in patients with proliferative disease. Although cysts alone did not substantially elevate the risk, women with both cysts and a family history of breast cancer had a risk 2.7 times higher than that for women without either of these risk factors (95 per cent confidence interval, 1.5 to 4.6). This study demonstrates that the majority of women (70 per cent) who undergo breast biopsy for benign disease are not at increased risk of cancer. However, patients with a clinically meaningful elevation in cancer risk can be identified on the basis of atypical hyperplasia and a family history of breast cancer.     

Quality of life of persons with severe mental illness living in an intermediate care facility

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.     

Feminist contributions on sexual experiences of women with serious mental illness: a literature review

Archives of Women's Mental Health - This paper aims to explore the contributions of research that include gender perspective&nbsp;in analysing the sexual experiences of women diagnosed with...     

Predictive testing for Huntington disease in a developing country

Predictive testing for Huntington disease (HD), by means of direct mutation analysis, has been offered at the Division of Human Genetics, University of Cape Town, from 1995. The aim of this study was to compile a comprehensive profile of the participants who had undergone predictive testing in the Western Cape from 1995 to 2005. The sociodemographic data, uptake and outcome of tests were analyzed to inform changes to improve the current genetic counseling services. A retrospective cross-sectional design using a 'multi-method' approach of both qualitative and quantitative methods was used. Data were gathered from the participants' hospital files and genetic database. Psychosocial data were obtained by face-to-face interviews with the participants in their homes or venues of choice. A total of 36 predictive tests were performed. The uptake for predictive testing was approximately 4.5% of the estimated at-risk population. The cohort of 27 individuals comprised 16 females and 11 males. Their mean age was 35.3 years; 6 were mixed ancestry and 21 were White people (European ancestry); 11 tested gene positive, 15 gene negative and 1 was in the reduced penetrance range. The most important issue identified was that the uptake of individuals classified as mixed ancestry was substantially lower than that of the White people possibly due to limited access to the predictive testing program because of the low levels of income and education in the general population of families with HD. Strategies to address these aspects have been incorporated into the program and will be reassessed after 1 year.     

Community mental healthcare providers’ attitudes and practices related to smoking cessation interventions for people living with severe mental illness

Objective

This study aimed to describe mental healthcare providers’ attitudes about tobacco use, their personal smoking status, their confidence in offering smoking cessation support to clients living with severe mental illness, and the extent to which they incorporated smoking cessation interventions into their practice. The study also aimed to determine whether the providers’ attitudes, smoking status, and confidence were associated with offering smoking cessation support to clients.

Methods

Self-administered questionnaires were distributed within community-based mental health agencies to those who provide care and support to adults living with severe mental illness. Outcomes measured included respondents’ smoking status, attitudes related to the provision of smoking cessation support, confidence in providing smoking cessation intervention, and smoking cessation practices. We conducted multivariate analyses using logistic regression analyses to examine the factors associated with the providers’ tobacco-related practices.

Results

In total 282 of 871 care providers responded to the survey, 22% of whom were current smokers. The providers who held sympathetic attitudes about their role and their clients’ role in smoking cessation, who were never or former smokers, who were healthcare professionals rather than paraprofessionals, who had relatively more confidence, and who had more experience working in the mental health field were more likely to engage their clients in tobacco-related interventions.

Conclusions

In this study the healthcare providers working in community-based mental health have a smoking prevalence rate that exceeds that of the region's general population and did not provide optimal smoking cessation support to their clients.

Practice implications

Interventions that bolster the confidence of providers to engage is smoking cessation activities and that support a shift in attitudes about the role of tobacco use in mental health are required.     

Risk factors for peripartum blood transfusion in women with placenta previa: a retrospective analysis

BACKGROUND: The incidence of placenta previa has been increasing. It is of a great importance to determine the clinical risk factors for peripartum blood transfusion in women with placenta previa in an effort to anticipate cases of severe hemorrhage. METHODS: A total of 129 consecutive cases of placenta previa (64 cases of complete placenta previa and 65 cases of marginal placenta previa), including 43 cases requiring blood transfusion, were retrospectively analyzed. Maternal and neonatal clinical data were examined with univariate and multivariate logistic regression analyses for potential risk factors for peripartum blood transfusion. RESULTS: The independent risk factors for blood transfusion were maternal age greater than 34 years (adjusted odds ratio [OR]=3.7; 95% confidence interval [CI]=1.5-7.5, p<0.05), history of having undergone dilatation and curettage more than once (adjusted OR=4.8; 95% CI=1.1-26.2, p<0.05), and complete placenta previa (adjusted OR=2.6, 95% CI=1.2-5.9, p<0.05). Body mass index, gravidity, parity, previous cesarean section, antepartum hemorrhage, use of tocolytic agents, gestational age at delivery, preoperative anemia, emergent surgery, birth weight, and Apgar score were not associated with the incidence of blood transfusion. CONCLUSION: Risk factors for blood transfusion in women with placenta previa are advanced maternal age, repeat dilatation and curettage, and complete placenta previa. Women with placenta previa who are at risk for blood transfusion should be carefully managed with sufficient preparation for blood transfusion.     

Risk factors for continued illness among Gulf War veterans: a cohort study

BACKGROUND: There are no prospective cohort studies of prognostic factors on the outcome of Gulf War veterans. We aimed to test the hypotheses that Gulf War veterans who were older; had more severe symptoms; had more exposures during deployment; had increased psychological distress and believed they had 'Gulf War syndrome' would experience greater fatigue and poorer physical functioning at follow-up. METHOD: Gulf War veterans who responded to an earlier retrospective cohort study were followed with a postal survey. More symptomatic individuals were oversampled. Outcome was measured on the Chalder fatigue questionnaire, the General Health Questionnaire and the Medical Outcome Study Short-Form 36. RESULTS: Of those surveyed, 73.8% responded. We found some evidence for four of the five hypotheses. More self-reported exposures at baseline were not associated with poorer outcome, but older people, those with more severe symptoms at baseline, those with psychological distress and who believed they were suffering from 'Gulf War syndrome' had more fatigue at follow-up. Officer status was associated with a better outcome. A similar lack of association was found for exposures and physical functioning and GHQ-12 score. 'Gulf War syndrome' attribution was associated with a worse outcome for GHQ-12 and physical functioning even after controlling for severity of symptoms at baseline. CONCLUSIONS: This study suggests that while multiple vaccination and military exposures are important risk factors for the onset of symptoms in Gulf War veterans, these are not important risk factors for persistence of such symptoms. Instead the severity of the initial symptoms; psychological distress and attributions may be more important determinants of outcome.     

Risk factors for developing mineral bone disease in phenylketonuric patients

There is a compromised bone mass in phenylketonuria patients compared with normal population, but the mechanisms responsible are still a matter of investigation. In addition, tetrahydrobiopterin therapy is a new option for a significant proportion of these patients and the prevalence of mineral bone disease (MBD) in these patients is unknown.We conducted a cross-sectional observational study including 43 phenylketonuric patients. Bone densitometry, nutritional assessment, physical activity questionnaire, biochemical parameters, and molecular study were performed in all patients. Patients were stratified by phenotype, age and type of treatment.The MBD prevalence in phenylketonuria was 14%. Osteopenic and osteoporotic (n = 6 patients) had an average daily natural protein intake significantly lower than the remaining (n = 37) patients with PKU (14.33 ± 8.95 g vs 21.25 ± 20.85 g). Besides, a lower body mass index was found. There were no statistical differences in physical activity level, calcium, phosphorus and fat intake, and in phenylalanine, vitamin D, paratohormone, docosahexaenoic and eicosapentaenoic acid blood levels. Mutational spectrum was found in up to 30 different PAH genotypes and no relationship was established among genotype and development of MBD. None of the twelve phenylketonuric patients treated with tetrahydrobiopterin (27.9%), for an average of 7.1 years, developed MBD. Natural protein intake and blood levels of eicosapentaenoic acid were significantly higher while calcium intake was lower in these patients.This study shows that the decrease in natural protein intake can play an important role in MBD development in phenylketonuric patients. Therapy with tetrahydrobiopterin allows a more relaxed protein diet, which is associated with better bone mass.