Transferring psychiatric specialist services to local authorities—Characteristics of the patients involved

Background: To obtain more co-ordinated services, better co-operation between the services and more efficient use of resources, a pilot project for transferring some district psychiatric centres (DPCs) to large municipalities is planned by the Norwegian government. Systematic knowledge about the patients involved is needed when clinical needs and standards, funding, and political agendas are discussed. This study identifies the clinical, socio-demographic, and behavioural characteristics of patients who need services from both the municipality and the DPC.

Method: A national mapping of patients in specialist mental health services was conducted in 2012/2013, including 65% of all inpatients (n?=?2358) and 60% of all outpatients (n?=?23?124). The need for services was assessed by each patient’s clinician.

Results: It was found that 74% of inpatients and 43% of outpatients needed one or more services from the municipality, usually involving housing, mental health treatment/therapy, or economic support according to their clinicians. These were typically patients with severe mental illness, young inpatients, older outpatients and persons with low education and weak social networks. Only small differences in the need for municipal services were found between patients in hospitals and DPCs.

Conclusions: Many of the patients in specialist mental health services, especially the inpatients, needed services from municipal social and health services. Because these patients had the most severe mental illnesses and were the most socially deprived, a stronger integration of service levels would potentially benefit these patients most. The pilot project should be evaluated to identify the consequences for patients, staff, quality of services, and costs of transferring services to a lower system level.     

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.     

Combined antioxidant and COMT inhibitor treatment reverses renal abnormalities in diabetic rats

The development and progression of diabetic nephropathy is dependent on glucose homeostasis and many other contributing factors. In the present study, we examined the effect of nitecapone, an inhibitor of the dopamine-metabolizing enzyme catechol-O-methyl transferase (COMT) and a potent antioxidant, on functional and cellular determinants of renal function in rats with streptozotocin-induced diabetes. Administration of nitecapone to diabetic rats normalized urinary sodium excretion in a manner consistent with the dopamine-dependent inhibition of proximal tubule Na,K-ATPase activity. Hyperfiltration, focal glomerulosclerosis, and albuminuria were also reversed by nitecapone, but in a manner that is more readily attributed to the antioxidant potential of the agent. A pattern of elevated oxidative stress, measured as CuZn superoxide dismutase gene expression and thiobarbituric acid-reactive substance content, was noted in diabetic rats, and both parameters were normalized by nitecapone treatment. In diabetic rats, activation of glomerular protein kinase C (PKC) was confirmed by isoform-specific translocation and Ser23 phosphorylation of the PKC substrate Na,K-ATPase. PKC-dependent changes in Na,K-ATPase phosphorylation were associated with decreased glomerular Na,K-ATPase activity. Nitecapone-treated diabetic rats were protected from these intracellular modifications. The combined results suggest that the COMT-inhibitory and antioxidant properties of nitecapone provide a protective therapy against the development of diabetic nephropathy.     

School‐based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory ‘It's Your Move!’

Objective: The Australian Capital Territory ‘It's Your Move!’ (ACT‐IYM) was a three‐year (2012–2014) systems intervention to prevent obesity among adolescents. Methods: The ACT‐IYM project involved three intervention schools and three comparison schools and targeted secondary students aged 12–16 years. The intervention consisted of multiple initiatives at individual, community, and school policy level to support healthier nutrition and physical activity. Intervention school‐specific objectives related to increasing active transport, increasing time spent physically active at school, and supporting mental wellbeing. Data were collected in 2012 and 2014 from 656 students. Anthropometric data were objectively measured and behavioural data self‐reported. Results: Proportions of overweight or obesity were similar over time within the intervention (24.5% baseline and 22.8% follow‐up) and comparison groups (31.8% baseline and 30.6% follow‐up). Within schools, two of three the intervention schools showed a significant decrease in the prevalence of overweight and obesity (p<0.05). Conclusions: There was some evidence of effectiveness of the systems approach to preventing obesity among adolescents. Implications for public health: The incorporation of systems thinking has been touted as the next stage in obesity prevention and public health more broadly. These findings demonstrate that the use of systems methods can be effective on a small scale.