Life after hospital closure: users' views of living in residential 'resettlement' projects. A case study in consumer-led research

Objective

To conduct a user‐led and focused study of the views and experiences of former psychiatric hospital patients in community‐based residential projects four years after hospital closure. The aims of the study were to assess residents’ views about their current living arrangements, their opportunities to give their views and their interest in a formal user‐group such as a residents’ council or citizen advocacy scheme.

Design

A small‐scale, qualitative study designed to enable users to voice their own views and experiences in their own words, conducted by a project group of psychiatric service users/survivors.

Setting and participants

All eight residential ‘re‐provision’ projects in the area were included, with a total potential sample of 65 residents. All residents were invited to take part and a total of 26 were interviewed, although a larger number of residents together with residential care staff took part in initial ‘house’ meetings to discuss the study.

Methods

Semi‐structured, open‐ended interviews with all residents willing to participate, researcher participation in ‘house meetings’, researchers’ personal reflection and discussion.

Results and conclusions

On the whole, residents were content with community living arrangements and preferred these to hospital, although levels of satisfaction varied across different residential projects. Residents lacked awareness of rights to and means of voicing concerns and making choices about major issues in their lives. They showed greater interest in individualized rather than group advocacy. Ideally, research and evaluation, to be truly user‐focused, should be long‐term and continuous in order to involve participants more fully, and should anticipate the structures and processes needed to act on findings.

     

Fatigue and psychological disorders in chronic hepatitis C

BACKGROUND AND AIM: Most patients with chronic hepatitis C report that they suffer from fatigue. The aim of this study was to determine if the symptom of fatigue can be a guide to indicate disease activity in chronic hepatitis C, or if it is related to psychological factors. METHODS: 115 chronic hepatitis C patients attending a liver clinic at Wollongong Hospital, Wollongong, Australia, were asked to fill out a questionnaire on the functional impact of their fatigue, and a questionnaire on psychological parameters. These were correlated with a history of intravenous drug use, alcohol history, transaminase levels and liver biopsy findings. RESULTS: Fatigue weakly correlated with the level of fibrosis on the liver biopsy, but strongly correlated with all the psychological domains of depression, anxiety, somatization, interpersonal sensitivity and hostility. CONCLUSION: The level of fatigue strongly correlated with all the psychological domains, particularly depression, and not with our measures of disease activity.     

Virtual reality surgical simulation for lower urinary tract endoscopy and procedures

BACKGROUND AND PURPOSE: To provide a realistic experience of lower urinary tract endoscopic procedures, we have developed and continue to expand a computer-based surgical simulator that incorporates a surgical tool interface with anatomic detail and haptic feedback. METHODS: Surface-based geometric data for the lower urinary tract were generated from the National Library of Medicine Visible Human dataset. The three-dimensional texture map of the surface geometry was developed from recorded endoscopic video procedures. Geometry and associated texture maps were rendered in real time using the Silicon Graphics Extreme Impacts program. The surgical interface device incorporated all normal ranges of motion and resistance that occur within an actual operative environment. The hands-on endoscopic device attached to the interface device was provided by Circon-ACMI, Inc. Urologic residents evaluated the program for correlation with actual endoscopic procedures. RESULTS: Texture-mapped digitized images provided a close anatomic similarity to actual videoendoscopic images. Virtual endoscopy of the lower urinary tract was reproducible and closely simulated actual visual and tactile endoscopic experience. CONCLUSIONS: Virtual reality surgical simulation is feasible for a variety of lower urinary tract procedures. This system coordinates visual perception with appropriate haptic feedback in both longitudinal and rotational axes. These types of procedures may be incorporated into future educational experiences for urologists to introduce new techniques and to provide documentation of surgical experience.     

Changes in self-concept while using SSRI antidepressants

In this study, the authors analyze how younger women see themselves within the context of using the antidepressants selective serotonin re-uptake inhibitors (SSRIs). Twelve in-depth interviews and 6 reinterviews were conducted with a community-based sample of women who had been taking SSRIs between 1 and 4 years. The empirical analysis revealed that SSRI users passed through stages in their careers as medicine users, these stages corresponding to how the users thought and felt about themselves. Four major changes in self-concept emerged: distressed and needing help, conflicts about taking the medicine, improvements in condition, and problems discontinuing the medicine. Users evaluated themselves from what they believed was the perspective of society, and the way they saw themselves was closely related to how they felt they functioned in everyday life.     

Enforced expression of CUL-4A interferes with granulocytic differentiation and exit from the cell cycle

The cullin family of proteins is involved in the ubiquitin-mediated degradation of cell cycle regulators. Relatively little is known about the function of the CUL-4A cullin, but its overexpression in breast cancer suggests CUL-4A might also regulate the cell cycle. In addition, since other cullins are required for normal development, we hypothesized that CUL-4A is involved in regulating cell cycle progression during differentiation. We observed that CUL-4A mRNA and protein levels decline 2.5-fold during the differentiation of PLB-985 myeloid cells into granulocytes. To examine the significance of this observation, we overexpressed CUL-4A in these cells and found that modest (< 2-fold), enforced expression of CUL-4A attenuates terminal granulocytic differentiation and instead promotes proliferation. This overexpression similarly affects the differentiation of these cells into macrophages. We recently reported that nearly one half of CUL-4A+/- mice are nonviable, and in this report, we show that the viable heterozygous mice, which have reduced CUL-4A expression, have dramatically fewer erythroid and multipotential progenitors than normal controls. Together these results indicate that appropriate CUL-4A expression is essential for embryonic development and for cell cycle regulation during granulocytic differentiation and suggest this gene plays a broader role in hematopoiesis. Since enforced CUL-4A expression does not alter the cell cycle distribution of uninduced cells but dramatically increases the proportion of induced cells that remains in S-phase and reduces the proportion that accumulates in G0/G1, our results show that this CUL-4A regulatory function is interconnected with differentiation, a novel finding for mammalian cullins.     

A double-blind comparison of olanzapine versus risperidone in the acute treatment of dementia-related behavioral disturbances in extended care facilities

BACKGROUND: In addition to demonstrating their superiority to placebo, there is a need to compare the relative efficacy and side effects of atypical neuroleptics for the acute treatment of dementia-related behavioral disturbances in residents of long-term care facilities. METHOD: In a double-blind parallel study allowing dose titration over 14 days, 39 agitated persons with DSM-IV dementia who were residing in long-term care facilities were administered olanzapine (N = 20) or risperidone (N = 19) as acute treatment. Drug was administered once a day at bedtime. The initial dosages were olanzapine, 2.5 mg/day, and risperidone, 0.5 mg/day. Titration was allowed to maximum doses of olanzapine, 10 mg/day, and risperidone, 2.0 mg/day. The primary outcome measures were the Clinical Global Impressions scale (CGI) and the Neuropsychiatric Inventory (NPI). Data were gathered from 2000 to 2002. RESULTS: Both drugs produced significant reductions in CGI and NPI scores (p <.0001), but there was no significant difference between drugs. The mean olanzapine dose was 6.65 mg/day; for risperidone, the dose was 1.47 mg/day. The positive drug effect was not accompanied by decreased mobility, and there was improvement on a quality-of-life measure. The chief adverse events were drowsiness and falls. At baseline, 42% (16/38) of subjects in both groups had extrapyramidal symptoms that increased slightly, but not significantly, by the end of the study. CONCLUSION: Low-dose, once-a-day olanzapine and risperidone appear to be equally safe and equally effective in the treatment of dementia-related behavioral disturbances in residents of extended care facilities.     

Brief report: A case of autism associated with del(2)(q32.1q32.2) or (q32.2q32.3)

Autism is a neurodevelopmental disorder presenting in the first 3 years of life. Deficits occur in the three core areas of communication, social interaction, and behavior. The causes of autism are unknown, but clinical genetic studies show strong evidence in favor of a genetic etiology. Molecular genetic studies report some association with candidate genes, and candidate regions have emerged from several genome-wide linkage studies. Here we report a clinical case of autism with a deletion on chromosome 2 in a young male with high-functioning autism. The deletion seems to correspond with regions emerging from linkage studies. We propose this as a possible candidate region in the search for autism genes.