The predictors of unsuccessful transition to foster care

The placement movements of 235 children entering foster care over a 12-month period were followed up 4 months after referral into care. Baseline and follow-up measures of the 170 children who were still in care at follow-up were also compared. Results indicated that adolescents with mental health or behavioural problems were the least likely to achieve placement stability or to display improved psychological adjustment in care. In fact, unsatisfactory transition to foster care was found to be so prevalent among these children that conventional foster family care should be considered unsuitable for them. The paper concludes that there is an urgent need for a wider range of alternative care options for the adolescent population.     

咽异感症患者心理症状自评量表分析

目的：了解咽异感症患者的心理状态,探讨心理因素在本病发生、发展、治疗和康复中的作用。方法：对79例咽异感症患者进行心理症状自评量表（SCL-90）评定,并与正常人群比较,应用SPSS12.0统计软件对所有数据资料进行统计分析。结果：①咽异感症患者SCL-90量表总分、阳性项目均分和阳性项目总分均高于正常人群（P〈0.05或P〈0.01）;②咽异感症患者各因子得分均高于正常人群（P〈0.05或P〈0.01）;③不同性别咽异感症患者SCL-90量表各因子得分差异无统计学意义。结论：咽异感症患者存在明显的躯体化、焦虑、抑郁等症状。     

Improving Workflow Efficiency in Interventional Radiology

Late starts result in late finishes which creates inefficient workflow. The purpose of this quality-improvement project was to improve workflow efficiency in interventional radiology (IR) at the Central Arkansas Veterans Healthcare System. Six articles reviewed for this project demonstrated underlying problems with workflow efficiency in procedural areas that should be addressed. Interventions including checklists, facilitators, reminder e-mails to staff, requiring staff to come in earlier, and reporting arrival times of staff to supervisors helped improve on-time starts and workflow efficiency. A preimplementation and postimplementation retrospective chart review was used to evaluate this project. Random samples of 200 charts were reviewed before and after implementation, to establish the percentage of on-time starts. All patient satisfaction surveys received during the 4 months were reviewed for response to the item “My procedure began at the time it was scheduled.” Percentage of on-time starts and percentage of patients scoring “agree” or “strongly agree” on the satisfaction survey were compared before and after implementation. On-time starts increased from 29% and 24% in the 2 months before implementation to 34% and 40% in the 2 months after implementation. The item scored on the satisfaction survey increased from 73% and 83% before implementation and to 93% and 100% after implementation. In conclusion, a comprehensive checklist and increased physician reminders of first-case starts sent via e-mail helped to improve on-time starts in IR and increase patient satisfaction.     

Improving treatment satisfaction and other patient-reported outcomes in people with type 2 diabetes: the role of once-daily insulin glargine

Insulin therapy becomes essential for many people with type 2 diabetes. After starting insulin, people with diabetes that is poorly controlled with oral agents typically report improved well-being and treatment satisfaction. However, healthcare professionals and people with type 2 diabetes are often reluctant to begin insulin treatment, citing concerns such as time/resources needed to educate patients, increased risks of hypoglycaemia and fear of injections, which lead them to focus on intensifying conventional oral therapy. Insulin glargine, which offers people with diabetes a once-a-day injection regimen with low risk of hypoglycaemia, is more likely to overcome such initial barriers than other more complex insulin regimens. Once-daily insulin glargine, in combination with modern glucose-dependent oral agents that do not need to be chased with food to prevent hypoglycaemia, does not require the fixed mealtimes and set amounts of carbohydrates necessary with twice-daily injection mixes and older sulphonylureas. We know that it is such dietary restrictions that cause the most damage to quality of life (QoL). To avoid damaging QoL unnecessarily and to ensure optimal satisfaction with treatment, it is important to evaluate the effects of treatment on QoL, treatment satisfaction and other patient-reported outcomes (PROs) using questionnaires validated for this purpose, such as the widely used Diabetes Treatment Satisfaction Questionnaire and the Audit of Diabetes-Dependent Quality of Life measure. A systematic electronic literature search identified reports of studies evaluating PROs associated with insulin glargine in comparison with other treatments. The studies show that insulin glargine is usually associated with greater improvements in treatment satisfaction and other PROs compared with intensifying oral therapy or alternative insulin regimens.     

综合医院心理科初诊患者《症状自评量表》特征

目的 了解综合医院心理科门诊患者的相关情况及心理状况。方法 对2003年7月～2005年7月在我院心理科门诊初次就诊的患者，采用症状自评量表（SCL-90）进行心理测试，并结合初诊登记资料进行统计分析。结果2年来初诊患者共4260例，2893例接受心理测试的初诊患者SCL-90总分、总均分、阳性症状均分及各因子分均高于常模（P〈0．05）。诊断以功能性精神障碍为主，其中神经症、抑郁症和精神分裂症是初诊的主要疾病。结论 综合医院心理科患者有较高的精神症状发生率，其心理健康水平明显低于普通人群。     

Cognitive styles and psychological functioning in rural South African school students: Understanding influences for risk and resilience in the face of chronic adversity

Adverse childhood experiences can show lasting effects on physical and mental health. Major questions surround how children overcome adverse circumstances to prevent negative outcomes. A key factor determining resilience is likely to be cognitive interpretation (how children interpret the world around them). The cognitive interpretations of 1025 school children aged 10–12 years in a rural, socioeconomically disadvantaged area of South Africa were examined using the Cognitive Triad Inventory for Children (CTI-C). These were examined in relation to psychological functioning and perceptions of the school environment. Those with more positive cognitive interpretations had better psychological functioning on scales of depression, anxiety, somatization and sequelae of potentially traumatic events. Children with more negative cognitions viewed the school-environment more negatively. Children living in poverty in rural South Africa experience considerable adversity and those with negative cognitions are at risk for psychological problems. Targeting children's cognitive interpretations may be a possible area for intervention.     

Caregiver and self-report of mental health symptoms in 9-year old children with prenatal cocaine exposure

Objective

To assess the effect of prenatal cocaine exposure on mental health symptoms in 9-year old children controlling for potential confounders.

Methods

332 children (170 prenatally cocaine-exposed (PCE), 162 non cocaine-exposed (NCE) were assessed using self (Dominic Interactive; DI) and caregiver report (Child Behavior Checklist; CBCL).

Results

Higher levels of PCE were associated with caregiver report of clinically elevated aggressive and delinquent behavior. With each increased unit of PCE, children were 1.3 times more likely to be rated as aggressive (OR = 1.30, 95% CI: 1.02-1.67, p < 0.04). For each increased unit of PCE, girls were 2 times more likely to be rated as having delinquent behavior (OR = 2.08, 95% CI: 1.46-2.96, p < 0.0001). PCE status was also associated with increased odds of delinquent behavior (OR = 2.41; 95% CI: 1.16-4.97, p = 0.02), primarily due to the increased risk among girls with PCE. While girls with PCE status were 7 times more likely than NCE girls to have delinquent behaviors (OR = 7.42; 95% CI: 2.03-27.11, p < 0.002) boys with PCE did not demonstrate increased risk (OR = 0.98; 95% CI: 0.36-2.65, p > 0.97). Foster or adoptive parents were more likely to rate their PCE children as having more thought problems, inattention, delinquent behavior, aggression, externalizing and overall problems (p < 0.05) than biologic mothers or relative caregivers. Higher 2nd trimester tobacco exposure was associated with increased odds of caregiver reported anxiety (OR = 1.73; 95% CI 1.06-2.81, p < 0.03) and marijuana exposure increased the odds of thought problems (OR = 1.68; 95% CI 1.01-2.79, p < 0.05). Children with PCE self-reported fewer symptoms of oppositional defiant disorder (ODD) compared to NCE children (OR = 0.44, 95% CI: 0.21-0.92, p < 0.03). Greater tobacco exposure was associated with increased odds of child reported ODD (OR = 1.24; 95% CI 1.03-1.78, p < 0.03).

Conclusion

Higher PCE was associated with disruptive behaviors including aggression and delinquent behavior among girls by caregiver report, but not child report. These findings highlight the need for early behavioral assessment using multiple informants in multi-risk children.     

Psychiatric symptom changes after corticoamygdalohippocampectomy in patients with medial temporal lobe epilepsy through Symptom Checklist 90 Revised

Background

Corticoamygdalohippocampectomy (anterior temporal lobe resection plus amygdalohippocampectomy) is common in epilepsy surgery. Pre- and postoperative psychiatric disorders occurred sometimes in patients with refractory medial TLE. We want to know if CAH has an affirmative effect on the psychiatric symptom of patients with medial TLE through a quantitative method.

Methods

Sixty-two patients with medial TLE who had CAH accomplished SCL-90-R questionnaires thrice (presurgical and postsurgical 1 and 2 years). Average GSI scores in SCL-90-R were calculated and statistically analyzed.

Results

There was no statistical difference in the presurgical average GSI scores between Engel I and Engel II to IV subgroup. Postoperative 1 and 2 years' average GSI scores of Engel II to IV subgroup were both statistically higher than those of Engel I subgroup. There were no statistical differences between other subgroups in different time. Postsurgical 1 and 2 years' average GSI scores of the whole group and Engel I subgroup were statistically lower than those of presurgery. Postoperative 2 years' average GSI scores of the whole group and Engel I subgroup were statistically lower than those of postsurgical 1 year. For Engel II to IV subgroup, there were no statistical differences among the average GSI scores in different time.

Conclusion

Corticoamygdalohippocampectomy could improve the psychiatric symptoms of patients with TLE as assessed by the SCL-90-R. This improvement was related to the therapeutic effect and was not related to sex, lateralization, and MRI abnormality.