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Objectives: This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China. Materials and methods: A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type. Results: Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p = 0.035) and autumn (adjusted OR = 1.925; p < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence. Conclusion: The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol. Clinical relevance statement: In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity. Key Points: • The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn. [ABSTRACT FROM AUTHOR]

Many patients referred for psychodynamic psychotherapy are also seen by other services. Due to the complex interplay between psychological distress, physical symptoms and care-seeking behaviour, engagement with a psychotherapy department has the potential either to increase or decrease use of other services. This service evaluation compared 268 patients' service use in the year preceding and following contact with an NHS psychodynamic psychotherapy department using t-tests. There were no significant changes from before therapy to afterwards for the sample as a whole. However, for sub-groups who made regular use of services at baseline, a full course of psychotherapy (16+ sessions) was associated with a statistically significant reduction in outpatient contacts, both for mental health (N = 32, mean 11.69 appointment per year pre-therapy vs 5.16 post-therapy, p = 0.01) and medical services (N = 23, from mean 9.65 to 3.00, p < 0.01). No compensatory changes were found in either A&E or inpatient contacts, suggesting this represents an overall reduction in service use. Due to the study design, it was not possible to establish causality; there may be other reasons for this observed reduction such as natural illness course. These findings tentatively support the existing literature that psychodynamic psychotherapy is associated with a reduction in use of wider services. [ABSTRACT FROM AUTHOR]

Objective: To establish the association between quality of life and depression among COPD patients of the Colombian Caribbean. Method: A cross‐sectional study was carried out with the participation of adult COPD patients. COPD‐related quality of life was quantified with the COPD Assessment Test (CAT) and depression using the Zung 10‐item Self‐rating Depression Scale (SDS‐10). The relationship between COPD‐related quality of life and depression with odds ratios (OR), crude and adjusted, was determined. Results: 408 patients participated in the study. They were aged between 40 and 102 years (mean = 72.9, SD = 10.2) and 58.8% men. Two hundred eighty‐four patients (69.6%) reported worse health status (CAT ≥10), and 114 patients (27.9%) scored for depression (SDS‐10). Patients with worse health status presented more depression (OR = 5.85, 95% CI 3.01–11.36) and after adjusting for gender (OR = 5.70, 95% CI 2.92–11.13). Conclusions: In patients with COPD and CAT ≥10, there is a five times greater risk of depression than patients with CAT <10. However, the relationship may be bidirectional. It is essential to specify the direction of causality in future investigations. [ABSTRACT FROM AUTHOR]

This study assessed the association between religiosity and treatment adherence, psychopathology of patients diagnosed with schizophrenia in a Nigerian psychiatric hospital. Duke University Religion Index (DUREL), Morisky Medication Adherence Scale (MMAS-8), Positive and Negative Symptoms Scale (PANSS) were used to measure religiosity, medication adherence and psychopathology, respectively. Organisational Religious Activity (ORA) was defined by DUREL's item 1, Non-Organisational Religious Activity (NORA) by item 2, and Intrinsic Religiosity (IR) by summing items 3, 4 and 5 of the DUREL. PANSS positive subscale was defined by summing PANSS first seven items (P1-P7), PANSS negative by summing next seven items (N1-N7) and general psychopathology dimension by summing last 16 items (G1-G16). Results showed no significant association between all measures of religiosity and medication adherence, and no significant association between ORA and various dimensions of psychopathology. NORA and IR tended to be negatively correlated with PANSS negative psychopathology. [ABSTRACT FROM AUTHOR]

Objective: The study assessed the knowledge, attitude and management practices of diabetes patients attending medical outpatient department in Federal Capital Territory Abuja. Materials and Methods: A total of 120 randomly selected respondents between 18 - 65 years were assessed using standard methods in a cross-sectional survey involving the use of validated semi-structured questionnaires. Results: The findings revealed that 60% of patients were without health insurance despite the fact that they are educated; 53% have been diagnosed and began their treatment between 2 and 5 years. For the knowledge indicators, 50% of the patients know two types of diabetes, 35% were able to list two types of diabetes while 56.70% could not list any type of diabetes. Attitude assessment among the diabetic patients revealed that 79.17%, 62.50%, 68.33% and 51.67% visit a physician; do monitor their blood glucose, have altered their eating habit and agreed that sedentary lifestyle is not good respectively; 41.67% of the respondents read health materials. In the area of lifestyle, changes made by the diabetic patients include check-up (3.33%), diet (18.33%) and exercise (20.00); 40.00% and 14.17% made a combination of two and three lifestyle changes respectively. Majority of the respondents do have their blood glucose level checked monthly. Conclusion: Based on the research findings, the diabetic patients' knowledge, attitude and dietary practices are contributing factors to their high fasting blood glucose and poor nutrition status. [ABSTRACT FROM AUTHOR]

Background: Since the outbreak in China due to coronavirus disease 2019 (COVID-19) various studies have been published describing olfactory and gustatory dysfunction (OGD). Objective: The aim was to investigate the frequency and severity of OGD in SARS-CoV-2 (+) out-patients compared to controls with common cold/flu like symptoms and two negative RT-PCR. Methods: A multicenter cross-sectional study on SARS-CoV-2-positive out-patients (n = 197) and controls (n = 107) from five Spanish Hospitals. Severity of OGD was categorized by visual analogue scale (VAS). Frequency and severity of the chemosensory impairment were analyzed. Results: The frequencies of smell (70.1%) and taste loss (65%) were significantly higher among COVID-19 subjects than in the controls (20.6% and 19.6%, respectively). Simultaneous OGD was more frequent in the COVID-19 group (61.9% vs 10.3%) and they scored higher in VAS for severity of OGD than controls. In the COVID-19 group, OGD was predominant in young subjects 46.5 ± 14.5 and females (63.5%). Subjects with severe loss of smell were younger (42.7 years old vs 45.5 years old), and recovered later (median = 7, IQR = 5.5 vs median = 4, IQR = 3) than those with mild loss of smell. Subjects with severe loss of taste, recovered later in days (median = 7, IQR = 6 vs median = 2, IQR = 2), compared to those with mild loss. Conclusion: OGD is a prevalent symptom in COVID-19 subjects with significant differences compared to controls. It was predominant in young and females subjects. Stratified analysis by the severity of OGD showed that more than 60% of COVID-19 subjects presented a severe OGD who took a longer time to recover compared to those with mild symptoms. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated whether the satisfaction of patients attending a physiotherapy-led postarthroplasty review out-patient clinic was non-inferior to that of patients attending traditional surgeon clinics. Methods. Using a modified nine-item Visit-Specific Satisfaction Instrument (VSQ-9), 50 patients attending the physiotherapy clinic and 50 patients attending surgeon clinics were surveyed. Sample means (± s.d.) were calculated for each domain of the VSQ-9. Non-inferiority testing was performed using 95% confidence intervals (CIs) of the adjusted mean difference to examine whether normalised patient satisfaction scores in the physiotherapy group were no worse than those in the surgeon group. Results. Both groups were satisfied (overall domain; 100% of both groups rated good-excellent). Based on mean item score, there was strong evidence that the satisfaction of the physiotherapy group was non-inferior to that of the surgeon group (adjusted mean difference (physiotherapy - surgeon) in mean score 5.1 (95% CI -0.3, 10.4). Furthermore, the mean differences in all but one of the nine domains were in favour of the physiotherapy group in this study. Conclusion. The satisfaction of patients attending a physiotherapy arthroplasty review clinic is not inferior to that of patients attending traditional surgeon clinics. [ABSTRACT FROM AUTHOR]

Background: Studies from developed countries have shown that poor premorbid adjustment in patients with schizophrenia is associated with poor outcome. However, similar studies in developing countries like Nigeria are few despite the stability of schizophrenia prevalence across cultures. Aim: The aim of this study was to assess the prevalence and correlates of poor premorbid adjustment amongst outpatients with schizophrenia. Setting: The Neuropsychiatric Hospital, Abeokuta in Ogun State, Nigeria. Methods: The premorbid adjustment of 300 outpatients with schizophrenia was assessed using the premorbid adjustment scale. Pattern and severity of psychosis, overall illness severity, global assessment of functioning and socio-demographic factors were investigated as correlates of premorbid functioning. Results: About half (53.3%) of the respondents had poor premorbid adjustment and most of them were males (56.9%). Poor premorbid adjustment was associated with male gender (χ² = 7.81, p = 0.005) whilst good premorbid adjustment was associated with no or borderline illness severity (χ² = 8.26, p = 0.016) as well as no or mild impairment in functioning (χ² = 7.01, p = 0.029) amongst the respondents. Positive, negative and general symptomatology were predicted by premorbid adjustment at different developmental stages. Conclusion: Consistent with existing literature, poor premorbid adjustment was prevalent amongst patients with schizophrenia in this study and was associated with male gender, poorer clinical outcomes and greater illness severity. Mental health promotion and other preventative approaches are recommended as possible early intervention strategies in dealing with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Four major non-communicable diseases (NCD), including T2DM, contributed to nearly three-quarters of all deaths worldwide in 2017. Dietary and lifestyle actors associated with NCDs are potentially modifiable. Therefore, this study was conducted to determine the dietary and lifestyle factors associated with T2DM, pre-diabetes, and hypertension among adult outpatients in Manzini, Swaziland.Methods: A random sample of 385 subjects aged 18 years and above was selected. The data regarding demographics, socio-economic status, lifestyle behaviour, diet, and physical activities were collected. Additionally, participants' anthropometric measurements and vital signs were taken. A biochemical examination was done for fasting plasma glucose, and a 2-h oral glucose tolerance test, where necessary. The Statistical Package for Social Sciences (SPSS) version 26 was used for this data analysis, and the level of statistical significance was set at p < 0.05.Results: A total of 385 (197 men and 188 women) subjects aged 18 years and older participated in the study. The overall prevalence of hypertension was 48.3%, while the prevalence of hypertension stage 1 and 2 were 29.4 and 19%, respectively. Smoking, SES and consumption of sweet drinks, salty processed foods, fruits, and vegetables were significantly associated with T2DM. However, in the multivariate analysis, only consumption of vegetables (p < 0.0001), fruits (p =0.014), sweet drinks (p = 0.042), and salty processed foods (p = 0.005) remained significantly associated with T2DM. Smoking (p = 0.002) and consumption of fruits (p < 0.0001), vegetables (p < 0.0001), and sweet drinks (p = 0.043) were independently associated with pre-diabetes, while the consumption of vegetables (p = 0.002) and salty processed foods (p = 0.003) were the factors independently associated with hypertension.Conclusions: The factors associated with T2DM, pre-diabetes, and hypertension are potentially modifiable. Therefore, interventions which target lifestyle changes at primary health care and population levels are warranted to address the growing burden of these chronic conditions in Swaziland. [ABSTRACT FROM AUTHOR]

Salivary alpha-amylase has been implemented as renewed non-invasive biomarker of interest to measure the levels of stress in humans. In the current clinical study, two-factor repeated-measures cross-sectional design was implemented to determine the salivary alpha-amylase levels and its rhythm characteristics in newly diagnosed female breast cancer in- and out-patients. Alpha-amylase levels were determined using the Salimetrics® salivary alpha-amylase assay kit. Rhythm characteristics of alpha-amylase were computed using the Cosinor Rhythmometry technique. Results showed that the levels of alpha-amylase significantly increased from/to the increasing number of chemotherapy cycle in patients of both group; however the levels were higher in in-patients. Further, results revealed significant differences in rhythm characteristics of alpha-amylase characterized by higher MESOR, lower amplitude, and advanced acrophase in in-patients as compared to out-patients. Current findings indicate that patients of both the groups were associated with progression under stress levels across the number of chemotherapy cycle; however, the levels of stress were higher in in-patients as compared to out-patients. Higher level of stress in cancer in-patients could be attributed to the possible effect of hospitalization and/or relative social isolation. [ABSTRACT FROM AUTHOR]

Background: The prescription error is a failure in the prescription writing process leading to wrong instructions about the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. This study is an effort directed to find errors in prescription writing and interventions to improve on such error-prone practices of prescription writing. Methods: This was a cross-sectional, observational study conducted to analyze the prescription writing errors in the outpatient department in the rural area of Anand district of Central Gujarat. Prescriptions were collected from two nearby rural areas of Anand city-Petlad and Anklav. The prescription copies so-obtained were analyzed as per the WHO guidelines for “Prescription Writing Errors.” Results: Overall, 191 prescriptions were collected from both rural areas in the study. The highest number of prescriptions was collected from general practitioners, followed by surgeons and gynecologists. Name, qualification, and address of prescribers were mentioned in all the prescriptions while registration number was mentioned only in 14.10% of prescriptions. The esoteric symbol was mentioned in 63% of prescriptions. Prescribers signed their prescription only in 48% of prescriptions. A total of 420 drugs were prescribed to the patients in the study. All but one drug were prescribed by brand name. Dosage form and route of administration of drugs were mentioned in >60% of drugs. Conclusion: Most medical schools provide some training in prescribing to medical undergraduates; however, this training is perceived to be suboptimal by medical students and junior doctors. Such training programs are the need of the hour. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate available and desired sources and types of social-support among hypertensive and type-2-diabetes (T2D) patients. Associations of medication adherence and clinical outcome with access to most available social-support and medicine affordability were subsequently investigated. Design: Cross-sectional questionnaire-guided interview among 250-hypertensive and 200-T2D patients, and review of medical records to retrieve disease-specific clinical parameters. Settings: University College Hospital and Ring-Road State Hospital, Ibadan, southwestern Nigeria. Participants: Adults out-patients with hypertension, T2D, and T2D comorbid with hypertension were enrolled, while in-patients were excluded. Results: Family source of support was the most available [hypertensive (225; 90.0%); T2D (174; 87.0%)], but government and non-governmental organisation support were largely desired, with financial support preferred, 233(93.2%) hypertensive and 190(95.0%) T2D, respectively. Adherent hypertensive patients with or without access to family support were (127; 56.4%) versus (18; 72.0%), p=0.135; while for T2D were (103; 59.2%) versus (21; 80.8%), p=0.035. Mean systolic blood pressure of hypertensive and fasting plasma glucose of T2D with access to family and financial support were better than their counterparts without access (p>0.05). Hypertensive (110; 76.4%) and T2D (87; 87.0%) participants who consistently afford medicine expenses had significantly better adherence and outcome (p<0.05). Conclusions: Family source of support is the most accessible, but government and non-governmental organisation support were largely desired. Access to family support did not positively influence medication adherence, while access to financial support marginally impacted on outcome among hypertensive and T2D patients. However, unwavering tendency for therapy affordability significantly influenced adherence and outcome, thus, the need for expanded social-support system in order to consistently ensure improved outcome. [ABSTRACT FROM AUTHOR]

Background:Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders. Aim:The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to investigate how psychopathic traits relate to psychiatric disorders. Method:The outpatient sample comprised 163 girls aged 15–17-years recruited from municipal mental health services. Psychiatric diagnoses were assessed based on the ICD-10 classification. The community sample comprised 355 girls from secondary, vocational, and high schools. The Youth Psychopathic trait Inventory (YPI) served as a self-assessment tool. Results:Treatment-seeking girls exhibit a more impulsive and irresponsible lifestyle than do girls in the community. Girls with externalizing psychopathology, unlike those with an internalizing disorder, exhibit more deficient affective experience than do girls in the community. Psychopathic traits associate with having a psychiatric disorder, a depressive disorder, ADHD, and a conduct disorder. Conclusions:The psychiatric examination of treatment-seeking adolescent girls would likely benefit from screening for psychopathy and its underlying components. [ABSTRACT FROM PUBLISHER]

Background: Tinnitus is an increasingly serious problem for health care systems. According to epidemiological data, 7-14 % of outpatients have asked their physician about tinnitus and management strategies. Integrative outpatient treatments are currently regarded as promising therapeutic approaches for managing tinnitus. In this article we report on the treatment success of an outpatient tinnitus treatment center in Germany.Methods: This cohort study included pre-post data of 5536 outpatients which were treated between 2003 and 2010 in the tinnitus-therapy center, Krefeld-Düsseldorf (TTZ). The intervention consisted of psychological immunization training as well as an auditory stimulation therapy component. The main outcome parameter was the score of the Tinnitus Questionnaire (TQ) which was assessed before and after a 9 days treatment and (in a small subsample) at a 6 months follow-up. Missing data were multiply imputed. Pre-post effect sizes were calculated and adjusted for regression to the mean (RTM).Results: RTM-adjusted treatment effects at the end of treatment were estimated as -18.6 (CI: -18.9 to 18.2, p < 0.001) score points which corresponds to a standardized effect of d = -1.03 (CI: -1.05 to -1.01). These effects can be corroborated in various subgroups and all subscales of the TQ (d ranging from -0.31 to -0.97).Conclusion: The study suggests the effectiveness of this outpatient tinnitus therapy concept. Multiple imputations techniques and RTM analysis were helpful in carving out true treatment effects. [ABSTRACT FROM AUTHOR]

The article explores the role of the Charity Organisation Society (COS) in conjunction with the local voluntary hospital (Radcliffe Infirmary) in Oxford, in attempts to filter the 'deserving' from the 'undeserving' poor in order to ensure the right people received 'gratuitous medical relief'. This was during a time when there was increased pressure on the out-patients department due to an expanding population, and the government had curbed public spending to restrict out-relief, which included medical relief. Through examination of unique patient records made by the COS visitors from 1878 to 1880, a picture of the work of the Oxford COS is gained. Other documentary sources concerned with associated health and welfare projects have also been examined to measure the outcome of the project, identify key personnel and influences within the city. [ABSTRACT FROM AUTHOR]

Background: Herbal medications are used worldwide for a variety of diseases and conditions. Patients often elect not to disclose their herbal use history, or health care practitioners fail to enquire about specific alternative therapy. The aim of this study was to assess the conditions most frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Garankuwa, South Africa. Methods: Patients attending an out-patient's clinic at the Dr George Mukhari Academic Hospital were given a questionnaire regarding their use of herbal remedies for various reasons. Assessment was done on past, current, and possible future use of herbal interventions. These interventions were categorised into acute medical conditions, chronic ailments, and cultural uses. Results: Respiratory tract infections were most frequently treated (34%). Other highly ranked uses included protection from evil spirits (32%) and for HIV/AIDS (29%). Digestive ailments (27%), hypertension (18%), and general malaise (17%) accounted for the remainder. Previous herbal use amounted to 74%, but only 30% indicated that they would use herbal medication in future. Conclusions: Traditional medication plays an important role in many communities in South Africa. For this reason health care workers need to be aware of the conditions most frequently self-treated with herbal remedies. Having knowledge about the incidence of herbal treatment for a specific condition could alert the health care practitioner to possible reasons for unidentifiable drug interactions, adverse events, treatment failure, or even death. [ABSTRACT FROM AUTHOR]

Context: Evidence suggests that certain yoga practices are useful in the management of depression. To the best of our knowledge, there has been no study that deals with the formulation of a yoga module for the particular clinical features of depression. Aim: The main aim of our study was to develop a comprehensive yoga therapy module targeting specific clinical features of depression. Settings and Design: Specific yoga practices were matched for clinical features of depression based on a thorough literature review. A yoga program was developed, which consisted of Sukṣmavyayāma, (loosening exercises), äsanas (postures), relaxation techniques, Prāṇāyāma (breathing exercises) and chanting meditation to be taught in a 2 week period. Materials and Methods: A structured questionnaire was developed for validation from nine experienced yoga professionals. The final version of yoga therapy module was pilot-tested on seven patients (five females) with depression recruited from outpatient service of National Institute of Mental Health and Neuro Sciences, Bangalore. Results: The final yoga therapy module had those practices that received a score of three or more (moderately/very much/extremely useful) from all responders. Six out of nine (>65%) experts suggested Sūkśmavyāyāma should be included. Five out of nine experts opined that training with 10 sessions (over 2 weeks) is rather short. All experts opined that the module is easy to teach, learn and practice. At the pilot stage, the five patients who completed the module reported more than 80% satisfaction about the yoga practices and how the yoga was taught. Severity of depression substantially reduced at both 1 and 3 months follow-up. Conclusion: The developed comprehensive yoga therapy module was validated by experts in the field and was found to be feasible and useful in patients with depression. [ABSTRACT FROM AUTHOR]

Services dedicated to patients with cognitive and behavioral consequences of cerebrovascular diseases (CVD) are not established. We started an out-patient clinic (the 'VAS-COG clinic') to assess patients with psycho-cognitive disturbances related to CVD. The work-up includes a clinical-neuroimaging diagnostic process and the individuation of the best therapeutic strategies as done in patients with neurodegenerative cognitive impairment. We report the results of the first 5 years of activity. Reasons for patient referral were not only cognitive, language, gait, and psychiatric disturbances related to stroke or chronic CVD, but also neuroimaging evidence of vascular encephalopathy and screening for familial microangiopathies. The patients were evaluated with uniformed protocols. From January 2006 to November 2010, we evaluated 403 patients. Of these, 374 (93%; mean age 69.7 years ± 15.0) were considered appropriate for the VAS-COG clinic. The following diagnoses were made: vascular dementia (8.6%), Alzheimer disease (2.1%), mixed dementia (vascular plus degenerative) (4.8%), vascular mild cognitive impairment (MCI) (9.1%), amnesic-MCI (8.0%), mixed-MCI (4.8%), post-stroke depression (2.7%), post-stroke language disturbances (4.5%), subjective memory complaint (1.3%), familiar microangiopathy (31.3%), vascular encephalopathy evidenced by neuroimaging not associated with specific clinical disturbances (15.3%), and other conditions (7.5%). Psycho-cognitive disturbances associated with CVD are heterogeneous. In addition to acute stroke care strategies, long-term assessment of patients with CVD is required. The VAS-COG clinic may represent a model in this regard and might be important for improving the care of patients and offering counseling to their families. The efficacy of this service needs, however, to be proved by successive work. [ABSTRACT FROM AUTHOR]

Depression and anxiety are estimated to be two of the most important causes of disease burden in the world, and they appear to be more prevalent among women than men. The present study aimed to explore and describe the psychofortology of female psychiatric out-patients living with mood and anxiety disorders. An exploratory descriptive research design was used and the participants were selected by means of non-probability purposive sampling. The sample consisted of 60 female psychiatric out-patients who were selected from the Nelson Mandela Metropole in the Eastern Cape. The selection was based on predetermined inclusion criteria. Data were gathered through the administration of a biographical questionnaire, Hammer and Marting’s Coping Resources Inventory, Antonovsky’s Sense-of-Coherence Scale, Diener, Emmons, Larson and Griffin’s Satisfaction-with- Life Scale, and Kamman and Flett’s Affectometer-2. These data were then analysed according to the aims of the study by the use of descriptive statistics, inferential statistics, and multivariate data analysis. The results of the study indicated that the female psychiatric out-patients with mood and anxiety disorders generally experienced lower levels of coping and subjective wellbeing when compared with normative data. The results also identified three clusters, which revealed that the psychiatric out-patients with mood disorders — although they experienced low levels of coping and subjective wellbeing —- obtained higher scores than the patients with anxiety disorders. The findings of the research also address the management and care of female psychiatric out-patients living with mood and anxiety disorders. [ABSTRACT FROM AUTHOR]

Objective. To determine the prevalence and predictors of poor or non-compliance with medications among respondents attending an adult psychiatry out-patient clinic in Benin City, Nigeria. Methods. Respondents ( n == 137) were randomly selected over a 3-month period using a cross-sectional study design. They were administered a questionnaire adapting the Factors Influencing Neuroleptic Medication Taking Scale as well as the Brief Psychiatric Rating Scale (BPRS) to ascertain medication, illness-related and psychosocial variables. Medication adherence was determined by self report and for the purpose of the study confined to the week prior to interview. Results. Almost half (42.3%) were poorly adherent to medications. Most admitted to good psychosocial support, but believed that their illness had a spiritual aetiology. Stigma, higher frequency of medication dosing as well as illness severity as measured by their BPRS scores were significant predictors of poor medication adherence. Conclusion. The prevalence of poor medication adherence in this environment is higher than in studies from Western cultures, and replicates rates from previously published reports in this environment. Factors responsible for poor adherence can form the template for intervention studies and programs to improve compliance. [ABSTRACT FROM AUTHOR]

Aims Our study sought to assess the prevalence of and risk factors for opioid drug dependence among out-patients on long-term opioid therapy in a large health-care system. Methods Using electronic health records, we identified out-patients receiving 4+ physician orders for opioid therapy in the past 12 months for non-cancer pain within a large US health-care system. We completed diagnostic interviews with 705 of these patients to identify opioid use disorders and assess risk factors. Results Preliminary analyses suggested that current opioid dependence might be as high as 26% [95% confidence interval (CI) = 22.0-29.9] among the patients studied. Logistic regressions indicated that current dependence was associated with variables often in the medical record, including age <65 [odds ratio (OR) = 2.33, P = 0.001], opioid abuse history (OR = 3.81, P < 0.001), high dependence severity (OR = 1.85, P = 0.001), major depression (OR = 1.29, P = 0.022) and psychotropic medication use (OR = 1.73, P = 0.006). Four variables combined (age, depression, psychotropic medications and pain impairment) predicted increased risk for current dependence, compared to those without these factors (OR = 8.01, P < 0.001). Knowing that the patient also had a history of severe dependence and opioid abuse increased this risk substantially (OR = 56.36, P < 0.001). Conclusion Opioid misuse and dependence among prescription opioid patients in the United States may be higher than expected. A small number of factors, many documented in the medical record, predicted opioid dependence among the out-patients studied. These preliminary findings should be useful in future research efforts. [ABSTRACT FROM AUTHOR]

Abstract: In a chart review at a psychiatric out-patient department, latitude 59.3°N, a sample of patients with tests of serum 25-hydroxy-vitamin D (25-OHD) and plasma intact parathyroid hormone (iPTH) was collected, together with demographic data and psychiatric diagnoses. During 19 months, 117 patients were included. Their median 25-OHD was 45nmol/l; considerably lower than published reports on Swedish healthy populations. Only 14.5% had recommended levels (over 75). In 56.4%, 25-OHD was under 50nmol/l, which is related to several unfavourable health outcomes. Seasonal variation of 25-OHD was blunted. Patients with ADHD had unexpectedly low iPTH levels. Middle East, South-East Asian or African ethnic origin, being a young male and having a diagnosis of autism spectrum disorder or schizophrenia predicted low 25-OHD levels. Hence, the diagnoses that have been hypothetically linked to developmental (prenatal) vitamin D deficiency, schizophrenia and autism, had the lowest 25-OHD levels in this adult sample, supporting the notion that vitamin D deficiency may not only be a predisposing developmental factor but also relate to the adult patients’ psychiatric state. This is further supported by the considerable psychiatric improvement that coincided with vitamin D treatment in some of the patients whose deficiency was treated. [ABSTRACT FROM AUTHOR]

Objective: Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one’s particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. Method: Out-patients with Schizophrenia ( n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Results: Overall, 21 patients (21.2%) were categorised as having ‘good’ and 36 (36.4%) as having ‘poor’ subjective QOL. ‘Poor’ subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93–11.48), comorbid medical problems (OR 4.75, 95% CI 1.43–16.33), unemployment (OR 3.75, 95% CI 1.25–11.72) and poor social support (OR 4.60, 95% CI 1.49–14.28). Conclusion: Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment. [ABSTRACT FROM AUTHOR]

Objective: Aggressive behaviour has been related to schizophrenia both in in-patient and out-patient samples. In this study, we aimed to assess the prevalence and factors associated with aggressive behaviour in out-patient compliant with their prescribed medication. Method: Eight hundred and ninety-five patients were interviewed at Community-Based Mental Health Services about aggressive–violent behaviour within the week prior to the study visit. Adult patients diagnosed with schizophrenia and receiving stable pharmacological treatment were enrolled. Presence of aggressive episodes, including type of aggression, severity and frequency, was assessed with the Modified Overt Aggression Scale (MOAS). Violence was defined as a score of 3 or more in any of the MOAS subscores. Results: Prevalence of recent aggressive behaviour was 5.07%, (95% CI 5.04–5.10), where 47% (43 behaviours 91) reached the violent threshold. Among the 91 violent episodes rated, most episodes were verbal (44%), followed by physical violence towards objects (29%), violence towards others (19%) and self-directed violence (8%). Recent episodes of any severity were more likely among patients with a history of violence and also with relapses within the previous year and with low treatment satisfaction. Conclusion: Five per cent of the studied cases showed aggressive behaviour in the week prior to assessment, despite having been compliant with their medication. Most aggressive behaviour was verbal rather than physical. [ABSTRACT FROM AUTHOR]

The National Institute of Health developed NETLAB, a Web based information system that increases the availability of laboratory results to health workers and patients living with HIV / AIDS (PLWHA) in HAART. To assure its effectiveness it is necessary to explore issues available like resources access to Internet Objectives: To describe the characteristics of Internet access and NETLAB access by potential users and the IT infrastructure in places where HAART is administered. Methods: We included 48 public and private health facilities where HAART is administered for 23 departments for Peru. 3 questionnaires were prepared, one for health professionals, another for PLWA and another for informatics specialists from each center. Results: We included in the survey 246 health workers, 201 PLWA and 45 informatics workers. 95,5% of the health workers reported they know how use the Internet, 62,6% had Internet connection with in his offices. 85% knew about NETLAB, but only 36% had an access code. 50,7% of PLWA knew how to use Internet (85,5% in Lima and 47,7% in provinces p<0,01). 81% access trough the public Internet booths ("cabinas públicas") and 93% are interesting accessing their lab results trough the Internet. All the health facilities have Internet access though the quality of the connection is very heterogeneous. Discussion: The high proportion of health workers who knew how and uses the Internet is encouraging and favors the introduction and the use of NETLAB and communications technology. The access gap between PLWA in Lima and regions and the high frequency of use of public Internet booths represent a challenge but also opportunities to promote the use of NETLAB in this group. [ABSTRACT FROM AUTHOR]

Abstract: In two Russian studies (UTIAP-1 and UTIAP-2) susceptibility to commonly used antimicrobial agents for urinary tract infections (UTI) was determined. 456 urinary isolates were obtained from 588 out-patients with uncomplicated UTI in eight Russian centers during 1998–2001. The most common pathogens were Escherichia coli (85.9%) and Klebsiella pneumoniae (6.0%). Over 90% of the E. coli isolates were susceptible to nitrofurantoin (95.7%), cefuroxime (96.4%) and ciprofloxacin (95.5%). Co-amoxiclav, nalidixic acid and pipemidic acid were less active −84.4%, 93.1% and 93.9% susceptibility stains correspondingly. In contrast, 37.1% of the E. coli isolates were resistant to ampicillin, 22.9% to trimethoprim, 21% to co-trimoxazole. Susceptibility patterns of uropathogens vary between geographical regions of Russia. [Copyright &y& Elsevier]

Abstract: Objective: To determine the prevalence and predictors of anxiety and depression in patients with heart failure due to Left Ventricular Systolic Dysfunction (LVSD). Background: Psychological adjustment to Chronic Heart Failure (CHF) can be poor, with the prevalence of depression in out-patients ranging from 13% to 48%. The prevalence of anxiety disorders in this population is unknown and the factors that predict anxiety and depression are not well understood. Methods: 100 out-patients from a community heart failure programme completed a clinical diagnostic interview—the Structured Clinical Interview (SCID-I), to evaluate anxiety and depression. Mean age was 67±11 years, 17% were women and 91% were NYHA Class II or III. Other standardised measures were of cognition, biomedical status, social support and previous physical and mental health history. Results: The prevalence rates of anxiety and depression (all subtypes) were 18.4% and 28.6%, respectively. Predictors of depression included a reported history of mental ill-health and NYHA class. Predictors of anxiety included a reported history of mental ill-health, co-morbid physical illness (diabetes and angina) and NYHA class. Severity of LVSD did not predict either anxiety or depression. Conclusions: Both anxiety and depression are common in CHF patients. The data on the predictors of poor psychological adjustment might assist in targeting bio-psychosocial intervention for patients who are at most at risk of anxiety and depression, within community CHF disease management programmes. [Copyright &y& Elsevier]

Grover S, Avasthi A, Chakrabarti S, Bhansali A, Kulhara P. Cost of care of schizophrenia: a study of Indian out-patient attenders. Acta Psychiatr Scand 2005: 1–10.© Blackwell Munksgaard 2005. To assess the cost of care of Indian out-patients with schizophrenia. Cost of illness in 50 out-patients with schizophrenia was assessed over a 6-month period together with structured assessments of psychopathology and disability, and compared with 50 out-patients with diabetes mellitus. Total annual costs of care of schizophrenia were US$274; these were not significantly different from diabetes mellitus. Indirect costs (63%) were higher than direct costs. Drug costs were high. The main brunt of financial burden was borne by the family. Total treatment costs in schizophrenia were significantly higher in those who were unemployed, those who visited the hospital more often, and were more severely ill and disabled. Schizophrenia is an expensive illness to treat even in developing countries. Costs of care are similar to those of chronic physical illness, such as diabetes mellitus. Costs are higher in severely ill and disabled patients. [ABSTRACT FROM AUTHOR]

To elicit the opinion of multiple sclerosis (MS) patients about the acceptability of a newly designed participation questionnaire - the 'Impact on Participation and Autonomy' (IPA), 35 MS outpatients who had completed an English version of the IPA questionnaire (IPA-E) were interviewed. Patients were recruited consecutively from outpatients attending the MS clinic. They were invited to answer 15 short questions during a 20-minute interview after signing a consent form and completing the IPA-E questionnaire. Completion time of the IPA-E questionnaire was 19.3 ± 4.7 minutes. Most respondents believed that the IPA-E items were easy or very easy to understand (83%), relevant (more than 74%), not embarrassing (more than 97%) and 94% considered that no items should be removed. Three additional topics were suggested: 'looking after children', 'the extent of information on current services' and information about 'treatment progress'. Among the eight domains of the IPA, most respondents considered mobility to be the most important and education the least important. The IPA-E was found to be acceptable and relevant to a sample of MS outpatients, although it could have been enhanced by items on parental or family roles. [ABSTRACT FROM AUTHOR]

Objective: Controversy exists about long-term outcome of schizophrenia, but few studies have compared older out-patients to normal subjects. We sought to examine the relationship of age to clinical features, psychopathology, movement abnormalities, quality of well-being, and everyday functioning in schizophrenia out-patients and normal comparison subjects, and to further characterize these outcomes in elderly schizophrenia out-patients. Method: A total of 290 out-patients and 144 comparison subjects, aged 40–85 years, underwent comprehensive assessments. Results: Among patients, aging was associated with decreased psychopathology, even after controlling for duration of illness. There was no accelerated aging-related decline on any measure in the patients. Yet, elderly patients were more impaired than comparison subjects on various measures. Conclusion: The course of schizophrenia in late life appears stable, but most elderly patients remain symptomatic and impaired. Our findings dispute notions of either progressive deterioration or marked improvement in aging schizophrenia out-patients. [ABSTRACT FROM AUTHOR]

Background Wound healing is a complex process, which requires adequate energy sources, proteins, and specific minerals and vitamins. If an individual is unable to get or to eat the nutrients required, the wound healing process might be disrupted. The aim of this study was to investigate food-related factors, meal patterns and meal quality in relation to nutritional status in elderly out-patients with leg ulcers. Methods Nutritional status was assessed by use of the Mini Nutritional Assessment in 70 patients living in their own homes. Fifty-six of the patients recorded actual meals and snacks over four consecutive days. Meal patterns and meal quality were evaluated with the help of a qualitative classification system, the Food Based Concept for Classification of Eating Episodes. Results Thirty-six patients were classified as well-nourished, 32 were at risk of malnutrition and two were malnourished. More patients in the risk group for malnutrition did not buy their own food, and usually ate alone. Incomplete Meals and Low Quality Snacks were the most common eating types. The patients at risk of malnutrition had significantly fewer prepared Complete Meals than the well-nourished patients. Conclusion The results show a diet and meal quality which hardly meets the requirements for nutrients that are important in wound healing, especially for those patients assessed at risk of malnutrition. [ABSTRACT FROM AUTHOR]