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This study aims to investigate the attitudes and opinions that are present among patients and health professionals toward addressing patients' alcohol use during a hospital stay. We conducted semi-structured interviews with nine health professionals and five patients to explore their opinions and attitudes toward asking and being asked about alcohol during a hospital stay. The data were analyzed using an ad hoc method consisting of primarily close reading and meaning condensing. The main barriers about alcohol as a topic in healthcare lie with health professionals. While patients have reservations and preferences regarding when and how they are asked about alcohol, they all consider knowledge about alcohol habits as important for the health professional to have. The study's results suggest that actions to better preventive efforts regarding inexpedient alcohol use should mainly focus on breaking barriers hindering the health professionals in asking their patients. This can be done by focusing on education for the health professionals on this topic and developing tangible guidelines for when and how to ask patients for the health professionals to depend on. [ABSTRACT FROM AUTHOR]

Many health-care systems use provider payment as an instrument to ensure an efficient and equitable delivery of care. Capitation-based payment schemes are popular because they contain costs. However, they are known to lead to underprovision of care, especially to high-need patients. Using a laboratory experiment, we test whether the availability of resources affects providers' response to a capitation-based scheme. We find that the relative underprovision of care to high-need patients exists both when providers are resource abundant and constrained. Next, we introduce two different versions of the scheme and test whether they incentivize providers to take better care of high-need patients. One scheme ring-fences part of the capitation payment to a fixed physician salary, whilst the other scheme differentiates payments based on patients' expected need of care. We find that high-need patients gain the most from a fixed provider salary under resource abundance, but find no difference in gains between patient types under resource constraint. Our results also show that differentiation of capitation makes providers take relatively better care of patients linked to an above average payment compared to a below average payment, regardless of resource constraints. Our findings suggest that both the design of the scheme and the market condition affect providers' patient prioritization under capitation. [ABSTRACT FROM AUTHOR]

Background: Continuity of mental health care is central to improve the conditions of people with enduring mental disorders. In Denmark, several government-funded projects on the improvement of continuity of mental health care have been initiated since 2009. Aim: The aim of this study was to investigate how national intervention projects on continuity of mental health care have addressed major barriers for continuity of care and extract general learning points from the projects on the improvement of continuity of care. Method: The study was designed as a thematic document analysis of external evaluations of 14 major national projects on the improvement of continuity of routine mental health care from 2009 to 2017. The data material was processed through thematic coding and comparative analysis. Results: The analysis was organized around four main barriers for continuity: Lack of models for collaboration, different professional cultures and methods, lack of channels of communication, and intersectoral differences in management, economy, and legislation. The first three barriers were addressed in a predominant part of the projects through development of collaborative models, common tools and communication systems. The latter structural barrier was not addressed in any of the projects. Conclusion: There is an ongoing need to address barriers for continuity of mental health care. So far, there has been a much larger focus on organizational, cultural and communicational aspects of continuity than on structural aspects. The study calls for an increased focus on how changes in existing managerial, economic and legislative structures can improve continuity of care. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe a graphic-mode communication intervention involving a girl with intellectual impairment and autism who did not develop comprehension of spoken language. The aim was to teach graphic-mode vocabulary that reflected her interests, preferences, and the activities and routines of her daily life, by providing sufficient cues to the meanings of the graphic representations so that she would not need to comprehend spoken instructions. METHOD: An individual case study design was selected, including the use of written records, participant observation, and registration of the girl's graphic vocabulary and use of graphic signs and other communicative expressions. RESULTS: While the girl's comprehension (and hence use) of spoken language remained lacking over a 3-year period, she acquired an active use of over 80 photographs and pictograms. CONCLUSIONS: The girl was able to cope better with the cognitive and attentional requirements of graphic communication than those of spoken language and manual signs, which had been focused in earlier interventions. Her achievements demonstrate that it is possible for communication-impaired children to learn to use an augmentative and alternative communication system without speech comprehension, provided the intervention utilizes functional strategies and non-language cues to the meaning of the graphic representations that are taught. [ABSTRACT FROM AUTHOR]

Objective: Myofascial pain syndromes associated with trigger points [TrPs] are an established clinical entity but the structural and functional abnormalities of TrPs are not well understood. The aim of the study was to conduct a blinded electromyographic investigation of TrPs.Methods: Nineteen young subjects with chronic shoulder and arm pain, who had a TrP [i.e., a tender point with referred pain, producing at least some of the pain complaint] in the infraspinatus muscle, were examined. This point and a nontender control point in the same muscle were code-marked, in order to blind the examiner. Around both points 20 concentric needle electromyographic [EMG] recordings were obtained at rest.Results: More subjects had spontaneous EMG activity at the TrPs than at the control point. The EMG activity was interpreted as end-plate noise or spikes or both. The TrP Root Mean Square amplitudes were significantly higher than at the control points.Conclusion: Our investigation has demonstrated the presence of spontaneous EMG activity in myofascial TrPs, probably reflecting end-plate activity. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the clinical and pathogenic significance of vitamin D metabolites in primary Sjögren's syndrome (primary SS). We measured blood concentrations of 25-hydroxyvitamin D (25 OH D) and calcitriol (1,25(OH)2D)vc in 41 patients and correlated the results with blood levels of various immune activation products, as well as with patients' clinical status. Levels of 25 OH D were slightly decreased as compared to normal controls and the reduced levels of 25 OH D were stable over the observed period of 2 years. Levels of 25 OH D correlated inversely with levels of soluble interleukin-2 receptor, status indices for global disease, total exocrine disease, surface exocrine disease, internal organ exocrine disease, and mediator-induced disease. Levels of 1,25(OH)2D varied considerably and compared to normal control values. Levels of 1,25(OH)2D did not correlate with clinical/immunopathological status. In conclusion the inverse correlations found between levels of 25 OH D and measures of clinical and immunoinflammatory status support the notion that vitamin D metabolism may be involved in the pathogenesis of primary SS. [ABSTRACT FROM AUTHOR]