Search

This study aimed to describe the impact of living with a cluster B personality disorder in an acute phase on social participation. A descriptive cross-sectional design was used. During their first week in a day hospital or inpatient admission, 31 participants completed the Assessment of Life Habits, examining the quality of social participation in 77 daily activities and social roles (life habits). The participants presented significantly more difficulties and dissatisfaction in realizing social roles than daily activities. Areas of life perceived to be the most problematic to accomplish were leisure, school, and work. Interpersonal relationships and fitness were the least satisfying. Personal care was the least disrupted and most satisfying life habit. Life habits that could be prioritized in psychiatric rehabilitation interventions with people with cluster B personality disorders included leisure activities, work and school, fitness, and interpersonal relationships. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the impact of a coordination-type integrated service delivery (ISD) model on health, satisfaction, empowerment, and services utilization of frail older people. METHODS: Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is a population-based, quasi-experimental study with three experimental and three comparison areas. From a random selection of people 75 years or older, 1,501 persons identified at risk of functional decline were recruited (728 experimental and 773 comparison). Participants were measured over 4 years for disabilities (Functional Autonomy Measurement System), unmet needs, satisfaction with services, and empowerment. Information on utilization of health and social services was collected by bimonthly telephone questionnaires. RESULTS: Over the last 2 years (when the implementation rate was over 70%), there were 62 fewer cases of functional decline per 1,000 individuals in the experimental group. In the fourth year of the study, the annual incidence of functional decline was lower by 137 cases per 1,000 in the experimental group, whereas the prevalence of unmet needs in the comparison region was nearly double the prevalence observed in the experimental region. Satisfaction and empowerment were significantly higher in the experimental group. For health services utilization, a lower number of visits to emergency rooms and hospitalizations than expected was observed in the experimental cohort. CONCLUSION: The PRISMA model improves the efficacy of the health care system for frail older people. [ABSTRACT FROM AUTHOR]

PRISMA is the only example of a co-ordinated-type model to be developed and fully implemented with a process and outcome evaluation. The PRISMA model was implemented in three areas (urban, rural with or without a local hospital) in Quebec, Canada and an implementation evaluation was carried out using mixed (qualitative and quantitative) methods. Over four years, the implementation rates went from 22% to 79%. The perception of integration by managers and clinicians working in the various organisations of the network shows that most interactions are perceived as at the co-operation level, some getting the highest collaboration level. The perception of the efficacy of case managers was very high. Implementing such a model is feasible, and the decision to generalise it was made in Quebec. This model might be more appropriate for a universal publicly funded health care system like those in Canada, the UK and the Scandinavian countries. [ABSTRACT FROM AUTHOR]

Purpose.The purpose of this study is to investigate rehabilitation through teletreatment as an alternative to a physical home-care visit to deliver services to individuals at home following discharge from an acute hospital or rehabilitation unit.Method.Four community-living elderly people were recruited for telerehabilitation services prior being discharged from an acute-care hospital and a geriatric rehabilitation unit. Once the patient returned home, an appointment was made for the assessing therapist to take the clinical measurements (T1) in a face-to-face session. Four clinical variables were used (functional autonomy, balance, locomotor performance in walking and lower-body strength). Telerehabilitation sessions with the participants were conducted with trained personnel in the individual's home. The system used to support telerehabilitation services for this proof of concept was built around network-attached remotely-controlled pan/tilt/zoom cameras with MJPEG compression, media displays and hands-free phones. Before the patient was discharged from the physiotherapy program, the same assessing therapist visited the subject again to take the T2 measurements in a face-to-face session. The satisfaction of the health-care professional was determined for each session with the homemade questionnaire. Costs related to telerehabilitation were compared to theoretically home visits.Results.All four subjects improved on the four clinical variables. Mean costs for the telerehabilitation program, comprising 12 sessions over 4 weeks was $487.Conclusion.Telerehabilitation seems to be a practical alternative for dispensing rehabilitation services after patients are discharged from an acute hospital or rehabilitation unit. [ABSTRACT FROM AUTHOR]

This study analyzes how social support is actualized by comparing 61 welfare recipients with a sample of 21 individuals above the poverty level in the area of St-Henri and Pointe Saint-Charles and by taking into account the level of psychological distress. A second goal is to document how an adversity experienced by a welfare recipient, with or without distress, breaks or change the support network. Results show that individuals with high distress have a less reliable network than those without, that they more often report a refusal of support or are let down and that they have more negative ties in their network. Besides, experienced events are more likely to attack their reputation, represent a threat, a betrayal or prevent access to a right. These individuals are also more likely to be isolated. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about the cost of home-based rehabilitation programs in Quebec, Canada. The objective of this pilot project was to test a cost estimation methodology in the context of rehabilitation services delivered at home and to provide preliminary data on the costs for lower limb orthopedic surgery patients. This pilot study examined a short-term home care program for adults, aged 65 and over who returned home after lower limb surgery and required rehabilitation services. Efficacy was determined as the functional autonomy changes between admission and discharge from home rehabilitation program, as measured by the functional autonomy measurement system (SMAF). Costs of professionals, including direct and indirect time related to the intervention, were also determined in order to document cost-effectiveness of the program. Eighteen subjects were recruited. From those, 14 had complete data available for the analysis. The result shows that costs related to the combined natural improvement and the effect of the home-based rehabilitation program were CAN$ 419 per unit of change of functional autonomy. The results of this pilot study confirm the feasibility of the cost estimation methodology for a home-based rehabilitation program. [Copyright &y& Elsevier]

Purpose. The objective was to estimate the psychometric properties of the Modified--Modified Schober Test (MMST).Design. This study compared range of motion measurements of lumbar flexion in low back pain (LBP) patients using the MMST with measurements calculated on X-rays as the gold standard, and compared the measurements taken by two independent examiners.Method. This study was conducted at the main hospital in the Outaouais area, Quebéc, Canada. Thirty-one subjects with LBP from private and public clinics participated in the study. After a warm-up session, measurements with the MMST were taken in neutral position and an X-ray technician took an exposure in the same position.Results. Pearson's correlation test (r) between measurements made with the MMST and the gold standard, intra-class correlation coefficient (ICC), minimum metrically detectable change (MMDC) and confidence interval (CI) were used to analyze the data. The MMST demonstrated moderate validity (r=0.67; 95%CI 0.44-0.84), excellent reliability (intra: ICC=0.95; 95%CI 0.89-0.97; inter: ICC=0.91; 95%CI 0.83-0.96) and a MMDC of 1cm.Conclusions. In our sample of LBP patients, the MMST showed moderate validity but excellent reliability and MMDC. [ABSTRACT FROM AUTHOR]

Benzodiazepine (BZD) drug use among seniors is an important public health issue because the benefit from their use is moderate and of short duration and numerous adverse events have been linked to their use. Furthermore, there is a significant discrepancy between the prevalence of mental health disorders and BZD drug use in the elderly population, which can be attributed to a measurement issue. The goal of this cross-sectional descriptive study was to determine the prevalence of mental health disorders among seniors using BZD and living in the community, basing this information on both a thorough face-to-face interview and a pair of self-reported validated instruments. Among the 216 seniors recruited in our study, nearly 20% were users of BZD and over three quarters of them had been using this drug for more than a year. Thirteen subjects were recognized as depressed according to a self-report measure compared to 18 according to the interview. Likewise, 13 seniors were categorized as anxious, based on a self-report questionnaire compared to 39 based on the interview. Among self-reported measures of mental health variables, logistic regression indicated that insomnia increases by 7 the likelihood of using BZD (odds ratio: 7.2) and is the only statistically significant variable associated with BZD consumption. Based on thorough interviews, logistic regression showed that insomnia (odds ratio: 6.9) is still the dominant symptom associated with BZD drugs. In conclusion, our results clearly support the assertion that mental health status is influenced according to how it is measured. Finally, nurses should be aware that not all individuals are capable of expressing their mental health problems using either psychological or emotional terminologies. They may opt for expressing their psychological suffering as a physical symptom such as sleeping problems. [ABSTRACT FROM AUTHOR]

The dramatic global impact of tuberculosis on mortality has been well documented, but its impact on morbidity has not been well described. The emphasis on treatment of latent tuberculosis (TB) infection highlights the tradeoff between short-term decrements in health status from 'preventive' therapy, and long-term gains related to fewer cases of active TB. However, these changes in health status have not been characterized. As a first step, we examined the feasibility and reliability of administering two health status questionnaires, in a multicultural TB clinic setting. The Medical Outcomes Study SF-36 and the EuroQOL EQ-5D were self-administered during 3 weekly interviews. One hundred and eighty-six potentially eligible patients were identified, of whom 112 could be evaluated; 106 (57%) were confirmed eligible. Sixty-seven (63%) agreed to participate; 24 (36%) were women. Fifty-three participants (79%) were foreign-born, with median residence in Canada of 3.5 years. Fifty (75%) of the participants completed all study measurements: 25 were treated for latent TB, 17 for active TB, and eight had previous active TB. Cronbach's alpha coefficients ranged from 0.73 to 0.94 for the SF-36 domain scores. Intraclass correlation coefficients were 0.66 for the SF-36 physical component summary, 0.79 for the mental component summary, and 0.73 for the EQ-5D. These instruments appeared reliable in a highly selected group of TB patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Electronic Digital Inclinometer (EDI-320) devices. METHODS. This study compared the range of motion measurements of low back pain (LBP) patients taken with the BROM II and EDI-320 with measurements using the double inclinometer (DI) method as the gold standard. Forty subjects with LBP volunteered for the study. The subjects were asked to do three forward flexion movements. A measurement was taken with each of the three different devices for each movement.Results: The BROM II demonstrated good linear relationship (Pearson r = 0.78; 95% CI: 0.78-0.94) and the EDI-320 very good linear relationship (Pearson r = 0.88; 95% CI: 0.62-0.89) with the gold standard, the DI.Conclusions: The Pearson correlation value indicates good validity of the EDI-320 in our sample of LBP patients. Although a good correlation was established for the BROM II, the significant difference of the mean ROM reported for this instrument compared to the gold standard data suggests that the BROM II actually measures ROM differently. Our results suggest that the EDI 320 is clinically useful in providing objective and valid data for outcome measures in a population with LBP. More research is needed on the BROM II before we can make final conclusion on its use in clinical settings as an outcome measure. [ABSTRACT FROM AUTHOR]

Describes a key informant survey done in Ecuador that shows that the rate of suicide in a rural area of the Andes is much higher than what is usually reported for regions with similar characteristics. Discusses the usually low rates of suicides in Third World countries' official records; Reasons for these low rates; Marital and family conflicts; Discussion and conclusion.

The article focuses on the effects of migration on the mental health of an individual and the prevention of bad effects thereof. It mentions that migration is one of the radical changes in a person's life. It adds that political and war refugees are the types of migrants most vulnerable to mental health problems as those people are forced to flee to seek security and oftentimes their families are broken. Moreover, it mentions that migration can be most difficult in specific portion of one's life particularly during adolescents and old age. It cites schools as the primary agent of socialization and is therefore can address the mental problems that may be brought by migration.

Murphy H B M [Department of Psychiatry, McGill University, Montreal, Canada], Negrete J C and Tousignant M. Exploring a new type of alcoholism survey. International Journal of Epidemiology 1979, 8: 119-126. A new type of method for surveying alcoholism and alcohol-abuse was tested in a way designed to cover about 20%of adults in a town of 50 000. The method proved able to identify types of alcohol-abuser which other survey techniques have difficulty with; it made no undue demands on respondents; and it is much more economical than conventional household surveys. However, more work is still needed on it, and for certain types of information the customary self-report is still going to be required. [ABSTRACT FROM PUBLISHER]

In highland Ecuador, pena refers to a state of mind characterized by a mixture of sadness and anxiety as well as to an illness state resembling depression. This paper attempts to illustrate, through an analysis of the discourse on pena, how the ideology in which it is embedded serves to interpret a bodily problem at the same time as it reflects a more global attitude toward life. In essence, the folk theory states that the physical complaints caused by suffering are the result of a disturbance of the heart, the central organ of man, and of the emotional life which it controls. Because this suffering is often attributed to the immediate family group of the victim, the community at large often formulates accusations against one of its members. Though the therapy is limited to a cure of the symptoms through herbal remedies, a formal request can be made to a perceived wrongdoer to amend his behavior. The pena is also a state which can lead to colerin, a dangerous and sometimes lethal illness which is characterized by a sudden explosion of anger or madness and which will follow an unattended state of pena. [ABSTRACT FROM AUTHOR]

Espanto or susto has been analysed from various points of view in the last fifteen years. From a survey covering 109 case analyses collected in Nicolas Ruiz (Chiapas, Mexico), we reached the conclusion that this folk illness cannot be conceived of as a syndrome in the medical sense. A semiological analysis showed that espanto can be better described as an indigenous theory whose function is to relate illness events to other levels of reality. According to indigenous belief, the Holy Earth and the chtonian spirits of the underworld play an important role in the origin of the illness. This origin is associated with an opening of the earth as is illustrated in the earthquakes or the volcanic eruptions forming the prototype of a fright experience leading to espanto; or, it is attributed to agents who inhabit locations where the earth presents a fissure (river, ravine, cave). It is through these holes that the Holy Earth exerts her power. Concomitantly, the body of the victim is believed to open itself to the influences of the bad winds of espanto. Trembling is another aspect of the phenomenon which is observed at numerous levels: first, during the fright experience; second, when the victim falls ill (chills jumping in bed); and third, when the curandera takes the pulse of the patient to see if the blood is afraid. These multiple analogies lead to the assumption that there is a meaning shared by these separate manifestations. [ABSTRACT FROM AUTHOR]

Verifies evidence that a genetic component may increase the predisposition to suicide and that deficiencies of the serotonin system play a significant role. Effort to replicate findings reported by Bondy and associates; Investigation of a large sample of suicide completers.

Reports findings of a research which assessed differences in the correlates of suicidal ideation in early adolescence as reported by children and their parents. INSET: COMMENTARY, by Mitchell J. Prinstein and Matthew K. Nock..

Objective: This study presents the results of a psychiatric epidemiological survey using a sample of adolescents from refugee families.Method: The sample included 203 adolescents, aged 13 to 19 years, coming from 35 countries. Psychopathology was assessed with the Diagnostic Interview Schedule for Children Version 2.25 and general functioning with the Children's Global Assessment Scale (CGAS).Results: The total rate of psychopathology excluding simple phobia was 21% compared with 11% in a province-wide survey of young adolescents. Overanxious disorder had a high prevalence of 13%. The rates of major depression and conduct disorders were also high, at 5% and 6%. The rate of 3% of attempted suicide was similar to the rate found in Montreal high schools. Girls had a higher rate of psychopathology than boys, with a gender ratio similar to the one found in the provincial survey. Father's long-term unemployment in the first year of settlement was associated with psychopathology for the whole sample, and family structure was associated with psychopathology for boys only.Conclusions: The high rate of psychopathology in this group confirmed results from other surveys with similar samples. On the other hand, the CGAS scores indicated that many of the adolescents with a diagnosis had good social adaptation. [ABSTRACT FROM AUTHOR]

Telehealth is defined as the use of information and communication technologies (ICT) to extend health care service delivery across distance. Remote vital sign monitoring is a common example for home telehealth and one promising market, but lacks the breadth, comforting and subtleties of face-to-face assessments usually done by having either the patient go to the clinic or the clinician going to see the patient at home. To conduct more lively and interactive sessions, virtual visits involve the use of video and audio for live and remote consultations between clinicians and patients [1] . These consultations are done through fixed workstations or mobile devices using web videoconferencing systems, which may not always be sufficient to the practice of clinicians [2] . Objectives To provide flexibility to the interactions that would normally take place in face-to-face consultations, we are developing a multi-point, multi-view and multi-data (video, audio, medical devices) videoconferencing system, called VIGIL, to conduct live sessions between health caregivers (e.g., physiotherapists, occupational therapists, doctors, nurses) and patients at home. Methods Like Skype and OmniJoin/Nefsis, VIGIL is a cloud-based videoconferencing system working on mobile devices, laptops and workstations. VIGIL has customized and simple interfaces to improve usability for specific telehealth needs. For instance, it can transmit images from one or multiple cameras, control pan-tilt-zoom (PTZ) cameras from a distance, and interface a mobile communication badge and a mobile PTZ camera for interaction away from the workstation. It can also receive data from wireless medical devices. Results VIGIL is currently hosted at Sherbrooke Techno-Centre and exploited in trials are underway at the Centre de réadaptation de l’Estrie. Discussion Technologically, it is possible to provide a diversity of interaction modalities in support of telehealth practice. It is now more a matter of finding out what is necessary to address those needs. [ABSTRACT FROM AUTHOR]