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Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-item GAP-REACH checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article.

The language of rights is alien to the Indian culture. Often thought of as synonymous, India and Hinduism are not. Although there slightly over 80% of the people of India are Hindus, remaining over half Muslims and the rest comprise of Christians, Sikhs, Jains, Buddhists etc. Even this, the 80% are not homogenous. Over a quarter of these are so called tribal and the untouchables, not quite within the fold of mainstream Hinduism. Even of the remaining a sizable number are designated “other backward castes”, a label derived from their socioeconomic status, and practice a heterodox religion.

The Hindu civilization has been a continuous tradition for at least the last 3,500 years, and it has also always been in transition. The Indians think of their tradition as a stream, pranalika, flowing at various speeds and changing with gradients, adapting to local conditions. Tradition changes slowly and sometimes looks outside , perhaps to other traditions to make a major shift. When a tradition changes substantially substantially it invariably generates conflicts. Human vulnerabilities emerge along the fault lines, the soft belly, of a culture, especially psychological vulnerabilities. Bioethics has to keep pace with a tradition that is in transition and assist in addressing the conflicts that are generated.

Psychiatric beds in public hospitals have decreased 80% since 1955, but admissions have risen correspondingly, largely because of high recidivism rates. Decreases in numbers of beds have been partly achieved by shortening the length of stay, which lessened by half between 1970 and 1980. This study was undertaken to determine whether duration of hospital treatment affects the rate and rapidity of relapse among schizophrenic patients.Data on 1,500 patients from 10 state hospitals were gathered for 18 months after initial discharge. Predictor variables included age, sex, marital status, race, number of previous admissions, location of the facility, and length of stay. Data were analyzed by survival analysis with a Cox regression model for two times to initial relapse: 30 days and 18 months (outcome).Length of stay was significantly related to each time to relapse after the effects of number of previous admissions and age were partialed out. Facility location was not predictive, but intrahospital effects were tested by examining the data on the largest facility; again, length of stay significantly predicted relapse.Although the magnitude of the effect was small, the clinical significance of the findings is the greater likelihood that brief-stay patients will be rehospitalized within 30 days after discharge than will patients treated for longer periods. Brief hospitalization seems generally applicable to psychiatric populations, but there may be a small but important group of seriously mentally ill patients for whom other alternatives are possibly more appropriate and should be explored.

The VA health care system is the largest source of public mental health care in the country, providing specialty mental health care services to more than 550,000 veterans annually. This chapter reviews the nature and scope of VA psychiatric emergency services.

Objective The study examined whether length of hospital stay is related to recidivism among psychiatric patients. A quasi-experimental approach was used to address limitations of controlled and epidemiological research. Methods Three matched groups, each consisting of 55 inpatients with schizophrenia, were selected from public psychiatric units with different mean lengths of stay. Regression models were used to compare the groups on three variables: time to first readmission (survival analysis), number of readmissions (ordinal logit regression), and total time in the community in the postdischarge year (multiple linear regression). Results An analysis based on the units with different lengths of stay, which was similar to that typically used in controlled studies, found no differences in the three outcome measures. However, a second analysis that examined data for all patients irrespective of their unit assignment found that inpatients treated for 30 days or less relapsed sooner than those with stays longer than 30 days. The disparity in results was largely due to overlapping quasi-experimental conditions: many patients on the short-stay units had a long lengths of stay, and vice versa. The first analysis supports an administrative policy of short stays. The second reinforces previous findings that a group of patients, primarily young males with onset of illness at an early age and multiple previous hospitalizations, is at greater risk of relapse with short-term treatment. Conclusions The apparent contradiction between a unit- or patient-based analysis suggests that unit-based results should be interpreted with caution when used to make clinical or utilization review decisions.

Previous studies have shown that bone mass is significantly decreased in chronic alcoholic white patients, especially those with evidence of liver involvement. However, liver disease is an independent risk factor for bone loss. In vitro studies have shown that alcohol has a direct effect on osteoblasts. The effects of chronic alcohol consumption on bone mass in the absence of liver disease are not known. In addition, the effect of alcohol on bone in black alcoholic subjects has not been examined previously. In the present study, we evaluated the effects of prolonged heavy alcohol intake on bone mass in both black (n = 21) and white (n = 19) male subjects without significant liver disease. Bone mineral density (BMD) of the lumbar spine and hip and various markers of bone metabolism in alcoholic subjects were compared with those in respective age-matched controls (n = 16 blacks and 14 whites). Mean values for BMD of the lumbar spine, total hip, and femoral neck were not significantly different between alcoholic subjects and their respective controls among either blacks or whites. In white subjects, age and duration of alcohol were noted to have significant independent effects on BMD, whereas in blacks, age was the only factor that significantly affected bone mass independently. In the absence of liver disease, prolonged heavy alcohol intake results in bone loss in white subjects. The skeleton of black subjects may be less affected by alcohol.

It has been two years since the publication of Volume One of the Bioethics Yearbook, a short time in the life of an ancient civilization. Except for specific developments on several issues that will be reported in Section II of this essay, only a modest amount of reflection in bioethics has transpired since 1990 in Hindu thought or in Indian medical practice. Yet the same two years have been a long time in the life of a people in cultural transition. India has been torn by interreligious and communal strife which, although not new, has recently increased dramatically in ferocity and intensity. Strife between the Hindu and Muslim communities has engulfed most of India, and places that previously had been known for their inter-faith amity have been engulfed in flames.

There has hardly been a time in Indian history when the Indian tradition has not been in transition, except perhaps at the very beginning of Indian civilization. In coming face to face with the West, India may appear to be a culture wrapped in its past, possessed by religion, and aglow in its mystical tradition. But India speaks in many voices, and this polyphony makes it difficult to articulate a singular judgment. An evocative metaphor often employed to capture the spirit of the tradition is that of a palimpsest, an ancient parchment upon which generation after generation inscribe their messages layer upon layer, and yet no succeeding layer completely erases or hides what was previously written ([56], p. 59).

Medical ethics in the Indian context is closely related to indigenous classical and folk traditions. This article traces the history of Indian conceptions of ethics and medicine, with an emphasis on the Hindu tradition. Classical Ayurvedic texts including Carakasamhita and Susrutasamhita provide foundational assumptions about the body, the self, and gunas, which provide the underpinnings for the ethical system. Karma, the notion that every action has consequences, provides a foundation for medical morality. Conception, prolongation of one's blood-line is an important ethical aim of life. Thus a wide range of practices to further conception are acceptable. Abortion is a more complex matter ethically. At the end of life death is viewed in the context of passage to another life. Death is a relief from suffering to be coped with by the thought of an eternal atman or rebirth.

Homelessness among mental patients is frequently associated with deinstitutionalization. In a study to clarify the relationship between homelessness and psychiatric hospitalization, data from Illinois statistical reports and from admission reports of a state hospital that serves about 75 percent of the undomiciled mentally ill population in Chicago were analyzed. The rate of homelessness had increased substantially among psychiatric admissions over the last decade and was even higher among applicants for hospitalization. The homeless had lower admission rates than the domiciled, largely because of differing paths of referral. Nearly 20 percent of the homeless left the hospital against advice, and relatively few were referred to licensed long-term-care facilities. Until various systems develop adequate responses to the problem, both the numbers and the visibility of the homeless mentally ill are likely to increase.

In an exploration of residential instability and recidivism in chronic mental patients, 215 psychiatric admissions were followed for a year after the initial episode. In addition to an unusually high incidence of residential mobility, a relationship between mobility and number of hospitalizations was evident, as were isolation, disruptive family situations, and homelessness. The needed response of the mental health system is discussed.