WorldWideScience

Sample records for mental hospital reform

  1. Mental Hospitals in India: Reforms for the future.

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    Daund, Muktesh; Sonavane, Sushma; Shrivastava, Amresh; Desousa, Avinash; Kumawat, Sanjay

    2018-02-01

    Mental hospitals are an integral part of mental health services in India. It is an interesting story how mental hospitals have responded to the challenges of contemporary period they were built in. It is beyond doubt that it is a progressive journey along with advances in mental health both in India and internationally. As in other countries, mental hospitals in India have responded to the social challenges, disparities, and poor resources of workforce and fiscal investment. Historically, there have been changes and three major reforms are needed, namely attempt to facilitate discharge and placing patients back into the family, introducing teaching and research in mental hospitals, and accountability to civil rights as per the requirements of the National Human Rights Commission. In this review, we explore the brief history of mental hospitals in India and examine the reforms in the clinical, administrative, and psychosocial areas of these hospitals and progress in teaching and research. We finally summarize and conclude the necessity and the relevance of mental hospitals in India akin to modern psychiatric practice. We believe that mental hospitals have an important and perhaps a central role in mental health services in India. Its modernization to address issues of long-term stay, burden on caregivers, stigma, research and teaching including undergraduate and postgraduate training, new curriculum, and training for nonpsychiatric professionals and primary care physicians are necessary components of the role of mental hospitals and responsibilities of both government and nongovernmental sectors. Last but not the least, it is obligatory for mental hospitals to ensure that evidence-based treatments are implemented and that the standard of care and respect of civil and human rights of the patients and families are provided while involving the people's participation in its functioning.

  2. Hospital Acquisitions Before Healthcare Reform.

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    McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun

    2015-01-01

    The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

  3. Mental health reforms in Eastern Europe.

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    Tomov, T

    2001-01-01

    To describe the background in general culture, public and professional discourse against which mental health care reform initiatives in Eastern Europe need to be seen. An account of some key aspects of sociopolitical and cultural transition in Eastern European countries is given, and core results of a research project on attitudes and needs assessment in psychiatry in six Eastern European countries are reported. In post-totalitarian cultures mental health reforms impinge on imagination in ways which are not easy to predict. Some of the reasons for this are traced to the psychiatric practices under the system of total control, e.g. dispensary care, political abuse, reification of classificatory terms. Data on a study of attitudes suggest that institutions had replaced community life in those parts of Europe. It is predicted that with time trust in the capacity of community to contain mental illness will be regained.

  4. Elling (2001. The Reform of Psychiatric Care from the Point of View of the Mental Patient. A ComparativeAnalysis with Testimony from the Old Psychiatric Hospital of Navarre

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    Francisco Javier DE PRADA PÉREZ

    2017-03-01

    Full Text Available Psychiatric care was reformed in Spain well into the 1980s, later than the rest of the countries in its milieu. In practice, it meant the closure and restructuring of the obsolete insane asylums and hospices, on the one hand in order to consider mental health as one aspect of an overall concept of health, and, on the other, to permit the assimilation into society of many of the individuals who had previously been committed to psychiatric hospitals owing to their illness. This reform, the objective of which was the closure of insane asylums, as they were known generally in society, gave rise to a profound transformation in the life of the patients who had been institutionalized for many years and were now obliged to adapt to new ways of living with others. The Norwegian film Elling deals with this process in the case of its two protagonists, who leave a psychiatric institution to move to a house in the city centre and try to live more autonomously with the help of minimal supervision.

  5. The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform.

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    Tjerbo, Trond

    2009-11-20

    The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT), which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did not necessarily facilitate reforms in the hospital structure

  6. The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform

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    Tjerbo Trond

    2009-11-01

    Full Text Available Abstract Background The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. Method The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT, which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. Results The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Conclusion Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did

  7. Implementing a Nation-Wide Mental Health Care Reform: An Analysis of Stakeholders' Priorities.

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    Lorant, Vincent; Grard, Adeline; Nicaise, Pablo

    2016-04-01

    Belgium has recently reformed its mental health care delivery system with the goals to strengthen the community-based supply of care, care integration, and the social rehabilitation of users and to reduce the resort to hospitals. We assessed whether these different reform goals were endorsed by stakeholders. One-hundred and twenty-two stakeholders ranked, online, eighteen goals of the reform according to their priorities. Stakeholders supported the goals of social rehabilitation of users and community care but were reluctant to reduce the resort to hospitals. Stakeholders were averse to changes in treatment processes, particularly in relation to the reduction of the resort to hospitals and mechanisms for more care integration. Goals heterogeneity and discrepancies between stakeholders' perspectives and policy priorities are likely to produce an uneven implementation of the reform process and, hence, reduce its capacity to achieve the social rehabilitation of users.

  8. The Impact of Mental Health Reform on Mental Illness Stigmas in Israel.

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    Ben Natan, Merav; Drori, Tal; Hochman, Ohad

    2017-12-01

    This study examined public perception of stigmas relating to mental illness six months after a reform, which integrated mental health care into primary care in Israel. The results reveal that the public feels uncomfortable seeking referral to mental health services through the public health system, with Arab Israelis and men expressing lower levels of comfort than did Jewish Israelis. The current reform has not solved the issue of public stigma regarding mental health care. The study suggests that the current reforms must be accompanied over time with appropriate public education regarding mental illness. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Business as usual--at the state mental hospital.

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    Fowlkes, M R

    1975-02-01

    Despite official policy and professional emphasis to the contrary, the custodial mental hospital continues to exist as a major form of state-provided mental health care. In this paper, one such institution, "New England State Hospital", is described, and the various features of hospital organization that sustain a system of custodial care are discussed. Although the custodial hospital offers little to its patients, its persistent survival can be explained by the number of non-patient vested interests that are well served by the state hospital, precisely in its existing custodial form. The case study of New England State Hospital suggests that reform of state mental institutions depends less on a programmatic formulation of desired changes than on an understanding of the structured resistance to such changes.

  10. Using accountability for mental health to drive reform.

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    Rosenberg, Sebastian P; Hickie, Ian B; McGorry, Patrick D; Salvador-Carulla, Luis; Burns, Jane; Christensen, Helen; Mendoza, John; Rosen, Alan; Russell, Lesley M; Sinclair, Sally

    2015-10-19

    Greatly enhanced accountability can drive mental health reform. As extant approaches are ineffective, we propose a new approach. Australia spends around $7.6 billion on mental health services annually, but is anybody getting better? Effective accountability for mental health can reduce variation in care and increase effective service provision. Despite 20 years of rhetoric, Australia's approach to accountability in mental health is overly focused on fulfilling governmental reporting requirements rather than using data to drive reform. The existing system is both fragmented and outcome blind. Australia has failed to develop useful local and regional approaches to benchmarking in mental health. New approaches must address this gap and better reflect the experience of care felt by consumers and carers, as well as by service providers. There are important social priorities in mental health that must be assessed. We provide a brief overview of the existing system and propose a new, modest but achievable set of indicators by which to monitor the progress of national mental health reform. These indicators should form part of a new, system-wide process of continuous quality improvement in mental health care and suicide prevention.

  11. Stigma as a Structural Power in Mental Health Care Reform: An Ethnographic Study Among Mental Health Care Professionals in Belgium.

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    Sercu, Charlotte; Bracke, Piet

    2016-12-01

    The growing interest among scholars and professionals in mental health stigma is closely related to different mental health care reforms. This article explores professionals' perceptions of the dehospitalization movement in the Belgian context, paying particular attention to the meaning of stigma. Combined participant observation and semi-structured interviews were used to both assess and contextualize the perceptions of 43 professionals. The findings suggest that stigma may function as a structural barrier to professionals' positive evaluation of de-hospitalization, depending on the framework they are working in. It is important to move beyond a unilateral understanding of the relationship between stigma and de-hospitalization in order to attain constructive health care reform. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

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    Mauricio Toyama

    2017-09-01

    Full Text Available Background Mental, neurological, and substance (MNS use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru

  13. Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

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    Toyama, Mauricio; Castillo, Humberto; Galea, Jerome T.; Brandt, Lena R.; Mendoza, María; Herrera, Vanessa; Mitrani, Martha; Cutipé, Yuri; Cavero, Victoria; Diez-Canseco, Francisco; Miranda, J. Jaime

    2017-01-01

    Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a

  14. Opportunities in Reform: Bioethics and Mental Health Ethics.

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    Williams, Arthur Robin

    2016-05-01

    Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. © 2015 John Wiley & Sons Ltd.

  15. Mental health care in general practice in the context of a system reform.

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    Magnée, T.

    2017-01-01

    The aim of this thesis was to monitor mental health care in Dutch general practices in recent years. In 2014, a reform of the Dutch mental health care system was introduced. Since this reform, general practitioners (GPs) are expected to only refer patients with a (suspected) psychiatric disorder or

  16. [The practice of the mental health in the general hospital].

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    Kuroki, Nobuo

    2012-01-01

    On December 2, 2011 a new reform bill concerning the Labor Safety and Hygiene law was presented to parliament. The bill states that all companies and businesses regardless of size are obliged to have all employees take a stress test once a year in addition to the regular health check. In September 2010 the employees fo Toho University Sakura Hospital were given this new stress. The test included categories for occupation and the various departments in the hospital. There were 40 employees found to test high for stress and to have depressive tendencies. We interviewed about 16 of these employees. One employee started to receive medicine to help reduce the stress and 4 employees received counseling only. The other 11 employees did not need to receive counseling or medicine. From April 2005 to September 2011, we conducted another study. The subjects this time were 92 employees of the hospital who have received treatment at other facilities for mental problems from occupational physicians. We categorized the subjects by sex, age occupation, length of time employed at the hospital, department and period of time from the onset of symptoms to the time they sought treatment. In this paper I will present my findings and suggestions for improving mental health care for employees of general hospital throughout Japan.

  17. The effects of hospital reforms on the management of public hospitals in Tanzania: Challenges and lessons learnt.

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    Shwekerela, Byera

    2014-01-01

    Although hospital reforms are being advocated internationally as part of a solution to hospital management problems in developing countries, studies have shown that they do give rise to some challenges. A study was undertaken that used in-depth interviews, focus group discussion and document review to examine hospital reforms. The article examines the effects of reforms on the management of Level II public hospitals in Tanzania and documents the related challenges and lessons Learnt. It is shown that hospital reforms have mixed effects in resource-strained hospitals, and that hospital reform actions may have replaced the bureaucratic inefficiencies associated with hospitals being managed from the central level (MoHSW) with the equally bureaucratic inefficiencies that characterize the management of these hospitals from a supposedly local level, the office of the Regional Administrative Secretary (RAS). Managing hospitals from this level seems to cause many hospital management problems to be left unattended.

  18. Outcomes of a Freedom of Choice Reform in Community Mental Health Day Center Services.

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    Eklund, Mona; Markström, Urban

    2015-11-01

    A freedom-of-choice reform within mental health day center services was evaluated. The reform aimed to (1) facilitate users' change between units and (2) increase the availability of service providers. Seventy-eight users responded to questionnaires about the reform, empowerment, social network, engagement and satisfaction and were followed-up after 15 months. Fifty-four percent knew about the reform. A majority stated the reform meant nothing to them; ~25 % had a negative and ~20 % a positive opinion. Satisfaction with the services had decreased after 15 months. Empowerment decreased for a more intensively followed subgroup. No positive consequences of the reform could thus be discerned.

  19. Is freedom (still) therapy? The 40th anniversary of the Italian mental health care reform.

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    Fioritti, A

    2018-01-16

    On 13 May 1978, the Italian Parliament approved Law 180, universally known as 'Basaglia Law' after the name of the leader of the anti-institutional movement which promoted this radical community mental health care reform. Forty years later, Italian psychiatry still runs a community care system, albeit with degrees of solidity and quality very varied along the peninsula. Mental health care is still an integral part of the National Health System, with liberal regulations on coercion and a lowest number of general hospital and residential facilities beds. Recently, Italy has also closed the special forensic psychiatric institutions and brought the care of the mentally ill offenders within the responsibilities of local Mental Health Departments. Over time, psychiatric deinstitutionalisation inspired policies in other sectors of Italian society, such as those regarding physical and intellectual disabilities, education of children with special needs, drug addictions and management of deviant minors. Furthermore, debate about Law 180 has reached and maintained an international dimension, becoming a term of reference for international agencies such as the World Health Organization and the European Commission, for good and for evil. The overall balance sheet of the Reform process would seem mostly positive, though the last decade has seen many threats challenging the system. Mental health care services have been asked to do much more, in terms of care to a larger population with very diversified needs, but with much less resources, due to the financial consequences of the economic crisis. Although there is no evidence of a trend towards re-institutionalisation, intensity and quality of care may have fallen below acceptable standards in some parts of Italy.

  20. Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health.

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    Weber, César Augusto Trinta; Juruena, Mario Francisco

    2016-07-01

    Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). Review of mental health legislation from 1990 to 2014. A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

  1. Caring for homeless persons with serious mental illness in general hospitals.

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    Bauer, Leah K; Baggett, Travis P; Stern, Theodore A; O'Connell, Jim J; Shtasel, Derri

    2013-01-01

    The care of homeless persons with serious mental illness remains a common and challenging problem in general hospital settings. This article aims to review data on homelessness and its psychiatric comorbidities, and to expand the skills of providers who encounter homeless individuals in general hospital settings. Literature review reveals patient, provider, and systems factors that contribute to suboptimal health outcomes in homeless individuals. Diagnostic rigor, integrated medical and psychiatric care, trauma-informed interventions, special considerations in capacity evaluations, and health care reform initiatives can improve the treatment of homeless persons with serious mental illness. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  2. The 2015 hospital treatment choice reform in Norway: Continuity or change?

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    Ringard, Ånen; Saunes, Ingrid Sperre; Sagan, Anna

    2016-04-01

    In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: "the treatment choice reform". This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  3. The Effects of Social Reforms on Mental Disability in China: Population-Based Study.

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    Wang, Zhenjie; Zhang, Lei; Li, Ning; Guo, Chao; Chen, Gong; Zheng, Xiaoying

    2016-04-01

    Few studies have explored how mental disabilities have changed with the waves of Chinese social reforms that occurred between 1912 and 2006. The present study evaluated population-based data from the Second China National Sample Survey on Disability to investigate these trends and their effects on mental disabilities. The Cox proportional hazards model was used to estimate the association between social reforms and mental disabilities. The confounding variables considered were as follows: survey age, gender, residence in 2006, ethnicity, and living arrangements in 2006. The highest risks of mental disabilities were observed in subjects born during the Mao Zedong era. Subjects who experienced social turbulence during their early development may have increased risks of mental disabilities in adulthood. The results and discussion herein contribute to our understanding of mental disabilities in China within the context of changing political, socioeconomic, and health system conditions and a developing mental health system. © 2016 APJPH.

  4. National Health and Hospital Reform Commission final report and patient-centred suggestions for reform.

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    Jowsey, Tanisha; Yen, Laurann; Wells, Robert; Leeder, Stephen

    2011-01-01

    The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants' recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination.

  5. Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles

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    Marie-Josée Fleury

    2017-03-01

    Full Text Available Introduction: This study evaluates implementation of the Quebec Mental Health Reform (2005–2015, which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. Methods: Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1 reform characteristics; 2 implementation context; 3 organizational characteristics; and 4 integration strategies. Results: While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. Conclusion: Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

  6. The need to evaluate public health reforms: Australian perinatal mental health initiatives.

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    Austin, Marie-Paule; Reilly, Nicole; Sullivan, Elizabeth

    2012-06-01

    To describe the Australian perinatal mental health reforms and explore ways of improving surveillance of maternal mental health morbidity and mortality in this context. We reviewed the Australian perinatal (defined as conception to one year postpartum) mental health reforms, in association with an appraisal of the population health methods that could be used for their evaluation. Despite the increasing focus of public health reforms on maternal mental health in the perinatal period, there is currently no national data available to evaluate these reforms or to provide an evidence base for improved health outcomes. National data development and linkage of relevant datasets would go a long way towards enabling such an endeavour. Inclusion of key mental health items in the Perinatal National Minimum Dataset and use of data linkage techniques will allow for monitoring of trends in maternal mental health morbidity and mortality in response to the Australian reforms. Once this is implemented, cost-benefit analyses can be undertaken. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  7. An analysis of policy levers used to implement mental health reform in Australia 1992-2012.

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    Grace, Francesca C; Meurk, Carla S; Head, Brian W; Hall, Wayne D; Carstensen, Georgia; Harris, Meredith G; Whiteford, Harvey A

    2015-10-24

    Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms. Australian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access. Policy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes. Patterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future.

  8. Final report of the National Health and Hospitals Reform Commission: will we get the health care governance reform we need?

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    Stoelwinder, Johannes U

    2009-10-05

    The National Health and Hospitals Reform Commission (NHHRC) has recommended that Australia develop a "single health system", governed by the federal government. Steps to achieving this include: a "Healthy Australia Accord" to agree on the reform framework; the progressive takeover of funding of public hospitals by the federal government; and the possible implementation of a consumer-choice health funding model, called "Medicare Select". These proposals face significant implementation issues, and the final solution needs to deal with both financial and political sustainability. If the federal and state governments cannot agree on a reform plan, the Prime Minister may need to go to the electorate for a mandate, which may be shaped by other economic issues such as tax reform and intergenerational challenges.

  9. Stepwise expansion of evidence-based care is needed for mental health reform.

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    McGorry, Patrick D; Hamilton, Matthew P

    2016-05-16

    Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.

  10. The Impact of Health Care Reform on Hospital and Preventive Care: Evidence from Massachusetts☆

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    Kolstad, Jonathan T.; Kowalski, Amanda E.

    2012-01-01

    In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, the number of inpatient admissions originating from the emergency room, and preventable admissions. At the same time, hospital cost growth did not increase. PMID:23180894

  11. The impact of health system reform plan on the hospital\\'s performance indicators of Lorestan University of Medical Sciences

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    Reza Dadgar

    2017-10-01

    Conclusion: The health system  reform plan has been positive changes in indicators of hospital performance. Therefore, while considering the current trend of continuous improvement, the continuity of the project was advised based on the results of this study.

  12. Análisis histórico de la reforma psiquiátrica andaluza: la salud mental reformada sin manicomios Historical analysis of the psychiatric reform in Andalucia: mental health reform without asylums

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    José Carmona Calvo

    2011-12-01

    Full Text Available Se expone en las páginas siguientes el proceso de transformación de los recursos psiquiátricos habido en la región de Andalucía, España. En esta segunda parte se analiza el desarrollo acaecido después de la desaparición del organismo creado para llevar a cabo la reforma. Así, se ofrece una visión crítica de la integración de los recursos de salud mental en el sistema sanitario general, del desmantelamiento completo de los hospitales psiquiátricos, de la creación de servicios sociales específicos para personas con trastornos mentales graves y de la situación actual de la salud mental "reformada", dando cuenta de los logros y de las dificultades de cada etapa de este extenso periodo de veinte años:1991-2011.The following paper talks about the transformation process of psychiatrics resources in Andalucia, Spain. This second part analyzes the development that took place after the disappearance of the organism created to carry out the reform. It offers a critical approach to the incorporation of the mental health resources into the general sanitary system, to the complete extinction of the psychiatric hospitals, to the creation of specific social services for people suffering from serious mental disorder and to the present situation of the "reformed" mental health, informing about the goals and difficulties of each phase of these long twenty years: 1991-2011.

  13. Reinforcing historic distinctions between mental and physical injury: the impact of the civil liability reforms.

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    Forster, Christine; Engel, Jeni

    2012-03-01

    Mental injury has been differentiated from physical injury since its entry into Australian tort law, with mental injury consistently subject to the most onerous regime. In 2002 in its Review of the Law of Negligence, the Ipp Panel supported the historic distinction between physical and mental injury and recommended further (restrictive) changes to the common law rules in relation to mental injury. This article considers and evaluates the reforms which were introduced into six Australian jurisdictions in relation to mental injury in the tort of negligence in response to the Ipp Panel's recommendations arguing that the rationale for differentiating pure mental injury from physical injury and consequential mental injury is nebulous. It argues that the reforms operate to reinforce and magnify historic distinctions between physical and mental harm despite increasing recognition in the medical literature of the interrelationship between physical and psychiatric injury; despite the recognition of the professional ability of psychiatrists and psychologists to accurately pinpoint and diagnose mental injury; despite extensive documentation of the far-reaching and devastating impact that psychiatric injury has on victims, families and the community; and despite evidence that early and adequate treatment of mental injury can prevent a raft of damaging and costly personal and societal consequences.

  14. The impact of healthcare reform on the efficiency of public county hospitals in China.

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    Jiang, Shuai; Min, Rui; Fang, Peng-Qian

    2017-12-20

    The new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals. The purpose of this study is to evaluate county hospitals efficiency before and after the healthcare reform, and further assess the reform effectiveness through the comparative analysis of the efficiency. Data envelopment analysis (DEA) was employed to calculate the efficiency of 1105 sample hospitals which were selected from 31 provinces of China, also, Tobit regression was used to regress against those main external environmental factors. Our results show that the scales and amounts of service of hospitals had increased sharply, however, the efficiency was relatively low and decreased slightly from 2008 to 2012. Thirteen (1.18%) in 2008 and six (0.54%) hospitals in 2012 were defined as technically efficient, and the average scores were 0.2916 and 0.2503. The technical efficiency average score of the post-reform was significantly less than that of the pre-reform (p reform had not well improved county hospital efficiency although hospitals have reached a fair developing scale, and the corresponding policies and measures should be put into effect for improving efficiency, especially in the level and structure of health investment, operation and supervision mechanism of county hospitals.

  15. [Lobotomy and leucotomy in Brazilian mental hospitals].

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    Masiero, André Luis

    2003-01-01

    Lobotomy and leucotomy were used in Brazilian mental institutions from 1936 to 1956. Also called psycho-surgeries, they were operations that separated the right and left frontal lobes and pre-frontal lobes from the rest of the brains, aiming at modifying behavior or curing mental diseases. The technique, created by the Portuguese neurologist Egas Moniz in 1935 and developed by Walter Freeman from the United States, arrived in Brazil through the hands of Aloysio Mattos Pimenta, neurologist from Hospital PsiquiátricoJuquely in São Paulo. Soon, many doctors followed suit. These procedures were used on more than a thousand in-patients aiming at not only healing results, but also the technical improvement of the surgical technique, since preliminary experiments with animals were quite rare at the time. In Brazil, the technique was used until 1956, when it was considered as going against the 1947 Nuremberg Code, whose objective was to detain and regulate the medical experiments with human beings made during the Second World War.

  16. Good governance and budget reform in Lesotho Public Hospitals: performance, root causes and reality.

    Science.gov (United States)

    Vian, Taryn; Bicknell, William J

    2014-09-01

    Lesotho has been implementing financial management reforms, including performance-based budgeting (PBB) since 2005 in an effort to increase accountability, transparency and effectiveness in governance, yet little is known about how these efforts are affecting the health sector. Supported by several development partners and $24 million in external resources, the PBB reform is intended to strengthen government capacity to manage aid funds directly and to target assistance to pressing social priorities. This study designed and tested a methodology for measuring implementation progress for PBB reform in the hospital sector in Lesotho. We found that despite some efforts on the national level to promote and support reform implementation, staff at the hospital level were largely unaware of the purpose of the reform and had made almost no progress in transforming institutions and systems to fully realize reform goals. Problems can be traced to a complex reform design, inadequate personnel and capacity to implement, professional boundaries between financial and clinical personnel and weak leadership. The Lesotho reform experience suggests that less complex designs for budget reform, better adapted to the context and realities of health sectors in developing countries, may be needed to improve governance. It also highlights the importance of measuring reform implementation at the sectoral level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  17. Lebanon: mental health system reform and the Syrian crisis.

    Science.gov (United States)

    Karam, Elie; El Chammay, Rabih; Richa, Sami; Naja, Wadih; Fayyad, John; Ammar, Walid

    2016-11-01

    The Lebanese Ministry of Public Health has launched a National Mental Health Programme, which in turn has established the Mental Health and Substance Use Strategy for Lebanon 2015-2020. In parallel, research involving refugees has been conducted since the onset of the Syrian crisis. The findings point to an increase in mental health disorders in the Syrian refugee population, which now numbers more than 1 million.

  18. Mental health in the Solomon Islands: developing reforms and partnerships.

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    Ryan, Brigid; Orotaloa, Paul; Araitewa, Stephen; Gaoifa, Daniel; Moreen, John; Kiloe, Edwin; Same, William; Goding, Margaret; Ng, Chee

    2015-12-01

    The Solomon Islands face significant shortages and geographical imbalances in the distribution of skilled health workers and resources, which severely impact the delivery of mental health services. The government's Integrated Mental Health Service has emphasised the importance of greater community ownership and involvement in community-based mental health care, and of moving from centralised services to increased local and accessible care. From 2012 to 2014, the Solomon Islands Integrated Mental Health service worked with Asia-Australia Mental Health to build workforce capacity and deliver sustainable community mental health programs. Supported by the Australian Aid Program's Public Sector Linkages Program, this project shared resources and fostered links between public sector agencies in Australia, Fiji and the Solomon Islands. Key learning points from the collaboration included the critical need to establish partnerships with community stakeholders, the importance of sustaining a well-functioning mental health team, and optimising the strengths of the local resources in the Solomon Islands. Through this project, national policies, promotion and service delivery were strengthened, through the exchange of experiences and mobilisation of north-south (Australia-Solomon Islands) and south-south (Solomon Islands-other Pacific nations) technical expertise. This project demonstrates the potential for international partnerships to contribute to the development of culturally-appropriate and integrated mental health services. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  19. Is the Colombian health system reform improving the performance of public hospitals in Bogotá?

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    McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena

    2003-06-01

    Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data

  20. Mental health policy and development in Egypt - integrating mental health into health sector reforms 2001-9

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    Siekkonen Inkeri

    2010-06-01

    Full Text Available Abstract Background Following a situation appraisal in 2001, a six year mental health reform programme (Egymen 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services. Results The project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers. Conclusions The bilateral collaboration programme

  1. Racial Disparities in Mental Health Outcomes after Psychiatric Hospital Discharge among Individuals with Severe Mental Illness

    Science.gov (United States)

    Eack, Shaun M.; Newhill, Christina E.

    2012-01-01

    Racial disparities in mental health outcomes have been widely documented in noninstitutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness was followed for a year after…

  2. Mental Illness Drives Hospitalizations for Detained California Youth

    Science.gov (United States)

    Anoshiravani, Arash; Saynina, Olga; Chamberlain, Lisa; Goldstein, Benjamin A; Huffman, Lynne C; Wang, N Ewen; Wise, Paul H

    2015-01-01

    Objective To describe inpatient hospitalization patterns among detained and non-detained youth in a large, total population of hospitalized adolescents in California. Methods We examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997-2011. We considered hospitalized youth aged 11-18 years “detained” if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay (LOS) between detained youth and their non-detained counterparts in the general population. Results There were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus non-detained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared to 19.8% of non-detained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median LOS compared to non-detained inpatient youth with mental illness (≥6 days versus 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays (≥43 days). Conclusions Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention. PMID:26208862

  3. Effects of Public Hospital Reform on Inpatient Expenditures in Rural China.

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    Zhang, Yuting; Ma, Qianheng; Chen, Yingchun; Gao, Hongxia

    2017-04-01

    Public hospital reform is one priority area in the healthcare system reform that China launched in 2009. The Chinese government invested over $10bn for pilot projects in public hospital reform in rural China. However, little evidence exists on their effects. Using a quasi-natural experiment design, we evaluated the effects of a public hospital pilot project in Hubei province on inpatient spending. We obtained inpatient claims data from 1/1/2011 through 6/30/2013 for enrollees in the New Cooperative Medical Scheme in two counties: Danjiangkou, one of the pilot counties selected for reform in September 2012, and Laohekou, a similar, adjacent county serving as the control group. Using a difference-in-differences approach with propensity score weighting, we found that total inpatient spending increased ¥1160 (95% CI 1155-1166), out-of-pocket spending increased ¥385 (95% CI 382-389), length of stay increased 0.51 days (95% CI 0.50-0.52), but inpatient medication spending decreased ¥147 (95% CI 145-150), post-policy in Danjiangkou, relative to the control group. The overall reimbursement rate increased by 5.7 percentage points. One of the goals of the recent public hospital reform is to make inpatient services affordable to patients. We found that although patients spent less on inpatient medications, total out-of-pocket spending increased considerably after reform. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Making Sense of Policy Implementation Process in Pakistan: The Case of Hospital Autonomy Reforms

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    Saeed, Aamir

    2012-01-01

    Hospital Autonomy Reforms were initiated in the 90s by the Government in the 17 teaching hospitals of the Province of Punjab, Pakistan with the claimed objectives of bringing efficiency and better services to the patients. A host of administrative, structural and financial changes were introduced in

  5. Mental health care in prisons and the issue of forensic hospitals in Italy.

    Science.gov (United States)

    Peloso, Paolo Francesco; D'Alema, Marco; Fioritti, Angelo

    2014-06-01

    Mental health (MH) care for Italian prisoners and offenders with mental illness is a paradoxical issue. Theory and practice remained unchanged throughout the 20th century, despite radical changes to general psychiatric care. Until recently, Italy had one of the most advanced National Health Service (NHS)-run community psychiatry care systems and a totally obsolete system of forensic psychiatry managed by criminal justice institutions. Not until 2008, after substantial pressure by public opinion and International Human Rights bodies, did the government approve a major reform transferring health care in prisons and forensic hospitals to the NHS. Forensic hospitals were to be progressively closed, and specialized small-scale facilities were to be developed for discharged offenders with mental illness, along with diversion schemes to ordinary community care. Despite some important achievements, three major problem areas remain: this reform happened without changes to the Criminal Code; regions differ in organization and resources for ordinary psychiatric services; and legal/criminological expertise among NHS MH professionals is limited.

  6. Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time.

    Science.gov (United States)

    Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

    2014-04-01

    Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Greek mental health reform: views and perceptions of professionals and service users.

    Science.gov (United States)

    Loukidou, E; Mastroyiannakis, A; Power, T; Craig, T; Thornicroft, G; Bouras, N

    2013-01-01

    The Greek mental health system has been undergoing radical reforms for over the past twenty years. In congruence with trends and practices in other European countries, Greek mental health reforms were designed to develop a community-based mental health service system. The implementation of an extensive transformation became possible through the "Psychargos" program, a national strategic and operational plan, which was developed by the Ministry of Health and Social Solidarity. The Psychargos program was jointly funded by the European Union by 75% of the cost over a period of 5 years and the Greek State. After the period of 5 years, the entire cost of the new services became the responsibility of the Greek National Budget. Over the years the Psychargos program became almost synonymous with the deinstitutionalisation of long term psychiatric patients with the development of a wide range of community mental health services. The Psychargos program ended in December 2009. This article presents the views of service providers and service users as part an ex-post evaluation of the Psychargos program carried out in 2010. Data derived for this part of the evaluation are from the application of the qualitative method of focus groups. The outcomes of the study identified several positive and noteworthy achievements by the reforms of the Greek mental health system as well as weaknesses. There was considerable similarity of the views expressed by both focus groups. In addition the service users' focus group emphasized more issues related to improving their mental health wellbeing and living a satisfying, hopeful, and contributing life.

  8. Can mental health commissions really drive reform? Towards better resourcing, services, accountability and stakeholder engagement.

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    Rosenberg, Sebastian; Rosen, Alan

    2012-06-01

    In this second and final part of this series about mental health commissions, we consider the extent to which it is possible to find hard evidence that these new structures really can drive mental health reform. Four key domains of improvement are established for the purposes of this review: do commissions lead to better resources, better services, better accountability and better stakeholder engagement? A review of the evidence from both Australia and overseas is presented. The article also considers how the commissions, federal and state, will organise their relationships productively to avoid duplication and promote synergy. What of those jurisdictions without commissions? Is this genuine national reform or merely more piecemeal activity in mental health? The authors have been informed by the varying structures and functions of mental health commissions internationally and were part of the New South Wales taskforce to establish a mental health commission. They had the opportunity to visit the Western Australian and New Zealand Commissions as part of this process. Addressing mental illness requires a joined up approach to government and services. Commissions offer a new organisational structure designed to deliver this contiguity. There is also evidence that nascent and established commissions are delivering real reforms, including in terms of additional resources and influence. Without concerted efforts to coordinate activity, the intersection between federal and state commissions will be confused and duplications might arise. The paper calls for a new network of commissions to be established across Australia and New Zealand, to share resources and common tasks, clarify roles and build common approaches.

  9. [Bavarian mental health reform 1851. An instrument of administrative modernization].

    Science.gov (United States)

    Burgmair, Wolfgang; Weber, Matthias M

    2008-01-01

    By 1850 the reformation of institutional psychiatric care in Bavaria was given the highest priority by monarchy and administration. Cooperating with experts, especially the psychiatrist Karl August von Solbrig, they provided for new asylums to be established throughout Bavaria in a surprisingly short period of time. It was, however, only at personal intervention of King Max II. that the administrative and financial difficulties which had existed since the beginning of the 19th century could be overcome. The planning of asylums done by each administrative district of Bavaria vividly reflects rivalry as well as cooperation between all governmental and professional agencies involved. Modernization of psychiatry was publicly justified by referring to scientism, the need for a more progressive restructuring of administration, and the paternalistic care of the monarchy, whereas, from an administrative point of view, aspects of psychiatric treatment, like what kind of asylum would be best, were rather insignificant. The structures established by means of the alliance between state administration and psychiatric care under the rule of King Max II. had a lasting effect on the further development of Bavaria.

  10. [The reform of the Penitentiary Order. A cultural revolution that involve the Mental Health Services].

    Science.gov (United States)

    Ferracuti, Stefano; Biondi, Massimo

    2018-01-01

    The reform of the penitentiary system (law 103/2017) which is about to enter into force in Italy represents a Copernican revolution for the management of psychiatric patients who are also authors of a crime. The change would have consequences similar to what happened with the law 180 of 1978. The basic principles on which the new Law is based are: 1) the extension of the faculty to suspend the sentence also for inmates and prisoners affected by a serious mental illness; 2) the full integration of the National Health System (SSN) and DSM in the penitentiary institutions; 3) the establishment of "sections for prisoners with disabilities", special sections for exclusive management for individuals with mental disorders, to be implemented inside the prisons and jails; 4) the possibility probation and parole for prisoners with sentences up to 6 years if suffering from mental illness with a procedure similar to the one already enacted for persons with drug dependency. The article deals with the positive aspects of the reform, but also with the critical aspects it presents in its implementation aspects: training of prison police officers and health workers; substantial and decisive employment of psychiatry in penal institutions; control functions by the DSM on patients; lack of staff and funds. The final aim of the reform is to contain recidivism, and the system must be organized on this goal.

  11. CMS reimbursement reform and the incidence of hospital-acquired pulmonary embolism or deep vein thrombosis.

    Science.gov (United States)

    Gidwani, Risha; Bhattacharya, Jay

    2015-05-01

    In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions. This study evaluates whether CMS's refusal to pay for hospital-acquired pulmonary embolism (PE) or deep vein thrombosis (DVT) resulted in a lower incidence of these conditions. We employ difference-in-differences modeling using 2007-2009 data from the Nationwide Inpatient Sample, an all-payer database of inpatient discharges in the U.S. Discharges between 1 January 2007 and 30 September 2008 were considered "before payment reform;" discharges between 1 October 2008 and 31 December 2009 were considered "after payment reform." Hierarchical regression models were fit to account for clustering of observations within hospitals. The "before payment reform" and "after payment reform" incidences of PE or DVT among 65-69-year-old Medicare recipients were compared with three different control groups of: a) 60-64-year-old non-Medicare patients; b) 65-69-year-old non-Medicare patients; and c) 65-69-year-old privately insured patients. Hospital reimbursements for the control groups were not affected by payment reform. CMS payment reform for hospital-based reimbursement of patients with hip and knee replacement surgeries. The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis. At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81% of all hip or knee replacement surgeries for Medicare patients aged 65-69 years old. CMS payment reform resulted in a 35% lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). Results were robust to sensitivity analyses. CMS's refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery

  12. Implementing health care reform: implications for performance of public hospitals in central Ethiopia.

    Science.gov (United States)

    Manyazewal, Tsegahun; Matlakala, Mokgadi C

    2018-06-01

    Understanding the way health care reforms have succeeded or failed thus far would help policy makers cater continued reform efforts in the future and provides insight into possible levels of improvement in the health care system. This work aims to assess and describe the implications of health care reform on the performance of public hospitals in central Ethiopia. A facility-based, cross-sectional study was carried out in five public hospitals with different operational characteristics that have been implementing health care reform in central Ethiopia. The reform documents were reviewed to assess the nature and targets of the reform for interpretive analysis. Adopting dimensions of health system performance as the theoretical framework, a self-administered questionnaire was developed. Consenting health care professionals who have been involved in the reform from inception to implementation filled the questionnaire. Cronbach's alpha was measured to ensure internal consistency of the instrument. Descriptive statistics, weighted median score, χ 2 , and Mann-Whitney U and Kruskal-Wallis tests were used for data analysis. s Despite implementation of the reform, the health care system in public hospitals was still fragmented as confirmed by 50% of respondents. Limited effects were reported in favour of quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%) of care, while poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. Though there was substantial gain in infrastructure and workspace, stewardship of health care resources was less benefited. The predominant hindrances of the reform were the working environment (adjusted Odds Ratio (aOR) = 2.27, 95% confidence interval (CI): 1.15-4.47), financial resources (aOR = 3.54, 95%CI = 1.97-6.33), management (aOR = 2.27, 95% CI = 1.15-4.47), and information technology system (aOR = 3.15, 95% CI = 1.57-6.32). s The Ethiopian

  13. Qualitative analysis of the dynamics of policy design and implementation in hospital funding reform.

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    Karen S Palmer

    Full Text Available As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM; and Quality-Based Procedures (QBP. This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model.We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy; Adoption Supporters (organizations and individuals supporting adoption of QBPs; and Hospital Implementers (those responsible for QBP implementation in hospitals. Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data.Five main findings emerged from our research: (1 Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s for hospital funding reform; (2 Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3 Perception of the primary goal(s of the policy reform continues to vary within and across all levels of key informants; (4 Four years into implementation, the QBP funding mechanism remains

  14. Narratives of change and reform processes: global and local transactions in French psychiatric hospital reform after the Second World War.

    Science.gov (United States)

    Henckes, Nicolas

    2009-02-01

    As with the rest of biomedicine, psychiatry has, since the Second World War, developed under the strong influence of the transnational accumulation of a whole series of practices and knowledge. Anthropology has taught us to pay attention to the transactions between local-level actors and those operating at the global level in the construction of this new world of medicine. This article examines the role played by the recommendations of the WHO Expert Committee of Mental Health in the reform of the French mental health system during the 1950s. Rooted in the experience of practitioners and administrators participating in the process of reforming local psychiatric systems, the recommendations of the WHO Expert Committee developed a new vision of regulating psychiatry, based on professionalism and an idea of a normativity of the doctor-patient relation. This article shows how, by mobilizing the WHO reports' recommendations, French administrators and doctors succeeded in creating a typically French object: "the psychiatric sector", founded on elaborating a new mandate for the psychiatric profession. The article thus questions the deinstitutionalization model as an explanation of transformations of the structure of the French psychiatry system in the post-war period.

  15. Assessing Accrual Accounting Reform in Greek Public Hospitals: An Empirical Investigation

    Directory of Open Access Journals (Sweden)

    Dimitrios Vasiliou

    2011-03-01

    Full Text Available During the last decades, several countries worldwide have introduced financial management reforms, as an important part of the New Public Management (NPM initiative at one or more levels of government sector, by either replacing or transforming their traditional budgetary cash accounting systems towards a business-like accrual accounting concept. Following the example of this upcoming managerial trend, the Greek government introduced in 2003 the accrual basis accounting into public hospitals, as the hospital sector is one of the areas where NPM reforms have been introduced in search of higher efficiency, effectiveness and economy in service production.The purpose of this paper is twofold. The first goal is to provide an overview of the government sector reform initiatives in Greece and to present empirical evidence regarding the adoption level of the accrual basis accounting standards in the Greek public Health sector. The second goal of the research is to investigate the impact of a range of potentially contingent factors on hospitals compliance with the accrual financial and cost accounting reform.The present analysis is based on the results of an empirical survey that took place during 2009. For the purposes of this survey, a structured questionnaire was prepared and sent to the Chief Financial Officers (CFOs of 132 Greek public hospitals. In particular, alinear regression model analysis was used to examine the cross-sectional differences on a number of explanatory and implementation factors of the accounting reform adoption level.The empirical evidence reveals that the level of accrual and especially cost accounting adoption in Greek public hospitals is realized only to a limited extent. In particular, results show that the level of reform adoption is positively related to IT quality, reform related training, education level of accounting staff, and professional consultants’ support. However, no significant relationship was found between

  16. Psychiatric advance directives: the new frontier in mental health law reform in Australia?

    Science.gov (United States)

    Bogdanoski, Tony

    2009-05-01

    The legal recognition of psychiatric advance directives is arguably at the forefront of human rights-based mental health law reform in Australia. However, academic discourse in Australia has largely neglected this important development. On the one hand, proponents of psychiatric advance directives believe that such instruments further the rights and autonomy of the mentally ill by allowing consumers of mental health services the right to participate in their own health care when they are competent to make health care decisions. On the other hand, opponents believe that they are undesirable and unworkable in practice and that giving mentally ill persons a right to consent to, or refuse, mental health treatment before the onset of any psychiatric illness does not actually promote or protect the best interests of the mentally ill since future decisions cannot be made about potentially unforeseen circumstances. This article argues that the time has come to consider using psychiatric advance directives in the mental health arena and for amending legislation to be introduced to give them a legal basis.

  17. Reforma, responsabilidades e redes: sobre o cuidado em saúde mental Reform, responsibilities and networks: about mental health care

    Directory of Open Access Journals (Sweden)

    Martinho Braga Batista e Silva

    2009-02-01

    Full Text Available Tendo em vista o processo paulatino de responsabilização de atores e instâncias sociais pelo cuidado no contexto da Reforma Psiquiátrica brasileira, percebe-se que familiares e vizinhos de pacientes psiquiátricos têm sido instigados a " participar" da política pública, principalmente no lugar de " suporte social" , embora oficialmente considerados " parceiros" . Essa reconfiguração da relação entre Estado e sociedade civil é consagrada pela diretriz governamental de tomada de responsabilidade dos serviços pelo território, uma mudança da lógica de demanda e oferta de atendimento no sentido de estimular serviços extra-hospitalares - como os Centros de Atenção Psicossocial, campo desse estudo - a se encarregarem pela população adscrita a uma área geográfica. O objetivo desse texto é investigar as tecnologias psicossociais produzidas nesse contexto político, institucional e histórico específico, tais como a mediação de trocas sociais e a arbitragem de conflitos. Um dos materiais analisados são os registros em prontuário, que podem constituir os atores e instâncias sociais citados como envolvidos no campo da saúde mental, enredando-os na malha administrativa construída como rede de suporte social.In the context of the Brazilian Psychiatric Reform family members and neighbors of psychiatric patients have been urged to " participate" in the public policies, mainly as " social support" although officially considered " partners" . This reconfiguration of the relationship between State and civil society is reflected in the directive that the services have to take over the responsibility for territories, a change in the logic of supply and demand aimed at stimulating extra-hospital services such as Psychosocial Care Centers, the object of this study, to provide care to the population of a certain geographical area. The purpose of this article is to investigate the psychosocial technologies produced in this specific

  18. Hospitalization due to drug use did not change after a decade of the Psychiatric Reform

    Science.gov (United States)

    Balbinot, Alexandre Dido; Horta, Rogério Lessa; da Costa, Juvenal Soares Dias; Araújo, Renata Brasil; Poletto, Simone; Teixeira, Marina Bressaneli

    2016-01-01

    ABSTRACT OBJECTIVE To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil. METHODS This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression. RESULTS The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds. CONCLUSIONS The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform. PMID:27253902

  19. Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital.

    Science.gov (United States)

    Rentoumis, Anastasios; Mantzoufas, Nikolaos; Kouris, Gavriil; Golna, Christina; Souliotis, Kyriakos

    2010-11-10

    To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals. We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals.

  20. Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

    Directory of Open Access Journals (Sweden)

    Golna Christina

    2010-11-01

    Full Text Available Abstract Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania. We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental hospitals.

  1. Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

    Science.gov (United States)

    Perkins, Barbara Bridgman

    2010-02-01

    Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

  2. Top 10 things hospitals need to know about health reform ... but were afraid to ask.

    Science.gov (United States)

    DeVore, Susan

    2010-08-01

    The top 10 critical areas of reform that are of concern to hospitals include: Understand financial implications. Do more with less. Optimize revenue cycle, labor productivity, and supply chain. Move patients from self-pay to coverage. Make quality job No.1. Prepare for transparency. Deal with infections. Implement physician alignment. Move from volume to value: accountable care organizations. Obtain HITECH funding.

  3. Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam.

    Directory of Open Access Journals (Sweden)

    Phan Minh Trang

    Full Text Available Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008-2012 to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90th percentile. The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79 for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95-1.13, 1.15 (1.005-1.31, and 1.36 (1-1.90 for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9 and mental retardation (F70-79, had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes.

  4. Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam.

    Science.gov (United States)

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Kullgren, Gunnar; Nilsson, Maria

    2016-01-01

    Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008-2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95-1.13), 1.15 (1.005-1.31), and 1.36 (1-1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes.

  5. [Reform of the treatment given to mental health patients in modern Spain].

    Science.gov (United States)

    Amezcua, Manuel

    2004-12-01

    Nursing for mental health patients was not born as a field of knowledge but rather as customary practice, that is, it was not born from a theoretical study, as a reflective exercise on the nature of appropriate treatment, but as a violent reaction against human indignity. Using the example of the Portuguese man Juan Ciudad Duarte, known as Saint John of God, the author removes the saintly nature of his man to introduce us to his most human side as a reformer, set in a historical context marked by the humanistic renaissance era and by his territory, the recently conquered Granada. Based on two cultural focuses of the Renaissance, mystical thinking and the disease of melancholy, we can get close to the origin of mental health care in Spain. Not due to a contemplative mysticism, but an active mysticism induces Juan Ciudad to rebel against the established order. Furthermore he does this using the metaphor of madness and madman in an epoch when melancholy was considered to be an evil which possessed the enlightened, a disease which afflicted the reformers, those who had crossed beyond the borders of acceptable behavior and thinking. Through this means, mysticism and melancholic humor became the basic formula which made it culturally possible to renovate the model for treating mental patients in modern Spain.

  6. The political development of "Program Realignment": California's 1991 mental health care reform.

    Science.gov (United States)

    Masland, M C

    1996-01-01

    This article reviews the legislative process that resulted in the most significant reform of California's public mental health system in nearly 25 years. The reform, termed "Program Realignment," decentralized administrative and fiscal control of the mental health system from the state to the county level. The system prior to Program Realignment is discussed here to reveal an already diverse and decentralized county mental health system, fiscal distress, and general dissatisfaction with the system. From these conditions, the objectives of the relevant political actors arose. By tracing the policy development process of Program Realignment, several independent variables are revealed that help explain how and why this legislation came into being and allow generalization of this case to other states' experiences. These independent variables are an urgent need for action within a limited timeframe, a preexisting knowledge base and well-developed policy networks, a spirit of bipartisan cooperation, and the presence of strong leadership. Preliminary evidence suggests that consolidation of fiscal and programmatic authority at the local level has reduced fragmentation of services and increased fiscal flexibility. However, there is concern that the quality of care offered by the state's 59 local mental health programs will become increasingly disparate and that increased financial flexibility may not be used to improve services for clients but to save money for local governments. Lessons from California's experience can alert other states to the pros and cons of this policy approach to providing mental health services and inform policymakers in other states of the steps involved in bringing about such a policy change.

  7. The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics

    Science.gov (United States)

    Hanchate, Amresh D; McCormick, Danny; Manze, Meredith G; Chu, Chieh; Kressin, Nancy R

    2014-01-01

    Objectives To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient discharge databases (hospital episode statistics) from Massachusetts and two control states (New York and New Jersey). Design Difference in differences analysis to identify the post-reform change, adjusted for secular changes unrelated to reform. Setting US hospitals in Massachusetts, New York, and New Jersey. Participants Adults aged 18-64 admitted for any cause, excluding obstetrical. Main outcome measure Readmissions at 30 days after an index admission. Results After adjustment for known confounders, including age, sex, comorbidity, hospital ownership, teaching hospital status, and nurse to census ratio, the odds of all cause readmission in Massachusetts was slightly increased compared with control states post-reform (odds ratio 1.02, 95% confidence interval 1.01 to 1.04, P<0.05). Racial and ethnic disparities in all cause readmission rates did not change in Massachusetts compared with control states. In analyses limited to Massachusetts only, there were minimal overall differences in changes in readmission rates between counties with differing baseline uninsurance rates, but black people in counties with the highest uninsurance rates had decreased odds of readmission (0.91, 0.84 to 1.00) compared with black people in counties with lower uninsurance rates. Similarly, white people in counties with the highest uninsurance rates had decreased odds of readmission (0.96, 0.94 to 0.99) compared with white people in counties with lower uninsurance rates. Conclusions In the United States, and in Massachusetts in particular, extending health insurance coverage alone seems insufficient to improve readmission rates. Additional efforts are needed to reduce hospital readmissions and disparities in this outcome. PMID:24687184

  8. A pilot project using evidence-based clinical pathways and payment reform in China's rural hospitals shows early success.

    Science.gov (United States)

    Cheng, Tsung-Mei

    2013-05-01

    Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

  9. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    Directory of Open Access Journals (Sweden)

    Zhang X

    2016-03-01

    Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

  10. Hospital Capacity, Waiting Times and Sick Leave Duration - an Empirical Analysis of a Norwegian Health Policy Reform

    OpenAIRE

    Aakvik, Arild; Holmås, Tor Helge; Kjerstad, Egil

    2012-01-01

    A health policy reform aiming to reduce hospital waiting times and sickness absences, the Faster Return to Work (FRW) scheme, is evaluated by creating treatment and control groups to facilitate causal interpretations of the empirical results. We use a unique dataset on individuals where we match hospital data with social security data and socio-economic characteristics. The main idea behind the reform is that long waiting times for hospital treatment lead to unnecessarily long periods of sick...

  11. Mortality of mentally handicapped patients after mass inter-hospital ...

    African Journals Online (AJOL)

    In September 1987847 mentally handicapped patients were moved from A. J. Stals Care and Rehabilitation Centre to Lentegeur Hospital. A study of the death rates of patients for 4 years before the move and 18 months afterwards showed a rise in the death rate in the 6-month interval after the move.

  12. The role of alienation in mental hospitalization.

    Science.gov (United States)

    McDowell, D J; Miller, I W; Magaro, P A

    1977-01-01

    A scale that assesses alienation was constructed from seven previously reported scales and administered to 74 psychiatric inpatients for whom behavioral and demographic data also were compiled. Factor analysis of alienation items yielded no major factors, which suggests that the construct is not unitary. A rotated factor matrix of alienation scores and behavioral and demographic variables showed that alienation does not account for a major proportion of variance in life history variables or current interpersonal functioning. Regression analysis indicated that alienation scores were predicted poorly from other variables. Moreover, alienation scores were poor predictors of length of hospitalization, which indicates that alienation has little power to account for relative severity of deviance.

  13. Investigating the health care delivery system in Japan and reviewing the local public hospital reform.

    Science.gov (United States)

    Zhang, Xing; Oyama, Tatsuo

    2016-01-01

    Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described.

  14. A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

    Science.gov (United States)

    Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

    2008-08-01

    Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

  15. Health and hospital reform in Australia--a local health district's perspective.

    Science.gov (United States)

    Anderson, Teresa; Catchlove, Barry

    2012-01-01

    Health and hospital reform is not new on the international stage. Increasing demand for health care services due to aging populations and the increased burden of chronic disease, continued advances in medical technology (including the rapid expansion of information systems) and ever growing community expectations mean that the health care expenditure of most health systems is growing at a rate greater than GDP (OECD 2008). Most countries appear to be grappling with how they can create a sustainable health system for the future. This article provides an overview of reform occurring within the Australian and New South Wales (NSW) Public Healthcare Systems, which includes devolution to Local Health Districts, a smaller and more focused Ministry of Health, increased transparency and funding reform. The article examines the challenges this reform presents for Local Health Districts and how these challenges are being addressed locally. This reform has also highlights the competencies that are required of chief executives and other senior executives in health in managing and leading these complex health organizations.

  16. The concept of capacity in Australian mental health law reform: Going in the wrong direction?

    Science.gov (United States)

    McSherry, Bernadette; Wilson, Kay

    2015-01-01

    The six Australian states and two territories each have legislation that enables the involuntary detention and treatment of individuals diagnosed with mental illness who are considered in need of treatment and where there is evidence of a risk of harm to self or others. A number of governments have undertaken or are currently undertaking reviews of mental health laws in light of the Australian Government's ratification of the Convention on the Rights of Persons with Disabilities. While United Nations bodies have made it clear that laws which enable the detention of and substituted decision-making for persons with disabilities should be abolished, debates in Australia about the reform of mental health legislation have largely focused on Article 12 of the CRPD and what is meant by the right of persons with disabilities to enjoy legal capacity on an equal basis with others. It is argued that a more holistic view of the CRPD rather than the current narrow focus on Article 12 would best serve the needs of persons with mental impairments. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Hospitalizations and hospital charges for co-occurring substance use and mental disorders.

    Science.gov (United States)

    Ding, Kele; Yang, Jingzhen; Cheng, Gang; Schiltz, Trisha; Summers, Karen M; Skinstad, Anne Helene

    2011-06-01

    Most published studies have examined co-occurring disorders among mental health patients. Our objective was to compare the length of stay and hospital charges between hospitalized patients with alcohol- or substance-related disorders with and without co-occurring disorders. We analyzed nationally representative hospital discharge data (Nationwide Inpatient Sample, 2003-2007) and examined factors associated with length of stay and hospital charges. Forty-four percent of patients who were hospitalized with alcohol- or substance-related disorders were diagnosed with co-occurring mental disorders, representing 979,421 such disorders nationwide between 2003 and 2007. Females, those of White race, those who paid with insurance, and those who stayed in large, rural, nonteaching, and Midwest region hospitals had a high prevalence of co-occurring disorders. Co-occurring disorders were associated with longer hospital stays, but there were mixed results with hospital charges per discharge. An increase in co-occurring disorders among hospitalized patients with substance-related disorder may be due to the improvement in diagnosis and clinical attention. Published by Elsevier Inc.

  18. 77 FR 29033 - Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of...

    Science.gov (United States)

    2012-05-16

    ... allowed hospitals to have an optional program for patient(s)/support person(s) on self- administration of... Regulatory Flexibility Act RPCH Rural Primary Care Hospital SBA Small Business Administration SBREFA Small... and the hospital's administration. At that time, we decided to leave decisions about liaison and...

  19. Comparing the Hospital Costs of the Neonates Admitted to NICU of Amirkola Children's Hospital Before and After the Implementation of the Health Sector Reform in Iran

    Directory of Open Access Journals (Sweden)

    Yadollah Zahed Pasha

    2017-09-01

    Full Text Available Background: The cost-effective strategies are of paramount importance in the improvement of neonatal health services. Regarding this, the present study aimed to evaluate the health sector reform of the Islamic Republic of Iran and its impact on hospital costs related to the admission of neonates in Amirkola Children's Hospital.Methods: This observational analytic study was conducted in 2015 to evaluate the hospital records of all neonates admitted to Amirkola Children's Hospital during late 2013 (before the implementation of health sector reform in Iran and late 2014 (after the implementation of this reform.Results: According to the results, the number of the neonates admitted to this center has increased by 11% after reform. Furthermore, the mean total hospital cost and share of insurance organizations have elevated by 2.2 and 2.5 fold, respectively. Mean of the cost paid by the patients has reached to 2.7 million Rials, which has had a 33% decrease, compared to that of the pre-reform stage. Additionally, 5.8% of the total expenditures related to neonatal inpatient cares were paid out-of-pocket.Conclusion: As the findings of the present study indicated, the health sector reform in Iran has increased the rate of neonatal admission and decreased the amount of direct payment by the people.

  20. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    OpenAIRE

    Minas, H; Zamzam, R; Midin, M; Cohen, A

    2011-01-01

    Abstract Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours...

  1. Is health care a right or a commodity? Implementing mental health reform in a recession.

    Science.gov (United States)

    Aggarwal, Neil Krishan; Rowe, Michael; Sernyak, Michael A

    2010-11-01

    The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, contains elements of two seemingly contradictory positions: health care as a commodity and as a right. The commodity argument posits that the marketplace should govern demand, supply, and costs of care. The law's establishment of state insurance exchanges reflects this position. The argument that health care is a right posits that it is a need, not a choice, and that government should regulate care standards that may be compromised as insurers attempt to minimize costs. The law's requirement for coverage of mental and substance use disorders reflects this position. This Open Forum examines these arguments in light of current state fiscal crises and impending reforms. Despite the federal government's interest in expanding prevention and treatment of mental illness, states may demonstrate varying levels of commitment, based in part on their perception of health care as a right or a commodity. The federal government should outline clear performance standards, with minimum services specified to maximize state commitments to services.

  2. Goffman's Asylums and the total institution model of mental hospitals.

    Science.gov (United States)

    Weinstein, R M

    1994-11-01

    The present report is an examination and evaluation of the importance and applicability of Goffman's Asylums three decades after its first publication. The book has achieved classic status due to its extensive academic citation, anthology reprinting, use in legal proceedings, and public influence. However, over the years the accuracy and generalizability of Goffman's total institution model of mental hospitals have been seriously questioned. An analysis of the criticisms of Goffman's theories, methods, and conclusions suggested that his work was biased and deficient in a number of ways but at times was misinterpreted or misrepresented. As a research study Asylums may be outdated and of little value to mental health practitioners due to the revolutionary changes in psychiatry that have occurred since the mid-1950s. As an academic work, however, Asylums continues to enjoy a high reputation perhaps because of its theoretical utility and teaching value as well as the popularity of Goffman's many other published works. The total institution model may have been limited from the start and doubts remain as to its validity today, but the longevity of Asylums is assured as Goffman's picture of mental hospitalization is firmly planted in the minds of sociologists, psychiatrists, patients' rights advocates, and students of formal organizations.

  3. Management and organization reforms at the Muhimbili National Hospital: challenges and prospects.

    Science.gov (United States)

    Mwangu, M A; Mbembati, N A A; Muhondwa, E P Y; Leshabari, M T

    2008-08-01

    To establish the state of organization structures and management situation existing at the Muhimbili National Hospital (MNH) and Muhimbili University College of Health Sciences (MUCHS) prior to the start of the MNH reforms and physical infrastructure rehabilitations. A checklist of key information items was used to get facts and figures about the organization of the MNH and management situation. Interviews with MNH and MUCHS leaders, and documentation of existing hospital data were done to gather the necessary information. The survey reveals that there are a number of organizational, managerial and human resource deficiencies that are impinging on the smooth running of the hospital as a national referral entity. The survey also revealed a complex relationship existing between the hospital and the college (MUCHS) that has a bearing on the functioning of both entities. In order for the hospital to function effectively as a referral hospital with a training component inbuilt, four basic things need to be put in place among others: a sound organization structure; adequate staffing levels especially of specialist cadre; a functional information system especially for inpatient services and a good working relationship with the college.

  4. Identifying Factors Influencing the Establishment of a Health System Reform Plan in Iran's Public Hospitals

    Directory of Open Access Journals (Sweden)

    Rasul Fani khiavi

    2016-09-01

    Full Text Available In today's world, health views have found a wider perspective in which non-medical expectations are particularly catered to. The health system reform plan seeks to improve society's health, decrease treatment costs, and increase patient satisfaction. This study investigated factors affecting the successful establishment of a health system reform plan. A mixed qualitative – quantitative approach was applied to conduct to explore influential factors associated with the establishment of a health system reform plan in Iran's public hospitals. The health systems and approaches to improving them in other countries have been studied. A Likert-based five-point questionnaire was the measurement instrument, and its content validity based on content validity ratio (CVR was 0.87. The construct validity, calculated using the factorial analysis and Kaiser Mayer Olkin (KMO techniques, was 0.964, which is a high level and suggests a correlation between the scale items. To complete the questionnaire, 185 experts, specialists, and executives of Iran’s health reform plan were selected using the Purposive Stratified Non Random Sampling and snowball methods. The data was then analyzed using exploratory factorial analysis and SPSS and LISREL software applications. The results of this research imply the existence of a pattern with a significant and direct relationship between the identified independent variables and the dependent variable of the establishment of a health system reform plan. The most important indices of establishing a health system reform plan, in the order of priority, were political support; suitable proportion and coverage of services presented in the society; management of resources; existence of necessary infrastructures; commitment of senior managers; constant planning, monitoring, and evaluation; and presentation of feedback to the plan's executives, intrasector/extrasector cooperation, and the plan’s guiding committee. Considering the

  5. Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study.

    Science.gov (United States)

    Doupnik, Stephanie K; Henry, M Katherine; Bae, Hanah; Litman, Jessica; Turner, Shanarra; Scharko, Alexander M; Feudtner, Chris

    2017-03-01

    Children and adolescents necessitating hospitalization for physical health conditions are at high risk for mental health conditions; however, the prevalence of mental health conditions and symptoms among hospitalized children and adolescents is uncertain. The objective of this study was to determine the proportion of hospitalized children and adolescents who have diagnosed mental health disorders or undiagnosed mental health problems. In this single-center point prevalence study of hospitalized children between the ages of 4 and 21 years, patients or their parents reported known mental health diagnoses and use of services using the Services Assessment for Children and Adolescent, and they reported patient mental health symptoms using the Pediatric Symptom Checklist, 17-item form (PSC-17). Of 229 eligible patients, 119 agreed to participate. Demographic characteristics of patients who enrolled were not statistically significantly different from those of patients who declined to participate. Among participants, 26% (95% confidence interval [CI], 18%-35%) reported a known mental health diagnosis. On the PSC-17, 29% (95% CI, 21%-38%) of participants had a positive screen for mental health symptoms. Of those with a positive screen, 38% (95% CI, 21%-55%) had no known mental health diagnosis, and 26% (95% CI, 12%-43%) had not received ambulatory mental health services in the 12 months before hospitalization. Mental health conditions and symptoms are common among patients hospitalized in a tertiary children's hospital, and many affected patients are not receiving ambulatory mental health services. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  6. Professional responses to post bureaucratic hospital reforms and their impact on care provision

    DEFF Research Database (Denmark)

    Johnsen, Helle

    2015-01-01

    Background Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care...... receivers. Question To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Method Data builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing...... theories of professionalism and post bureaucracy. Findings Two overarching themes were identified: ‘Time, tasks and institutional duties’ which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs...

  7. Study of Educational Hospital Employees' Satisfaction with the Administration of the Health Reform Plan in Ghazvin, 2015.

    Science.gov (United States)

    Gholami, Soheyla; Oveisi, Sonia; Ghamari, Fatemeh; Etedal, Mahboobeh Ghorban; Rajaee, Roya

    2015-11-01

    Employee satisfaction is considered to be an important component in the promotion of service quality and increased efficiency and effectiveness in the reform plan for a healthcare system. Neglecting this issue could result in a lack of success in achieving the healthcare system's objectives. The healthcare reform plan is being implemented to achieve the objectives of the healthcare system. Thus, given the key role of hospital employees in implementing the reform plan, the aim of this study was to determine the levels of hospital employees' satisfaction with their jobs. This was a qualitative study in 2015 that included thematic analysis, and 138 employees of the Kosar, Rajaii, and Ghods Hospitals participated. Data were collected using semi-structured interviews, and the data were analyzed using content analysis. After analyzing the data collected by interviewing the employees, 132 codes were identified. The codes were classified into five general concepts including opinions about 1) the reform plan and its administrative barriers, 2) changes in visits, 3) changes in working conditions, 4) changes in salaries and 5) General satisfaction of personnel. Increasing workloads, stagnant salaries, and the shortage of personnel were the main factors that reduced the satisfaction of the hospitals' employees with the administration of the healthcare reform plan.

  8. ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE-EVENT SIMULATION

    Science.gov (United States)

    2016-03-24

    ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE-EVENT SIMULATION...in the United States. AFIT-ENV-MS-16-M-166 ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE-EVENT SIMULATION...UNLIMITED. AFIT-ENV-MS-16-M-166 ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE-EVENT SIMULATION Erich W

  9. 76 FR 65891 - Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of...

    Science.gov (United States)

    2011-10-24

    ... encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp... impediments may be unduly limiting access to care and/or delaying treatment for patients and causing undue... the State in which the hospital is located, a doctor of dental surgery or dental medicine. CMS...

  10. Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.

    Science.gov (United States)

    Zhang, Xing; Tone, Kaoru; Lu, Yingzhe

    2018-04-01

    To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.

  11. Policy and Practice Model of Public-Private Partnership in Public Hospitals during the New Medical Reform Period.

    Science.gov (United States)

    Zhang, Ju-Yang; Long, Ru-Yin; Yan, Hai; Yang, Qing; Yang, Bo

    2016-01-01

    Purpose: Since the beginning of the new health care reform in 2009, the state has illustrated the top design and health care improvement strategy of "encouraging social capital to participate in the reform of public hospitals", in accordance with the program's general objective. All areas have been explored on this matter and the results obtained are very interesting, not to mention the acquisition of significant experience. At present, the existing business models in China are mainly the following: Rebuild-Operate-Transfer (ROT), franchise business model, Build-Own-Operate-Transfer (BOOT) model, mixed ownership model and business insurance model. This paper introduces a variety of alternative models, and provides a simple analysis of the advantages and disadvantages. Moreover, for the reform of public hospitals, the government shares should go into franchise mode or mixed ownership, and all property rights should be transferred to the government to ensure the conservation and proliferation of state-owned assets.

  12. Psychosocial risk at work and mental illness in hospital workers

    Directory of Open Access Journals (Sweden)

    Elisa Ansoleaga M

    2011-11-01

    Full Text Available There is growing evidence on the association between exposure to psychosocial risk at work and adverse health outcomes. Objective: to describe and analyze the presence of psychosocial risks at work and mental health symptoms in non-clinical workers from a public hospital. Methods: a crosssectional study was conducted at a public hospital in Santiago (Chile. A self-administered questionnaire was applied to assess exposure to psychosocial risks (demand-control and effort-reward imbalance models. The outcome variables were depression symptoms, anxiety symptoms, and psychotropic drug consumption. The analysis was descriptive and associative (Fisher’s exact test Results: 47% of the workers showed high psychological demands, 46% low autonomy, 61% low social support and 75% imbalance between effort expended and rewards received. The prevalence of depressive and anxious symptoms in the total sample was 10% and 30% respectively, while 25% reported having used psychotropic drugs. The consumption of psychotropic drugs was significantly higher (p < 0.05 among those with low social support and effort-reward imbalance. Discussion: the consumption of psychotropic drugs was associated with low social support and imbalance between efforts expended and rewards received. This might have implications in the workers’ health and performance; therefore, further research is required, particularly on this kind of population, to understand this relationship and thus develop prevention programs in this regard.

  13. Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013.

    Science.gov (United States)

    Barr, Ben; Kinderman, Peter; Whitehead, Margaret

    2015-12-01

    Several indicators of population mental health in the UK have deteriorated since the financial crisis, during a period when a number of welfare reforms and austerity measures have been implemented. We do not know which groups have been most affected by these trends or the extent to which recent economic trends or recent policies have contributed to them. We use data from the Quarterly Labour Force Survey to investigate trends in self reported mental health problems by socioeconomic group and employment status in England between 2004 and 2013. We then use panel regression models to investigate the association between local trends in mental health problems and local trends in unemployment and wages to investigate the extent to which these explain increases in mental health problems during this time. We found that the trend in the prevalence of people reporting mental health problems increased significantly more between 2009 and 2013 compared to the previous trends. This increase was greatest amongst people with low levels of education and inequalities widened. The gap in prevalence between low and high educated groups widened by 1.29 percentage points for women (95% CI: 0.50 to 2.08) and 1.36 percentage points for men (95% CI: 0.31 to 2.42) between 2009 and 2013. Trends in unemployment and wages only partly explained these recent increases in mental health problems. The trend in reported mental health problems across England broadly mirrored the pattern of increases in suicides and antidepressant prescribing. Welfare policies and austerity measures implemented since 2010 may have contributed to recent increases in mental health problems and widening inequalities. This has led to rising numbers of people with low levels of education out of work with mental health problems. These trends are likely to increase social exclusion as well as demand for and reliance on social welfare systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Mental health literacy survey of non-mental health professionals in six general hospitals in Hunan Province of China.

    Science.gov (United States)

    Wu, Qiuxia; Luo, Xiaoyang; Chen, Shubao; Qi, Chang; Long, Jiang; Xiong, Yifan; Liao, Yanhui; Liu, Tieqiao

    2017-01-01

    Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals' conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis. In 2014-2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured. Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse. The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals' mental health knowledge in mainland China in order to provide better support for mental health service users.

  15. Institutional Ethnography (IE, Nursing Work and Hospital Reform: IE's Cautionary Analysis

    Directory of Open Access Journals (Sweden)

    Janet Rankin

    2009-03-01

    Full Text Available Hospitals in Canada have been subject to intensive reorganization in the past few decades as the public health care system absorbs and adapts to a neoliberal government agenda that promotes more "efficient and effective" use of public funds and increased involvement on the part of the private sector. A massive infusion of public money for health information technology and health services research has created the capacity to generate objectified knowledge and to use it to reform the health care system—both its organization and, increasingly, its therapeutics—with the promise of making it all work better. The research reported here is on the engagement of professional nurses in their everyday/night work in restructured hospitals and on how nursing practice is being reshaped in consequence. Our research approach, institutional ethnography, focuses on the social organization of health knowledge from the standpoint of those involved in and subordinated to its managerial uses, in this case, the nurses. We argue that a new form of ruling is being deployed. Nurses play an active part in the subordination of their own professional judgment to the objectified knowledge and knowledge-based practices that externalize decision making and reposition authoritative knowing. The paper describes and discusses the conduct of an institutional ethnographic inquiry (RANKIN & CAMPBELL, 2006 and illustrates some of its distinctive features using examples from our research. URN: urn:nbn:de:0114-fqs090287

  16. Introduction of freedom of choice for hospital outpatient care in Portugal: Implications and results of the 2016 reform.

    Science.gov (United States)

    Simões, J; Augusto, G F; Fronteira, I

    2017-12-01

    In Portugal, the National Health Service (NHS) assures universal access to medical treatment and care that is free at the point of delivery - except for relatively small user charges. Freedom of choice is limited and competition between the public and the private sectors is almost non-existent. In May 2016, the Ministry of Health introduced a new law that facilitates the referral of NHS users from primary healthcare units to outpatient consultations in NHS hospitals outside of the referral area. However, for inpatient care, patients are still bound to receive treatment within their referral area, which is determined by place of residence. The aim of the reform was to provide a timelier response to citizens' health needs and to increase efficiency. According to preliminary data from June 2016 to May 2017, 10.6% of all outpatient referrals from NHS primary health care units were made to an NHS hospital out of the referral area, with the highest proportion in the Lisbon (15.8%) region. In general, median waiting time for first outpatient consultation increased after the introduction of choice in the five specialties with the highest proportions of out-of-area referrals - but it reduced in two departments with the longest waiting times prior to the reform. The reform constitutes a major change to the relationship between NHS hospitals, with foreseeable consequences in hospital funding and the patients' perception of hospital quality. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. [Mental Health in the General Hospital: Results of the Patient Health Questionnaire (PHQ) in Four Hospital Services].

    Science.gov (United States)

    Castro-Camacho, Leonidas; Escobar, Juan Manuel; Sáenz-Moncaleano, Camilo; Delgado-Barrera, Lucía; Aparicio-Turbay, Soraya; Molano, Juan Carlos; Noguera, Efraín

    2012-03-01

    Few individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. Detection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). Cross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. 1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. The usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  18. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes.

    Science.gov (United States)

    Minas, Harry; Zamzam, Ruzanna; Midin, Marhani; Cohen, Alex

    2011-05-14

    The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298). Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions.

  19. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    Directory of Open Access Journals (Sweden)

    Midin Marhani

    2011-05-01

    Full Text Available Abstract Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356 gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298. Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented

  20. [The opinion of patients with mental disorder about tobacco and its prohibition in psychiatric hospitalization].

    Science.gov (United States)

    Marques de Oliveira, Renata; Furegato, Antonia Regina Ferreira

    2014-06-01

    To identify the opinion of patients with mental disorder about tobacco and its prohibition during psychiatric hospitalization. An exploratory study with 96 patients smokers with mental disorders hospitalized in a psychiatric ward of a general hospital. The interviews were conducted individually, using an instrument designed for this study. The content from the interviews was recorded, transcribed and submitted to a thematic content analysis. The patients with mental disorder were identified as perceiving smoking during the psychiatric hospitalization as a help to support the difficulties in socialization and in the lack of activities. The permission for smoking is seen as a signal of respect to their needs. The subjects mentioned to not accept the total smoking prohibition. Tobacco helps to face difficulties and conflicts in the psychiatric hospitalization. There is resistance regarding the possibility to totally withdraw the smoking permission during hospitalization.

  1. The opinion of patients with mental disorder about tobacco and its prohibition in psychiatric hospitalization

    Directory of Open Access Journals (Sweden)

    Renata Marques de Oliveira

    2014-06-01

    Full Text Available Objective: To identify the opinion of patients with mental disorder about tobacco and its prohibition during psychiatric hospitalization. Method: An exploratory study with 96 patients smokers with mental disorders hospitalized in a psychiatric ward of a general hospital. The interviews were conducted individually, using an instrument designed for this study. The content from the interviews was recorded, transcribed and submitted to a thematic content analysis. Results: The patients with mental disorder were identified as perceiving smoking during the psychiatric hospitalization as a help to support the difficulties in socialization and in the lack of activities. The permission for smoking is seen as a signal of respect to their needs. The subjects mentioned to not accept the total smoking prohibition. Conclusion: Tobacco helps to face difficulties and conflicts in the psychiatric hospitalization. There is resistance regarding the possibility to totally withdraw the smoking permission during hospitalization.

  2. Attitudes towards mentally ill in professionals working in Ndera neuropsychiatric hospital in Rwanda 

    OpenAIRE

    Ngirababyeyi, Alfred

    2012-01-01

    ABSTRACT: This quantitative study investigated the attitudes toward the mentally ill in professionals working in Ndera neuropsychiatric hospital. The research questions explored were centered on the attitudes of directly involved and supportive professionals toward mentally ill clients and also on the difference between the attitudes of directly involved and supportive professionals toward mentally ill clients and demographic variables. The purpose of this study was to determine whether...

  3. Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics.

    Science.gov (United States)

    McCormick, Danny; Hanchate, Amresh D; Lasser, Karen E; Manze, Meredith G; Lin, Mengyun; Chu, Chieh; Kressin, Nancy R

    2015-04-01

    To examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics) from Massachusetts and three control states. Difference in differences analysis to identify the change, overall and according to race/ethnicity, adjusted for secular changes unrelated to reform. Hospitals in Massachusetts, New York, New Jersey, and Pennsylvania, United States. Adults aged 18-64 (those most likely to have been affected by the reform) admitted for any of 12 ACSCs in the 21 months before and after the period during which reform was implemented (July 2006 to December 2007). Admission rates for a composite of all 12 ACSCs, and subgroup composites of acute and chronic ACSCs. After adjustment for potential confounders, including age, race and ethnicity, sex, and county income, unemployment rate and physician supply, we found no evidence of a change in the admission rate for overall composite ACSC (1.2%, 95% confidence interval -1.6% to 4.1%) or for subgroup composites of acute and chronic ACSCs. Nor did we find a change in disparities in admission rates between black and white people (-1.9%, -8.5% to 5.1%) or white and Hispanic people (2.0%, -7.5% to 12.4%) for overall composite ACSC that existed in Massachusetts before reform. In analyses limited to Massachusetts only, we found no evidence of a change in admission rate for overall composite ACSC between counties with higher and lower rates of uninsurance at baseline (1.4%, -2.3% to 5.3%). Massachusetts reform was not associated with significantly lower overall or racial and ethnic disparities in rates of admission to hospital for ACSCs. In the US, and Massachusetts in particular, additional efforts might be needed to improve access to outpatient care and reduce

  4. Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

    Science.gov (United States)

    Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

    2015-01-01

    High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is

  5. Effects on the medical revenue of comprehensive pricing reform in Chinese urban public hospitals after removing drug markups: case of Nanjing.

    Science.gov (United States)

    Tang, Wenxi; Xie, Jing; Lu, Yijuan; Liu, Qizhi; Malone, Daniel; Ma, Aixia

    2018-04-01

    The State Council of China requires that all urban public hospitals must eliminate drug markups by September 2017, and that hospital drugs must be sold at the purchase price. Nanjing-one of the first provincial capital cities to implement the reform-is studied to evaluate the effects of the comprehensive reform on drug prices in public hospitals, and to explore differential compensation plans. Sixteen hospitals were selected, and financial data were collected over the 48-month period before the reform and for 12 months after the reform. An analysis was carried out using a simple linear interrupted time series model. The average difference ratio of drug surplus fell 13.39% after the reform, and the drug markups were basically eliminated. Revenue from medical services showed a net growth of 28.25%. The overall compensation received from government financial budget and medical service revenue growth was 103.69% for the loss from policy-permitted 15% markup sales, and 116.48% for the net loss. However, there were large differences in compensation levels at different hospitals, ranging from -21.92% to 413.74% by medical services revenue growth, causing the combined rate of both financial and service compensation to vary from 28.87-413.74%, There was a significant positive correlation between the services compensation rate and the proportion of medical service revenue (p revenue. Nanjing's pricing and compensation reform has basically achieved the policy targets of eliminating the drug markups, promoting the growth of medical services revenue, and adjusting the structure of medical revenue. However, the growth rate of service revenue of hospitals varied significantly from one another. Nanjing's reform represents successful pricing and compensation reform in Chinese urban public hospitals. It is recommended that a differentiated and dynamic compensation plan should be established in accordance with the revenue structure of different hospitals.

  6. Mental Health Law Reform: The Impact on Children and Young People in Northern Ireland

    Science.gov (United States)

    Niwa, Laura

    2007-01-01

    The Bamford Review of Mental Health and Learning Disability (Northern Ireland) was established in October 2002 to examine all aspects of the law, policy and provisions that affect people with mental health needs or a learning disability in Northern Ireland. Its report "A Comprehensive Legislative Framework," which deals with the reform…

  7. Mental Health Reforms in Europe: Further Evaluation of the Dutch Supervision System for Suicides of Mental Health Care Users

    NARCIS (Netherlands)

    Huisman, A.; Robben, P.B.M.; Kerkhof, A.J.F.M.

    2013-01-01

    Until recently, suicides of mental health care users in the Netherlands had to be reported to the Health Care Inspectorate by treating clinicians and medical directors. Interview data from 38 clinicians who reported a suicide and directors of the 28 facilities where they worked indicated ambivalence

  8. 'These schemes will win for themselves the confidence of the people': irish independence, poor law reform and hospital provision.

    Science.gov (United States)

    Lucey, Donnacha Seán

    2014-01-01

    This article examines hospital provision in Ireland during the early twentieth century. It examines attempts by the newly independent Irish Free State to reform and de-stigmatise medical relief in former workhouse infirmaries. Such reforms were designed to move away from nineteenth century welfare regimes which were underpinned by principles of deterrence. The reform initiated in independent Ireland - the first attempted break-up of the New Poor Law in Great Britain or Ireland - was partly successful. Many of the newly named County and District Hospitals provided solely for medical cases and managed to dissociate such health care provision from the relief of poverty. However, some hospitals continued to act as multifunctional institutions and provided for various categories including the sick, the aged and infirm, 'unmarried mothers' and 'harmless lunatics'. Such institutions often remained associated with the relief of poverty. This article also examines patient fee-payment and outlines how fresh terms of entitlement and means-testing were established. Such developments were even more pronounced in voluntary hospitals where the majority of patients made a financial contribution to their treatment. The article argues that the ability to pay at times determined the type of provision, either voluntary or rate-aided, available to the sick. However, it concludes that the clinical condition of patients often determined whether they entered a more prestigious voluntary hospital or the former workhouse. Although this article concentrates on two Irish case studies, County Kerry and Cork City; it is conceptualised within wider developments with particular reference to the British context.

  9. Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings

    Directory of Open Access Journals (Sweden)

    Montse Ballbè

    2016-09-01

    Full Text Available Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain. To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units. Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.

  10. [The Need of a New Integral Approach to the Care of Patient with Severe Mental Disorder Thirty Years after the Psychiatric Reform].

    Science.gov (United States)

    Madoz-Gúrpide, Agustín; Ballesteros Martín, Juan Carlos; Leira Sanmartín, Mónica; García Yagüe, Ernesto

    2017-01-18

    More than thirty years have passed since the beginning of the psychiatric reform, a period of intense and relevant social, scientific and cultural changes which have directly impacted on mental disorders and their management. Improvement in psychopharmacological treatment, a new model of physician-patient relationship, patient´s empowerment as a key issue and the fight against social stigma related to mental health disorders, changes in clinical governance and health policy, the assistential burden derived from the treatment of less severe pathology in mental health community centers, improvements in teamwork and coordination with other resources involved… are some of the relevant changes which determine the scene of community-based mental health assistance. We think this is a right time to check the state of the community-based care programmes for severe mental disorders, and the role of mental health center. We propose to have a reflexion about two relevant topics: where we are and where we are heading.

  11. Deinstitutionalisation for long-term mental illness: cost differences in hospital and community care.

    Science.gov (United States)

    Lapsley, H M; Tribe, K; Tennant, C; Rosen, A; Hobbs, C; Newton, L

    2000-06-01

    This project studied the cost analysis of psychiatric hospital and then community care for long-stay patients with chronic mental illness discharged during the closure of a psychiatric hospital in Sydney. Expenditure and income data in both settings were collected. Costs were analysed on an occupied bed-day basis. The hospital setting cost more per patient per day compared with the various community costs which were one-third to one-half of the comparable hospital costs. The analysis demonstrated overall that hospital care was nearly twice as expensive as care in the community setting. The factors which may have influenced, although not necessarily altered, the substance of the findings largely related to 'organisational efficiency'. The mental hospital as an older, more rigid system was likely to be less efficient than the newer community service provision which was under intensive scrutiny both clinically and financially by all interested parties.

  12. A reforma e os hospitais psiquiátricos: histórias da desinstitucionalização Reform and psychiatric hospitals: histories of deinstitutionalization

    Directory of Open Access Journals (Sweden)

    Maria Stella Brandão Goulart

    2010-04-01

    Full Text Available Esta pesquisa investigou como o processo de Reforma da Política de saúde mental repercutiu no mais antigo hospital psiquiátrico público de Belo Horizonte, o Instituto Raul Soares, resultando em iniciativas institucionais que procuravam responder à crítica aos asilos e à cultura manicomial que emergiu desde os anos 60 (século XX, em Minas Gerais. Trata-se de um esforço historiográfico, realizado em 2007, que trabalhou com fontes documentais e orais (entrevistas com psiquiatras, psicólogos, enfermeiros e outros, recuperando informações sobre as décadas de 60, 70 e 80. O referencial teórico foi o da Análise Institucional. Foram enfocadas iniciativas instituintes que tomaram a forma de projetos assistenciais e de formação que objetivavam a reestruturação do hospital: o Ambulatório Central Roberto Resende; a Residência em Psiquiatria, o Projeto Guimarães Rosa e o Hospital Dia. São evidenciados os paradigmas de referência e o contraditório processo de desinstitucionalização.The aim of the present research is to determine how the mental health Policy Reform affected the Raul Soares Institute, the first public psychiatric hospital (asylum in Belo Horizonte, tracing institutional initiatives that aimed to respond to criticisms on the mental houses and their set of procedures in usage since the 1960s, in the state of Minas Gerais. The research became a historiographic effort, carried out in 2007, dealing with oral and documental sources (interviews with psychiatrists, psychologists, nurses and others and collecting information about facts that occurred in the 1960s, 1970s and 1980s. Institutional analysis was taken as the theoretical support. The present study focused on initiatives that assumed the format of assisting and constitutional projects that aimed to remodel the Raul Soares Institute. In addition, paradigms of references and the contradiction-marked process of deinstitutionalization were made evident.

  13. Health system organizational reform in governing Iranian public hospitals: A content analysis to comprehend the barriers in Board of Trustees' hospitals.

    Science.gov (United States)

    Jafari, Mehdi; Habibirad, Amin; Pourtaleb, Arefeh; Salarianzadeh, Mohammad Hossein

    2018-03-24

    Since the early 1990s, Iran has initiated structural and decentralization reforms in the hospital system. This policy led to the formation of a Board of Trustees (BOTs) for the governing of public educational hospitals and making important modifications in hospitals' financing. This study was conducted to identify the barriers in implementing this policy. All the Iranian Medical Sciences Universities and hospitals involved in the policy implementation were included in this qualitative study. The data were analyzed by using content analysis. In total, 403 problems were divided into 9 classes including problems related to implementing regulation, financial problems in policy implementation, problems related to faculty members, ambiguity in executive regulation, problems related to the BOTs, authority level, hospital structure, the quality and quantity of hospital human resources, and fee for services. It appears that "implementing regulation" and "financial problems" embrace over 50% of the barriers. Apparently, the new approach to hospitals' autonomy has not achieved the desired goals. Considering the contextual factor, the evidence and identification of the clear role of various stakeholders should be essential determinants. Partial implementation of this policy without paying attention to the other aspects would end in failure. The results showed insufficient budget to be the most influential factor that posed a dilemma in implementing the BOTs' policy. However, BOTs in Iranian health system need to strive toward a higher level of performance that will improve effectiveness and efficiency now more than ever. Copyright © 2018 John Wiley & Sons, Ltd.

  14. Mortality of mentally handicapped patients after mass inter-hospital ...

    African Journals Online (AJOL)

    1990-08-18

    Aug 18, 1990 ... handicapped group the death rate was as high as 58,5/1 000 because it was an older population. In our patients we observed that in spite of the preparation before transfer, and the improved facilities and nursing care afterwards, there was an increase in the death rate of mentally handicapped patients after ...

  15. Implementation of hospital-wide reform at improving access and flow: Impact on time to antibiotics in the emergency department.

    Science.gov (United States)

    Roman, Cristina P; Poole, Susan G; Dooley, Michael J; Smit, De Villiers; Mitra, Biswadev

    2016-04-01

    ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics. A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted. There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders.

    Science.gov (United States)

    Cheung, Adrienne; Somers, Julian M; Moniruzzaman, Akm; Patterson, Michelle; Frankish, Charles J; Krausz, Michael; Palepu, Anita

    2015-08-05

    Homelessness, substance use, and mental disorders each have been associated with higher rates of emergency department (ED) use and hospitalization. We sought to understand the correlation between ED use, hospital admission, and substance dependence among homeless individuals with concurrent mental illness who participated in a 'Housing First' (HF) intervention trial. The Vancouver At Home study consisted of two randomized controlled trials addressing homeless individuals with mental disorders who have "high" or "moderate" levels of need. Substance dependence was determined at baseline prior to randomization, using the Mini International Neuropsychiatric Interview diagnostic tool, version 6.0. To assess health service use, we reviewed the number of ED visits and the number of hospital admissions based on administrative data for six urban hospitals. Negative binomial regression modeling was used to test the independent association between substance dependence and health service use (ED use and hospitalization), adjusting for HF intervention, age, gender, ethnicity, education, duration of lifetime homelessness, mental disorders, chronic health conditions, and other variables that were selected a priori to be potentially associated with use of ED services and hospital admission. Of the 497 homeless adults with mental disorders who were recruited, we included 381 participants in our analyses who had at least 1 year of follow-up and had a personal health number that could be linked to administrative health data. Of this group, 59% (n = 223) met criteria for substance dependence. We found no independent association between substance dependence and ED visits or hospital admissions [rate ratio (RR) = 0.85; 95% CI 0.62-1.17 and RR = 1.21; 95% CI 0.83-1.77, respectively]. The most responsible diagnoses (defined as the diagnosis that accounts for the length of stay) for hospital admissions were schizo-affective disorder, schizophrenia-related disorder, or bipolar affective

  17. What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China.

    Science.gov (United States)

    Fang, Pengqian; Luo, Zhenni; Fang, Zi

    2015-05-16

    In China, public hospital reform has been underway for almost 5 years, and 311 pilot county hospitals are the current focus. This study aimed to assess the job satisfaction and active participation of medical staff in the reform. A total of 2268 medical staff members in pilot and non-pilot county hospitals in Hubei, China, were surveyed. Questionnaires were used to collect data. The Pearson chi-square statistical method was used to assess the differences between pilot and non-pilot county hospitals and identify the factors related to job satisfaction as well as the understanding and perception of the reform. Binary logistic regression was performed to determine the significant factors that influence the job satisfaction of medical staff in pilot county hospitals. Medical staff members in pilot county hospitals expressed higher satisfaction on current working situation, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P job and they have evidently less satisfaction on compensation packages and learning and training opportunities. The working hours and work stress were negatively related to the job satisfaction (P Satisfaction on the performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction (P influencing factors of job satisfaction and focus on the reasonable demands of medical staff. In addition, the medical staff in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence, but there still were some medical staff members who hold negative attitude. The publicity and education of the public hospital reform still need improvement.

  18. Hospitality and the mental health of children and families.

    Science.gov (United States)

    Pohl, Christine D

    2011-10-01

    In many ancient cultures, hospitality was a significant moral and religious practice in responding to the needs of strangers. Although largely trivialized in contemporary society, the practice of hospitality continues to create contexts that contribute to individual and communal flourishing and that resist several dehumanizing social trends. A recovery of the practice can help faith communities connect their moral and theological commitments to the needs of children, families, and neighborhoods. © 2011 American Orthopsychiatric Association.

  19. Bootstrapping data envelopment analysis of efficiency and productivity of county public hospitals in Eastern, Central, and Western China after the public hospital reform.

    Science.gov (United States)

    Wang, Man-Li; Fang, Hai-Qing; Tao, Hong-Bing; Cheng, Zhao-Hui; Lin, Xiao-Jun; Cai, Miao; Xu, Chang; Jiang, Shuai

    2017-10-01

    China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis (DEA) to evaluate the technical efficiency (TE) and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals (39, 45, and 43 in Eastern, Central, and Western China, respectively) were collected during 2012-2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal-Wallis H test and Mann-Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency (PTE), and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012-2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012-2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county

  20. Workers' load and job-related stress after a reform and work system change in a hospital kitchen in Japan.

    Science.gov (United States)

    Matsuzuki, Hiroe; Haruyama, Yasuo; Muto, Takashi; Aikawa, Kaoru; Ito, Akiyoshi; Katamoto, Shizuo

    2013-03-01

    Many kitchen work environments are considered to be severe; however, when kitchens are reformed or work systems are changed, the question of how this influences kitchen workers and environments arises. The purpose of this study is to examine whether there was a change in workload and job-related stress for workers after a workplace environment and work system change in a hospital kitchen. The study design is a pre-post comparison of a case, performed in 2006 and 2008. The air temperature and humidity in the workplace were measured. Regarding workload, work hours, fluid loss, heart rate, and amount of activity [metabolic equivalents of task (METs)] of 7 and 8 male subjects pre- and post-reform, respectively, were measured. Job-related stress was assessed using a self-reporting anonymous questionnaire for 53 and 45 workers pre- and post-system change, respectively. After the reform and work system change, the kitchen space had increased and air-conditioners had been installed. The workplace environment changes included the introduction of temperature-controlled wagons whose operators were limited to male workers. The kitchen air temperature decreased, so fluid loss in the subjects decreased significantly. However, heart rate and METs in the subjects increased significantly. As for job-related stress, although workplace environment scores improved, male workers' total job stress score increased. These results suggest that not only the workplace environment but also the work system influenced the workload and job stress on workers.

  1. Liaison psychiatry professionals' views of general hospital care for patients with mental illness: The care of patients with mental illness in the general hospital setting.

    Science.gov (United States)

    Noblett, J; Caffrey, A; Deb, T; Khan, A; Lagunes-Cordoba, E; Gale-Grant, O; Henderson, C

    2017-04-01

    Explore the experiences of liaison psychiatry professionals, to gain a greater understanding of the quality of care patients with mental illness receive in the general hospital setting; the factors that affect the quality of care; and their insights on interventions that could improve care. A survey questionnaire and qualitative in depth interviews were used to collect data. Data collection took place at the Royal College of Psychiatrists Faculty of Liaison Psychiatry Annual conference. Qualitative analysis was done using thematic analysis. Areas of concern in the quality of care of patients with co-morbid mental illness included 'diagnostic overshadowing', 'poor communication with patient', 'patient dignity not respected' and 'delay in investigation or treatment'. Eleven contributing factors were identified, the two most frequently mentioned were 'stigmatising attitudes of staff towards patients with co-morbid mental illness' and 'complex diagnosis'. The general overview of care was positive with areas for improvement highlighted. Interventions suggested included 'formal education' and 'changing the liaison psychiatry team'. The cases discussed highlighted several areas where the quality of care received by patients with co-morbid mental illness is lacking, the consequences of which could be contributing to physical health disparities. It was acknowledged that it is the dual responsibility of both the general hospital staff and liaison staff in improving care. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Consumer perspectives and mental health reform movements in the United States: 30 years of first-person accounts.

    Science.gov (United States)

    Gumber, Shinakee; Stein, Catherine H

    2013-09-01

    The present qualitative study examined 69 published first-person accounts written by adults diagnosed with schizophrenia from 1979-2010 within the historical context of the four major mental health movements in the United States. Content analysis techniques were used to identify major topics and overarching content categories in the first-person accounts written over the 30-year period. The frequency of topics in each content category was examined as a function of the decade and corresponding mental health movement in which accounts were published. Five overarching content categories emerged reflecting authors' conceptualizations of schizophrenia, their experiences with psychiatric hospitalization, medications, coping with social stigma, and achieving and maintaining valued social roles. Two summary categories emerged reflecting authors explicit views about what helped and what did not help in their experience of living with schizophrenia. With the exception of social stigma, frequency of topics within content categories did not change as a function of decade and corresponding mental health movement. Despite changes in mental health policies, treatment, and systems of care, the overall lack of significant differences in the content of first-person accounts across the 30-year period suggests an enduring nature to the experiences of individuals coping with schizophrenia. Implications of present findings for research and practice are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  3. Patient-controlled hospital admission for patients with severe mental disorders

    DEFF Research Database (Denmark)

    Thomsen, Christoffer Torgaard; Benros, Michael Eriksen; Hastrup, Lene Halling

    2016-01-01

    INTRODUCTION: Patient-controlled hospital admission for individuals with severe mental disorders is a novel approach in mental healthcare. Patients can admit themselves to a hospital unit for a short stay without being assessed by a psychiatrist or contacting the emergency department. Previous...... the use of coercive measures and of healthcare services, the use of medications and suicidal behaviour. Descriptive statistics will be used to investigate hospitalisations, global assessment of functioning (GAF) and patient satisfaction with treatment. To minimise selection bias, we will match individuals...

  4. Perspectives of hospitalized patients with mental disorders and their clinicians on vocational goals, barriers, and steps to overcome barriers

    NARCIS (Netherlands)

    Knaeps, J.; Neyens, I.; van Weeghel, Jaap; Van Audenhove, C.

    2015-01-01

    Background: People with mental disorders experience difficulties with finding competitive jobs. In countries with longer psychiatric hospitalization periods, the vocational rehabilitation process can start during hospitalization. Yet, rehabilitation can be hindered by a lack of focus by clinicians

  5. When and why should mentally ill prisoners be transferred to secure hospitals: a proposed algorithm.

    Science.gov (United States)

    Vogel, Tobias; Lanquillon, Stefan; Graf, Marc

    2013-01-01

    For reasons well known and researched in detail, worldwide prevalence rates for mental disorders are much higher in prison populations than in general, not only for sentenced prisoners but also for prisoners on remand, asylum seekers on warrant for deportation and others. Moreover, the proportion of imprisoned individuals is rising in most countries. Therefore forensic psychiatry must deal not only with the typically young criminal population, vulnerable to mental illness due to social stress and at an age when rates of schizophrenia, suicide, drug abuse and most personality disorders are highest, but also with an increasingly older population with age-related diseases such as dementia. While treatment standards for these mental disorders are largely published and accepted, and scientific evidence as to screening prisoners for mental illness is growing, where to treat them is dependent on considerations for public safety and local conditions such as national legislation, special regulations and the availability of treatment facilities (e.g., in prisons, in special medical wards within prisons or in secure hospitals). While from a medical point of view a mentally ill prisoner should be treated in a hospital, the ultimate decision must consider these different issues. In this article the authors propose an algorithm comprising screening procedures for mental health and a treatment chain for mentally ill prisoners based on treatment facilities in prison, medical safety, human rights, ethics, and the availability of services at this interface between prison and medicine. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Managing between the agendas: implementing health care reform policy in an acute care hospital.

    Science.gov (United States)

    Sorensen, Roslyn; Paull, Glenn; Magann, Linda; Davis, JanMaree

    2013-01-01

    This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance. A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units. This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised. The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect. While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation. This paper addresses a significant problem in health service governance, namely the divide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.

  7. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder.

    Science.gov (United States)

    Rayner, L; Matcham, F; Hutton, J; Stringer, C; Dobson, J; Steer, S; Hotopf, M

    2014-01-01

    To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings.

    Science.gov (United States)

    Ballbè, Montse; Gual, Antoni; Nieva, Gemma; Saltó, Esteve; Fernández, Esteve

    2016-01-01

    Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals -the early adopters- based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Mental Health and Job Burnout Among Pre-Hospital Emergency Care Personnel

    Directory of Open Access Journals (Sweden)

    Mahsa Haji Mohammad Hoseini

    2017-01-01

    Full Text Available Background: Work environment dictates physical, social and mental tensions each of which affect the staff’s health. Likewise, pre-hospital emergency care staff, due to the special nature of their job, are exposed to the tensions of emergency situations which can affect their health. Therefore, this study was conducted to scrutinize the relationship between the job burnout and mental health in pre-hospital emergencies of Qom Province. Materials and Methods: In this descriptive sectional study, 150 employed personnel of Qom 115 Emergency Care entered the study using census method. Data were gathered using questionnaires of “Background and Clinical Information”, “Mental Health”, and “Job Burnout”, and then based on central indices, Pearson correlation test and multiple linear regression statistical tests were run through software SPSS13 and then analyzed. Results: The average age of the participants was 30.8±5.8. The averages of the values of burnout and mental health were 69.43±12.4 and 60±14.1, respectively. According to Pearson correlation test, the values of the burnout and mental health have a significant negative correlation (r=-0.8. The results of multiple linear regression test showed that the correlation of the burnout and mental health considering the confounding variables is significant. (P=0.05 Conclusion: Pre-hospital employed personnel have desirable mental health and [low] burnout. Furthermore, improved mental health results in decreasing job burnout. Therefore, it is advisable to consider necessary facilities for caring for oneself.

  10. Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions.

    Science.gov (United States)

    Cecil, Elizabeth; Bottle, Alex; Sharland, Mike; Saxena, Sonia

    2015-01-01

    We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions. We conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004. The introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission. © 2015 Annals of Family Medicine, Inc.

  11. Gender differences in recurrent mental health contact after a hospitalization for interpersonal violence: Western Australia, 1997 to 2008.

    Science.gov (United States)

    Meuleners, Lynn B; Fraser, Michelle L

    2015-01-01

    Interpersonal violence and mental illness are significant public health issues. This study aimed to determine gender differences in risk factors for recurrent mental health contacts after a hospitalization for interpersonal violence in Western Australia between 1997 and 2008. This population-based retrospective cohort study used linked hospital morbidity data and mental health records to identify individuals who were hospitalized due to interpersonal violence and had recurrent mental health contacts following hospitalization. A total of 1,969 individuals had a first-ever mental health contact after their index hospitalization for violence. The most common reasons for a mental health contact after interpersonal violence hospitalization were anxiety and/or depression (n = 396, 20.1%), neurotic disorders (n=338, 11.8%), schizophrenia (n=232, 11.8%), and psychoactive substance use (n = 206, 10.5%). Different risk factors for recurrent contact with mental health services emerged for males and females. For males, factors significantly associated with increased risk of recurrent mental health contacts included advancing age and not being married. However, for females, type of violence, Indigenous status, age, and living in rural or remote areas affected the risk of recurrent mental health contacts, whereas marital status did not. These findings have implications for the targeting of mental health prevention programs tailored specifically for males and females affected by violence. © The Author(s) 2014.

  12. 42 CFR 440.10 - Inpatient hospital services, other than services in an institution for mental diseases.

    Science.gov (United States)

    2010-10-01

    ... an institution for mental diseases. 440.10 Section 440.10 Public Health CENTERS FOR MEDICARE... for mental diseases. (a) Inpatient hospital services means services that— (1) Are ordinarily furnished... and treatment of patients with disorders other than mental diseases; (ii) Is licensed or formally...

  13. Relationship between mental workload and musculoskeletal disorders among Alzahra Hospital nurses.

    Science.gov (United States)

    Habibi, Ehsanollah; Taheri, Mohamad Reza; Hasanzadeh, Akbar

    2015-01-01

    Musculoskeletal disorders (MSDs) are a serious problem among the nursing staff. Mental workload is the major cause of MSDs among nursing staff. The aim of this study was to investigate the mental workload dimensions and their association with MSDs among nurses of Alzahra Hospital, affiliated to Isfahan University of Medical Sciences. This descriptive cross-sectional study was conducted on 247 randomly selected nurses who worked in the Alzahra Hospital in Isfahan, Iran in the summer of 2013. The Persian version of National Aeronautics and Space Administration Task Load Index (NASA-TLX) (measuring mental load) specialized questionnaire and Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used for data collection. Data were collected and analyzed by Pearson correlation coefficient and Spearman correlation coefficient tests in SPSS 20. Pearson and Spearman correlation tests showed a significant association between the nurses' MSDs and the dimensions of workload frustration, total workload, temporal demand, effort, and physical demand (r = 0.304, 0.277, 0.277, 0.216, and 0.211, respectively). However, there was no significant association between the nurses' MSDs and the dimensions of workload performance and mental demand (P > 0.05). The nurses' frustration had a direct correlation with MSDs. This shows that stress is an inseparable component in hospital workplace. Thus, reduction of stress in nursing workplace should be one of the main priorities of hospital managers.

  14. Patterns of treatment seeking behavior for mental illnesses in Southwest Ethiopia: a hospital based study

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    Tesfaye Markos

    2011-08-01

    Full Text Available Abstract Background Early recognition of the signs and symptoms of mental health disorders is important because early intervention is critical to restoring the mental as well as the physical and the social health of an individual. This study sought to investigate patterns of treatment seeking behavior and associated factors for mental illness. Methods A quantitative, institution-based cross sectional study was conducted among 384 psychiatric patients at Jimma University Specialized Hospital (JUSH located in Jimma, Ethiopia from March to April 2010. Data was collected using a pretested WHO encounter format by trained psychiatric nurses. Data was analyzed using SPSS V.16. Result Major depression disorder 186 (48.4%, schizophrenia 55 (14.3% and other psychotic disorders 47 (12.2% were the most common diagnoses given to the respondents. The median duration of symptoms of mental illness before contact to modern mental health service was 52.1 weeks. The main sources of information for the help sought by the patients were found to be family 126 (32.8% and other patients 75 (19.5%. Over a third of the patients 135 (35.2%, came directly to JUSH. Half of the patients sought traditional treatment from either a religious healer 116 (30.2% or an herbalist 77 (20.1% before they came to the hospital. The most common explanations given for the cause of the mental illness were spiritual possession 198 (51.6% and evil eye 61 (15.9%, whereas 73 (19.0% of the respondents said they did not know the cause of mental illnesses. Nearly all of the respondents 379 (98.7% believed that mental illness can be cured with modern treatment. Individuals who presented with abdominal pain and headache were more likely to seek care earlier. Being in the age group 31-40 years had significant statistical association with delayed treatment seeking behavior. Conclusions There is significant delay in modern psychiatric treatment seeking in the majority of the cases. Traditional healers

  15. Health Reform and its Impact on Healthcare Workers: A Case Study of the National Clinical Hospital of Cordova, Argentina

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    Carlos Álvarez

    2007-10-01

    Full Text Available Since the mid 1990’s, health in Argentina has no longer been considered a social function of the State but was transformed into a market commodity. Neoliberal decentralization favored the introduction of corporate methods and incentivized privatization. In practice, this led to self-management for hospitals, deregulation of social services and incorporation of private capital to the public health business. This exploratory study looks at the impact of these reforms in the public health services sector. It analyzes living and working conditions, changes produced in the organization of work and their effect on labor relations and on participation in union, political and social activities by workers at the National Clinical Hospital of Cordoba, Argentina. Data was primarily collected through an interview survey of a convenience sample of 68 workers from the non-teaching staff; this represents 10% of the total professional, administrative and maintenance staff of the hospital. The interviews demonstrate deterioration in income and living conditions. Hospital self-management for these workers led to increased competition, the fragmentation in the work spaces, tension and the distrust between co-workers, as well as increased intensity in the workload of some employees. The profile of these healthcare workers is structured and marked by silence, the resolution of the conflicts by means of individual action in the workplace, and minimal participation in social-political-union or community organizations.

  16. REORGANISATION OF HOSPITAL SYSTEM – A KEY FACTOR IN REFORMATION OF THE REPUBLIC OF MOLDOVA’S HEALTH SYSTEM

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    Victor MOCANU

    2016-01-01

    Full Text Available Topicality. Starting with the middle of the ‘90s of the previous century, the Republic of Moldova started to implement a series of important reforms, aimed at improving the access and quality of the services for increasing the efficiency and the performances of the health system. The aim of the research is the analysis of the Regionalization Plan of the Hospital Services and the assessment of medical workers opinion from district and republican hospitals regarding the envisaged transformations, in order to elaborate conclusions and recommendations that will be considered at the stage of reform’s implementation. The object of the research is the physicians of different profile (therapeutic, surgical, diagnostic, which work in republican and district hospitals. Methods: questioners, statistic data analyze, comparative method. Results. The logic of the regionalization suggests a reality, and namely, the need to transfer the physicians from the republican institutions to regional hospitals will be little. As a result, it will be applied only for the provision of the highly specialized services, for the solution of the associated cases or for the use of certain sophisticated methods of diagnosis and treatment (cardiac catheterization with subsequent plasty, etc. Therefore, it can be appreciated positively the fact that only 1/5 of physicians that work in the republican hospitals accept to commute or the transfer. It is more regrettable another reality, which shows that almost ½ of the specialists from the republican medical institutions generally do not want the regionalization and boycott the reform, just when they should promote the change. It results that mainly these physicians plead for the continuous maintenance of poor quality of hospital medical assistance, for the access limitation of the rural population at quality health service and, as consequence, and the financial burden to be left on patients shoulders – a fact mentioned in all

  17. Hydrotherapy in state mental hospitals in the mid-twentieth century.

    Science.gov (United States)

    Harmon, Rebecca Bouterie

    2009-08-01

    This research describes nurses' experiences in administering "the water cure," hot or cold wet sheet packs, and continuous tub baths in state mental hospitals during the early twentieth century. Student and graduate nurses were required to demonstrate competence in hydrotherapy treatments used to calm agitated or manic patients in the era before neuroleptics. The nurses interviewed for this study indicated that, although labor intensive, hydrotherapy worked, at least temporarily. Although no longer used in state hospitals, hydrotherapy is regaining popularity with the general public and may serve as an adjunct to pharmacological treatments to calm hospitalized patients in the future.

  18. Geography and the Medicaid mental health care infrastructure: implications for health care reform.

    Science.gov (United States)

    Cummings, Janet R; Wen, Hefei; Ko, Michelle; Druss, Benjamin G

    2013-10-01

    Medicaid is the largest payer of mental health (MH) care in the United States, and this role will increase among states that opt into the Medicaid expansion. However, owing to the dearth of MH care providers who accept Medicaid, expanded coverage may not increase access to services. Facilities that provide specialty outpatient MH services and accept Medicaid compose the backbone of the community-based treatment infrastructure for Medicaid enrollees. For states that opt into the expansion, it is important to understand which local communities may face the greatest barriers to access these facilities. To examine the availability of outpatient MH facilities that accept Medicaid across US counties and whether specific types of communities are more likely to lack this infrastructure. Data from the 2008 National Survey of Mental Health Treatment Facilities and Area Resource File were merged. A generalized ordered logistic regression with state fixed effects was estimated to examine determinants of accessibility of these facilities. Covariates included the percentages of residents who are black, Hispanic, living in poverty, and living in a rural area. An ordered variable assessed whether a county had no access to outpatient MH facilities that accept Medicaid, intermediate access to these facilities (ie, ≥1 facility, but not top quintile of facility to Medicaid enrollee per capita ratio), or high access (ie, top quintile of facility to Medicaid enrollee per capita ratio). More than one-third of counties do not have any outpatient MH facilities that accept Medicaid. Communities with a larger percentage of residents who are black (marginal effect [ME] = 3.9%; 95% CI, 1.2%-6.6%), Hispanic (ME = 4.8%; 95% CI, 2.3%-7.4%), or living in a rural area (ME = 27.9%; 95% CI, 25.3%-30.4%) are more likely to lack these facilities. Many communities may face constraints on the MH safety-net system as Medicaid is expanded, especially rural communities and communities with a large

  19. The prevalence of mental health problems among older adults admitted as an emergency to a general hospital

    OpenAIRE

    Goldberg, Sarah E.; Whittamore, Kathy H.; Harwood, Rowan H.; Bradshaw, Lucy E.; Gladman, John R. F.; Jones, Rob G.

    2011-01-01

    Background: a high prevalence of co-morbid mental health problems is reported among older adults admitted to general hospitals. Setting: an 1,800 bed teaching hospital. Design: consecutive general medical and trauma orthopaedic admissions aged 70 or older were screened for mental health problems. Those screening positive were invited to undergo further assessment, and were interviewed to complete a battery of health status measurements. Results: of 1,004 patients screened, 36% had no mental h...

  20. Teaching hospital planning: a case study and the need for reform.

    Science.gov (United States)

    Davis, Christopher K; Smith, Harry

    2010-08-16

    Academic teaching hospitals and their networks can best serve patients and other stakeholders by achieving critical mass and scope of clinical services, teaching and research. Successful hospital reconfigurations are associated with a convincing case and majority clinician buy-in. The inscrutable political decision to relocate services away from a major teaching hospital campus and into a merged Queensland Children's Hospital was determined without broad stakeholder consultation or a transparent and accountable business case. This compromised process poses a significant and enduring risk to patient care and Queensland's paediatric, perinatal, adolescent and obstetric academic teaching hospital services. As the proposed major stakeholder in Australia's public hospitals and medical workforce training, the federal government should review this decision using an effective methodology incorporating relevant criteria. National guidelines are needed to ensure best practice in the future planning and auditing of major health care projects. The medical profession is responsible for ensuring that health care policy complies with reliable evidence and good practice.

  1. Exposure of Mental Health Nurses to Violence in Mental Hospital : a Systematic Review

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    Iyus Yosep

    2017-10-01

    Full Text Available Shortage of nurses and declining interest in becoming a mental health nurse are often attributed to workplace distress and violence. These have become global issues and believed that shortage of nurses decreases the quality of health care services. It leads distress among nurses, which is exposure to violence and traumatic experiences. In addition, nurses are also accused of seizing the rights of patients and committing violence against a patient. This paper focuses on the violence that occurred in mental health nurses during working in unpredictable situation. A literature search of systematic review through the CINAHL, Medline, Google scholars and PsycInfo databases, the empirical report using a nursing sample includes data on rates of violence exposure including violence, aggressive behavior, bullying, and sexual harassment. The result, a total of 400 articles provide data on 2742 publications indicates near all of nurses in mental health experienced verbal abuse in the past month, furthermore, most of respondents’ ever experienced psychological abuse, and less of respondents experienced physical violence and sexual harassment. Rates of exposure vary by world region (Developed countries, Asia, Europe and Middle East, with the highest rates for physical violence and sexual harassment in the USA, Australia, United Kingdom, New Zealand region, and the highest rates of psychological violence and bullying in the Middle East. The presence of violence signals an "alarm" that violence against nurses calls for special attention in many countries. Essentially, the world must give a "priority" to handling violence against nurses.

  2. [Designing and Operating a Comprehensive Mental Health Management System to Support Faculty at a University That Contains a Medical School and University Hospital].

    Science.gov (United States)

    Kawanishi, Chiaki

    2016-01-01

    In Japan, healthcare professionals and healthcare workers typically practice a culture of self-assessment when it comes to managing their own health. Even where this background leads to instances of mental health disorders or other serious problems within a given organization, such cases are customarily addressed by the psychiatrists or psychiatric departments of the facilities affected. Organized occupational mental health initiatives for professionals and workers within the healthcare system are extremely rare across Japan, and there is little recognition of the need for such initiatives even among those most directly affected. The author has some experience designing and operating a comprehensive health management system to support students and faculty at a university in the Tokyo Metropolitan Area that contains a medical school and university hospital. At this university, various mental health-related problems were routinely being allowed to develop into serious cases, while the fundamental reforms required by the health management center and the mental health management scheme organized through the center had come to represent a challenge for the entire university. From this initial situation, we undertook several successive initiatives, including raising the number of staff in the health management center and its affiliated organizations, revising and drafting new health management rules and regulations, launching an employment support and management system, implementing screenings to identify people with mental ill-health, revamping and expanding a counselling response system, instituting regular collaboration meetings with academic affairs staff, and launching educational and awareness-raising activities. This resulted in the possibility of intervention in all cases of mental health crisis, such as suicidal ideation. We counted more than 2,400 consultations (cumulative total number; more than half of consultations was from the medical school, postgraduate

  3. China's Health Reform Update.

    Science.gov (United States)

    Liu, Gordon G; Vortherms, Samantha A; Hong, Xuezhi

    2017-03-20

    China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

  4. Mental Health promotion of a hospital through the nurse in the liaison psychiatry team

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    Natalia Cámara Conde

    2008-09-01

    Full Text Available We show a proposal to increase the quality of nursing cares, improving mental health care of hospitalized patients by creating the figure of the liaison nurse within the liaison psychiatry team. This nurse would not only be a reference to support the nursing staff at the level of patient care, but also the psycho-emotional self-care professional.Objectives: Justifying the need to include the figure of the specialist mental health team liaison psychiatry nurse. Method: The rotation as residents, for a month, with the interconsultation team psychiatric hospital Gregorio Marañón and literature review. Results: There have been partially unmet needs, these could be covered with the existence of a nurse specialist in mental health consultation in this hospital. Discussion: Possibly it poses difficulties in defining the roles of various liaison team professionals, which we expect can be defined at the start implementing the new member.The hospital itself has an own field defined, articulated through the NANDA, NIC, NOC methodology, which covers aspects that so far have not being made, there is not a nurse figure into the psychiatric consultation liaison team.

  5. [Investigation of verdicts of civil suits brought against hospitals involving crimes committed by mental hospital inpatients with psychotic disorders].

    Science.gov (United States)

    Nakajima, N

    2001-01-01

    The author investigated 11 verdicts of Japanese civil suits brought against hospitals involving crimes committed by mental hospital inpatients with psychotic disorders, principally by victims of injuries or by surviving relatives of homicide victims. About the half of the verdicts are based on the same logic. First, a detailed, case-specific investigation was performed. In some cases it was proven that the accidents could not have been predicted, and the suits were dismissed. In others the plaintiffs won the suits, because it was found that the violent acts were predictable and that the hospital staff had the means to prevent them. These verdicts require the hospital staff to predict the patient's actions according to the psychiatric history and present condition and then to make an appropriate response. This process is similar to the clinical decision-making process, although there have been some dubious findings in some of the court cases. However, the author also found that some verdicts were inappropriate and insufficient in that there was no individual investigation of the offender. Examining all 11 verdicts, the author found that the type of admission procedure adopted for the offender, whether they had a past history of violence, and whether the hospital was public or private did not seem to be significant to the judges in making their decisions.

  6. A model of facilitative communication for support of general hospital nurses nursing mentally ill people

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    TR Mavundla

    2001-09-01

    Full Text Available Part 1 of this article dealt with a full description of the research design and methods. This article aims at describing a model of facilitative communication to support general hospital nurses nursing the mentally-ill. In this article a model of facilitative communication applicable to any general hospital setting is proposed. Fundamental assumptions and relationship statements are highlighted and the structure and process of facilitative communication is described according to the three steps employed: 1 assisting the general hospital nurse learn the skill; 2 assisting the general hospital nurse practise the skill in order to develop confidence; and 3 using the skill in a work setting. The guidelines for operationalising this model are dealt with in the next article. The evaluation of the model is also briefly described.

  7. Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation.

    Science.gov (United States)

    Taube-Schiff, Marlene; Mehak, Adrienne; Marangos, Sandy; Kalim, Anastasia; Ungar, Thomas

    2017-11-13

    Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

  8. Patients' Perspectives on Stigma of Mental Illness(An Egyptian Study in a private hospital

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    Emad eSidhom

    2014-11-01

    Full Text Available The present study is concerned with the stigma of mental illness. It examines the subjective element of the experience of stigma among a sample of in-patients with different mental disorders. The sample was taken from consecutive admissions of in-patients meeting ICD-10 criteria for mental disorders who had capacity to decide on participation in the study and were willing to respond to the structured interview. The study was undertaken in an Egyptian private psychiatric hospital. The structured clinical interview included aspects of the emotional, behavioral and cognitive effects of having a psychiatric diagnosis on in-patients with various diagnostic labels in an Egyptian psychiatric hospital. It also studied whether this effect changes with specific disorders, total duration of illness or sociodemographic variables as gender, age or educational level. The study illustrated the core items of stigmatization attached to the diagnosis of mental illness (Sidhom et al, 2012, which more than half of the participants responded affirmatively. The study aimed to explore the most prevailing aspects of stigma or social disadvantage; hoping that this may offer a preliminary guide for clinicians to address these issues in their practice.

  9. Hospital reform and staff morale in South Africa: a case study of Dr ...

    African Journals Online (AJOL)

    2012-02-16

    Feb 16, 2012 ... Settings and subjects: This study included all medical and nursing staff working at the district hospital. Outcome measures: A ..... The nurses and doctors work as a team at my workplace. 58. 40. 64. 58. 0.5. The staff .... important motivating factors for healthcare workers.7. Conclusion. The dynamics of staff ...

  10. Hospital reform and staff morale in South Africa: a case study of Dr ...

    African Journals Online (AJOL)

    Settings and subjects: This study included all medical and nursing staff working at the district hospital. Outcome measures: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction, demographic information and a list of factors to which participants responded by indicating ...

  11. Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness.

    Science.gov (United States)

    Rüsch, Nicolas; Müller, Mario; Lay, Barbara; Corrigan, Patrick W; Zahn, Roland; Schönenberger, Thekla; Bleiker, Marco; Lengler, Silke; Blank, Christina; Rössler, Wulf

    2014-02-01

    Compulsory admission to psychiatric inpatient treatment can be experienced as disempowering and stigmatizing by people with serious mental illness. However, quantitative studies of stigma-related emotional and cognitive reactions to involuntary hospitalization and their impact on people with mental illness are scarce. Among 186 individuals with serious mental illness and a history of recent involuntary hospitalization, shame and self-contempt as emotional reactions to involuntary hospitalization, the cognitive appraisal of stigma as a stressor, self-stigma, empowerment as well as quality of life and self-esteem were assessed by self-report. Psychiatric symptoms were rated by the Brief Psychiatric Rating Scale. In multiple linear regressions, more self-stigma was predicted independently by higher levels of shame, self-contempt and stigma stress. A greater sense of empowerment was related to lower levels of stigma stress and self-contempt. These findings remained significant after controlling for psychiatric symptoms, diagnosis, age, gender and the number of lifetime involuntary hospitalizations. Increased self-stigma and reduced empowerment in turn predicted poorer quality of life and reduced self-esteem. The negative effect of emotional reactions and stigma stress on quality of life and self-esteem was largely mediated by increased self-stigma and reduced empowerment. Shame and self-contempt as reactions to involuntary hospitalization as well as stigma stress may lead to self-stigma, reduced empowerment and poor quality of life. Emotional and cognitive reactions to coercion may determine its impact more than the quantity of coercive experiences. Interventions to reduce the negative effects of compulsory admissions should address emotional reactions and stigma as a stressor.

  12. Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals.

    Science.gov (United States)

    Yelland, Jane; Krastev, Ann; Brown, Stephanie

    2009-08-01

    four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care. to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives. 'before and after' study design incorporating two postal surveys of recent mothers (baseline and post-implementation). four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational. 1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001. the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change. mainstream maternity care can be restructured to improve women's experiences of early postnatal care. maternity service providers should consider a multi-faceted approach to reorienting postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice

  13. Essential Professional Nursing Practices in mental health: A cross-sectional study of hospital inpatient care.

    Science.gov (United States)

    Frechette, Julie; Pugnaire Gros, Catherine; B Brewer, Barbara; Kramer, Marlene; Lavigne, Geneviève; Lavoie-Tremblay, Mélanie

    2018-02-27

    Quality organizational structures and nursing practices are key to positive patient outcomes. Whereas structures have been largely studied over the past few decades, less is known of the nursing practices that account for patient outcomes, such as patient satisfaction. This is especially true in psychiatric, mental health care settings. The aim of the present study is to determine the relative importance of eight Essential Professional Nursing Practices (EPNPs) on the satisfaction of hospitalized patients on mental health care units. A cross-sectional design was selected; 226 point-of-care mental health nurses completed the online EPNP questionnaire in Spring 2015. Statistical analyses included MANOVAs and a 2-step linear regression. A significant relationship was found between university preparation and scores on two EPNP subscales: autonomous decision-making and practicing with competent nurses. Scores on patient advocacy and control over practice subscales were significantly related to nurse-rated patient satisfaction. The findings reinforce the positive link between university education and the work of nurses and highlight the power dynamics that are salient in mental health care. The pertinence of EPNPs in psychiatric settings is brought to the fore, with practices of patient advocacy and nurse control over care examined in relation to empowerment. Implications for clinical and administrative leaders are addressed, with a focus on strategies for empowering patients and nurses. © 2018 Australian College of Mental Health Nurses Inc.

  14. Screening for Common Mental Disorders and Substance Abuse among Temporary Hired Cleaners in Egyptian Governmental Hospitals, Zagazig City, Sharqia Governorate

    OpenAIRE

    RA Abbas; RAM Hammam; SS El-Gohary; LME Sabik; MS Hunter

    2012-01-01

    Background: Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. Objectives: To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. Methods: A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egyp...

  15. Medication-administration errors in an urban mental health hospital: a direct observation study.

    Science.gov (United States)

    Cottney, Alan; Innes, James

    2015-02-01

    In the present study, we aimed to identify the incidence, type, and potential clinical consequence of medication-administration errors made in a mental health hospital, and to investigate factors that might increase the risk of error. A prospective, direct observational technique was used to collect data from nurse medication rounds on each of the hospital's 43 inpatient wards. Regression analysis was used to identify potential error predictors. During the 172 medication rounds observed, 139 errors were detected in 4177 (3.3%) opportunities. The most common error was incorrect dose omission (52/139, 37%). Other common errors included incorrect dose (25/139, 18%), incorrect form (16/139, 12%), and incorrect time (12/139, 9%). Fifteen (11%) of the errors were of serious clinical severity; the rest were of negligible or minor severity. Factors that increased the risk of error included the nurse interrupting the medication round to attend to another activity, an increased number of 'when required' doses of medication administered, a higher number of patients on the ward, and an increased number of doses of medication due. These findings suggest that providers of inpatient mental health-care services should adopt medicine-administration systems that minimize task interruption and the use of 'when required' medication, as well as taking steps to reduce nursing workload. © 2014 Australian College of Mental Health Nurses Inc.

  16. Ships of fools and vessels of the divine: mental hospitals and madness, a case study.

    Science.gov (United States)

    Connor, L H

    1982-01-01

    Rural Balinese conceive of madness as a phenomenon which gives men intimations of another reality transcending the everyday world, and which reveals the possibility of more direct communication with the divine. European views of madness became gradually secularized over a period of several centuries, and were finally absorbed by the predominantly medical models of modern psychiatry. In Bali, this transformation is occurring within a much shorter time span, under different socioeconomic conditions. In this paper, I examine the ideas which traditional healers in Bali and their clients invoke about the influence of the supernatural in worldly affairs. I then contrast traditional classifications and treatments of madness with the version of Western psychiatry currently practised in mental hospitals and out-patient clinics on the island. This section of the paper is based on the author's field study of mental health services in Bali, incorporating a survey of mental hospital inpatients and their families. I conclude with a discussion of the genesis, future development and possible effects of the increase in psychiatric facilities on the island.

  17. Hospital de custódia: os direitos preconizados pela reforma psiquiátrica e a realidade dos internos Hospital de custodia: los derechos preconizados por la reforma psiquiátrica y la realidad de los internos Hospital of custody: the rights recommended by the psychiatric reform and the patients' reality

    Directory of Open Access Journals (Sweden)

    Maria Sirene Cordioli

    2006-12-01

    preconizado por el nuevo paradigma de atención al portador de trastorno mental.This is a qualitative research whose objective was to identify the patients' of a Hospital of Custody and Psychiatric Treatment (HCPT located in Florianópolis, view on the institution. The data were collected in 2004, through semi-structured interviews and participant observation. They were analyzed by establishing a parallel between the studies of Goffman on total institution and the norms recommended by the Brazilian Psychiatric Reform. Most of the interviewees referred to be HCPT as a cross between hospital and prison, predominantly of a custodial character. The treatments and the operational conditions of the institution were also questioned by the patients. The conclusion is that the institutional conditions reveal to be way different to the ones considered ideal by the Psychiatric Reform, a situation which demands the adaption of such conditions to the recommendations of the new paradigm on patient care to the mentally-ill.

  18. Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil É a reforma psiquiátrica uma estratégia para reduzir o orçamento da saúde mental? O caso do Brasil

    Directory of Open Access Journals (Sweden)

    Sérgio Baxter Andreoli

    2007-03-01

    Full Text Available OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants. Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita. CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.OBJETIVO: Investigar o desenvolvimento da infra-estrutura de serviço de saúde mental e do seu financiamento no Brasil. MÉTODO: Os dados sobre número de leitos, centros comunitários de saúde mental, profissionais de saúde mental e custos, no período de 1995 a 2005, foram coletados no sítio de internet de livre acesso do DATASUS. RESULTADOS: Em 10 anos, houve uma redução de 41% no número de leitos psiquiátricos (5,4 a 3,2 por 10.000 habitantes, enquanto os serviços comunitários aumentaram nove vezes (0

  19. Medication safety at the interface: evaluating risks associated with discharge prescriptions from mental health hospitals.

    Science.gov (United States)

    Keers, R N; Williams, S D; Vattakatuchery, J J; Brown, P; Miller, J; Prescott, L; Ashcroft, D M

    2015-12-01

    When compared to general hospitals, relatively little is known about the quality and safety of discharge prescriptions from specialist mental health settings. We aimed to investigate the quality and safety of discharge prescriptions written at mental health hospitals. This study was undertaken on acute adult and later life inpatient units at three National Health Service (NHS) mental health trusts. Trained pharmacy teams prospectively reviewed all newly written discharge prescriptions over a 6-week period, recording the number of prescribing errors, clerical errors and errors involving lack of communication about medicines stopped during hospital admission. All prescribing errors were reviewed and validated by a multidisciplinary panel. Main outcome measures were the prevalence (95% CI) of prescribing errors, clerical errors and errors involving a lack of details about medicines stopped. Risk factors for prescribing and clerical errors were examined via logistic regression and results presented as odds ratios (OR) with corresponding 95% CI. Of 274 discharge prescriptions, 259 contained a total of 1456 individually prescribed items. One in five [20·8% (95%CI 15·9-25·8%)] eligible discharge prescriptions and one in twenty [5·1% (95%CI 4·0-6·2%)] prescribed or omitted items were affected by at least one prescribing error. One or more clerical errors were found in 71·9% (95%CI 66·5-77·3%) of discharge prescriptions, and more than two-thirds [68·8% (95%CI 56·6-78·8%)] of eligible discharge prescriptions erroneously lacked information on medicines discontinued during hospital admission. Logistic regression analyses revealed that middle-grade [whole discharge prescription level OR 3·28 (3·03-3·56)] and senior [whole discharge OR 1·43 (1·04-1·96)] prescribers as well as electronic discharge prescription pro formas [whole discharge OR 2·43 (2·08-2·83)] were all associated with significantly higher risks of prescribing errors than junior prescribers and

  20. [The origin of mental hospital in Japan and its typological classification].

    Science.gov (United States)

    Omata, Waichiro

    2003-01-01

    Before the beginning of the Modernization in 1868, there were no psychiatric hospitals in the sense of Modern-Western in Japan. Instead of them, as far as I ascertained, altogether 30 asylums are existed in the whole country. They are mainly buddhistic temples and shrines, where psychotic patients and their families are treated by monks in various way. The ways of treatment are quite different, so that the typological classification of asylums is possible according to this point: 1. treatment by waterfall or water, 2. treatment with old Chinese herbal medicine, 3. treatment with collaborative conjuration associated musical instrument (drum). From the historical standpoint of view the Type 1 has oldest tradition. In the late of 11th century a daughter of the emperor was psychotic and sent into the temple Iwakura-Daiunji in northern suburb in Kyoto-City. She was treated successfully with holly waterfall and water and after this legend many psychotic patients gathered there. From the end of 14th century the Temple Juninji near the City of Okazaki began treatment with Chinese herb for the psychotics. Compared to Daiunji which belongs to Mikkyo-sect in the national Buddhism Juninji belongs to Jodoshin-sect in the frame of the reformed Buddhism. Altogether 4 temples of Type 2 are belonging to this new sect without exception and after the Modernization (Meiji-Restoration in 1868) became psychiatric hospitals. The all temples belonging to Type 3 are Nichiren-sect also in the reformed Buddhism and began the conjuration-treatment after 17th. century. The typology of asylums before the Modernization brings us necessary to the question on the origin of the ways and methods in psychiatric treatments in the history.

  1. [Closing forensic psychiatric hospitals in Italy: a new deal for mental health care?].

    Science.gov (United States)

    Casacchia, Massimo; Malavolta, Maurizio; Bianchini, Valeria; Giusti, Laura; Di Michele, Vittorio; Giosuè, Patricia; Ruggeri, Mirella; Biondi, Massimo; Roncone, Rita

    2015-01-01

    The date of March 31, 2015, following the Law 81/2014, has marked a historical transition with the final closure of the six forensic psychiatric hospitals in Italy. This law identifies a new pathway of care that involves small-scale high therapeutic profile facilities (Residenze per la Esecuzione della Misura di Sicurezza, REMS) instead of the old forensic psychiatric hospitals. The Law promotes a new recovery-oriented rehabilitation approach for the persons with mental disorders who committed a criminal offence, but lack criminal responsibility and deemed as socially dangerous. After a brief description of what happens abroad, this article highlights the positive aspects of the law that, as a whole, has to be considered innovative and unavoidable. The main debated problems are also reviewed, including the lack of changes to the Criminal Code; the improper equation between insanity and mental illness and social dangerousness; the evaluation of "socially dangerousness", based solely on "subjective qualities" of the person, assessed out of his/her context, without paying attention to family and social conditions suitable for discharge; the expensive implementation of the REMS, mainly based on security policies and less on care and rehabilitation, the delay in their construction, and the search for residential alternatives structures; the uncertain boundaries of professional responsibility. Finally, several actions are suggested that can support the implementation of the law: information programs addressed to the general population; training activities for mental health professionals; systematic monitoring and evaluation of the outcomes of the care provided to the forensic psychiatric population; implementation of Agreement Protocols and a better cooperation with the judiciary. Scientific societies dealing with psychosocial rehabilitation need to be involved in such issues relating to the identification of the best care and rehabilitation pathways, which should be

  2. Psychosocial work environment and hospital admissions due to mental disorders: a 15-year prospective study of industrial employees.

    Science.gov (United States)

    Joensuu, Matti; Väänänen, Ari; Koskinen, Aki; Kivimäki, Mika; Virtanen, Marianna; Vahtera, Jussi

    2010-07-01

    Low levels of job control and social support may increase the risk of mental disorders, particularly depression, but the evidence is mostly based on self-reports. We examined whether components of job control and work-related social support predict medically-certified mental disorders. 13868 forest company employees with no previous hospital admissions for mental disorders responded to questionnaires on decision authority, skill discretion, co-worker and supervisor support. They were followed-up for hospital admissions due to mental disorders (ICD-9 codes 290 to 319), using national hospital discharge records (577 hospitalized, mean follow-up 15.1 years). In analyses adjusted for confounders, high skill discretion was associated with a reduced risk of hospital admission for mental disorders (HR 0.74, 95% CI 0.58-0.95). High decision authority was associated with an elevated risk (HR 1.48, 95% CI 1.17-1.87). Diagnosis-specific analyses showed high skill discretion to associate with a reduced risk of both depressive and non-depressive non-alcohol-related mental disorders. High decision authority was a risk factor for alcohol-related and depressive disorders. Good co-worker support was associated with a reduced risk of non-depressive non-alcohol-related mental disorders. Supervisor support was not associated with any mental disorders. We used a single time point estimate in an industrial sample comprising largely of men. Contrary to previous research on job control, high decision authority increased the risk of depressive and alcohol-related disorders, which suggest a need to reconsider the strategies for prevention and clinical practise in regard to psychosocial work environment and mental health.

  3. Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized Veterans Health Administration and Medicare patients.

    Science.gov (United States)

    Rosen, Amy K; Loveland, Susan A; Romano, Patrick S; Itani, Kamal M F; Silber, Jeffrey H; Even-Shoshan, Orit O; Halenar, Michael J; Teng, Yun; Zhu, Jingsan; Volpp, Kevin G

    2009-07-01

    Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.

  4. The Therapeutic garden: Gaudí and the patients of the former Sant Boi Mental Hospital

    OpenAIRE

    Barbé Farré, Daniel

    2010-01-01

    Dins de l'antic hospital psiquiàtric de Sant Boi de Llobregat, actualment transformat en el Parc Sanitari Sant Joan de Déu, es conserven els rastres d'un jardí modernista inspirat en l'obra de Gaudí. Construït entre el 1903 i el 1912 amb la participació destacada dels malalts mentals, el jardí s'estructura a partir d'un conjunt de llacs, coves i cascades que van ocupant els límits interiors dels horts de l'hospital fins al punt de transformar-se en un jardí «a l'anglesa», tal com recon...

  5. Nutritional status of patients in a long-stay hospital for people with mental handicap.

    Science.gov (United States)

    Molteno, C; Smit, I; Mills, J; Huskisson, J

    2000-11-01

    To investigate the general nutritional status of patients in Alexandra Hospital, Cape Town, and to determine whether dietary copper deficiency was causing anaemia in hospital patients. Descriptive and cross-sectional analytical studies. A long-stay hospital for people with mental handicap. Information was obtained from the total hospital population. In addition, groups of 15 patients were selected from each of two specific wards, one with active and the other inactive patients. To determine whether copper deficiency was causing anaemia, a sample of 30 patients, divided into three groups (a hypochromic microcytic, a normochromic anaemic and a non-anaemic group) was studied. Body mass indices (BMI) and daily dietary intakes were compared with Recommended Daily Allowance (RDA) values. Serum copper and serum caeruloplasmin levels were used to detect possible copper deficiency. A considerable number of patients were found to be underweight (32% of males and 26% of females had BMIs 30). Poor nutrition was more common in severely handicapped patients and those with acquired causes of their mental handicap. Subjects with Down syndrome were generally well nourished and occasionally obese. Poor dietary intakes of biotin, pantothenic acid, vitamin D and copper were encountered. The serum copper and caeruloplasmin values were found to be within normal limits. Patients with hypochromic, microcytic anaemia had higher serum copper and caeruloplasmin levels than those with normochromic anaemia and the control group. A number of nutritional problems among the inpatient population were found. Many were undernourished, while a smaller number of patients were overweight. In both the active and inactive wards macronutrient intakes were generally within normal limits. However, some micronutrient nutritional deficiencies were encountered. We were unable to establish that dietary copper deficiency was the cause of anaemia in our patients. Elevated serum copper and caeruloplasmin levels

  6. Patient turnover and nursing employment in Massachusetts hospitals before and after health insurance reform: implications for the Patient Protection and Affordable Care Act.

    Science.gov (United States)

    Shindul-Rothschild, Judith; Gregas, Matt

    2013-01-01

    The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (p<.001) than that in California and New York (p=.007). The rate of change in registered nurses full-time equivalent hours per patient day was significantly less (p=.02) in Massachusetts than that in California and was not different from zero. The rate of change in admissions to registered nurses full-time equivalent hours per patient day was significantly greater in Massachusetts than California (p=.001) and New York (p<.01). Nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.

  7. From early intervention in psychosis to youth mental health reform: a review of the evolution and transformation of mental health services for young people.

    Science.gov (United States)

    Malla, Ashok; Iyer, Srividya; McGorry, Patrick; Cannon, Mary; Coughlan, Helen; Singh, Swaran; Jones, Peter; Joober, Ridha

    2016-03-01

    The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy. The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field. Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child-adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples. There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.

  8. Visa refusal following compulsory hospital admission under the Mental Health Act 1983 (England and Wales): fact or fiction?

    Science.gov (United States)

    Ashmore, R

    2015-08-01

    Historically, compulsory hospital admission led to discrimination for service users. For example, until recently detention under the Mental Health Act 1983 (England and Wales) would disqualify a person from being a Member of Parliament. There is a belief among mental health professionals that compulsory hospital admission will result in service users being refused a tourist visa. However, there is a paucity of literature on this topic, particularly from an international perspective. Based on the information reviewed in this study, there is no evidence to support this belief. Of 262 travel destinations, 96 (36.6%) require British citizens to obtain a tourist visa. Six (2.3%) destinations require applicants to declare a mental health condition in order to obtain a tourist visa. None of these destinations ask applicants to declare a history of compulsory hospital admission. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health nurses require education to ensure that their knowledge of mental health legislation is up to date. This education should include information on the potential consequences of compulsory hospital admission for the service user's social life following discharge. Service users and their families should be provided with written information on the potential social impact of detention along with a list of organizations that can provide advice on specific issues. This study sought to establish whether a history of compulsory hospital admission prevented a person from obtaining a tourist visa. A visa application form and/or other relevant information were obtained for 262 travel destinations visited by British citizens. Ninety-six (36.6%) destinations require British citizens to obtain a tourist visa. All visas are issued subject to travellers meeting a number of conditions, for example being in possession of travel insurance

  9. Categorising Patients Mental Illness by Medical Surgical Nurses in the General Hospital Ward: A Focus Group Study.

    Science.gov (United States)

    Brunero, Scott; Buus, Niels; West, Sandra

    2017-12-01

    To gain insight into medical surgical nurses' process(es) of categorising mental illness in general hospitals. Categorising patients is a daily social practice that helps medical surgical nurses understand their work and actions. Medical surgical nurses' categorising of mentally ill patients in general hospitals is a means in which they articulate their understanding of mental illness and perform their clinical practice. How medical surgical nurses categorise, and the impact that categorising can have on their work practices is poorly understood. A focus group study. Focus group discussions (n=2) of medical surgical nurses' understanding and experience of delivering care to patients with mental illness in a general tertiary referral hospital were conducted in November 2014. Discourse analysis was used to analyse the transcribed data to uncover how participants made discursive evaluations and how this related to their daily clinical practice. The analysis uncovered participant's use of four categories of mentally ill patients: the managed, the unpredictable, the emotional and the dangerous. For participants these categories explained and justified their clinical practice as linked to the challenges and barriers they experienced in providing effective care within the larger healthcare organisation. The language used by medical/surgical reflects the wider discourse of managerialism in healthcare organisations. The recognition of these categories can be used by educators, liaison mental health services and policy makers to reconsider service design and learning opportunities for medical surgical nurses to reduce stigmatisation of patients with mental illness. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Multimorbidity, Mental Illness, and Quality of Care: Preventable Hospitalizations among Medicare Beneficiaries

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    Mayank Ajmera

    2012-01-01

    Full Text Available Background. Individuals with multimorbidity are vulnerable to poor quality of care due to issues related to care coordination. Ambulatory care sensitive hospitalizations (ACSHs are widely accepted quality indicators because they can be avoided by timely, appropriate, and high-quality outpatient care. Objective. To examine the association between multimorbidity, mental illness, and ACSH. Study Design. We used a longitudinal panel design with data from multiple years (2000–2005 of Medicare Current Beneficiary Survey. Individuals were categorized into three groups: (1 multimorbidity with mental illness (MM/MI; (2 MM/no MI; (3 no MM. Multivariable logistic regressions were used to analyze the association between multimorbidity and ACSH. Results. Any ACSH rates varied from 10.8% in MM/MI group to 8.8% in MM/No MI group. Likelihood of any ACSH was higher among beneficiaries with MM/MI (AOR = 1.62; 95% CI = 1.14, 2.30 and MM (AOR = 1.54; 95% CI = 1.12, 2.11 compared to beneficiaries without multimorbidity. There was no statistically significant difference in likelihood of ACSH between MM/MI and MM/No MI groups. Conclusion. Multimorbidity (with or without MI had an independent and significant association with any ACSH. However, presence of mental illness alone was not associated with poor quality of care as measured by ACSH.

  11. Mental health and hospital chaplaincy: strategies of self-protection (case study: toronto, Canada).

    Science.gov (United States)

    Kianpour, Masoud

    2013-01-01

    This is a study about emotion management among a category of healthcare professional - hospital chaplains - who have hardly been the subject of sociological research about emotions. The aim of the study was to understand how chaplains manage their work-related emotions in order to protect their mental health, whilst also providing spiritual care. Using in-depth, semi structured interviews, the author spoke with 21 chaplains from five faith traditions (Christianity, Islam, Judaism, Buddhism and modern paganism) in different Toronto (Canada) Hospitals to see how they manage their emotion, and what resources they rely on in order to protect their mental health. Data analysis was perfumed according to Sandelowski's method of qualitative description. The average age and work experience of the subjects interviewed in this study are 52 and 9.6 respectively. 11 chaplains worked part-time and 10 chaplains worked full-time. 18 respondents were women and the sample incudes 3 male chaplains only. The findings are discussed, among others, according to the following themes: work-life balance, self-reflexivity, methods of self-care, and chaplains' emotional make-up. Emotion management per se is not a problem. However, if chaplains fail to maintain a proper work-life balance, job pressure can be harmful. As a strategy, many chaplains work part-time. As a supportive means, an overwhelming number of chaplains regularly benefit from psychotherapy and/or spiritual guidance. None.

  12. Alcoholism and degeneration in the Departmental Mental Hospital of Antioquia, Colombia (1920-1930

    Directory of Open Access Journals (Sweden)

    Alejandro Salazar Bermúdez

    2017-12-01

    Full Text Available In this article we analyze 159 clinical records of patients with diagnoses related to alcohol at the Departamental Mental Hospital of Antioquia, between the years of 1920 and 1930. In that decade an institutional transformation began with the arrival at the direction of Dr. Lázaro Uribe Calad. Besides it was very discussed in the medical and political sector the idea of the racial degeneracy, a matter in which alcoholism played a central role. It is observed in medical publications a constant concern due to the terrible consequences that the high consumption of alcohol could bring in society. However, a deeper review of sources such as the annual Statistics of the Mental Hospital and the clinical records, shows how clinical practice reflected another reality. It is concluded that both, the number of patients who were diagnosed as alcoholic or whose etiology was related to the drink, were much lower than those indicated by the doctors. These incomes mainly responded to moral and social problems, but not to psychiatric issues.

  13. A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals.

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    Gloria Ser

    Full Text Available AIMS: To investigate the perceptions and reported practices of mental health hospital staff using national hospital electronic health records (EHRs in order to inform future implementations, particularly in acute mental health settings. METHODS: Thematic analysis of interviews with a wide range of clinical, information technology (IT, managerial and other staff at two early adopter mental health National Health Service (NHS hospitals in London, UK, implementing national EHRs. RESULTS: We analysed 33 interviews. We first sought out examples of workarounds, such as delayed data entry, entering data in wrong places and individuals using the EHR while logged in as a colleague, then identified possible reasons for the reported workarounds. Our analysis identified four main categories of factors contributing to workarounds (i.e., operational, cultural, organisational and technical. Operational factors included poor system integration with existing workflows and the system not meeting users' perceived needs. Cultural factors involved users' competence with IT and resistance to change. Organisational factors referred to insufficient organisational resources and training, while technical factors included inadequate local technical infrastructure. Many of these factors, such as integrating the EHR system with day-to-day operational processes, staff training and adequate local IT infrastructure, were likely to apply to system implementations in various settings, but we also identified factors that related particularly to implementing EHRs in mental health hospitals, for example: EHR system incompatibility with IT systems used by mental health-related sectors, notably social services; the EHR system lacking specific, mental health functionalities and options; and clinicians feeling unable to use computers while attending to distressed psychiatric patients. CONCLUSIONS: A better conceptual model of reasons for workarounds should help with designing, and

  14. A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals.

    Science.gov (United States)

    Ser, Gloria; Robertson, Ann; Sheikh, Aziz

    2014-01-01

    To investigate the perceptions and reported practices of mental health hospital staff using national hospital electronic health records (EHRs) in order to inform future implementations, particularly in acute mental health settings. Thematic analysis of interviews with a wide range of clinical, information technology (IT), managerial and other staff at two early adopter mental health National Health Service (NHS) hospitals in London, UK, implementing national EHRs. We analysed 33 interviews. We first sought out examples of workarounds, such as delayed data entry, entering data in wrong places and individuals using the EHR while logged in as a colleague, then identified possible reasons for the reported workarounds. Our analysis identified four main categories of factors contributing to workarounds (i.e., operational, cultural, organisational and technical). Operational factors included poor system integration with existing workflows and the system not meeting users' perceived needs. Cultural factors involved users' competence with IT and resistance to change. Organisational factors referred to insufficient organisational resources and training, while technical factors included inadequate local technical infrastructure. Many of these factors, such as integrating the EHR system with day-to-day operational processes, staff training and adequate local IT infrastructure, were likely to apply to system implementations in various settings, but we also identified factors that related particularly to implementing EHRs in mental health hospitals, for example: EHR system incompatibility with IT systems used by mental health-related sectors, notably social services; the EHR system lacking specific, mental health functionalities and options; and clinicians feeling unable to use computers while attending to distressed psychiatric patients. A better conceptual model of reasons for workarounds should help with designing, and supporting the implementation and adoption of, EHRs for

  15. Internalized Stigma among Patients with Mental Illness Attending Psychiatric Follow-Up at Dilla University Referral Hospital, Southern Ethiopia.

    Science.gov (United States)

    Asrat, Biksegn; Ayenalem, Alem Eskeziya; Yimer, Tenaw

    2018-01-01

    This study tried to reflect evidences regarding internalized stigma and assessed risk factors of internalized stigma. It aims to assess the magnitude, domains, and covariates of internalized stigma among patients with mental illness in southern Ethiopia. The study was carried out by using a cross-sectional study design at Dilla University Referral Hospital (DURH). A total of 317 patients with mental illness were involved. Internalized stigma was measured using Internalized Stigma of Mental Illness (ISMI) scale. Data analysis was done using SPSS version 20. Descriptive statistics and logistic regression were done. The prevalence of internalized stigma was 32.1% among people living with mental illness in Dilla University Referral Hospital. Being female, medication nonadherence, and lack of family support were factors independently associated with internalized stigma. The results of this study found an intermediate prevalence of internalized stigma among people living with mental illness in Dilla University Referral Hospital (DURH). It revealed how much antistigma campaigns are so much important to tackle internalized stigma among people living with mental illness. Incorporating counseling and structured therapy played an important role in maximizing their quality of life.

  16. Screening for common mental disorders and substance abuse among temporary hired cleaners in Egyptian Governmental Hospitals, Zagazig City, Sharqia Governorate.

    Science.gov (United States)

    Abbas, R A; Hammam, R A M; El-Gohary, S S; Sabik, L M E; Hunter, M S

    2013-01-01

    Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egypt. All participants were invited to complete a structured questionnaire through a semi-structured interview which included the self-reporting questionnaire 20 items (SRQ-20) and the work stress scale. Assessment of drug use included urine-based screening tests for common substances abused. The prevalence of job stress, common mental disorders and substance abuse, particularly tramadol and cannabis (Bango), was significantly higher in the studied temporary cleaners compared to permanent cleaners. Risk factors associated with increased susceptibility of the temporary cleaners to common mental disorders were family history of substance abuse, high crowding index, history of physical illness, low educational level, and smoking; while being unmarried, male sex, family history of mental disorder, age ≥40 years, smoking, and length of service ≥8 years, were associated with substance abuse among the same group. Temporary hired hospital cleaners suffered from impaired mental health more than permanent cleaners. Therefore, expanding the coverage of current laws and occupational safety and health standards to cover workers in the informal sector especially in developing countries is recommended.

  17. Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.

    Science.gov (United States)

    Chambers, Georgina M; Randall, Sean; Mihalopoulos, Cathrine; Reilly, Nicole; Sullivan, Elizabeth A; Highet, Nicole; Morgan, Vera A; Croft, Maxine L; Chatterton, Mary Lou; Austin, Marie-Paule

    2017-12-05

    Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the

  18. Relapse and hospitalization in patients with schizophrenia and bipolar disorder at the St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a comparative quantitative cross-sectional study

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    Ayano G

    2017-06-01

    Full Text Available Getnet Ayano,1 Bereket Duko2 1Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, 2School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia Background: Relapse and hospital admission are common among, and carry a heavy burden in, patients with schizophrenia and bipolar disorder. The aim of this study was to assess the risk of relapse and hospitalizations in patients with schizophrenia and bipolar disorder at the St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.Patients and methods: A hospital-based comparative cross-sectional study was conducted in June 2016. Systematic random sampling technique was used to recruit 521 (260 schizophrenia cases and 261 bipolar disorder cases study participants. Face-to-face interviews were conducted by trained psychiatry professionals. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR criteria and Structured Clinical Interview of DSM-IV (SCID were used.Results: The risk of relapse and hospitalizations was slightly higher in patients with bipolar disorder than in patients with schizophrenia. A majority of schizophrenic (213 [81.92%] and bipolar (215 [82.37%] patients had a history of hospital admission, and 228 (87.69% schizophrenic and 230 (88.12% bipolar patients had a history of relapse. Patients who had a history of hospitalizations also had co-occurring substance use disorders compared to those who had no history of hospitalizations for schizophrenia (81.5% vs 37.9% and bipolar disorder (82.56% vs 38.2%, respectively. Similarly, those patients who had a history of relapse had high comorbid substance use disorders than those who had no history of relapse for both schizophrenia (87.88% vs 47.37% and bipolar disorder (88.37% vs 47.19%, respectively.Conclusion: It is vital that, in the local context, mental health professionals strengthen their therapeutic

  19. Use of patient-controlled psychiatric hospital admissions: mental health professionals' perspective.

    Science.gov (United States)

    Ellegaard, Trine; Mehlsen, Mimi; Lomborg, Kirsten; Bliksted, Vibeke

    2017-07-01

    In a patient-controlled admission (PCA) programme, the decision about hospital admission is made solely by the patient, with no gatekeeper function allocated to the mental health professionals (MHPs). Current knowledge about how MHPs experience and evaluate PCA is sparse. This Danish multi-centre study examined the MHP assessment of the PCA programme in daily clinical practice, and compared PCA evaluations made by MHPs and patients. A questionnaire was developed and a survey conducted over the course of a year at all Danish mental health units included in the PCA programme. MHPs made an overall evaluation of the PCA programme. At each unique PCA, both patient and MHP evaluated the specific admission when the patient entered the unit and at discharge. In total, 546 questionnaires were included in the survey, based on 252 unique MHPs. The MHPs rated the PCA programme positively. The MHPs believed that PCA helped patients receive early help and avoid long admissions. Overall, agreement was poor when comparing patients' and MHPs' evaluation of the same PCA. MHPs (and patients) seem to be in favour of implementing the PCA programme. However, results revealed that MHPs and patients have different views of what caused the patient to admit themselves and why patients were discharged. MHPs should be aware that patients might have other reasons for admitting and discharging themselves than what seems most obvious to the MHP.

  20. Audit of new long-stay patients in Permai Mental Hospital, Johor.

    Science.gov (United States)

    Cheah, Y C; Nur Aiza, Z; Paramasivam, S; Kadir, A B; Jeyarajah, S

    1997-06-01

    We report a cross-sectional descriptive study of 90 new long-stay patients (NLS) (i.e. those who had been resident for six months to three years in Permai Mental Hospital, Johor) and studied from April to June, 1995. The age of this sample ranged from 18 to 85 years. Two subgroups were observed (i.e. younger NLS patients aged 18 to 34 years and older NLS patients aged 35 to 85 years). Among the younger NLS patients, the commonest diagnosis was schizophrenia (51.2%), followed by mental retardation with related problems (24.4%). Sixty-one percent of these younger patients had a history of serious violence or dangerous behaviour. Older NLS patients were likely to have a diagnosis of schizophrenia (79.6%), followed by mood disorder (6.1%) and dementia (4.1%). Forty seven percent of these older group had history of danger to others and 57.1% were at moderate or severe risk of non-deliberate self-harm. Focusing on the schizophrenic patients, all of them had some form of psychopathology, either positive, negative or general symptoms and about one-fourth were assessed to pose a risk for aggression.

  1. An overview of the mental health system in Gaza: an assessment using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS).

    Science.gov (United States)

    Saymah, Dyaa; Tait, Lynda; Michail, Maria

    2015-01-01

    Mental health system reform is urgently needed in Gaza to respond to increasing mental health consequences of conflict. Evidence from mental health systems research is needed to inform decision-making. We aimed to provide new knowledge on current mental health policy and legislation, and services and resource use, in Gaza to identify quality gaps and areas for urgent intervention. As part of a mixed methods study, we used the World Health Organization's Assessment Instrument for Mental Health Systems Version 2·2 to collect data on mental health services and resources. Data collection was carried out in 2011, based on the year 2010. Gaza's mental health policy suggests some positive steps toward reform such as supporting deinstitutionalisation of mental health services. The decrease in the number of beds in the psychiatric hospital and the progressive transition of mental healthcare toward more community based care are indicative of deinstitutionalisation. However, mental health legislation in support of deinstitutionalisation in Gaza is lacking. The integration of mental health into primary healthcare and general hospitals has not been fully achieved. Mental health in Gaza is underfunded, human rights protection of service users is absent, and human resources, service user advocacy, and mental health training are limited. Priority needs to be given to human rights protection, mental health training, and investment in human and organisational resources. Legislation is needed to support policy and plan development. The ongoing political conflict and expected increase in need for mental health services demonstrates an urgent response is necessary.

  2. Dressing and Addressing the Mental Patient: The Uses of Clothing in the Admission, Care and Employment of Residents in English Provincial Mental Hospitals, c. 1860–1960

    Science.gov (United States)

    Baur, Nicole; Melling, Joseph

    2014-01-01

    Abstract Scholars of insanity and its historical antecedents have paid very little attention to personal and institutional clothing. Such dress, distributed to patients in mental institutions, has always been inscribed with the conflicting narratives of the period in which it was made and worn. The language of civil and medical authority is more evident than personal choice in the shape and address of the attire. This article examines clothing worn by patients in three Devon mental hospitals during the century before 1960. We consider the ways in which institutional clothing formed part of a hospital regimen of overt control, as well as suiting considerations of economy and employment that figured in these institutions. PMID:26989271

  3. Therapeutic activities in mental health extra-hospital services: the inclusion of psychosocial actions

    Directory of Open Access Journals (Sweden)

    Regina Célia Fiorati

    2012-09-01

    Full Text Available Two studies were carried out in Ribeirao Preto, State of Sao Paulo, Brazil, in two extra-hospital mentalhealth services: one regional mental health outpatient clinic and one psychosocial care center. The purpose of thisresearch was to study the organization of the extra-hospital and therapeutic projects of these services, and theinclusion of psychosocial rehabilitation in such projects. The study was based on qualitative methodology and usedsemi-directive interviews and focal groups to collect data. Data analysis was based on the hermeneutic dialecticphilosophy of Jürgen Habermas according to the interpretative technique of reconstruction. Results indicated thatthese services are organized focusing on the clinical-psychiatric work, emphasizing the diagnosis, pathology andmedication treatment; while psychosocial actions have a secondary role in the therapeutic project. This articlediscusses part of this study in relation to the therapeutic activities and how they are implemented. Therapeuticactions are extremely technical, individually applied and imposed to an interdisciplinary field aiming to integratehealth actions. From a complementary perspective, as the therapeutic activities are mainly implemented in theinternal areas of the services and minimize territorial and community actions, they do not include individuals withpsychological distress in society; rather, they include these individuals in the service itself.

  4. Nursing care and actions in mental health in a psychiatric day hospital: an integrative review

    Directory of Open Access Journals (Sweden)

    João Mário Pessoa Júnior

    2014-03-01

    Full Text Available Objetivo: Identificar na literatura evidências disponíveis sobre as ações e os cuidados de enfermagem em saúde mental num hospital-dia psiquiátrico. Método: Revisão integrativa da literatura realizada a partir de busca on-line de estudos nas bases de dados: LLILACS, MEDLINE e BDENF, tendo como critérios de inclusão: artigos publicados nos idiomas português, inglês ou espanhol no período de 1997 a 2012 e que abordassem a temática em questão. Resultados: Os cuidados de enfermagem a pacientes acompanhados em hospitais-dia focam atividades terapêuticas interdisciplinares voltadas à reinserção da pessoa que sofre com transtornos mentais ao convívio familiar e em sociedade. Conclusão: A Enfermagem tem priorizado um cuidado pautado na humanização e na integralidade da atenção no espaço do hospital-dia, a partir da priorização de atividades terapêuticas interdisciplinares.

  5. Attitudes Towards the Mentally Ill: A Study with Health Workers at a University Hospital in Rio de Janeiro.

    Science.gov (United States)

    Siqueira, Sylvia Rosa Gonçalves; Abelha, Lúcia; Lovisi, Giovanni Marcos; Sarução, Keli Rodrigues; Yang, Lawrence

    2017-03-01

    As there are few studies about evaluation of attitudes of health care workers to people with mental disorders in Brazil, a cross-sectional study was carried out to assess the health professionals' attitudes working in a university hospital in Rio de Janeiro and also examine the proportion of negative and positive attitudes endorsed by healthcare professionals in Brazil towards people with mental illness in comparison with other parts of the world. Data were collected using the Community Attitudes towards the Mentally Ill (CAMI) in a random sampling frame of health professionals (n = 246) working in a University Hospital in Rio de Janeiro between April 2013 and June 2013. The CAMI consists of four sub-scales: Authoritarianism, Benevolence, Social Restrictiveness and Community Mental Health Ideology. The results showed attitudes that range from neutral to positive, with the Benevolence and Social Restrictiveness sub-scales showing the least stigmatizing results. The following individual characteristics were associated with negative attitudes: lower levels of education and less clinical experience. In general, health workers attitudes towards service users are characterized as positive when compared with other international studies. However, educational programs for health workers should be reinforced to further promote pre-existing positive attitudes towards people with mental health and the implementation of Brazilian Mental Health Policies.

  6. Effectiveness of day hospital mentalization-based treatment for patients with severe borderline personality disorder : A matched control study

    NARCIS (Netherlands)

    Bales, D.; Timman, R.; Andrea, H.; Busschbach, J.J.V.; Verheul, R.; Kamphuis, J.

    2015-01-01

    The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who

  7. Effectiveness of Day Hospital Mentalization-Based Treatment for Patients with Severe Borderline Personality Disorder: A Matched Control Study

    NARCIS (Netherlands)

    Bales, D.L.; Timman, R.; Andrea, H.; Busschbach, J.J.V.; Verheul, R.; Kamphuis, J.H.

    2015-01-01

    The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who

  8. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

    NARCIS (Netherlands)

    Ruitenburg, Martijn M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2012-01-01

    Background: We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods: A questionnaire was sent to all (n = 958) hospital physicians of one

  9. Staff perspectives: What is the function of adult mental health day hospital programs?

    Science.gov (United States)

    Taube-Schiff, Marlene; Ruhig, Megan; Mehak, Adrienne; Deathe van Dyk, Melanie; Cassin, Stephanie E; Ungar, Thomas; Koczerginski, David; Sockalingam, Sanjeev

    2017-10-01

    WHAT IS KNOWN ON THE SUBJECT?: Psychiatric day hospital (DH) treatment has been offered since the 1930s and is appropriate for individuals experiencing intense psychiatric symptoms without requiring 24-hour inpatient care. No empirical research has examined the specific purpose of DH treatment from the perspectives of healthcare providers within these programs. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study was the first to address the question of the purpose and function of DH treatment from the outlook of frontline workers within this setting, and confirmed anecdotal observations that DH treatment provides an alternative to intensive psychiatric care, and also operates as "bridge" between these intensive services and purely outpatient treatment. Additional information emerged, such as the importance of the name of DH programs avoiding connotations of illness, the benefits and skills that draw patients to these programs, and challenges that staff and patients experience within DH programs (e.g. short length of treatment, barriers to treatment access). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This information can enhance curriculum development within these settings. For example, given the importance of skill building, it is essential to integrate the provision of skill building and coping strategies within these settings. In addition, given that the name of the setting can impact staff (and perhaps service users as well), ensuring that the name of such program highlight wellness and recovery may enable a different type of therapeutic community to develop within these settings. Introduction Despite the benefits of psychiatric day hospitals (DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care

  10. Resilience of the health team in caring for people with mental disorders in a psychiatric hospital.

    Science.gov (United States)

    Brolese, Débora Felippe; Lessa, Greice; Santos, José Luís Guedes Dos; Mendes, Jucimara da Silva; Cunha, Kamylla Santos da; Rodrigues, Jeferson

    2017-08-17

    Evaluating and understanding the resilience process of the health team in caring for people with mental disorders in a psychiatric hospital. A mixed-method study with concomitant triangulation of data from a cross-sectional study, with health professionals, and Grounded Theory in the data. Quantitative data were collected using the Resilience Scale and analyzed using descriptive and inferential statistics. Qualitative data were obtained from interviews and analyzed using initial and focused coding. 40 health professionals participated in the study. Mean responses of the participants in the resilience scale were 99.80 ± 12.86 points, with a minimum of 35 and a maximum of 114 points. From the qualitative data, we can highlight the professionals' commitment in developing competencies in caring for people with mental disorders; valorization of teamwork and positive impact on work for the re-signification of the meaning of life. Understanding this process of resilience enables developing strategies to improve the quality of life of workers in psychiatric hospitals. Avaliar e compreender o processo de resiliência da equipe de saúde no cuidado a pessoas com transtornos mentais em um hospital psiquiátrico. Estudo de método misto com triangulação concomitante de dados de um estudo transversal, com profissionais de saúde, e uma Teoria Fundamentada nos Dados. Os dados quantitativos foram coletados a partir da Escala de Resiliência e analisados por meio de estatística descritiva e inferencial. Os dados qualitativos foram obtidos a partir de entrevistas e analisados mediante codificação inicial e focalizada. Participaram da pesquisa 40 profissionais de saúde. Na escala de resiliência, a média das respostas dos participantes foi 99,80±12,86 pontos, o mínimo foi de 35 e o máximo de 114 pontos. Nos dados qualitativos, destacaram-se o empenho dos profissionais para o desenvolvimento de competências para o cuidado de pessoas com transtornos mentais, a valoriza

  11. Risk characterization of hospitalizations for mental illness and/or behavioral disorders with concurrent heat-related illness.

    Directory of Open Access Journals (Sweden)

    Michael T Schmeltz

    Full Text Available Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD. However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI in the United States.To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis.This study uses hospitalization data from the Nationwide Inpatient Sample (2001-2010. Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI.Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06, African Americans (RR, 1.16, Native Americans (RR, 1.70, uninsured (RR, 1.92, and those 40 years and older, compared to MBD hospitalizations alone.Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies.

  12. [The Asahi Model-Regional Mental Health Services at Department of Psychiatry and Child Psychiatry, Asahi General Hospital].

    Science.gov (United States)

    Aoki, Tsutomu

    2015-01-01

    The Asahi model, Psychiatric Services of Department of Psychiatry and Child Psychiatry, Asahi General Hospital, is characterized by multiple dimensions of mental health services, such as multidisciplinary team approach, medical cooperation, specialized psychiatric treatment of acute care, clozapine and modified ECT, outreach services of home nursing and assertive community treatment, and the close and mutual coordination with housing services and social welfare services. The Asahi Model makes it possible to be deinstitutionalized, to improve patients satisfaction, to shorten hospitalization, to decrease psychiatric emergency visits and to be of service in a natural disaster. It also might prevent the relapse of schizophrenics within twelve months after discharge and improve the quality of mental health staffs trainings to support patients better. In the future, we will need to work on providing sectorized care, early psychosis intervention programs, to construct networking systems of clozapine and modified ECT, to strengthen growth of home nursing, and to take place mental health anti-stigma campaigns.

  13. Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

    Science.gov (United States)

    2016-10-01

    Aim(s) • Objectives: 1. decrease length of  hospital  stay 2. improve physiological and  psychological  outcomes   • Aim 1: Characterize SOC in the ICU...AD______________ AWARD NUMBER: W81XWH-14-2-0160 TITLE: Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves...Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Oscar E

  14. Functional mental capacity, treatment as usual and time: magnitude of change in secure hospital patients with major mental illness.

    LENUS (Irish Health Repository)

    Dornan, Julieanne

    2015-01-01

    Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function.

  15. "The family is the clinic, the community is the hospital": community mental health in Timor-Leste.

    Science.gov (United States)

    Hawkins, Zoe; Tilman, Teofilo

    2011-07-01

    This paper describes the history and recent development of mental health services in Timor-Leste, a small developing country recovering from conflict. Challenges to effective service delivery are discussed as well as plans for future development. Timor-Leste's mental health service began just over a decade ago. Unlike many other low and middle income countries where hospital-based services predominate, the mental health model in Timor-Leste is entirely community based. However, challenges to effective mental health care delivery are similar to most developing countries and include a lack of sufficient financial resources, human resources, and mental health infrastructure. Addressing these issues successfully requires political will, a greater prioritization of mental health services, close coordination between stakeholders, as well as developments in the area of education, training and infrastructure. Greater understanding and education about the links between mental and physical health would benefit the overall health of the population, and integration of these respective policies may prove a successful method of more equitably redistributing finances and resources.

  16. What helps or undermines adolescents' anticipated capacity to cope with mental illness stigma following psychiatric hospitalization.

    Science.gov (United States)

    Moses, Tally

    2015-05-01

    Better understanding of the individual and environmental factors that promote adolescents' use of more or less adaptive coping strategies with mental illness stigma would inform interventions designed to bolster youth resilience. This cross-sectional study draws on data from research on adolescents' well-being after discharge from a first psychiatric hospitalization to explore the relationships between anticipated coping in reaction to a hypothetical social stigma scenario, and various factors conceptualized as 'coping resource' and 'coping vulnerability' factors. Focusing on coping strategies also identified in the companion article, we hypothesize that primary and secondary control engagement coping would relate to more coping resource and less coping vulnerability factors, and the opposite would be true for disengagement, aggression/confrontation and efforts to disconfirm stereotypes. Data were elicited from interviews with 102 adolescents within 7 days of discharge. Hypothesized coping resource factors included social resources, optimistic illness perceptions, better hospital experiences and higher self-esteem. Vulnerability factors included more previous stigma experiences, desire for concealment of treatment, more contingent self-worth, higher symptom levels and higher anticipated stress. Multivariate ordinary least squares (OLS) regression was used to analyze associations between coping strategy endorsement and correlates. Although some coping correlates 'behaved' contrary to expectations, for the most part, our hypotheses were confirmed. As expected, youth anticipating reacting to the stigmatizing situation with greater disengagement, aggression/confrontation or efforts to disconfirm stenotypes rated significantly lower on 'coping resources' such as self-esteem and higher on vulnerability factors such as symptom severity. The opposite was true for youth who anticipated exercising more primary and secondary control engagement coping. This study begins to

  17. Profile of Mental and Behavioral Disorders Among Preschoolers in a Tertiary Care Hospital in Oman: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Marwan M. Al-Sharbati

    2016-09-01

    Full Text Available Objectives: Early diagnosis and prompt treatment of mental and behavioral disorders in preschoolers is critical for a better prognosis, ultimately leading to improved quality of life for both the child and the family. Our study investigated the clinical profile of mental and behavioral disorders in children < 7 years of age, seeking consultation at Sultan Qaboos University Hospital, Muscat, Oman, between 1 June 2006 and 31 December 2010. The objective was to explore demographic variables, intervention types, and annual trends. Methods: This retrospective, descriptive study was conducted by reviewing the electronic records of preschoolers seeking consultation on mental and behavioral disorders at the Department of Behavioral Medicine. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria. Results: The total number of cases was 466, the majority (77.9% being boys. The cumulative frequencies and annual hospital-based prevalence rates were estimated for each category of mental and behavioral disorders. Our findings showed increased service utilization among preschoolers, as reflected in the annual trend and case-specific prevalence rates. While comorbidity was common, the most frequent disorders encountered were attention deficit hyperactivity disorder (70.8%, developmental language disorder (23.6%, autism spectrum disorders (20.2%, and disruptive behavior disorders (11.6%. The most commonly prescribed drugs/supplementation were risperidone (18.7%, atomoxetine (9.7%, omega-3 (8.8%, and methylphenidate (6.2%. Conclusions: Consultations for mental and behavioral disorders are being sought for Omani preschoolers. Beside pharmacotherapy, other interventions, which are an integral part of a much desired multidisciplinary approach should be introduced. Readdressing the missing needs is essential for a comprehensive approach to managing mental and behavioral disorders.

  18. Absolute risk of suicide after first hospital contact in mental disorder

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Mortensen, Preben Bo; Pedersen, Carsten Bøcker

    2011-01-01

    Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up.......Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up....

  19. Prevalence of mental health problem during first-half pregnancy at Siriraj Hospital.

    Science.gov (United States)

    Wingwontham, Surapol; Thitadilok, Wiboolphan; Singhakant, Supachoke

    2008-04-01

    To study the prevalence of mental health problem during first-half pregnancy. Cross-sectional descriptive study. The 255 singleton pregnant women mental health problem screening tool) and frequent psychosocial stressor forms. The prevalence and factors associated with mental health problem were evaluated. The prevalence of mental health problem. The prevalence of mental health problem was 17.3%. Factors independently associated with mental health problem included worrying about health, stress of taking care of other family members and financial problem with adjusted OR 3.5 (95% CI 1.16, 10.74), 3.8 (95% CI 1.80, 7.89) and 3.2 (95% CI 1.34, 7.53) respectively. The prevalence of mental health problem was 17.3%. Screening of mental health problem should be included in antenatal care service especially in the risk group.

  20. Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison.

    Science.gov (United States)

    Gorsky, Martin

    2012-06-01

    Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.

  1. Depressive syndromes among female caregivers of schizophrenic patients in prof. dr. m. ildrem mental hospital medan

    Science.gov (United States)

    Handi, A.; Husada, M. S.; Gultom, D. P.

    2018-03-01

    Caring for schizophrenic patients can lead to emotional distress. It remains unclear about the level of depressive syndromes among female caregivers of schizophrenic patients. To determine the level of depression among female caregivers of schizophrenic patients. This is a descriptive study with a cross-sectional approach to describe the level of depression of female caregivers in Prof. dr. M. Ildrem Mental Hospital Medan, using HADS instruments. Most age group of caregivers is from age 51-60 years that is 48.15%, caregiver’s work status mostly not works (62.96%), marital status of caregiver mostly is married (59.26%), kinship with most patients are a biological mother (57.41%). Most patient age group is from age below 30 years (50%), work status of most patients is not working (81.48%), marital status of most caregiver is married (83.33%). Mostly of the depressive syndrome is mild depression (42.59%). Mostly of the depressive syndrome is from mild depression.

  2. Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana.

    Science.gov (United States)

    Olashore, Anthony A; Rukewe, Ambrose

    2017-05-10

    There is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital, Lobatse, Botswana. Data involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models. The prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177-9.9673) and psychotropic side effects (OR = 5.782, 95% CI: 1.636-20.430) were significantly associated with polypharmacy after regression analysis. Psychiatric co-morbidity and psychotropic side effects were significant risk factors for polypharmacy in Botswana.

  3. Stigma towards mental illness: A hospital-based cross-sectional study among caregivers in West Bengal.

    Science.gov (United States)

    Mukherjee, Shrabani; Mukhopadhyay, Dipta Kanti

    2018-01-01

    Stigma among caregivers of people with mental illness has a serious impact on the disease outcome and lives of people with mental illness as well as other family members. The objectives of this study were (i) To determine the level of self-perceived stigma toward mental illness, (ii) To measure perception to it among caregivers of people with mental illness, and (iii) To identify the factors associated with self-perceived stigma of caregivers. In this cross-sectional study, a structured interview was conducted among 200 caregivers of people with mental illness in the psychiatry outpatient department of a tertiary care hospital in West Bengal, India. Stigma and perception regarding mental illness were assessed with a validated 12-item Explanatory Model Interview Catalogue and 20-item perception scale, respectively. Information on their sociodemographic characteristics was also collected. Average stigma score (53.3 ± 13.2) was higher than 50% of maximum attainable score. Caregivers of higher age, female gender, low income, higher education, manual job, rural residence, and those who are single or widowed scored higher in stigma scale. Caregivers with female gender (P = 0.007) and rural residence (P = 0.01) were more likely to have stigma while the perception score was negatively associated (P illness and improve family life.

  4. Hospital contact for mental disorders in survivors of childhood cancer and their siblings in Denmark

    DEFF Research Database (Denmark)

    Lund, Lasse Wegener; Winther, Jeanette; Dalton, Susanne Oksbjerg

    2013-01-01

    Survivors of childhood cancer are known to be at risk for long-term physical and mental effects. However, little is known about how cancers can affect mental health in the siblings of these patients. We aimed to assess the long-term risks of mental disorders in survivors of childhood cancer and t...

  5. Supporting recovery by improving patient engagement in a forensic mental health hospital: results from a demonstration project.

    Science.gov (United States)

    Livingston, James D; Nijdam-Jones, Alicia; Lapsley, Sara; Calderwood, Colleen; Brink, Johann

    2013-01-01

    Mental health services are shifting toward approaches that promote patients' choices and acknowledge the value of their lived experiences. To support patients' recovery and improve their experiences of care in a Canadian forensic mental health hospital, an intervention was launched to increase patient engagement by establishing a peer support program, strengthening a patient advisory committee, and creating a patient-led research team. The effect of the intervention on patient- and system-level outcomes was studied using a naturalistic, prospective, longitudinal approach. Quantitative and qualitative data were gathered from inpatients and service providers twice during the 19-month intervention. Despite succeeding in supporting patients' participation, the intervention had minimal impacts on internalized stigma, personal recovery, personal empowerment, service engagement, therapeutic milieu, and the recovery orientation of services. Peer support demonstrated positive effects on internalized stigma and personal recovery. Strengthening patient engagement contributes toward improving experiences of care in a forensic hospital, but it may have limited effects on outcomes.

  6. Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views.

    Science.gov (United States)

    Quinn, Chris; Happell, Brenda

    2015-08-01

    To explore perceptions of privacy and dignity for sexual relationships in a Forensic mental health hospital. The role of nurses in forensic mental health hospitals is frequently complicated by opposing expectations of therapeutic relationships and maintaining security. What can result is an over-emphasis on risk reduction by controlling patient behaviour, which can extend to patient intimacy and sexual relationships. An exploratory, qualitative approach. Individual interviews were conducted with 12 nurses and 10 patients in a forensic mental health hospital. Thematic data analysis was undertaken to identify the main themes. The need for a private and dignified place for patient intimacy was one major theme to emerge from this research from both nurse and patient participants and is the focus of this article. A disparity is reported between the level of support reported by nurse participants with the experience of the patient participants. Sexual intimacy and sexual relationships are important components of normal human behaviour. Institutional rules and rule adherence create barriers for patients, forcing their intimacy and sexual relationships into secrecy. There is a need for further research to consider the benefits and risks of patient intimacy and sexual relationships for long-term patients in forensic mental health settings. Patients in forensic hospitals are sexually active and seek support from nurses. Nurses are in an ideal role to recognise the important part they can play in supporting the intimacy and sexual relationship needs of patients. Strategies to assist in developing confidence in responding to normal human behaviour is a matter of priority. © 2015 John Wiley & Sons Ltd.

  7. Nurses and opioids: results of a bi-national survey on mental models regarding opioid administration in hospitals

    Directory of Open Access Journals (Sweden)

    Guest C

    2017-03-01

    Full Text Available Charlotte Guest,1 Fabian Sobotka,2 Athina Karavasopoulou,3 Stephen Ward,3 Carsten Bantel4,5 1Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 2Division of Epidemiology and Biometry, Department of Health Services Research, Faculty 6, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany; 3Pain Service, Barts Health, St Bartholomew’s Hospital, London, UK; 4Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Oldenburg University, Klinikum Oldenburg Campus, Oldenburg, Germany; 5Department of Surgery and Cancer, Anaesthetics Section, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK Objective: Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses’ mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors. Material and methods: A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses’ mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580 and one German (n=799 hospital between September 2014 and February 2015. Results: A total of 511 (37.1% questionnaires were returned. Mean (standard deviation age of participants were 37 (11 years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87

  8. The institutional response to mental disorder in Ireland: censuses of Irish asylums, psychiatric hospitals and units 1844-2014.

    Science.gov (United States)

    Walsh, D; Daly, A; Moran, R

    2016-08-01

    Before the eighteenth century, there was limited response to the problem of psychiatric illness in Ireland as in many other countries. The asylums of the 1820s and 1830s were no sooner opened than they were overcrowded. A second wave of asylum building commenced in the second half of the nineteenth century continuing up to the early twentieth century. In 1966, the Report of the Commission on Mental Illness noted that the rate of psychiatric beds in Ireland per 1,000 was one of the highest in the world. The report called for a change in the policy of caring for the mentally ill in psychiatric hospitals to more community-based settings and in psychiatric units located in general hospital settings, along with a call for more research into mental illness. The result of the latter was the establishment of the first census of psychiatric patients resident in psychiatric hospitals. Thus began fifty years of census reporting and the subsequent establishment of the National Psychiatric Inpatient Reporting System (NPIRS).

  9. Kilpauk Mental Hospital: The Bethlem of South Asia - A recall of its history prior to 1970.

    Science.gov (United States)

    Somasundaram, O; Ratnaraj, Ponnudurai

    2018-02-01

    The magnificent "Institute of Mental Health" has its history almost from 1795 when the East India company appointed Surgeon Valentine Conolly to be in charge of a "House for accommodating persons of unsound mind." After a few transitions, backed by a government order for the construction of a lunatic asylum in a 66 1/2 acre site, the asylum started functioning from 1871. The period of about six decades from its inception could be referred to as "the period of custodial care." However, the quality of care for the general medical problems gradually improved with the creation of separate facilities for some common ailments and also one for seriously ill. Separate wards were also conceptualized for criminal patients and female inmates. Thanks to Government sanctions, the staff strength gradually increased with regularization of bed strength to 1800, and by 1948-1957, the hospital had 14 medical officers and a host of other staff. The period from 1939 to 1948 witnessed the introduction of electroconvulsive therapy and insulin coma therapy including the modified one and also insulin histamine therapy. During the prephenothiazine era, the drugs used were barbiturates, paraldehyde, opiates, and Rauwolfia serpentina, which were discontinued after the use of Chlorpromazine from 1954. Psychosurgery was also undertaken in selected cases from 1948, but the procedure went out of vogue soon due to the quality of outcome being poor and development of complications. Rehabilitation of patients got a fillip with the introduction of occupation therapy in 1949 and industrial therapy center in 1970. Extension of psychiatric services to general hospitals began from 1949. Regular training was imparted to paramedical and undergraduate medical students from 1948. The institute had the privilege of hosting the Annual National Conference of Indian Psychiatric Society - 1957. The institute also spearheaded in several pioneering researches such as insulin coma therapy, syphilis, and Alzheimer

  10. [Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital: Clinicodemographical features and 6-month follow-up].

    Science.gov (United States)

    Teti, Germán L; Rebok, Federico; Grendas, Leandro N; Rodante, Demián; Fógola, Agustina; Daray, Federico M

    2014-01-01

    Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.

  11. Effects of ambient temperature on daily hospital admissions for mental disorders in Shanghai, China: A time-series analysis.

    Science.gov (United States)

    Peng, Zhuoxin; Wang, Qi; Kan, Haidong; Chen, Renjie; Wang, Weibing

    2017-07-15

    Evidence for extreme ambient temperature effects on the risk of mental disorders (MDs) is limited. In this study, we evaluated the short-term effects of daily mean temperature on hospital admissions of MDs in Shanghai, China. We obtained daily hospital admission data for MDs, daily meteorological and ambient pollution data in Shanghai from January 2008 to December 2015. Adjusted for time trend, air pollution, relative humidity and other confounders, a quasi-Poisson generalized additive model (GAM) combined with a distributed lag non-linear model (DLNM) was used to analyze the lag-exposure-response relationship between daily mean temperature and hospital admissions for MDs. Total daily hospital admissions for MDs during the study period were 93,971. With a reference of median temperature (18.3°C), there was a significant positive association between the temperature above threshold (24.6°C) and MD hospital admission visits at a lag of 0-1days. The relative risks of extreme hot temperatures (33.1°C, 99% percentile) over the lag 0-1days compared to median temperature were 1.266 (95% confidence intervals: 1.074-1.493). No effect of cold weather on the hospital admissions for MDs was observed. This study suggests that extreme hot temperature poses significant risks on MD; health counseling and cooling measures should be considered for the susceptible population. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. A família e o doente mental usuário do hospital-dia: estudo de um caso La familia y el enfermo mental usuário del hospital/día: estudo de un caso The family and the mentally-ill user of day-hospitals: a case study

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    Ana Ruth Macêdo Monteiro

    2000-12-01

    Full Text Available O hospital-dia, como modalidade de assistência psiquiátrica, proporciona a família a possibilidade de vivenciar junto ao seu familiar doente uma maior convivência durante o tratamento, e a leva a buscar junto a esse familiar formas de facilitar o processo adaptativo de interação na família. A proposta deste estudo se configura na busca de compreender de que modo a família e o usuário do hospital-dia interagem no recesso do lar e descrever a experiência narrada por uma família. A família deste estudo foi selecionada a partir de um usuário do hospital-dia que possuísse ou possua história anterior de internações psiquiátricas. Foram entrevistados cinco membros da família em estudo. A partir das experiências descritas pelos sujeitos emergiram duas grandes categorias temáticas: A família vivenciando junto ao seu familiar o hospital-dia , A convivência família ¾ usuário. As experiências relatadas pelos sujeitos neste estudo são bastante significativas para a construção de novas possibilidades na assistência à família do doente mental.El hospital-día como modalidad de atención psiquiátrica, proporciona a la familia la posibilidad de tener una mayor convivencia con su familiar enfermo durante el tratamiento y la lleva a buscar de forma conjunta con éste, formas para facilitar el proceso de adaptación e interacción en la familia. El estudio pretende comprender la manera como la familia y usuario del hospital-día interactuan en el ambiente del hogar y describir la experiencia narrada por una familia. La familia de este estudio fue seleccionada de un usuario del hospital-día que tuviese historia anterior de hospitalizaciones psiquiátricas. Fueron entrevistados cinco familiares. A partir de las experiencias descritas por los sujetos se formaron dos grandes categorías temáticas: La familia conviviendo con su familiar en el hospital-día y la convivencia familia/usuario. Las experiencias relatadas por los sujetos en

  13. [Mental job strain in a university children's hospital--a study on stress experience and the resulting employee health].

    Science.gov (United States)

    Hiemisch, A; Kiess, W; Brähler, E

    2011-07-01

    The aim of the following survey was to evaluate the mental job strain at an university hospital and its effect on the health of the employees. Furthermore the trigger factors should have been identified and optimized after the survey. The data were collected by an employee survey during November/December of 2006. All employees of the Hospital for Children and Adolescents of the University Leipzig were included. Overall 174 questionnaires were evaluated (response rate 51.5%). As standardized methods the Irritations-Scale of Mohr et al. and the shortform of the Gießener Beschwerdebogen GBB-24 of Brähler et al. were used. In addition a self designed scale for the measurement of strain-experience was applied. More than half of the physicians/psychologists, a quarter of the nursing staff and every tenth of the remaining employees suffered from work related mental stress disorder. Especially physicians and psychologists were additionally affected by psychosomatic symptoms. The main strain was caused by an excessive amount of documentation, the manpower shortage and the lack of appreciation. The occupational groups differ as well in their ways of coping with the daily job strain as in its effects on the mental health. The health effect of the daily strain on physicians and psychologists seems to be age dependent. An urge for intervention can be derived from our results. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Anthropometric characteristics and the burden of altered nutritional status among neuropsychiatric patients at Zomba Mental Hospital in Zomba, Malawi.

    Science.gov (United States)

    Mhango, S N; Kalimbira, A; Mwagomba, B

    2015-06-01

    To determine the prevalence of overnutrition and undernutrition among neuropsychiatric inpatients and outpatients at Zomba Mental Hospital in Zomba, Malawi. In this analytical cross-sectional study (n = 239), data were collected from psychiatric patients who were either inpatients (n = 181) or outpatients (n = 58) at Zomba Mental Hospital, which is the largest mental health facility in Malawi. Information was collected about patient demographics, anthropometric data, dietary information, and tobacco and alcohol use, among other variables. Data were entered and analysed in SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Means were generated and compared between male and female patients, and between inpatients and outpatients. The study recruited 158 male and 81 female patients, with mean ages of 31.24 ± 11.85 years and 33.08 ± 15.18 years (p = 0.328), respectively. Male patients were significantly taller (165.27 ± 7.25 cm) than female patients (155.30 ± 6.56 cm) (p underweight. There were no significant differences in the prevalence of overweight, obesity, and underweight between male and female participants, or between inpatients and outpatients. Our study-the first one of its kind in Malawi-characterised the anthropometry of neuropsychiatric patients at a major metal health facility in Malawi, and has shown a high proportion of overweight patients and a notable presence of underweight patients among them. Being overweight or obese is a risk factor for metabolic disorders. Being underweight may aggravate mental illness or disturb the effect of medication. There is need, therefore, to include nutrition screening and therapeutic or supplementary feeding as part of a comprehensive care and treatment plan for neuropsychiatric patients.

  15. Help-seeking behaviors in the relatives of mentally Ill persons at a Tertiary Care Hospital

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    Korem Anusha

    2017-01-01

    Full Text Available Background: There are few studies in Indian context on factors affecting generalized help-seeking behaviors in the relatives of persons with mental illness. Hence, the present study was undertaken. Materials and Methods: This is a cross-sectional, purposive sampling, comparative study. Sociodemographic profile, illness details, treatment, compliance, reactions to mental illness scale, and cope inventory scores were compared between the low and high help-seeking groups on General Help-seeking Questionnaire divided on the lower 25th and upper 75th quartiles, respectively, for the groups. The data were statistically analyzed on SPSS-17. Results: Out of a total of 100 patients, 25 and 28 subjects in the low and high help-seeking groups, respectively, were included in the study. In the low help-seeking group, drug compliance was good and caregivers' education level was higher compared to the high help-seeking group. High help-seeking group was characterized by higher scores of hope and compassion on reactions to mental illness scale and the coping mechanisms of humor, denial, use of instrumental and emotional support, acceptance, and planning were frequently used. Conclusions: There is a need to develop awareness about mental illness in the general population and improve the available social support systems to the patients with mental illness and their family members. The help-seeking behaviors could be improved by training the personnel at primary health centers about the treatment of mental illness and importance of drug compliance and regular follow-up.

  16. Patient-controlled hospital admission for patients with severe mental disorders: study protocol for a nationwide prospective multicentre study.

    Science.gov (United States)

    Thomsen, Christoffer Torgaard; Benros, Michael Eriksen; Hastrup, Lene Halling; Andersen, Per Kragh; Giacco, Domenico; Nordentoft, Merete

    2016-09-28

    Patient-controlled hospital admission for individuals with severe mental disorders is a novel approach in mental healthcare. Patients can admit themselves to a hospital unit for a short stay without being assessed by a psychiatrist or contacting the emergency department. Previous studies assessing the outcomes of patient-controlled hospital admission found trends towards reduction in the use of coercive measures and length of hospital stay; however, these studies have methodological shortcomings and small sample sizes. Larger studies are needed to estimate the effect of patient-controlled hospital admission on the use of coercion and of healthcare services. We aim to recruit at least 315 patients who are offered a contract for patient-controlled hospital admissions in eight different hospitals in Denmark. Patients will be followed-up for at least 1 year to compare the use of coercive measures and of healthcare services, the use of medications and suicidal behaviour. Descriptive statistics will be used to investigate hospitalisations, global assessment of functioning (GAF) and patient satisfaction with treatment. To minimise selection bias, we will match individuals using patient-controlled hospital admission and controls with a 1:5 ratio via a propensity score based on the following factors: sex, age group, primary diagnosis, substance abuse as secondary diagnosis, coercion, number of psychiatric bed days, psychiatric history, urbanity and suicidal behaviour. Additionally, a historical control study will be undertaken in which patients serve as their own control group prior to index date. The study has been approved by The Danish Health and Medicines Authority (j.nr.: 3-3013-934/1/) and by The Danish Data Protection Agency (j.nr.: 2012-58-0004). The study was categorised as a register study by The Danish Health Research Ethics Committee and therefore no further approval was needed (j.nr.: H-2-2014-FSP70). Findings will be disseminated through scientific

  17. An exploration of mental capacity assessment within acute hospital and intermediate care settings in England: a focus group study.

    Science.gov (United States)

    Jayes, Mark; Palmer, Rebecca; Enderby, Pamela

    2017-10-01

    To explore approaches to the assessment of mental capacity within acute hospital and intermediate care settings in England. Two focus group interviews were conducted with multidisciplinary staff (n = 13) within a large hospital trust. Data were analysed using a Framework approach. Three main themes were identified: (i) the assessment process; (ii) staff experience of assessment; (iii) assessing capacity for patients with communication difficulties. Staff identified the main patient groups, patient decisions and professionals involved in capacity assessment. They described using both formal and informal approaches to assess capacity and specific methods to identify and support the needs of patients with communication difficulties during the assessment process. Most staff reported finding capacity assessment challenging, due to time pressures, a perceived lack of knowledge or skills and encountering practice that is not consistent with legal requirements. Staff stated a need for initiatives to facilitate and improve practice. These findings provide confirmatory evidence that mental capacity assessment is complex and challenging and that staff would benefit from additional support and resources to aid their practice. It provides new evidence about the methods used by staff to assess capacity, particularly for patients with communication difficulties. Implications for Rehabilitation This study contributes to our understanding of how staff assess capacity in hospital and intermediate care settings. Mental capacity assessment is a complex activity and many staff reported finding it challenging. Patients with communication difficulties need additional support during capacity assessments but may not always receive this. Current practice needs to be improved and staff need support and resources to achieve this.

  18. How can a change in the operating system of the mental health review board promote the discharge of long-term hospitalized psychiatric patients? A case study of Seoul city.

    Science.gov (United States)

    Lee, Myung-Soo; Lim, Hee-Young; Kim, Youngki; Lee, Yong-Suk

    2014-01-01

    One of the most typical and chronic problem in Korean mental health system is the prolonged length of hospital stay. In contrast to there are many components which leads to long length of stay of psychiatric patients in Korean situation such as low and fixed medical fee for psychiatric inpatient treatment, shortage of community resources, lack of care-givers' awareness and so on, there are just few mechanisms to handle this issue such as Mental Health Review Board (MHRB) which is based on Mental Health Act since 1995. However, the discharge order rate was very low and there community care system after discharge order is still very weak. The Korean government has revised the Mental Health Act in 2008 and changed the operating principals of the MHRB from a regional level to a local level to strengthen the function of MHRB. However, the discharge order rate versus the whole evaluation requests still remains at a very low level or less than 5%. And it is still very difficult to execute a discharge order against a patient whose symptoms and conditions become psychiatrically stabilized enough for discharge, due to a shortage of community care facilities and a lack of social support system. These results are exactly same with former studies. Any policies to promote psychiatric discharge including MHRB are needed to take the comprehensive factors into consideration, such as payment program, community infrastructure, increasing care-givers' acceptance and so on. Despite of the political trial of Korean government to reduce length of stay of chronic psychiatric patients, it was not successful. Still it had failed to propose a detailed policy measure in terms of the above-mentioned prerequisites. Therefore, new system and program developments including reform of payment system which reflect prior studies' recommendations are essential.

  19. [Mental health problems among female staff in a provincial maternal and child health hospital: an investigation of 647 individuals].

    Science.gov (United States)

    He, W J; Xia, J H; Lv, X; Li, L M

    2018-02-20

    Objective: To investigate the current status of depression and anxiety among female staff in a maternal and child health hospital, and to provide a basis for developing related prevention and intervention measures and promoting the mental health of female staff. Methods: The female staff from a provincial maternal and child health hospital completed a psycho-health questionnaire survey on Internet from June to October, 2016. The questionnaires used in the survey consisted of Patient Health Questionnaire (PHQ-9) , Generalized Anxiety Disorder Scale (GAD-7) , and Symptom Checklist-90 (SCL-90) . The distribution features of mental health problems such as depression and anxiety were analyzed according to the results: of the questionnaire survey. Results Of all female staff surveyed, 42.04% showed depression symptoms, 28.90% showed anxiety symptoms, and 26.12% showed comorbid symptoms of depression and anxiety. Moderate or severe depression (anxiety) was mainly distributed among the female staff with comorbid symptoms (90.63% and 97.01%, respectively) . There were significant differences in the distribution of moderate or severe anxiety symptoms between the medical staff and nursing staff (χ(2)= 5.81, P =0.05) and between those with intermediate and junior professional titles (χ(2)=7.99, P =0.018) . As for SCL-90 results, the total score, total average score, and scores on factors of somatization, compulsion, interpersonal sensitivity, depression, and anxiety in the female staff with comorbid symptoms, moderate or severe depression, and moderate or severe anxiety were significantly higher than the national norm ( P staff with comorbid symptoms than in the female staff with a single symptom and asymptomatic female staff (both P staff in the maternal and child health hospital, mainly characterized by comorbid symptoms of moderate or severe depression and anxiety. Comorbidity is accompanied by mental health problems such as interpersonal sensitivity, obsessive compulsion

  20. Chile mental health country profile.

    Science.gov (United States)

    Stewart, Carmen López

    2004-01-01

    This paper describes main facts about Chile starting with key socio-demographic, socio-economic, political, environmental, epidemiological, social support and social pathology aspects that characterize the context in which current mental and neurological policy and programmes have been put in place since 2000, as part of the National Health Plan and Health Sector Strategy Plan. The 'National Plan for Mental Health and Psychiatry', using a community psychiatry approach, has been partially implemented for people covered by the Public Health Insurance, which comprises 62% of the Chilean population (people with lower income). This paper also describes: the management, population needs and demands, financial resources, human resources in primary care, mental health specialist care and community-based care, physical capital, social capital, provision and processes, and outcomes of the plan. Strengths are analyzed, like the health reform, including its values and principles, the active participation of consumer and family groups as well as mental health NGOs, access to mental health services through primary care, quality assurance of the mental health services delivered to the population and progressive development of a culture of respect for human rights, including those of people with mental illnesses. Finally, difficulties for the advance of mental health care are also enumerated: the low priority still given to mental health compared with physical health by the country's leaders, the insufficient emphasis on mental health in both undergraduate and postgraduate professional training, the strong stigma and discrimination associated with mental illness in the general population and the advocacy by some mental health professionals of the traditional model of care (role of the psychiatric hospital).

  1. Private psychiatric hospitals, mental health care management, and wellness: an interface with industry.

    Science.gov (United States)

    Baker, J W

    1986-01-01

    Hospitals doing business is good business. Hospitals that use their professional staff to enhance their interface with industry are usually pleased with the outcome. Health care professionals must reach beyond their doors and be willing to understand the needs of a large corporate bureaucracy and the aspiring entrepreneur. Using hospital professionals in a consultative model with gatekeepers of industry is an ideal way to market and enhance the hospital's image in the community. Professionals employed by private hospitals are usually quite willing to expand their roles into the community as trainers, consultants, educators, diagnosticians, and treatment resource consultants to the business world. Business people understand business problems, and health care is a business issue as well as a humanitarian issue. In the current climate of cost containment, the hospital's ability to help the business work with paying for health care, if properly presented, will be welcomed.

  2. A study of tobacco and substance abuse among mentally ill outpatients in a tertiary care general hospital

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    Anju Gupta

    2016-01-01

    Full Text Available Background: The comorbidity of substance abuse and mental disorder is known to exist and may cause many diagnostic, prognostic, and management difficulties. Indian data are sparse in this area. Objectives: The aim of the study was to identify the prevalence and pattern of substance abuse in psychiatric outpatients and to examine the relation between demographic variables and drug abuse pattern. Materials and Methods: Medical records of the patients attending psychiatry outpatient clinic at a tertiary care general hospital over a 3-month period were reviewed. Information was obtained from medical chart and Drug Abuse Monitoring Scale pro forma about substance abuse. Psychiatric diagnosis made by a qualified psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition diagnostic criteria, as recorded in the case record form, was used. Observation: The results revealed that 50.8% (half of all psychiatry outpatients were using one or more substances including tobacco in the last month prior to registration (1 month prevalence and 28.35% were using substances at any time in their life prior to the last month (lifetime prevalence. Male patients had 6 to 8 times higher substance abuse than female patients. Tobacco and alcohol were found to be the most common substances of abuse, followed by cannabis. Part-time and full-time employed male patients consumed more alcohol and tobacco than unemployed patients. Conclusions: Substance abuse was common among mentally ill outpatients and could be the cause of various health hazards and hence requires due attention.

  3. Prevalence of Cannabis Residues in Psychiatric Patients: A Case Study of Two Mental Health Referral Hospitals in Uganda

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    Epaenetus A. Awuzu

    2014-01-01

    Full Text Available Various studies have reported that abuse of cannabis is a risk factor for psychosis. The aims of this study were to determine the prevalence of delta 9-tetrahydrocanabinol (Δ 9 -THC, a major metabolite of cannabis, in psychiatric patients in Uganda, and to assess the diagnostic capacity of two referral mental health hospitals to screen patients for exposure to cannabis in Uganda. Socio-demographic characteristics of the patients were collected through questionnaires and review of medical records. Urine samples were collected from 100 patients and analyzed using Δ 9 -THC immunochromatographic kit (Standard Diagnostics®, South Korea. Seventeen percent of the patients tested positive for Δ 9 -THC residues in their urine. There was strong association ( p < 0.05 between history of previous abuse of cannabis and presence of Δ 9 -THC residues in the urine. Alcohol, cocaine, heroin, pethidine, tobacco, khat and kuber were the other substances abused in various combinations. Both referral hospitals lacked laboratory diagnostic kits for detection of cannabis in psychiatric patients. In conclusion, previous abuse of cannabis is associated with occurrence of the residues in psychiatric patients, yet referral mental health facilities in Uganda do not have the appropriate diagnostic kits for detection of cannabis residues as a basis for evidence-based psychotherapy.

  4. [From the Principle of Beneficence to the Principle of Autonomy. Assessment of Patients' Mental Competency in the General Hospital].

    Science.gov (United States)

    Diana, Restrepo B; Carlos, Cardeño C; Marle, Duque G; Santiago, Jaramillo

    2012-06-01

    Refusing a medical procedure is a valid way of exercising every patient's right to autonomy. From the legal point of view, autonomy is based on the right to privacy. In recent decades the legal right to self-determination has gradually expanded and today patients in full possession of their mental faculties, have the moral and legal right to make their own decisions and these decisions take precedence over physician and family. Often liaison psychiatrists are called in to assess the mental competence of patients in the general hospital. To determine the psychiatrist's role in evaluating these patients. The assessment of a patient's ability to decide and self-determine is a common clinical problem in general hospitals. Evaluation of these patients requires a proper understanding of the philosophical, ethical, and legal issues that guide the appropriate treatment of these complex clinical problems. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  5. AFRONTAMIENTO FAMILIAR ANTE LA PRIMERA CRISIS DEL PACIENTE PSIQUIATRICO DEL HOSPITAL MENTAL RUDESINDO SOTO EN EL SEGUNDO SEMESTRE DE 2004

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    Luz Paola Morales-Contreras

    2005-12-01

    Full Text Available Con el propósito de determinar el grado de afrontamiento de la familia del paciente psiquiátrico ante el padecimiento de sus primeras crisis que asisten al Hospital Mental Rudesindo Soto de Cúcuta Norte de Santander, se desarrollo el presente estudio de tipo cuantitativo, descriptivo y de corte transversal. La población de estudio estuvo constituida por 40 cuidadores primarios de los pacientes con primera crisis que ingresaron al Hospital Mental Rudesindo Soto durante el periodo comprendido entre Julio y Octubre de 2004 residentes en Ia ciudad de acutal y su área metropolitana, caracterizados de acuerdo al sexo, edad, parentesco, ocupación y escolaridad, a quienes se aplico el instrumento F-COPES "Escala de Evaluación personal del funcionamiento familiar en situación de crisis", para determinar Ia utilización de los mecanismos de afrontamiento y mecanismo de defensa así como la Búsqueda de redes de apoyo social. De acuerdo al afrontamiento familiar el cuidador primario algunas veces busca redes de apoyo, casi nunca utiliza los mecanismos de defensa y los mecanismos de afrontamiento son utilizados algunas veces. Se concluye principalmente que el grado de afrontamiento de Ia familia del paciente psiquiátrico en su primera crisis es desfavorable.

  6. Positive mental health among health professionals working at a psychiatric hospital.

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    Louisa Picco

    Full Text Available Positive mental health (PMH is a combination of emotional, psychological and social well-being that is necessary for an individual to be mentally healthy. The current study aims to examine the socio-demographic differences of PMH among mental health professionals and to explore the association between job satisfaction and total PMH.Doctors, nurses and allied health staff (n = 462 completed the online survey which included the multidimensional 47-item PMH instrument as well as a single item job satisfaction question. Associations of PMH with job satisfaction were investigated via linear regression models.Significant differences in PMH total and domain specific scores were observed across socio-demographic characteristics. Age and ethnicity were significantly correlated with PMH total scores as well as various domain scores, while gender, marital and residency status and the staff's position were only significantly correlated with domain specific scores. Job satisfaction was also found to be a significantly associated with total PMH.The workplace is a key environment that affects the mental health and well-being of working adults. In order to promote and foster PMH, workplaces need to consider the importance of psychosocial well-being and the wellness of staff whilst providing an environment that supports and maintains overall health and work efficiency.

  7. The right of patients in mental hospitals to refuse drug treatment.

    Science.gov (United States)

    Buchwald, W; Lazorishak, K

    1986-01-01

    The use of antipsychotic drugs has caused conflicts between the medical decision concerning what is in a patient's best interests and the legal decision as to what treatment constitutes a violation of the mental patient's right to due process. The medical profession has a duty to treat patients; patients have a right to refuse medical treatment. With legislation leading to the release of mental patients into the community, the focus has turned away from treatment of a disease and toward prevention through changes in social policy. The law has recognized that the state has an interest in compelling treatment and that the patient has a right to refuse medical treatment. The rights of the state and the patient are not absolute and must be balanced by the judiciary. The result is that a mental patient's right to refuse antipsychotic drugs mut be determined on a case by case basis. The authors propose that states pass legislation covering the rights of mental patients. A model bill is proposed at the end of the article. It establishes a procedural system which addresses the issues of informed consent, competency, emergencies, medical review, and judicial review.

  8. Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations?

    Directory of Open Access Journals (Sweden)

    Flavius Robert Lilly

    Full Text Available This study examined outcomes for two groups of stroke survivors treated in Veteran Health Administration (VHA hospitals, those with a severe mental illness (SMI and those without prior psychiatric diagnoses, to examine risk of non-psychiatric medical hospitalizations over five years after initial stroke.This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VHA medical center during fiscal year 2003. The survivors were followed using administrative data documenting inpatient stroke treatment, patient demographics, disease comorbidities, and VHA hospital admissions. Multivariate Poisson regression was used to examine the relationship between patients with and without SMI diagnosis preceding the stroke and their experience with non-psychiatric medical hospitalizations after the stroke.The study included 100 patients with SMI and 423 without SMI. Unadjusted means for pre-stroke non-psychiatric hospitalizations were higher (p = 0.0004 among SMI patients (1.47 ± 0.51 compared to those without SMI (1.00 ± 1.33, a difference which persisted through the first year post-stroke (SMI: 2.33 ± 2.46; No SMI: 1.74 ± 1.86; p = 0.0004. Number of non-psychiatric hospitalizations were not significantly different between the two groups after adjustment for patient sociodemographic, comorbidity, length of stay and inpatient stroke treatment characteristics. Antithrombotic medications significantly lowered risk (OR = 0.61; 95% CI: 0.49-0.73 for stroke-related readmission within 30 days of discharge.No significant differences in medical hospitalizations were present after adjusting for comorbid and sociodemographic characteristics between SMI and non-SMI stroke patients in the five-year follow-up. However, unadjusted results continue to draw attention to disparities, with SMI patients experiencing more non-psychiatric hospitalizations both prior to and up to one year after their initial stroke. Additionally

  9. [Characteristics of Hospitalized Mentally ill Spanish Migrants in Germany - Results of a Statistical Reanalysis].

    Science.gov (United States)

    Valdés-Stauber, J; Valdés-Stauber, M A

    2015-10-01

    To draft a clinical profile of mentally ill first-generation Spanish immigrants in Germany treated in a special setting in their native language and to identify possible correlations between time of onset of a mental disorder and migration and also between degree of utilization and clinical as well as care variables. Statistical reanalysis of individual data (n = 100) of a previously published descriptive study with aggregated data corresponding to 15 variables. Correlations are calculated using chi-square as well as Fisher's exact test. Multivariate regression and logistic models were conducted. In addition to the explained variance of the models (R(2)), analyses of residuals as well as post-hoc power analyses (1-β) were performed. A quarter of the sample (26 %) was mentally ill before migration; most of the patients received treatment very late (about 10 years after onset) and became chronically ill. Half of the sample shows a relevant somatic comorbidity and large average lengths of inpatient stays (54 days). In 16 % of treated cases, repatriation had to be organized. The degree of chronicity correlates with mental illness prior to migration. Severe mood disorders and psychoses occur late after having migrated, addictions and neurotic disorders are equally distributed over time. Migration can not be set in a causal relationship with the development of mental disorders, although there is a positive correlation between affective disorders and the duration of the migration status. Chronicity is related to an outbreak of the disease before migration. The sample is relatively homogeneous (one nationality, first generation), but loses epidemiological representativeness (not related to a catchment area). © Georg Thieme Verlag KG Stuttgart · New York.

  10. Review of triage reform: the case for national consensus on a single triage scale for clients with a mental illness in Australian emergency departments.

    Science.gov (United States)

    Broadbent, Marc; Creaton, Anne; Moxham, Lorna; Dwyer, Trudy

    2010-03-01

    The aim of this paper is to examine the use of mental health triage scales in Australian emergency departments (EDs) and to explore the use of the Australasian Triage Scale (ATS) with existing mental health triage scales. Since the introduction of mainstreaming and deinstitutionalisation in Australian mental health care, the number of clients presenting to Australian EDs has been increasing. It has become apparent that the lack of mental health descriptors in existing triage scales diminishes the ability of ED triage staff to accurately assess clients with a mental illness. In response to this, specialised mental health triage scales have been developed and introduced into practice. Concurrently, mental health descriptors have been incorporated into the ATS used across Australian EDs. A review of English language literature was conducted. The data bases Proquest, Synergy and CINAHL were searched using the key words 'emergency department', 'triage', 'mental health' and again using the term 'emergency mental health triage'. There is a paucity of literature surrounding the use of mental health triage scales in Australian EDs; 18 articles were found to be directly relevant to the subject matter. Currently clients with a mental illness presenting to the ED may be triaged against one of four mental health triage scales. Research has shown that the mental health descriptors in the ATS are not as reliable as a specialised mental health triage scale. This has implications for clinical practice on two levels. First, it affects the initial triage assessment in the ED and the ability for mental health clinicians to respond in a timely manner and this will have an impact on clinical outcomes. Second, the use of the mental health triage criteria in the ATS may misrepresent ED workloads and affect data pertaining to ED performance.

  11. PLHIV are more likely to have mental distress: evidence from a comparison of a cross-section of HIV and diabetes patients at Tertiary Hospitals in Nigeria.

    Science.gov (United States)

    Abiodun, Olumide; Lawal, Ismail; Omokanye, Christopher

    2018-02-19

    HIV is now regarded as a chronic disease because of the availability of treatment. However, it is not well known if there are differences (clinically and in magnitude) between the mental health status of PLHIV and people living with other chronic diseases. The aim of this study was to compare the mental health status of patients attending antiretroviral clinics to patients attending diabetes clinics at tertiary hospitals in Ogun State, Nigeria. A comparative hospital-based cross-sectional study of mental distress among 639 HIV-positive and 639 diabetic patients was carried out. Multivariate logistic regression analysis was used to control for confounders and to predict the probability of mental distress in PLHIV. The mean age of the participants was 44.87 (± 13.83) years and it had a range of 63 years (17 to 80). The prevalence of mental distress was higher among HIV-positive participants (46.79%) than diabetic participants (33.02%) (p < 0.0001). HIV-positive participants had greater odds of mental distress than diabetics (odds ratio = 1.78; 95% CI = 1.41-2.25). HIV-positivity, female sex, lower levels of education, being unemployed, poorer housing conditions and separated, widowed or divorced were associated with higher odds of mental distress (p < 0.05). Mental distress was predicted by HIV-positivity, occupation and current marital status. HIV infection and social inequalities are independent risk factors for mental distress. The odds of having mental distress is higher among PLHIV compared with diabetic patients. Addressing social inequalities might be the critical factor in the control of mental distress among PLHIV. ART: Anti-retroviral therapy; CI: Confidence interval; YLD: Years Lived with Disability; GHQ: General Health Questionnaire; HIV/AIDS: Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome; LMIC: Low and middle-income countries; MH: Mantel-Haenszel; PLHIV: People living with HIV; ROC: Receiver operating characteristic.

  12. Critical Cases Faced by Mental Health Nurses and Assistant Nurses in Psychiatric Hospitals in Greece

    Directory of Open Access Journals (Sweden)

    Evmorfia Koukia

    2013-01-01

    Full Text Available Background: Psychiatric Nurses and nurses’ assistants working in an inpatient unit experience a significant number of critical cases. A small number of studies have explored which patients’ problems nurses perceive as ‘critical case or incident’ and particularly which interventions they choose. Aim: The aim of the research was 1. To identify the clinical problems that mental health nurses and assistant nurses characterize as critical 2. To report the main nursing interventions 3. To investigate the main person involved in the critical incident. Material-Method: Critical incident technique was used as a method of data collection. Content analysis was carried out in order nurses’ information to be categorized into subcategories. The sample consisted of 35 mental health nurses and nurses’ assistants who work in psychiatric acute inpatient wards.Results: Nurses identified ten types of critical incidents. They noted violence (verbal, physical by patients and psychotic symptoms to be the most critical situations. Nurses were the main person involved in these incidents. The study also described eight nursing interventions used by nurses when faced with critical events. Conclusions: The findings indicated that mental health nurses and assistant nurses working in acute inpatient wards are called to confront a variety of critical incidents in their every day practice. Further research is necessary to identify in-depth nursing interventions and decision-making used in these situations.

  13. Consumer sexual relationships in a forensic mental health hospital: perceptions of nurses and consumers.

    Science.gov (United States)

    Quinn, Chris; Happell, Brenda

    2015-04-01

    The management of consumer-related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long-term and secure setting. Individual in-depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes 'supportive factors' and 'potential dangers', reflecting their qualified support. Consumer responses included the subthemes 'therapeutic', 'feeling normal', 'restrictions and barriers', and 'lack of support and secrecy'. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly-avoided issue and the education of nurses and other health professionals is required. © 2014 Australian College of Mental Health Nurses Inc.

  14. Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort

    DEFF Research Database (Denmark)

    Levenstein, Susan; Jacobsen, Rikke Kart; Rosenstock, Steffen

    2017-01-01

    Objective: To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. Materials and methods: A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30–60, in 1982–3. Mental vulnerability...... vulnerability was 1.5 (CI 1.0–2.2, p =.04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. Conclusions...

  15. Mental and nonmental health hospital admissions among chronically homeless adults before and after supportive housing placement.

    Science.gov (United States)

    Rieke, Katherine; Smolsky, Ann; Bock, Erin; Erkes, Laura Peet; Porterfield, Erin; Watanabe-Galloway, Shinobu

    2015-01-01

    Individuals experiencing chronic homelessness may utilize hospital services more frequently than the general population. Understanding the benefits of providing permanent supportive housing to these individuals can lead to improved services for this population. This study examined the effect of supportive housing placement on hospital admissions of adults who were homeless. Admissions were examined for a period of one-year pre- and postsupportive housing placement for 23 adults. Results showed a reduction in the number of emergency department admissions and an increase in outpatient admissions during the year following housing placement, indicating that supportive housing may encourage more appropriate use of health care services.

  16. Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008

    Directory of Open Access Journals (Sweden)

    Chemali ZN

    2013-07-01

    Full Text Available Zeina N Chemali,1,2 Christina PC Borba,1,2 Tanya E Henderson,3 Markos Tesfaye41Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3International and Human Rights Law Consultants, Cambridge, MA, USA; 4Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, EthiopiaAbstract: This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.Keywords: global mental health, low income country, Africa, gender differences

  17. Hospitalization for mental illness among parents after the death of a child

    DEFF Research Database (Denmark)

    Li, Jiong; Laursen, Thomas Munk; Precht, Dorthe Hansen

    2005-01-01

    Background The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital admission for a psychiatric disorder, especially for affective disorders. Methods We studied a cohort of 1,082,503 person...

  18. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  19. Pedagogical Mediation as an Educational Strategy for Students with Mental Illness in alphabetization level offered in the National Psychiatric Hospital

    Directory of Open Access Journals (Sweden)

    Karen Hidalgo-Montoya

    2013-03-01

    Full Text Available This study focuses on the work of teachers in the Open Education Program of the National Psychiatric Hospital (Costa Rica and identifies the learning barriers of the student population. It aims at promoting educational delivery strategies adapted to the needs of the community attending the literacy level. This is a qualitative study with a participatory action research design. Information was collected through interviews to teachers, observation, and pedagogical mediation with the teachers of the program. The results indicate that the pedagogical mediation methodology contributed to improve the access of students to the curriculum. Among the conclusions, it is recommended to implement significant curriculum modifications focused on the student population and a classroom methodology adjusted to the different learning needs. Finally, it is recommended to have an interdisciplinary team to support the teaching staff working with students with mental illness.

  20. Trabalhadores em saúde mental: contradições e desafios no contexto da reforma psiquiátrica Trabajadores del área de salud mental: contradicciones y desafíos en el contexto de la reforma psiquiátrica Mental health workers': contradictions and challenges in the psychiatric reform context

    Directory of Open Access Journals (Sweden)

    Leandro Barbosa de Pinho

    2010-06-01

    cuidar de la locura en el servicio. Se espera que este estudio pueda ayudar en la problematización del movimiento de reforma psiquiátrica en el contexto brasileño.This study analyzes the mental health workers discourse, pointing directions, doubts and uncertainties about the formation of the community mental health service team. The corpus consists in interviews applied in 2006 to 17 of 25 mental health workers in a substitutive service in a city in southern Brazil. The methodological device which subsidizes the systematization of the data is the "axiological-discursive diagram", constructed from the Critical Discourse Analysis theoretical framework. It was found that the operational uncertainty that joins the team and its fragments at the same time, is related to a cascade of possibilities, which began operating in the very vagueness of the objects and instruments of work in mental health and ending on the difficulty of identifying who are the professionals who must take care of madness in the service. We hope this study can help in questioning the movement of psychiatric reform in the Brazilian context.

  1. Parliamentary Reform

    OpenAIRE

    Norton, Philip

    2016-01-01

    The key concept of any study of the role of Parliament focuses on the extent to which it is able to influence and constrain the Executive. Reforming Parliament should seek to strengthen its capacity to do so. A clear distinction ought to be drawn between external and internal reforms of the Parliamentary system. While the former strive to achieve the desired goal through changes in the constitutional framework – e.g. the reform of the House of Lords – the latter aim to improve the working of ...

  2. Exploring sexual risks in a forensic mental health hospital: perspectives from patients and nurses.

    Science.gov (United States)

    Quinn, Chris; Happell, Brenda

    2015-01-01

    Patients utilising forensic mental health inpatient services experience a range of sexual risks, including vulnerability to sexual exploitation and exposure to sexually transmissible infections. However, there is a paucity of research exploring the issue of sexual risks from the standpoint of patients and the nurses who work closely with them in inpatient secure settings. This article presents findings from a qualitative exploratory study, which investigated the views of patients and nurses about sexual relationships in forensic mental health settings. Risk was a major theme arising from the data and is the focus of this article. Subthemes from nurse participants included sexual safety, sexual vulnerability, unplanned pregnancies, and male sexuality issues. Subthemes from patients included risks associated with sexual activity, access to information and sexual health care, unplanned pregnancies, vulnerability, and male sexuality issues. Knowledge about these sexual risks by patients and nurses were well articulated, however information and assistance were considered by patients to be less than satisfactory in improving their knowledge or in providing the support they considered important to reduce sexual risks. The issue of risk needs to be addressed, and nurses would be well placed to contribute; however they require education to improve their ability to provide sexual health education to patients along with strategies to ensure patients receive the support and services they require to reduce their exposure to sexual risks.

  3. Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan

    Science.gov (United States)

    Shiina, Akihiro; Iyo, Masaomi; Hirata, Toyoaki; Igarashi, Yoshito

    2015-01-01

    AIM: To clarify the components of hospitalization for assessment (HfA) and the management changes from the beginning of the scheme to the present. METHODS: This study is composed of two surveys. In 2013 survey, we created two paper questionnaires (facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the HfA cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer (public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through HfA during the survey period. The case questionnaire was then used to collect data of the patients under HfA based on the Medical Treatment and Supervision (MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during HfA, information regarding seclusion and restraint during the HfA, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of HfA patients from July 15, 2005 (the date the MTS Act was enforced) to January 15, 2007. RESULTS: We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent

  4. Effects of yoga on patients in an adolescent mental health hospital and the relationship between those effects and the patients' sensory-processing patterns.

    Science.gov (United States)

    Re, Pamela; McConnell, John W; Reidinger, Gloria; Schweit, Ronnie; Hendron, Angela

    2014-11-01

    This study investigated the effects of yoga as a sensory regulation tool in reducing adolescent distress in an acute care psychiatric hospital. This was a descriptive, correlational pre-intervention/post-intervention design conducted in a mental health hospital over 5 months from mid-January to mid-June 2012. The population consisted of a convenience sample of 75 adolescent mental health unit inpatients and partial-hospitalization patients 12-18 years of age who participated in two or more yoga sessions. Patient charts provided Diagnostic and Statistical Manual of Mental Disorders-IV Axes I-V diagnosis, gender, and age. Dependent variables were pulse and Subjective Units of Disturbance Scale scores, which were recorded before and after each yoga class. The Adult/Adolescent Sensory Profile provided a measure of patient sensory-processing preference levels that were related to the pulse and Subjective Units of Disturbance Scale results. Yoga sessions significantly improved patient pulse and self-reported distress ratings regardless of gender or sensory profile levels. This article contributes to research on the therapeutic effects of yoga as a sensory regulation intervention in the treatment of psychiatrically hospitalized adolescents. Yoga has the potential to help adolescents in an acute care psychiatric hospital learn to soothe themselves, to regulate their emotions, and to find relief from emotional distress while hospitalized. © 2014 Wiley Periodicals, Inc.

  5. Does implementing a development plan for user participation in a mental hospital change patients' experience? A non-randomized controlled study.

    Science.gov (United States)

    Rise, Marit B; Steinsbekk, Aslak

    2015-10-01

    Governments in several countries attempt to strengthen user participation through instructing health-care organizations to implement user participation initiatives. There is, however, little knowledge on the effect on patients' experience from comprehensive plans for enhancing user participation in whole health service organizations. To investigate whether implementing a development plan intending to enhance user participation in a mental hospital had any effect on the patients' experience of user participation. A non-randomized controlled study including patients in three mental hospitals in Central Norway, one intervention hospital and two control hospitals. A development plan intended to enhance user participation was implemented in the intervention hospital as a part of a larger reorganizational process. The plan included establishment of a patient education centre and a user office, purchase of user expertise, appointment of contact professionals for next of kin and improvement of the centre's information and the professional culture. Perceptions of Care, Inpatient Treatment Alliance Scale and questions made for this study. A total of 1651 patients participated. Implementing a development plan in a mental hospital intending to enhance user participation had no significant effect on the patients' experience of user participation. The lack of effect can be due to inappropriate initiatives or challenges in implementation processes. Further research should ensure that initiatives and implementation processes are appropriate to impact the patients' experience. © 2013 John Wiley & Sons Ltd.

  6. Hospitalization for mental illness among parents after the death of a child

    DEFF Research Database (Denmark)

    Li, Jiong; Laursen, Thomas Munk; Precht, Dorthe Hansen

    2005-01-01

    Background The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital admission for a psychiatric disorder, especially for affective disorders. Methods We studied a cohort of 1,082,503 persons...... identified from national registers in Denmark who were born between 1952 and 1999 and had at least one child under 18 years of age during the follow-up period, from 1970 to 1999. Parents who lost a child during follow-up were categorized as “bereaved” from the date of death of the child. Results As compared...... with parents who did not lose a child, parents who lost a child had an overall relative risk of a first psychiatric hospitalization for any disorder of 1.67 (95 percent confidence interval, 1.53 to 1.83). Bereaved mothers had a higher relative risk of being hospitalized for any psychiatric disorder than...

  7. Administrative Reform

    DEFF Research Database (Denmark)

    Plum, Maja

    Through the example of a Danish reform of educational plans in early childhood education, the paper critically addresses administrative educational reforms promoting accountability, visibility and documentation. Drawing on Foucaultian perspectives, the relation between knowledge and governing...... of administrative technology, tracing how the humanistic values of education embed and are embedded within ‘the professional nursery teacher' as an object and subject of administrative practice. Rather than undermining the humanistic potential of education, it is argued that the technology of accounting...

  8. Returning to Work after a Common Mental Health Disorder: a New Preoccupation for Mental Health Professionals?

    Science.gov (United States)

    Lepièce, Brice; Reynaert, Christine; Jacques, Denis; Zdanowicz, Nicolas

    2017-09-01

    Since 2010, the Belgian mental healthcare system has been involved in a structural reform: the main objective of this reorganisation is to foster the reintegration in the community of patients suffering from a mental health disorder. In parallel, the role of mental health professionals has evolved these last years: from a strictly clinical role, to the preoccupation with the rehabilitation of social competencies such as enhancing patients' abilities to return to work. The aim of this paper is to explore, specifically for patients hospitalized for a common mental health disorder, the predictive variables of returning to work within 6 months after hospitalization (RTW6). Our sample was extracted from routinely collected data during the patients' hospital stay (10 days) at the Psychosomatic Rehabilitation Day Centre of CHU Godinne. A sample of 134 patients participated in our study. Those patients were contacted 6 months after their hospitalization to assess resumption of work. We found that a patient's sociodemographicand socioeconomic variables, and depressive symptoms at the beginning of hospitalization were not predictive of return to work within 6 months (RTW6). On the other hand, duration of absence from work before hospitalization and the diagnosis of a major depression in particular were negatively associated with RTW6, whereas improvement of depressive symptoms during hospitalization stay was positively associated to RTW6. Our study identified the diagnosis of major depression and the duration of absence from work before hospitalization as two important risk factors impeding a fast return to work for patients hospitalised for a common mental health disorder. As the preoccupation with patients' abilities to return to work is now on the agenda of mental health professionals, special support and supervision should be dedicated to the more vulnerable patients.

  9. Reform and Backlash to Reform

    DEFF Research Database (Denmark)

    Hougaard Jensen, Svend E.; Hagen Jørgensen, Ole

    Using a stochastic general equilibrium model with overlapping generations, this paper studies (i) the effects on both extensive and intensive labor supply responses to changes in fertility rates, and (ii) the potential of a retirement reform to mitigate the effects of fertility changes on labor...... supply. In order to neutralize the effects on effective labor supply of a fertility decline, a retirement reform, designed to increase labor supply at the extensive margin, is found to simultaneously reduce labor supply at the intensive margin. This backlash to retirement reform requires the statutory...

  10. One-Year Follow-Up of Suicidal Adolescents: Parental History of Mental Health Problems and Time to Post-Hospitalization Attempt

    Science.gov (United States)

    King, Cheryl A.; Kerr, David C. R.; Passarelli, Michael N.; Foster, Cynthia Ewell; Merchant, Christopher R.

    2010-01-01

    This longitudinal study of recently hospitalized suicidal youth examined parental mental health history in addition to several indices of adolescent functioning as risk factors for time-to-suicide attempt over a 1-year period. Participants were 352 adolescents (253 girls, 99 boys; ages 13-17 years) who participated in self-report and interview…

  11. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality in the Netherlands

    NARCIS (Netherlands)

    Bales, D.; van Beek, N.; Smits, M.; Willemsen, S.; Busschbach, J.J.V.; Verheul, R.; Andrea, H.

    2012-01-01

    Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As

  12. Treatment outcome of 18-month, day hospital Mentalization-Based Treatment (MBT) in patients with severe borderline personality disorder in the Netherlands

    NARCIS (Netherlands)

    D.L. Bales (Dawn); N. van Beek (Nicole); M. Smits (Maaike); S.P. Willemsen (Sten); J.J. van Busschbach (Jan); R. Verheul (Roel); H. Andrea (Helene)

    2012-01-01

    textabstractPsychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United

  13. Ações de saúde mental no Programa Saúde da Família: confluências e dissonâncias das práticas com os princípios das reformas psiquiátrica e sanitária Mental health care in the Family Health Program: consensus and dissent in practices and principles under the psychiatric reform and health reform in Brazil

    Directory of Open Access Journals (Sweden)

    Mônica Nunes

    2007-10-01

    Full Text Available Em um grande número de Reformas Psiquiátricas que se sedimentam sobre os pressupostos básicos da não-institucionalização dos pacientes psiquiátricos e da consolidação de bases territoriais do cuidado em saúde mental, a ênfase é atribuída a uma rede de cuidados que contemple a rede de atenção primária. No Brasil, a Reforma Psiquiátrica Brasileira nasce no bojo da Reforma Sanitária, guardando em comum princípios que reorientariam o modelo de atenção. Neste artigo, discutiremos as articulações entre esses dois movimentos por intermédio das práticas concretas do cuidado de saúde mental no Programa Saúde da Família (PSF, tomando como base um estudo etnográfico com quatro equipes de saúde da família, em que priorizamos a narrativa dos trabalhadores de saúde. Analisaremos, dessas práticas, discrepâncias entre o proposto normativo e o instituído, fatores dificultadores e conquistas da operacionalização das ações e limites da confrontação e potencialidades da transversalidade de campos epistemológicos particulares como a clínica ampliada da saúde mental e do PSF. Moveremos nossa discussão com base em conceitos como modelo psicossocial do cuidado, integralidade da atenção, participação social, territorialidade, ações coletivas, entre outros.In many psychiatric reforms based on the principles of deinstitutionalization of psychiatric patients and the consolidation of territorial systems for mental health care, the emphasis is on a mental health care system that includes the primary care network. In Brazil, the Psychiatric Reform emerged within the country's overall Health Reform, with which it shares common principles for reorienting the model of care. The current article discusses the links between these two movements through actual mental health care practices within the Family Health Program (FHP, based on an ethnographic study with four family health teams, in which the authors prioritize health workers

  14. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology....... Documentation exists in; well-being of patients and staff, sleep disorders, pain distraction, confidentiality and privacy, levels of errors in hospitals. Art and the use of color: Art can be context related so one should be aware whether it is in a private ward or the foyer and related to the experience...... of the patient. Art can be used as a stress reducing factor, pain distracter, and also to orientate and to provide landmarks in the hospital landscape. Air, the use of natural ventilation as much as possible, complemented by mechanical ventilation in most cases, particularly in northern Europe; the emphasis...

  15. Developing a Child and Youth Mental Health and Addictions Framework for Yukon as a Foundation for Policy Reform: Engaging Stakeholders Through a Policy and Research Partnership

    Directory of Open Access Journals (Sweden)

    Gillian Mulvale

    2016-09-01

    Full Text Available In April 2015 the Yukon Government released a new child and youth mental health and addictions framework (CYMHAF to improve territory-wide access to basic mental health care and coordination of services for children and families. Yukon’s limited resource base and dispersed population challenges delivery of child and youth mental health and addictions services to small rural communities where needs are often high as a legacy of residential school policies. The objective of CYMHAF is to improve outcomes by identifying and capitalizing on current strengths, and reallocating existing resources to better meet the mental health needs of Yukon youth and families. Access, coordination and quality problems associated with existing services, growing public awareness of mental health issues, and a new national policy framework designed to assist provinces and territories, led Yukon policy makers to partner with researchers to capitalize on a Canadian Institutes of Health Research (CIHR strategic grant initiative. CYMHAF was based on extensive stakeholder engagement, best evidence and advice from key informants in other jurisdictions, and offers a cascading model of service delivery through which basic mental health care can be provided by existing health and human service workers in communities. These workers will be trained in child and youth mental health competencies, and will have electronic linkages and support to integrated teams of primary care providers who will be located in regional hubs once fully implemented, and to specialists in Whitehorse and out of Territory. Implementation is underway with some training of front line Health and Social Service and First Nations workers, a new mental wellness strategy for Yukon founded on CYMHAF scheduled for release in spring 2016, and may be accelerated by federal government promises of a new Health Accord and a new relationship with indigenous people.

  16. An historical account of shell shock during the First World War and reforms in mental health in Australia 1914-1939.

    Science.gov (United States)

    Rae, Ruth

    2007-08-01

    The study of the disorders of the mind at the turn of the twentieth century offered useful knowledge about the psyche and the First World War (FWW) provided an avalanche of case studies. Prior to the war the mentally ill were treated with disdain and the social distrust of individuals who did not present as 'normal' was high. The level of diagnostic expertise of psychiatric illness by doctors and nurses was low and as a consequence medicine and nursing was ill-equipped to deal with the phenomenon initially referred to as 'shell shock'. However, the soldiers of the FWW who endured the varied and seemingly unrelated symptoms of shell-shock were respected men - occasional heroes - who were reduced to the status of 'mentals'. There is evidence that civilian trained health professionals altered their views about mental illness during the FWW but initially, the military imperatives inherent in a global conflict perpetuated the notion that mental illness was linked with defective morality. This paper provides an historical account of changes in attitude toward the mentally ill as a consequence of the FWW. The interregnum (1918-39) was a period of advancement in the field of mental health within the civilian sector. However, the imperatives of war negated these developments and there is evidence that the management of soldiers suffering from post-traumatic stress disorders in the Second World War did not benefit from the lessons learnt in the FWW.

  17. A lobotomia e a leucotomia nos manicômios brasileiros Lobotomy and leucotomy in Brazilian mental hospitals

    Directory of Open Access Journals (Sweden)

    André Luis Masiero

    2003-08-01

    Full Text Available A lobotomia e leucotomia foram utilizadas em pacientes de instituições asilares brasileiras, entre 1936 e 1956. Também chamadas de psicocirurgias, eram intervenções que consistiam em desligar os lobos frontais direito e esquerdo de todo o encéfalo, visando modificar comportamentos ou curar doenças mentais. A técnica, idealizada pelo neurologista português Egas Moniz em 1935 e aperfeiçoada pelo americano Walter Freeman, chegou ao Brasil por intermédio de Aloysio Mattos Pimenta, neurocirurgião do Hospital Psiquiátrico do Juquery, em São Paulo, logo seguido por outros médicos. Esta medida foi aplicada em mais de mil pacientes internados não só para fins curativos, mas também para aprimorar tecnicamente a cirurgia, uma vez que os experimentos preliminares com animais eram escassos. No Brasil, a técnica foi adotada até 1956, passando a ferir o Código de Nuremberg, de 1947, concebido para regulamentar e conter os abusos da experimentação médica em seres humanos ocorridos durante a Segunda Guerra Mundial.Lobotomy and leucotomy were used in Brazilian mental institutions from 1936 to 1956. Also called psycho-surgeries, they were operations that separated the right and left frontal lobes and pre-frontal lobes from the rest of the brains, aiming at modifying behavior or curing mental diseases. The technique, created by the Portuguese neurologist Egas Moniz in 1935 and developed by Walter Freeman from the United States, arrived in Brazil through the hands of Aloysio Mattos Pimenta, neurologist from Hospital Psiquiátrico Juquery in São Paulo. Soon, many doctors followed suit. These procedures were used on more than a thousand in-patients aiming at not only healing results, but also the technical improvement of the surgical technique, since preliminary experiments with animals were quite rare at the time. In Brazil, the technique was used until 1956, when it was considered as going against the 1947 Nuremberg Code, whose objective was

  18. Administrative Reform

    DEFF Research Database (Denmark)

    Plum, Maja

    Through the example of a Danish reform of educational plans in early childhood education, the paper critically addresses administrative educational reforms promoting accountability, visibility and documentation. Drawing on Foucaultian perspectives, the relation between knowledge and governing......, implied in the reform, is analysed as a technology of accounting. A technology producing ‘the professional nursery teacher' as a reflective daily researcher, who outlives her pedagogical desire as an analytical care of the optimisation of ‘the learning child'. Thus, the paper analyses the micro physics...... of administrative technology, tracing how the humanistic values of education embed and are embedded within ‘the professional nursery teacher' as an object and subject of administrative practice. Rather than undermining the humanistic potential of education, it is argued that the technology of accounting...

  19. Slab reformer

    Science.gov (United States)

    Spurrier, Francis R. (Inventor); DeZubay, Egon A. (Inventor); Murray, Alexander P. (Inventor); Vidt, Edward J. (Inventor)

    1985-01-01

    Slab-shaped high efficiency catalytic reformer configurations particularly useful for generation of fuels to be used in fuel cell based generation systems. A plurality of structures forming a generally rectangular peripheral envelope are spaced about one another to form annular regions, an interior annular region containing a catalytic bed and being regeneratively heated on one side by a hot combustion gas and on the other side by the gaseous products of the reformation. An integrally mounted combustor is cooled by impingement of incoming oxidant.

  20. Slab reformer

    Science.gov (United States)

    Spurrier, Francis R.; DeZubay, Egon A.; Murray, Alexander P.; Vidt, Edward J.

    1984-02-07

    Slab-shaped high efficiency catalytic reformer configurations particularly useful for generation of fuels to be used in fuel cell based generation systems. A plurality of structures forming a generally rectangular peripheral envelope are spaced about one another to form annular regions, an interior annular region containing a catalytic bed and being regeneratively heated on one side by a hot comubstion gas and on the other side by the gaseous products of the reformation. An integrally mounted combustor is cooled by impingement of incoming oxidant.

  1. Telecom Reform

    DEFF Research Database (Denmark)

    and information infrastructure issues - for people in government, academia, industry and the consulting community. This book addresses the process of policy and regulatory reform in telecom that is now in its formative stage. It draws on detailed knowledge of industry development and regulatory experience......, as well as expertise in the new technologies, industries, economics, policy development, and law to present and critique the principles, policies and regulatory practices associated with telecom reform. Twenty six international experts address thirty two topics that are essential to successful telecom...

  2. Exploration of the comorbidity of cannabis use disorders and mental health disorders among inpatients presenting to all hospitals in New South Wales, Australia.

    Science.gov (United States)

    Lai, Harry Man Xiong; Sitharthan, Thiagarajan

    2012-11-01

    Cannabis is one of the most commonly used illegal psychoactive substances and its use often coexists with mental health disorders. This study explores the relationships between cannabis use disorders and some common mental health disorders. Admissions to all New South Wales (NSW) hospitals were analyzed. The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period 1 July 2006 to 30 June 2007. Readmissions within 28 days were excluded. Data extraction and analyses were performed by using the SAS program. Chi-square tests and odds ratio were used to examine the association between cannabis use disorder and mental health disorders. Of the 1.8 million admissions, associations between cannabis use disorders and mental health disorders were strong (odds ratio = 7.8-10.7, p cannabis had at least one identifiable mental disorder. Higher comorbidity rates were observed for females (39.6%) and for those aged between 30 and 49 years. Cannabis use disorder comorbid with the most common mental disorders were: anxiety disorder (3.4%), bipolar affective disorder (5.7%), major depressive disorder (10.9%), personality disorder (9.2%), schizophrenia (15.0%), and severe stress disorder (8.7%). Cannabis use disorder has strong associations with these mental health disorders (odds ratio 4.8-34.8). The average length of stay (ALOS) for cannabis use disorders was 9.0 days and the ALOS for the most common mental health disorders was 11.0 days. This study provides detailed information about the association between cannabis use disorders and mental health disorders and extends our understanding of comorbidity presentations in inpatient admissions.

  3. Percepções de profissionais de enfermagem sobre intervenções de Terapia Ocupacional em Saúde Mental em hospital universitário Percepciones de profesionales de enfermería sobre intervenciones de Terapia Ocupacional en Salud Mental en hospital universitario Perceptions of professional nurses about occupational therapy interventions in mental health at a university hospital

    Directory of Open Access Journals (Sweden)

    Solange Tedesco

    2011-01-01

    Full Text Available OBJETIVO: Conhecer as percepções de profissionais de enfermagem sobre intervenções grupais de Terapia Ocupacional em Saúde Mental realizadas com pacientes internados em um hospital universitário. MÉTODOS: Estudo de abordagem qualitativa do tipo descrito. As anotações das coordenadoras dos grupos de Terapia Ocupacional foram analisadas em relação às entrevistas abertas junto a n enfermeiras e n técnicos de enfermagem que participaram das intervenções grupais de Terapia Ocupacional pelo período de dois anos. As respostas foram submetidas à análise do Discurso do Sujeito Coletivo (DSC. RESULTADOS: Foram identificadas quatro ideias centrais do DSC: a Terapia Ocupacional como favorecedora do cuidado integrado, valorizando o sujeito e sua experiência; a terapia ocupacional como processo de ajuda e cuidado para a própria equipe; o grupo de Terapia Ocupacional como espaço de ressonância e facilitação no manejo com o paciente em razão da percepção de aspectos relacionais. CONCLUSÃO: As estratégias foram percebidas, quer como promotoras da reorganização da situação vivida pelo paciente na internação, quer como oportunidades de ensino e apoio para a equipe de enfermagem.OBJETIVO: Conocer las percepciones de profesionales de enfermería sobre intervenciones grupales de Terapia Ocupacional en Salud Mental realizadas con pacientes internados en un hospital universitario. MÉTODOS: Estudio de abordaje cualitativo del tipo descrito. Las anotaciones de las coordinadoras de los grupos de Terapia Ocupacional fueron analizadas en relación a las entrevistas abiertas junto a n enfermeras y n técnicos de enfermería que participaron de las intervenciones grupales de Terapia Ocupacional por el período de dos años. Las respuestas fueron sometidas al análisis de Discurso del Sujeto Colectivo (DSC. RESULTADOS: Se identificaron cuatro ideas centrales del DSC: la Terapia Ocupacional como favorecedora del cuidado integrado, valorizando

  4. A decentralised model of psychiatric care: Profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western Cape

    Directory of Open Access Journals (Sweden)

    Eileen Thomas

    2015-02-01

    Full Text Available Background. There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care. Objective. To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape.  Method. Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (N=487 admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected.  Results. Psychotic disorders were the most prevalent (n=287, 59% diagnoses, while 228 (47% of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38% of admission episodes, 37 (57% of readmissions and 19 (61% of abscondments. Most admission episodes (n=372, 76% were discharged without referral to specialist/tertiary care.  Conclusion. Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.

  5. An overview of Uganda's mental health care system: results from an assessment using the world health organization's assessment instrument for mental health systems (WHO-AIMS

    Directory of Open Access Journals (Sweden)

    Cooper Sara

    2010-01-01

    Full Text Available Abstract Background The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda. Methods A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS Version 2.2. Results Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC. The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health, and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population. Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry. Conclusion Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda.

  6. Patient communication self-efficacy, self-reported illness symptoms, physician communication style and mental health and illness in hospital outpatients.

    Science.gov (United States)

    Capone, Vincenza

    2016-07-01

    In this cross-sectional study, we investigated the associations between patient communication self-efficacy and self-reported symptoms in doctor-patient communication, as perceived by patients, and the mental health and illness of hospital outpatients. Using data from a sample of 74 outpatients (mean age = 37.58 years, standard deviation = 12.54), a structural equation model was calculated. The results showed that communication self-efficacy and respectful behaviour were associated with mental health and illness. Furthermore, self-reported symptoms were correlated with mental illness. Gender and educational differences also occurred. The findings suggest that enhancing patients' communication skills could benefit outpatients in general, but female and less educated patients in particular. © The Author(s) 2014.

  7. The outcomes of psychiatric inpatients by proportion of experienced psychiatrists and nurse staffing in hospital: New findings on improving the quality of mental health care in South Korea.

    Science.gov (United States)

    Han, Kyu-Tae; Kim, Sun Jung; Jang, Sung-In; Hahm, Myung-Il; Kim, Seung Ju; Lee, Seo Yoon; Park, Eun-Cheol

    2015-10-30

    Readmission rates for mental health care are higher in South Korea than other Organization for Economic Development (OECD) countries. Therefore, it is worthwhile to continue investigating how to reduce readmissions. Taking a novel approach, we determined the relationship between psychiatrist experience and mental health care readmission rates. We used National Health Insurance claim data (N=21,315) from 81 hospitals to analyze readmissions within 30 days of discharge for "mood disorders" or "schizophrenia, schizotypal and delusional disorders" during 2010-2013. In this study, multilevel models that included both patient and hospital-level variables were analyzed to examine associations with readmission. Readmissions within 30 days of discharge accounted for 1079 (5.1%) claims. Multilevel analysis demonstrated that the proportion of experienced psychiatrists at a hospital was inversely associated with risk of readmission (OR: 0.79, 95% CI: 0.74-0.84 per 10% increase in experienced psychiatrists). Readmission rates for psychiatric disorders within 30 days of discharge were lower in hospitals with a higher number of nurses (OR: 0.95, 95% CI: 0.94-0.96 per 10 nurses). In conclusion, health policymakers and hospital managers should make an effort to reduce readmissions for psychiatric disorders and other diseases by considering the role that physician experience plays and nurse staffing. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort.

    Science.gov (United States)

    Levenstein, Susan; Jacobsen, Rikke Kart; Rosenstock, Steffen; Jørgensen, Torben

    2017-09-01

    To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry. Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.

  9. Public health and health reform in Australia.

    Science.gov (United States)

    Macintyre, C Raina

    2011-01-03

    The national health reform agenda appears to have omitted public health. In this article, I outline how public health is different from primary care, and why a holistic approach to reform should include public health. The current reform agenda is very much focused on addressing the problems in acute care and the hospital system, with the focus on primary care being a means to this end. Until the health system is addressed as a whole, with all its essential components integrated and interlinked, truly successful reform of the health system, with genuine long-term vision and sustainability, will not be possible.

  10. Hospital

    African Journals Online (AJOL)

    Burkitt's lymphoma of the head and neck region in a Nigerian tertiary. Hospital ... Some complications of treatment were noted. Discussion: ..... Cancer. Biother Radiopharm 1999 14: 251-62 (Medline). Reece DE. Evidence based management of Hodgkin's disease. The role of autologous stem cell transplantation. Cancer ...

  11. Illicit substance use among persons admitted to probation polyclinic of a regional mental hospital in the Eastern Anatolia, Turkey

    Science.gov (United States)

    Telo, Selda; Kaman, Dilara; Korkmaz, Sevda

    2016-01-01

    Objectives: To investigate the illicit substance use trends by gender and year in Eastern Turkey, Elazığ. Methods: This is a retrospective study designed to assess the drug use prevalence in persons who admitted to the Probation Policlinic of Elazig Mental Health Hospital between January 2011 and December 2014 in Eastern Turkey, Elazığ. Laboratory screening tests for drugs were studied using the cloned enzyme donor immunoassay technique in urine. Results: The study consisted of 10267 males (95.3%) and 510 females (4.7%), with a mean age of 30.42±10.83 years. Overall prevalence was 32.1% for cannabis, 3.8% for opiate, 0.35% for cocaine and 1.2% for polydrug usage. The prevalence of cannabis was significantly higher in males (32.7%, p=0.000). The prevalence of cannabis use was the lowest in the age group of 50-59 while it was significantly higher in the age groups of 20-29 and 30-39 (p=0.000). The prevalence of opiate use showed a significant difference among the years (p=0.000). There was a significant difference in the prevalence of cocaine use among the years (p=0.02). The prevalence of polysubstance use showed a significant difference among years (p=0.000). Conclusion: Cannabis was the most common illicit drug in the east of the Turkey. Further studies are required for comparing the results of various regions of the country and developing early interventions and treatment facilities. PMID:27381538

  12. Effect of a rotation training system on the mental health status of postgraduate dental trainees at Kyushu University Hospital, Fukuoka, Japan.

    Science.gov (United States)

    Takarada, Tohru; Asada, Tetsunosuke; Sumi, Yoshihisa; Higuchi, Yoshinori

    2014-02-01

    In Japan, the increasing frequency of mental health problems in postgraduate dental trainees has recently become apparent. To our knowledge, there has been no previous research to investigate the influence of the type of training program on the mental health of dental residents during one year of postgraduate clinical training. Therefore, the purpose of this study was to compare changes in the mental health of two groups of dental trainees at Kyushu University Hospital, Fukuoka, Japan: those who undertook a rotation training program and those who trained solely in one department (the control group). Study subjects in both groups completed the Profile of Mood States (POMS) and the General Health Questionnaire (GHQ) at five intervals throughout the postgraduate training year. Analysis of the questionnaire responses were performed by Student's t-test, analysis of variance, Bonferroni's test, and the chi-square test. Statistical tests showed differences in the mean scores of POMS-30 subscales and GHQ-28. The mood of anger was the factor that seemed to best describe the trainees' response to stress. The study results led to the conclusion that dental trainees' mental health is influenced by the type of training program and that dental trainees in rotation training programs may need more mental health support.

  13. Caregivers' Attitude towards People with Mental Illness and Perceived Stigma: A Cross-Sectional Study in a Tertiary Hospital in Nepal.

    Directory of Open Access Journals (Sweden)

    Dipika Neupane

    Full Text Available Mental illness is stigmatized in most of the communities and people with such illness are often subjected to defame. Stigma impairs an individual's and their caregiver's physical, social and emotional wellbeing, and health-seeking behavior. Sufficient literature on how often the caregivers of people with mental illness from low and middle-income countries are stigmatized and how they perceive people with mental illness is unavailable. In this study, we examined caregivers' attitude towards people with mental illness and perceived stigma.We conducted face-to-face interviews with 170 caregivers in an outpatient clinic of a hospital in Nepal using a structured questionnaire. We calculated median and inter-quartile range of the attitude and perceived stigma scores. To assess the correlates, Kruskal Wallis H test and Mann Whitney U test were carried out.Overall median score for the domains: attitude (score range: 18-90 and perceived stigma (score range: 12-60 were 42 and 28 respectively, inter-quartile range being 8 each. Attitude score differed significantly by the sex of caregiver (p<0.05, educational status of caregiver (p<0.001, sex of patient (p<0.05 and type of mental illness (p<0.05. Perceived stigma score varied significantly by caregiver's sex (p<0.05, marital status (p<0.001, educational status (p<0.001, occupation (p<0.05, relation with the patient (p<0.005 and use of alternative treatment modalities (p<0.05.Sex of participant, educational status, sex of patient and type of mental illness were the correlates of attitude towards mental illness. Similarly, sex of participant, marital status, educational status, occupation, caregiver's relation with patient and use of alternative treatment modalities were correlates of perceived stigma. Findings of this study suggest that interventions targeting these high-risk populations might be beneficial to help build a positive attitude and overcome the perceived social stigma.

  14. We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England

    Directory of Open Access Journals (Sweden)

    Takian Amirhossein

    2012-12-01

    Full Text Available Abstract Background In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR systems into specialist mental health settings. The National Programme for Information Technology (NPfIT in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders’ experiences and the local consequences of the implementation of an EHR system into a mental health hospital. Methods Longitudinal, real-time, case study-based evaluation of the implementation and adoption of an EHR software (RiO into an English mental health hospital known here as Beta. We conducted 48 in-depth interviews with a wide range of internal and external stakeholders, undertook 26 hours of on-site observations, and obtained 65 sets of relevant documents from various types relating to Beta. Analysis was both inductive and deductive, the latter being informed by the ‘sociotechnical changing’ theoretical framework. Results Many interviewees perceived the implementation of the EHR system as challenging and cumbersome. During the early stages of the implementation, some clinicians felt that using the software was time-consuming leading to the conclusion that the EHR was not fit for purpose. Most interviewees considered the chain of deployment of the EHR–which was imposed by NPfIT–as bureaucratic and obstructive, which restricted customization and as a result limited adoption and use. The low IT literacy among users at Beta was a further barrier to the implementation of the EHR. This along with inadequate training in using the EHR software led to resistance to the significant cultural and work environment changes initiated by EHR. Despite the many challenges, Beta achieved some early positive results. These

  15. We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England.

    Science.gov (United States)

    Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

    2012-12-31

    In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders' experiences and the local consequences of the implementation of an EHR system into a mental health hospital. Longitudinal, real-time, case study-based evaluation of the implementation and adoption of an EHR software (RiO) into an English mental health hospital known here as Beta. We conducted 48 in-depth interviews with a wide range of internal and external stakeholders, undertook 26 hours of on-site observations, and obtained 65 sets of relevant documents from various types relating to Beta. Analysis was both inductive and deductive, the latter being informed by the 'sociotechnical changing' theoretical framework. Many interviewees perceived the implementation of the EHR system as challenging and cumbersome. During the early stages of the implementation, some clinicians felt that using the software was time-consuming leading to the conclusion that the EHR was not fit for purpose. Most interviewees considered the chain of deployment of the EHR-which was imposed by NPfIT-as bureaucratic and obstructive, which restricted customization and as a result limited adoption and use. The low IT literacy among users at Beta was a further barrier to the implementation of the EHR. This along with inadequate training in using the EHR software led to resistance to the significant cultural and work environment changes initiated by EHR. Despite the many challenges, Beta achieved some early positive results. These included: the ability to check progress notes and monitor staff

  16. [Mental hygiene: ideas and practice in Serbia].

    Science.gov (United States)

    Backović, Dusan

    2010-01-01

    Mental health has great importance for the welfare both of individuals and society, because mental disorders cause reduced quality of life, suffering, alienation and discrimination of the diseased. The whole community also takes enormous burden of economic factors caused by mental health impairment (medical and social care and reduced productivity of patients). All societies and cultures throughout history had specific activities aimed at prevention and mental health improvement.The treatment of the diseased was under the influence of magic and empirical concepts, doctrine and religion, but also by the presence of scientific knowledge and progressive liberal streams. In Serbia the tradition of humanity is enriched with the cultural heritage of medieval history. Mental hygiene as a discipline that promoted mental health and the prevention of mental disorders was created a hundred years ago inspired by the work of Clifford Beers. Reforms of mental healthcare in the European countries, and Serbia as well, in the form of deinstitutionalisation (decreased number of beds in psychiatric institutions and increased social care), tends to develop into reinstitutionalization or transinstitutionalization (increased number of patients in isolated departments and forced hospitalizations). At the beginning of the new century the World Health Organization recognises again mental health as its priority. At the present moment, with new scientific knowledge and capabilities, but in the face of the struggle with multiple challenges of civilization (the experience of war conditions, social transition), as well as new harmful influences of polluted environment, we perceive the experience arising from the development of ideas and practices of mental hygiene in Serbia.

  17. First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder.

    Science.gov (United States)

    Munk-Olsen, Trine; Laursen, Thomas Munk; Pedersen, Carsten B; Lidegaard, Ojvind; Mortensen, Preben Bo

    2012-02-01

    Mental health problems are associated with women's reproductive decisions and predict poor mental health outcomes after abortion and childbirth. To study whether having a first-trimester induced abortion influenced the risk of psychiatric readmission and compare findings with readmission risk in women with mental disorders giving birth. Survival analyses were performed in a population-based cohort study merging data from the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register from January 1,1994, to December 31, 2007. Denmark. All women born in Denmark between 1962 and 1992 with a record of 1 or more psychiatric admissions at least 9 months before a first-time first-trimester induced abortion or childbirth. Main Outcome Measure  Readmission at a psychiatric hospital with any type of mental disorder from 9 months before to 12 months after a first-time first-trimester induced abortion or childbirth. Relative risk (RR) for readmission risk 9 to 0 months before a first-trimester induced abortion was 0.95 (95% CI, 0.73-1.23) compared with the first year after the abortion. This contrasts with a reduced risk of readmission before childbirth (RR, 0.56; 95% CI, 0.42-0.75) compared with the first year post partum. Proximity to previous psychiatric admission in particular predicted rehospitalization risks in both the abortion and the childbirth group. Risk of readmission is similar before and after first-time first-trimester abortion, contrasting with a marked increased in risk of readmission post partum. We speculate that recent psychiatric episodes may influence women's decisions to have an induced abortion; however, this decision does not appear to influence the illness course in women with a history of treated mental disorders.

  18. Psychiatric reform in Greece: an overview.

    Science.gov (United States)

    Giannakopoulos, George; Anagnostopoulos, Dimitris C

    2016-12-01

    Leros became infamous worldwide in the 1980s because of a scandal in its mental institution, the Leros asylum. The scandal provoked universal outrage and the international pressure triggered the Greek mental health reform. Under the reform projects Leros I and Leros II (1990-1994), numerous interventions took place in the Leros asylum as part of deinstitutionalisation. Following that, the Psychargos programme advanced developments for community-based services. Deinstitutionalisation and development of community mental health services have advanced significantly since the 1980s. However, this reform is still incomplete, given that sectorisation, adequate primary care policies, inter-sectoral coordination and specialised services are under-developed. This problematic situation is further complicated by the severe impact of the current financial crisis.

  19. Patient overcrowding in hospital wards as a predictor of diagnosis-specific mental disorders among staff: a 2-year prospective cohort study.

    Science.gov (United States)

    Virtanen, Marianna; Batty, G David; Pentti, Jaana; Vahtera, Jussi; Oksanen, Tuula; Tuisku, Katinka; Salo, Paula; Terho, Kirsi; Ahola, Kirsi; Elovainio, Marko; Kivimäki, Mika

    2010-10-01

    Hospital ward patient overcrowding has been hypothesized to increase psychiatric morbidity among staff, but it is unknown whether the association is specific to depressive disorders. This study examined whether patient overcrowding in hospital wards predicts diagnosis-specific mental disorders among staff. A 2-year prospective cohort study was conducted, in which the extent of hospital ward overcrowding was determined using routinely recorded patient bed occupancy rates between 2003 and 2004 and linked to sickness absence for 5,166 nurses and physicians in 203 somatic illness wards in 16 Finnish acute-care hospitals. Medically certified long-term (> 9 days) sickness absence spells in 2004 and 2005 with physician-determined diagnosis (based on ICD-10 criteria) were obtained from the register of the Social Insurance Institution of Finland. Cox proportional hazard models for recurrent events adjusted for sex, age, occupation, type and length of employment contract, hospital district, and specialty showed that health professionals working in wards with a patient occupancy level 10 percentage units above the optimal during a 1-year period experienced twice the risk of sickness absence due to depressive disorders (HR = 1.95; 95% CI, 1.18-3.24) relative to colleagues working in wards with optimal or below-occupancy levels. No significant association was found for diagnoses of severe stress and adjustment disorders or other psychiatric disorders. Chronic workload, as expressed by patient overcrowding in hospital wards, is associated with the onset of depressive disorders among staff. © Copyright 2010 Physicians Postgraduate Press, Inc.

  20. First World War and Mental Health: a retrospective comparative study of veterans admitted to a psychiatric hospital between 1915 and 1918.

    Science.gov (United States)

    Lagonia, Paolo; Aloi, Matteo; Magliocco, Fabio; Cerminara, Gregorio; Segura-Garcia, Cristina; Del Vecchio, Valeria; Luciano, Mario; Fiorillo, Andrea; De Fazio, Pasquale

    2017-01-01

    The association between mental illness and war has been repeatedly investigated. Higher levels of depressive symptoms and an increased suicidal risk have been found in veterans. In this study we investigated the mental health conditions among Italian soldiers during the “Great War”, who were hospitalized in a mental health hospital in Italy. The study sample consists of 498 soldiers who were admitted during the World War I between 1915 and 1918, and 498 civilian patients admitted in two different periods (1898-1914, 1919- 1932). Psychiatric diagnoses have been recorded retrospectively by a detailed examination of clinical records. Socio-demographic informations, diagnosis at first admission, number of admissions, and deployment in war zones were collected. A logistic regression analysis was performed, the diagnosis of depression was considered as dependent variable while clinical and demographic variables as independent predictors. Soldiers deployed in war zones were more likely to have a diagnosis of depression compared to those not serving on the frontline. The logistic regression analysis showed that the diagnosis of depression is predicted by being a soldier and being deployed in a war area. Our data confirm that soldiers engaged in war are at higher risk of developing depression compared to non-deployed soldiers.

  1. Arbitration Reform

    Directory of Open Access Journals (Sweden)

    Svetlana Stepurina

    2017-01-01

    Full Text Available УДК 347.73:341.63Subject. This informational article highlights recent changes to the Russian legislation on arbitration.Purpose. To highlight the most important aspects of arbitration law reform, and examines the effects they will have on the development of arbitration in RussiaMethodology. The author uses a formal-legal method.Results, scope of application. The author distinguishes the difference between constantly acting arbitration courts and arbitration courts ad hoc. The special status of a number of arbitration institutions (the ICAC and MAC at the Russian Chamber of Commerce and Industry, is contrary to the constitutional principle of equality under the law. A major achievement of the new legislation on arbitration courts is expanding the range arbitrarily disputes.Conclusions. The new legislation more clearly prescribed the interaction of arbitration and state courts, including requiring the latter to promote the arbitrators, acting under the regulations of the permanent arbitration institutions in obtaining evidence.In addition, the reform of the arbitration law have left aside the problem of improving the quality of judicial control over arbitration decisions.The arbitration law will still be able to improve the arbitration, to enhance its credibility and attractiveness for the participants of civil turnover.

  2. Mental health priorities in Vietnam: a mixed-methods analysis

    Directory of Open Access Journals (Sweden)

    Niemi Maria

    2010-09-01

    Full Text Available Abstract Background The Mental Health Country Profile is a tool that was generated by the International Mental Health Policy and Services Project to inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. The Mental Health Country Profile contains four domains, which include the mental health context, resources, provision and outcomes. We have aimed to generate a Mental Health Country Profile for Vietnam, in order to highlight the strengths and weaknesses of the Vietnamese mental health situation, in order to inform future reform efforts and decision-making. Methods This study used snowball sampling to identify informants for generating a Mental Health Country Profile for Vietnam, and the data gathering was done through semi-structured interviews and collection of relevant reports and documents. The material from the interviews and documents was analysed according to qualitative content analysis. Results Marked strengths of the Vietnam mental health system are the aims to move toward community management and detection of mental illness, and the active involvement of several multilateral organizations and NGOs. However, there are a number of shortages still found, including the lack of treatment interventions apart from medications, the high proportion of treatments to be paid out-of-pocket, prominence of large tertiary psychiatric hospitals, and a lack of preventative measures or mental health information to the public. Conclusions At the end of this decade, mental health care in Vietnam is still characterised by unclear policy and poor critical mass especially within the governmental sector. This initial attempt to map the mental health situation of Vietnam suffers from a number of limitations and should be seen as a first step towards a comprehensive profile.

  3. Deinstitutionalisation of mental health care in The Netherlands: towards an integrative approach.

    Science.gov (United States)

    Ravelli, Dick P

    2006-01-01

    The objective of this policy paper is to put recent developments in Dutch mental health reform in an international perspective and draw conclusions for future directions in policy. CONTEXT OF THE CASE: The practice of Western psychiatry in the second half and particularly in the last decade of the 20th century has fundamentally changed. Dutch psychiatry has traditionally been prominently bed-based and various policies in the last ten years have been intended to reduce the influence of the mental hospitals. Until the mid-1990s, this had not resulted in reducing the psychiatric bed rate in comparison to other countries. Since then, there have been rapid, dramatic changes. We summarised two recent national studies on this subject and placed them in a national and international context, using documents on psychiatric reforms, government and advisory board reports and reviews on deinstitutionalisation in different countries. The practice of psychiatry in the second half, and particularly in the last decade, of the 20th century has fundamentally changed. This has resulted in a spectacular decline in the number of beds in mental hospitals, increased admissions, decreased length of stay, closure of the large asylums and in community treatment away from asylums and in society, although this is a reform process. This article examines how the Dutch mental health care system has developed at the national level. The main topics cover the size, nature, aims and effects of the process of deinstitutionalisation and how alternative facilities have been developed to replace the old-fashioned institutes. There are two contrasting aspects of deinstitutionalisation in Dutch mental health care: the tendency towards rehospitalisation in relation to the sudden, late, but rapid reduction of the old mental hospitals and their premises; and a relatively large scale for community-based psychiatry in relation to building mental health care centres. Compared to other countries the bed rate in

  4. Deinstitutionalisation of mental health care in the Netherlands: towards an integrative approach

    Directory of Open Access Journals (Sweden)

    Dick P. Ravelli

    2006-03-01

    Full Text Available Objective: The objective of this policy paper is to put recent developments in Dutch mental health reform in an international perspective and draw conclusions for future directions in policy. Context of the case: The practice of Western psychiatry in the second half and particularly in the last decade of the 20th century has fundamentally changed. Dutch psychiatry has traditionally been prominently bed-based and various policies in the last ten years have been intended to reduce the influence of the mental hospitals. Until the mid-1990s, this had not resulted in reducing the psychiatric bed rate in comparison to other countries. Since then, there have been rapid, dramatic changes. Data sources: We summarised two recent national studies on this subject and placed them in a national and international context, using documents on psychiatric reforms, government and advisory board reports and reviews on deinstitutionalisation in different countries. Case description: The practice of psychiatry in the second half, and particularly in the last decade, of the 20th century has fundamentally changed. This has resulted in a spectacular decline in the number of beds in mental hospitals, increased admissions, decreased length of stay, closure of the large asylums and in community treatment away from asylums and in society, although this is a reform process. This article examines how the Dutch mental health care system has developed at the national level. The main topics cover the size, nature, aims and effects of the process of deinstitutionalisation and how alternative facilities have been developed to replace the old-fashioned institutes. Conclusions and discussion: There are two contrasting aspects of deinstitutionalisation in Dutch mental health care: the tendency towards rehospitalisation in relation to the sudden, late, but rapid reduction of the old mental hospitals and their premises; and a relatively large scale for community-based psychiatry in

  5. Steepest Ascent Tariff Reform

    DEFF Research Database (Denmark)

    Raimondos-Møller, Pascalis; Woodland, Alan

    2014-01-01

    The policy reform literature is primarily concerned with the construction of reforms that yield welfare gains. By contrast, this paper’s contribution is to develop a theoretical concept for which the focus is upon the sizes of welfare gains accruing from policy reforms rather than upon their signs....... In undertaking this task, and by focusing on tariff reforms, we introduce the concept of a steepest ascent policy reform, which is a locally optimal reform in the sense that it achieves the highest marginal gain in utility of any feasible local reform. We argue that this reform presents itself as a natural...... benchmark for the evaluation of the welfare effectiveness of other popular tariff reforms such as the proportional tariff reduction and the concertina rules, since it provides the maximal welfare gain of all possible local reforms. We derive properties of the steepest ascent tariff reform, construct...

  6. Influence of gender, working field and psychosocial factors on the vulnerability for burnout in mental hospital staff: results of an Austrian cross-sectional study.

    Science.gov (United States)

    Schadenhofer, Petra; Kundi, Michael; Abrahamian, Heidemarie; Stummer, Harald; Kautzky-Willer, Alexandra

    2018-03-01

    According to the European Agency for Safety and Health at Work (EU-OSHA), hospitals represent a work environment with high job strain. Prolonged perceived occupational stress may result in symptoms of burnout, such as emotional exhaustion (EE), depersonalisation (DP) and reduced personal accomplishment (PA). Understanding which factors may reduce vulnerability for burnout is an important requirement for well-targeted occupational stress prevention in mental hospital staff. To identify the influence of gender, age, working field, family structure, education, voluntarily occupational training during holidays and length of stay on job on occupational stress perception. In a cross-sectional design, 491 employees (311 female, 180 male) of an Austrian mental health centre participated in the study. The extent of perceived occupational stress was assessed by the Maslach Burnout Inventory (MBI) with the scales for emotional exhaustion, depersonalisation and personal accomplishment. Participants were divided according to their working field in those working with/without patients. Prevalence of emotional exhaustion was higher in women working with patients compared to men working with patients (25% vs. 18%, p = 0.003). Age above 45 years was significantly associated with decreased vulnerability for burnout in men (EE p = 0.040, DP p = 0.010, PA p = 0.007), but not in women. A lower level of education had a significant impact on depersonalisation in both sexes (p = 0.001 for men, p = 0.048 for women). Length of stay on job showed a significant influence on emotional exhaustion. No significant relationship was found between family structure and vulnerability for burnout. Gender had a differential effect on perceived occupational stress indicating a need for gender-tailored preventive strategies. Age, working field, education, voluntarily occupational training during holidays and length of stay on job affect vulnerability for burnout in mental hospital staff.

  7. It isn't something to yodel about, but it exists! Faeces, nurses, social relations and status within a mental hospital.

    Science.gov (United States)

    van Dongen, E

    2001-08-01

    In medical settings, emotion-provoking work creates a hierarchy among health care professionals. "Lower" emotions like disgust, contempt or aversion that are evoked by "body work" with elderly patients often remain invisible, but they play an important role in morality and shape the social relations between the patients and the professionals. With the help of ethnographic data from the nursing wards of a mental hospital, the author shows how feelings about excrement are determined not only by their nature, but also by the nature of the relationships among the nurses and the relationships between the nurses and the elderly patients. Body care and the emotions that are evoked are connected to morality and moral care. Dealing with bodily and moral "dirt" gives nurses a special position within the hospital as a whole, which will have effects on the care for elderly.

  8. [Prevalence of mental disorders associated with suicide attempts treated at an emergency hospital in Rio de Janeiro, Brazil].

    Science.gov (United States)

    Santos, Simone Agadir; Lovisi, Giovanni; Legay, Letícia; Abelha, Lúcia

    2009-09-01

    There are few Brazilian studies on prevalence of mental disorders in suicide attempters. The available studies have mainly used secondary data and screening instruments. The principal objective of this study was to estimate the prevalence of mental disorders in 96 suicide attempters seen in an emergency ward in Rio de Janeiro, Brasil (2006-2007) using the Composite International Development Interview. Most were female, young, and illiterate, and the main method was ingestion of psychoactive drugs. Other factors included history of prior attempts and use of alcohol at the time of attempt. The most frequent mental disorders were: depression (38.9%), use of psychoactive substances (21.9%), posttraumatic stress disorder (20.8%), alcohol abuse (17.7%), and schizophrenia (15.6%). Total prevalence of mental disorders was 71.9%. These findings are largely consistent with studies conducted in other developing countries. Besides access to treatment for mental disorders, public policies with an emphasis on the control of suicide methods and social responses for the reduction of suicidal behavior are needed.

  9. Psychological status and quality of life among primary caregivers of individuals with mental illness: a hospital based study.

    Science.gov (United States)

    Jeyagurunathan, Anitha; Sagayadevan, Vathsala; Abdin, Edimansyah; Zhang, YunJue; Chang, Sherilyn; Shafie, Saleha; Rahman, Restria Fauziana Abdul; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2017-05-19

    This study aimed to explore the psychological status and quality of life among primary caregivers of individuals suffering from various mental illnesses including early psychosis, chronic schizophrenia, depressive disorders, anxiety disorders and dementia. A total of 350 primary caregivers with relatives seeking treatment at a tertiary psychiatric hospital were recruited for this study. Socio-demographic data was obtained and the brief version of the World Health Organisation Quality of Life instrument was used to assess caregiver's quality of life (QOL). Psychological status among primary caregivers was assessed using the General Anxiety Disorder - 7 item (GAD-7) and Patient Health Questionnaire - 9 item (PHQ-9) scales. Family Interview Schedule (FIS) was used to assess the impact of caregiving relating to social problems, interpersonal strain among family members, work related problems and financial difficulties as a result of their relative's illness. The socio-demographic and clinical correlates of QOL, PHQ-9 and GAD-7 were examined using multiple linear and logistic regression analyses. Associations between QOL domains and psychological status was examined using multiple linear regression analyses. The mean age of the primary caregivers was 49.7 years (SD = 13.2), ranging from 21 to 82 years, with a preponderance of females (67.6%), aged 50-64 years old (45.7%). Majority were of Chinese ethnicity (57.5%), had secondary level education (43.1%), were married (65.2%), and employed (64.9%). 18.3% of primary caregivers had symptoms of depression (based on PHQ-9 cut-off point of 10 or greater) while 12.7% had symptoms of anxiety (based on GAD-7 cut-off point of 10 or greater). Multiple linear and logistic regression analyses revealed that primary caregivers aged between 35-49 years and 50-64 years, unemployed, living with others, providing care to those diagnosed with dementia and who had higher FIS scores were significantly more likely to report symptoms

  10. Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania

    Directory of Open Access Journals (Sweden)

    Ambikile Joel

    2012-07-01

    Full Text Available Abstract Background It is estimated that world-wide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD, depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them. Methodology A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. Results The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The

  11. Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania.

    Science.gov (United States)

    Ambikile, Joel Semel; Outwater, Anne

    2012-07-05

    It is estimated that world-wide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them. A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with

  12. Estrategias de cooperación técnica de la Organización Panamericana de la Salud en la nueva fase de la reforma de los servicios de salud mental en América Latina y el Caribe Technical cooperation strategies of the Pan American Health Organization in the new phase of mental health services reform in Latin America and the Caribbean

    Directory of Open Access Journals (Sweden)

    José Miguel Caldas de Almeida

    2005-11-01

    Full Text Available La entrada en el nuevo milenio coincidió con el inicio de una nueva fase de la reforma de los servicios de salud mental en América Latina y el Caribe. Esta nueva fase ha impuesto nuevas prioridades e inspirado nuevas estrategias de cooperación técnica a escala internacional. En el presente artículo se mencionan las características principales de las primeras fases de la reforma de los servicios de salud mental en América Latina y el Caribe, se discuten los factores que llevaron a la fase iniciada en 2001 y se describen las estrategias y acciones de cooperación técnica desarrolladas por la Organización Panamericana de la Salud para enfrentar los desafíos surgidos en la etapa actual de la reforma. Además, se exponen algunas reflexiones sobre las perspectivas de la cooperación internacional en este campo, así como las ventajas de establecer un programa regional para la reforma de los servicios de salud mental que facilite el trabajo conjunto de los gobiernos y de las organizaciones internacionales en un plan de acción con objetivos definidos. Se recomienda aprovechar la celebración del decimoquinto aniversario de la Declaración de Caracas para lanzar un plan de acción regional que dé un nuevo impulso a la reforma de los servicios de salud mental.The beginning of the new millennium coincided with the start of a new phase in the reform of mental health services in Latin America and the Caribbean. This new phase has imposed new priorities and prompted new technical cooperation strategies at the international level. This piece points out the main characteristics of the first phases in the reform of mental health services in Latin America and the Caribbean, discusses the factors that led to the phase that started in 2001, and describes the strategies and the technical cooperation activities of the Pan American Health Organization to deal with the challenges that have arisen in the current stage of reform. The piece also considers the

  13. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality disorder in the Netherlands.

    Science.gov (United States)

    Bales, Dawn; van Beek, Nicole; Smits, Maaike; Willemsen, Sten; Busschbach, Jan J V; Verheul, Roel; Andrea, Helene

    2012-08-01

    Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As to yet it has not been shown whether manualized day hospital MBT would yield similar results when conducted by an independent institute outside the UK. We investigated the applicability and treatment outcome of 18-month, manualized day hospital MBT in the Netherlands by means of a prospective cohort study with 45 Dutch patients with severe BPD and a high degree of comorbid Axis I and Axis II disorders. Outcomes were assessed each six months. Symptom distress, social and interpersonal functioning, and personality pathology and functioning all improved significantly, with effect sizes between 0.7 and 1.7. Suicide attempts, acts of self-harm, and care consumption were also significantly reduced. The results indicate that MBT can effectively be implemented in an independent treatment institute outside the UK. This study also supports the clinical effectiveness of manualized day hospital MBT in patients with severe BPD and a high degree of psychiatric comorbidity.

  14. National Health-Care Reform

    Science.gov (United States)

    2009-03-24

    Federal Hospital Insurance (HI) Trust Fund, or Medicare Part A, called for decisive policy action to achieve long-term solvency of the trust fund. For the... insurance companies . To prevent a loss of income, these groups have used tactics such as stoking fears of socialism and communism to thwart reform.33...the next most expensive country in the world, Switzerland.9 Health-care insurance costs exceed the national average inflation. From 2000 to 2007, health

  15. A study on the relationship between employee mental health and agility strategic readiness: A case study of Esfahan hospitals in Iran

    Directory of Open Access Journals (Sweden)

    Hassan Ghodrati

    2013-04-01

    Full Text Available This study investigates whether enhancing organizational agility and mental health of staff could increase strategic readiness for crises or not. In this study, descriptive statistics is used to present demographic data of the research, and P-Test is employed for analyzing the data. In addition, to examine research hypotheses, correlation coefficients and descriptive statistics are implemented. Finally, to rank the variables and indicators of the research, Friedman test and for comparison of indicators and components of the research, nonparametric Kruskal-Wallis test are used. The proposed study designs a questionnaire and The questionnaire and distributes it among some nurses in obstetrics and anesthesiology department and among supervisors. Cronbach's alpha is also employed for determining the reliability in this study. The results indicate that working conditions as well as employees’ mental health are in good conditions, the employees with higher levels of mental health have higher readiness to deal with potential crises, and the relationship between agility of hospitals and their strategic readiness for dealing with crises is confirmed.

  16. FORMAÇÃO EM SAÚDE MENTAL E ATUAÇÃO PROFISSIONAL NO ÂMBITO DO HOSPITAL PSIQUIÁTRICO

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    João Mário Pessoa Júnior

    2016-01-01

    Full Text Available RESUMEN: Se objetivó identificar la opinión de los profesionales sobre la actuación en salud mental y la formación profesional en el ámbito de los hospitales psiquiátricos. Estudio descriptivo, exploratorio de abordaje cualitativo, desarrollado junto a 60 profesionales de nivel superior en dos macros hospitales psiquiátricos del Rio Grande do Norte. Se recolectaron los datos por medio de un cuestionario, los cuales fueron transcritos y procesados a través del software Alceste y sometidos a análisis de contenido de Bardin. Los resultados fueron estructurados en dos ejes temáticos y sus respectivos temas: Eje temático 1- actuación profesional en salud mental y; Eje temático 2- Formación en salud mental. Se evidenció la confluencia de asimetrías y divergencias en la actuación de los equipos en el hospital psiquiátrico. El escenario encontrado refleja la actual coyuntura política e ideológico del proceso de Reforma Psiquiátrica brasileño, considerándose los desafíos de implementación y capacitación profesional en el campo de la atención psicosocial.

  17. The Effect of Stress Coping Skills Training on Family Functioning in Families with Mental Patients Referred to Razi Psychiatric Hospital in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Fateme Mollasalehi

    2016-12-01

    Full Text Available The aim of this study was to evaluate the effect of stress coping skills training on family functioning in families with mental patients referred to Razi Psychiatric Hospital in Tehran, Iran during 2015-2016. In this experimental study, 82 members of the families with psychiatric patients who had been hospitalized for the first time for treatment were randomly selected. To collect data, the standard Family Assessment Device (FAD was used before and after intervention. The samples were randomly divided into two intervention and control groups. The first test was held for both groups. In the intervention group four training sessions were held, as well as educational pamphlet was provided. The second test was held 14 days after the implementation of the training for the intervention group, but it was held for the control group 14 days after implementation of the first test. Finally, the test results were compared before and after training, as well as between the two groups. The results showed that family functioning in the intervention group compared to the control group after training is statistically significant (p= 0.001 also the average of general family function and other dimensions has decreased after the intervention except for behavioral control (p =0.001. According to findings of this study stress coping training is considerably effective on family functioning in families with mental patients; therefore the implementation of this method to improve family functioning is recommended.

  18. Job Stress and Self-Efficacy among Psychiatric Nursing Working in Mental Health Hospitals at Cairo, Egypt

    Science.gov (United States)

    Zaki, Rania. A.

    2016-01-01

    Nursing stress is considered a problem that affects the practice worldwide. Job stress is a harmful response physically and emotionally when the nurses' skills, resources, and needs could not fulfill the requirement of the job. This study was aimed to assess job stress and self-efficacy among psychiatric nursing working in mental health hospitals…

  19. Physical activity and quality of life in long-term hospitalized patients with severe mental illness: a cross-sectional study.

    Science.gov (United States)

    Deenik, Jeroen; Kruisdijk, Frank; Tenback, Diederik; Braakman-Jansen, Annemarie; Taal, Erik; Hopman-Rock, Marijke; Beekman, Aartjan; Tak, Erwin; Hendriksen, Ingrid; van Harten, Peter

    2017-08-18

    Increasing physical activity in patients with severe mental illness is believed to have positive effects on physical health, psychiatric symptoms and as well quality of life. Till now, little is known about the relationship between physical activity and quality of life in long-term hospitalized patients with severe mental illness and knowledge of the determinants of behavioural change is lacking. The purpose of this study was to elucidate the relationship between objectively measured physical activity and quality of life, and explore modifiable psychological determinants of change in physical activity in long-term hospitalized patients with severe mental illness. In 184 inpatients, physical activity was measured using an accelerometer (ActiGraph GTX+). Quality of life was assessed by EuroQol-5D and WHOQol-Bref. Attitude and perceived self-efficacy towards physical activity were collected using the Physical Activity Enjoyment Scale and the Multidimensional Self Efficacy Questionnaire, respectively. Patient and disease characteristics were derived retrospectively from electronic patient records. Associations and potential predictors were analysed using hierarchical regression. Physical activity was positively related with and a predictor of all quality of life outcomes except on the environmental domain, independent of patient and disease characteristics. However, non-linear relationships showed that most improvement in quality of life lies in the change from sedentary to light activity. Attitude and self-efficacy were not related to physical activity. Physical activity is positively associated with quality of life, especially for patients in the lower spectrum of physical activity. An association between attitude and self-efficacy and physical activity was absent. Therefore, results suggest the need of alternative, more integrated and (peer-)supported interventions to structurally improve physical activity in this inpatient population. Slight changes from sedentary

  20. What Is the Impact of Health Reforms on Uncompensated Care in Critical Access Hospitals? A 5-Year Forecast in Washington State

    Science.gov (United States)

    Coyne, Joseph; Fry, Benjamin; Murphy, Sean; Smith, Gary; Short, Robert

    2012-01-01

    Context: The 2008 financial crisis had a far-reaching impact on nearly every sector of the economy. As unemployment increased so did the uninsured. Already operating on a slim margin and poor payer mix, many critical access hospitals are facing a tough road ahead. Purpose: We seek to examine the increasing impact of uncompensated care on the…

  1. Ensino da enfermagem psiquiátrica/saúde mental: sua interface com a Reforma Psiquiátrica e diretrizes curriculares nacionais La enseñanza de la enfermería psiquiátrica/salud mental: su conexión con la Reforma Psiquiátrica y las directrices curriculares nacionales Teaching psychiatric nursing/mental health: its interface with the Brazilian Psychiatric Reform and national curriculum guidelines

    Directory of Open Access Journals (Sweden)

    Josicelia Dumêt Fernandes

    2009-12-01

    Full Text Available Estudo teórico acerca do processo de formação em Enfermagem Psiquiátrica e Saúde Mental, frente às crescentes mudanças no mundo globalizado e seu acelerado processo de modernização científica e tecnológica. Objetiva discutir o fazer pedagógico no ensino da Enfermagem Psiquiátrica e Saúde Mental, e sua interface com os princípios da Reforma Psiquiátrica e das Diretrizes Curriculares Nacionais dos Cursos de Graduação em Enfermagem. Para sua sustentação teórica, adota como referência alguns construtos da Reforma Psiquiátrica e das Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem, e sua relação com fatores constituintes do fazer pedagógico na Enfermagem Psiquiátrica e Saúde Mental. Evidencia que não basta apontar questões técnicas relativas a conteúdos e ensino, procedimentos didáticos, métodos e técnicas pedagógicas; é necessário superar desafios e implementar as mudanças, pautando-se numa nova perspectiva, e ousando colocar em questão a natureza do saber e das práticas institucionais psiquiátricas.Estudio teórico acerca del proceso de formación en Enfermería Psiquiátrica y Salud Mental, frente a los crecientes cambios en el mundo globalizado y su acelerado proceso de modernización científica y tecnológica. Objetiva discutir el quehacer pedagógico en la enseñanza de Enfermería Psiquiátrica y Salud Mental, y su conexión con los principios de la Reforma Psiquiátrica y de las Directrices Curriculares Nacionales de los Cursos de Graduación en Enfermería. Para su sustentación teórica, adopta como referencia algunos constructos de la Reforma Psiquiátrica y de las Directrices Curriculares Nacionales del Curso de Graduación en Enfermería, y su relación con factores constituyentes del quehacer pedagógico en la Enfermería Psiquiátrica y Salud Mental. Evidencia que no basta apuntar cuestiones técnicas relativas a contenidos y enseñanza, procedimientos didácticos, m

  2. Hospitality Invites Sociability, Which Builds Cohesion: a Model for the Role of Main Streets in Population Mental Health.

    Science.gov (United States)

    Izenberg, Jacob M; Fullilove, Mindy Thompson

    2016-04-01

    The aim of this study was to investigate the contribution of main streets to community social cohesion, a factor important to health. Prior work suggests that casual contact in public space, which we call "sociability," facilitates more sustained social bonds in the community. We appropriate the term "hospitality" to describe a main street's propensity to support a density of such social interactions. Hospitality is a result of the integrity and complex contents of the main street and surrounding area. We examine this using a typology we term "box-circle-line" to represent the streetscape (the box), the local neighborhood (the circle), and the relationship to the regional network of streets (the line). Through field visits to 50 main streets in New Jersey and elsewhere, and a systematic qualitative investigation of main streets in a densely interconnected urban region (Essex County, New Jersey), we observed significant variation in main street hospitality, which generally correlated closely with sociability. Physical elements such as street wall, neighborhood elements such as connectivity, inter-community elements such as access and perceived welcome, and socio-political elements such as investment and racial discrimination were identified as relevant to main street hospitality. We describe the box-circle-line as a theoretical model for main street hospitality that links these various factors and provides a viable framework for further research into main street hospitality, particularly with regard to geographic health disparities.

  3. Mentally challenged patients in a forensic hospital: a feasibility study concerning the executive functions of forensic patients with organic brain disorder, learning disability, or mental retardation.

    Science.gov (United States)

    Bastert, Eva; Schläfke, Detlef; Pein, Annika; Kupke, Franziska; Fegert, Jörg M

    2012-01-01

    The past years have seen an increasing number of patients of lower intelligence or with organic brain disorder being committed into our forensic psychiatry. Our clinic has an ongoing scientific project to investigate the possibilities of reducing costs while at the same time guaranteeing adequate treatment and enforcement practice in forensic hospitals. This current project did not take these kinds of patients into consideration initially. This feasibility study is intended to examine if and to what extent these patients can be part of the scientific project. All patients of forensic psychiatry in Rostock (Mecklenburg-Western-Pomerania) with an IQintelligence or an organic brain dysfunction achieve lower results in neuropsychological testing than other patients participating in the main project. Nevertheless, participation in neuropsychological testing does not appear to overtax them. Future examination of the patients will be conducted to investigate to what extent certain therapeutic methods have been of noticeable benefit to this problematic group. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Reformed Narration

    DEFF Research Database (Denmark)

    Roesen, Tine

    2008-01-01

    thought. Furthermore, it is argued that a central role in the structuring of this mental text is played by an overwhelming amount of brackets. The article suggests a categorisation of the different types of parenthetic remarks in the novel according to their function in the textual, would-be narrative......The article analyses Vladimir Makanin's novel Andegraund ili Geroj našego vremeni (1998), focusing on its author-hero relation and narrative characteristics. The hero, Petrovič to whom the author leaves the stage, neither writes nor tells his story, rather, his words reach the reader as if directly...... from his mind, and the text appears as a kind of structured stream-of-consciousness. A comparison of Makanin's hero to that of Dostoevskij reveals that while the latter, according to Michail Bachtin, aimed to present his hero as pure voice, Makanin apparently aims to present his Petrovič as pure...

  5. Panoramic radiographic study of mental foramen in selected dravidians of south Indian population: A hospital based study.

    Science.gov (United States)

    Gupta, Vaibhav; Pitti, Parag; Sholapurkar, Amar

    2015-10-01

    This study aimed at documenting information on appearance, size, horizontal and vertical locations of Mental Foramen (MF) in Panoramic Radiograph. We also analyzed the age and gender differences with radiographic appearance and location of MF. We evaluated these findings in our population and co-relate with results of previous studies. 1662 panoramic radiographs were evaluated, of which 245 fulfilled the inclusion criteria. Each radiograph was traced to record the horizontal and vertical locations. The size of MF was recorded using digital caliper and its appearance was determined by visual examination. Chi-square and t-test were employed. The most common appearance of MF was continuous type and the tests showed significant difference with age and gender. The most frequent horizontal location of MF was "location c" with no statistical significant difference with age and gender. The MF was most commonly positioned mesially in relation to the apex of second premolar with no significant differences with gender. The vertical location of the foramen varied drastically with no statistical significant difference in both sides. The difference in dimensions on the left and right sides were not statistically significant. Determining the morphological appearance and positional variation of MF is important for isolation of mental nerves and vessels when administering local anesthesia and performing surgeries. We therefore stress the importance of accurate radiographic identification of MF and interpretation. Our research findings can be used as reference material by the dental practitioners of South India while performing clinical procedures that involve MF. Mental foramen, mental nerve, panoramic radiograph, mandible.

  6. Post-traumatic stress disorder following patient assaults among staff members of mental health hospitals: a prospective longitudinal study

    Directory of Open Access Journals (Sweden)

    Richter Dirk

    2006-04-01

    Full Text Available Abstract Background Violence by patients against staff members in mental health institutions has become an important challenge. Violent attacks may not only cause bodily injuries but can also have posttraumatic consequences with high rates of stress for mental health staff. This study prospectively assessed posttraumatic stress disorder (PTSD in employees who were severely assaulted by patients in nine German state mental health institutions. Methods During the study period of six months 46 assaulted staff members were reported. Each staff member was interviewed three times after the violent incident, using the Impact of Event Scale-Revised (IES-R, a widely used PTSD research tool, as well as the Posttraumatic Stress Disorder Checklist – Civilian (PCL-C. Results In the baseline assessment following an assault by a patient, eight subjects (17% met the criteria for PTSD. After two and six months, three and four subjects respectively still met diagnosis criteria. Conclusion A small minority of assaulted employees suffer from PTSD for several months after a patient assault.

  7. Saúde mental em um hospital público: o olhar de profissionais médicos do município do Rio de Janeiro Mental health in a public hospital: the perspective of medical professionals of the city of Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Heloisa dos Reis Malheiro Máximo

    2006-01-01

    Full Text Available Este estudo teve por objetivo compreender percepções de médicos de um hospital público acerca do papel dos profissionais de Saúde Mental nesse espaço institucional, explorando interfaces estabelecidas entre as duas categorias no cotidiano da assistência, tal como percebidas pelos informantes. Para tanto, desenvolveu-se um estudo qualitativo fundamentado na tradição crítico-interpretativa como caminho metodológico, elegendo-se como técnica a entrevista não-diretiva. A amostra foi composta por médicos de diferentes setores que, no momento do estudo, haviam encaminhado pacientes para os profissionais de Saúde Mental e integravam a equipe do hospital por um período mínimo de dois anos. Com base nas categorias que emergiram no campo, a análise identificou diferentes temas, configurando uma rede interpretativa que representou a base do exercício hermenêutico. Os resultados do estudo apontam uma heterogeneidade no que se refere às concepções dos informantes acerca do papel da Saúde Mental no espaço hospitalar. No que tange à organização do trabalho, a variável tempo é fator fundamental no cotidiano do atendimento. Percebe-se uma nítida diferenciação entre o paradigma "psi", referente aos profissionais da Psicologia e da Psiquiatria, e o paradigma médico, revelando obstáculos para uma efetiva integração entre esses dois modelos.This study aims to understand the perceptions of the medical professionals at a public hospital, concerning the role of the Mental Health professionals, identifying simultaneously, the interfaces established between these two categories in the assistance enviroment. Therefore, we begin with the study on demand that characterizes the client assisted by mental health professionals, discussing the main demands required by the medical doctors in the different areas of the hospital unit. At the same time, we highlight the reasons of these indications. Based on this data, we have developed this

  8. Gun Violence, Mental Illness, And Laws That Prohibit Gun Possession: Evidence From Two Florida Counties.

    Science.gov (United States)

    Swanson, Jeffrey W; Easter, Michele M; Robertson, Allison G; Swartz, Marvin S; Alanis-Hirsch, Kelly; Moseley, Daniel; Dion, Charles; Petrila, John

    2016-06-01

    Gun violence kills about ninety people every day in the United States, a toll measured in wasted and ruined lives and with an annual economic price tag exceeding $200 billion. Some policy makers suggest that reforming mental health care systems and improving point-of-purchase background checks to keep guns from mentally disturbed people will address the problem. Epidemiological research shows that serious mental illness contributes little to the risk of interpersonal violence but is a strong factor in suicide, which accounts for most firearm fatalities. Meanwhile, the effectiveness of gun restrictions focused on mental illness remains poorly understood. This article examines gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence. Among the study population in two large Florida counties, we found that 62 percent of violent gun crime arrests and 28 percent of gun suicides involved individuals not legally permitted to have a gun at the time. Suggested policy reforms include enacting risk-based gun removal laws and prohibiting guns from people involuntarily detained in short-term psychiatric hospitalizations. Project HOPE—The People-to-People Health Foundation, Inc.

  9. Gun Violence, Mental Illness, And Laws That Prohibit Gun Possession: Evidence From Two Florida Counties

    Science.gov (United States)

    Swanson, Jeffrey W.; Easter, Michele M.; Robertson, Allison G.; Swartz, Marvin S.; Alanis-Hirsch, Kelly; Moseley, Daniel; Dion, Charles; Petrila, John

    2016-01-01

    Gun violence kills about ninety people every day in the United States, a toll measured in wasted and ruined lives and with an annual economic price tag exceeding $200 billion. Some policy makers suggest that reforming mental health care systems and improving point-of-purchase background checks to keep guns from mentally disturbed people will address the problem. Epidemiological research shows that serious mental illness contributes little to the risk of interpersonal violence but is a strong factor in suicide, which accounts for most firearm fatalities. Meanwhile, the effectiveness of gun restrictions focused on mental illness remains poorly understood. This article examines gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence. Among the study population in two large Florida counties, we found that 62 percent of violent gun crime arrests and 28 percent of gun suicides involved individuals not legally permitted to have a gun at the time. Suggested policy reforms include enacting risk-based gun removal laws and prohibiting guns from people involuntarily detained in short-term psychiatric hospitalizations. PMID:27269024

  10. Comorbidity, hospitalization, and medication use and their influence on mental and motor development of young infants with Down syndrome

    NARCIS (Netherlands)

    van Trotsenburg, A. S. Paul; Heymans, Hugo S. A.; Tijssen, Jan G. P.; de Vijlder, Jan J. M.; Vulsma, Thomas

    2006-01-01

    OBJECTIVE: Young infants with Down syndrome have an increased occurrence of several well-known medical conditions such as congenital heart and gastrointestinal disease. The aim of this study was to establish consequences like hospitalization and medication use rates and to determine their possible

  11. The diagnosis, prevalence and outcome of delirium in a cohort of older people with mental health problems on general hospital wards.

    Science.gov (United States)

    Whittamore, Kathy H; Goldberg, Sarah E; Gladman, John R F; Bradshaw, Lucy E; Jones, Rob G; Harwood, Rowan H

    2014-01-01

    This paper aimed to measure the prevalence and outcomes of delirium for patients over 70 admitted to a general hospital for acute medical care and to assess the validity of the Delirium Rating Scale-Revised-98 (DRS-R-98) in this setting. Prospective study in a British acute general hospital providing sole emergency medical services for its locality. We screened consecutive patients over 70 with an unplanned emergency hospital admission and recruited a cohort of 249 patients likely to have mental health problems. They were assessed for health status at baseline and followed over 6 months. A sub-sample of 93 participants was assessed clinically for delirium. 27% (95% confidence interval (CI) 23-31) of all older medical patients admitted to hospital had DRS-diagnosed delirium, and 41% (95% CI 37-45) had dementia (including 19% with co-morbid delirium and dementia). Compared with clinician diagnosis, DRS-R-98 sensitivity was at least 0.75, specificity 0.71. Compared with reversible cognitive impairment, sensitivity was at least 0.50, specificity 0.67. DRS-diagnosed delirium was associated with cognitive impairment, mood, behavioural and psychological symptoms, activities of daily living, and number of drugs prescribed, supporting construct validity. Of those with DRS-diagnosed delirium, 37% died within 6 months (relative risk 1.4, 95% CI 0.97-2.2), 43% had reversible cognitive impairment, but only 25% had clinically important recovery in activities of daily living. Behavioural and psychological symptoms were common and mostly resolved, but new symptoms frequently developed. Delirium is common. Some, but not all, features are reversible. DRS-R-98 has reasonable validity in populations where co-morbid dementia is prevalent. Copyright © 2013 John Wiley & Sons, Ltd.

  12. A Decade of Reform

    International Development Research Centre (IDRC) Digital Library (Canada)

    Ongoing waves of enterprise-management reforms,. – Broader economic and social reforms pertaining to the environment in which the enterprises operate;. – Ambitious efforts to upgrade the technology of enterprises through the procurement (often from abroad) of advanced production technology; and. – S&T reforms ...

  13. An evaluation of the benefits to a UK Health Care Trust working in a partnership with a hospital in Northern Uganda: International partnership working in mental health.

    Science.gov (United States)

    Hague, Ben; Sills, Jenny; Thompson, Andrew R

    2015-12-22

    Despite the worthy intentions of international health partnerships between high-income countries and countries with developing economies, the tangible benefits are rarely evaluated, limiting the assessment of the achievements of such collaborations. The present study used longitudinal qualitative methods to examine the individual and organisational benefits of a partnership between a National Health Service (NHS) mental health Trust in the United Kingdom and a mental health referral hospital in Northern Uganda. Benefits to UK staff and organisational development were benchmarked against an existing framework of healthcare competencies. Partnership involvement was beneficial to UK staff, by increasing awareness of diversity, and in enhancing ability to work flexibly and as a team. There were clear benefits expressed with regards to the partnership having the potential to enhance organisational reputation and staff morale. The findings from this study demonstrate that international partnerships are experienced as being of tangible value for healthcare staff from high-income countries, providing opportunities for the development of recognised healthcare competencies. In this study there was also some evidence that staff involvement might also provide wider organisational benefits.

  14. Using data linkage to electronic patient records to assess the validity of selected mental health diagnoses in English Hospital Episode Statistics (HES).

    Science.gov (United States)

    Davis, Katrina Alice Southworth; Bashford, Oliver; Jewell, Amelia; Shetty, Hitesh; Stewart, Robert J; Sudlow, Cathie L M; Hotopf, Matthew Hugo

    2018-01-01

    Administrative data can be used to support research, such as in the UK Biobank. Hospital Episode Statistics (HES) are national data for England that include contain ICD-10 diagnoses for inpatient mental healthcare episodes, but the validity of these diagnoses for research purposes has not been assessed. 250 peoples' HES records were selected based on a HES recorded inpatient stay at the South London and Maudsley NHS Foundation Trust with a diagnosis of schizophrenia, a wider schizophrenia spectrum disorder, bipolar affective disorder or unipolar depression. A gold-standard research diagnosis was made using Clinical Records Interactive Search pseudonymised electronic patient records using, and the OPCRIT+ algorithm. Positive predictive value at the level of lifetime psychiatric disorder was 100%, and at the level of lifetime diagnosis in the four categories of schizophrenia, wider schizophrenia spectrum, bipolar or unipolar depression was 73% (68-79). Agreement varied by diagnosis, with schizophrenia having the highest PPV at 90% (80-96). Each person had an average of five psychiatric HES records. An algorithm that looked at the last recorded psychiatric diagnosis led to greatest overall agreement with the research diagnosis. For people who have a HES record from a psychiatric admission with a diagnosis of schizophrenia spectrum disorder, bipolar affective disorder or unipolar depression, HES records appear to be a good indicator of a mental disorder, and can provide a diagnostic category with reasonable certainty. For these diagnoses, HES records can be an effective way of ascertaining psychiatric diagnosis.

  15. Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

    Science.gov (United States)

    2017-10-01

    rate and growth arrest, length of hospital stay and psychosocial health; 2) To assess the effects of long - term OX on bone and muscle mass and their...Aims: 1) To determine the effects of long - term propranolol administration on cardiac work as reflected by the product of heart rate and mean arterial...blood pressure, and resting energy expenditure as reflected by resting oxygen consumption; 2) To determine the effects of long - term propranolol

  16. Social Reform Groups and the Legal System: Enforcement Problems. Discussion Paper No. 209-74.

    Science.gov (United States)

    Handler, Joel F.

    During the last two decades, there has been a great increase in the use of litigation by social reform groups. This activity has been stimulated by the hospitality of the courts to the demands of social reform groups and the availability of subsidized young, activist lawyers. The paper examines the uses of the legal system by social reform groups…

  17. A model of facilitative communication for the support of general hospital nurses nursing mentally ill people. Part I: background, problem statement and research methodology.

    Science.gov (United States)

    Mavundla, T R; Poggenpoel, M; Gmeiner, A

    2001-03-01

    The impressive growth in the extent and range of psychiatric services provided by general hospitals in South Africa creates stress among nurses employed in these settings who are not psychiatric trained. This manifests itself in negative attitudes displayed towards mentally ill people. The aim of this paper is to discuss the process followed in the development of the model of facilitative communication. A theory generative design was used. The research methods were dealt with in four steps of theory generation as set out below. Step 1 entailed concept analysis. This step was dealt with in two phases, namely concept identification and concept definition. During concept identification, a qualitative research strategy that is explorative, descriptive and contextual was used. This was achieved through field research conducted in an urban general hospital. A sample of twelve professional nurses was selected from a population of 800 professional nurses employed in a general hospital using the purposive sampling technique. This sample size was determined by saturation of data in themes. Both semi-structured individual phenomenological interviews and observations were used as methods of data collection. Giorgi's method of descriptive data analysis (1985) was used. Four themes emerged from the results of the study. The main concepts of the model were identified and classified using a survey list of Dickoff et al. (1968). Step 2 dealt with the creation of interrelationship statements between concepts identified in Step 1, while Step 3 dealt with the description of the model using strategies proposed by Chinn and Kramer (1991). In Step 4, the description of guidelines for operationalizing in practice was ensured. To ensure valid results, a model for trustworthiness proposed by Guba (Lincoln & Guba, 1985) was used. The following criteria for trustworthiness were applied in all the steps of theory generation: truth value, applicability, consistency and neutrality.

  18. [Treatment of offenders with mental disorders: focusing on prison psychiatry].

    Science.gov (United States)

    Nakatani, Yoji

    2011-01-01

    Forensic mental health services exist in a nebulous space at the intersection of two different systems-criminal justice and mental health-and the entanglement of these systems poses intricate problems for psychiatrists. This article discusses the present circumstances of forensic mental health services in Japan, focusing on trends in prison psychiatry. In the traditional Japanese system, offenders with mental disorders were treated within general psychiatry as involuntarily admitted patients, or within the prison system as mentally ill inmates. As a consequence of recent legal reform, however, this situation has radically changed. The Medical Treatment and Supervision Act of 2005 aimed to provide intensive psychiatric treatment to offenders with mental disorders, attaching great importance to their reintegration into society. Under the new system, a person who commits a serious criminal offense in a state of insanity or diminished capacity shall be referred by the public prosecutor to the district court; following a treatment order of the court, the person shall be treated in psychiatric facilities established by the law. While the new system is expected to play a role in the context of specialist forensic psychiatry, its distinction from general psychiatry remains unclear. For example, persons who commit serious crimes, such as assault, in an acute psychotic state are occasionally admitted to general psychiatric hospitals, even if they meet the criteria for a treatment order under the Medical Treatment and Supervision Act. The relationship between prison psychiatry and specialist forensic psychiatry is still more problematic. Compared to the intensive, rehabilitation-oriented care provided under the Medical Treatment and Supervision Act, mental health services in penal institutions have a number of disadvantages, and it is unlikely that mentally ill prisoners have benefited from the recent progress in forensic psychiatry. Statistics show that the number of

  19. Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial

    Science.gov (United States)

    2014-01-01

    Background Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. Methods/design The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months’ intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning

  20. Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial.

    Science.gov (United States)

    Laurenssen, Elisabeth M P; Westra, Dieuwertje; Kikkert, Martijn J; Noom, Marc J; Eeren, Hester V; van Broekhuyzen, Anna J; Peen, Jaap; Luyten, Patrick; Busschbach, Jan J V; Dekker, Jack J M

    2014-05-22

    Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months' intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning

  1. The impact of healthcare workers job environment on their mental-emotional health. Coping strategies: the case of a local general hospital

    Directory of Open Access Journals (Sweden)

    Aristotelis Koinis

    2015-04-01

    Full Text Available Workplace stress can influence healthcare professionals’ physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers’ mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%. Our research protocol was first approved by the hospital’s review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events, evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach’s α=0.862. Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals’ emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life -BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001 and quitting (t=−2.564, P=0.011 are predisposing factors. For the ‘mental health and spirituality’ regression model, positive re-assessment (t=5.528, P=0.000 and seeking social support (t=−1.991, P=0.048 are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0

  2.  Railway Reforms

    DEFF Research Database (Denmark)

    Asmild, Mette; Holvad, Torben; Hougaard, Jens Leth

    This paper considers railway operations in 23 European countries during 1995-2001, where a series of reform initiatives were launched by the European Commission, and analyses whether these reform initiatives improved the operating efficiency of the railways. Efficiency is measured using Multi-dir...... empirical evidence that accounting separation is important for improving operating efficiency for both material and staff costs, whereas other reforms only influenced one of these factors...

  3. The Moral Career of 'Outmates': Towards a History of Manufactured Mental Disorders in Post-Socialist China.

    Science.gov (United States)

    Wu, Harry Yi-Jui

    2016-01-01

    This study focuses on 'manufactured mentally ill' (bei jingshenbing, [symbol in text]) individuals in post-socialist China. In Chinese society, bei jingshenbing is a neologistic catchphrase that refers to someone who has been misidentified as exhibiting symptoms of mental illness and has been admitted to a mental hospital. Specifically, it refers to those individuals who were subjected to unnecessary psychiatric treatment during the first decade of the twenty-first century. Based on archival analysis and ethnographic fieldwork, this study addresses the ways in which the voices of bei jingshenbing victims and those who support them reveal China's experiences with psychiatric modernity. It also discusses the active role of these individuals in knowledge production, medical policymaking, and the implications for reforming the psychiatric and mental health systems in post-socialist China.

  4. The Moral Career of ‘Outmates’: Towards a History of Manufactured Mental Disorders in Post-Socialist China

    Science.gov (United States)

    Wu, Harry Yi-Jui

    2016-01-01

    This study focuses on ‘manufactured mentally ill’ (bei jingshenbing, 被精神病) individuals in post-socialist China. In Chinese society, bei jingshenbing is a neologistic catchphrase that refers to someone who has been misidentified as exhibiting symptoms of mental illness and has been admitted to a mental hospital. Specifically, it refers to those individuals who were subjected to unnecessary psychiatric treatment during the first decade of the twenty-first century. Based on archival analysis and ethnographic fieldwork, this study addresses the ways in which the voices of bei jingshenbing victims and those who support them reveal China’s experiences with psychiatric modernity. It also discusses the active role of these individuals in knowledge production, medical policymaking, and the implications for reforming the psychiatric and mental health systems in post-socialist China. PMID:26651190

  5. Psychiatric Reform in Rio de Janeiro: the current situation and future perspectives.

    Science.gov (United States)

    Fagundes Júnior, Hugo Marques; Desviat, Manuel; Silva, Paulo Roberto Fagundes da

    2016-05-01

    This article analyzes the mental health network in the city of Rio de Janeiro. It provides a report on the current status of the implementation of psychiatric reform and identifies progress, limitations and challenges in this area. Documentary research was carried out by examining official documents, ordinances, SUS databases, information that was available at the Superintendency of Mental Health of the city of Rio de Janeiro, and a literature review of Brazilian and international scientific articles. The results point to important advances in the de-institutionalization of care, with a substantial reduction in the numbers of psychiatric beds, and increased community facilities. However, the following significant challenges remain: the need for increased coverage by psychosocial care centers; the implementation of psychiatric beds in general hospitals; the integration of mental health with primary health care; the de-institutionalization of people who remain in hospitals for long periods; the expansion of the number of residential facilities; and an increase in the provision of specific services for people using alcohol and other drugs.

  6. Lesotho - Land Administration Reform

    Data.gov (United States)

    Millennium Challenge Corporation — Michigan State University was assigned to design the impact evaluation (IE) of the Land Administration Reform Project (LARP) funded under the Millennium Challenge...

  7. Philippines - Revenue Administration Reform

    Data.gov (United States)

    Millennium Challenge Corporation — The Millennium Challenge Account-Philippines' (MCA-P) implementation of the Revenue Administration Reform Project (RARP) is expected to improve tax administration,...

  8. Prevalence and Correlates of Intestinal Parasites among Patients Admitted to Mirembe National Mental Health Hospital, Dodoma, Tanzania

    Directory of Open Access Journals (Sweden)

    Azan A. Nyundo

    2017-01-01

    Full Text Available Background. Neglected tropical diseases continue to be one of the leading causes of morbidity and mortality in the developing world. Psychiatric patients are among groups at risk for parasitic infection although control and monitoring programs largely overlook this population. This study aimed at determining prevalence and factors associated with intestinal parasitic infection among patients admitted to a psychiatric facility. Method. The study followed cross-sectional design; all the residing patients that met the inclusion criteria were included in the survey. Stool samples were collected and examined by direct wet preparation and formol-ether concentration. Data were analyzed with STATA version 12.1; Chi-square test was computed to determine the level of significance at p value < 0.05. Results. Of all 233 patients who returned the stool samples, 29 (12.45% screened were positive for an intestinal parasite. There was no significant association between parasite carriage and age, sex, or duration of hospital stay. Conclusion. The study shows that intestinal parasitic infection is common among patients in a psychiatric facility and highlights that parasitic infections that enter through skin penetration may be a more common mode of transmission than the oral route. Furthermore, the study underscores the need for surveillance and intervention programs to control and manage these infections.

  9. Prevalence of Antipsychotic Polypharmacy and Associated Factors among Outpatients with Schizophrenia Attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Siranesh Tesfaye

    2016-01-01

    Full Text Available Background. Despite recommendations by guidelines to avoid combinations of antipsychotics unless after multiple trials of antipsychotic monotherapy, it is quite a common practice to use combinations. This practice leads to unnecessary expenses and exposes the patient to severe drug adverse effects. Methods. An institution based cross-sectional study was conducted from April to May 2014. Systematic random sampling technique was used to select 423 study subjects. Logistic regression analysis was conducted to identify associated factors of antipsychotic polypharmacy among schizophrenia outpatients. Result. The overall prevalence of antipsychotic polypharmacy was found to be 28.2%. Extra pyramidal side effects (AOR = 2.80; 95% CI: 1.38, 5.71, repeated psychiatric hospitalization (AOR = 2.83; 95% CI: 1.45, 5.50, history of substance use (AOR = 2.82; 95% CI: 1.36, 5.88, longer duration of treatment (AOR = 2.10; 95% CI: 1.14, 3.87, and drug nonadherence (AOR = 1.84; 95% CI: 1.14, 2.98 were found to be significantly associated with antipsychotic polypharmacy. Conclusion. Prevalence of antipsychotic polypharmacy was found to be high among the current study participants. Individuals who had extra pyramidal side effects, admission, substance use, duration of treatment, and drug nonadherence were associated with antipsychotic polypharmacy.

  10. The Reform of Rehabilitation in the Community of Persons with Psychiatric Disabilities: Lessons from the Israeli Experience.

    Science.gov (United States)

    Aviram, Uri

    2017-07-01

    Purpose is to present the mental health rehabilitation reform enacted in Israel in 2000, and to analyze the challenges it faces in its second decade of implementation. Lessons are drawn with regard to other jurisdictions interested in reforming mental health services. Besides reviewing the reform's accomplishments and its contribution to the changes that have occurred in mental health services, the article also assesses the dangers it has to contend with. Analysis focuses on the system's clients, budget, personnel and services-and on its functional environment. During the past decade, the rehabilitation services have considerably expanded. However they cover only about one-fifth of the target population. Paper discusses the mutual dependency between the rehabilitation services and the recently implemented (mid-2015) mental health insurance reform, emphasizing the importance of the rehabilitation system's efficient and effective functioning to the success of that reform and improvement of the mental health services in general.

  11. Psychiatry, homeless patients and welfare reforms: historical links and chains.

    Science.gov (United States)

    Abdul-Hamid, Walid Khalid; Bhui, Kamaldeep

    2014-02-01

    The birthplace of the specialty of psychiatry was in the asylum, which was created to divert patients from workhouses where the most disadvantaged and destitute people with mental illness were to be found. The current welfare reforms are endangering the welfare and livelihood of the most disadvantaged of our patients. These reforms in the authors' opinion are related more to the historical cycle of societal attitude to homeless people than to seeing them as the undeserving poor. This is particularly true since the current economic crisis was not caused by the poor, so it is very unfair that our poorest patients should suffer most as a result of the welfare reforms.

  12. Work-related psychosocial risk factors and mental health problems amongst nurses at a university hospital in Estonia: a cross-sectional study.

    Science.gov (United States)

    Freimann, Tiina; Merisalu, Eda

    2015-07-01

    Rapid changes in the Estonian health care system have placed extra pressure on the nursing profession, but the potential impacts of psychosocial changes have not been investigated. We aimed to explore the work-related psychosocial risk factors and their relationships with mental health problems (MHPs) amongst nurses at the university hospital in Estonia. A cross-sectional survey was undertaken amongst registered nurses at Tartu University Hospital (TUH). Psychosocial work factors and MHPs (stress, somatic symptoms, depressive symptoms and burnout) were measured using version two of the Copenhagen Psychosocial Questionnaire (COPSOQ II). Descriptive statistics and Pearson's r correlation with sequential Bonferroni correction were used to analyse the data. The analysis was based on 404 nurses (45% of the full-time working population of nurses). The highest mean scores recorded for the positive work-related psychosocial factors studied were meaning of work, role clarity, social relationships and mutual trust between employees. The highest scores for the negative factors studied were the demands for hiding emotions, work pace, cognitive and emotional demands. Stress and burnout showed the highest mean scores amongst the MHPs. Quantitative and emotional demands were positively related to all of the studied MHPs, while work pace and role conflicts had a positive correlation with stress and burnout. All of the studied negative psychosocial factors were significantly correlated with burnout. work-related psychosocial risk factors such as quantitative demands work load, emotional demands, work pace and role conflicts, had significant positive relationships with MHPS in nurses in Estonia, and may contribute to high levels of stress as well as burnout amongst nurses: . © 2015 the Nordic Societies of Public Health.

  13. Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.

    Science.gov (United States)

    Shelef, Assaf; Mazeh, Doron; Berger, Uri; Baruch, Yehuda; Barak, Yoram

    2015-06-01

    Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days. A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT. Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01). Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.

  14. Homeless mentally ill or mentally ill homeless?

    Science.gov (United States)

    Cohen, C I; Thompson, K S

    1992-06-01

    Mainstream psychiatry conceptualizes people who are homeless and mentally ill as distinct from other homeless persons because it is thought that their status stems from their mental disorder and the poor implementation of deinstitutionalization. The authors believe this dichotomy is illusory. They present data indicating that recent socioeconomic and political shifts contributed greatly to homelessness among all groups, regardless of mental illness; that those with and without mental illness have similar biographical and demographic profiles; that high levels of mental distress are common to all homeless persons; and that few mentally ill homeless persons require involuntary hospitalization. This perspective suggests novel responses that de-emphasize clinical solutions and focus on empowerment, consumerism, entitlement, community-level interventions, and closer alliances with other advocates for the homeless.

  15. O Manicômio Judiciário: saúde ou justiça? The Judiciary Mental Hospital: a question of health or of law?

    Directory of Open Access Journals (Sweden)

    Evelin Naked de Castro Sá

    1985-10-01

    Full Text Available O Manicômio Judiciário, por ser um hospital-presídio, pode estar subordinado tanto à Secretaria da Saúde como à Justiça. Como elementos de análise dessa decisão, são apresentadas comparações estruturais e de recursos humanos entre o Manicômio Judiciário e a Penitenciária de Araraquara, entre a situação de recursos humanos do Manicômio em 1981 e 1984 e entre os salários de algumas funções de servidores ligados àqueles tipos de instituições. As conclusões apontam a Secretaria da Justiça como a mais adequada para subordinar o Manicômio Judiciário, desde que tomadas algumas medidas de modernização organizacional. É sugerido um quadro de pessoal estruturado percentualmente por subgrupos de funções. As propostas relativas ao pessoal necessitam ser tratadas em leis complementares que garantam, por sua hierarquia, o atendimento das condições excepcionais de trabalho do Manicômio Judiciário.As the Manicômio Judiciário (a Judiciary Mental Health Hospital is a hospital-prison it could be subordinated either to the State Health Department or to the Department of Justice. In order to reach a sound decision regarding this issue, structural and human resource comparisons as between the Manicômio Judiciário on one side and the Araraquara Prison on the other are provided. Comparisons between the status of the human resources of the Manicômio Judiciário in 1981 and 1984 and between the wages earned by workers exercising similar functions and belonging to similar institutions are also presented. The conclusion points to the Department of Justice as the most adequate institution to which the Manicômio Judiciário should be subordinated, provided some up-to-date managerial measures are taken. A personnel chart is suggested, showing percentages of people organized according to subgroups of functions. The proposals regarding personnel must be dealt with by, supplementary laws which guarantee, adequate provision for the

  16. Thinking about Tax Reform.

    Science.gov (United States)

    Boskin, Michael J.

    1985-01-01

    Providing pre-college teachers with an analysis of tax reform is the primary goal of this publication. The present tax system is both inefficient and inequitable. Three goals of tax reform proposals are detailed: (1) fairness--the dimensions of horizontal equity, or equal treatment of equals however defined, and vertical equity, reflecting the…

  17. Tax Reform & University Development.

    Science.gov (United States)

    Myers, John Holt

    This brochure discusses the implications of the Tax Reform Act of 1969 for university and college development officers charged with the responsibility for solicitation of gifts, bequests and grants from foundations. The solicitation of deferred gifts, bequests and grants from foundations is discussed in chapter one in relation to tax reform and…

  18. Life After Tax Reform.

    Science.gov (United States)

    Clotfelter, Charles T.

    1987-01-01

    The impact of the Tax Reform Act of 1986 on higher education is discussed. Background on the tax reform movement and the specific provisions of the 1986 law are examined. The law will reduce private donations, raise the cost of college, and raise the cost of operating institutions. (MLW)

  19. Malawi's Mental Health Service

    African Journals Online (AJOL)

    legislation humane treatment for the mentally ill. In 1913 there was a .... way, the person leaves his village and his com- munity at a time when he is ..... fective treatment? How might we predict if an epileptic patient may commit murder? We have in our mental hospital population a number of people who have murdered while ...

  20. Health reform through tax reform: a primer.

    Science.gov (United States)

    Furman, Jason

    2008-01-01

    Tax incentives for employer-sponsored insurance and other medical spending cost about $200 billion annually and have pervasive effects on coverage and costs. This paper surveys a range of proposals to reform health care, either by adding new tax incentives or by limiting or replacing the existing tax incentives. Replacing the current tax preference for insurance with an income-related, refundable tax credit has the potential to expand coverage and reduce inefficient spending at no net federal cost. But such an approach by itself would entail substantial risks, so complementary reforms to the insurance market are essential to ensure success.

  1. The Danish Police Reform

    DEFF Research Database (Denmark)

    Degnegaard, Rex; Mark, Sofie

    2013-01-01

    and private organisations doing business-in-society. The case concerns the reformation of the Danish Police. In 2007 the Danish Police started implementing an extensive reform that affected all parts of the organisation. Despite thorough planning of the process including several change management initiatives...... for organisations to work with transparency and involvement with the aim of upholding and further developing a social responsibility to their environment. This case on the other hand takes an inside-out perspective on social responsibility by illustrating how social responsibility is necessary for public......, the reform process was problematic and the following years were challenging and filled with changes and turbulence. Media, politicians and the police itself directed heavy criticism towards the effects of the reform and reviews of the reform as well as of the work of the police were carried out resulting...

  2. Reforming Educational Reform: A Democratic Perspective

    Science.gov (United States)

    Green, J.

    2005-05-01

    This essay examines the status of educational reform in the United States as represented by the current Bush administration's program titled "No Child Left Behind" (NCLB). Employing the techniques of critical theory and logical analysis, contemporary reform efforts are compared with other, more progressive, educational reform movements in an effort to gain perspective and conceptual "traction" as it were, in differentiating such movements. Criteria are established for the assessment and evaluation of reform movements. These are employed in judging the efficacy of NCLB's aim, content, and methods, as well as the results of its program following four years of implementation. The merits of the centrality of standardized testing, pre-ordained curricular content, and exclusively didactic teaching methodologies are criticized, along with the extra-school societal forces which ordain these and determine their prominence in the NCLB program. The essentialism adopted by NCLB is, moreover, evaluated in the light of pragmatic, phenomenological, and postmodern educational theory. Arguing that the school is always and inevitably an instrument of societal forces, interests, and groups, it is contended that these not only be acknowledged, but that avenues be formalized for a thorough going and continuous educational "conversation," to borrow Rorty's term, for an amicable resolution of the issues of education's aim(s), content, and methods.

  3. Reforming Romanian energy policy

    International Nuclear Information System (INIS)

    Perkins, S.

    1993-01-01

    Success in reforming energy sector depends on the implementation of the programme of economic reform agreed in February 1993. The difficulty of the negotiations between the International Monetary Fund and the Romanian government reflects the wider difficulties faced by the economy as a whole. They can be blamed in part on the legacy of uneconomic and inflexible industrial development and in part on opposition from interest groups which stand to lose from reform. Nonetheless, in spite of hesitant approach, the government does appear committed to the economic reform necessary to establish a market-oriented economy. But as the danger of a financial crisis engendered by the inadequately supported short-term borrowing of foreign exchange becomes urgent, the question is whether economic reform can be now implemented fast enough to protect economic enterprises and saving from a debt crisis. The scope for further delay in implementing the 1993 economic reform programme is fast disappearing. Procrastination should not be allowed to threaten the success of the reforms achieved in the energy and other sectors of the economy. 8 refs., 2 figs

  4. [Assessing deinstitutionalization of the nursing home area of a large state mental hospital from the point of view of patients and staff].

    Science.gov (United States)

    Kallert, T W; Stoll, A; Leisse, M; Winiecki, P

    2004-08-01

    Within the deinstitutionalization process of a large psychiatric hospital, the development of two cohorts of patients with chronic schizophrenia is compared over a two-year period: patients living in the hospital's nursing-home area (n = 50) vs. patients already released to two social therapeutic hostels (n = 51). Results of the cohort study were compared with assessments of nurses working in the nursing home (n = 55), focusing on their subjective views of the deinstitutionalization process and its impact on their working conditions. Patients are assessed through yearly home-visits in their place of residence. The instruments used measure several outcome parameters: psychopathology, social disabilities, subjective quality of life, and normative needs for care. Concurrent staff assessments were conducted using standardized survey instruments focusing on current working conditions and quality of teamwork. Nineteen nurses participated in qualitative interviews evaluating the deinstitutionalization process. For all measures, patients living in the nursing home show significantly worse outcomes. Furthermore, during the study period 34 % experienced a change in their living situation with which they were dissatisfied. Needs for care and the number of areas of "unmet" need increased significantly for this subgroup. Patients living in social therapeutic hostels demonstrate stable levels of psychopathological symptoms, social disabilities, and needs for care. Assessments indicating a deterioration in patients' subjective quality of life focus mainly on areas important for social contacts. Regarding "personal concerns" and "insecurity at work", ratings from nursing home staff were significantly worse than those of a reference group from several other health care institutions (n = 224). Staff showed a tendency to give higher ratings for their opportunities to participate in decisions, in contrast with the low ratings for chances to improve their knowledge in the workplace, a

  5. The recent health reform in Croatia: true reforms or just a fundraising exercise?

    Science.gov (United States)

    Svaljek, Sandra

    2014-03-01

    Croatia's most recent reform of the healthcare system was implemented in 2008. The aim of the reform was to enhance financial stability of the system by introducing additional sources of financing, as well as increase the efficiency of the system by reducing sick pay transfers to households, rationalising spending on pharmaceuticals, restructuring hospitals etc. This paper attempts to assess the success of the 2008 healthcare system reform in reaching financial stability and sustainability, and to evaluate the effects of the reform on equity in funding the system. It takes into account the fact that the reform coincided with a severe economic crisis and decline in the overall living standard of Croatian citizens. The paper shows that the reform ended up being expansionary and thus impaired the necessary fiscal adjustment. Finally, it is argued that in circumstances of declining disposable incomes, increased co-payments aimed at the financial stabilisation of the health system made health services less affordable and could have had detrimental effects on equity in the utilisation of health care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Catalytic reforming methods

    Science.gov (United States)

    Tadd, Andrew R; Schwank, Johannes

    2013-05-14

    A catalytic reforming method is disclosed herein. The method includes sequentially supplying a plurality of feedstocks of variable compositions to a reformer. The method further includes adding a respective predetermined co-reactant to each of the plurality of feedstocks to obtain a substantially constant output from the reformer for the plurality of feedstocks. The respective predetermined co-reactant is based on a C/H/O atomic composition for a respective one of the plurality of feedstocks and a predetermined C/H/O atomic composition for the substantially constant output.

  7. Perceived Stigma and Associated Factors among People with Schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Institution Based Study

    Directory of Open Access Journals (Sweden)

    Berhanu Boru Bifftu

    2014-01-01

    Full Text Available Background. While effective treatments are available for people with schizophrenia, presence of perceived stigma prevents them from accessing and receiving the help they need to get. Objectives. To assess the prevalence and associated factors of perceived stigma among people with schizophrenia attending the Outpatient Department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Methods. Institution based cross-sectional study design was conducted among 411 subjects using an Amharic version of the perceived devaluation and discrimination scale. Single population proportion formula was used to calculate sample size. Subjects were selected by systematic sampling techniques. Binary logistic regression and odds ratio with 95% confidence interval were used to identify the association factors of outcome variables. Results. A total of 411 subjects participated in the study giving a response rate of 97.4%. The prevalence of perceived stigma was found to be 83.5%. Education status (not able to read and write (AOR=2.64, 95% CI: 1.118, 6.227, difficulties of adherence to antipsychotic drug (AOR=4.49, 95% CI: 2.309, 8.732, and duration of illness less than one year (AOR=3.48, 95% CI: 2.238, 5.422 were factors associated with perceived stigma. Conclusion. Overall, the prevalence of perceived stigma was found to be high. Education status (not able to read and write, difficulties of adherence to antipsychotic medication, and duration of illness were factors associated with perceived stigma. Adherence to antipsychotic medication particularly during the early stage of the illness and strengthening the educational status of the participants were suggested in the clinical care setting.

  8. Drug pricing reform in China: analysis of piloted approaches and potential impact of the reform.

    Science.gov (United States)

    Chen, Yixi; Hu, Shanlian; Dong, Peng; Kornfeld, Åsa; Jaros, Patrycja; Yan, Jing; Ma, Fangfang; Toumi, Mondher

    2016-01-01

    In 2009, the Chinese government launched a national healthcare reform programme aiming to control healthcare expenditure and increase the quality of care. As part of this programme, a new drug pricing reform was initiated on 1 June 2015. The objective of this study was to describe the changing landscape of drug pricing policy in China and analyse the potential impact of the reform. The authors conducted thorough research on the drug pricing reform using three Chinese databases (CNKI, Wanfang, and Weipu), Chinese health authority websites, relevant press releases, and pharmaceutical blogs and discussion forums. This research was complemented with qualitative research based on targeted interviews with key Chinese opinion leaders representing the authorities' and prescribers' perspectives. With the current reform, the government has attempted to replace its direct control over the prices of reimbursable drugs with indirect, incentive-driven influence. Although the exact implementation of the reform remains unclear at the moment, the changes introduced so far and the pilot project designs indicate that China is considering adaptation of some form of internal and external reference pricing policies, commonly used in the Organisation for Economic Co-operation and Development countries. Several challenges related to the potential new mechanism were identified: 1) the risk of hospital underfunding, if hospital funding reform is not prioritised; 2) the risk of promoting the use of cheap, low-quality drugs, if a reliable quality control system is not in place and discrepancy between the available drugs is present; 3) the risk of increasing disparity in access to care between poor and rich regions, in case of country-wide price convergence; and 4) the risk of industry underinvestment, resulting in reduced competition, issues with quality and sustainability of supply, and potentially negative social impact. Foreign pricing policies cannot be transferred to China without

  9. Development of Mental Health Indicators in Korea

    Science.gov (United States)

    Han, Hyeree; Ahn, Dong Hyun; Song, Jinhee; Hwang, Tae Yeon

    2012-01-01

    Objective Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea. Methods This paper reviews the mental health indicator development policies and practices of seven organizations, countries, and regions: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries. Results We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders. Conclusion Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation. PMID:23251193

  10. Non-catalytic recuperative reformer

    Science.gov (United States)

    Khinkis, Mark J.; Kozlov, Aleksandr P.; Kurek, Harry

    2015-12-22

    A non-catalytic recuperative reformer has a flue gas flow path for conducting hot flue gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is embedded in the flue gas flow path to permit heat transfer from the hot flue gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, extended surfaces of metal material such as stainless steel or metal alloy that are high in nickel content are included within at least a portion of the reforming mixture flow path.

  11. Practice Makes Perfect and Other Myths about Mental Health Services.

    Science.gov (United States)

    Bickman, Leonard

    1999-01-01

    Examines forces motivating reform in mental health services, suggesting that mental health practitioners and researchers have relied on traditional and apparently unsuccessful methods (with little or no scientific support) to ensure service quality and effectiveness; debunking six myths about mental health services; and suggesting that…

  12. Education system discrimination against children with mental disorders.

    Science.gov (United States)

    Bor, William; Dakin, Jean

    2006-03-01

    To describe the conceptual confusion, inconsistency and discrimination within some state and territory education systems towards children with mental disorders. Reforms are required to achieve a consistent Australia wide framework for the classification of childhood mental disorders as disabilities. The mental health diagnostic assessment to qualify for disability status needs to be simplified when participation in complex evaluation procedures is not possible.

  13. Social Security Reform

    National Research Council Canada - National Science Library

    Nuschler, Dawn

    2005-01-01

    .... In recent years, reform ideas have ranged from relatively minor changes to the current pay-as-you-go social insurance system to a redesigned program based on personal savings and investments modeled after IRAs and 401(k...

  14. Reformer Fuel Injector

    Science.gov (United States)

    Suder, Jennifer L.

    2004-01-01

    Today's form of jet engine power comes from what is called a gas turbine engine. This engine is on average 14% efficient and emits great quantities of green house gas carbon dioxide and air pollutants, Le. nitrogen oxides and sulfur oxides. The alternate method being researched involves a reformer and a solid oxide fuel cell (SOFC). Reformers are becoming a popular area of research within the industry scale. NASA Glenn Research Center's approach is based on modifying the large aspects of industry reforming processes into a smaller jet fuel reformer. This process must not only be scaled down in size, but also decrease in weight and increase in efficiency. In comparison to today's method, the Jet A fuel reformer will be more efficient as well as reduce the amount of air pollutants discharged. The intent is to develop a 10kW process that can be used to satisfy the needs of commercial jet engines. Presently, commercial jets use Jet-A fuel, which is a kerosene based hydrocarbon fuel. Hydrocarbon fuels cannot be directly fed into a SOFC for the reason that the high temperature causes it to decompose into solid carbon and Hz. A reforming process converts fuel into hydrogen and supplies it to a fuel cell for power, as well as eliminating sulfur compounds. The SOFC produces electricity by converting H2 and CO2. The reformer contains a catalyst which is used to speed up the reaction rate and overall conversion. An outside company will perform a catalyst screening with our baseline Jet-A fuel to determine the most durable catalyst for this application. Our project team is focusing on the overall research of the reforming process. Eventually we will do a component evaluation on the different reformer designs and catalysts. The current status of the project is the completion of buildup in the test rig and check outs on all equipment and electronic signals to our data system. The objective is to test various reformer designs and catalysts in our test rig to determine the most

  15. The Danish school reform

    DEFF Research Database (Denmark)

    Bager, Ann; Mølholm, Martin; Horsbøl, Anders

    The paper presents a methodological framework for the study of the discursive emergence of the recent Danish School reform (2014). The framework will enable discourse scholars to hold an actively involved position in changing and furthering plurivocal processes of translations, negotiations...... and implementation of the reform. The framework is operationalized through research-based participatory collaborative processes involving local actors in two Danish public schools. It interlinks diverse discourse strategies and perceptive distances that traditionally belong to separate branches within discourse...

  16. Managing mental health service provision in the decentralized, multi-layered health and social care system of Germany.

    Science.gov (United States)

    Bramesfeld, Anke; Wismar, Matthias; Mosebach, Kai

    2004-03-01

    The effective coordination of mental health service provision is a requirement for successfully reforming mental health care from a hospital-focused system towards a more decentralized, community-oriented one. Implementing such coordination is particularly challenging in a decentralized, multi-layered health and social care system such as exists in Germany. (i) To investigate the coordination and planning of mental health service provision performed at and between the local, Länder and federal political levels in Germany; (ii) to outline the disparities in coordination and planning of mental health service provision that exist between the different political levels and locate key-authorities; (iii) to determine whether a decentralized, multi-layered health and social system such as Germany's allows for adequate coordination. (i) Analysis of mental health legislation and policy documents; (ii) guided interviews with officers and consultants of the government units responsible for mental health affairs of the 16 Länder and the federal Ministry of Health and Social Security; (iii) submission of results to the interviewed experts for verification. Multi-professional boards and posts for coordinating and planning mental health services are widely implemented on local state and federal level in Germany. Most of them operate without being required by legislation. The sickness and pension funds are represented in less than half of the boards on state level. Boards on local and on state level are mainly concerned with coordinating social mental health care and have little influence on medical mental health care. Mental health policy documents exist federally and in most Länder. All but one of the mental health legislations of the Länder (present in 12 out of the 16 Länder) also considers regulations concerning coordinating and planning mental heath services. The key-authorities for mental-health policy, legislation and service implementation is with the 16 Länder. The

  17. Considerations on occupational therapy in a custody and psychiatric treatment hospital: The psychosocial field versus the forensic psychiatry field

    Directory of Open Access Journals (Sweden)

    Ana Carolina Santos de Souza

    2014-12-01

    Full Text Available The Custody and Psychiatric Treatment Hospital (CPTH is ambivalent and ambiguous in its essence, because it gathers not only the characteristics of a mental institution, but also those of a prison – epitomized by the security system. By analyzing this context, one can perceive the importance of implementing some knowhow able to attend the real needs of the individuals hospitalized in this type of institution. This interpretation of their needs must be done in association with a work in mental health based on the principles of the Brazilian Psychiatric Reform and Psychosocial Field Practice. The objective of this study is to reflect on the real possibilities of implementing mental health work based on the Brazilian Psychiatric Reform, inserted in the Psychosocial Field, in institutions such as CPTHs. This reflection occurs from the conflicts arisen in the beginning of Occupational Therapy service in a CPTH located in the state of Sao Paulo, Brazil, as well as through the analysis of the reality in which this Custody Hospital is inserted. When studying the Psychiatric Reform Law, ordinance 28.195/1988, which deliberates on the functions of Occupational Therapy in the CPTHs of the state of Sao Paulo, and the Penal Execution Law, the reality was analyzed from its dimensions, to conclude that the institutional forces ruled the work process of occupational therapists. Therefore, the structural, particular, singular dimensions that rule the CPTH were understood and, after that, the “nodes” that hinder the implementation of mental health work in the Psychosocial Field in this type of institution were revealed.

  18. What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms.

    Science.gov (United States)

    Joseph, Tiffany D

    2016-02-01

    The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide. Copyright © 2016 by Duke University Press.

  19. Mental vulnerability as a risk factor for depression

    DEFF Research Database (Denmark)

    Østergaard, Ditte; Dalton, Susanne Oksbjerg; Bidstrup, Pernille Envold

    2012-01-01

    Mental vulnerability (i.e. a tendency to experience psychosomatic symptoms, mental symptoms or interpersonal problems) is associated with various diseases. This study investigated whether mental vulnerability is associated with hospitalization for depression.......Mental vulnerability (i.e. a tendency to experience psychosomatic symptoms, mental symptoms or interpersonal problems) is associated with various diseases. This study investigated whether mental vulnerability is associated with hospitalization for depression....

  20. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

    In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  1. Rorty the Reformer?

    Directory of Open Access Journals (Sweden)

    Harvey Cormier

    2008-12-01

    Full Text Available Rorty should be read as a reformer, rather than a revolutionary transformer. While the reformer aims to improve what is already good, the revolutionary transformer seeks to dispense with the merely good in a quest for the absolutely best. For Rorty this choice was a bad choice. In order to make the case that Rorty was a reformer,we explicate Rorty’s views on truth. These views argue that we can obtain consensus about what is worth preserving and improving without reference to either rightness, truth, or objectivity. For after all, there is no way for philosophers to get outside the circle of language within which we debate about what we take to be authoritative and aceptable.

  2. Brazilian healthcare model for people with mental disorders: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Marcelo Theophilo Lima

    2013-03-01

    Full Text Available Objective: To evaluate the process of implementing the Brazilian psychiatric reform, especially regarding its impact on families’ management of healthcare issues. Methods: Interpretative research performed between August 2011 and January 2012, where symbolic interactionism was used as theoretical reference and Grounded Theory was used as the methodological reference. Initially, 49 articles on the subject were selected applying as descriptors mental health, psychiatric reform and psychosocial care, in Scielo, lIlACS and university libraries’ databases. of these, 17 articles were excluded for being published prior to 2008 and 18 for having approaches not comprised in the scope of the study. Results: The power relationships in the treatment method were identified as causal conditions of the de-hospitalization process, which occurs in a context of deficiency in the network intended to replace psychiatric hospitals, therefore requiring the participation of patients’ families in their reintegration at home and treatment. This strategy to deconstruct the psychiatric hospital-based model results in an excessive burden to the families. Conclusion: If, on one hand, the shift from hospitalization to in-home care, with embracement of the disease and of patients’ suffering in their very social relationships, was to propose the recovery of patients’ civil and human rights and their remaining into the society, on the other hand, it creates another series of problems, such as the emotional and logistical burden imposed on patients’ families.

  3. China's health care system reform: Progress and prospects.

    Science.gov (United States)

    Li, Ling; Fu, Hongqiao

    2017-07-01

    This paper discusses the progress and prospects of China's complex health care reform beginning in 2009. The Chinese government's undertaking of systemic reform has achieved laudable achievements, including the expansion of social health insurance, the reform of public hospitals, and the strengthening of primary care. An innovative policy tool in China, policy experimentation under hierarchy, played an important role in facilitating these achievements. However, China still faces gaps and challenges in creating a single payer system, restructuring the public hospitals, and establishing an integrated delivery system. Recently, China issued the 13th 5-year plan for medical reform, setting forth the goals, policy priorities, and strategies for health reform in the following 5 years. Moreover, the Chinese government announced the "Healthy China 2030" blueprint in October 2016, which has the goals of providing universal health security for all citizens by 2030. By examining these policy priorities against the existing gaps and challenges, we conclude that China's health care reform is heading in the right direction. To effectively implement these policies, we recommend that China should take advantage of policy experimentation to mobilize bottom-up initiatives and encourage innovations. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Systemic Reform and Organizational Change

    Science.gov (United States)

    Fusarelli, Bonnie C.; Fusarelli, Lance D.

    2003-01-01

    In this article, the authors explore whether educational systems have the institutional capacity to implement comprehensive, systemic reform, as envisioned in legislation such as No Child Left Behind. Drawing upon evidence from various state-level reform initiatives, the authors highlight the ways in which systemic reform appears to positively…

  5. Reforming Technical and Technological Education.

    Science.gov (United States)

    Wilson, David N.

    1993-01-01

    Review of technical and technological educational reform in Brazil, Canada, Germany, Great Britain, Indonesia, Malaysia, Singapore, and Sweden shows that reform takes time to complete effectively, long-term approaches are needed, and reform is linked to industrial development, regional cooperation, and decentralized decision making. (SK)

  6. How to Reform Business Licenses

    OpenAIRE

    International Finance Corporation; World Bank

    2010-01-01

    Reforming business licenses is part of a suite of products delivered by the World Bank group's investment climate advisory services, under the business operations practice. The approach to reforms highlighted in this handbook fits into the broader policy framework for business licensing reform and simplification. The framework paper provides the context for business licensing practices; es...

  7. Right to mental health in prison system: reflections on the process of deinstitutionalization of the HCTP.

    Science.gov (United States)

    Soares, Marden Marques; Bueno, Paula Michele Martins Gomes

    2016-06-01

    This study aimed to discuss the close relationship between mental health, the criminal justice system and the prison system, whose specific interfaces are the HCTP (Hospital de Custódia e Tratamento Psiquiátrico, or Judicial Psychiatric Hospital) conflict and the person with mental disorder in conflict with the law. There will be presented extensive discussions on the Penal Execution Law and the Brazilian Psychiatric Reform Law, as well as cross-sector actions taken by the judiciary and the federal government (Brazilian National Health System - SUS and National Social Assistance System - SUAS) to bring the criminal justice system and the prison system to the anti-asylum combat. Two successful experiences in the states of Minas Gerais and Goiás will also be presented for they reflect the emergence of a new strategy on public health policy: The Evaluation Service and Monitoring Therapeutic Measures for the Person with Mental Disorder in Conflict with the Law, device connector between systems, willing to operate in the process of deinstitutionalization of people with mental disorders of HCPT.

  8. Indicators predicting use of mental health services in Piedmont, Italy.

    Science.gov (United States)

    Tibaldi, Giuseppe; Munizza, Carmine; Pasian, Sherri; Johnson, Sonia; Salvador-Carulla, Luis; Zucchi, Serena; Cesano, Simona; Testa, Cristina; Scala, Elena; Pinciaroli, Luca

    2005-06-01

    Since the 1978 Italian reform, an integrated network of community mental health services has been introduced. With few exceptions, research on determinants of mental health service use at the district level has focused on inpatient activities and social deprivation indicators. The European Psychiatric Care Assessment Team (EPCAT) standardized methodology allows for an evidence-based comparison of mental health systems between geographical areas. To compare service provision and utilization between local catchment areas; to explore quantitative relationships between residential and community service use and socio-demographic indicators at the ecological level. The European Socio-demographic Schedule (ESDS) was used to describe area characteristics, and the European Service Mapping Schedule (ESMS) to measure service provision and utilization in 18 catchment areas in Piedmont. Substantial variation in service use emerged. Acute hospital bed occupancy rates were lower in areas with more intensive community continuing care service users and with a smaller percentage of the population living alone. The non-acute hospital bed occupancy rate was directly related to the percentage of the population living alone or in overcrowded conditions, and to the level of mobile continuing care service users. Community continuing care service use was highest in areas with a larger percentage of the population living alone. Multiple regression models explained between 48 and 55% of the variation in inpatient and community service use between areas. Relationships based on ecological characteristics do not necessarily apply to the individual. This level of assessment, however, is necessary in evaluating mental health policy and service systems, and in allocating resources. The distribution of mental health care resources should be weighted in terms of indicators of social deprivation shown to be important predictors of both inpatient and community service use, as these are likely to be

  9. Educational Reform in Turkey

    Science.gov (United States)

    Lindquist, Cynthia

    2017-01-01

    As a country seeking admission to the European Union, this paper explores educational reforms in Turkey that enhance its possible entry into the European Union and changes still needed for it to be an equal partner. An overview of the school system in Turkey is provided including information on teacher training and preparation, special education…

  10. Sex and School Reform.

    Science.gov (United States)

    Cuban, Larry

    1986-01-01

    Predicts that reformers will not attack sex education as an inappropriate addition to otherwise rigorous academic programs. Examines (1) some of the political, social, and practical reasons behind this avoidance and (2) the ineffectiveness of existing programs in preventing teenage pregnancies. Suggests that sex education programs may even hinder…

  11. Reforming Water, Adding Women?

    International Development Research Centre (IDRC) Digital Library (Canada)

    Karen Kershaw

    Strong state-civil society collaboration: alternatives. • 1997: first sector reform project launched (Ghogha) ... management? • What role does civil society (NGOs, CBOs, networks, academia) play in this process? ... campaigns, folk media, street theatre, engage communities. • Technical training for women, socially excluded ...

  12. Comments on regulatory reform

    International Nuclear Information System (INIS)

    Hendrie, J.M.

    1982-01-01

    Nuclear regulatory reform is divided into two parts. The first part contains all those matters for which new legislation is required. The second part concerns all those matters that are within the power of the Commission under existing statutes. Recommendations are presented

  13. Reform: Learning from Japan.

    Science.gov (United States)

    Barnes, Michael

    1999-01-01

    Examining differences between education in the United States and in Japan means analyzing cultural dissimilarities. An overview of Japan's educational makeup, curriculum, and graduation rates provides background in comparing educational systems for future reforms. This paper examines Japanese school structures, government support, institutional…

  14. Massachusetts Reform and Disparities in Inpatient Care Utilization

    Science.gov (United States)

    Hanchate, Amresh D.; Lasser, Karen E.; Kapoor, Alok; Rosen, Jennifer; McCormick, Danny; D’Amore, Meredith M.; Kressin, Nancy R.

    2012-01-01

    Background The 2006 Massachusetts health reform substantially decreased uninsurance rates. Yet, little is known about the reform’s impact on actual healthcare utilization among poor and minority populations, particularly for receipt of inpatient surgical procedures that are commonly initiated by outpatient physician referral. Methods Using discharge data on MA hospitalizations for 21 months preceding and following health reform implementation (7/1/2006 – 12/31/2007), we identified all non-obstetrical major therapeutic procedures for patients aged ≥ 40 and for which ≥70 percent of hospitalizations were initiated by outpatient physician referral. Stratifying by race/ethnicity and patient residential zip code median (area) income, we estimated pre- and post-reform procedure rates, and their changes, for those aged 40–64 (non-elderly), adjusting for secular changes unrelated to reform by comparing to corresponding procedure rate changes for those aged >= 70 (elderly), whose coverage (Medicare) was not affected by reform. Results Overall increases in procedure rates (among 17 procedures identified) between pre- and post-reform periods were higher for non-elderly low area income (8%, p=0.04) and medium area income (8%, preform, post-reform increases in procedure utilization among non-elderly were: by area income, low=13% (95% CI=[9%, 17%]), medium=15% ([6%, 24%]) and high=2% ([−3%, 8%]), and by race/ethnicity, Hispanics=22% ([5%, 38%]), Blacks=5% ([−20%, 30%]) and Whites=7% ([5%, 10%]). Conclusions Post-reform use of major inpatient procedures increased more among non-elderly lower and medium area income populations, Hispanics, and whites, suggesting potential improvements in access to outpatient care for these vulnerable subpopulations. PMID:22683590

  15. Plasma devices for hydrocarbon reformation

    KAUST Repository

    Cha, Min Suk

    2017-02-16

    Plasma devices for hydrocarbon reformation are provided. Methods of using the devices for hydrocarbon reformation are also provided. The devices can include a liquid container to receive a hydrocarbon source, and a plasma torch configured to be submerged in the liquid. The plasma plume from the plasma torch can cause reformation of the hydrocarbon. The device can use a variety of plasma torches that can be arranged in a variety of positions in the liquid container. The devices can be used for the reformation of gaseous hydrocarbons and/or liquid hydrocarbons. The reformation can produce methane, lower hydrocarbons, higher hydrocarbons, hydrogen gas, water, carbon dioxide, carbon monoxide, or a combination thereof.

  16. Mental health disabilities and human rights protections.

    Science.gov (United States)

    Szmukler, G; Bach, M

    2015-01-01

    Around the world, reports regularly expose persistent and systemic human rights violations of patients in mental health services and facilities, and of those who are unable to access needed supports. A number of factors contribute - political will; the range and quality of services available; public and professional attitudes to mental health; stigma; health professionals' training and expertise; and available resources. This paper examines one of the main determinants, the legal framework. This sets the parameters for mental health policies and services and for applicable human rights norms and standards that can be realized in practice. We provide an overview of international human rights instruments in relation to mental health disabilities, and of the major human rights violations in this area. Key implications for mental health law reform are drawn with a particular focus on discrimination and coercive interventions. The major challenges posed by the UN Convention on the Rights of Persons with Disabilities (2006) are examined. Current mental health laws, to greater or lesser degrees, fail to meet the newly required standards. We discuss reforms based on 'generic law' and 'legal capacity' principles that seek to meet those standards. We outline some emergent and promising examples of reform. The role of civil society and the importance of the standing of those with mental health disabilities in this process is noted.

  17. Housing, income support and mental health: points of disconnection.

    Science.gov (United States)

    Forchuk, Cheryl; Joplin, Libbey; Schofield, Ruth; Csiernik, Rick; Gorlick, Carolyne; Turner, Katherine

    2007-12-12

    There exists a disconnection between evolving policies in the policy arenas of mental health, housing, and income support in Canada. One of the complexities associated with analysing the intersection of these policies is that federal, provincial, and municipal level policies are involved. Canada is one of the few developed countries without a national mental health policy and because of the federal policy reforms of the 1970s, the provincial governments now oversee the process of deinstitutionalization from the hospital to the community level. During this same period the availability of affordable housing has decreased as responsibility for social housing has been transfered from the federal government to the provincial and/or municipal levels of government. Canada also stands alone in terms of being a developed nation without national housing policy instead what is considered "affordable" housing is partially dependant upon individuals' personal economic resources. As well, over the past decade rates of income supports have also been reduced. Psychiatric survivors have long been identified as being at risk for homelessness, with the disconnection existing between housing, income and mental health policies and the lack of a national policy in any of these policies areas further contributing to this risk.

  18. Housing, income support and mental health: Points of disconnection

    Directory of Open Access Journals (Sweden)

    Csiernik Rick

    2007-12-01

    Full Text Available Abstract There exists a disconnection between evolving policies in the policy arenas of mental health, housing, and income support in Canada. One of the complexities associated with analysing the intersection of these policies is that federal, provincial, and municipal level policies are involved. Canada is one of the few developed countries without a national mental health policy and because of the federal policy reforms of the 1970s, the provincial governments now oversee the process of deinstitutionalization from the hospital to the community level. During this same period the availability of affordable housing has decreased as responsibility for social housing has been transfered from the federal government to the provincial and/or municipal levels of government. Canada also stands alone in terms of being a developed nation without national housing policy instead what is considered "affordable" housing is partially dependant upon individuals' personal economic resources. As well, over the past decade rates of income supports have also been reduced. Psychiatric survivors have long been identified as being at risk for homelessness, with the disconnection existing between housing, income and mental health policies and the lack of a national policy in any of these policies areas further contributing to this risk.

  19. Health reform and the Medical Journal of Australia.

    Science.gov (United States)

    Kalucy, Elizabeth C; Bowers, Eleanor M Jackson

    2010-07-19

    In 2008, the Australian Government established three major health reform initiatives - the National Health and Hospitals Reform Commission, the first National Primary Health Care Strategy working group, and the Preventative Health Taskforce. We examined which journals were most frequently cited in the publicly available discussion papers, commissioned papers, submissions and final reports of these initiatives. Journal articles were cited most in discussion papers, commissioned papers and submissions, followed by reports and other publications from Australian organisations and governments. The Medical Journal of Australia was the most cited journal, with 392 references to its articles (11.8% of all journal articles cited) in discussion papers, commissioned papers, submissions and an interim report, and 58 references to its articles (13.7% of total journal articles) in the three final reports. Our findings demonstrate the importance of credible, local, accessible, peer-reviewed evidence in reforming the national health system, including hospitals, primary health care and preventive health care.

  20. A review of the new provisions for sanctioning mentally disordered offenders in China, in a broader historical context.

    Science.gov (United States)

    Pei, Wei; van der Wolf, Michiel

    Reforms of the criminal justice system in China in recent years have included the 2012 Code of Criminal Procedure (CCP), which resulted in new disposals for mentally disordered offenders. From a Western perspective, changes in Chinese criminal law are sometimes clichéd as toothless window dressing, but they may represent a genuine step forward in safeguarding human rights. Taking a historical perspective, this paper reveals that in the East, as much as in the West, there is a 'moral tradition' of not punishing mentally disordered offenders who are not considered responsible for their acts. There are clear differences in disposal for those acquitted having been found 'not guilty by reason of insanity'. Whereas Western jurisdictions have offered (criminal) courts the opportunity for commitment in (forensic) mental hospitals from the early 19th Century, in China, disposal has remained, until the recent changes, the responsibility of the administration (mainly the police) or the family of the offender. A few high profile cases brought to light the inadequacy of these arrangements and the general disregard of obvious mental health issues when sentencing offenders. There was lack of clarity regarding who would take responsibility for treatment and issues of future public protection arising from a mental disorder. The 2012 CCP introduces the power of mental health commitment by the judiciary for those found non-responsible for an offense because of a mental disorder. Similar to provisions in Western jurisdictions there remain human rights concerns regarding aspects of 2012 CCP and the role of 'preventive detention' for mentally disordered offenders on indeterminate secure mental health detention. Nevertheless, the shift to judicial decision making in such cases and the possibility of mental health commitment are welcome steps in improving the human rights of this vulnerable population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Acute mental health care and South African mental health legislation ...

    African Journals Online (AJOL)

    Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part, qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, in a retrospective review of ...

  2. Physical activity and quality of life in long-term hospitalized patients with severe mental illness: a cross-sectional study

    NARCIS (Netherlands)

    Deenik, J.; Kruisdijk, F.; Tenback, D.; Braakman-Jansen, A.; Taal, E.; Hopman-Rock, M.; Beekman, A.; Tak, E.C.; Hendriksen, I.; Harten, P. van

    2017-01-01

    Background. Increasing physical activity in patients with severe mental illness is believed to have positive effects on physical health, psychiatric symptoms and as well quality of life. Till now, little is known about the relationship between physical activity and quality of life in long-term

  3. Physical activity and quality of life in long-term hospitalized patients with severe mental illness : A cross-sectional study

    NARCIS (Netherlands)

    Deenik, Jeroen; Kruisdijk, Frank; Tenback, Diederik; Braakman-Jansen, Annemarie; Taal, Erik; Hopman-Rock, Marijke; Beekman, Aartjan T.F.; Tak, Erwin; Hendriksen, Ingrid; van Harten, Peter

    2017-01-01

    Background: Increasing physical activity in patients with severe mental illness is believed to have positive effects on physical health, psychiatric symptoms and as well quality of life. Till now, little is known about the relationship between physical activity and quality of life in long-term

  4. Welfare reform and parenting: reasonable expectations.

    Science.gov (United States)

    Chase-Lansdale, P Lindsay; Pittman, Laura D

    2002-01-01

    Although the primary goals of federal welfare reform legislation were to move welfare mothers into the workforce and reduce births outside of marriage, promotion of responsible parenting was also an important underlying theme. Parenting is a complex, multifaceted phenomenon, however, encompassing a wide range of functions related to nurturing, discipline, stimulation, values, activities, and routines. This article provides a framework for assessing the impact of welfare reform on various dimensions of parenting, with the following key findings: Many aspects of life affect parenting and child development, such as parent characteristics, child characteristics, family economic resources, family structure, parental mental health, marital or partner relationships, and the quality of parents' kin and social networks. About two-thirds of states are using federal welfare funds to promote better parenting through programs such as home visits to new parents and parenting classes, but virtually no state parenting programs have been evaluated. Welfare reform appears to have limited effects on parenting. The only dimension of parenting significantly affected by some welfare demonstration programs was parents' choice of child care settings and extracurricular activities for their children. The programs with the greatest positive impact on parenting were those with more generous work supports and more flexible work requirements. Not only did these programs lead to different choices concerning child care and activities for preschool and school-age children, but they also resulted in more stable marriages and less violence between partners, which also could lead to improved parenting. The authors conclude that many important aspects of the connection between welfare reform and parenting have yet to be examined, and that further research is needed to identify the ways states' welfare programs can promote better parenting.

  5. Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK.

    Science.gov (United States)

    Simpson, Alan; Flood, Chris; Rowe, Julie; Quigley, Jody; Henry, Susan; Hall, Cerdic; Evans, Richard; Sherman, Paul; Bowers, Len

    2014-02-05

    Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to

  6. Management And Organization Reforms At The Muhimbili National ...

    African Journals Online (AJOL)

    Objective: To establish the state of organization structures and management situation existing at the Muhimbili National Hospital (MNH) and Muhimbili University College of Health Sciences (MUCHS) prior to the start of the MNH reforms and physical infrastructure rehabilitations. Methods: A checklist of key information items ...

  7. Bulgaria mental health country profile.

    Science.gov (United States)

    Tomov, Toma; Mladenova, Maya; Lazarova, Irina; Sotirov, Vladimir; Okoliyski, Mihail

    2004-01-01

    The mental health profile of Bulgaria has been compiled and following analysis of both the factual findings and the process of data collection a report has been prepared. The subject of discussion in the paper concerns several major findings: the discrepancy between what the policy documents state and the actual situation in mental health; the organizational culture, which alienates; and the peculiarities of the process of change and how it is driven under political pressure from outside the country. Analysis extends to encompass the influence of the general health reform on the mental health sector, the deficits of the leadership and how they impact on the effectiveness of the system, and the interdependence between the country's economy and the health sector. A conclusion is made about the need to consolidate the public health approach using the lever of international collaboration in the field of mental health.

  8. Retardo mental Mental retardation

    Directory of Open Access Journals (Sweden)

    Marcio M. Vasconcelos

    2004-04-01

    Full Text Available OBJETIVO: Esta revisão aborda as recentes descobertas da neurobiologia do retardo mental, enfatizando os novos recursos da citogenética, das técnicas moleculares e da neurorradiologia para esclarecer o diagnóstico. FONTES DE DADOS: O autor pesquisou o banco de dados MEDLINE da National Library of Medicine utilizando as palavras-chave "mental retardation", "developmental disability", "child" e "adolescent" em diferentes combinações, abrangendo o período de janeiro de 2000 a outubro de 2003. Também foram utilizados os bancos de dados das revistas científicas Pediatrics e New England Journal of Medicine através da palavra-chave "mental retardation". No total, o autor consultou cerca de 1.500 títulos de artigos e 500 resumos, e teve acesso direto a 150 artigos completos pertinentes. Quando oportuno, algumas referências dos artigos consultados também foram consideradas. O site Online Mendelian Inheritance in Man foi utilizado como fonte de informações em genética clínica. SÍNTESE DOS DADOS: Em outubro de 2003, o total de síndromes genéticas associadas a retardo mental chegou a 1.149. Considerando-se o conjunto das causas genéticas ou ambientais e congênitas ou adquiridas de retardo mental, a avaliação diagnóstica atual é capaz de esclarecer a etiologia em 50 a 70% dos casos. CONCLUSÕES: O autor sugere uma avaliação diagnóstica do retardo mental em etapas lógicas, visando ao uso racional dos dispendiosos recursos da citogenética, biologia molecular e neuroimagem.OBJECTIVE: This paper describes recent advances in the neurobiology of mental retardation, emphasizing new diagnostic resources provided by cytogenetics, molecular testing, and neuroimaging. SOURCES OF DATA: MEDLINE (January 2000 through October 2003, using the following key words: mental retardation, developmental disability, child, and adolescent. Search of the Pediatrics and New England Journal of Medicine websites using the key word mental retardation. The

  9. Medical Professionals Designing Hospital Management Models

    OpenAIRE

    Byg, Vibeke

    2016-01-01

    Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research lit...

  10. The Danish school reform

    DEFF Research Database (Denmark)

    Bager, Ann; Mølholm, Martin; Horsbøl, Anders

    (Latour), e.g. civil service and municipal practices and texts, into the organizational practices of two local schools. On the basis of these analyses, we will establish a participatory process in which local actors are involved in the co-creation of new plurivocal and egalitarian dialogue designs......The paper presents a methodological framework for the study of the discursive emergence of the recent Danish School reform (2014). The framework will enable discourse scholars to hold an actively involved position in changing and furthering plurivocal processes of translations, negotiations...... and implementation of the reform. The framework is operationalized through research-based participatory collaborative processes involving local actors in two Danish public schools. It interlinks diverse discourse strategies and perceptive distances that traditionally belong to separate branches within discourse...

  11. Methanol partial oxidation reformer

    Science.gov (United States)

    Ahmed, Shabbir; Kumar, Romesh; Krumpelt, Michael

    1999-01-01

    A partial oxidation reformer comprising a longitudinally extending chamber having a methanol, water and an air inlet and an outlet. An igniter mechanism is near the inlets for igniting a mixture of methanol and air, while a partial oxidation catalyst in the chamber is spaced from the inlets and converts methanol and oxygen to carbon dioxide and hydrogen. Controlling the oxygen to methanol mole ratio provides continuous slightly exothermic partial oxidation reactions of methanol and air producing hydrogen gas. The liquid is preferably injected in droplets having diameters less than 100 micrometers. The reformer is useful in a propulsion system for a vehicle which supplies a hydrogen-containing gas to the negative electrode of a fuel cell.

  12. Reforming process. Reformierungsverfahren

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, C.S.

    1982-05-19

    A naphta fraction is subjected to a catalytic reforming process in several series-connected reactors. The first reactor is equipped with a moving catalyst bed containing not more the 30% of volume of the total catalyst amount. The other reactors are designed as packed-bed systems. The content of coke deposited on the catalyst of the first reactor owing to the reforming process is maintained at below 1% of weight. This is effected by periodic removal of a proportion of the contaminated catalyst from the bottom part of the bed, by its regeneration and re-feeding to the top part of the bed. This results in prolonged service life of the catalyst and simultaneous improvement of the anti-knock value of the product.

  13. Medical Professionals Designing Hospital Management Models

    DEFF Research Database (Denmark)

    Byg, Vibeke

    Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...

  14. Socially Improving Tax Reforms

    OpenAIRE

    Duclos, Jean-Yves; Makdissi, Paul; Wodon, Quentin

    2008-01-01

    This paper proposes graphical methods to determine whether commodity-tax changes are "socially improving", in the sense of improving social welfare or decreasing poverty for large classes of social welfare and poverty indices. It also derives estimators of critical poverty lines and economic efficiency ratios which can be used to characterize socially-improving tax reforms. The statistical properties of the various estimators are derived in order to make the method implementable using survey ...

  15. Environmental fiscal reforms

    OpenAIRE

    Ashish Chaturvedi; Manjeet S. Saluja; Abhijit Banerjee; Rachna Arora

    2014-01-01

    The paper presents concepts and instruments of environmental fiscal reforms (EFR) and their application in the Indian context. EFR can lead to environmental improvement more efficiently and cost effectively than traditional regulation. There is substantial experience of successful EFR implementation in the European Union. India has also adopted some EFR measures such as deregulation of petrol prices, coal cess, and subsidy for setting up common effluent treatment plants. The challenges of imp...

  16. Gaols or De Facto Mental Institutions? Why Individuals with a Mental Illness Are Over-Represented in the Criminal Justice System in New South Wales, Australia

    Science.gov (United States)

    Henderson, Corinne

    2007-01-01

    The over-representation of people with mental illness in the criminal justice system highlights the need for legislative reform and the implementation of programs breaking the cycle of mental illness, poverty, unemployment and substance abuse across Australia. Whilst there is no inherent association between mental illness and crime, there is a…

  17. Hospital-based child protection teams that care for parents who abuse or neglect their children recognize the need for multidisciplinary collaborative practice involving perinatal care and mental health professionals: a questionnaire survey conducted in Japan.

    Science.gov (United States)

    Okato, Ayumi; Hashimoto, Tasuku; Tanaka, Mami; Tachibana, Masumi; Machizawa, Akira; Okayama, Jun; Endo, Mamiko; Senda, Masayoshi; Saito, Naoki; Iyo, Masaomi

    2018-01-01

    Child abuse and/or neglect is a serious issue, and in many cases, parents are the perpetrators. Hospital-based child protection teams (CPTs) play pivotal roles in the management of not only abused and/or neglected children but also of their parents; this is generally conducted through multidisciplinary practice. The aim of this study is to survey hospital-based CPT members to determine the professions they perceive to be most applicable to participation in CPTs. The participants were members of CPTs affiliated with hospitals that had pediatric emergency departments and which were located in Chiba Prefecture; specifically, 114 CPT members from 23 hospitals responded to this survey. The two main questionnaire items concerned are as follows: 1) each respondent's evaluation of conducting assessments, providing support, and implementing multidisciplinary collaborative practice in the treatment of abusive and negligent parents, and 2) each CPT member's opinion on the professions that are most important for CPT activities. An exploratory factor analysis (EFA) was performed to explore the factor structure of the data, and a correlation analysis was performed using the result obtained. The EFA returned two factors: multidisciplinary collaborative practice (α = 0.84) and assessment and support (α = 0.89). A correlational analysis showed that multidisciplinary collaborative practice had a positive correlation for obstetricians ( r = 0.315, p = 0.001), neonatologists ( r = 0.261, p = 0.007), midwives ( r = 0.248, p = 0.011), and psychiatrists ( r = 0.194, p = 0.048); however, assessment and support was only significantly correlated with midwives ( r = 0.208, p = 0.039). This study showed that hospital-based CPT members highly evaluate multidisciplinary collaborative practice for the management of abusive and/or negligent parents, and they believe that, in addition to pediatric physicians and nurses, perinatal care and mental health professionals are the most important

  18. Recent developments in community mental health: Relevance and relationship with the mental health care bill

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Chadda

    2015-01-01

    Full Text Available Community mental health refers to the treatment of persons with mental disorders in the community. In the earlier periods, treatment of patients with mental illness was limited to the mental hospitals or asylums. This paper traces the beginnings of community psychiatry in India from the time Dr. Vidya Sagar initiated his famous experiment of treating patients with mental illnesses along with family members in tents outside the mental hospital, Amritsar. It then discusses the role of the National Mental Health Program and the District Mental Health Program. The role of the United Nations Convention on the Rights of Persons with Disability in leading onto the development of the current Mental Health Care Bill, 2013 is discussed. Authors critically evaluate some of the merits and drawbacks of the Bill as related to recent developments in community mental health in India.

  19. Integrating mental health into primary health care – Uganda's ...

    African Journals Online (AJOL)

    Most developing countries and indeed many African countries have been undertaking reforms of the mental health policies and strategies to improve access and equity for the community to mental health and psychiatric services. This has been in conformity with a health policy philosophy which emphasize decentralization ...

  20. Crime e doença psiquiátrica: perfil da população de um hospital de custódia no Rio de Janeiro Crime and mental disorders: profile of a group of inmates in a custody hospital in Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Juliana Garbayo

    2008-01-01

    Full Text Available OBJETIVOS: Estudar a população internada em um hospital de custódia no Rio de Janeiro quanto a aspectos demográficos, diagnósticos e criminais. MÉTODOS: Todos os internos cumprindo medida de segurança detentiva no Hospital de Custódia e Tratamento Psiquiá­trico Heitor Carrilho, em dezembro de 2007, (n = 177 foram avaliados pelo censo sociodemográfico aplicado por psiquiatras da instituição e tiveram seus prontuários analisados quanto a diagnóstico, tratamento psiquiátrico prévio e tipo de crime. Foi avaliada a relação entre vítima e perpetrador nos homicídios. RESULTADOS: A população é preferencialmente masculina (80%, solteira (72%, com 30 a 39 anos de idade (34%, baixa escolaridade (69% e inativa (56%. Os diagnósticos mais prevalentes foram transtornos psicóticos (67%, seguidos por retardo mental (15,2%, transtornos em virtude de uso de substâncias psicoativas (7,3%, de personalidade (4,5% e outros (6,2%. A maioria (71% já havia recebido tratamento psiquiátrico prévio. O homicídio foi o crime mais comum (44%, seguido por crimes contra o patrimônio (26%, crimes sexuais (11%, crimes relacionados a entorpecentes (11% e outros. O homicídio intrafamiliar predominou entre os psicóticos e os portadores de retardo mental. Os últimos cometeram proporcionalmente mais crimes sexuais do que os primeiros. CONCLUSÃO: O perfil da população foi compatível com o descrito para outras populações de internos em hospitais de custódia no país.OBJETIVES: To study the hospital population in a custody hospital in Rio de Janeiro with regard to demographical, diagnostic and criminal aspects. METHODOLOGY: Inmates serving detentional security measures in Custody and Psychiatric Treatment Heitor Carrilho Hospital (Hospital de Custódia e Tratamento Psiquiátrico Heitor Carrilho in december 2007(n=177 were evaluated in a social-demographic questionnaire applied by staff psychiatrists at the Hospital and had their medical records

  1. Security Sector Reform in Albania

    OpenAIRE

    Abazi, Enika; Bumci, Aldo; Hide, Enri; Rakipi, Albert

    2009-01-01

    International audience; This paper analyses security sector reform (SSR) in Albania. In all its enterprises in reforming the security sector,Albania is assisted by different initiatives and projects that provide expertise and financial support. To assesswhether reforms improved the overall security environment (national and human) of the country, it is necessaryto measure the effectiveness of the various initiatives and projects. This is gauged by how well the initiatives andprojects achieved...

  2. Challenges in the use of the mental health information system in a resource-limited setting: lessons from Ghana.

    Science.gov (United States)

    Kpobi, Lily; Swartz, Leslie; Ofori-Atta, Angela L

    2018-02-08

    One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants' knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental

  3. Steam reformer with catalytic combustor

    Science.gov (United States)

    Voecks, Gerald E. (Inventor)

    1990-01-01

    A steam reformer is disclosed having an annular steam reforming catalyst bed formed by concentric cylinders and having a catalytic combustor located at the center of the innermost cylinder. Fuel is fed into the interior of the catalytic combustor and air is directed at the top of the combustor, creating a catalytic reaction which provides sufficient heat so as to maintain the catalytic reaction in the steam reforming catalyst bed. Alternatively, air is fed into the interior of the catalytic combustor and a fuel mixture is directed at the top. The catalytic combustor provides enhanced radiant and convective heat transfer to the reformer catalyst bed.

  4. Education Reform in Hong Kong

    Directory of Open Access Journals (Sweden)

    Chris Dowson

    2000-05-01

    Full Text Available Since the early 1990s, the pace of educational reform in Hong Kong has accelerated and broadened to incorporate almost all areas of schooling. The reforms introduced during this period can be subsumed under what has generally been labelled the quality movement. In this paper, we review and comment on a number of policy reform initiatives in the four areas of "Quality Education," English Language Benchmarking, Initial Teacher Training and the Integration of Pupils with Special Needs into Ordinary Classrooms. Following a brief description of each policy initiative, the reforms are discussed in terms of their consistency, coherence and cultural fit.

  5. Subgroup differences and determinants of patient-reported mental and physical health at hospital discharge among patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Rasmussen, T. B.; Herning, M.; Johansen, P. P.

    2017-01-01

    Purpose: (i) To describe patient-reported outcomes (PROs) at hospital-discharge across three diagnostic IHD sub-groups; chronic ischemic heart disease/stable angina (IHD/AP), non-ST-elevation myocardial infarction/unstable angina (NSTEMI/UAP) and ST-elevation myocardial infarction (STEMI), and (ii...

  6. Subgroup differences and determinants of patient-reported mental and physical health at hospital discharge among patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Rasmussen, T B; Herning, M; Johansen, P P

    Purpose: (i) To describe patient-reported outcomes (PROs) at hospital-discharge across three diagnostic IHD sub-groups; chronic ischemic heart disease/stable angina (IHD/AP), non-ST-elevation myocardial infarction/unstable angina (NSTEMI/UAP) and ST-elevation myocardial infarction (STEMI), and (ii...

  7. Health-related quality of life 6 months after burns among hospitalized patients: Predictive importance of mental disorders and burn severity.

    Science.gov (United States)

    Palmu, Raimo; Partonen, Timo; Suominen, Kirsi; Saarni, Samuli I; Vuola, Jyrki; Isometsä, Erkki

    2015-06-01

    Major burns are likely to have a strong impact on health-related quality of life (HRQoL). We investigated the level of and predictors for quality of life at 6 months after acute burn. Consecutive acute adult burn patients (n=107) admitted to the Helsinki Burn Centre were examined with a structured diagnostic interview (SCID) at baseline, and 92 patients (86%) were re-examined at 6 months after injury. During follow-up 55% (51/92) suffered from at least one mental disorder. The mean %TBSA was 9. TBSA of men did not differ from that of women. Three validated instruments (RAND-36, EQ-5, 15D) were used to evaluate the quality of life at 6 months. All the measures (RAND-36, EQ-5, 15D) consistently indicated mostly normal HRQoL at 6 months after burn. In the multivariate linear regression model, %TBSA predicted HRQoL in one dimension (role limitations caused by physical health problems, p=0.039) of RAND-36. In contrast, mental disorders overall and particularly major depressive disorder (MDD) during follow-up (p-values of 0.001-0.002) predicted poor HRQoL in all dimensions of RAND-36. HRQoL of women was worse than that of men. Self-perceived HRQoL among acute burn patients at 6 months after injury seems to be mostly as good as in general population studies in Finland. The high standard of acute treatment and the inclusion of small burns (%TBSAburn itself on HRQoL. Mental disorders strongly predicted HRQoL at 6 months. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  8. Hospital hygiene in an age of Diagnostic Related Groups (DRG), Protection against Infection Act (IfSG), Book V of the German Code of Social Law (SGB V) and administrative reforms - facts and visions from Bavaria.

    Science.gov (United States)

    Hingst, Volker

    2007-09-13

    Since 1 January 2001, German hospitals and establishments engaged in outpatient surgery are obliged to continually record and evaluate nosocomial infections and the emergence of nosocomial pathogens showing special resistance and multi-resistance profiles. A survey conducted among 164 hospitals revealed that 79 % of establishments already carried out separate surveillance and evaluation of postoperative wound infections, while 77 % also recorded nosocomial infections and 91 % recorded pathogens with special resistance and multi-resistance profiles. However, only the larger hospitals had their own in-house infection control physician, while the smaller establishments generally consulted external infection control physicians. When asked how long such experts made their services available to the hospitals, no clear answer was given. Furthermore, only two-thirds of hospitals had their own infection control nurses (most of whom worked part time). These findings have induced the State Office for Health and Food Safety (LGL) in Bavaria to expand its advisory and information services and to formulate standards in consultation with partners at state level. The public health offices are legally obliged to supervise infection control policies in hospitals and medical establishments. These supervisory activities have not always been conducted in a uniform manner, thus engendering anxiety among the institutions to be supervised when it comes to discharging their prescribed duties. A concept devised to improve and standardize the monitoring of hospital hygiene is to be used to standardize supervision of infection control practices (by the statutory authorities). With the incorporation of the, hitherto, State Office for Occupational Safety, Occupational Medicine and Safety Engineering into the LGL, the specialist centers for public health and the Trade Supervisory Office will be united under one umbrella. The idea is to avail of the resulting improved cooperation possibilities

  9. Reform Drivers and Reform Obstacles in Natural Resource Management

    DEFF Research Database (Denmark)

    Gezelius, Stig S.; Raakjær, Jesper; Hegland, Troels Jacob

    2010-01-01

    ABSTRACT: The ability to transform historical learning into institutional reform is a key to success in the management of common pool natural resources. Based on a model of institutional inertia and a comparative analysis of Northeast Atlantic fisheries management from 1945 to the present....... Institutional inertia entails that large-scale management reform tends to be crisis driven....

  10. Novel Reforming Catalysts

    Energy Technology Data Exchange (ETDEWEB)

    Pfefferle, Lisa D; Haller, Gary L

    2012-10-16

    Aqueous phase reforming is useful for processing oxygenated hydrocarbons to hydrogen and other more useful products. Current processing is hampered by the fact that oxide based catalysts are not stable under high temperature hydrothermal conditions. Silica in the form of structured MCM-41 is thermally a more stable support for Co and Ni than conventional high surface area amorphous silica but hydrothermal stability is not demonstrated. Carbon nanotube supports, in contrast, are highly stable under hydrothermal reaction conditions. In this project we show that carbon nanotubes are stable high activity/selectivity supports for the conversion of ethylene glycol to hydrogen.

  11. Reforming Russian civil Procedure

    OpenAIRE

    MALESHIN DMITRY; SILVESTRI ELISABETTA; SITDIKOV RUSLAN; VALEEV DAMIR

    2016-01-01

    The II Annual symposium of the journal Herald of Civil Procedure ‘2015: the Civil Procedure 2.0: reform and Current state’took place on october 9, 2015, at the Faculty of Law of kazan (Volga region) Federal university. the symposium is now an established tradition for the university. In 2015 it brought together in kazan eminent scholars of civil procedure from cities across the whole of russia: Moscow, st. Petersburg, saratov, Ekaterinburg, omsk, samara, Nizhnekamsk and others. this large-sca...

  12. Reforming Russian Civil Procedur

    OpenAIRE

    Dmitry Maleshin; Elisabetta Silvestri; Ruslan Sitgikov; Damir Valeev

    2016-01-01

    The II Annual Symposium of the journal Herald of Civil Procedure ‘2015: The Civil Procedure 2.0: Reform and Current State’ took place on October 9, 2015, at the Faculty of Law of Kazan (Volga region) Federal University.The Symposium is now an established tradition for the University. In 2015 it brought together in Kazan eminent scholars of civil procedure from cities across the whole of Russia: Moscow, St. Petersburg, Saratov, Ekaterinburg, Omsk, Samara, Nizhnekamsk and others. This large-sca...

  13. Environmental fiscal reforms

    Directory of Open Access Journals (Sweden)

    Ashish Chaturvedi

    2014-09-01

    Full Text Available The paper presents concepts and instruments of environmental fiscal reforms (EFR and their application in the Indian context. EFR can lead to environmental improvement more efficiently and cost effectively than traditional regulation. There is substantial experience of successful EFR implementation in the European Union. India has also adopted some EFR measures such as deregulation of petrol prices, coal cess, and subsidy for setting up common effluent treatment plants. The challenges of implementing EFR measures in India are also discussed, including inadequate analysis, policy framework and institutional capacity, as well as conflict with poverty reduction and building political support.

  14. Medical Education and Curriculum Reform: Putting Reform Proposals in Context

    Directory of Open Access Journals (Sweden)

    Daniel Kam Yin Chan, MD, MB.BS, MHA

    2004-01-01

    Full Text Available The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders.

  15. Dispositivos extra-hospitalares que apoiam as Residências Terapêuticas para utentes com transtorno mental em Volta Redonda/Rio de Janeiro (2005 - 2009 Dispositivos extra hospitalarios que apoyan a las Residencias Teurapéuticas para los usuarios con trastornos mentales en Volta Redonda - Rio de Janeiro (2005-2009 Non-hospital arrangements that support therapeutic homes for users with mental disorders in Volta Redonda - Rio de Janeiro (2005-2009

    Directory of Open Access Journals (Sweden)

    Gizele da Conceição Soares Martins

    2012-07-01

    stas presentaban características diferentes con respecto a las viviendas comunes, su propósito era asemejarse a un hogar. En aquel entonces, el municipio contaba con una red de atención extra hospitalaria compuesta por diversos dispositivos que daban apoyo a las residencias. Cabe destacar que la asistencia en estas instituciones no era privilegiada en virtud de la enfermedad mental. Por lo tanto, se intentó rescatar la ciudadanía de sus usuarios mediante su reinserción social. Aunque la articulación entre los dispositivos de la red de atención a la salud mental fuese incipiente, se dio prioridad a la calidad de vida de los usuarios y a su rehabilitación psicosocial. Por ello, el enfermero actúo por medio de visitas a domicilio, ofrecidas por estos servicios, permitiendo así el desarrollo de prácticas innovadoras que han contribuido a la producción de nuevos conocimientos en el campo de la salud mental que procura ofrecer una atención al usuario de forma integral.This is a qualitative study with a social historical approach. The objectives are to describe the non-hospital network in mental health care in Volta Redonda - RJ, and to analyze the importance of the non-hospital network for the functioning of the therapeutic residences. The primary sources were composed of written documents and four interviews. The data were organized, classified and analyzed according to the historical method. Three therapeutic residences were created in 2009 as an emergency measure. Although these have different characteristics from normal houses, the purpose is to resemble a home. At the time, the city had a non-hospital care network composed of various arrangements that supported the residences. Note that attendance at such facilities was not exclusively for those with mental illness. Therefore, we attempted to safeguard the citizenship of users through social reintegration. The link between the mental health network arrangements was just at the beginning; however, the quality of life

  16. Hospital-based child protection teams that care for parents who abuse or neglect their children recognize the need for multidisciplinary collaborative practice involving perinatal care and mental health professionals: a questionnaire survey conducted in Japan

    Directory of Open Access Journals (Sweden)

    Okato A

    2018-02-01

    Full Text Available Ayumi Okato,1 Tasuku Hashimoto,1 Mami Tanaka,2 Masumi Tachibana,1 Akira Machizawa,3 Jun Okayama,4 Mamiko Endo,5 Masayoshi Senda,6,7 Naoki Saito,5,7 Masaomi Iyo1 1Department of Psychiatry, Graduate School of Medicine, Chiba University, 2Division of Clinical Study on Juvenile Delinquency, Center for Forensic Mental Health, Chiba University, 3Department of Psychiatry, Chiba University Hospital, 4Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 5Department of Pediatrics, Graduate School of Medicine, Chiba University, 6Department of Pediatrics, Asahi General Hospital, 7Division of Clinical Forensic Medicine, Education and Research Center of Legal Medicine, Chiba University, Chiba, Japan Background: Child abuse and/or neglect is a serious issue, and in many cases, parents are the perpetrators. Hospital-based child protection teams (CPTs play pivotal roles in the management of not only abused and/or neglected children but also of their parents; this is generally conducted through multidisciplinary practice. The aim of this study is to survey hospital-based CPT members to determine the professions they perceive to be most applicable to participation in CPTs. Participants and methods: The participants were members of CPTs affiliated with hospitals that had pediatric emergency departments and which were located in Chiba Prefecture; specifically, 114 CPT members from 23 hospitals responded to this survey. The two main questionnaire items concerned are as follows: 1 each respondent’s evaluation of conducting assessments, providing support, and implementing multidisciplinary collaborative practice in the treatment of abusive and negligent parents, and 2 each CPT member’s opinion on the professions that are most important for CPT activities. An exploratory factor analysis (EFA was performed to explore the factor structure of the data, and a correlation analysis was performed using the result obtained. Results: The EFA

  17. Historical perspectives of mental health in the Eastern Cape

    African Journals Online (AJOL)

    The development of mental health services in the Eastern Cape Province is inextricably entwined in South Africa's colonial history and the racist policy of apartheid. Prior to the development of mental hospitals, mental health services were provided through a network of public and mission hospitals. This paper explores the ...

  18. Mental Disorders

    Science.gov (United States)

    Mental disorders include a wide range of problems, including Anxiety disorders, including panic disorder, obsessive-compulsive disorder, ... disorders, including schizophrenia There are many causes of mental disorders. Your genes and family history may play ...

  19. Mental Health

    Science.gov (United States)

    Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel and act as ... stress, relate to others, and make choices. Mental health is important at every stage of life, from ...

  20. Ecological tax reform

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-12-31

    An environmental tax reform is seen by many as a possible solution to some crucial problems of modern society - pollution, excessive resource consumption and unemployment. Changes in the system of taxation are here seen as a long term process, one that must cheapen the costs of labour and make the costs of resource use more expensive - a process which can also create major changes in our society as to conceptions of quality, work, consumption etc. The conference presented proposals for an ecological tax and duty system that would contribute to: Changing technology so that it becomes more resource and energy effective. Changing the economic mechanisms so that resource consumption and pollution become more expensive while human resources become cheaper. Changing personal life styles and values so that material consumption becomes less decisive for our choices and priorities. An environmental tax reform is neither without problems nor painless. An economy and an industrial sector based on increasing consumption of energy and raw materials will, in the long run, lead to drawbacks that far outweigh those that are connected with an economic re-orientation whose driving force is another conception of nature. (EG)

  1. Land Reform : Reconcentration Risks

    Directory of Open Access Journals (Sweden)

    Gilda Diniz dos Santos

    2016-10-01

    Full Text Available The Agrarian Reform, from the 1988 Federal Constitution, is premised on state intervention in private property in the event of breach of the property social function and the consequent allocation of such areas for the landless rural workers, making it beneficiaries of agricultural policy. The need for intervention arises especially evil and historical land concentration in Brazil, which favored the existence and maintenance of a class of landless laborers, with no room to work and production, even though subsistence. After state intervention and from the creation of the settlement project, a number of public policies implemented by INCRA - National Institute of Colonization and Agrarian Reform, such as credits and technical assistance. It has been provided in the Constitution titration of such beneficiaries, however, in 2014, it was promulgated and publicized the Law 13,001, which will implement a massive policy titration, which will lead the transfer of public assets to the private and in consequence the alternative this particular also sell to third parties, which brings the unwanted possibility of re-concentration.

  2. Small School Reform

    Directory of Open Access Journals (Sweden)

    Carroll E. Bronson

    2013-05-01

    Full Text Available This qualitative ethnographic case study explored the evolution of a public urban high school in its 3rd year of small school reform. The study focused on how the high school proceeded from its initial concept, moving to a small school program, and emerging as a new small high school. Data collection included interviews, observations, and document review to develop a case study of one small high school sharing a multiplex building. The first key finding, “Too Many Pieces, Not Enough Glue,” revealed that the school had too many new programs starting at once and they lacked a clear understanding of their concept and vision for their new small school, training on the Montessori philosophies, teaching and learning in small schools, and how to operate within a teacher-cooperative model. The second key finding, “A Continuous Struggle,” revealed that the shared building space presented problems for teachers and students. District policies remain unchanged, resulting in staff and students resorting to activist approaches to get things done. These findings offer small school reform leaders suggestions for developing and sustaining a small school culture and cohesion despite the pressures to revert back to top-down, comprehensive high school norms.

  3. Ecological tax reform

    International Nuclear Information System (INIS)

    1996-01-01

    An environmental tax reform is seen by many as a possible solution to some crucial problems of modern society - pollution, excessive resource consumption and unemployment. Changes in the system of taxation are here seen as a long term process, one that must cheapen the costs of labour and make the costs of resource use more expensive - a process which can also create major changes in our society as to conceptions of quality, work, consumption etc. The conference presented proposals for an ecological tax and duty system that would contribute to: Changing technology so that it becomes more resource and energy effective. Changing the economic mechanisms so that resource consumption and pollution become more expensive while human resources become cheaper. Changing personal life styles and values so that material consumption becomes less decisive for our choices and priorities. An environmental tax reform is neither without problems nor painless. An economy and an industrial sector based on increasing consumption of energy and raw materials will, in the long run, lead to drawbacks that far outweigh those that are connected with an economic re-orientation whose driving force is another conception of nature. (EG)

  4. Pension Reform in China.

    Science.gov (United States)

    Liu, Tao; Sun, Li

    2016-01-01

    This article analyzes China's pension arrangement and notes that China has recently established a universal non-contributory pension plan covering urban non-employed workers and all rural residents, combined with the pension plan covering urban employees already in place. Further, in the latest reform, China has discontinued the special pension plan for civil servants and integrated this privileged welfare class into the urban old-age pension insurance program. With these steps, China has achieved a degree of universalism and integration of its pension arrangement unprecedented in the non-Western world. Despite this radical pension transformation strategy, we argue that the current Chinese pension arrangement represents a case of "incomplete" universalism. First, its benefit level is low. Moreover, the benefit level varies from region to region. Finally, universalism in rural China has been undermined due to the existence of the "policy bundle." Additionally, we argue that the 2015 pension reform has created a situation in which the stratification of Chinese pension arrangements has been "flattened," even though it remains stratified to some extent.

  5. Education Finance Reform in Tennessee.

    Science.gov (United States)

    Green, Harry A.

    1999-01-01

    The Education Improvement Act instigated funding allocation reform, equalization and equity, system accountability, systemwide report cards, value-added assessment, and governance reform. The most dissatisfied educators are those in large, wealthier urban systems. Horizontal equity, accountability, and test results have improved throughout the…

  6. Reforming Teacher Education in Tanzania

    Science.gov (United States)

    Hardman, Frank; Abd-Kadir, Jan; Tibuhinda, Audax

    2012-01-01

    It is widely acknowledged that in order to improve the quality of education in primary schools in developing countries there is a need to place pedagogy and its training implications at the centre of teacher education reform. Like many countries in Eastern and Southern Africa, Tanzania has introduced various initiatives and reforms to improve the…

  7. Local Tax Reform in Pennsylvania.

    Science.gov (United States)

    Hartman, William T.

    This report reviews local tax reform and describes an approach to simulating the effects of proposed tax reform on local school districts in Pennsylvania. The microcomputer spreadsheet simulation led to the development of a model able to meet the feasibility criteria established for such a simulation model. The model was designed to input…

  8. Tax Reform and Environmental Taxation

    OpenAIRE

    Gilbert E. Metcalf

    2005-01-01

    I measure the industry impacts of an environmental tax reform where a carbon tax is used to finance full or partial corporate tax integration. I find that the industry impacts of such a reform are likely to be modest (in the sense of impacts on returns on equity).

  9. George's Complaint: Reforming the Dragon

    Science.gov (United States)

    Buxton, Bruce

    2007-01-01

    The evangelical tone and history of American culture has long been identified as a force for anti-intellectualism. The metaphors of educational reform are a demonstration of how this plays out. The very nature of the positivist social science research used to support proposed reform is anti-intellectual and feeds a debate that favors extremes over…

  10. Free Speech and Campaign Reform.

    Science.gov (United States)

    Sharp, Harry, Jr.

    The Federal Election Campaign Act of 1971, a political campaign reform measure, was enacted to limit campaign contributions and independent expenditures, to mandate disclosure of contributors, and to establish public financing of campaigns, all to minimize the opportunity for political corruption. Unfortunate implications of such reform on the…

  11. The Danish Regulatory Reform of Telecommunications

    DEFF Research Database (Denmark)

    Skouby, Knud Erik

    1998-01-01

    An overview of the liberalisation process and regulatory reform of telecommunications in Denmark......An overview of the liberalisation process and regulatory reform of telecommunications in Denmark...

  12. Implementing Comprehensive Reform: Implications for Practice

    Science.gov (United States)

    Stout, Karen A.

    2016-01-01

    This chapter describes the challenges and practical barriers community colleges face when implementing comprehensive reform, exploring how reforms are leading to some improvements but not often scaled improvements.

  13. Current trends in hospital mergers and acquisitions.

    Science.gov (United States)

    Brown, Thomas C; Werling, Krist A; Walker, Barton C; Burgdorfer, Rex J; Shields, J Jordan

    2012-03-01

    Healthcare reform will impact hospital consolidation in three key areas: Payment rates will decrease, indirectly encouraging consolidation by forcing hospitals to find new ways to reduce costs and increase negotiating clout with suppliers and payers. The cost of doing business will increase as hospitals spend more on compliance, technology, and physician employment. The ACO model will encourage hospital network formation by rewarding integrated healthcare systems that can reduce costs and improve quality.

  14. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

    Directory of Open Access Journals (Sweden)

    Gladman John RF

    2011-05-01

    Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of

  15. Effects of group metacognitive training (MCT on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study

    Directory of Open Access Journals (Sweden)

    Naughton Marie

    2012-06-01

    Full Text Available Abstract Background Metacognitive Training (MCT is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. The aim of MCT is to facilitate symptom reduction and protect against relapse. In a naturalistic audit of clinical effectiveness we examined what effect group MCT has on mental capacity, symptoms of psychosis and global function in patients with a psychotic illness, when compared with a waiting list comparison group. Methods Of 93 patients detained in a forensic mental health hospital under both forensic and civil mental health legislation, 19 were assessed as suitable for MCT and 11 commenced. These were compared with 8 waiting list patients also deemed suitable for group MCT who did not receive it in the study timeframe. The PANSS, GAF, MacArthur Competence Assessment Tool- Treatment (MacCAT-T and MacArthur Competence Assessment Tool-Fitness to Plead (MacCAT-FP were recorded at baseline and repeated after group MCT or following treatment as usual in the waiting list group. Results When baseline functioning was accounted for, patients that attended MCT improved in capacity to consent to treatment as assessed by the MacCAT-T (p = 0.019. The more sessions attended, the greater the improvements in capacity to consent to treatment, mainly due to improvement in MacCAT-T understanding (p = 0.014 and reasoning . The GAF score improved in patients who attended the MCT group when compared to the waiting list group (p = 0.038 but there were no changes in PANSS scores. Conclusion Measures of functional mental capacity and global function can be used as outcome measures for MCT. MCT can be used successfully even in psychotic patients detained in a forensic setting. The restoration of elements of decision making capacity such as understanding and reasoning may be a hither-to unrecognised advantage of such treatment. Because pharmacotherapy can be optimised

  16. Hospital centralization and performanced in Denmark - ten years on

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Vrangbæk, Karsten

    2017-01-01

    Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support...... a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform....... The reform emphasized an improved acute service and high quality. The number of acute hospitals was reduced from about 40 to 21 hospitals with joint acute facilities. The restructuring and geographical placement of acute hospitals took place in a democratic process subject to central guidelines...

  17. Massachusetts Healthcare Reform and Trends in Emergent Colon Resection.

    Science.gov (United States)

    Eskander, Mariam F; Bliss, Lindsay A; McCarthy, Ellen P; de Geus, Susanna W L; Chau Ng, Sing; Nagle, Deborah; Rodrigue, James R; Tseng, Jennifer F

    2016-11-01

    Insurance impacts access to therapeutic options, yet little is known about how healthcare reform might change the pattern of surgical admissions. We compared rates of emergent admissions and outcomes after colectomy before and after reform in Massachusetts with a nationwide control group. This study is a retrospective cohort analysis in a natural experiment. Prereform was defined as hospital discharge from 2002 through the second quarter of 2006 and postreform from the third quarter of 2006 through 2012. Categorical variables were compared by χ. Piecewise functions were used to test the effect of healthcare reform on the rate of emergent surgeries. The study included acute care hospitals in the Massachusetts Healthcare Cost and Utilization Project State Inpatient Database (2002-2012) and the Nationwide Inpatient Sample (2002-2011). Patients aged 18 to 64 years with public or no insurance who underwent inpatient colectomy (via International Classification of Diseases, Ninth Revision, Clinical Modification procedural code) were included and patients with Medicare were excluded. Massachusetts health care reform was the study intervention. We measured the rate of emergent colectomy, complications, and mortality. The unadjusted rate of emergent colectomies was lower in Massachusetts after reform but did not change nationally over the same time period. For emergent surgeries in Massachusetts, a piecewise model with an inflection point (peak) in the third quarter of 2006, coinciding with implementation of healthcare reform in Massachusetts, had a lower mean squared error than a linear model. In comparison, the national rate of emergent surgeries demonstrated no change in pattern. Postreform, length of stay decreased by 1 day in Massachusetts; however, there were no significant improvements in other outcomes. The study was limited by its retrospective design and unadjusted analysis. There was a unique and sustained decline in the rate of emergent colon resection among

  18. Forty years of the Law 180: the aspirations of a great reform, its successes and continuing need.

    Science.gov (United States)

    Mezzina, R

    2018-03-06

    Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades. After 40 years of implementation, this article presents the main achievements and challenges of the Italian MH reform law, including its long-term effect and impact in Italy and abroad. The Legislation of 1978 was based on the discovery of rights as a key tool in mental healthcare. At the climax of crisis of psychiatric hospitals as total institutions in this country, through the new community-based system of care, it has fostered the lowest rate of involuntary care and gave back the full citizenship to people with MH disorders. This act was also part of a social movement for expanding civil and social rights, and a promise of a true paradigm shift not only in psychiatry, but also in the way of providing an adequate welfare community for all citizens. According to the WHO, the Italian city of Trieste, together with its region, is a practical example of how the Italian movement achieved deinstitutionalisation, intended as a complex process resulting in the gradual relocation of the economic and human resources and subsequent creation of 24 h services together with the development of social inclusion programmes. Even if the great principles of the Italian reform law were anticipatory (e.g., the UN Convention on Rights of Persons with Disabilities - CRPD), the law application has been poorly provided with resources and did not follow those avant-garde experiences as models. Limitations are evident today especially at the organisational levels, such as services capable to take up the challenge and transforming the field, left free from the imprint of total institutions. These endemic critical aspects concerning to implementation policies, together with the financial crisis of the Italian healthcare system, must be taken into consideration

  19. Mapa Mental

    OpenAIRE

    do Couto, Hildo Honório

    2017-01-01

    O objetivo principal deste artigo é mostrar que no interior do ecossistema mental da língua, e do nosso ecossistema cognitivo geral, existe uma parte que se pode chamar de mapa mental, intimamente associado ao mapa cognitivo. Após caracterizar o conceito de mapa mental e de associá-lo a conceitos assemelhados, comento o mapa mental que eu tinha de Brasília, por ter vivido lá por mais de 30 anos. Como me mudei para Goiânia, comecei a perder partes do mapa mental de Brasília. Por outro lado, es...

  20. [Changing Forensic Mental Health in France: A Review].

    Science.gov (United States)

    Nakatani, Yoji; Hasuzawa, Suguru

    2015-01-01

    This article describes the background and recent changes in French forensic mental health. The literature suggests that three law reforms have been crucial to changes in the mental health system. First, the Penal Code of 1992 redefined the provisions of criminal responsibility and introduced the category of diminished responsibility. Second, a controversial law for preventive detention (rétention de sûretê) was enacted in 2008, according to which criminals with severe personality disorders are subject to incarceration even after the completion of their prison sentences if they are still considered to pose a danger to the public. Third, the revision of mental health laws in 2011 altered the forms of involuntary psychiatric treatments, stipulating a judge's authority to decide treatment. In parallel with these legal reforms, the psychiatric treatment system for offenders with mental disorders has been reconstructed. The number of difficult patient units (unités pour malades difficiles) has increased from four to ten across the nation in order to meet the needs of patients transferred from general psychiatric institutions for the reason of being unmanageable. In the penitentiary system, new facilities have been established to cope with the growing number of inmates with mental disorders. As background to these changes, it is pointed out that the current psychiatric system has undergone deinstitutionalization and become less tolerant of aggressive behavior in patients. In the broader context, public sensitivity towards severe crime, as shown by the sensation triggered by serious crimes conducted by pedophiles, seems to urge tough policies. In the 2000 s, several homicides committed by psychiatric patients had a great impact on the public, which led President Sarkozy to issue a statement calling for stronger security in psychiatric institutions. The harsh attitude of courts towards psychiatric practices is illustrated by a 2012 ruling; after a patient escaped from

  1. Occupational therapists’ conceptions on mental health care line

    Directory of Open Access Journals (Sweden)

    Michelle Helena Pereira de Paiva

    2012-12-01

    Full Text Available The care line recommended by the Brazilian Health System - SUS must be attained by every professionalof the area, milieu and subject. This study aimed to know the occupational therapists’ conceptions about the lineof care in mental health. The data of this study were obtained from a questionnaire sent via virtual network ofcontacts and snowball technique. Data were subjected to qualitative and quantitative analysis. Most participantswere professionals from the southeast region of the country with over five years of training. They exercise theprofessional activity mainly in Psychiatric Hospitals, Psychosocial Assistance Centers – CAPS II and MentalHealth Clinics. There was no registry of professional performance in Residential Therapeutic Services – SRTand Outpatient Clinics - UBS. Regarding care line, six participants did not respond and five were unaware of theterm, followed by the psychosocial rehabilitation principles and therapeutic project; only one answer identified care line as a practice based on care management with reception principles and articulation of social networksand services. Results showed that the professionals’ practices are little guided in care line logic; however, thereis the need systematization of the assistance according this logic in order to apply the Psychiatric Reform,searching the quality of life improvement and reestablishment of the citizenship of people with psychologicaldistress insofar as, in addition to optimizing the care network, which promotes comprehensive humane careand social contractualism.

  2. Drug Pricing Reforms

    DEFF Research Database (Denmark)

    Kaiser, Ulrich; Mendez, Susan J.; Rønde, Thomas

    2015-01-01

    Reference price systems for prescription drugs have found widespread use as cost containment tools. Under such regulatory regimes, patients co-pay a fraction of the difference between pharmacy retail price of the drug and a reference price. Reference prices are either externally (based on drug...... prices in other countries) or internally (based on domestic drug prices) determined. In a recent study, we analysed the effects of a change from external to internal reference pricing in Denmark in 2005, finding that the reform led to substantial reductions in prices, producer revenues, and expenditures...... for patients and the health insurance system. We also estimated an increase in consumer welfare but the size effect depends on whether or not perceived quality differences between branded and other drugs are taken into account....

  3. Effect of an E-mental health approach to workers' health surveillance versus control group on work functioning of hospital employees: a cluster-RCT.

    Directory of Open Access Journals (Sweden)

    Sarah M Ketelaar

    Full Text Available To evaluate an e-mental health (EMH approach to workers' health surveillance (WHS targeting work functioning (WF and mental health (MH of healthcare professionals in a randomised controlled trial.Nurses and allied health professionals (N = 1140 were cluster-randomised at ward level to the intervention (IG or control group (CG. The intervention consisted of two parts: (a online screening and personalised feedback on impaired WF and MH, followed by (b a tailored offer of self-help EMH interventions. CG received none of these parts. Primary outcome was impaired WF (Nurses Work Functioning Questionnaire, assessed at baseline and after three and six months. Analyses were performed in the positively screened subgroup (i and in all participants (ii.Participation rate at baseline was 32% (NIG = 178; NCG = 188. Eighty-two percent screened positive for at least mild impairments in WF and/or MH (NIG = 139; NCG = 161. All IG-participants (N = 178 received part (a of the intervention, nine participants (all positively screened, 6% followed an EMH intervention to at least some extent. Regarding the subgroup of positively screened participants (i, both IG and CG improved over time regarding WF (non-significant between-group difference. After six months, 36% of positively screened IG-participants (18/50 had a relevant WF improvement compared to baseline, versus 28% (32/115 of positively screened CG-participants (non-significant difference. In the complete sample (ii, IG and CG improved over time but IG further improved between three and six months while CG did not (significant interaction effect.In our study with a full compliance rate of 6% and substantial drop-out leading to a small and underpowered sample, we could not demonstrate that an EMH-approach to WHS is more effective to improve WF and MH than a control group. The effect found in the complete sample of participants is not easily interpreted. Reported results may be useful for

  4. A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention.

    Science.gov (United States)

    Adegbaju, Dapo Adebowale; Olagunju, Andrew Toyin; Uwakwe, Richard

    2013-09-01

    Bipolar affective disorder (BAD) and schizophrenia are two severe psychotic conditions that are associated with disability. The present study was designed to compare the pattern of disability between clinically stable individuals with BAD and schizophrenia in a sub-Saharan mental health facility. A total of 200 consecutive participants (made up of 100 each among clinically stable individuals with BAD and schizophrenia) were recruited. All participants had their diagnoses confirmed using Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), after which the designed questionnaire and the 36-item World Health Organisation Disability Assessment Schedule interview (WHODAS II) were administered to them. In this study, the level of disability among participants with BAD was better compared to those with schizophrenia as determined by mean WHODAS score of 24.93 and 27.02, respectively. Similarly, there was a significant difference between participants with BAD and schizophrenia with respect to four domains of the WHODAS-II, viz, self-care (p disability in the two groups (BAD and schizophrenia) were: unemployment status (p disabled. Overall, participants with BAD fared better in the level of disability and most of the measured domains of disability in comparison with those with schizophrenia. Both socio-demographic and treatment-related factors seem to define the pattern disability among participants. Thus, evidence-guided preventive and rehabilitative treatment strategies directed against functional impairment using prioritized model among individuals with BAD and schizophrenia are advocated.

  5. Reducing medical students' stigmatization of people with chronic mental illness: a field intervention at the "living museum" state hospital art studio.

    Science.gov (United States)

    Cutler, Janis L; Harding, Kelli J; Hutner, Lucy A; Cortland, Clarissa; Graham, Mark J

    2012-05-01

    The authors designed an intervention to reduce beginning medical students' stigmatization of people with chronic mental illness (CMI). Pre-clinical medical students visited a state psychiatric facility's "Living Museum," a combination patient art studio/display space, as the intervention. During the visit, students interacted with artist-guides who showed their work and discussed their experiences creating art. Students completed a self-assessment survey developed to measure attitudes and feelings toward people with CMI after half of the class visited the Living Museum, constituting a Visit/No-Visit cross-sectional comparison. Students who visited the Living Museum (N=64), as compared with those who did not visit (N=110), endorsed more positive attitudes toward people with CMI. Among the students who visited, however, those who reported having spoken individually with a patient-artist (N=44), paradoxically, indicated less-positive feelings toward people with CMI. An intervention in which pre-clinical medical students visited patient-artist guides in an art-studio setting generally improved students' attitudes toward people with CMI. Thus, nontraditional psychiatric settings offer a valuable adjunct to more traditional clinical settings to reduce stigma when introducing medical students to the field of psychiatry.

  6. Japanese Government Policies in Education, Science, Sports and Culture, 1998. Mental and Physical Health and Sports.

    Science.gov (United States)

    Ministry of Education, Science, and Culture, Tokyo (Japan).

    This annual publication introduces Japan's educational policies in education, science, sports, and culture. Part 1, "Trends in Education Reform," discusses fundamental concepts in educational reform. Part 2, "Mental and Physical Health and Sports," includes two chapters. Chapter 1, "Health and Sports into the Future,"…

  7. Letters to a Young Education Reformer

    Science.gov (United States)

    Hess, Frederick M.

    2017-01-01

    In "Letters to a Young Education Reformer," Frederick M. Hess distills knowledge from twenty-five years of working in and around school reform. Inspired by his conversations with young, would-be reformers who are passionate about transforming education, the book offers a window into Hess's thinking about what education reform is and…

  8. Mental Health Ethnography

    DEFF Research Database (Denmark)

    Ringer, Agnes

    2017-01-01

    hospitalized, but to get inside the contemporary psychiatric institution and to participate in the social world of patients and professionals, I had to experiment with different ethnographic approaches. Ethnographies of mental health have become increasingly rare, and much research on language in psychiatric......In 2010, I began a PhD study to examine how professionals and patients talked to—and about—each other in mental health institutions in Denmark. One year later, I found myself chain-smoking, dressed in baggy clothing, and slouching on a sofa in a closed psychiatric ward. I had not myself been...... institutions is done by interview research. My study involved observing and participating in the day-to-day life at two mental health facilities: an outpatient clinic and an inpatient closed ward. The case study provides an account of some of the specific methodological problems and unanticipated events...

  9. Pension reform in Latin America : quick fixes or sustainable reform?

    OpenAIRE

    Aiyer, Sri-Ram

    1997-01-01

    Because of better health and higher standards of living, people are living longer. By 2030, more than 16 percent of the world's population will be older than 60, compared with 9 percent today. As a result, pension systems will need reform. Most current systems have substantial unfunded liabilities that will impose significant financial burdens onfuture generations without providing adequate protection for older individuals and lower-income workers. Pension reform is inevitable because of demo...

  10. Transtornos mentais e comportamentais no sistema de informações hospitalares do SUS: perspectivas para a enfermagem Trastornos mentales y de compotamiento en el sistema de informaciones hospitalarias del sus: perspectivas para la enfermerìa Mental and behavioral disturbances in the hospital information system: perspectives for nursing

    Directory of Open Access Journals (Sweden)

    Edilaine Cristina da Silva

    2006-06-01

    átrica.The purpose of this study was to explore some of the possibilities of getting information about mental and behavior disorders using the Internet, specifically at the Ministry of Health's DATASUS website. The site presented elements that illustrate the Health Information Systems' resources, which may be used by nurses as a safe and simplified way of obtaining data. The study focused on psychiatric hospitalization through the SIH-SUS in the city of Ribeirão Preto, State of São Paulo. Given the nurses' needs to use technological resources that can contribute for the organization of the service and the analysis of the situation of the mental and behavior disorders, SIH-SUS data are a possible instrument to start the analysis whose results may make possible important and effective changes for the management of the services, in search for quality in mental and psychiatric health assistance.

  11. Prevalência de transtornos mentais nas tentativas de suicídio em um hospital de emergência no Rio de Janeiro, Brasil Prevalence of mental disorders associated with suicide attempts treated at an emergency hospital in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Simone Agadir Santos

    2009-09-01

    Full Text Available Há poucos estudos nacionais sobre prevalência de transtornos mentais nas tentativas de suicídio, os quais utilizararam principalmente dados secundários e instrumentos de rastreamento. O objetivo deste estudo foi estimar a prevalência de transtornos mentais em 96 casos de tentativas de suicídio atendidos em hospital de emergência, Rio de Janeiro, Brasil (2006-2007, utilizando o Composite International Development Interview. A maioria da amostra consistiu em mulheres, jovens, baixa escolaridade e ingestão de medicamentos psicoativos como principal meio. Outros fatores: histórias prévias de tentativa e uso de álcool no momento do agravo. Os transtornos mentais mais freqüentes foram: episódio depressivo (38,9%, dependência de substâncias psicoativas (21,9%, transtorno de estresse pós-traumático (20,8%, dependência de álcool (17,7% e esquizofrenia (15,6%. A taxa total dos transtornos mentais foi de 71,9%. Tais achados são mais próximos aos estudos em países em desenvolvimento. Além do acesso ao tratamento dos transtornos mentais, são necessárias políticas públicas que enfatizem o controle de meios e respostas sociais à redução do comportamento suicida.There are few Brazilian studies on prevalence of mental disorders in suicide attempters. The available studies have mainly used secondary data and screening instruments. The principal objective of this study was to estimate the prevalence of mental disorders in 96 suicide attempters seen in an emergency ward in Rio de Janeiro, Brasil (2006-2007 using the Composite International Development Interview. Most were female, young, and illiterate, and the main method was ingestion of psychoactive drugs. Other factors included history of prior attempts and use of alcohol at the time of attempt. The most frequent mental disorders were: depression (38.9%, use of psychoactive substances (21.9%, posttraumatic stress disorder (20.8%, alcohol abuse (17.7%, and schizophrenia (15.6%. Total

  12. DUNDRUM-2: Prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a Forensic Mental Health Hospital.

    LENUS (Irish Health Repository)

    Flynn, Grainne

    2011-07-03

    Abstract Background The criteria for deciding who should be admitted first from a waiting list to a forensic secure hospital are not necessarily the same as those for assessing need. Criteria were drafted qualitatively and tested in a prospective \\'real life\\' observational study over a 6-month period. Methods A researcher rated all those presented at the weekly referrals meeting using the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale. The key outcome measure was whether or not the individual was admitted. Results Inter-rater reliability and internal consistency for the DUNDRUM-2 were acceptable. The DUNDRUM-1 triage security score and the DUNDRUM-2 triage urgency score correlated r = 0.663. At the time of admission, after a mean of 23.9 (SD35.9) days on the waiting list, those admitted had higher scores on the DUNDRUM-2 triage urgency scale than those not admitted, with no significant difference between locations (remand or sentenced prisoners, less secure hospitals) at the time of admission. Those admitted also had higher DUNDRUM-1 triage security scores. At baseline the receiver operating characteristic area under the curve for a combined score was the best predictor of admission while at the time of admission the DUNDRUM-2 triage urgency score had the largest AUC (0.912, 95% CI 0.838 to 0.986). Conclusions The triage urgency items and scale add predictive power to the decision to admit. This is particularly true in maintaining equitability between those referred from different locations.

  13. Participative mental health consumer research for improving physical health care: An integrative review.

    Science.gov (United States)

    Happell, Brenda; Ewart, Stephanie B; Platania-Phung, Chris; Stanton, Robert

    2016-10-01

    People with mental illness have a significantly lower life expectancy and higher rates of chronic physical illnesses than the general population. Health care system reform to improve access and quality is greatly needed to address this inequity. The inclusion of consumers of mental health services as co-investigators in research is likely to enhance service reform. In light of this, the current paper reviews mental health consumer focussed research conducted to date, addressing the neglect of physical health in mental health care and initiatives with the aim of improving physical health care. The international literature on physical healthcare in the context of mental health services was searched for articles, including mental health consumers in research roles, via Medline, CINAHL and Google Scholar, in October 2015. Four studies where mental health consumers participated as researchers were identified. Three studies involved qualitative research on barriers and facilitators to physical health care access, and a fourth study on developing technologies for more effective communication between GPs and patients. This review found that participatory mental health consumer research in physical health care reform has only become visible in the academic literature in 2015. Heightened consideration of mental health consumer participation in research is required by health care providers and researchers. Mental health nurses can provide leadership in increasing mental health consumer research on integrated care directed towards reducing the health gap between people with and without mental illness. © 2016 Australian College of Mental Health Nurses Inc.

  14. Socio-Cultural Factors of the Russian Reforming Process of the 18-20th Centuries

    Directory of Open Access Journals (Sweden)

    Yuriy Korobkov

    2017-11-01

    Full Text Available The modern Russian reforms aimed at moving the society to a new stage of development are going through a complicated, contradictory way, with great social costs and zigzags of the political course of power. This poses the task of identifying and overcoming the inhibiting factors in the development of the country. One of the most effective mechanisms of such work is the study of the three-hundred-year experience of Russian reformation and the identification of timeless sociocultural and mental risk factors affecting the nature and content of reforms. This article is devoted to this purpose. In the course of study, we have drawn the conclusions about the deterrent effect on the development of the country of such features of Russian society as its socio-cultural split, absence of internal mechanisms for the self-development of society, lack of a dialogue between government and society, whose relationships are determined by the principle of "antisocial state - anti-state society", mental characteristics of the Russian intelligentsia, which dogmatically implements particular ideas at the expense of economic expediency and common sense, orientation of the ruling elite on the Western values as opposed to national traditions, conservatism and lack of conscious reformative motivation of the masses. This leads to the need to correlate the current reforms not only with the current trends of socio-economic development, but also with the sociocultural foundations of Russian society and the peculiarities of its mentality.

  15. Psychiatric and Mental Health Nursing in China: Past, Present and Future.

    Science.gov (United States)

    Xu, Xiuying; Li, Xin-Min; Xu, Dongmei; Wang, Wenqiang

    2017-10-01

    The mental health service model and policy have undergone dramatic changes and are moving toward the establishment of integrated service network-based community mental health services in China. But there are still some issues, such as shortage of resources, a relatively low rate of psychiatric treatment, lack of the knowledge about mental health in the general population, and stigma associated with mental disorders. This paper summarizes the history of psychiatric and mental health nursing in China and analyzes the characteristics of the current situation. There are healthcare challenges for psychiatric and mental health nurses with the mental health services reform by government, and in this paper we discuss future trends and provide suggestions for development of the psychiatric nursing profession, and mental health services reform. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Radiant non-catalytic recuperative reformer

    Energy Technology Data Exchange (ETDEWEB)

    Khinkis, Mark J.; Kozlov, Aleksandr P.

    2017-10-31

    A radiant, non-catalytic recuperative reformer has a flue gas flow path for conducting hot exhaust gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is positioned adjacent to the flue gas flow path to permit heat transfer from the hot exhaust gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, a portion of the reforming mixture flow path is positioned outside of flue gas flow path for a relatively large residence time.

  17. Unplanned Hospital Visits - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Unplanned Hospital Visits – provider data. This data set includes provider data for the hospital return days (or excess days in acute care) measures, the unplanned...

  18. Can Education Reform Canada's Criminals?

    Science.gov (United States)

    Griffin, D. K.

    1978-01-01

    Discusses the development of the existing correctional programs in Canada's prisons, some theories of criminality, and two competing views on the best way to reform criminals today. Also gives a short review of penitentiary education programs. (RK)

  19. Contract Reform Self Assessment Report

    National Research Council Canada - National Science Library

    1997-01-01

    The primary objective of this self assessment is to report on the Department of Energy's progress in implementing the Contract Reform initiative launched in February 1994 and to discuss remaining challenges...

  20. Applications of solar reforming technology

    Energy Technology Data Exchange (ETDEWEB)

    Spiewak, I. [Weizmann Inst. of Science, Rehovoth (Israel); Tyner, C.E. [Sandia National Labs., Albuquerque, NM (United States); Langnickel, U. [Deutsche Forschungsanstalt fuer Luft- und Raumfahrt e.V. (DLR), Koeln (Germany)

    1993-11-01

    Research in recent years has demonstrated the efficient use of solar thermal energy for driving endothermic chemical reforming reactions in which hydrocarbons are reacted to form synthesis gas (syngas). Closed-loop reforming/methanation systems can be used for storage and transport of process heat and for short-term storage for peaking power generation. Open-loop systems can be used for direct fuel production; for production of syngas feedstock for further processing to specialty chemicals and plastics and bulk ammonia, hydrogen, and liquid fuels; and directly for industrial processes such as iron ore reduction. In addition, reforming of organic chemical wastes and hazardous materials can be accomplished using the high-efficiency destruction capabilities of steam reforming. To help identify the most promising areas for future development of this technology, we discuss in this paper the economics and market potential of these applications.

  1. A enfermagem e o cuidar na área de saúde mental La Enfermería en el cuidar en el área de la salud mental Nursing and caring for in the area of mental health

    Directory of Open Access Journals (Sweden)

    Sueli de Carvalho Villela

    2004-12-01

    Full Text Available Este trabalho descreve os aspectos político-sociais que envolveram a reforma da assistência psiquiátrica, enfocando o processo de desinstitucionalização e a importância da enfermagem além de constituinte da equipe interdisciplinar. Objetiva analisar o processo de assistência de enfermagem ao doente mental em serviços externos ao hospital. Constitui-se de revisão bibliográfica em periódicos nacionais no período de 1999 a 2001. As autoras discutem sobre o comprometimento dos trabalhadores na área de saúde mental, com a "desconstrução"/construção a cerca do cuidado, fazendo-se necessária uma abordagem humanizada por meio do relacionamento interpessoal de pacientes, enfermeiros e as equipes responsáveis pela assistência ao doente mental.Este trabajo describe los aspectos político-sociales que involucraron la reforma de la asistencia psiquiátrica, enfocando el proceso de desinstitucionalización y la importancia de la enfermería además de constituyente del equipo interdisciplinar. Objetiva analizar el proceso de asistencia de enfermería al enfermo mental en servicios externos al hospital. Se constituye de revisión bibliográfica en periódicos nacionales en el período de 1999 a 2001. Las autoras discuten sobre el compromiso de los trabajadores en el área de salud mental, con la "desconstrucción"/construcción acerca del cuidado, haciéndose necesario un abordaje humanizado por medio de la relación interpersonal de pacientes, enfermeros y los equipos responsables por la asistencia al enfermo mental.This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss

  2. Misrecognition and science education reform

    Science.gov (United States)

    Brandt, Carol B.

    2012-09-01

    In this forum, I expand upon Teo and Osborne's discussion of teacher agency and curriculum reform. I take up and build upon their analysis to further examine one teacher's frustration in enacting an inquiry-based curriculum and his resulting accommodation of an AP curriculum. In this way I introduce the concept of misrecognition (Bourdieu and Passeron 1977) to open up new ways of thinking about science inquiry and school reform.

  3. Child Mortality under Chinese Reforms

    OpenAIRE

    Christopher GRIGORIOU; Patrick GUILLAUMONT

    2004-01-01

    This paper looks for the impact of the Chinese economic reforms on its health performance. From an appropriate health outcomes indicator, it appears that while still being one of the most performing countries, China’s relative advance decreased during the reforms. Consistent with the fact that the health system had to rely more and more on private expenditures, we find an increasing impact of income on infant survival. We also show that relative prices matter for infant survival: for a given ...

  4. Telemental health: responding to mandates for reform in primary healthcare.

    Science.gov (United States)

    Myers, Kathleen M; Lieberman, Daniel

    2013-06-01

    Telemental health (TMH) has established a niche as a feasible, acceptable, and effective service model to improve the mental healthcare and outcomes for individuals who cannot access traditional mental health services. The Accountability Care Act has mandated reforms in the structure, functioning, and financing of primary care that provide an opportunity for TMH to move into the mainstream healthcare system. By partnering with the Integrated Behavioral Healthcare Model, TMH offers a spectrum of tools to unite primary care physicians and mental health specialist in a mind-body view of patients' healthcare needs and to activate patients in their own care. TMH tools include video-teleconferencing to telecommute mental health specialists to the primary care setting to collaborate with a team in caring for patients' mental healthcare needs and to provide direct services to patients who are not progressing optimally with this collaborative model. Asynchronous tools include online therapies that offer an efficient first step to treatment for selected disorders such as depression and anxiety. Patients activate themselves in their care through portals that provide access to their healthcare information and Web sites that offer on-demand information and communication with a healthcare team. These synchronous and asynchronous TMH tools may move the site of mental healthcare from the clinic to the home. The evolving role of social media in facilitating communication among patients or with their healthcare team deserves further consideration as a tool to activate patients and provide more personalized care.

  5. Swedes test capitalist waters in new health system reforms.

    Science.gov (United States)

    Gardner, E

    1994-01-01

    While most Swedes say they're satisfied with their socialized health care system, problems ranging from long waits for surgery to a growing federal deficit have prompted health officials to inject some elements of American-style managed care and competition. Reforms include abandoning central primary care clinics in favor of allowing patients to choose a family physician; privatizing some hospitals; and separating health financing from delivery.

  6. Giving Voice to the Trans Community on GID Reform in the "DSM-5": A Saskatchewan Perspective

    Science.gov (United States)

    Richards, Jai T.

    2013-01-01

    The inclusion of the diagnosis of gender identity disorder (GID) within the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM") is a contentious issue. A summary of the arguments for retention, removal, or reform of the diagnosis in the "DSM-5" is presented. A qualitative study with 7 individuals from…

  7. Reforming health care in Hungary.

    Science.gov (United States)

    Császi, L; Kullberg, P

    1985-01-01

    Over the past two decades Hungary has initiated a series of social and economic reforms which have emphasized decentralization of control and the reintroduction of market mechanisms into the socialized economy. These reforms both reflect and reinforce a changing social structure, in particular the growing influence of upper class special interest groups. Market reforms are an expression of concurrent ideological shifts in Hungarian society. We examined the political significance of three recent proposals to reform health services against the backdrop of broader social and economic changes taking place. The first proposes a bureaucratic reorganization, the second, patient co-payments, and the third, a voucher system. The problems each proposal identifies, as well as the constituency each represents, reveal a trend toward consolidation of class structure in Hungary. Only one of these proposals has any potential to democratize the control and management of the heath care system. Moreover, despite a governmental push toward decentralization, two of these proposals would actually increase centralized bureaucratic control. Two of the reforms incorporate market logic into their arguments, an indication that the philosophical premises of capitalism are re-emerging as an important component of the Hungarian world-view. In Hungary, as well as in other countries, social analysis of proposed health care reforms can effectively illuminate the social and political dynamics of the larger society.

  8. Australian maternity reform through clinical redesign.

    Science.gov (United States)

    Hartz, Donna L; White, Jan; Lainchbury, Kathleen A; Gunn, Helen; Jarman, Helen; Welsh, Alec W; Challis, Daniel; Tracy, Sally K

    2012-05-01

    The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context.

  9. La red de atención a la salud mental correspondiente al hospital universitario Príncipe de Asturias en Madrid (España The network of mental health care in the hospital universitário Principe de Asturias in Madrid (Spain

    Directory of Open Access Journals (Sweden)

    Alberto Fernández Liria

    2011-12-01

    Full Text Available Se describe la estructura y funcionamiento de una red pública de atención a la salud mental que cubre una población de 450.000 habitantes de la zona metropolitana este de Madrid. Se trata de una red que funciona como parte de un sistema público, universal y gratuito en el momento del pago, aunque tiene varios financiadores y parte de los proveedores son instituciones de titularidad privada que se financian mediante un concierto con la administración pública. Integra 26 dispositivos en los que trabajan 229 profesionales asignados a equipos interprofesionales. Además de las funciones asistenciales, la red desarrolla labores de docencia e investigación.We describe the structure and functioning of a public mental health care network that covers a population of 450.000 inhabitants in the metropolitan east area of Madrid. It is a network that operates as part of a public, universal and without payment at the time of being attended National Health Service, although it is granted from several different public founders and some of the providers are private institutions employed by the public system. It includes 229 mental health professionals work in 26 integrated inter-professional teams. In addition to the functions of care, the network develops teaching and research work.

  10. Reforming the European Scene

    Directory of Open Access Journals (Sweden)

    Joseph Ezra Bigio

    2010-10-01

    Full Text Available An unbridled globalization based on a simple premise about earnings and profit may be detrimental to the livelihood of many thousands of individuals. The greed and utter selfishness that result from the adherence to this sort of business practice are the two things that generate more unemployment, misery and degradation than most other characteristics of the human species. These considerations present the challenge for Western societies and call for the implementation of other principles, standards and procedures, such as cooperation, cohesion, development objectives and social responsibility. In the first part of the paper this approach is tested in the case of the EU-US foreign exchange relationships. The second part of the paper raises more general and fundamental issues. While adhering to the Schumpeter-type innovation environment, it aims to introduce the social dimension ahead of the immediate competitiveness and, therefore, argues for the fundamental reform of the catechism of the capitalist manager. The EU, due to its advanced integration, is relatively well-equipped to move towards the new economic system.

  11. Steam reforming of ethanol

    DEFF Research Database (Denmark)

    Trane-Restrup, Rasmus; Dahl, Søren; Jensen, Anker Degn

    2013-01-01

    on Ni-based catalysts during SR of ethanol were investigated in a flow reactor. Four different supports for Ni were tested and Ce0.6Zr0.4O2 showed the highest activity, but also suffered from severe carbon deposition at 600 °C or below. Operation at 600 °C or above were needed for full conversion......Steam reforming (SR) of oxygenated species like bio-oil or ethanol can be used to produce hydrogen or synthesis gas from renewable resources. However, deactivation due to carbon deposition is a major challenge for these processes. In this study, different strategies to minimize carbon deposition...... of ethanol over the most active catalysts at the applied conditions. At these temperatures the offgas composition was close to the thermodynamical equilibrium. Operation at high temperatures, 700 °C and 750 °C, gave the lowest carbon deposition corresponding to 30–60 ppm of the carbon in the feed ending...

  12. Changing Hearts and Minds: The Importance of Formal Education in Reducing Stigma Associated with Mental Health Conditions

    Science.gov (United States)

    Hampson, Margaret E.; Watt, Bruce D.; Hicks, Richard E.; Bode, Andrew; Hampson, Elizabeth J.

    2018-01-01

    Background: The expansion of user-friendly mental health services for young people is an important goal of mental health reform in Australia; however, stigma and discrimination associated with mental health conditions constitute major deterrents to help-seeking among young people. Objective: This paper reports on a qualitative study conducted in…

  13. Children First: It's Time to Change! Mental Health Promotion, Prevention, and Treatment Informed by Public Health, and Resiliency Approaches

    Science.gov (United States)

    Schwean, Vicki; Rodger, Susan

    2013-01-01

    Although the importance of healthy mental development in children and youth is not disputed, the mental health needs of far too many Canadian children are being ignored. Within the context of recent federal and provincial calls for systemic reform of the mental health care systems for children and youth, we underscore the necessity for ongoing…

  14. Massachusetts Health Reform was Cost Saving for Individuals with New Venous Thromboembolism: A Cost-effectiveness Analysis

    Science.gov (United States)

    Kapoor, Alok; Shaffer, Nicholas; Hanchate, Amresh; Roberts, Mark; Smith, Kenneth

    2015-01-01

    Background Patients with venous thromboembolism (VTE) require access to comprehensive physician and pharmacy benefits to prevent recurrence and hemorrhage. Prior to 2006, Massachusetts provided these benefits through a program restricted to safety net hospitals called Free Care. Providing portable health insurance through Massachusetts health reform could improve outcomes for uninsured with VTE but its cost-effectiveness is unknown. Methods and Results We constructed a Markov decision analysis model comparing our conceptualization of the Massachusetts health reform (“health reform strategy”) to no health reform strategy for a patient beginning warfarin for new episode of VTE. In the model, a patient may develop recurrent VTE or develop hemorrhage or stop warfarin after 6 months if no event occurs. To measure effectiveness, we analyzed laboratory data from Boston Medical Center, the largest safety net hospital in Massachusetts. Specifically, we measured the probability of having a subtherapeutic warfarin level for patients newly insured compared to those on Free Care pre-reform adjusting for secular trends. To calculate inpatient costs, we used the Health Care Utilization Project (HCUP). We then calculated the incremental cost effectiveness ratio (ICER) for the health reform strategy adjusted to 2014 USD per quality adjusted life year (QALY) and performed sensitivity analyses. The health reform strategy cost less and gained more QALYS than the no health reform strategy. Our result was most sensitive to the odds that Health Reform protected against a subtherapeutic warfarin level, the cost of Health Reform, and the percentage of total health care costs attributable to VTE in Massachusetts. Conclusions The health reform strategy cost less and was more effective than the no health reform strategy for patients with VTE. PMID:26908086

  15. Using an intervention mapping framework to develop an online mental health continuing education program for pharmacy staff.

    Science.gov (United States)

    Wheeler, Amanda; Fowler, Jane; Hattingh, Laetitia

    2013-01-01

    Current mental health policy in Australia recognizes that ongoing mental health workforce development is crucial to mental health care reform. Community pharmacy staff are well placed to assist people with mental illness living in the community; however, staff require the knowledge and skills to do this competently and effectively. This article presents the systematic planning and development process and content of an education and training program for community pharmacy staff, using a program planning approach called intervention mapping. The intervention mapping framework was used to guide development of an online continuing education program. Interviews with mental health consumers and carers (n = 285) and key stakeholders (n = 15), and a survey of pharmacy staff (n = 504) informed the needs assessment. Program objectives were identified specifying required attitudes, knowledge, skills, and confidence. These objectives were aligned with an education technique and delivery strategy. This was followed by development of an education program and comprehensive evaluation plan. The program was piloted face to face with 24 participants and then translated into an online program comprising eight 30-minute modules for pharmacists, 4 of which were also used for support staff. The evaluation plan provided for online participants (n ≅ 500) to be randomized into intervention (immediate access) or control groups (delayed training access). It included pre- and posttraining questionnaires and a reflective learning questionnaire for pharmacy staff and telephone interviews post pharmacy visit for consumers and carers. An online education program was developed to address mental health knowledge, attitudes, confidence, and skills required by pharmacy staff to work effectively with mental health consumers and carers. Intervention mapping provides a systematic and rigorous approach that can be used to develop a quality continuing education program for the health workforce

  16. Mental health and public policies implemented in the Northeast of Brazil: A systematic review with meta-analysis.

    Science.gov (United States)

    Januário, Sonilde Saraiva; das Neves Peixoto, Florido Sampaio; Lima, Nádia Nara Rolim; do Nascimento, Vânia Barbosa; de Sousa, Danilo Ferreira; Pereira Luz, Dayse Christina Rodrigues; da Silva, Claúdio Gleidiston Lima; Rolim Neto, Modesto Leite

    2017-02-01

    Studies about mental disorders are very rare in the Northeast of Brazil, especially when psychopathologies in children and adolescents are considered. The consequence is a small availability of data and an absence of a real epidemiological profile. This is a systematic review with meta-analysis, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol, in the period from 2003 to 2015, using the databases LILACS, SciELO and BVS. The analysis comprised the keywords 'models of primary and secondary healthcare in mental health', 'psychiatric reform' and 'policies and services in mental health', using the Boolean operator '# AND'. Original texts based on secondary data from the Hospital Information System of the Brazilian Unified Health System were also included via the Citizen Electronic Record System, Instituto Brasileiro de Geografia e Estatística, and Ministry of Health. Grey literature was used by means of hand searching. A combined analysis of the strategies mentioned in the analyzed articles shows a combined odds ratio of 1.291 (confidence interval (CI) = 1.054-1.582), thus it demonstrates the efficacy of using such strategies in the elaboration of institutional apparatus in mental health. The p-value of the chi-square distribution resulted in .9753, which does not reject the hypothesis of association between strategies in mental health and possible development of institutional apparatus in mental health. A combined analysis of all strategies mentioned in the analyzed studies shows efficacy of using strategies to elaborate institutional apparatus in mental health.

  17. Health Reform in Mexico City, 2000-2006

    Directory of Open Access Journals (Sweden)

    Asa Cristina Laurell

    2008-07-01

    Full Text Available With the goal of fully guaranteeing the constitutional right to health protection, Mexico City’s leftist administration (2000-2006 undertook a reform to provide health services to people without insurance. The reform had four components: free medicine and health services; the introduction of a new service model (MAS; the strengthening, expansion, and improvement of services, and legislation to ensure that the city government become guarantor of this constitutional right. The reform resulted in 95% of eligible families being enrolled in free care; expansion of health care infrastructure with the construction of five new health care centers and a 1/3 increase in the number of public hospital beds in impoverished and disadvantaged areas; increased access to and use of health services particularly by the poor and for expensive interventions; and the legal guarantee of the continuity of this policy. The implementation of this new policy was made possible through an 80% budget increase, improvements in efficiency, and a successful fight against corruption. The health impact of the reform was seen in decline of mortality rates in all age groups between 1997 and 2005 (22% for child mortality, 11% for economically active age groups, and 7.9% for retired age groups and by a 16% decline in AIDS related mortality between 2000 and 2005. This reform contrasts with the health care reform promoted by the right wing Federal government in the rest of the country; the latter was based on voluntary health insurance, cost-sharing by families, access to a limited package of services, and gradual enrollment of the population

  18. Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness.

    Science.gov (United States)

    Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate

    2017-02-01

    Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  19. Innovations in health service delivery: the corporatization of public hospitals

    National Research Council Canada - National Science Library

    Harding, April; Preker, Alexander S

    2003-01-01

    ... hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. Much can be learned in this respect from the experiences of hospital reforms initiated during the 1990s. Innovations in Health Service Delivery: The Corporatization of Public Hospitals is an a...

  20. Access to primary care services for homeless mentally ill people.

    Science.gov (United States)

    Woollcott, Madeleine

    Modernisation of mental health services has been a government priority in recent years with new legislation, increased funding and investment and service reforms. The National Service Framework (NSF) for Mental Health defines national standards to meet the mental healthcare needs of adults up to the age of 65. This article considers standards two and three of the NSF regarding access to primary care services for people with a mental health problem. It discusses whether these standards consider homeless people, who continue to experience significant problems gaining equal access to health care.

  1. A mindfulness-based stress management program and treatment with omega-3 fatty acids to maintain a healthy mental state in hospital nurses (Happy Nurse Project): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Watanabe, Norio; Furukawa, Toshi A; Horikoshi, Masaru; Katsuki, Fujika; Narisawa, Tomomi; Kumachi, Mie; Oe, Yuki; Shinmei, Issei; Noguchi, Hiroko; Hamazaki, Kei; Matsuoka, Yutaka

    2015-01-31

    It is reported that nursing is one of the most vulnerable jobs for developing depression. While they may not be clinically diagnosed as depressed, nurses often suffer from depression and anxiety symptoms, which can lead to a low level of patient care. However, there is no rigorous evidence base for determining an effective prevention strategy for these symptoms in nurses. After reviewing previous literature, we chose a strategy of treatment with omega-3 fatty acids and a mindfulness-based stress management program for this purpose. We aim to explore the effectiveness of these intervention options for junior nurses working in hospital wards in Japan. A factorial-design multi-center randomized trial is currently being conducted. A total of 120 nurses without a managerial position, who work for general hospitals and gave informed consent, have been randomly allocated to a stress management program or psychoeducation using a leaflet, and to omega-3 fatty acids or identical placebo pills. The stress management program has been developed according to mindfulness cognitive therapy and consists of four 30-minute individual sessions conducted using a detailed manual. These sessions are conducted by nurses with a managerial position. Participants allocated to the omega-3 fatty acid groups are provided with 1,200 mg/day of eicosapentaenoic acid and 600 mg/day of docosahexaenoic acid for 90 days. The primary outcome is the change in the total score of the Hospital Anxiety and Depression Scale (HADS), determined by a blinded rater via the telephone at week 26. Secondary outcomes include the change in HADS score at 13 and 52 weeks; presence of a major depressive episode; severity of depression, anxiety, insomnia, burnout, and presenteeism; utility scores and adverse events at 13, 26 and 52 weeks. An effective preventive intervention may not only lead to the maintenance of a healthy mental state in nurses, but also to better quality of care for inpatients. This paper outlines the

  2. Reforming Preschools and Schools.

    Science.gov (United States)

    Duncan, Greg J; Magnuson, Katherine; Murnane, Richard J

    2016-04-01

    Compared with their higher-income counterparts, children growing up in low-income families in the United States typically complete less schooling, report worse health, and work and earn less in adulthood. Moreover, changes in the American economy over the last 40 years have raised the level of skills and qualifications that children need to obtain a good middle-class job, as well as making it much more difficult for children from low-income families to attend schools that support their learning of these skills. We first review strategies used in the past to improve K-12 schooling-including investing more money, introducing more accountability, and putting in place new governance structures (eg, charter schools)-and show why these strategies have been relatively ineffective. Drawing on the research literature and case studies, we then describe education reform strategies for prekindergarten programs and for elementary, middle, and high schools that may help meet these challenges. All of the initiatives described in our case studies provide ample opportunities for teachers and school leaders to improve their skills through coaching and other professional development activities; incorporate sensible systems of accountability, including requiring teachers to open their classrooms to the scrutiny of colleagues and school leaders and to work with their colleagues to improve their teaching practices; and incorporate high academic standards, such as those described in the Common Core State Standards. By focusing directly on improving teaching and promoting learning, these successful initiatives have boosted the achievement of low-income children. They show that it is indeed possible to make a real difference in the life chances of low-income children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  3. Immigration reform, American style.

    Science.gov (United States)

    Papademetriou, D G

    1984-01-01

    This article reviews the background of the proposed Immigration and Reform Act (also known as the Simpson-Mazzoli bill), which seeks to overhaul US immigration law for the first time since 1952. This bill is consistent with President Reagan's hard line on border enforcement and mandates stiff penalties for those who transport illegal aliens for commercial advantage or private profit. It further offers Mexico preferential treatment in immigration (40,000 add