http://www.ncbi.nlm.nih.gov/pubmed/22380467
Early Interv Psychiatry. 2012 Mar 2. doi: 10.1111/j.1751-7893.2012.00351.x. [Epub ahead of print]
Gender and duration of untreated psychosis: a systematic review and meta-analysis.
Cascio MT, Cella M, Preti A, Meneghelli A, Cocchi A.
Source
Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan Genneruxi Medical Center, Psychiatry Branch, Cagliari, Italy Department of Clinical and Health Psychology, University College of London Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
Abstract
Aim:
Duration of untreated psychosis (DUP) can influence the prognosis of schizophrenia. Previous studies have suggested that gender may influence the length of DUP. This study reports the result of the first systematic literature review and meta-analysis on the role of gender in influencing DUP in first-episode psychosis.
Method:
Systematic literature search in PubMed/Medline and Ovid/PsychINFO. Twenty-seven studies presenting data on 4721 patients diagnosed with psychosis at their first episode (2834 males and 1887 females) were included in the analysis.
Results:
Samples had a higher proportion of males: odds ratio = 2.5 (95% confidence interval: 1.8-3.3). Mean age at first contact was 25.4 for males and 27.5 for females. Patients from non-Western countries were older at first contact than patients from Western countries. Average DUP in schizophrenia was 64 weeks and did not differ between genders but was shorter in Western compared with non-Western countries.
Conclusion:
Earlier age at first contact and larger incidence in males support the existence of specific gender differences in first-episode psychosis; however, these are not associated with DUP length.
Monday, March 5, 2012
Physical comorbidity of migraine and other headaches in US adolescents
http://www.ncbi.nlm.nih.gov/pubmed/22381023
J Pediatr. 2012 Feb 28. [Epub ahead of print]
Physical Comorbidity of Migraine and Other Headaches in US Adolescents.
Lateef TM, Cui L, Nelson KB, Nakamura EF, Merikangas KR.
Source
Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD; Departments of Neurology and Pediatrics, Children's National Medical Center, Washington, DC.
Abstract
OBJECTIVE:
To examine the pattern and extent to which other physical conditions are comorbid with migraine and other headaches in youth in a representative sample of the US population.
STUDY DESIGN:
The National Comorbidity Survey-Adolescent Supplement is a face-to-face survey of adolescents aged 13-18 years in the continental US. Sufficient information to assess the International Headache Society's criteria for migraine with and without aura over the past 12 months was available in the diagnostic module. A caretaker/parental self-administered report was used to assess a broad range of other physical conditions. The sample for these analyses was 6843 adolescents with systematic caretaker/parent reports.
RESULTS:
Adolescents with any headaches reported higher rates of other neurologic conditions, including epilepsy (OR, 2.02; 95% CI, 1.04-3.94), persistent nightmares (OR, 2.28; 95% CI, 1.34-3.87), and motion sickness (OR, 1.6; 95% CI, 1.07-2.4), as well as abdominal complaints (OR, 2.36; 95% CI, 1.59-3.51). Asthma (OR, 2.22; 95% CI, 1.26-3.92) and seasonal allergies (OR, 1.66; 95% CI, 1.12-2.48) were more common in adolescents with migraines than in adolescents with nonspecific headaches.
CONCLUSION:
Adolescent migraine is associated with inflammatory conditions such as asthma and seasonal allergies, as well as with epilepsy, persistent nightmares, and motion sickness. Our findings suggest that comorbid medical conditions should be evaluated comprehensively in determining treatment options in youth with headache. Such comorbidity also could be an important source of the clinical and etiologic heterogeneity in migraine.
J Pediatr. 2012 Feb 28. [Epub ahead of print]
Physical Comorbidity of Migraine and Other Headaches in US Adolescents.
Lateef TM, Cui L, Nelson KB, Nakamura EF, Merikangas KR.
Source
Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD; Departments of Neurology and Pediatrics, Children's National Medical Center, Washington, DC.
Abstract
OBJECTIVE:
To examine the pattern and extent to which other physical conditions are comorbid with migraine and other headaches in youth in a representative sample of the US population.
STUDY DESIGN:
The National Comorbidity Survey-Adolescent Supplement is a face-to-face survey of adolescents aged 13-18 years in the continental US. Sufficient information to assess the International Headache Society's criteria for migraine with and without aura over the past 12 months was available in the diagnostic module. A caretaker/parental self-administered report was used to assess a broad range of other physical conditions. The sample for these analyses was 6843 adolescents with systematic caretaker/parent reports.
RESULTS:
Adolescents with any headaches reported higher rates of other neurologic conditions, including epilepsy (OR, 2.02; 95% CI, 1.04-3.94), persistent nightmares (OR, 2.28; 95% CI, 1.34-3.87), and motion sickness (OR, 1.6; 95% CI, 1.07-2.4), as well as abdominal complaints (OR, 2.36; 95% CI, 1.59-3.51). Asthma (OR, 2.22; 95% CI, 1.26-3.92) and seasonal allergies (OR, 1.66; 95% CI, 1.12-2.48) were more common in adolescents with migraines than in adolescents with nonspecific headaches.
CONCLUSION:
Adolescent migraine is associated with inflammatory conditions such as asthma and seasonal allergies, as well as with epilepsy, persistent nightmares, and motion sickness. Our findings suggest that comorbid medical conditions should be evaluated comprehensively in determining treatment options in youth with headache. Such comorbidity also could be an important source of the clinical and etiologic heterogeneity in migraine.
Tourette Syndrome and quality of life
http://www.ncbi.nlm.nih.gov/pubmed/22381812
Eur J Paediatr Neurol. 2012 Feb 28. [Epub ahead of print]
Predictors during childhood of future health-related quality of life in adults with Gilles de la Tourette syndrome.
Cavanna AE, David K, Orth M, Robertson MM.
Source
Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, United Kingdom; Department of Mental Health Sciences, UCL, London, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, United Kingdom.
Abstract
BACKGROUND:
Gilles de la Tourette syndrome (GTS) is a chronic neurodevelopmental disorder characterised by multiple motor and phonic tics and behavioural problems. Patients with GTS of all ages often report a poor health-related quality of life (HR-QOL). The diagnosis of GTS is usually established in childhood but little is known about factors that predict the long-term well-being of patients, especially in the presence of co-morbid behavioural problems.
AIM:
To investigate the childhood predictors of HR-QOL in a cohort of adult patients with GTS.
METHODS:
Forty-six patients with GTS aged 6-16 years underwent a baseline standardised clinical assessment of both tics and behavioural symptoms at a specialist GTS clinic. The same patients were re-assessed aged 16 years and above, with a mean follow-up period of 13 years (range 3-25 years), when they completed the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), a disease-specific measure of HR-QOL.
RESULTS:
Tic severity, premonitory urges and family history of GTS were identified as predictors during childhood of a poorer HR-QOL in adults with GTS by multiple linear regression analysis. Specifically, tic severity significantly predicted poor outcome across physical, psychological and cognitive domains of the GTS-QOL, reflecting widespread effects on HR-QOL.
CONCLUSION:
Young patients with severe tics associated with characteristic premonitory urges and a family history of tic disorders appear to be at higher risk for poorer HR-QOL as adults. Further prospective research into HR-QOL in GTS is required in order to inform long-term strategic resource allocation.
Eur J Paediatr Neurol. 2012 Feb 28. [Epub ahead of print]
Predictors during childhood of future health-related quality of life in adults with Gilles de la Tourette syndrome.
Cavanna AE, David K, Orth M, Robertson MM.
Source
Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, United Kingdom; Department of Mental Health Sciences, UCL, London, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, United Kingdom.
Abstract
BACKGROUND:
Gilles de la Tourette syndrome (GTS) is a chronic neurodevelopmental disorder characterised by multiple motor and phonic tics and behavioural problems. Patients with GTS of all ages often report a poor health-related quality of life (HR-QOL). The diagnosis of GTS is usually established in childhood but little is known about factors that predict the long-term well-being of patients, especially in the presence of co-morbid behavioural problems.
AIM:
To investigate the childhood predictors of HR-QOL in a cohort of adult patients with GTS.
METHODS:
Forty-six patients with GTS aged 6-16 years underwent a baseline standardised clinical assessment of both tics and behavioural symptoms at a specialist GTS clinic. The same patients were re-assessed aged 16 years and above, with a mean follow-up period of 13 years (range 3-25 years), when they completed the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), a disease-specific measure of HR-QOL.
RESULTS:
Tic severity, premonitory urges and family history of GTS were identified as predictors during childhood of a poorer HR-QOL in adults with GTS by multiple linear regression analysis. Specifically, tic severity significantly predicted poor outcome across physical, psychological and cognitive domains of the GTS-QOL, reflecting widespread effects on HR-QOL.
CONCLUSION:
Young patients with severe tics associated with characteristic premonitory urges and a family history of tic disorders appear to be at higher risk for poorer HR-QOL as adults. Further prospective research into HR-QOL in GTS is required in order to inform long-term strategic resource allocation.
Chronic depressive disorder and the proposed DSM-5
http://www.ncbi.nlm.nih.gov/pubmed/22381955
J Affect Disord. 2012 Feb 29. [Epub ahead of print]
Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder.
Murphy JA, Byrne GJ.
Source
The University of Queensland, School of Medicine, Academic Discipline of Psychiatry, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
Abstract
CONTEXT:
The draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis.
OBJECTIVE:
The objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing.
DESIGN:
Secondary analysis of a nationally representative household survey.
SETTING:
Urban and rural census tracts.
PARTICIPANTS:
One individual between the ages of 16 and 85years from 8841 households was interviewed for the survey.
MAIN OUTCOME MEASURE:
Lifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0).
RESULTS:
Chronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9-5.3%) and was found in 29.4% (95% CI: 25.6-33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR=1.42; 95% CI=1.26-1.61), older age (OR=1.04; 95% CI=1.02-1.05), a younger age of onset (OR=0.97; 95% CI=0.95-0.98) and more frequent episodes of depression (OR=1.75; 95% CI=1.07-2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR=2.38; 95% CI 1.16-5.79).
CONCLUSIONS:
Chronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.
J Affect Disord. 2012 Feb 29. [Epub ahead of print]
Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder.
Murphy JA, Byrne GJ.
Source
The University of Queensland, School of Medicine, Academic Discipline of Psychiatry, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
Abstract
CONTEXT:
The draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis.
OBJECTIVE:
The objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing.
DESIGN:
Secondary analysis of a nationally representative household survey.
SETTING:
Urban and rural census tracts.
PARTICIPANTS:
One individual between the ages of 16 and 85years from 8841 households was interviewed for the survey.
MAIN OUTCOME MEASURE:
Lifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0).
RESULTS:
Chronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9-5.3%) and was found in 29.4% (95% CI: 25.6-33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR=1.42; 95% CI=1.26-1.61), older age (OR=1.04; 95% CI=1.02-1.05), a younger age of onset (OR=0.97; 95% CI=0.95-0.98) and more frequent episodes of depression (OR=1.75; 95% CI=1.07-2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR=2.38; 95% CI 1.16-5.79).
CONCLUSIONS:
Chronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.
Web-based patient education on psychiatric wards
http://www.ncbi.nlm.nih.gov/pubmed/22381805
Int J Med Inform. 2012 Feb 28. [Epub ahead of print]
Use of web-based patient education sessions on psychiatric wards.
Anttila M, Välimäki M, Hätönen H, Luukkaala T, Kaila M.
Source
Finnish Post-Graduate School in Nursing Science and University of Turku, Department of Nursing Science, Finland.
Abstract
OBJECTIVE:
To evaluate the use of web-based patient education sessions in the psychiatric inpatient care.
METHODS:
The qualitative and quantitative data was collected from 93 patients' evaluation reports in two psychiatric hospitals in Finland completed by 83 nurses.
RESULTS:
The web-education included six patient education sessions which were used over a period lasting between 1 and 70 days and took 10-360min per patient. Out of 508 sessions, 464 had no interruptions or disturbances, 37 sessions had disturbances and seven sessions were interrupted. Three fourths of the sessions were used successfully. Factors associated with use were patients' vocational education level, mental status, diagnoses, number of nurses involved and hospital.
CONCLUSION:
It is important to invest effort in web-based patient education during patients' hospitalization and to use it even with patients suffering from serious mental health disorders. This is meant to provide more alternatives in nursing.
Int J Med Inform. 2012 Feb 28. [Epub ahead of print]
Use of web-based patient education sessions on psychiatric wards.
Anttila M, Välimäki M, Hätönen H, Luukkaala T, Kaila M.
Source
Finnish Post-Graduate School in Nursing Science and University of Turku, Department of Nursing Science, Finland.
Abstract
OBJECTIVE:
To evaluate the use of web-based patient education sessions in the psychiatric inpatient care.
METHODS:
The qualitative and quantitative data was collected from 93 patients' evaluation reports in two psychiatric hospitals in Finland completed by 83 nurses.
RESULTS:
The web-education included six patient education sessions which were used over a period lasting between 1 and 70 days and took 10-360min per patient. Out of 508 sessions, 464 had no interruptions or disturbances, 37 sessions had disturbances and seven sessions were interrupted. Three fourths of the sessions were used successfully. Factors associated with use were patients' vocational education level, mental status, diagnoses, number of nurses involved and hospital.
CONCLUSION:
It is important to invest effort in web-based patient education during patients' hospitalization and to use it even with patients suffering from serious mental health disorders. This is meant to provide more alternatives in nursing.
Resilience and mental health in Marines leaving military service
http://www.ncbi.nlm.nih.gov/pubmed/22381952
J Affect Disord. 2012 Feb 29. [Epub ahead of print]
Longitudinal study of resilience and mental health in marines leaving military service.
Hourani L, Bender R, Weimer B, Peeler R, Bradshaw M, Lane MB, Larson G.
Source
RTI International, 2769 Pleasant Acres Drive, Virginia Beach, VA 23453, United States.
Abstract
BACKGROUND:
Despite a growing emphasis on psychological outcomes following military combat, few longitudinal studies have examined the combined role of risk and protective factors in the mental health of combat-exposed military personnel. This study characterizes the impact of resilience scale scores and combat exposure on mental health outcomes among Marines after separating from military service, along with intra-individual changes in mental health status.
METHODS:
Data were collected from longitudinal surveys of 475 active duty Marines attending a random sample of mandatory Transition Assistance Program workshops before leaving the military and responding to follow-up mail or web surveys an average of 6months after returning to civilian life.
RESULTS:
Results revealed distinct risk and protective factors for those meeting screening criteria for mental health problems (depression, anxiety, and PTSD) and functional impairment at follow-up. Primary risk factors included experiencing higher levels of pre-separation combat exposure; post-separation stress across multiple life domains; and experiencing multiple areas of pain post-separation. Protective factors include having higher scores on pre-separation resilience and perceived social support at follow-up indices. We also identified a number of factors associated with change in mental health status from baseline to follow-up.
LIMITATIONS:
Generality is limited by a lower than expected follow-up response rate and an exclusively Marine sample.
CONCLUSION:
The role of resilience appeared to have a greater impact on functional impairment than on mental health symptoms per se. Findings provide important input for enhancing training programs and services intended to promote adjustment from military to civilian life. Additional emphasis on social support and coping with stress-related issues are needed in support of combat veterans.
J Affect Disord. 2012 Feb 29. [Epub ahead of print]
Longitudinal study of resilience and mental health in marines leaving military service.
Hourani L, Bender R, Weimer B, Peeler R, Bradshaw M, Lane MB, Larson G.
Source
RTI International, 2769 Pleasant Acres Drive, Virginia Beach, VA 23453, United States.
Abstract
BACKGROUND:
Despite a growing emphasis on psychological outcomes following military combat, few longitudinal studies have examined the combined role of risk and protective factors in the mental health of combat-exposed military personnel. This study characterizes the impact of resilience scale scores and combat exposure on mental health outcomes among Marines after separating from military service, along with intra-individual changes in mental health status.
METHODS:
Data were collected from longitudinal surveys of 475 active duty Marines attending a random sample of mandatory Transition Assistance Program workshops before leaving the military and responding to follow-up mail or web surveys an average of 6months after returning to civilian life.
RESULTS:
Results revealed distinct risk and protective factors for those meeting screening criteria for mental health problems (depression, anxiety, and PTSD) and functional impairment at follow-up. Primary risk factors included experiencing higher levels of pre-separation combat exposure; post-separation stress across multiple life domains; and experiencing multiple areas of pain post-separation. Protective factors include having higher scores on pre-separation resilience and perceived social support at follow-up indices. We also identified a number of factors associated with change in mental health status from baseline to follow-up.
LIMITATIONS:
Generality is limited by a lower than expected follow-up response rate and an exclusively Marine sample.
CONCLUSION:
The role of resilience appeared to have a greater impact on functional impairment than on mental health symptoms per se. Findings provide important input for enhancing training programs and services intended to promote adjustment from military to civilian life. Additional emphasis on social support and coping with stress-related issues are needed in support of combat veterans.
Oregon's parity law and the federal Mental Health Parity and Addiction Equality Act
http://www.ncbi.nlm.nih.gov/pubmed/22382046
Drug Alcohol Depend. 2012 Feb 28. [Epub ahead of print]
What Oregon's parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services.
McConnell KJ, Ridgely MS, McCarty D.
Source
Oregon Health & Science University, United States.
Abstract
BACKGROUND:
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires commercial group health plans offering coverage for mental health and substance abuse services to offer those services at a level that is no more restrictive than for medical-surgical services. The MHPAEA is notable in restricting the extent to which health plans can use managed care tools on the behavioral health benefit. The only precedent for this approach is Oregon's 2007 state parity law. This study aims to provide evidence on the effect of comprehensive parity on utilization and expenditures for substance abuse treatment services.
METHODS:
A difference-in-difference analysis compared individuals in five Oregon commercial plans (n=103,820) from 2005 to 2008 to comparison groups exempt from parity in Oregon (n=19,633) and Washington (n=39,447). The primary outcome measures were annual use and total expenditures.
RESULTS:
Spending for alcohol treatment services demonstrated statistically significant increase in comparison to the Oregon and Washington comparison groups. Spending on other drug abuse treatment services was not associated with statistically significant spending increases, and the effect of parity on overall spending (alcohol plus other drug abuse treatment services) was positive but not statistically significant from zero.
CONCLUSIONS:
Oregon's experience suggests that behavioral health insurance parity that places restrictions on how plans manage the benefit may lead to increases in expenditures for alcohol treatment services but is unlikely to lead to increases in spending for other drug abuse treatment services.
Drug Alcohol Depend. 2012 Feb 28. [Epub ahead of print]
What Oregon's parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services.
McConnell KJ, Ridgely MS, McCarty D.
Source
Oregon Health & Science University, United States.
Abstract
BACKGROUND:
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires commercial group health plans offering coverage for mental health and substance abuse services to offer those services at a level that is no more restrictive than for medical-surgical services. The MHPAEA is notable in restricting the extent to which health plans can use managed care tools on the behavioral health benefit. The only precedent for this approach is Oregon's 2007 state parity law. This study aims to provide evidence on the effect of comprehensive parity on utilization and expenditures for substance abuse treatment services.
METHODS:
A difference-in-difference analysis compared individuals in five Oregon commercial plans (n=103,820) from 2005 to 2008 to comparison groups exempt from parity in Oregon (n=19,633) and Washington (n=39,447). The primary outcome measures were annual use and total expenditures.
RESULTS:
Spending for alcohol treatment services demonstrated statistically significant increase in comparison to the Oregon and Washington comparison groups. Spending on other drug abuse treatment services was not associated with statistically significant spending increases, and the effect of parity on overall spending (alcohol plus other drug abuse treatment services) was positive but not statistically significant from zero.
CONCLUSIONS:
Oregon's experience suggests that behavioral health insurance parity that places restrictions on how plans manage the benefit may lead to increases in expenditures for alcohol treatment services but is unlikely to lead to increases in spending for other drug abuse treatment services.
Subjective well-being, hope, and needs of individuals with serious mental illness
http://www.ncbi.nlm.nih.gov/pubmed/22382051
Psychiatry Res. 2012 Feb 28. [Epub ahead of print]
Subjective well-being, hope, and needs of individuals with serious mental illness.
Werner S.
Abstract
Hope, as a basic resource in human life, may affect individuals' perceptions of subjective well-being (SWB). Further, understanding individuals' needs is essential to improving their SWB. It is unclear how the impact of hope on SWB may be mediated by needs. The current study aimed to examine a mediation model for the relation between hope and SWB among individuals with serious mental illness (SMI). Face-to-face structured interviews were conducted with 172 individuals with SMI. Instruments included the Personal Wellbeing Index, the Hope Scale, and the Camberwell Assessment of Needs. Hope and needs were predictive of 40% of the variability in SWB, with hope being a stronger predictor. Having no needs was positively predictive of SWB, while total number of needs was negatively predictive of SWB. Path analyses revealed a strong direct effect of hope on SWB and a weaker, though still strong, indirect effect mediated through needs. The results underscore the importance of hope in improving SWB and, consequently, enhancing the recovery process of individuals with SMI. Therefore, mental health services should focus on hope-building.
Psychiatry Res. 2012 Feb 28. [Epub ahead of print]
Subjective well-being, hope, and needs of individuals with serious mental illness.
Werner S.
Abstract
Hope, as a basic resource in human life, may affect individuals' perceptions of subjective well-being (SWB). Further, understanding individuals' needs is essential to improving their SWB. It is unclear how the impact of hope on SWB may be mediated by needs. The current study aimed to examine a mediation model for the relation between hope and SWB among individuals with serious mental illness (SMI). Face-to-face structured interviews were conducted with 172 individuals with SMI. Instruments included the Personal Wellbeing Index, the Hope Scale, and the Camberwell Assessment of Needs. Hope and needs were predictive of 40% of the variability in SWB, with hope being a stronger predictor. Having no needs was positively predictive of SWB, while total number of needs was negatively predictive of SWB. Path analyses revealed a strong direct effect of hope on SWB and a weaker, though still strong, indirect effect mediated through needs. The results underscore the importance of hope in improving SWB and, consequently, enhancing the recovery process of individuals with SMI. Therefore, mental health services should focus on hope-building.
Quality of life of adolescents with autism spectrum disorders
http://www.ncbi.nlm.nih.gov/pubmed/22382494
Eur Child Adolesc Psychiatry. 2012 Mar 1. [Epub ahead of print]
Quality of life of adolescents with autism spectrum disorders: comparison to adolescents with diabetes.
Cottenceau H, Roux S, Blanc R, Lenoir P, Bonnet-Brilhault F, Barthélémy C.
Source
Centre Universitaire de Pédopsychiatrie, CHRU de Tours, Université François Rabelais de Tours, 37044, Tours Cedex 9, France, h.cottenceau@chu-tours.fr.
Abstract
Relationships are of great importance during adolescence. Because of their social, communication and behavioral impairments, adolescents with Asperger's syndrome (AS) or high functioning autism (HFA) probably suffer from considerable impairment of their quality of life when facing their peers in school. Nevertheless, only one recent study has been published on this subject, indicating a lower health-related quality of life in children and adolescents with autism spectrum disorders (ASD) than in healthy controls. The goals of our study were to clarify the consequences of autistic disorder without mental retardation on such adolescents' daily lives, and to consider them in comparison with the impact of a chronic somatic disease (diabetes) and with the period of adolescence itself, using the VSP-A questionnaire. Adolescents with diabetes were chosen as a comparison group because of the encumbrance of having a constant need for insulin supplementation, to be assimilated to the constant need for communicative adjustments in teenagers with ASD, and the consequences in daily life. The effects of social skill training and social support on quality of life and the appropriateness of using the VSP-A in this population were also studied. Twenty-six adolescents with AS and HFA, 44 diabetic adolescents, and 250 controls completed a self-administered and validated questionnaire on quality of life, the VSP-A. Scores for adolescents with ASD were significantly lower than those of the control and the diabetic adolescents, especially for friendships, leisure time, and affective and sexual relationships. On the other hand, better scores were obtained for the relationships with parents and teachers and for self-image. Social parameters affected the quality of life of subjects with ASD, such as having friends, regularly participating in a sport, and having the support of a school carer. For subjects with autistic spectrum disorders and without mental retardation, impairment of quality of life is significant in adolescence and young adulthood. Such adolescents are dissatisfied with their relationships, although they often have real motivation to succeed with them. Relevance of VSP-A questionnaire in these special individuals is discussed.
Eur Child Adolesc Psychiatry. 2012 Mar 1. [Epub ahead of print]
Quality of life of adolescents with autism spectrum disorders: comparison to adolescents with diabetes.
Cottenceau H, Roux S, Blanc R, Lenoir P, Bonnet-Brilhault F, Barthélémy C.
Source
Centre Universitaire de Pédopsychiatrie, CHRU de Tours, Université François Rabelais de Tours, 37044, Tours Cedex 9, France, h.cottenceau@chu-tours.fr.
Abstract
Relationships are of great importance during adolescence. Because of their social, communication and behavioral impairments, adolescents with Asperger's syndrome (AS) or high functioning autism (HFA) probably suffer from considerable impairment of their quality of life when facing their peers in school. Nevertheless, only one recent study has been published on this subject, indicating a lower health-related quality of life in children and adolescents with autism spectrum disorders (ASD) than in healthy controls. The goals of our study were to clarify the consequences of autistic disorder without mental retardation on such adolescents' daily lives, and to consider them in comparison with the impact of a chronic somatic disease (diabetes) and with the period of adolescence itself, using the VSP-A questionnaire. Adolescents with diabetes were chosen as a comparison group because of the encumbrance of having a constant need for insulin supplementation, to be assimilated to the constant need for communicative adjustments in teenagers with ASD, and the consequences in daily life. The effects of social skill training and social support on quality of life and the appropriateness of using the VSP-A in this population were also studied. Twenty-six adolescents with AS and HFA, 44 diabetic adolescents, and 250 controls completed a self-administered and validated questionnaire on quality of life, the VSP-A. Scores for adolescents with ASD were significantly lower than those of the control and the diabetic adolescents, especially for friendships, leisure time, and affective and sexual relationships. On the other hand, better scores were obtained for the relationships with parents and teachers and for self-image. Social parameters affected the quality of life of subjects with ASD, such as having friends, regularly participating in a sport, and having the support of a school carer. For subjects with autistic spectrum disorders and without mental retardation, impairment of quality of life is significant in adolescence and young adulthood. Such adolescents are dissatisfied with their relationships, although they often have real motivation to succeed with them. Relevance of VSP-A questionnaire in these special individuals is discussed.
Gender differences in psychosocial functioning in adolescents with symptoms of anxiety and depression
http://www.ncbi.nlm.nih.gov/pubmed/22382555
Soc Psychiatry Psychiatr Epidemiol. 2012 Mar 2. [Epub ahead of print]
Gender differences in psychosocial functioning of adolescents with symptoms of anxiety and depression: longitudinal findings from the Nord-Trøndelag Health Study.
Derdikman-Eiron R, Indredavik MS, Bakken IJ, Bratberg GH, Hjemdal O, Colton M.
Source
Department of Neuroscience, Faculty of Medicine, The Regional Centre for Child and Adolescent Mental Health (RBUP), Norwegian University of Science and Technology, 7491, Trondheim, Norway, ruth.derdikman@ntnu.no.
Abstract
PURPOSE:
To explore longitudinally gender differences in the associations between psychosocial functioning, subjective well-being and self-esteem among adolescents with and without symptoms of anxiety and depression.
METHODS:
Data were obtained from a major population-based Norwegian study, the Nord-Trøndelag Health Study, in which 1,092 boys and 1,262 girls (86% of all invited) completed an extensive self-report questionnaire at baseline (mean age 14.4 years) and at follow-up (mean age 18.4 years).
RESULTS:
Gender was a moderator variable in the associations between symptoms of anxiety and depression and impairment, meaning that boys' functioning was impaired to a larger extent than girls' functioning. A statistically significant interaction effect between gender and symptoms of anxiety and depression was found at follow-up in terms of subjective well-being (p < 0.05), self-esteem (p < 0.05), academic problems (p < 0.01), behaviour problems (p < 0.01) and frequency of meeting friends (p < 0.001). Onset of symptoms between baseline and follow-up was associated with less frequent meetings with friends among boys, but not among girls. After remission of symptoms, boys still had more behaviour and academic problems, less frequently met friends and reported lower subjective well-being and self-esteem than boys who had no symptoms at both time points. No similar differences were found among the girls.
CONCLUSION:
Previous and ongoing symptoms of anxiety and depression had more negative consequences for boys than for girls. These findings may contribute to improved assessment and intervention methods tailored differently for each gender.
Soc Psychiatry Psychiatr Epidemiol. 2012 Mar 2. [Epub ahead of print]
Gender differences in psychosocial functioning of adolescents with symptoms of anxiety and depression: longitudinal findings from the Nord-Trøndelag Health Study.
Derdikman-Eiron R, Indredavik MS, Bakken IJ, Bratberg GH, Hjemdal O, Colton M.
Source
Department of Neuroscience, Faculty of Medicine, The Regional Centre for Child and Adolescent Mental Health (RBUP), Norwegian University of Science and Technology, 7491, Trondheim, Norway, ruth.derdikman@ntnu.no.
Abstract
PURPOSE:
To explore longitudinally gender differences in the associations between psychosocial functioning, subjective well-being and self-esteem among adolescents with and without symptoms of anxiety and depression.
METHODS:
Data were obtained from a major population-based Norwegian study, the Nord-Trøndelag Health Study, in which 1,092 boys and 1,262 girls (86% of all invited) completed an extensive self-report questionnaire at baseline (mean age 14.4 years) and at follow-up (mean age 18.4 years).
RESULTS:
Gender was a moderator variable in the associations between symptoms of anxiety and depression and impairment, meaning that boys' functioning was impaired to a larger extent than girls' functioning. A statistically significant interaction effect between gender and symptoms of anxiety and depression was found at follow-up in terms of subjective well-being (p < 0.05), self-esteem (p < 0.05), academic problems (p < 0.01), behaviour problems (p < 0.01) and frequency of meeting friends (p < 0.001). Onset of symptoms between baseline and follow-up was associated with less frequent meetings with friends among boys, but not among girls. After remission of symptoms, boys still had more behaviour and academic problems, less frequently met friends and reported lower subjective well-being and self-esteem than boys who had no symptoms at both time points. No similar differences were found among the girls.
CONCLUSION:
Previous and ongoing symptoms of anxiety and depression had more negative consequences for boys than for girls. These findings may contribute to improved assessment and intervention methods tailored differently for each gender.
From Ghent U-Belgium: Associative stigma among mental health professionals
http://www.ncbi.nlm.nih.gov/pubmed/22382718
J Health Soc Behav. 2012;53(1):17-32.
Associative Stigma among Mental Health Professionals: Implications for Professional and Service User Well-Being.
Verhaeghe M, Bracke P.
Source
1Ghent University, Belgium.
Abstract
In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.
J Health Soc Behav. 2012;53(1):17-32.
Associative Stigma among Mental Health Professionals: Implications for Professional and Service User Well-Being.
Verhaeghe M, Bracke P.
Source
1Ghent University, Belgium.
Abstract
In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.
From Stanford: Language proficiency and health status-Are bilingual immigrants healthier?
http://www.ncbi.nlm.nih.gov/pubmed/22382721
J Health Soc Behav. 2012;53(1):124-45.
Language proficiency and health status: are bilingual immigrants healthier?
Schachter A, Kimbro RT, Gorman BK.
Source
1Stanford University, Stanford, CA, USA.
Abstract
Bilingual immigrants appear to have a health advantage, and identifying the mechanisms responsible for this is of increasing interest to scholars and policy makers in the United States. Utilizing the National Latino and Asian American Study (NLAAS; n = 3,264), we investigate the associations between English and native-language proficiency and usage and self-rated health for Asian and Latino U.S. immigrants from China, the Philippines, Vietnam, Mexico, Cuba, and Puerto Rico. The findings demonstrate that across immigrant ethnic groups, being bilingual is associated with better self-rated physical and mental health relative to being proficient in only English or only a native language, and moreover, these associations are partially mediated by socioeconomic status and family support but not by acculturation, stress and discrimination, or health access and behaviors.
J Health Soc Behav. 2012;53(1):124-45.
Language proficiency and health status: are bilingual immigrants healthier?
Schachter A, Kimbro RT, Gorman BK.
Source
1Stanford University, Stanford, CA, USA.
Abstract
Bilingual immigrants appear to have a health advantage, and identifying the mechanisms responsible for this is of increasing interest to scholars and policy makers in the United States. Utilizing the National Latino and Asian American Study (NLAAS; n = 3,264), we investigate the associations between English and native-language proficiency and usage and self-rated health for Asian and Latino U.S. immigrants from China, the Philippines, Vietnam, Mexico, Cuba, and Puerto Rico. The findings demonstrate that across immigrant ethnic groups, being bilingual is associated with better self-rated physical and mental health relative to being proficient in only English or only a native language, and moreover, these associations are partially mediated by socioeconomic status and family support but not by acculturation, stress and discrimination, or health access and behaviors.
Neuroscience may supersede ethics and law
http://www.ncbi.nlm.nih.gov/pubmed/22382922
Sci Eng Ethics. 2012 Mar 1. [Epub ahead of print]
Neuroscience May Supersede Ethics and Law.
Scott TR.
Source
San Diego State University, San Diego, California, USA, tom.scott@sdsu.edu.
Abstract
Advances in technology now make it possible to monitor the activity of the human brain in action, however crudely. As this emerging science continues to offer correlations between neural activity and mental functions, mind and brain may eventually prove to be one. If so, such a full comprehension of the electrochemical bases of mind may render current concepts of ethics, law, and even free will irrelevant.
Sci Eng Ethics. 2012 Mar 1. [Epub ahead of print]
Neuroscience May Supersede Ethics and Law.
Scott TR.
Source
San Diego State University, San Diego, California, USA, tom.scott@sdsu.edu.
Abstract
Advances in technology now make it possible to monitor the activity of the human brain in action, however crudely. As this emerging science continues to offer correlations between neural activity and mental functions, mind and brain may eventually prove to be one. If so, such a full comprehension of the electrochemical bases of mind may render current concepts of ethics, law, and even free will irrelevant.
From UC Davis: Gaps in treating depression in older Mexican-origin and white men
http://www.ncbi.nlm.nih.gov/pubmed/22383214
Int J Geriatr Psychiatry. 2012 Mar 1. doi: 10.1002/gps.3779. [Epub ahead of print]
Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men.
Hinton L, Apesoa-Varano EC, González HM, Aguilar-Gaxiola S, Dwight-Johnson M, Barker JC, Tran C, Zuniga R, Unützer J.
Source
Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA. ladson.hinton@ucdmc.ucdavis.edu.
Abstract
OBJECTIVES:
This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders.
METHODS:
This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire.
RESULTS:
The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression.
CONCLUSIONS:
Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.
Int J Geriatr Psychiatry. 2012 Mar 1. doi: 10.1002/gps.3779. [Epub ahead of print]
Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men.
Hinton L, Apesoa-Varano EC, González HM, Aguilar-Gaxiola S, Dwight-Johnson M, Barker JC, Tran C, Zuniga R, Unützer J.
Source
Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA. ladson.hinton@ucdmc.ucdavis.edu.
Abstract
OBJECTIVES:
This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders.
METHODS:
This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire.
RESULTS:
The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression.
CONCLUSIONS:
Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.
From King's College London: The Equality Act 2010 and mental health
http://www.ncbi.nlm.nih.gov/pubmed/22383764
Br J Psychiatry. 2012 Mar;200:182-3.
The Equality Act 2010 and mental health.
Lockwood G, Henderson C, Thornicroft G.
Source
Department of Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Claire.Henderson@iop.kcl.ac.uk.
Abstract
One aim of the Equality Act 2010 is to protect people with disabilities and prevent disability discrimination. We review the key provisions of the Act relevant to disability discrimination with respect to mental illness.
Br J Psychiatry. 2012 Mar;200:182-3.
The Equality Act 2010 and mental health.
Lockwood G, Henderson C, Thornicroft G.
Source
Department of Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Claire.Henderson@iop.kcl.ac.uk.
Abstract
One aim of the Equality Act 2010 is to protect people with disabilities and prevent disability discrimination. We review the key provisions of the Act relevant to disability discrimination with respect to mental illness.
Friday, March 2, 2012
America's health care reform and the concept of "compulsion"
http://www.ncbi.nlm.nih.gov/pubmed/22362723
J Health Serv Res Policy. 2012 Feb 23. [Epub ahead of print]
Compulsion: the key to US health care reform.
Donaldson C, Bryan S.
Source
Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK.
Abstract
To meet the twin goals of cost containment and universal coverage, health care legislators in the US will eventually have to come to grips with the concept of 'compulsion'. This is the main tenet of this paper, which also addresses what compulsion might mean as applied in the context of recent US health care legislation and its implications for the US health care industry. Missing the opportunity to embrace compulsion more fully may lead to cost containment not being achieved, thus threatening the sustainability of the reforms contained in the recently Patient Protection and Affordable Care Act.
J Health Serv Res Policy. 2012 Feb 23. [Epub ahead of print]
Compulsion: the key to US health care reform.
Donaldson C, Bryan S.
Source
Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK.
Abstract
To meet the twin goals of cost containment and universal coverage, health care legislators in the US will eventually have to come to grips with the concept of 'compulsion'. This is the main tenet of this paper, which also addresses what compulsion might mean as applied in the context of recent US health care legislation and its implications for the US health care industry. Missing the opportunity to embrace compulsion more fully may lead to cost containment not being achieved, thus threatening the sustainability of the reforms contained in the recently Patient Protection and Affordable Care Act.
Behavioral health care and health care reform
http://www.ncbi.nlm.nih.gov/pubmed/22371190
Adm Policy Ment Health. 2012 Feb 28. [Epub ahead of print]
Care Integration in the Patient Protection and Affordable Care Act: Implications for Behavioral Health.
Croft B, Parish SL.
Source
Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02454-9110, USA, bcroft@brandeis.edu.
Abstract
Individuals with co-occurring serious mental illness and substance use disorders experience a highly fragmented system of care, contributing to poor health outcomes and elevated levels of unmet treatment needs. Several elements in the health care reform law may address these issues by enhancing the integration of physical and behavioral health care systems. The purpose of this paper is to analyze these elements, which fall into three domains: increasing access, restructuring financing and reimbursement mechanisms, and enhancing infrastructure. We conclude with a consideration of the implementation challenges that lie ahead.
Adm Policy Ment Health. 2012 Feb 28. [Epub ahead of print]
Care Integration in the Patient Protection and Affordable Care Act: Implications for Behavioral Health.
Croft B, Parish SL.
Source
Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02454-9110, USA, bcroft@brandeis.edu.
Abstract
Individuals with co-occurring serious mental illness and substance use disorders experience a highly fragmented system of care, contributing to poor health outcomes and elevated levels of unmet treatment needs. Several elements in the health care reform law may address these issues by enhancing the integration of physical and behavioral health care systems. The purpose of this paper is to analyze these elements, which fall into three domains: increasing access, restructuring financing and reimbursement mechanisms, and enhancing infrastructure. We conclude with a consideration of the implementation challenges that lie ahead.
The role of specialists in health care reform
http://www.ncbi.nlm.nih.gov/pubmed/22373614
Acad Med. 2012 Mar;87(3):258-260.
Commentary: Sense and Sensibility: The Role of Specialists in Health Care Reform.
Schwann NM, Nester BA, McLoughlin TM Jr.
Source
Dr. Schwann is vice chair of research, Department of Anesthesiology, Lehigh Valley Health Network, Allentown, Pennsylvania, and professor of surgery, Division of Surgical Anesthesiology, University of South Florida College of Medicine, Tampa, Florida. Dr. Nester is chief strategy officer, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr. McLoughlin is chair, Department of Anesthesiology, Lehigh Valley Health Network, Allentown, Pennsylvania, and professor of surgery, Division of Surgical Anesthesiology, University of South Florida College of Medicine, Tampa, Florida.
Abstract
How to redesign the incentives structure in the United States to reward effective coordinated care rather than production volume is a staggering public health policy challenge. In the mind of the public, there is a fine distinction between health care rationing and rational health care. Specialists have a vital but underappreciated role in reining in health care costs, but specific incentives to elicit behavior change with positive social outcomes remain ambiguous. It is imperative, therefore, that redesigning the incentives structure is thoughtfully considered, modeled, and tested prior to implementation, lest an inferior-quality model is inadvertently adopted and costs are only marginally contained. Quality metrics need to be universal and reflect real patient outcomes instead of the degree of investment by the institution in the reporting tools. Still, specialists should take immediate action to implement safe and efficient procedures and to assess their long-term impact on patients' quality of life. Scientific evaluations should guide both the assessment of the appropriateness and the safe delivery of care. Investment in high-quality data architecture and the science of health delivery implementation is an imperative if health care reform is to achieve its goals. Coordination and collaboration between specialists and primary care physicians is essential to this enterprise. Specialists can champion these efforts as they pertain to their areas of expertise by considering their care episodes in the context of the patient as a whole, working closely with generalists, and returning to the mindset of the specialist as a family doctor.
Acad Med. 2012 Mar;87(3):258-260.
Commentary: Sense and Sensibility: The Role of Specialists in Health Care Reform.
Schwann NM, Nester BA, McLoughlin TM Jr.
Source
Dr. Schwann is vice chair of research, Department of Anesthesiology, Lehigh Valley Health Network, Allentown, Pennsylvania, and professor of surgery, Division of Surgical Anesthesiology, University of South Florida College of Medicine, Tampa, Florida. Dr. Nester is chief strategy officer, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr. McLoughlin is chair, Department of Anesthesiology, Lehigh Valley Health Network, Allentown, Pennsylvania, and professor of surgery, Division of Surgical Anesthesiology, University of South Florida College of Medicine, Tampa, Florida.
Abstract
How to redesign the incentives structure in the United States to reward effective coordinated care rather than production volume is a staggering public health policy challenge. In the mind of the public, there is a fine distinction between health care rationing and rational health care. Specialists have a vital but underappreciated role in reining in health care costs, but specific incentives to elicit behavior change with positive social outcomes remain ambiguous. It is imperative, therefore, that redesigning the incentives structure is thoughtfully considered, modeled, and tested prior to implementation, lest an inferior-quality model is inadvertently adopted and costs are only marginally contained. Quality metrics need to be universal and reflect real patient outcomes instead of the degree of investment by the institution in the reporting tools. Still, specialists should take immediate action to implement safe and efficient procedures and to assess their long-term impact on patients' quality of life. Scientific evaluations should guide both the assessment of the appropriateness and the safe delivery of care. Investment in high-quality data architecture and the science of health delivery implementation is an imperative if health care reform is to achieve its goals. Coordination and collaboration between specialists and primary care physicians is essential to this enterprise. Specialists can champion these efforts as they pertain to their areas of expertise by considering their care episodes in the context of the patient as a whole, working closely with generalists, and returning to the mindset of the specialist as a family doctor.
From NEJM: SCOTUS review of the health care reform law
http://www.ncbi.nlm.nih.gov/pubmed/22375936
N Engl J Med. 2012 Feb 29. [Epub ahead of print]
Supreme Court Review of the Health Care Reform Law.
Curfman GD, Abel BS, Landers RM.
Source
Dr. Curfman is the Executive Editor, and Mr. Abel the Senior Perspective Researcher, of the Journal; Ms. Landers is a Professor of law at Suffolk University Law School, Boston.
Abstract
Later this month, the U.S. Supreme Court will examine the constitutionality of the Affordable Care Act (ACA),(1) potentially producing a landmark decision. For most cases, the Supreme Court allocates 1 hour for oral argument - 30 minutes for each side. For the health care reform case, the Court has scheduled 6 hours for oral argument - the most time devoted to a case in more than 45 years. These arguments will take place on March 26, 27, and 28 (see box), and the Court's ruling will probably be announced in June. Setting the foundation for the largest expansion of health . . .
N Engl J Med. 2012 Feb 29. [Epub ahead of print]
Supreme Court Review of the Health Care Reform Law.
Curfman GD, Abel BS, Landers RM.
Source
Dr. Curfman is the Executive Editor, and Mr. Abel the Senior Perspective Researcher, of the Journal; Ms. Landers is a Professor of law at Suffolk University Law School, Boston.
Abstract
Later this month, the U.S. Supreme Court will examine the constitutionality of the Affordable Care Act (ACA),(1) potentially producing a landmark decision. For most cases, the Supreme Court allocates 1 hour for oral argument - 30 minutes for each side. For the health care reform case, the Court has scheduled 6 hours for oral argument - the most time devoted to a case in more than 45 years. These arguments will take place on March 26, 27, and 28 (see box), and the Court's ruling will probably be announced in June. Setting the foundation for the largest expansion of health . . .
Tuberculosis among drug users and the homeless
http://www.ncbi.nlm.nih.gov/pubmed/22237472
Infection. 2012 Jan 12. [Epub ahead of print]
Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding.
Goetsch U, Bellinger OK, Buettel KL, Gottschalk R.
Source
Department of Health, Department of Infectious Diseases, Health Protection Authority, City of Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany.
Abstract
BACKGROUND:
Illicit drug use and homelessness are major contributors to the incidence of tuberculosis (TB) among inhabitants of major cities.
OBJECTIVE:
The primary objective of this study was to establish a sustainable low-threshold chest X-ray screening programme for pulmonary TB among illicit drug users and homeless persons and to integrate this into the existing public health programme for active case finding. A secondary objective was to estimate the coverage of the programme, assess other risk factors and determine TB rates and treatment outcome in these two groups.
METHODS:
Illicit drug users and homeless persons were asked to voluntarily participate in an X-ray screening programme. The coverage of the intervention, total number and characteristics of cases and the follow-up of treatment were assessed.
RESULTS:
A total of 4,529 chest radiographs were made from 3,477 persons, of whom 66% were homeless and 34% were illicit drug users, between May 2002 and April 2007. Coverage for screening once every 2 years ranged between 18 and 26%. Thirty-nine TB cases (14 drug users, 25 homeless persons) were identified, representing 8.7% of the total case load of 448 notified cases of pulmonary TB in Frankfurt during this period. Among the drug users, human immunodeficiency virus coinfection (10/14) seemed to play a key role in the development of TB. The case-finding rate of 861/100,000 radiographs (1,122/100,000 persons) is as high as that in routine contact investigations (1,078/100,000). Among all individuals with TB, 76% completed treatment.
CONCLUSION:
A novel targeted TB screening approach with voluntary radiographic examination of illicit drug users and homeless persons can be integrated into the existing public TB prevention programme and provides a high case-finding rate.
Infection. 2012 Jan 12. [Epub ahead of print]
Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding.
Goetsch U, Bellinger OK, Buettel KL, Gottschalk R.
Source
Department of Health, Department of Infectious Diseases, Health Protection Authority, City of Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany.
Abstract
BACKGROUND:
Illicit drug use and homelessness are major contributors to the incidence of tuberculosis (TB) among inhabitants of major cities.
OBJECTIVE:
The primary objective of this study was to establish a sustainable low-threshold chest X-ray screening programme for pulmonary TB among illicit drug users and homeless persons and to integrate this into the existing public health programme for active case finding. A secondary objective was to estimate the coverage of the programme, assess other risk factors and determine TB rates and treatment outcome in these two groups.
METHODS:
Illicit drug users and homeless persons were asked to voluntarily participate in an X-ray screening programme. The coverage of the intervention, total number and characteristics of cases and the follow-up of treatment were assessed.
RESULTS:
A total of 4,529 chest radiographs were made from 3,477 persons, of whom 66% were homeless and 34% were illicit drug users, between May 2002 and April 2007. Coverage for screening once every 2 years ranged between 18 and 26%. Thirty-nine TB cases (14 drug users, 25 homeless persons) were identified, representing 8.7% of the total case load of 448 notified cases of pulmonary TB in Frankfurt during this period. Among the drug users, human immunodeficiency virus coinfection (10/14) seemed to play a key role in the development of TB. The case-finding rate of 861/100,000 radiographs (1,122/100,000 persons) is as high as that in routine contact investigations (1,078/100,000). Among all individuals with TB, 76% completed treatment.
CONCLUSION:
A novel targeted TB screening approach with voluntary radiographic examination of illicit drug users and homeless persons can be integrated into the existing public TB prevention programme and provides a high case-finding rate.
Utility of mentoring homeless adolescents
http://www.ncbi.nlm.nih.gov/pubmed/22242619
Am J Drug Alcohol Abuse. 2012 Jan 13. [Epub ahead of print]
The Utility of Mentoring Homeless Adolescents: A Pilot Study.
Bartle-Haring S, Slesnick N, Collins J, Erdem G, Buettner C.
Source
Department of Human Development and Family Science, The Ohio State University , Columbus, OH , USA.
Abstract
Background: Despite the intuitive appeal and popularity of mentoring programs, mentoring has shown only limited success for positively impacting children's psychosocial functioning. Furthermore, we were not able to identify a study that examined the potential utility of mentoring for homeless adolescents. Objective: The purpose of this pilot study was to examine the impact of mentoring among a group of homeless adolescents who were also receiving substance abuse treatment. Methods: This pilot study examined the impact of mentoring among homeless adolescents (n = 90) between the ages of 14 and 20 years who also received substance abuse treatment. A longitudinal design was used in which adolescents were assessed at baseline, 3 months, and following the completion of treatment at 6 months postbaseline. Results: Findings showed that adolescents with a history of physical or sexual abuse attended more mentoring sessions. Also, mentoring in addition to treatment was associated with a decrease in problem consequences associated with substance use. However, more mentoring with fewer treatment sessions was associated with an increase in internalizing behaviors. Only these two outcomes were associated with mentoring. Conclusions and Scientific Significance: While not providing resounding support for mentoring, this study suggests that examining the mentor/mentee relationship may be a fruitful line of future research given that significant variability among the mentor/mentee pairs was noted for some outcomes of interest.
Am J Drug Alcohol Abuse. 2012 Jan 13. [Epub ahead of print]
The Utility of Mentoring Homeless Adolescents: A Pilot Study.
Bartle-Haring S, Slesnick N, Collins J, Erdem G, Buettner C.
Source
Department of Human Development and Family Science, The Ohio State University , Columbus, OH , USA.
Abstract
Background: Despite the intuitive appeal and popularity of mentoring programs, mentoring has shown only limited success for positively impacting children's psychosocial functioning. Furthermore, we were not able to identify a study that examined the potential utility of mentoring for homeless adolescents. Objective: The purpose of this pilot study was to examine the impact of mentoring among a group of homeless adolescents who were also receiving substance abuse treatment. Methods: This pilot study examined the impact of mentoring among homeless adolescents (n = 90) between the ages of 14 and 20 years who also received substance abuse treatment. A longitudinal design was used in which adolescents were assessed at baseline, 3 months, and following the completion of treatment at 6 months postbaseline. Results: Findings showed that adolescents with a history of physical or sexual abuse attended more mentoring sessions. Also, mentoring in addition to treatment was associated with a decrease in problem consequences associated with substance use. However, more mentoring with fewer treatment sessions was associated with an increase in internalizing behaviors. Only these two outcomes were associated with mentoring. Conclusions and Scientific Significance: While not providing resounding support for mentoring, this study suggests that examining the mentor/mentee relationship may be a fruitful line of future research given that significant variability among the mentor/mentee pairs was noted for some outcomes of interest.
Obesity and dental caries in homeless children
http://www.ncbi.nlm.nih.gov/pubmed/22243922
J Pediatr Health Care. 2012 Jan 11. [Epub ahead of print]
Childhood Obesity and Dental Caries in Homeless Children.
Chiu SH, Dimarco MA, Prokop JL.
Abstract
INTRODUCTION:
Childhood obesity and dental caries are increasing epidemics, especially among children who are living below the poverty level. This study was conducted to determine the relationship between body mass index (BMI) and caries in homeless children.
METHODS:
A secondary data analysis with a correlational design was used. A convenience sample of 157 children was recruited from a homeless shelter.
RESULTS:
Pearson's and partial correlations were used to explore the relationships among age, BMI, and caries. Most of the children were girls and were African American. Slightly more than half of the children were overweight (19.7%) or obese (30.6%) and had caries (50.3%). Significant positive correlations between age and BMI (p = .03) as well as between age and caries (p = .003) were found. As BMI increased, so did caries (p = .08).
DISCUSSION:
Consistent with reports from the Centers for Disease Control and Prevention, homeless children had higher BMI and caries rates than the national averages. Although a definitive conclusion between obesity and dental caries cannot be drawn, these two health issues are important areas for all pediatric health care providers to address at every visit.
J Pediatr Health Care. 2012 Jan 11. [Epub ahead of print]
Childhood Obesity and Dental Caries in Homeless Children.
Chiu SH, Dimarco MA, Prokop JL.
Abstract
INTRODUCTION:
Childhood obesity and dental caries are increasing epidemics, especially among children who are living below the poverty level. This study was conducted to determine the relationship between body mass index (BMI) and caries in homeless children.
METHODS:
A secondary data analysis with a correlational design was used. A convenience sample of 157 children was recruited from a homeless shelter.
RESULTS:
Pearson's and partial correlations were used to explore the relationships among age, BMI, and caries. Most of the children were girls and were African American. Slightly more than half of the children were overweight (19.7%) or obese (30.6%) and had caries (50.3%). Significant positive correlations between age and BMI (p = .03) as well as between age and caries (p = .003) were found. As BMI increased, so did caries (p = .08).
DISCUSSION:
Consistent with reports from the Centers for Disease Control and Prevention, homeless children had higher BMI and caries rates than the national averages. Although a definitive conclusion between obesity and dental caries cannot be drawn, these two health issues are important areas for all pediatric health care providers to address at every visit.
Mobilizing homeless youth for HIV prevention
http://www.ncbi.nlm.nih.gov/pubmed/22247453
Health Educ Res. 2012 Jan 13. [Epub ahead of print]
Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention.
Rice E, Tulbert E, Cederbaum J, Barman Adhikari A, Milburn NG.
Source
1School of Social Work, University of Southern California, CA, USA.
Abstract
The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future.
Health Educ Res. 2012 Jan 13. [Epub ahead of print]
Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention.
Rice E, Tulbert E, Cederbaum J, Barman Adhikari A, Milburn NG.
Source
1School of Social Work, University of Southern California, CA, USA.
Abstract
The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future.
Association of childhood abuse with homeless women's social networks
http://www.ncbi.nlm.nih.gov/pubmed/22265902
Child Abuse Negl. 2012 Jan;36(1):21-31. Epub 2012 Jan 20.
Association of childhood abuse with homeless women's social networks.
Green HD Jr, Tucker JS, Wenzel SL, Golinelli D, Kennedy DP, Ryan GW, Zhou AJ.
Source
RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90401-3208, USA.
Abstract
OBJECTIVE:
Childhood abuse has been linked to negative sequelae for women later in life including drug and alcohol use and violence as victim or perpetrator and may also affect the development of women's social networks. Childhood abuse is prevalent among at-risk populations of women (such as the homeless) and thus may have a stronger impact on their social networks. We conducted a study to: (a) develop a typology of sheltered homeless women's social networks; (b) determine whether childhood abuse was associated with the social networks of sheltered homeless women; and (c) determine whether those associations remained after accounting for past-year substance abuse and recent intimate partner abuse.
METHODS:
A probability sample of 428 homeless women from temporary shelter settings in Los Angeles County completed a personal network survey that provided respondent information as well as information about their network members' demographics and level of interaction with each other. Cluster analyses identified groups of women who shared specific social network characteristics. Multinomial logistic regressions revealed variables associated with group membership.
RESULTS:
We identified three groups of women with differing social network characteristics: low-risk networks, densely connected risky networks (dense, risky), and sparsely connected risky networks (sparse, risky). Multinomial logistic regressions indicated that membership in the sparse, risky network group, when compared to the low-risk group, was associated with history of childhood physical abuse (but not sexual or emotional abuse). Recent drug abuse was associated with membership in both risky network groups; however, the association of childhood physical abuse with sparse, risky network group membership remained.
CONCLUSIONS:
Although these findings support theories proposing that the experience of childhood abuse can shape women's social networks, they suggest that it may be childhood physical abuse that has the most impact among homeless women.
PRACTICAL IMPLICATIONS:
The effects of childhood physical abuse should be more actively investigated in clinical settings, especially those frequented by homeless women, particularly with respect to the formation of social networks in social contexts that may expose these women to greater risks.
Child Abuse Negl. 2012 Jan;36(1):21-31. Epub 2012 Jan 20.
Association of childhood abuse with homeless women's social networks.
Green HD Jr, Tucker JS, Wenzel SL, Golinelli D, Kennedy DP, Ryan GW, Zhou AJ.
Source
RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90401-3208, USA.
Abstract
OBJECTIVE:
Childhood abuse has been linked to negative sequelae for women later in life including drug and alcohol use and violence as victim or perpetrator and may also affect the development of women's social networks. Childhood abuse is prevalent among at-risk populations of women (such as the homeless) and thus may have a stronger impact on their social networks. We conducted a study to: (a) develop a typology of sheltered homeless women's social networks; (b) determine whether childhood abuse was associated with the social networks of sheltered homeless women; and (c) determine whether those associations remained after accounting for past-year substance abuse and recent intimate partner abuse.
METHODS:
A probability sample of 428 homeless women from temporary shelter settings in Los Angeles County completed a personal network survey that provided respondent information as well as information about their network members' demographics and level of interaction with each other. Cluster analyses identified groups of women who shared specific social network characteristics. Multinomial logistic regressions revealed variables associated with group membership.
RESULTS:
We identified three groups of women with differing social network characteristics: low-risk networks, densely connected risky networks (dense, risky), and sparsely connected risky networks (sparse, risky). Multinomial logistic regressions indicated that membership in the sparse, risky network group, when compared to the low-risk group, was associated with history of childhood physical abuse (but not sexual or emotional abuse). Recent drug abuse was associated with membership in both risky network groups; however, the association of childhood physical abuse with sparse, risky network group membership remained.
CONCLUSIONS:
Although these findings support theories proposing that the experience of childhood abuse can shape women's social networks, they suggest that it may be childhood physical abuse that has the most impact among homeless women.
PRACTICAL IMPLICATIONS:
The effects of childhood physical abuse should be more actively investigated in clinical settings, especially those frequented by homeless women, particularly with respect to the formation of social networks in social contexts that may expose these women to greater risks.
Prevalence and risk of homelessness among US veterans
http://www.ncbi.nlm.nih.gov/pubmed/22280960
Prev Chronic Dis. 2012 Jan;9(1):E45. Epub 2012 Jan 26.
Prevalence and Risk of Homelessness Among US Veterans.
Fargo J, Metraux S, Byrne T, Montgomery AE, Jones H, Culhane D, Munley E, Sheldon G, Kane V.
Source
National Center on Homelessness Among Veterans and Utah State University Department of Psychology, 2810 Old Main Hill St, Logan, UT 84322-2810. E-mail: jamison.fargo@usu.edu.
Abstract
INTRODUCTION:
Understanding the prevalence of and risk for homelessness among veterans is prerequisite to preventing and ending homelessness among this population. Homeless veterans are at higher risk for chronic disease; understanding the dynamics of homelessness among veterans can contribute to our understanding of their health needs.
METHODS:
We obtained data on demographic characteristics and veteran status for 130,554 homeless people from 7 jurisdictions that provide homelessness services, and for the population living in poverty and the general population from the American Community Survey for those same jurisdictions. We calculated prevalence of veterans in the homeless, poverty, and general populations, and risk ratios (RR) for veteran status in these populations. Risk for homelessness, as a function of demographic characteristics and veteran status, was estimated by using multivariate regression models.
RESULTS:
Veterans were overrepresented in the homeless population, compared with both the general and poverty populations, among both men (RR, 1.3 and 2.1, respectively) and women (RR, 2.1 and 3.0, respectively). Veteran status and black race significantly increased the risk for homelessness for both men and women. Men in the 45- to 54-year-old age group and women in the 18- to 29-year-old age group were at higher risk compared with other ages.
CONCLUSION:
Our findings confirm previous research associating veteran status with higher risk for homelessness and imply that there will be specific health needs among the aging homeless population. This study is a basis for understanding variation in rates of, and risks for, homelessness in general population groups, and inclusion of health data from US Department of Veterans Affairs records can extend these results to identifying links between homelessness and health risks.
Prev Chronic Dis. 2012 Jan;9(1):E45. Epub 2012 Jan 26.
Prevalence and Risk of Homelessness Among US Veterans.
Fargo J, Metraux S, Byrne T, Montgomery AE, Jones H, Culhane D, Munley E, Sheldon G, Kane V.
Source
National Center on Homelessness Among Veterans and Utah State University Department of Psychology, 2810 Old Main Hill St, Logan, UT 84322-2810. E-mail: jamison.fargo@usu.edu.
Abstract
INTRODUCTION:
Understanding the prevalence of and risk for homelessness among veterans is prerequisite to preventing and ending homelessness among this population. Homeless veterans are at higher risk for chronic disease; understanding the dynamics of homelessness among veterans can contribute to our understanding of their health needs.
METHODS:
We obtained data on demographic characteristics and veteran status for 130,554 homeless people from 7 jurisdictions that provide homelessness services, and for the population living in poverty and the general population from the American Community Survey for those same jurisdictions. We calculated prevalence of veterans in the homeless, poverty, and general populations, and risk ratios (RR) for veteran status in these populations. Risk for homelessness, as a function of demographic characteristics and veteran status, was estimated by using multivariate regression models.
RESULTS:
Veterans were overrepresented in the homeless population, compared with both the general and poverty populations, among both men (RR, 1.3 and 2.1, respectively) and women (RR, 2.1 and 3.0, respectively). Veteran status and black race significantly increased the risk for homelessness for both men and women. Men in the 45- to 54-year-old age group and women in the 18- to 29-year-old age group were at higher risk compared with other ages.
CONCLUSION:
Our findings confirm previous research associating veteran status with higher risk for homelessness and imply that there will be specific health needs among the aging homeless population. This study is a basis for understanding variation in rates of, and risks for, homelessness in general population groups, and inclusion of health data from US Department of Veterans Affairs records can extend these results to identifying links between homelessness and health risks.
Outcomes of Homeless veterans in transitional housing
http://www.ncbi.nlm.nih.gov/pubmed/22294507
Community Ment Health J. 2012 Feb 1. [Epub ahead of print]
Comparison of Outcomes of Homeless Female and Male Veterans in Transitional Housing.
Tsai J, Rosenheck RA, McGuire JF.
Source
VA New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA, Jack.Tsai@yale.edu.
Abstract
Homelessness among female veterans is of national concern, but there have been few studies of how they differ from male veterans or whether they have different outcomes. This study compared 59 female and 1,181 male participants in a multi-site study of three VA-funded transitional housing programs over a 1-year period following completion of an episode of treatment. At baseline, female participants were younger, reported more psychiatric symptoms, had shorter histories of homelessness, were less likely to have substance use disorders, and were less likely to be working than males. After controlling for these baseline differences, there were no overall gender differences in outcomes measures of housing, employment, substance use, physical and mental health, or quality of life. These results suggest homeless female veterans have different characteristics than male veterans, but benefit equally from transitional housing.
Community Ment Health J. 2012 Feb 1. [Epub ahead of print]
Comparison of Outcomes of Homeless Female and Male Veterans in Transitional Housing.
Tsai J, Rosenheck RA, McGuire JF.
Source
VA New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA, Jack.Tsai@yale.edu.
Abstract
Homelessness among female veterans is of national concern, but there have been few studies of how they differ from male veterans or whether they have different outcomes. This study compared 59 female and 1,181 male participants in a multi-site study of three VA-funded transitional housing programs over a 1-year period following completion of an episode of treatment. At baseline, female participants were younger, reported more psychiatric symptoms, had shorter histories of homelessness, were less likely to have substance use disorders, and were less likely to be working than males. After controlling for these baseline differences, there were no overall gender differences in outcomes measures of housing, employment, substance use, physical and mental health, or quality of life. These results suggest homeless female veterans have different characteristics than male veterans, but benefit equally from transitional housing.
A coherent strategy in response to homeless and street-involved youth
http://www.ncbi.nlm.nih.gov/pubmed/22302217
J Youth Adolesc. 2012 Feb 1. [Epub ahead of print]
Invited Commentary: Seeking a Coherent Strategy in our Response to Homeless and Street-Involved Youth: A Historical Review and Suggested Future Directions.
Kidd S.
Source
Department of Psychiatry, University of Toronto, Toronto, ON, Canada, sean_kidd@camh.net.
Abstract
This invited commentary seeks to encourage a critical dialogue about youth homelessness that might assist in re-energizing a field that seems increasingly stagnant with a research body focused primarily on analyses of risk, hopelessly inadequate policy frameworks in most cities, diminishing funds for services, and decreasing media attention. Reviewing major trends in research and public responses to youth homelessness in the past century, I propose that there exist three major culturally-bound dimensions from which we construct our understanding of and responses to youth homelessness. These dimensions, which are considered in a transactional framework, are the scope of responsibility, the location of moral responsibility, and the amount of agency attributed to the youth. In this review I highlight the manner in which our historically binary and uncritical understanding of these dimensional characterizations of youth homelessness has led to major lapses in the effectiveness of our collective efforts to address this problem. I highlight gaps in the existing body of research literature and provide this framework, arguing that a strategic and cohesive response is vital if we are to move from reiterations of risk and hackneyed calls for prevention strategies to the generation of meaningful solutions.
J Youth Adolesc. 2012 Feb 1. [Epub ahead of print]
Invited Commentary: Seeking a Coherent Strategy in our Response to Homeless and Street-Involved Youth: A Historical Review and Suggested Future Directions.
Kidd S.
Source
Department of Psychiatry, University of Toronto, Toronto, ON, Canada, sean_kidd@camh.net.
Abstract
This invited commentary seeks to encourage a critical dialogue about youth homelessness that might assist in re-energizing a field that seems increasingly stagnant with a research body focused primarily on analyses of risk, hopelessly inadequate policy frameworks in most cities, diminishing funds for services, and decreasing media attention. Reviewing major trends in research and public responses to youth homelessness in the past century, I propose that there exist three major culturally-bound dimensions from which we construct our understanding of and responses to youth homelessness. These dimensions, which are considered in a transactional framework, are the scope of responsibility, the location of moral responsibility, and the amount of agency attributed to the youth. In this review I highlight the manner in which our historically binary and uncritical understanding of these dimensional characterizations of youth homelessness has led to major lapses in the effectiveness of our collective efforts to address this problem. I highlight gaps in the existing body of research literature and provide this framework, arguing that a strategic and cohesive response is vital if we are to move from reiterations of risk and hackneyed calls for prevention strategies to the generation of meaningful solutions.
Blood exposure in hostels and hepatitis C among the homeless
http://www.ncbi.nlm.nih.gov/pubmed/22305305
Int J Drug Policy. 2012 Feb 2. [Epub ahead of print]
Routine exposure to blood within hostel environments might help to explain elevated levels of hepatitis C amongst homeless drug users: Insights from a qualitative study.
Neale J, Stevenson C.
Source
Department of Social Work and Public Health, Oxford Brookes University, Jack Straw's Lane, Marston, Oxford OX3 0FL, UK.
Abstract
BACKGROUND:
Although homelessness is a risk factor for HCV infection, there is a lack of research exploring the relationship between living in a hostel for homeless people and blood-borne viruses. The tendency to focus on risky injecting practices and HCV has also eclipsed the transmission risks potentially posed by spilt and dried blood.
METHODS:
Semi-structured qualitative interviews were conducted with 40 homeless drug users (HDUs) (29 men and 11 women). The aim of the study was to explore the support needs of HDUs staying in emergency hostels or night shelters, but blood emerged as an unexpected recurring topic within participants' accounts. Accordingly, all blood data were coded and analysed inductively.
RESULTS:
Participants reported that spilt and dried blood were routine features of hostel life, particularly in larger night shelters. Given that the hepatitis C virus can survive outside the human body for several weeks and even months, this poses a worrying but largely overlooked transmission risk. According to the HDUs interviewed, hostel providers were often slow to remove blood and other bodily waste, leaving residents to clean it themselves or to avoid soiled areas.
CONCLUSIONS:
The routine presence of blood within hostel environments might help to explain elevated levels of HCV amongst homeless drug users. However, there is a need for robust quantitative and qualitative research to systematically test and explore associations between HCV and hostel life. Recommendations are made for improving hostel cleanliness, apprising hostel staff and residents of HCV and other blood-borne virus transmission risks, and ensuring that blood and other bodily waste are deemed unacceptable features of any hostel setting.
Int J Drug Policy. 2012 Feb 2. [Epub ahead of print]
Routine exposure to blood within hostel environments might help to explain elevated levels of hepatitis C amongst homeless drug users: Insights from a qualitative study.
Neale J, Stevenson C.
Source
Department of Social Work and Public Health, Oxford Brookes University, Jack Straw's Lane, Marston, Oxford OX3 0FL, UK.
Abstract
BACKGROUND:
Although homelessness is a risk factor for HCV infection, there is a lack of research exploring the relationship between living in a hostel for homeless people and blood-borne viruses. The tendency to focus on risky injecting practices and HCV has also eclipsed the transmission risks potentially posed by spilt and dried blood.
METHODS:
Semi-structured qualitative interviews were conducted with 40 homeless drug users (HDUs) (29 men and 11 women). The aim of the study was to explore the support needs of HDUs staying in emergency hostels or night shelters, but blood emerged as an unexpected recurring topic within participants' accounts. Accordingly, all blood data were coded and analysed inductively.
RESULTS:
Participants reported that spilt and dried blood were routine features of hostel life, particularly in larger night shelters. Given that the hepatitis C virus can survive outside the human body for several weeks and even months, this poses a worrying but largely overlooked transmission risk. According to the HDUs interviewed, hostel providers were often slow to remove blood and other bodily waste, leaving residents to clean it themselves or to avoid soiled areas.
CONCLUSIONS:
The routine presence of blood within hostel environments might help to explain elevated levels of HCV amongst homeless drug users. However, there is a need for robust quantitative and qualitative research to systematically test and explore associations between HCV and hostel life. Recommendations are made for improving hostel cleanliness, apprising hostel staff and residents of HCV and other blood-borne virus transmission risks, and ensuring that blood and other bodily waste are deemed unacceptable features of any hostel setting.
Housing, work support, and outcomes for the homeless with mental illness
http://www.ncbi.nlm.nih.gov/pubmed/22307878
Psychiatr Serv. 2012 Feb 1. [Epub ahead of print]
Impact of Housing and Work Supports on Outcomes for Chronically Homeless Adults With Mental Illness: LA's HOPE.
Burt MR.
Abstract
OBJECTIVE:
This study examined the impact of a federally funded housing and employment demonstration program (Los Angeles' Homeless Opportunity Providing Employment [LA's HOPE]) for homeless adults with mental illness.
METHODS:
The sample included all participants enrolled between July 1, 2004, and May 17, 2005, in one of 18 Los Angeles County community mental health centers offering a state-funded program (AB2034) to reduce homelessness among people with serious mental illness. Fifty-six demonstration clients enrolled in three centers received housing and special employment supports. Their outcomes were compared with those of 415 clients enrolled in the county's other 15 AB2034 programs during the same period. Data included demographic characteristics, circumstances at enrollment and in the previous 12 months, and outcomes for at least 13 months after enrollment. Outcomes analyses used propensity score matching.
RESULTS:
Demonstration clients got and kept housing and worked in paid employment and employment-related activities at rates significantly higher than those of the comparison group. Other than client group, no personal characteristics made any systematic difference to employment outcomes. Several personal characteristics-race and ethnicity, preenrollment length of homelessness, and whether the client had a co-occurring substance use disorder-affected housing outcomes independently of client group.
CONCLUSIONS:
The demonstration provided the structure and resources to help clients achieve better housing and employment outcomes than the comparison group had. The outcomes for LA's HOPE clients suggest that this very challenged population can achieve improved work outcomes if programs devote adequate and appropriate resources to help them.
Psychiatr Serv. 2012 Feb 1. [Epub ahead of print]
Impact of Housing and Work Supports on Outcomes for Chronically Homeless Adults With Mental Illness: LA's HOPE.
Burt MR.
Abstract
OBJECTIVE:
This study examined the impact of a federally funded housing and employment demonstration program (Los Angeles' Homeless Opportunity Providing Employment [LA's HOPE]) for homeless adults with mental illness.
METHODS:
The sample included all participants enrolled between July 1, 2004, and May 17, 2005, in one of 18 Los Angeles County community mental health centers offering a state-funded program (AB2034) to reduce homelessness among people with serious mental illness. Fifty-six demonstration clients enrolled in three centers received housing and special employment supports. Their outcomes were compared with those of 415 clients enrolled in the county's other 15 AB2034 programs during the same period. Data included demographic characteristics, circumstances at enrollment and in the previous 12 months, and outcomes for at least 13 months after enrollment. Outcomes analyses used propensity score matching.
RESULTS:
Demonstration clients got and kept housing and worked in paid employment and employment-related activities at rates significantly higher than those of the comparison group. Other than client group, no personal characteristics made any systematic difference to employment outcomes. Several personal characteristics-race and ethnicity, preenrollment length of homelessness, and whether the client had a co-occurring substance use disorder-affected housing outcomes independently of client group.
CONCLUSIONS:
The demonstration provided the structure and resources to help clients achieve better housing and employment outcomes than the comparison group had. The outcomes for LA's HOPE clients suggest that this very challenged population can achieve improved work outcomes if programs devote adequate and appropriate resources to help them.
Suicide ideation among homeless men
http://www.ncbi.nlm.nih.gov/pubmed/22324750
Suicide Life Threat Behav. 2012 Feb 10. doi: 10.1111/j.1943-278X.2011.00078.x. [Epub ahead of print]
Psychache and Suicide Ideation among Men Who Are Homeless: A Test of Shneidman's Model.
Patterson AA, Holden RR.
Source
Allisha A. Patterson and Ronald R. Holden, Psychology Department, Queen's University, Kingston, Ontario, Canada.
Abstract
Suicide ideation among the homeless is 10 times more common than in the general population. Cognitive theories of depression and hopelessness propose to explain suicidality; however, as yet, none of these fully account for the phenomenon. Shneidman has suggested a theory of psychache or unbearable psychological pain to explain suicidality. This theory has found support among low-risk populations but has not been extensively tested within a high-risk population. The current research assessed the utility of psychache among men who are homeless (N = 97). In support of Shneidman's theory, analyses revealed that psychache was a stronger predictor of suicide ideation than was depression, hopelessness, or life meaning.
Suicide Life Threat Behav. 2012 Feb 10. doi: 10.1111/j.1943-278X.2011.00078.x. [Epub ahead of print]
Psychache and Suicide Ideation among Men Who Are Homeless: A Test of Shneidman's Model.
Patterson AA, Holden RR.
Source
Allisha A. Patterson and Ronald R. Holden, Psychology Department, Queen's University, Kingston, Ontario, Canada.
Abstract
Suicide ideation among the homeless is 10 times more common than in the general population. Cognitive theories of depression and hopelessness propose to explain suicidality; however, as yet, none of these fully account for the phenomenon. Shneidman has suggested a theory of psychache or unbearable psychological pain to explain suicidality. This theory has found support among low-risk populations but has not been extensively tested within a high-risk population. The current research assessed the utility of psychache among men who are homeless (N = 97). In support of Shneidman's theory, analyses revealed that psychache was a stronger predictor of suicide ideation than was depression, hopelessness, or life meaning.
Health-related quality of life among the homeless compared to the general population
http://www.ncbi.nlm.nih.gov/pubmed/22327187
Scand J Public Health. 2012 Feb 10. [Epub ahead of print]
Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006.
Sun S, Irestig R, Burström B, Beijer U, Burström K.
Source
Karolinska Institutet, Stockholm, Sweden.
Abstract
AIMS:
To describe and compare health-related quality of life (HRQoL) among homeless persons with a general population sample in Stockholm County, 2006, and to analyse the importance of certain social determinants of health among the homeless.
METHODS:
Face-to-face interviews with 155 homeless persons and a postal survey to a general population sample, mainly based on the same questionnaire, including questions on social determinants of health and HRQoL measured with the EQ-5D.
RESULTS:
Chronic illness was three times more common among the homeless. HRQoL was worse among homeless persons than in the general population sample: the homeless reported more problems, especially more severe problems, in all the EQ-5D dimensions and had considerably lower EQ-5D(index) and EQ(VAS) score than the general population. Most problems were reported in the dimension anxiety/depression. Among the homeless, longer duration and more severe degree of homelessness lowered HRQoL, but few determinants were statistically significantly related to HRQoL. Having mental disease significantly lowered HRQoL.
CONCLUSIONS:
This study was an attempt to include hard-to-reach groups in an assessment of population health. Homeless persons had considerably worse HRQoL than the general population and reported most problems in the dimension anxiety/depression. Some diseases may contribute to causing homelessness; others may be seen as consequences. Homeless persons are a vulnerable group in society. Further interview studies are needed based on larger sample of homeless persons to explore health determinants such as sex, age, socioeconomic factors, duration and degree of homelessness, and health-related behaviours among the homeless persons.
Scand J Public Health. 2012 Feb 10. [Epub ahead of print]
Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006.
Sun S, Irestig R, Burström B, Beijer U, Burström K.
Source
Karolinska Institutet, Stockholm, Sweden.
Abstract
AIMS:
To describe and compare health-related quality of life (HRQoL) among homeless persons with a general population sample in Stockholm County, 2006, and to analyse the importance of certain social determinants of health among the homeless.
METHODS:
Face-to-face interviews with 155 homeless persons and a postal survey to a general population sample, mainly based on the same questionnaire, including questions on social determinants of health and HRQoL measured with the EQ-5D.
RESULTS:
Chronic illness was three times more common among the homeless. HRQoL was worse among homeless persons than in the general population sample: the homeless reported more problems, especially more severe problems, in all the EQ-5D dimensions and had considerably lower EQ-5D(index) and EQ(VAS) score than the general population. Most problems were reported in the dimension anxiety/depression. Among the homeless, longer duration and more severe degree of homelessness lowered HRQoL, but few determinants were statistically significantly related to HRQoL. Having mental disease significantly lowered HRQoL.
CONCLUSIONS:
This study was an attempt to include hard-to-reach groups in an assessment of population health. Homeless persons had considerably worse HRQoL than the general population and reported most problems in the dimension anxiety/depression. Some diseases may contribute to causing homelessness; others may be seen as consequences. Homeless persons are a vulnerable group in society. Further interview studies are needed based on larger sample of homeless persons to explore health determinants such as sex, age, socioeconomic factors, duration and degree of homelessness, and health-related behaviours among the homeless persons.
Encounters between homeless pet owners and the public
http://www.ncbi.nlm.nih.gov/pubmed/22329059
Sociol Q. 2012;53(1):25-43.
Confrontations and donations: encounters between homeless pet owners and the public.
Irvine L, Kahl KN, Smith JM.
Source
University of Colorado at Boulder.
Abstract
This study examines the interactions between homeless pet owners and the domiciled public with a focus on how the activities of pet ownership help construct positive personal identities. Homeless people are often criticized for having pets. They counter these attacks using open and contained responses to stigmatization. More often, they redefine pet ownership to incorporate how they provide for their animals, challenging definitions that require a physical home. Homeless pet owners thus create a positive moral identity by emphasizing that they feed their animals first and give them freedom that the pets of the domiciled lack. Through what we call “enabled resistance,” donations of pet food from the supportive public provide the resources to minimize the impact of stigmatization.
Sociol Q. 2012;53(1):25-43.
Confrontations and donations: encounters between homeless pet owners and the public.
Irvine L, Kahl KN, Smith JM.
Source
University of Colorado at Boulder.
Abstract
This study examines the interactions between homeless pet owners and the domiciled public with a focus on how the activities of pet ownership help construct positive personal identities. Homeless people are often criticized for having pets. They counter these attacks using open and contained responses to stigmatization. More often, they redefine pet ownership to incorporate how they provide for their animals, challenging definitions that require a physical home. Homeless pet owners thus create a positive moral identity by emphasizing that they feed their animals first and give them freedom that the pets of the domiciled lack. Through what we call “enabled resistance,” donations of pet food from the supportive public provide the resources to minimize the impact of stigmatization.
Needs and outcomes of homeless veterans and non-veterans
http://www.ncbi.nlm.nih.gov/pubmed/22338975
Mil Med. 2012 Jan;177(1):27-31.
Do homeless veterans have the same needs and outcomes as non-veterans?
Tsai J, Mares AS, Rosenheck RA.
Source
VA New England Mental Illness Research, Education, and Clinical Center, West Haven, CT 06516, USA.
Abstract
Although veterans have been found to be at increased risk for homelessness as compared to non-veterans, it is not clear whether those who are homeless have more severe health problems or poorer outcomes in community-based supported housing. This observational study compared 162 chronically homeless veterans to 388 non-veterans enrolled in a national-supported housing initiative over a 1-year period. Results showed that veterans tended to be older, were more likely to be in the Vietnam era age group, to be male, and were more likely to have completed high school than other chronically homeless adults. There were no differences between veterans and non-veterans on housing or clinical status at baseline or at follow-up, but both groups showed significant improvement over time. These findings suggest that the greater risk of homelessness among veterans does not translate into more severe problems or treatment outcomes. Supported housing programs are similarly effective for veterans and non-veterans.
Mil Med. 2012 Jan;177(1):27-31.
Do homeless veterans have the same needs and outcomes as non-veterans?
Tsai J, Mares AS, Rosenheck RA.
Source
VA New England Mental Illness Research, Education, and Clinical Center, West Haven, CT 06516, USA.
Abstract
Although veterans have been found to be at increased risk for homelessness as compared to non-veterans, it is not clear whether those who are homeless have more severe health problems or poorer outcomes in community-based supported housing. This observational study compared 162 chronically homeless veterans to 388 non-veterans enrolled in a national-supported housing initiative over a 1-year period. Results showed that veterans tended to be older, were more likely to be in the Vietnam era age group, to be male, and were more likely to have completed high school than other chronically homeless adults. There were no differences between veterans and non-veterans on housing or clinical status at baseline or at follow-up, but both groups showed significant improvement over time. These findings suggest that the greater risk of homelessness among veterans does not translate into more severe problems or treatment outcomes. Supported housing programs are similarly effective for veterans and non-veterans.
Work skills training for the homeless
http://www.ncbi.nlm.nih.gov/pubmed/22350627
Community Ment Health J. 2012 Feb 21. [Epub ahead of print]
Moving Ahead: Evaluation of a Work-Skills Training Program for Homeless Adults.
Nelson SE, Gray HM, Maurice IR, Shaffer HJ.
Source
Division on Addiction, Cambridge Health Alliance, Medford, MA, 01060, USA, snelson@hms.harvard.edu.
Abstract
This study examines the impact of a work-skills program grounded in an integrated services approach on both employment and related life domains among homeless individuals. Six hundred thirty-eight participants in a 14-week work-skills program at a large day center in New England completed assessments at intake between 1999 and 2007; a subsample of 333 also completed assessments at graduation from the program; a smaller subsample of 55 participants were re-assessed 6 months after graduation. These assessments measured work and related life skills, employment, housing status, general health status, substance use, self-esteem and self-efficacy, and legal involvement. Results revealed improvement in all types of work and related life skills, employment and income, and multiple other life domains from baseline to graduation and follow-up. Exploratory analyses suggested that improvements in work and related life skills were associated with improvement in self-esteem and self-efficacy, and that these improvements predicted stable housing situations at follow-up. Overall, these findings indicate that, for individuals struggling with the challenges of homelessness, completion of a work-skills program has a positive impact on skills and employment, and on a diverse set of life domains.
Community Ment Health J. 2012 Feb 21. [Epub ahead of print]
Moving Ahead: Evaluation of a Work-Skills Training Program for Homeless Adults.
Nelson SE, Gray HM, Maurice IR, Shaffer HJ.
Source
Division on Addiction, Cambridge Health Alliance, Medford, MA, 01060, USA, snelson@hms.harvard.edu.
Abstract
This study examines the impact of a work-skills program grounded in an integrated services approach on both employment and related life domains among homeless individuals. Six hundred thirty-eight participants in a 14-week work-skills program at a large day center in New England completed assessments at intake between 1999 and 2007; a subsample of 333 also completed assessments at graduation from the program; a smaller subsample of 55 participants were re-assessed 6 months after graduation. These assessments measured work and related life skills, employment, housing status, general health status, substance use, self-esteem and self-efficacy, and legal involvement. Results revealed improvement in all types of work and related life skills, employment and income, and multiple other life domains from baseline to graduation and follow-up. Exploratory analyses suggested that improvements in work and related life skills were associated with improvement in self-esteem and self-efficacy, and that these improvements predicted stable housing situations at follow-up. Overall, these findings indicate that, for individuals struggling with the challenges of homelessness, completion of a work-skills program has a positive impact on skills and employment, and on a diverse set of life domains.
Common needs of homeless and foster care children
http://www.ncbi.nlm.nih.gov/pubmed/22356430
Health Soc Care Community. 2012 Feb 22. doi: 10.1111/j.1365-2524.2011.01053.x. [Epub ahead of print]
Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.
Zlotnick C, Tam T, Zerger S.
Source
Children's Hospital & Research Center Oakland, CHORI/Center for the Vulnerable Child, Oakland, CA, USA.
Abstract
Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition.
Health Soc Care Community. 2012 Feb 22. doi: 10.1111/j.1365-2524.2011.01053.x. [Epub ahead of print]
Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.
Zlotnick C, Tam T, Zerger S.
Source
Children's Hospital & Research Center Oakland, CHORI/Center for the Vulnerable Child, Oakland, CA, USA.
Abstract
Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition.
Music therapy for homeless verterans
http://www.ncbi.nlm.nih.gov/pubmed/22359994
Tenn Med. 2012 Jan;105(1):38-9.
Music therapy to promote movement from isolation to community in homeless veterans.
Powers JS, Heim D, Grant B, Rollins J.
Source
Tennessee Valley Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA. james.powers@vanderbilt.edu
Abstract
The U.S. Department of Veterans Affairs' Operation Stand Down has done much to address homeless needs among veterans. Gaining client trust is central to the effectiveness of the program. Music therapy has been found beneficial in moving individuals from isolation to community. We report our experience with participatory music therapy in Operation Stand Down and offer this as a legitimate intervention to enhance client participation.
Tenn Med. 2012 Jan;105(1):38-9.
Music therapy to promote movement from isolation to community in homeless veterans.
Powers JS, Heim D, Grant B, Rollins J.
Source
Tennessee Valley Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA. james.powers@vanderbilt.edu
Abstract
The U.S. Department of Veterans Affairs' Operation Stand Down has done much to address homeless needs among veterans. Gaining client trust is central to the effectiveness of the program. Music therapy has been found beneficial in moving individuals from isolation to community. We report our experience with participatory music therapy in Operation Stand Down and offer this as a legitimate intervention to enhance client participation.
Homeless mothers' perceptions of service providers
http://www.ncbi.nlm.nih.gov/pubmed/22368312
J Soc Serv Res. 2011 Oct;37(5):457-468.
'Don't Leave Me Hanging': Homeless Mothers' Perceptions of Service Providers.
Sznajder-Murray B, Slesnick N.
Source
University of Nebraska-Lincoln, Lincoln, NE.
Abstract
Few interventions have been developed for substance-abusing homeless mothers. Among those interventions, high dropout rates (up to 85%) are consistently reported. Understanding homeless mothers' experiences with service providers may be an important first step to understanding ways to increase treatment engagement. Therefore, the current study used qualitative methods to gain a better understanding of homeless mothers' perceptions of service providers. A total of 28 mothers who were currently residing at a homeless shelter in a Midwestern city participated in three focus groups. Overall, mothers held negative perceptions of service providers related to understanding, support, and fear. Based upon this study's findings, recommendations are offered to improve service delivery and guide future research.
J Soc Serv Res. 2011 Oct;37(5):457-468.
'Don't Leave Me Hanging': Homeless Mothers' Perceptions of Service Providers.
Sznajder-Murray B, Slesnick N.
Source
University of Nebraska-Lincoln, Lincoln, NE.
Abstract
Few interventions have been developed for substance-abusing homeless mothers. Among those interventions, high dropout rates (up to 85%) are consistently reported. Understanding homeless mothers' experiences with service providers may be an important first step to understanding ways to increase treatment engagement. Therefore, the current study used qualitative methods to gain a better understanding of homeless mothers' perceptions of service providers. A total of 28 mothers who were currently residing at a homeless shelter in a Midwestern city participated in three focus groups. Overall, mothers held negative perceptions of service providers related to understanding, support, and fear. Based upon this study's findings, recommendations are offered to improve service delivery and guide future research.
Hepatitis vaccine completion among the homeless
http://www.ncbi.nlm.nih.gov/pubmed/22372394
J Forensic Nurs. 2012 Mar;8(1):13-22. doi: 10.1111/j.1939-3938.2011.01123.x. Epub 2012 Jan 6.
Hepatitis A/B vaccine completion among homeless adults with history of incarceration.
Nyamathi AM, Marlow E, Branson C, Marfisee M, Nandy K.
Source
University of California, Los Angeles, California University of California, San Francisco, California.
Abstract
Hepatitis B virus (HBV) vaccination rates for incarcerated adults remain low despite their high risk for infection. This study determined predictors of vaccine completion in homeless adults (N= 297) who reported histories of incarceration and who participated in one of three nurse-led hepatitis programs of different intensity. Moreover time since release from incarceration was also considered. Just over half of the former prisoners completed the vaccine series. Older age (≥40), having a partner, and chronic homelessness were associated with vaccine completion. Recent research has documented the difficulty in providing vaccine services to younger homeless persons and homeless males at risk for HBV. Additional strategies are needed to achieve HBV vaccination completion rates greater than 50% for formerly incarcerated homeless men.
J Forensic Nurs. 2012 Mar;8(1):13-22. doi: 10.1111/j.1939-3938.2011.01123.x. Epub 2012 Jan 6.
Hepatitis A/B vaccine completion among homeless adults with history of incarceration.
Nyamathi AM, Marlow E, Branson C, Marfisee M, Nandy K.
Source
University of California, Los Angeles, California University of California, San Francisco, California.
Abstract
Hepatitis B virus (HBV) vaccination rates for incarcerated adults remain low despite their high risk for infection. This study determined predictors of vaccine completion in homeless adults (N= 297) who reported histories of incarceration and who participated in one of three nurse-led hepatitis programs of different intensity. Moreover time since release from incarceration was also considered. Just over half of the former prisoners completed the vaccine series. Older age (≥40), having a partner, and chronic homelessness were associated with vaccine completion. Recent research has documented the difficulty in providing vaccine services to younger homeless persons and homeless males at risk for HBV. Additional strategies are needed to achieve HBV vaccination completion rates greater than 50% for formerly incarcerated homeless men.
Thursday, March 1, 2012
Difficult and controversial: Informing study participants (and others) of genetic research results
http://www.ncbi.nlm.nih.gov/pubmed/22333903
Eur J Hum Genet. 2012 Feb 15. doi: 10.1038/ejhg.2012.24. [Epub ahead of print]
One thing leads to another: the cascade of obligations when researchers report genetic research results to study participants.
Miller FA, Hayeems RZ, Li L, Bytautas JP.
Source
1] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [2] Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.
Abstract
Even as debate continues about the putative obligation to proactively report genetic research results to study participants, there is an increasing need to attend to the obligations that might cascade from any initial report. We conducted an international, quasi-experimental survey of researchers involved in autism spectrum disorders (ASD) and cystic fibrosis (CF) genetics to explore perceived obligations to ensure updated information or relevant clinical care subsequent to any initial communication of research results, and factors influencing these attitudes. 5-point Likert scales of dis/agreement were analyzed using descriptive and multivariate statistics. Of the 343 respondents (44% response rate), large majorities agreed that in general and in a variety of hypothetical research contexts, research teams that report results should ensure that participants gain subsequent access to updated information (74-83%) and implicated clinical services (79-87%). At the same time, researchers perceived barriers restricting access to relevant clinical care, though this was significantly more pronounced (P<0.001) for ASD (64%) than CF (34%). In the multivariate model, endorsement of cascading obligations was positively associated with researcher characteristics (eg, clinical role/training) and attitudes (eg, perceived initial reporting obligation), and negatively associated with the initial report of less scientifically robust hypothetical results, but unaffected by perceived or hypothetical barriers to care. These results suggest that researchers strongly endorse information and care-based obligations that cascade from the initial report of research results to study participants. In addition, they raise challenging questions about how any cascading obligations are to be met, especially where access challenges are already prevalent.
Eur J Hum Genet. 2012 Feb 15. doi: 10.1038/ejhg.2012.24. [Epub ahead of print]
One thing leads to another: the cascade of obligations when researchers report genetic research results to study participants.
Miller FA, Hayeems RZ, Li L, Bytautas JP.
Source
1] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [2] Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.
Abstract
Even as debate continues about the putative obligation to proactively report genetic research results to study participants, there is an increasing need to attend to the obligations that might cascade from any initial report. We conducted an international, quasi-experimental survey of researchers involved in autism spectrum disorders (ASD) and cystic fibrosis (CF) genetics to explore perceived obligations to ensure updated information or relevant clinical care subsequent to any initial communication of research results, and factors influencing these attitudes. 5-point Likert scales of dis/agreement were analyzed using descriptive and multivariate statistics. Of the 343 respondents (44% response rate), large majorities agreed that in general and in a variety of hypothetical research contexts, research teams that report results should ensure that participants gain subsequent access to updated information (74-83%) and implicated clinical services (79-87%). At the same time, researchers perceived barriers restricting access to relevant clinical care, though this was significantly more pronounced (P<0.001) for ASD (64%) than CF (34%). In the multivariate model, endorsement of cascading obligations was positively associated with researcher characteristics (eg, clinical role/training) and attitudes (eg, perceived initial reporting obligation), and negatively associated with the initial report of less scientifically robust hypothetical results, but unaffected by perceived or hypothetical barriers to care. These results suggest that researchers strongly endorse information and care-based obligations that cascade from the initial report of research results to study participants. In addition, they raise challenging questions about how any cascading obligations are to be met, especially where access challenges are already prevalent.
Systemic inflammation and hospitalization in patients with Cystic Fibrosis
http://www.ncbi.nlm.nih.gov/pubmed/22333132
BMC Pulm Med. 2012 Feb 14;12(1):3. [Epub ahead of print]
The relationship of systemic inflammation to prior hospitalization in adult patients with cystic fibrosis.
Ngan DA, Wilcox PG, Aldaabil M, Li Y, Leipsic JA, Sin DD, Man SP.
ABSTRACT:
BACKGROUND:
In cystic fibrosis (CF) patients, it has been suggested that systemic inflammation may be an important risk factor for poor health outcomes. The relationship of plasma inflammatory biomarkers to lung function and hospitalization history remains largely unexplored.
METHODS:
This cross-sectional study included 58 consecutive, clinically stable adults from the CF Clinic at St. Paul's Hospital (Vancouver, Canada). Blood levels of interleukin (IL)-6, IL-1beta, C-reactive protein (CRP), interleukin (IL)-6, IL-1beta, granzyme B (GzmB), chemokine C-C motif ligand 18 (CCL18/PARC), surfactant protein D (SP-D), lipopolysaccharide (LPS)-binding protein, and soluble cluster of differentiation 14 (sCD14) were measured using enzyme-linked immunosorbent assays, and LPS levels were measured using a Limulus amebocyte lysate assay. Spirometry was also performed. Multivariable linear regression analysis was used to assess relationships of the blood biomarkers to lung function.
RESULTS:
Lung function impairment was independently associated with elevated plasma levels of CRP (P < 0.01), IL-6 (P = 0.04), IL-1beta (P < 0.01), and LBP (P < 0.01), Increasing age (P < 0.01), reduced body mass index (P = 0.02), prior hospitalizations (P = 0.03), and presence of Pseudomonas aeruginosa in sputum cultures (P < 0.01) were also associated with reduced lung function. Elevated concentrations of LPS in plasma were associated with a previous history of hospitalization (p<.05). There was a trend towards an increase in plasma IL-6 (p=.07) and IL-1beta (p=.06) levels in patients who were previously hospitalized.
CONCLUSIONS:
IL-6 and IL-1beta are promising systemic biomarkers for lung function impairment and history of hospitalization in adult patients with CF.
BMC Pulm Med. 2012 Feb 14;12(1):3. [Epub ahead of print]
The relationship of systemic inflammation to prior hospitalization in adult patients with cystic fibrosis.
Ngan DA, Wilcox PG, Aldaabil M, Li Y, Leipsic JA, Sin DD, Man SP.
ABSTRACT:
BACKGROUND:
In cystic fibrosis (CF) patients, it has been suggested that systemic inflammation may be an important risk factor for poor health outcomes. The relationship of plasma inflammatory biomarkers to lung function and hospitalization history remains largely unexplored.
METHODS:
This cross-sectional study included 58 consecutive, clinically stable adults from the CF Clinic at St. Paul's Hospital (Vancouver, Canada). Blood levels of interleukin (IL)-6, IL-1beta, C-reactive protein (CRP), interleukin (IL)-6, IL-1beta, granzyme B (GzmB), chemokine C-C motif ligand 18 (CCL18/PARC), surfactant protein D (SP-D), lipopolysaccharide (LPS)-binding protein, and soluble cluster of differentiation 14 (sCD14) were measured using enzyme-linked immunosorbent assays, and LPS levels were measured using a Limulus amebocyte lysate assay. Spirometry was also performed. Multivariable linear regression analysis was used to assess relationships of the blood biomarkers to lung function.
RESULTS:
Lung function impairment was independently associated with elevated plasma levels of CRP (P < 0.01), IL-6 (P = 0.04), IL-1beta (P < 0.01), and LBP (P < 0.01), Increasing age (P < 0.01), reduced body mass index (P = 0.02), prior hospitalizations (P = 0.03), and presence of Pseudomonas aeruginosa in sputum cultures (P < 0.01) were also associated with reduced lung function. Elevated concentrations of LPS in plasma were associated with a previous history of hospitalization (p<.05). There was a trend towards an increase in plasma IL-6 (p=.07) and IL-1beta (p=.06) levels in patients who were previously hospitalized.
CONCLUSIONS:
IL-6 and IL-1beta are promising systemic biomarkers for lung function impairment and history of hospitalization in adult patients with CF.
Risk factors for Mycobacterium abscessus infection in Cystic Fibrosis patients
http://www.ncbi.nlm.nih.gov/pubmed/22342403
J Cyst Fibros. 2012 Feb 17. [Epub ahead of print]
Risk factors for Mycobacterium abscessus infection in cystic fibrosis patients; a case-control study.
Verregghen M, Heijerman HG, Reijers M, van Ingen J, van der Ent CK.
Source
University of Utrecht, Faculty of Medicine, Utrecht, The Netherlands.
Abstract
Mycobacterium abscessus is a nontuberculous mycobacterium that is increasingly recognized as an opportunistic pathogen in cystic fibrosis (CF) patients. Factors that predispose CF patients to infection by this environmental bacterium remain unknown. In a case-control study of 22 CF patients with M. abscessus infection and 22 CF controls, we investigated risk factors for MAB infection as well as the positioning of MAB infection in relation to the other pathogens infecting CF patients. No clear risk factors were found; steroid treatment and CF related diabetes were equally common among cases and controls. M. abscessus disease affects CF patients of varying age, lung function and co-morbidities. Antimicrobial maintenance therapy did not prevent M. abscessus infection. A history of Stenotrophomonas maltophilia infection was significantly more frequent among cases than among controls and there may be a relation with Aspergillus fumigatus infection, or both may be signs of advanced lung damage that predisposes to MAB disease. The absence of clear risk factors and the omnipresence of MAB in the environment suggest that MAB infection in CF patients is a random event. Its symptoms and impact on lung function seem to warrant treatment.
J Cyst Fibros. 2012 Feb 17. [Epub ahead of print]
Risk factors for Mycobacterium abscessus infection in cystic fibrosis patients; a case-control study.
Verregghen M, Heijerman HG, Reijers M, van Ingen J, van der Ent CK.
Source
University of Utrecht, Faculty of Medicine, Utrecht, The Netherlands.
Abstract
Mycobacterium abscessus is a nontuberculous mycobacterium that is increasingly recognized as an opportunistic pathogen in cystic fibrosis (CF) patients. Factors that predispose CF patients to infection by this environmental bacterium remain unknown. In a case-control study of 22 CF patients with M. abscessus infection and 22 CF controls, we investigated risk factors for MAB infection as well as the positioning of MAB infection in relation to the other pathogens infecting CF patients. No clear risk factors were found; steroid treatment and CF related diabetes were equally common among cases and controls. M. abscessus disease affects CF patients of varying age, lung function and co-morbidities. Antimicrobial maintenance therapy did not prevent M. abscessus infection. A history of Stenotrophomonas maltophilia infection was significantly more frequent among cases than among controls and there may be a relation with Aspergillus fumigatus infection, or both may be signs of advanced lung damage that predisposes to MAB disease. The absence of clear risk factors and the omnipresence of MAB in the environment suggest that MAB infection in CF patients is a random event. Its symptoms and impact on lung function seem to warrant treatment.
Spirometer games to help with airway clearance in children with Cystic Fibrosis
http://www.ncbi.nlm.nih.gov/pubmed/22348602
Respir Care. 2012 Feb 17. [Epub ahead of print]
Pilot Trial of Spirometer Games for Airway Clearance Practice in Cystic Fibrosis.
Bingham PM, Lahiri T, Ashikaga T.
Abstract
BACKGROUND:
Many children with cystic fibrosis (CF) adhere poorly to airway clearance techniques (ACTs), and would rather play video games that challenge their dexterity and visual tracking skills. We developed gaming technology that encourages forced expiratory maneuvers.
OBJECTIVE:
Following interviews regarding recreational activities and subjects' practice of ACTs, we conducted a pilot trial of spirometer games in thirteen adolescents with CF to test the hypothesis that games could (1) increase subjects' engagement with forced expiratory breathing maneuvers, and (2) improve pulmonary function tests (PFTs).
METHODS:
After baseline PFTs, subjects were provided with digital spirometers and PCs set up as "game only" or "control" devices. After the first of 2 periods (each > 2 weeks), the PC was set-up for the alternate condition for period 2. T test and non-parametric correlation analyses examined use, number of expiratory high flow events (HFEs), and change in PFTs, identifying trends at p< .1, significance at p< .05.
RESULTS:
Interviews disclosed minimal awareness of ACTs among our pediatric CF patients. Subjects used games and control software a similar percentage of days during Game (26%) and Control periods (32%). There was a trend towards more minutes with the Game vs. Control setup (p=.07), though HFE count did not differ between the two conditions (p=.71). Game play showed no overall effect on FEV₁, though correlation analysis showed a modest relation between minutes of play and change in FEV₁ from Baseline (r = .50, p = .09). Game period showed a trend to increased VC (p=.05).
CONCLUSION:
Spirometer games elicit forced expiratory breath maneuvers in pediatric CF patients. Improvement in PFTs may be due to improved test performance technique, though improved obstructive/restrictive lung function due to game play cannot be excluded. A formal clinical trial of this approach is planned.
Respir Care. 2012 Feb 17. [Epub ahead of print]
Pilot Trial of Spirometer Games for Airway Clearance Practice in Cystic Fibrosis.
Bingham PM, Lahiri T, Ashikaga T.
Abstract
BACKGROUND:
Many children with cystic fibrosis (CF) adhere poorly to airway clearance techniques (ACTs), and would rather play video games that challenge their dexterity and visual tracking skills. We developed gaming technology that encourages forced expiratory maneuvers.
OBJECTIVE:
Following interviews regarding recreational activities and subjects' practice of ACTs, we conducted a pilot trial of spirometer games in thirteen adolescents with CF to test the hypothesis that games could (1) increase subjects' engagement with forced expiratory breathing maneuvers, and (2) improve pulmonary function tests (PFTs).
METHODS:
After baseline PFTs, subjects were provided with digital spirometers and PCs set up as "game only" or "control" devices. After the first of 2 periods (each > 2 weeks), the PC was set-up for the alternate condition for period 2. T test and non-parametric correlation analyses examined use, number of expiratory high flow events (HFEs), and change in PFTs, identifying trends at p< .1, significance at p< .05.
RESULTS:
Interviews disclosed minimal awareness of ACTs among our pediatric CF patients. Subjects used games and control software a similar percentage of days during Game (26%) and Control periods (32%). There was a trend towards more minutes with the Game vs. Control setup (p=.07), though HFE count did not differ between the two conditions (p=.71). Game play showed no overall effect on FEV₁, though correlation analysis showed a modest relation between minutes of play and change in FEV₁ from Baseline (r = .50, p = .09). Game period showed a trend to increased VC (p=.05).
CONCLUSION:
Spirometer games elicit forced expiratory breath maneuvers in pediatric CF patients. Improvement in PFTs may be due to improved test performance technique, though improved obstructive/restrictive lung function due to game play cannot be excluded. A formal clinical trial of this approach is planned.
Managing nasal polyposis in Cystic Fibrosis patients
http://www.ncbi.nlm.nih.gov/pubmed/22350539
Curr Allergy Asthma Rep. 2012 Feb 17. [Epub ahead of print]
Pathogenesis and Management of Nasal Polyposis in Cystic Fibrosis.
Mainz JG, Koitschev A.
Source
Cystic Fibrosis Center, Department of Paediatrics, Paediatric Pulmonology, Jena University Hospital, Kochstrasse 2, 07740, Jena, Germany, jochen.mainz@med.uni-jena.de.
Abstract
Beginning in preschool age, during their lives, up to 50% of cystic fibrosis (CF) patients experience obstructing nasal polyposis (NP), which is rare in non-CF children. Pathogenetic factors of NP in general and especially in CF are still obscure. However, defective epithelial ion transport from mucosal glands plays a central role in CF, and viscous secretions impair mucociliary clearance, promoting chronic pathogen colonization and neutrophil-dominated chronic inflammation. Presently, CF-NP is not curable but can be clinically stabilized, though the large variety of proposed treatment modalities indicates a lack of standardization and of evidence of treatment efficacy. When conservative measures are exhausted, surgical intervention combining individually adapted endoscopic sinus surgery and supportive conservative treatment is performed. Topical steroids, approved as the gold standard for non-CF NP, may be beneficial, but they are discussed to be less effective in neutrophilic inflammation, and CF-specific antimicrobial and mucolytic therapy, as is true of all treatment modalities, urgently requires evaluation by controlled clinical trials within interdisciplinary networks.
Curr Allergy Asthma Rep. 2012 Feb 17. [Epub ahead of print]
Pathogenesis and Management of Nasal Polyposis in Cystic Fibrosis.
Mainz JG, Koitschev A.
Source
Cystic Fibrosis Center, Department of Paediatrics, Paediatric Pulmonology, Jena University Hospital, Kochstrasse 2, 07740, Jena, Germany, jochen.mainz@med.uni-jena.de.
Abstract
Beginning in preschool age, during their lives, up to 50% of cystic fibrosis (CF) patients experience obstructing nasal polyposis (NP), which is rare in non-CF children. Pathogenetic factors of NP in general and especially in CF are still obscure. However, defective epithelial ion transport from mucosal glands plays a central role in CF, and viscous secretions impair mucociliary clearance, promoting chronic pathogen colonization and neutrophil-dominated chronic inflammation. Presently, CF-NP is not curable but can be clinically stabilized, though the large variety of proposed treatment modalities indicates a lack of standardization and of evidence of treatment efficacy. When conservative measures are exhausted, surgical intervention combining individually adapted endoscopic sinus surgery and supportive conservative treatment is performed. Topical steroids, approved as the gold standard for non-CF NP, may be beneficial, but they are discussed to be less effective in neutrophilic inflammation, and CF-specific antimicrobial and mucolytic therapy, as is true of all treatment modalities, urgently requires evaluation by controlled clinical trials within interdisciplinary networks.
Risk of using CT scan as an outcome surrogate in Cystic Fibrosis patients
http://www.ncbi.nlm.nih.gov/pubmed/22357879
Radiology. 2012 Mar;262(3):746-9.
CT as an Outcome Surrogate in Patients with Cystic Fibrosis: Does the Effort Justify the Risks?
Hernanz-Schulman M.
Source
Department of Diagnostic Imaging, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232.
"Although the potential effects of radiation in monitoring disease activity in patients with cystic fibrosis may never be completely eliminated, radiation dose can be markedly lowered by manipulating the technical parameters of the examination and by using state-of-the art equipment such that effective dose at CT approaches that of chest radiography; undersampling, as tested by Loeve et al and others is still applicable, but it should be used judiciously based on appropriate data and carefully applied in longitudinal patient evaluation."
Radiology. 2012 Mar;262(3):746-9.
CT as an Outcome Surrogate in Patients with Cystic Fibrosis: Does the Effort Justify the Risks?
Hernanz-Schulman M.
Source
Department of Diagnostic Imaging, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232.
"Although the potential effects of radiation in monitoring disease activity in patients with cystic fibrosis may never be completely eliminated, radiation dose can be markedly lowered by manipulating the technical parameters of the examination and by using state-of-the art equipment such that effective dose at CT approaches that of chest radiography; undersampling, as tested by Loeve et al and others is still applicable, but it should be used judiciously based on appropriate data and carefully applied in longitudinal patient evaluation."
From Radiology: CT scan assessment of trapped air in Cystic Fibrosis patients
http://www.ncbi.nlm.nih.gov/pubmed/22357896
Radiology. 2012 Mar;262(3):969-76.
Three-Section Expiratory CT: Insufficient for Trapped Air Assessment in Patients with Cystic Fibrosis?
Loeve M, de Bruijne M, Hartmann IC, van Straten M, Hop WC, Tiddens HA.
Source
Department of Pediatric Pulmonology & Allergology, Erasmus Medical Center-Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands; Departments of Radiology, Medical Informatics, and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
Purpose: To estimate the effect of the number of computed tomography (CT) sections on trapped air (TA) assessment in patients with cystic fibrosis (CF) by using an established scoring system and a new quantitative scoring system and to compare CT and pulmonary function test (PFT) estimates of TA in a cross-sectional and longitudinal study.
Materials and Methods:
In this institutional review board-approved pilot study, 20 subjects aged 6-20 years (12 female and eight male; median age, 12.6 years) contributed two expiratory CT studies (three-section baseline CT, volumetric follow-up CT) and two PFT studies over 2 years after parental informed consent was obtained. From follow-up CT studies, seven sets were composed: Set 1 was volumetric. Sets 2, 3, 4, and 5, had spacing of 2.4, 4.8, 9.6, and 20.4 mm, respectively, between sections. Sets 6 and 7 contained five and three sections, respectively. Longitudinal follow-up was performed with three sections. All images were deidentified and randomized, and TA was scored with the Brody II system and a new quantitative system. Statistical analysis included the Wilcoxon signed rank test, calculation of Spearman and intraclass correlation coefficients, and use of three-section and linear mixed models.
Results:
For the Brody II system, the intraclass correlation coefficient for set 1 versus those for sets 2 through 7 was 0.75 versus 0.87; however, mean scores from sets 6 and 7 were significantly lower than the mean score from set 1 (P = .01 and P < .001, respectively). For the quantitative system, the number of sections did not affect TA assessment (intraclass correlation coefficient range, 0.82-0.88; P > .13 for all). CT and PFT estimates were not correlated (r(s) = 20.19 to 0.09, P = .43-.93). No change in TA over time was found for CT or PFT (P > .16 for all).
Conclusion:
The number of sections affected Brody II estimates, suggesting that three-section protocols lead to underestimation of TA assessment in patients with CF when using the Brody II system; CT and PFT estimates of TA showed no correlation and no significant change over time.
Radiology. 2012 Mar;262(3):969-76.
Three-Section Expiratory CT: Insufficient for Trapped Air Assessment in Patients with Cystic Fibrosis?
Loeve M, de Bruijne M, Hartmann IC, van Straten M, Hop WC, Tiddens HA.
Source
Department of Pediatric Pulmonology & Allergology, Erasmus Medical Center-Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands; Departments of Radiology, Medical Informatics, and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
Purpose: To estimate the effect of the number of computed tomography (CT) sections on trapped air (TA) assessment in patients with cystic fibrosis (CF) by using an established scoring system and a new quantitative scoring system and to compare CT and pulmonary function test (PFT) estimates of TA in a cross-sectional and longitudinal study.
Materials and Methods:
In this institutional review board-approved pilot study, 20 subjects aged 6-20 years (12 female and eight male; median age, 12.6 years) contributed two expiratory CT studies (three-section baseline CT, volumetric follow-up CT) and two PFT studies over 2 years after parental informed consent was obtained. From follow-up CT studies, seven sets were composed: Set 1 was volumetric. Sets 2, 3, 4, and 5, had spacing of 2.4, 4.8, 9.6, and 20.4 mm, respectively, between sections. Sets 6 and 7 contained five and three sections, respectively. Longitudinal follow-up was performed with three sections. All images were deidentified and randomized, and TA was scored with the Brody II system and a new quantitative system. Statistical analysis included the Wilcoxon signed rank test, calculation of Spearman and intraclass correlation coefficients, and use of three-section and linear mixed models.
Results:
For the Brody II system, the intraclass correlation coefficient for set 1 versus those for sets 2 through 7 was 0.75 versus 0.87; however, mean scores from sets 6 and 7 were significantly lower than the mean score from set 1 (P = .01 and P < .001, respectively). For the quantitative system, the number of sections did not affect TA assessment (intraclass correlation coefficient range, 0.82-0.88; P > .13 for all). CT and PFT estimates were not correlated (r(s) = 20.19 to 0.09, P = .43-.93). No change in TA over time was found for CT or PFT (P > .16 for all).
Conclusion:
The number of sections affected Brody II estimates, suggesting that three-section protocols lead to underestimation of TA assessment in patients with CF when using the Brody II system; CT and PFT estimates of TA showed no correlation and no significant change over time.
Risk factors for onset of persistent respiratory symptoms in children with Cystic Fibrosis
http://www.ncbi.nlm.nih.gov/pubmed/22359344
Pediatr Pulmonol. 2012 Feb 22. doi: 10.1002/ppul.22519. [Epub ahead of print]
Risk factors for onset of persistent respiratory symptoms in children with cystic fibrosis.
McColley SA, Ren CL, Schechter MS, Regelmann WE, Pasta DJ, Konstan MW; for the Investigators Coordinators of the Epidemiologic Study of Cystic Fibrosis.
Source
Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois. smccolley@northwestern.edu.
Abstract
OBJECTIVES:
To characterize the onset of persistent signs and symptoms of cystic fibrosis (CF) lung disease and identify characteristics that predict onset.
STUDY DESIGN:
Patients in the Epidemiologic Study of CF who were <4 years of age at enrollment and had ≥2 years of follow-up were included. We defined persistence as a sign or symptom that was present during two consecutive encounters separated by 60-365 days, and persistent clubbing as ≥50% of encounters with clubbing within 365 days. Predictors were assessed in a Cox proportional hazards model for age at first occurrence of each symptom.
RESULTS:
Each sign or symptom met the criterion of persistence in a substantial proportion of patients during a follow-up period of 7 ± 3 years (mean ± SD; range 2-12). Risk factors that predicted earlier onset of signs and symptoms included pancreatic enzyme use, Pseudomonas aeruginosa infection, and prior diagnosis of asthma. Other risk factors had variable effects on signs and symptoms.
CONCLUSIONS:
Signs and symptoms of lung disease begin early in CF. Risk factors previously reported for lower forced expiratory volume in 1 sec are also associated with earlier onset of persistent signs and symptoms of CF lung disease, but their impact varies.
Pediatr Pulmonol. 2012 Feb 22. doi: 10.1002/ppul.22519. [Epub ahead of print]
Risk factors for onset of persistent respiratory symptoms in children with cystic fibrosis.
McColley SA, Ren CL, Schechter MS, Regelmann WE, Pasta DJ, Konstan MW; for the Investigators Coordinators of the Epidemiologic Study of Cystic Fibrosis.
Source
Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois. smccolley@northwestern.edu.
Abstract
OBJECTIVES:
To characterize the onset of persistent signs and symptoms of cystic fibrosis (CF) lung disease and identify characteristics that predict onset.
STUDY DESIGN:
Patients in the Epidemiologic Study of CF who were <4 years of age at enrollment and had ≥2 years of follow-up were included. We defined persistence as a sign or symptom that was present during two consecutive encounters separated by 60-365 days, and persistent clubbing as ≥50% of encounters with clubbing within 365 days. Predictors were assessed in a Cox proportional hazards model for age at first occurrence of each symptom.
RESULTS:
Each sign or symptom met the criterion of persistence in a substantial proportion of patients during a follow-up period of 7 ± 3 years (mean ± SD; range 2-12). Risk factors that predicted earlier onset of signs and symptoms included pancreatic enzyme use, Pseudomonas aeruginosa infection, and prior diagnosis of asthma. Other risk factors had variable effects on signs and symptoms.
CONCLUSIONS:
Signs and symptoms of lung disease begin early in CF. Risk factors previously reported for lower forced expiratory volume in 1 sec are also associated with earlier onset of persistent signs and symptoms of CF lung disease, but their impact varies.
From Chest: Is body habitus associated with Cystic Fibrosis mortality?
http://www.ncbi.nlm.nih.gov/pubmed/22362875
Chest. 2012 Feb 23. [Epub ahead of print]
Are measures of body habitus associated with mortality in cystic fibrosis?
Fogarty AW, Britton J, Clayton A, Smyth A.
Source
Nottingham Biomedical Research Unit, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK.
Abstract
BACKGROUND:
Nutrition is an important component of clinical care for patients with cystic fibrosis. We aimed to test the hypothesis that increased body mass index (BMI), height and creatinine as a biomarker for lean muscle mass were associated with lower mortality, and whether differences in these measures may contribute towards gender differences in survival in cystic fibrosis.
METHODS:
We used a cohort study design using data from the UK Cystic Fibrosis Registry who attended an annual assessment visit in 2007 and were followed up until July 2009.
RESULTS:
Of 1517 individuals, 62 died during the follow up period. The odds of death was higher among those in the lowest quintile of serum creatinine compared to the rest of the study population (OR 3.28, 95% confidence interval (CI) 1.79 to 5.98). Increased height and higher BMI were also associated with lower risk of death. The higher mortality in females (OR 1.48, 95%CI: 0.93 to 2.34) was reversed by adjustment using the absolute values for these variables, the adjusted OR being 0.44 (95%CI: 0.21 to 0.90) after adjustment for height, BMI and serum creatinine but not by the use of gender specific values for these exposure variables.
CONCLUSION:
Lower muscle mass, shorter stature and a low BMI are associated with increased mortality in cystic fibrosis. These measures of body habitus may contribute to the gender survival differences in individuals with cystic fibrosis.
Chest. 2012 Feb 23. [Epub ahead of print]
Are measures of body habitus associated with mortality in cystic fibrosis?
Fogarty AW, Britton J, Clayton A, Smyth A.
Source
Nottingham Biomedical Research Unit, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK.
Abstract
BACKGROUND:
Nutrition is an important component of clinical care for patients with cystic fibrosis. We aimed to test the hypothesis that increased body mass index (BMI), height and creatinine as a biomarker for lean muscle mass were associated with lower mortality, and whether differences in these measures may contribute towards gender differences in survival in cystic fibrosis.
METHODS:
We used a cohort study design using data from the UK Cystic Fibrosis Registry who attended an annual assessment visit in 2007 and were followed up until July 2009.
RESULTS:
Of 1517 individuals, 62 died during the follow up period. The odds of death was higher among those in the lowest quintile of serum creatinine compared to the rest of the study population (OR 3.28, 95% confidence interval (CI) 1.79 to 5.98). Increased height and higher BMI were also associated with lower risk of death. The higher mortality in females (OR 1.48, 95%CI: 0.93 to 2.34) was reversed by adjustment using the absolute values for these variables, the adjusted OR being 0.44 (95%CI: 0.21 to 0.90) after adjustment for height, BMI and serum creatinine but not by the use of gender specific values for these exposure variables.
CONCLUSION:
Lower muscle mass, shorter stature and a low BMI are associated with increased mortality in cystic fibrosis. These measures of body habitus may contribute to the gender survival differences in individuals with cystic fibrosis.
From Duke: Heritability of Psuedomonas lung infection in patients with Cystic Fibrosis
http://www.ncbi.nlm.nih.gov/pubmed/22364820
J Pediatr. 2012 Feb 22. [Epub ahead of print]
Heritability of Respiratory Infection with Pseudomonas aeruginosa in Cystic Fibrosis.
Green DM, Collaco JM, McDougal KE, Naughton KM, Blackman SM, Cutting GR.
Source
Division of Pediatric Pulmonary and Sleep Medicine, Duke University Medical Center, Durham, NC.
Abstract
OBJECTIVE:
To quantify the relative contribution of factors other than cystic fibrosis transmembrane conductance regulator genotype and environment on the acquisition of Pseudomonas aeruginosa (Pa) by patients with cystic fibrosis.
STUDY DESIGN:
Lung infection with Pa and mucoid Pa was assessed using a co-twin study design of 44 monozygous (MZ) and 17 dizygous (DZ) twin pairs. Two definitions were used to establish infection: first positive culture and persistent positive culture. Genetic contribution to infection (ie, heritability) was estimated based on concordance analysis, logistic regression, and age at onset of infection through comparison of intraclass correlation coefficients.
RESULTS:
Concordance for persistent Pa infection was higher in MZ (0.83; 25 of 30 pairs) than DZ twins (0.45; 5 of 11 pairs) generating a heritability of 0.76. Logistic regression adjusted for age corroborated genetic control of persistent Pa infection. The correlation for age at persistent Pa infection was higher in MZ twins (0.589; 95% CI, 0.222-0.704) than in DZ twins (0.162; 95% CI, -0.352 to 0.607), generating a heritability of 0.85.
CONCLUSION:
Genetic modifiers play a significant role in the establishment and timing of persistent Pa infection in individuals with cystic fibrosis.
J Pediatr. 2012 Feb 22. [Epub ahead of print]
Heritability of Respiratory Infection with Pseudomonas aeruginosa in Cystic Fibrosis.
Green DM, Collaco JM, McDougal KE, Naughton KM, Blackman SM, Cutting GR.
Source
Division of Pediatric Pulmonary and Sleep Medicine, Duke University Medical Center, Durham, NC.
Abstract
OBJECTIVE:
To quantify the relative contribution of factors other than cystic fibrosis transmembrane conductance regulator genotype and environment on the acquisition of Pseudomonas aeruginosa (Pa) by patients with cystic fibrosis.
STUDY DESIGN:
Lung infection with Pa and mucoid Pa was assessed using a co-twin study design of 44 monozygous (MZ) and 17 dizygous (DZ) twin pairs. Two definitions were used to establish infection: first positive culture and persistent positive culture. Genetic contribution to infection (ie, heritability) was estimated based on concordance analysis, logistic regression, and age at onset of infection through comparison of intraclass correlation coefficients.
RESULTS:
Concordance for persistent Pa infection was higher in MZ (0.83; 25 of 30 pairs) than DZ twins (0.45; 5 of 11 pairs) generating a heritability of 0.76. Logistic regression adjusted for age corroborated genetic control of persistent Pa infection. The correlation for age at persistent Pa infection was higher in MZ twins (0.589; 95% CI, 0.222-0.704) than in DZ twins (0.162; 95% CI, -0.352 to 0.607), generating a heritability of 0.85.
CONCLUSION:
Genetic modifiers play a significant role in the establishment and timing of persistent Pa infection in individuals with cystic fibrosis.
The canary in the Cystic Fibrosis coal mine?
http://www.ncbi.nlm.nih.gov/pubmed/22366207
J Infect. 2012 Feb 23. [Epub ahead of print]
Pulmonary mycobacterium abscessus: A canary in the cystic fibrosis coalmine.
Haverkamp MH, van Wengen A, de Visser AW, van Kralingen KW, van Dissel JT, van de Vosse E.
Source
Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
Abstract
We present a case of pulmonary nontuberculous mycobacterial infection (PNTM) with M. abscessus. After exclusion of genetic immune disorders known to cause NTM susceptibility, we found compound heterozygosity of two mutations, F508del and R117H in CFTR. The combination of F508del with a hypomorphic CFTR mutation can cause a mild Cystic Fibrosis (CF) phenotype with delayed CF symptoms in adulthood. Although the patient was continuously treated for her lung infection by different physicians for more than twenty years, the diagnosis CF had been missed. The forme fruste of CF should be considered in the analysis of host factors predisposing for PNTM.
J Infect. 2012 Feb 23. [Epub ahead of print]
Pulmonary mycobacterium abscessus: A canary in the cystic fibrosis coalmine.
Haverkamp MH, van Wengen A, de Visser AW, van Kralingen KW, van Dissel JT, van de Vosse E.
Source
Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
Abstract
We present a case of pulmonary nontuberculous mycobacterial infection (PNTM) with M. abscessus. After exclusion of genetic immune disorders known to cause NTM susceptibility, we found compound heterozygosity of two mutations, F508del and R117H in CFTR. The combination of F508del with a hypomorphic CFTR mutation can cause a mild Cystic Fibrosis (CF) phenotype with delayed CF symptoms in adulthood. Although the patient was continuously treated for her lung infection by different physicians for more than twenty years, the diagnosis CF had been missed. The forme fruste of CF should be considered in the analysis of host factors predisposing for PNTM.
Cell and gene based therapies for Cystic Fibrosis lung disease
http://www.ncbi.nlm.nih.gov/pubmed/22371844
Mol Ther. 2012 Feb 28. doi: 10.1038/mt.2012.32. [Epub ahead of print]
Advances in Cell and Gene-based Therapies for Cystic Fibrosis Lung Disease.
Oakland M, Sinn PL, McCray Jr PB.
Source
Department of Microbiology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.
Abstract
Cystic fibrosis (CF) is a disease characterized by airway infection, inflammation, remodeling, and obstruction that gradually destroy the lungs. Direct delivery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene to airway epithelia may offer advantages, as the tissue is accessible for topical delivery of vectors. Yet, physical and host immune barriers in the lung present challenges for successful gene transfer to the respiratory tract. Advances in gene transfer approaches, tissue engineering, and novel animal models are generating excitement within the CF research field. This review discusses current challenges and advancements in viral and nonviral vectors, cell-based therapies, and CF animal models.
PMID: 22371844 [PubMed - as supplied by publisher]
Mol Ther. 2012 Feb 28. doi: 10.1038/mt.2012.32. [Epub ahead of print]
Advances in Cell and Gene-based Therapies for Cystic Fibrosis Lung Disease.
Oakland M, Sinn PL, McCray Jr PB.
Source
Department of Microbiology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.
Abstract
Cystic fibrosis (CF) is a disease characterized by airway infection, inflammation, remodeling, and obstruction that gradually destroy the lungs. Direct delivery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene to airway epithelia may offer advantages, as the tissue is accessible for topical delivery of vectors. Yet, physical and host immune barriers in the lung present challenges for successful gene transfer to the respiratory tract. Advances in gene transfer approaches, tissue engineering, and novel animal models are generating excitement within the CF research field. This review discusses current challenges and advancements in viral and nonviral vectors, cell-based therapies, and CF animal models.
PMID: 22371844 [PubMed - as supplied by publisher]
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