1,720,972 research outputs found
The impact of psychosis on vocational functioning
No full textIn order to further the field of psychiatric vocational rehabilitation, an innovative research model has been used to study the neurobiological, developmental, and psychosocial pathways through which psychotic affective disorders might affect vocational functioning among 226 participants enrolled in the Suffolk County Mental Health Project. This model was based on the social selection hypothesis, which theorizes that disruption of a career path or educational attainment can cause a decline in socio-economic status. It is also based on the results of empirical studies which have found that vocational decline within the psychiatric population is associated with past vocational functioning, social functioning deficits, and hospitalization history. Vocational profiles that assess functioning retrospectively before the first hospitalization and prospectively after the first hospitalization reveal that most vocational active participants experienced a descending career path. For students educational stagnation is dominantly present at the college level. Neuro-cognitive deficits in the form of lack of concentration and a short-term memory dysfunction, were associated with a downward vocational drift. From a social learning perspective, the adverse events of an interrupted educational path, during the development of a vocational personality was associated with a downward vocational drift. According to the open linked systems model, social impairments, stressors in the living situation, mood, limitations of medical treatment, and illness factors were found to be related to poor performance in the vocational domain. The participants enrolled in this study indicated that the vocational rehabilitative system on Long Island was unable to meet their needs. There was a specific demand for more effective vocational training, help locating resources to facilitate vocational functioning, help to maintain their vocational role, job development and placement services, and supported education programs. Policy reforms should therefore focus on promoting community-based psychosocial rehabilitation programs that have vocational services included in their package. Access to these services should be more readily available to all individuals with psychiatric disabilities. In addition, the participants included in this study mentioned that current legislation regarding vocational role protection was lacking. <br/
Extracurricular activity participation moderates impact of family and school factors on adolescents’ disruptive behavioural problems
Full text linkBackgroundThe prevalence of problem behaviours among British adolescents has increased in the past decades. Following Erikson’s psychosocial developmental theory and Bronfenbrenner’s developmental ecological model, it was hypothesized that youth problem behaviour is shaped in part by social environment. The aim of this project was to explore potential protective factors within the social environment of British youth’s for the presentation of disruptive behavioural problems.MethodThis study used secondary data from the Longitudinal Study of Young People in England, a cohort study of secondary school students. These data were analysed with generalized estimation equations to take the correlation between the longitudinal observations into account. Three models were built. The first model determined the effect of family, school, and extracurricular setting on presentation of disruptive behavioural problems. The second model expanded the first model by assuming extracurricular activities as protective factors that moderated the interaction between family and school factors with disruptive behavioural problems. The third model described the effect of prior disruptive behaviour on current disruptive behaviour.ResultsAssociations were found between school factors, family factors, involvement in extracurricular activities and presence of disruptive behavioural problems. Results from the second generalized estimating equation (GEE) logistic regression models indicated that extracurricular activities buffered the impact of school and family factors on the presence of disruptive behavioural problems. For instance, participation in sports activities decreased the effect of bullying on psychological distress. Results from the third model indicated that prior acts of disruptive behaviour reinforced current disruptive behaviour.ConclusionThis study supports Erikson’s psychosocial developmental theory and Bronfenbrenner’s developmental ecological model; social environment did influence the presence of disruptive behavioural problems for British adolescents. The potential of extracurricular activities to intervention strategies addressing disruptive behavioural problems of adolescents is discussed
A synthetic dataset for the exploration of survival and classification models: prediction of heart attack or stroke within a 10-year follow-up period
No full textMachine learning methodologies are becoming increasingly popular in healthcare research. This shift to integrated data science approaches necessitates professional development of the existing healthcare data analyst workforce. To enhance this smooth transition, educational resources need to be developed. Real healthcare datasets, vital for healthcare data analysis and training purposes, have many barriers, including financial, ethical, and patient confidentiality concerns. Synthetic datasets that mimic real-world complexities offer simple solutions. The presented synthetic dataset mirrors the routinely collected primary care data on heart attacks and strokes among the adult population. Training experiences using this synthetic dataset are elevated as the data incorporate many of the practical challenges encountered in routinely collected primary care systems, such as missing data, informative censoring, interactions, variable irrelevance, and noise.By openly sharing this synthetic dataset, our goal was to contribute a transformative asset for professional training in health and social care data analysis. The dataset covers demographics, lifestyle variables, comorbidities, systolic blood pressure, hypertension treatment, family history of cardiovascular diseases, respiratory function, and experience of heart attack and/or stroke. Methods for simulating each variable are detailed to ensure a realistic representation of the patient data. This initiative aims to bridge the gap in sophisticated healthcare datasets for training, fostering professional development in the healthcare and social care research workforce
Silymarin (milk thistle) treatment of adults with gambling disorder: a double-blind, placebo-controlled trial
No full textObjective: data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder. Methods: forty-three individuals (18 [41.9%] women; mean age=49.61 [±13.1] years) with gambling disorder entered an 8-week, double-blind, placebo-controlled study. Dosing of silymarin ranged from 150 to 300 mg twice a day. The primary outcome measure was the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS). Secondary outcome measures comprised the Gambling Symptom Assessment Scale and measures of depression and anxiety. Outcomes were examined using mixed-effect models. Results: silymarin did not statistically differentiate from the placebo on any of the outcome measures of interest, in terms of treatment group time interactions. There was a robust response in the placebo group (57% reduction on the PG-YBOCS), and on average there was a 56% reduction in YBOCS score for the milk thistle. Conclusions: the findings of this study do not support the use of silymarin/milk thistle in the treatment of gambling disorder but highlight the large placebo response seen in gambling disorder. Treatment interventions for gambling disorder need to better understand and address the placebo response.</p
Health and social care diversity among individuals with longstanding physical and psychological health problems: Pooled repeated cross sectional analyses
No full textThis paper examines differences in health-and-social care utilisation for individuals with physical and/or mental health problems. Logistic regression models are used to determine disparity in the percentage of General Household/Lifestyle Survey participants with physical compared to mental health problems receiving disability benefits or health care services between 2000 and 2011. Our findings of a relative underutilisation of secondary health care combined with a relative overutilization of out-of-work benefits by individuals with mental health problems is novel to the field of rehabilitative health care. These results provide evidence for the previously suspected disparity in health care utilisation of individuals with mental health problems and indicate problems in labour force integration. The findings support the political call for a 'parity of esteem', which, in Britain, was enshrined in the Health and Social Care Act of 2012.</p
Primary ciliary dyskinesia
No full textPrimary ciliary dyskinesia (PCD) is a genetically and clinically heterogeneous lung disease. Dysfunction of motile cilia causes impaired mucociliary function. Patients typically present with neonatal respiratory distress of unknown cause, persistent daily wet cough, perennial rhinosinusitis, otitis media and bronchiectasis; 50% of patients have situs inversus. In this chapter we review the underlying genetics of PCD, and how this leads to progressive disease. We discuss what is known about the prevalence, natural history and risk factors for less favourable outcomes. We review current diagnostic and management strategies. Finally, we discuss future directions to maintain the trajectory of evidence
Age at onset, childhood psychopathology, and 2-year outcome in psychotic bipolar disorder
No full textOBJECTIVE: The relationships of age at onset and childhood psychopathology to 2-year clinical and functional outcomes in first-admission patients with bipolar I disorder were examined. METHOD: Patients with bipolar I disorder (N=123) presenting with psychotic symptoms were followed over a 2-year period. Age at onset was stratified into <19 and ?19 years. Childhood psychopathology was categorized as behavior problems, other psychopathology, and none. Functional and clinical outcomes were rated with standard measures. RESULTS: Childhood psychopathology and age at onset were independently related to poorer functional and clinical outcome. In the multivariate models that included psychopathology, age at onset, sex, and education, early age at onset was related to incomplete remission, and childhood psychopathology was related to functional outcome. CONCLUSIONS: Childhood psychopathology and age at onset contribute independently to outcomes of bipolar disorder. Childhood psychopathology is a much stronger predictor of functioning than age at onset.Early age at onset and/or poor premorbid functioning may be associated with poor course and outcome in bipolar disorder (1). Our previous research demonstrated that an earlier age at onset in bipolar disorder is associated with prior child psychopathology (2). We hypothesized that childhood psychopathology may, in fact, explain the association between young age at onset and poor outcome. In this report we address this issue by examining the independent and combined contributions of age at onset and childhood psychopathology to functional outcome and clinical course over 2 years of follow-up in a representative group of first-admission subjects with psychotic bipolar disorder
Mental health service users' perceptions of data sharing and data protection: a qualitative report
Full text linkBACKGROUND: To improve health services, social, economic and health data should be shared and linked to create a full narrative of lived experience. Mental health data sharing is often considered a particularly sensitive area. OBJECTIVE: To assess mental health service users' perceptions regarding the current practice of administrative data-driven research. METHOD: We conducted a focus group using case study scenarios. Themes and subthemes were analysed using qualitative methods. RESULTS: Participants were generally happy for data owners to share their health, social and economic data if the purpose was transparent and if the information would inform and improve health policy and practice. Participants were less keen on sharing data through digital applications. CONCLUSION: This case study informs a data linkage study protocol. Research teams and database owners should strive to educate service users on data protection and create dissent opportunities.</p
First validation study of the living with long term conditions scale (LwLTCs) among English-speaking population living with Parkinson's disease
Full text linkINTRODUCTION: Parkinson's disease is the second most prevalent neurodegenerative disease, affecting 10 million people worldwide. Health and social care professionals need to have personalised tools to evaluate the process of living with Parkinson's disease and consequently, plan individualised and targeted interventions. Recently, the English version of the Living with Long term conditions (LwLTCs) scale has been developed filling an important gap related to person-centred tools to evaluate the process of living with long term conditions among English-speaking population. However, no validation studies for testing its psychometric properties have been conducted. AIM: To analyse the psychometric properties of the LwLTCs scale in a wide English-speaking population living with Parkinson's disease. METHODS: Validation study, with an observational and cross-sectional design. The sample was composed of individuals living with Parkinson's disease from non-NHS services in the community. Psychometric properties including feasibility and acceptability, internal consistency, reproducibility, and construct, internal and known-groups validity were tested. RESULTS: A total sample of 241 people living with Parkinson's disease were included. 6 individuals did not complete 1 or 2 items on the scale. Ordinal alpha was 0.89 for the total scale. The intraclass correlation coefficient for the total scale was 0.88. The LwLTCs scale is strongly correlated with scales measuring satisfaction with life (rs=0.67), quality of life (rs=0.54), and moderately correlated with social support (rs=0.45). Statistically significant difference just for therapy and co-morbidity, yet no for gender, employment situation, or lifestyle changes. CONCLUSIONS: The LwLTCs scale is a valid scale to evaluate how the person is living with Parkinson's disease. Future validation studies to prove the repeatability of the total scale and particularly, domains 3-Self-management, and 4-Integration and internal consistency will be needed. Developing further studies on the English version of the LwLTC in people with other long term conditions is also proposed
Psychometric properties of the Living with long term conditions scale in an English-speaking population living with long term conditions in the UK
Full text linkObjective To present the psychometric properties of the living with long-term condition (LwLTCs) scale in an English-speaking population of people with different LTCs. Design An observational and cross-sectional study, with retest was conducted. Psychometric properties including feasibility, internal consistency, confirmatory factor analysis, reproducibility and content validity were tested. Setting The study took place across the UK via primary care surgeries and voluntary organisations, between December 2021 and June 2022. Participants The study included 577 patients living with different LTCs, as chronic obstructive pulmonary disease, arthritis, chronic heart failure, Parkinson's disease, chronic kidney disease and type 2 diabetes mellitus. Inclusion criteria included: (a) having been diagnosed with one or more of the conditions; (b) being able to read, understand and answer written questionnaires; (c) being fluent in English and (d) being able to provide written informed consent. Patients were involved in the design and pilot study of the scale. Results A total sample of 577 people with an age range of 37-97 years (98±9.65) were recruited. Internal consistency of the total 26-item LwLTCs scale score was excellent (ordinal alpha=0.90) but confirmatory factor analysis showed better fit indices (Normed Fit Index=0.96; standardised root mean square residual=0.051; Goodness of Fit Index=0.98) for a 20-item LwLTCs scale. Conclusions A shorter version of the LwLTCs scale, with just 20 items and with excellent psychometric properties, is recommended. Having a short scale is key when considering the implementation of the scale in clinical practice to develop person-centred pathways and more comprehensive care plans.</p
- …
