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Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices.Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics; b) working environment; and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents.Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75; 31.4% [95% CI 26%, 38%]) and saliva testing (17; 7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (χ2 = 6.27; p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (χ2 = 34.98; p <0.001) more likely to restore teeth with amalgam.Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.
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Aims There is increasing recognition that sleep disturbances can affect lifestyle, economy and health. General dental practitioners (GDPs) can play a vital role in helping to identify at-risk patients through screening as well as aid in the management of these conditions. The aim of this study was to assess the knowledge of UK-based GDPs in relation to sleep-related breathing disorders (SRBDs).Material and methods A questionnaire was developed to assess GDPs' knowledge of SRBDs and their current practice in relation to the management of SRBDs, and identify the factors associated with improved knowledge and management. A volunteer sample was recruited from social media platforms and conference attendees.Results In total, 152 GDPs completed the questionnaire; 101 (66% [95% CI 59%,74%]) agreed that GDPs should ask their patients about sleep disorders, while only 82 (54% [95% CI 46%,62%]) confirmed that they actually asked their patients about the problem. On a 22-point knowledge scale, the mean score was 12.93 (95%CI 12.23, 13.63). Postgraduate education (F = 5.47; p = 0.001), increasing age (r = 0.23; p = 0.005) and GDP workplace (F = 4.98; p = 0.008) contributed to a higher knowledge score. GDPs were strongly in favour of having more information (N = 141; 93% [95% CI 87%,97%]).Conclusion Although GDPs' knowledge of SRBDs was better than anticipated, they clearly felt a need for further information and training. There is a compelling case to include this subject in the undergraduate dental curriculum.
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Odontólogos , Trastornos del Sueño-Vigilia , Actitud del Personal de Salud , Odontología General , Humanos , Rol Profesional , Sueño , Ronquido , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Feedback plays a significant role in informing students about the outcome of their assessments and contributes to their ongoing learning. The aim of this study was to investigate feedback currently given by clinical teachers to dental students throughout Europe. METHODS: This study used a piloted questionnaire, delivered on-line to members of the Association for Dental Education in Europe (ADEE). A largely quantitative approach was adopted with multiple-choice, single answer, open text boxes and Likert scale type questions. These data were collected via Google Forms, transferred to an excel spreadsheet and analysed using SPSS software Version 24. RESULTS: Data were collected from 223 questionnaires completed by respondents from 42 countries. Students received feedback following: (i) formative assessment (70%; n = 155), (ii) summative assessment (88%; n = 196) and iii) informally at any time (85%; n = 188). Feedback was delivered by different people including administrative staff (15%; n = 25). Several methods were used to deliver feedback, including written, oral/spoken, email and individually or as a group. 85% (n = 184) of teachers reported that their teaching had changed following feedback they had received from students. CONCLUSION: The study showed a strong ethos of delivering feedback from teachers to dental students following both assessment and non-assessment related activities. Teachers should understand/appreciate the individualistic nature of feedback and the importance of cultivating a congenial environment for feedback delivery. Challenges remain in delivering them to a high standard and in a timely manner.
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Educación en Odontología , Estudiantes de Medicina , Europa (Continente) , Retroalimentación , Humanos , Aprendizaje , Encuestas y Cuestionarios , EnseñanzaRESUMEN
BACKGROUND: The occurrence of personality disorder among community supervised offenders may have important implications for their management. There is, however, a dearth of contextual information on personality disorder in such populations. AIMS: This study aimed to identify demographic, substance use and forensic features that distinguish community-sentenced offenders with personality disorder from those without. METHODS: One hundred and seventy-three offenders under community supervision were screened for personality disorder using the Standardised Assessment of Personality--Abbreviated Scale. Alcohol and drug misuse, demographic and forensic data were also recorded. RESULTS: Nearly half of the sample (82, 47%) had probable personality disorder. Compared with those without personality disorder, they were younger, more likely to be unemployed, less likely to be divorced, more likely to have been convicted of robbery and more likely to be alcohol or illicit drug misusers, as well as under drug rehabilitation requirements. Multivariate analyses confirmed that only alcohol and drug abuse were independently associated with personality disorder in this group, and only the latter was significant. CONCLUSIONS: In this broadly representative sample of offenders serving community sentences in a defined geographical area, those with personality disorder were not more likely to attract higher risk of recidivism ratings, but they were more likely to have problems with heavy alcohol and/or illicit drug misuse.
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Criminales/psicología , Trastornos de la Personalidad/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Distribución por Edad , Estudios de Cohortes , Psiquiatría Forense , Humanos , Drogas Ilícitas , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Análisis Multivariante , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , Características de la Residencia , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
OBJECTIVES: Genetic markers in the genes encoding ankyrin 3 (ANK3) and the α-calcium channel subunit (CACNA1C) are associated with bipolar disorder (BP). The associated variants in the CACNA1C gene are mainly within intron 3 of the gene. ANK3 BP-associated variants are in two distinct clusters at the ends of the gene, indicating disease allele heterogeneity. METHODS: In order to screen both coding and non-coding regions to identify potential aetiological variants, we used whole-genome sequencing in 99 BP cases. Variants with markedly different allele frequencies in the BP samples and the 1,000 genomes project European data were genotyped in 1,510 BP cases and 1,095 controls. RESULTS: We found that the CACNA1C intron 3 variant, rs79398153, potentially affecting an ENCyclopedia of DNA Elements (ENCODE)-defined region, showed an association with BP (p = 0.015). We also found the ANK3 BP-associated variant rs139972937, responsible for an asparagine to serine change (p = 0.042). However, a previous study had not found support for an association between rs139972937 and BP. The variants at ANK3 and CACNA1C previously known to be associated with BP were not in linkage disequilibrium with either of the two variants that we identified and these are therefore independent of the previous haplotypes implicated by genome-wide association. CONCLUSIONS: Sequencing in additional BP samples is needed to find the molecular pathology that explains the previous association findings. If changes similar to those we have found can be shown to have an effect on the expression and function of ANK3 and CACNA1C, they might help to explain the so-called 'missing heritability' of BP.
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Ancirinas/genética , Trastorno Bipolar/genética , Canales de Calcio Tipo L/genética , Predisposición Genética a la Enfermedad/genética , Polimorfismo de Nucleótido Simple/genética , Femenino , Frecuencia de los Genes , Estudios de Asociación Genética , Genotipo , Humanos , Intrones/genética , Desequilibrio de Ligamiento , Masculino , Población BlancaRESUMEN
BACKGROUND: Evaluation of complex interventions, including standardisation of the intervention, types of outcomes selected and measures of change, is a fairly novel concept in the field of intellectual disabilities. Our aim was to explore these issues in a feasibility study of Manualised Individual Cognitive Behaviour Treatment (M-iCBT) compared to the treatment as usual alone (TAU). METHODS: Service users with mild to moderate intellectual disability experiencing a mood disorder or symptoms of depression and/or anxiety (mini PAS-ADD total score >10 or 7 respectively) were randomly assigned to either. RESULTS: In total, 32 participants were randomly assigned to 16 sessions of M-iCBT (n=16) in addition to TAU or TAU alone (n=16). We explored recruitment and accrual rates, willingness to participate, acceptability of the intervention and suitability of assessment tools. Mean change (95% CI) in the Beck Depression Inventory-Youth (BDI-Y) score from baseline to the 16 week endpoint (primary variable) was 0.10 (95% CI: -8.56, 8.76) and in the Beck Anxiety Inventory-Youth (BAI-Y) 2.42 (95% CI: -5.27, 10.12) in favour of TAU. However, there was a clear trend in favour of CBT in depressed participants with or without anxiety. LIMITATIONS: The intervention targeted both depression and anxiety following a transdiagnostic model. This may have impacted the anticipated size of change in the primary outcome. The precise impact of cognitive limitations on ability to use therapy effectively is not fully understood. CONCLUSIONS: This study demonstrates that it is feasible to carry out a pragmatic randomised controlled trial of M-iCBT for people with mild to moderate intellectual disability. However, uncertainties about its clinical and cost effectiveness can only be fully answered by further examination of its superiority against other treatments.
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Terapia Cognitivo-Conductual/métodos , Discapacidad Intelectual/psicología , Trastornos del Humor/terapia , Adulto , Anciano , Ansiedad/complicaciones , Ansiedad/terapia , Terapia Cognitivo-Conductual/economía , Depresión/complicaciones , Depresión/terapia , Estudios de Factibilidad , Femenino , Costos de la Atención en Salud , Humanos , Discapacidad Intelectual/complicaciones , Masculino , Persona de Mediana Edad , Trastornos del Humor/complicaciones , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
IMPORTANCE: Genetic markers at the gene encoding the metabotropic glutamate receptor 3 (GRM3) showed allelic association with bipolar disorder. OBJECTIVE: To screen the GRM3 gene and adjacent control regions of genomic DNA in volunteers with bipolar affective disorder for mutations increasing susceptibility to bipolar disorder. DESIGN: Sequencing and high-resolution melting curve analysis of DNA followed by genotyping was carried out in 1099 patients with bipolar affective disorder and 1152 healthy comparator individuals. SETTING: Participants with bipolar disorder were recruited from National Health Service psychiatric services and from patient organizations. PARTICIPANTS: Individuals were included if they had Research Diagnostic Criteria diagnoses of bipolar I and bipolar II disorder and were of British or Irish ancestry. MAIN OUTCOMES AND MEASURES: Identification of base pair changes in the GRM3 gene that affected expression or function of the GRM3 receptor that also showed an allelic association with bipolar disorder. RESULTS: A base pair variant (rs148754219) was found in the Kozak sequence of exon 1 of the GRM3 gene, 2 bases before the translation start codon of one of the receptor isoforms, in 23 of 2251 people who were screened and genotyped. Nineteen of the 1099 bipolar cases (1.7%) were mutation carriers compared with 4 of 1152 healthy comparators (0.3%). The variant was associated with bipolar disorder (P = .005; odds ratio, 4.20). Bioinformatic, electrophoretic mobility shift assay, and gene expression analysis found that the variant created a new transcription factor protein binding site and had a strong effect on gene transcription and translation. CONCLUSIONS AND RELEVANCE: Confirmation of these findings is needed before the Kozak sequence variant can be accepted as a potential marker for personalized treatment of affective disorders with drugs targeting the metabotropic glutamate receptor 3.
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Trastorno Bipolar/genética , Receptores de Glutamato Metabotrópico/genética , Alelos , Disparidad de Par Base/genética , Estudios de Casos y Controles , Ensayo de Cambio de Movilidad Electroforética , Estudios de Asociación Genética , Genotipo , Heterocigoto , Humanos , Polimorfismo de Nucleótido Simple/genética , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
BACKGROUND: Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial. METHODS: Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes. DISCUSSION: The broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities. TRIAL REGISTRATION: ISRCTN: ISRCTN38099525.
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Terapia Cognitivo-Conductual , Discapacidad Intelectual/psicología , Personas con Discapacidades Mentales , Proyectos de Investigación , Adulto , Ansiedad/diagnóstico , Ansiedad/economía , Ansiedad/etiología , Ansiedad/psicología , Ansiedad/terapia , Terapia Cognitivo-Conductual/economía , Análisis Costo-Beneficio , Depresión/diagnóstico , Depresión/economía , Depresión/etiología , Depresión/psicología , Depresión/terapia , Costos de la Atención en Salud , Humanos , Discapacidad Intelectual/complicaciones , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/economía , Londres , Satisfacción del Paciente , Personas con Discapacidades Mentales/psicología , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Calidad de Vida , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
Sleep disturbance is common in major depressive disorder (MDD), and is often characterized by early-morning waking. Melatonin is a hypnotic and synchronizes circadian rhythms. It may also be an antidepressant. The melatonin agonists, ramelteon and agomelatine, have hypnotic and antidepressant properties, but there is a dearth of trials investigating the use of melatonin in MDD. This randomized, controlled trial aimed to determine whether exogenous melatonin is a sleep promoter and antidepressant. Thirty-three participants with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnosis of MDD and early-morning waking were selected for a 4-week, randomized, double-blind trial of slow-release melatonin (6 mg; vs. placebo) given at bedtime over 4 weeks. Sleep was measured subjectively using sleep diaries and the Leeds Sleep Evaluation Questionnaire and objectively using wrist actigraphy. Of the 33 participants, 31 completed the trial. General Linear Modelling showed significant improvements in depression and sleep over time, but this was not specific to melatonin. However, there was a trend towards an improvement in mood with melatonin, and no adverse side effects were observed. In conclusion, melatonin may be beneficial for treating MDD, it seems to be safe and well tolerated, but its potential for treating depression in people who do not wish to take antidepressants requires further evaluation.
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Depresores del Sistema Nervioso Central/administración & dosificación , Preparaciones de Acción Retardada/administración & dosificación , Trastorno Depresivo Mayor/tratamiento farmacológico , Melatonina/administración & dosificación , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Adulto , Antidepresivos/uso terapéutico , Depresores del Sistema Nervioso Central/efectos adversos , Trastorno Depresivo Mayor/complicaciones , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Masculino , Melatonina/efectos adversos , Placebos , Trastornos del Sueño-Vigilia/complicacionesRESUMEN
OBJECTIVE: Community-based specialist behavior therapy teams may be helpful in managing challenging behavior, but evidence of their effectiveness is limited. This study was designed to examine the effectiveness and costs associated with treatment by a specialist behavior therapy team. METHOD: This was a parallel-group, randomized, single-blind controlled trial carried out in an intellectual disabilities service in England. Participants were 63 male and female service users with mild to severe intellectual disability who presented with challenging behavior. The interventions were standard treatment plus applied behavioral analysis (N=32) and standard treatment only (N=31). The primary outcome measure was challenging behavior, as measured by total and subscale scores on the Aberrant Behavior Checklist 3 and 6 months after randomization. Secondary outcome measures were psychiatric comorbidity assessed at 3 and 6 months using the Psychiatric Assessment Schedule for Adults With a Developmental Disability Checklist (PAS-ADD) and total costs recorded at 6 months. Multilevel modeling was used to compare square root transformations of Aberrant Behavior Checklist scores. RESULTS: Significant differences were found in the transformed total scores on the Aberrant Behavior Checklist (difference=-0.89, 95% CI=-1.74 to -0.04) and transformed lethargy and hyperactivity subscale scores (common intervention effect=-0.56, 95% CI=-0.97 to -0.15). Standard care participants fared worse on the PAS-ADD comorbid organic disorder subscale. There was a clear trend for lower overall costs of the intervention. CONCLUSIONS: Use of a specialist behavior therapy team in addition to standard treatment appears to be more effective in improving challenging behavior and may have financial advantages over standard treatment.
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Terapia Conductista/métodos , Discapacidades del Desarrollo/terapia , Discapacidad Intelectual/terapia , Adulto , Terapia Conductista/economía , Niño , Comorbilidad , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/epidemiología , Inglaterra/epidemiología , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Evaluación de Resultado en la Atención de Salud/métodos , Grupo de Atención al Paciente/economía , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Método Simple Ciego , Especialización/economía , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
The only randomised controlled trial to test high-fidelity assertive community treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from community mental health teams in reducing the need for in-patient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants' service contact, in-patient service use and adverse events 36 months after randomisation.
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Asertividad , Servicios Comunitarios de Salud Mental , Hospitalización , Trastornos Mentales/terapia , Terapia Conductista/métodos , Estudios de Seguimiento , Humanos , Tiempo de Internación , Grupo de Atención al Paciente , Evaluación de Programas y Proyectos de Salud , Reino UnidoRESUMEN
OBJECTIVES: Alzheimer's disease (AD) is associated with variable but shortened life expectancy. Knowing expected survival time may empower people with AD and their families, but clinicians currently have limited predictive information. Our objective was to identify determinants of survival in a cohort of people with mild to moderate AD and test these on a separate validation cohort. METHODS: We followed a representative cohort of 158 people for 42 months and identified independent determinants of shorter survival. From these we constructed the Survival in Alzheimer's Model (SAM), and tested this on a validation cohort. RESULTS: Baseline constructional apraxia, age and gait apraxia independently predicted shorter survival: about half of those scoring 2 on the SAM survived > or =3.5 years compared to 85% of those scoring 0. CONCLUSIONS: The SAM is a potentially useful tool for clinicians who previously had very limited specific and quantitative prognostic information to tell AD patients and carers. This model predicted survival from age, constructional and gait apraxia. This may be because constructional and gait apraxia are relatively free from educational or cultural bias and thus are better indicators of severe neuropathology than global cognitive tests. Alternatively, they may increase falls or immobility, or represent disease sub-types with worse prognoses. Oncology services are able to inform patients and their families about 5-year survival rates. This step towards such provision in AD is new and of potential importance to patients and their carers.
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Enfermedad de Alzheimer/mortalidad , Esperanza de Vida/tendencias , Anciano , Anciano de 80 o más Años , Intervalos de Confianza , Femenino , Evaluación Geriátrica , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Pronóstico , Índice de Severidad de la EnfermedadRESUMEN
AIMS: This study aims to evaluate the psychological and career-planning impact of the new postgraduate training system Modernising Medical Careers (MMC) on junior doctor applicants in the UK. We hypothesized that certain junior doctor groups were more vulnerable to distress during the process than others. METHOD: Online, anonymous, cross-sectional attitudes survey of applicants in June 2007. Participants were Medical Training Application System (MTAS) applicants of all grades in the UK. RESULTS: Of 1,002 responders, 703 (70%) reported four or more depressive symptoms; 231 (23%) reported increased suicidal thinking; 932 (93%) increased stress; 856 (85%) increased worry; 374 (37%) consumed more alcohol. Some 941 (94%) attributed increased stress to ;MMC/MTAS'. Female sex (OR = 1.48, 95% CI = 1.12, 1.95) and not receiving a job offer (OR = 1.85, 95% CI = 1.35, 2.56) predicted higher number of depressive symptoms. CONCLUSION: At the onset of MMC, MTAS applicants reported negative process experiences, psychological distress and poor coping (including increased alcohol use), with possible implications for mental health, career planning and patient care.
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Educación de Postgrado en Medicina , Internet , Satisfacción en el Trabajo , Salud Mental , Médicos/psicología , Estudios Transversales , Evaluación Educacional , Femenino , Humanos , Masculino , Reino UnidoRESUMEN
OBJECTIVE: To determine the prevalence of abusive behaviours by family carers of people with dementia. DESIGN: Representative cross sectional survey SETTING: Community mental health teams in Essex and London. PARTICIPANTS: 220 family carers of people newly referred to secondary psychiatric services with dementia who were living at home. MAIN OUTCOME MEASURE: Psychological and physical abuse (revised modified conflict tactics scale). RESULTS: 115 (52%, 95% confidence interval 46% to 59%) carers reported some abusive behaviour and 74 (34%, 27% to 40%) reported important levels of abuse. Verbal abuse was most commonly reported. Only three (1.4%) carers reported occasional physical abuse. CONCLUSIONS: Abusive behaviour by family carers towards people with dementia is common, with a third reporting important levels of abuse and half some abusive behaviour. We found few cases of physical or frequent abuse, although those with the most abusive behaviour may have been reluctant to report it.
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Cuidadores/estadística & datos numéricos , Demencia/psicología , Abuso de Ancianos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Cuidadores/psicología , Estudios Transversales , Demencia/epidemiología , Abuso de Ancianos/psicología , Inglaterra/epidemiología , Relaciones Familiares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: Most studies of outcome in schizophrenia have focused on incidence cohorts or samples identified through specialist mental health services; population-based samples provide a more complete picture of the effectiveness of community services. AIMS: To examine whether outcome predictors, derived from studies of selected patients with prolonged schizophrenia, would emerge in a largely community-dwelling population sample. METHODS: A follow-up sample of 114 adults with schizophrenia was identified via two censuses of key informants conducted for two prevalence surveys in North London, five years apart. Symptomatic, clinical and functional outcomes were assessed after five years. A composite score was derived for each individual. Multiple Linear Regression analyses were conducted in two phases to derive a best subset of predictors for global outcome. RESULTS: After five years, 33% were worse and 62% were better overall. The four best predictors (social isolation, living apart from relatives, longer illness and being an inpatient at first census) accounted for 32% of the variance in outcome of those with schizophrenia and related diagnoses. CONCLUSIONS: Social relationships during the course of illness are an important predictor of overall outcome and relationships with friends and family each seem to make a positive contribution. Policy and service developments should focus on improving participation in community life for people with schizophrenia, particularly their social connectedness.
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Evaluación de Procesos y Resultados en Atención de Salud , Esquizofrenia/epidemiología , Apoyo Social , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Entrevistas como Asunto , Modelos Lineales , Londres/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
A proposed risk factor for schizophrenia is materno-foetal incompatibility. We tested the hypothesis that, in multiply affected families, later born children would exhibit a more severe form of schizophrenia than their older siblings. The effect of birth order on (1) severity of the worst ever episode of illness; (2) deterioration from premorbid level of functioning; (3) age of onset; (4) response to medication; and (5) illness course, was assessed in 150 sibling pairs with schizophrenia and schizoaffective disorder. We found that later birth order reduced the likelihood of regaining the premorbid level of functioning after an acute episode and was also associated with an earlier age of presentation. This study lends some support to the hypothesis that later birth order results in a more severe form of the disorder, although there are other possible explanations for our findings. Further work is needed to explore the possibility of maternal-foetal genotype incompatibility as a risk factor for schizophrenia.
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Orden de Nacimiento , Trastornos Psicóticos/genética , Isoinmunización Rh/genética , Esquizofrenia/genética , Psicología del Esquizofrénico , Adulto , Factores de Edad , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Calidad de Vida/psicología , Isoinmunización Rh/diagnóstico , Isoinmunización Rh/psicología , Factores de Riesgo , Esquizofrenia/diagnóstico , Ajuste SocialRESUMEN
BACKGROUND: Caring for relatives with advanced cancer may cause psychological and physical ill health. AIMS: To evaluate the effectiveness of increased support for distressed, informal carers of patients receiving palliative care. METHOD: The sample was composed of 271 informal carers who scored over 5 on the 28-item General Health Questionnaire (GHQ-28). The intervention comprised six weekly visits by a trained advisor. Primary outcome was carer distress (GHQ-28) at 4-week, 9-week and 12-week follow-up. Secondary outcomes were carer strain and quality of life, satisfaction with care, and bereavement outcome. RESULTS: Scores on the GHQ-28 fell below the threshold of 5/6 in a third of participants in each trial arm at any follow-up point. Mean scores in the intervention group were lower at all time points but these differences were not significant. No difference was observed in secondary outcomes. Carers receiving the intervention reported qualitative benefit. CONCLUSIONS: The intervention might have been too brief, and ongoing help might have had accruing benefits. Alternatively, informal carers of patients with cancer may already receive considerable input and the advisor's help gave little additional advantage; or caring for a dying relative is extremely stressful and no amount of support is going to make it much better.
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Cuidadores/psicología , Cuidados Paliativos/psicología , Calidad de la Atención de Salud/normas , Estrés Psicológico/prevención & control , Adaptación Psicológica , Adulto , Anciano , Costo de Enfermedad , Consejo , Femenino , Estudios de Seguimiento , Atención Domiciliaria de Salud , Humanos , Masculino , Persona de Mediana Edad , Apoyo SocialRESUMEN
BACKGROUND: The aim of this study was to perform a systematic review and meta-analysis of the literature regarding the incidence of delirium following orthopedic surgery. METHODS: Relevant papers were sourced from online databases and gray literature. Included studies used a validated diagnostic method to measure the incidence of delirium in a prospective sample of adult/elderly orthopedic patients. Data were subject to meta-analysis after stratification by type of surgery (elective v. emergency) and inclusion/exclusion of pre-existing cognitive impairment. A funnel plot assessed for publication bias. RESULTS: 26 publications reported an incidence of postoperative delirium of 4-53.3% in hip fracture samples and 3.6-28.3% in elective samples. Significant heterogeneity was evident, and this persisted despite stratification. Hip fracture was associated with a higher risk of delirium than elective surgery both when the cognitively impaired were included in the sample (random effects pooled estimate = 21.7% [95% CI = 14.6-28.8] vs. 12.1% [95% CI = 9.6-14.6]), and when the cognitively impaired were excluded (random effects pooled estimate = 25% [95% CI = 15.7-34.7] vs. 8.8% [95% CI = 4.1-13.6]). The funnel plot showed a deficit of small studies showing low risk and large studies showing high risk. In eight hip fracture studies, the proportion of delirium cases with a preoperative onset ranged from 34 to 92%. CONCLUSIONS: Delirium occurs more commonly with hip fracture than elective surgery, and frequently has a preoperative onset when associated with trauma. Recommendations are made with the aim of standardizing future research in order to further explore and reduce the heterogeneity and possible publication bias observed.
Asunto(s)
Delirio/epidemiología , Delirio/psicología , Procedimientos Ortopédicos/psicología , Procedimientos Ortopédicos/estadística & datos numéricos , Anciano , Trastornos del Conocimiento/epidemiología , Delirio/diagnóstico , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Humanos , IncidenciaRESUMEN
OBJECTIVES: This was a pilot, phase 2a study to assess methodological feasibility and the safety and efficacy of donepezil in preventing postoperative delirium after elective total hip replacement surgery in older people without pre-existing dementia. The hypothesis was that donepezil would reduce the incidence of postoperative delirium. METHODS: A double blind, placebo controlled, parallel group randomized trial was undertaken. Patients were block randomized pre-operatively to receive placebo or donepezil 5 mg immediately following surgery and every 24 h thereafter for a further three days. The main outcome was the incidence of delirium (using the Delirium Symptom Interview). The secondary outcome was length of hospital stay. RESULTS: Thirty-three patients (mean age 67 years; 17 males, 16 females) completed the study (19 donepezil, 14 placebo). Donepezil was well tolerated with no serious adverse events. Postoperative delirium occurred in 21.2% of subjects. Donepezil did not significantly reduce the incidence of delirium. The unadjusted risk ratio (donepezil vs placebo) for delirium was 0.29 (95% CI = 0.06,1.30) (chi(2) ([1]) = 3.06; p = 0.08). Mean length of hospital stay was 9.9 days for the donepezil group vs 12.1 days in the placebo group; difference in means = -2.2 days (95% CI = -0.39,4.78) (t([31]) = 1.73: p = 0.09). CONCLUSIONS: The experimental paradigm was feasible and acceptable. Donepezil did not significantly reduce the incidence of delirium or length of hospital stay, however for both outcomes there was a consistent trend suggesting possible benefit. The sample size required for a definitive trial (99% power, alpha 0.05) would be 95 subjects per arm.