RESUMEN
AIMS: Despite an increasing awareness of the importance of spirituality in mental health contexts, a 'religiosity gap' exists in the difference in the value placed on spirituality and religion by professionals compared with service users. This may be due to a lack of understanding about the complex ways people connect with spirituality within contemporary society and mental health contexts, and can result in people's spiritual needs being neglected, dismissed or pathologised within clinical practice. The aim of this qualitative systematic review is to characterise the experiences of spirituality among adults with mental health difficulties in published qualitative research. METHODS: An electronic search of seven databases was conducted along with forward and backward citation searching, expert consultation and hand-searching of journals. Thirty-eight studies were included from 4944 reviewed papers. The review protocol was pre-registered (PROSPERO:CRD42017080566). RESULTS: A thematic synthesis identified six key themes: Meaning-making (sub-themes: Multiple explanations; Developmental journey; Destiny v. autonomy), Identity, Service-provision, Talk about it, Interaction with symptoms (sub-themes: Interactive meaning-making; Spiritual disruption) and Coping (sub-themes: Spiritual practices; Spiritual relationship; Spiritual struggles; Preventing suicide), giving the acronym MISTIC. CONCLUSIONS: This qualitative systematic review provides evidence of the significant role spirituality plays in the lives of many people who experience mental health difficulties. It indicates the importance of mental health professionals being aware of and prepared to support the spiritual dimension of people using services. The production of a theory-based framework can inform efforts by health providers to understand and address people's spiritual needs as part of an integrated holistic approach towards care.
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Trastornos Mentales/psicología , Espiritualidad , Adaptación Psicológica , Adulto , Bases de Datos Factuales , Humanos , Investigación CualitativaRESUMEN
Extensive agricultural land use and intensive urban residential growth of the Calleguas Creek, California, watershed has increased chloride load and impaired beneficial uses. The hydrology of the watershed is typical of the semiarid U.S. West in that nearly all rainfall occurs in a small number of discrete storm events that each produces peak discharges of a duration of several days or less; conversely, during the dry weather season, discharge has historically been near zero. Currently, a year-round flow is sustained by two factors: base line flow sustained by discharges from publicly owned treatment works (POTWs) and increased groundwater discharge from a shallow water table elevated by intensive agricultural irrigation (deep groundwater basins used for water supply have declined into overdraft). Water quality impairment of Calleguas Creek increases during low-flow days, but cannot be defined seasonally because days not influenced by storm discharge occur at substantial proportions during all months. Impairment is greatest not during lowest flows, which are dominated by POTW effluent, but when groundwater and other nonpoint sources are highest, thereby contributing chloride load disproportionately to their flow. The highest nonstorm days are identified through cumulative frequency of mean daily discharge (MDD) as the transition from nonstorm conditions (described by normal distribution) to storm conditions (described by log-normal distribution). Transition occurs at approximately the 80th to 85th percentile MDD at three Calleguas Creek locations. Critical conditions for chloride impairment are defined as volumetric flow at those percentiles of cumulative MDD distribution.
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Conservación de los Recursos Naturales , Modelos Teóricos , Movimientos del Agua , Contaminantes del Agua/análisis , Abastecimiento de Agua , Agricultura , Ciudades , Monitoreo del Ambiente , Predicción , Lluvia , Estaciones del Año , Estados UnidosRESUMEN
Massospora cicadina Peck is a fungal pathogen of 13- and 17-year periodical cicadas (Magicicada spp.). In northwest Arkansas, during the spring 1998 emergence of the 13-year periodical cicada, Magicicada tredecassini (Brood XIX), <1% of emerging cicadas were infected with the conidial stage of M. cicadina, similar to data collected from the same population in 1985. However, in northwest Arkansas plots treated with M. cicadina resting spores collected from infected 17-year Magicicada septendecim cicadas (Brood IV) in 1997 from southern Iowa, 10 months prior to the 1998 emergence in Arkansas, conidial stage infections of M. cicadina in 13-year Arkansas M. tredecassini cicadas increased significantly to 10.6% (7.9% in males and 2.6% in females). These data suggest that M. cicadina resting spores do not require a dormancy of 13 or 17 years between cicada emergences. Instead M. cicadina resting spores appear to be capable of germinating and infecting periodical cicadas after less than 1 year. In addition, M. cicadina resting spores derived from one species (17-year M. septendecim cicadas) were infective for a second species (13-year M. tredecassini cicadas). A mean of 1.4 x 10(6)(SE = 1.8 x 10(5)) mature resting spores were produced per infected male M. septendecim.
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Entomophthorales/fisiología , Hemípteros/microbiología , Animales , Arkansas , Femenino , Iowa , Masculino , Esporas FúngicasRESUMEN
This paper reviews the literature concerning executive control impairments in degenerative dementias. The construct of executive control functioning is examined, as is the neuroanatomy of frontal-subcortical networks, believed to underlie executive function (EF) impairments. The pattern of EF impairments in Alzheimer's disease (AD) which affects temporal and parietal brain regions most severely is contrasted with observed executive dysfunctions in patients with dementias involving degeneration of primarily frontal and frontal-subcortical brain areas. EF impairments are present in each of these types of dementing illnesses. Although EF impairments are present in AD, they are less prominent than the memory disorder in the neuropsychological profile of the disease and tend to become more pronounced later in the course of the illness. In contrast, patients with frontal or frontal-subcortical dementia may demonstrate executive dysfunction, which occurs earlier in the disease progression and may be initially more severe.
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Encéfalo/patología , Trastornos del Conocimiento/diagnóstico , Demencia/diagnóstico , Demencia/psicología , Trastornos de la Memoria/diagnóstico , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/psicología , Atención , Encéfalo/anatomía & histología , Encéfalo/fisiopatología , Trastornos del Conocimiento/fisiopatología , Trastornos del Conocimiento/psicología , Demencia/patología , Demencia/fisiopatología , Diagnóstico Diferencial , Humanos , Trastornos de la Memoria/fisiopatología , Trastornos de la Memoria/psicología , Modelos Neurológicos , Trastornos del Movimiento/patología , Trastornos del Movimiento/psicología , Red Nerviosa , Enfermedades Neurodegenerativas/complicaciones , Enfermedades Neurodegenerativas/patología , Pruebas Neuropsicológicas , Índice de Severidad de la Enfermedad , Controles Informales de la Sociedad , VoliciónRESUMEN
Two studies of the relationship between depression and resting frontal electroencephalographic (EEG) activity are reported. Although considerable research supports the theory of left and right hemispheric specialization for approach and withdrawal behaviors, only four studies involving clinically depressed individuals have been published to date. Despite methodological similarities with published research, no significant differences in frontal activation emerged between depressed and nondepressed participants with either college students having high Beck Depression Inventory scores (Study 1) or with individuals diagnosed with DSM-III-R depression (Study 2). Post hoc analyses in Study 2 revealed one effect confined to lateral frontal leads during the first 2 min of EEG data; this finding was significant in only one of three reference montages. Results are discussed in light of methodological considerations and mediating variables such as temperament and coping styles.
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Trastorno Depresivo/fisiopatología , Dominancia Cerebral/fisiología , Electroencefalografía , Lóbulo Frontal/fisiopatología , Adolescente , Adulto , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Individualidad , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Factores de RiesgoRESUMEN
The Mattis Dementia Rating Scale (DRS), a widely used dementia screening instrument, generates five subscale scores in the areas of Attention (ATT), Initiation-Perseveration (IP), Construction (CN), Conceptualization (CON), and Memory (MEM). The present study sought to determine the criterion validity of the DRS subscales in a sample of 50 patients with Alzheimer's disease (25 with mild and 25 with moderate dementia). Subject performance on the five DRS subscales was correlated with performance on five well-validated neuropsychological criterion measures using Pearson r and stepwise regression. On a univariate level, each DRS subscale correlated most strongly with its assigned neuropsychological criterion measure. On a multivariate level, each DRS subscale emerged as the Step 1 predictor of its assigned criterion measure, with the exception of DRS CN, which was the Step 2 predictor. The results suggested that overall the DRS subscales are valid measures of their respective constructs and have value for both clinical and research purposes in mild and moderate dementia.
RESUMEN
As part of the NIMH Genetics Initiative Alzheimer's Disease (AD) Study Group, a brief structured telephone interview to distinguish individuals with normal cognitive functioning from those with changes in cognition and daily functioning suggestive of early AD was developed. The Structured Telephone Interview for Dementia Assessment (STIDA), yields a dementia score between 0 and 81 (higher scores indicating greater impairment). Subscales corresponding to the subscales of the Clinical Dementia Rating Scale (CDR) can be derived. The STIDA performed well as a screening instrument for mildly demented individuals. When a score of 10 or more (based on informant interview and subject testing) was used to identify mildly impaired individuals, the STIDA had a sensitivity of .93 and a specificity of .92 for a clinician-derived CDR of 0.5 or more. The STIDA was also capable of accurately assessing the level of dementia. STIDA-derived CDR ratings agreed with clinician-derived CDR scores in 23 of 28 cases, corresponding to an unweighted kappa of.71 and a weighted kappa of.81. A much-abbreviated short STIDA that could be administered directly to the subject was able to detect possible impairment with a sensitivity of .93 and a specificity of.77. These results suggest that the short STIDA provides a sensitive and fairly specific telephone screen for dementia, and that the full STIDA, consisting of an interview with a knowledgeable informant and subject testing, approximates the success of a face-to-face clinical interview, and provides reliable and valid screening and staging of dementia over the telephone.
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Enfermedad de Alzheimer/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Consulta Remota/métodos , Teléfono , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , National Institute of Mental Health (U.S.) , Psicometría , Consulta Remota/normas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Estados UnidosRESUMEN
This study investigated the effects of normal aging and Alzheimer's disease on listeners' ability to recognize gated spoken words. Groups of healthy young adults, healthy older adults, and adults with Alzheimer's disease were presented isolated gated spoken words. Theoretical predictions of the Cohort model of spoken word recognition (Marslen-Wilson, 1984) were tested, employing both between-group and within-group comparisons. The findings for the young adults supported the Cohort model's predictions. The findings for the older adult groups revealed different effects for age and disease. These results are interpreted in relation to the theoretical predictions, the findings of previous gating studies, and differentiating age from disease-related changes in spoken word recognition.
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Envejecimiento , Enfermedad de Alzheimer/fisiopatología , Encéfalo/fisiopatología , Percepción del Habla , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Discriminación del Habla , Factores de TiempoRESUMEN
In an outbreak of gastroenteritis affecting 43 people, cryptosporidium and campylobacter were isolated from stool specimens and in two cases dual infection was found. All the cases had drunk unboiled water from a private untreated water supply. Investigations revealed the carcasses of three lambs in a collection chamber connected with the water supply, and these, or run-off of slurry from surrounding fields, were the presumed source of contamination. Issues relating to the maintenance and monitoring of private water supplies are discussed. Problems with such supplies include old piping, proximity of livestock, inadequate knowledge of the layout and limited resources for monitoring and maintenance.
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Infecciones por Campylobacter/epidemiología , Criptosporidiosis/epidemiología , Brotes de Enfermedades , Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Microbiología del Agua , Abastecimiento de Agua , Adulto , Animales , Infecciones por Campylobacter/complicaciones , Campylobacter jejuni/aislamiento & purificación , Criptosporidiosis/complicaciones , Cryptosporidium/aislamiento & purificación , Inglaterra/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , OvinosRESUMEN
Mothers in developing countries are being successfully taught to give an oral rehydration solution (ORS) at home. The quantity of oral rehydration fluid that mothers administer to their child remains a critical question. Inadequate quantities render oral rehydration therapy (ORT) ineffective. The primary focus of our investigation was direct measurement of the quantity of fluid unsupervised mothers gave their children at home. This study validates a methodology that provides precise information on ORS administration in the home, information essential for evaluating the effectiveness of home-based therapy and for planning programmes to influence unsupervised mothers to correctly administer ORS to their sick children. This study, conducted in the Kingdom of Lesotho, assessed the impact on home care of the national control of diarrhoeal disease (CDD) programme. Direct observations in the home established each child's status and the quantity of fluid used 24 hr after children left the ORT unit where mothers were instructed to give ORS at home. Data were gathered on natural consequences that might discourage use of ORS, such as vomiting, increased frequency of watery stools and distaste for the solution. The health status of most of the 197 children followed improved. The average volume of ORS administered was 544 ml. A full liter was given by 21% of the mothers. Only 3% of the mothers gave no ORS. The average dose was 65 ml/kg. Younger children got about the same volume as older children; thus, they received a higher ml/kg dose. Mothers gave more ORS to children who had more symptoms of diarrhoeal disease at the time they were brought to the clinic.(ABSTRACT TRUNCATED AT 250 WORDS)
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Países en Desarrollo , Diarrea Infantil/terapia , Fluidoterapia , Estado de Salud , Atención Domiciliaria de Salud/métodos , Madres , Desarrollo de Programa , Soluciones para Rehidratación/uso terapéutico , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Lesotho , Masculino , Proyectos Piloto , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
In Experiment 1, young and old adults both generated and read the same words either two, five, or eight times (with frequencies combined orthogonally) and then judged the frequency of either the generated or read words. In Experiment 2, young and old adults generated and read different words either one, two, or three times and judged the frequency of both the generated and read words. In both experiments, generation, compared to reading, increased the slope of frequency judgments comparably for the two age groups. In Experiment 1, neither age group could discriminate read from generated frequency. In Experiment 2, a 24-h retention interval reduced the slope of frequency judgments, but did not interact with either age or generation efforts. These results seem most consistent with a semantic activation explanation of the generation effect and a familiarity-based judgment about frequency of occurrence.
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Envejecimiento/psicología , Juicio , Retención en Psicología/fisiología , Conducta Verbal/fisiología , Adulto , Anciano , Análisis de Varianza , Discriminación en Psicología , Femenino , Humanos , Masculino , Pensamiento , EscrituraRESUMEN
Diurnal variation in leucocyte cystine and the effects of equimolar single doses of oral phosphocysteamine and rectal cysteamine were studied in eight patients with cystinosis, aged 1.8-16.5 years. No significant diurnal variation in leucocyte cystine was found. Absorption of cysteamine was reduced after rectal administration compared with the oral dose: mean (SD) peak concentration 17.2 (6.3) mumol/l v 36.4 (5.5) mumol/l at 40 min and mean (SD) area under the curve 22.3 (14.3) v 59.4 (33.1) mumol/h/l. Oral phosphocysteamine significantly reduced the mean (SD) leucocyte cystine from 8.09 (0.47) to 3.26 (1.48) nmol 1/2 cystine/mg protein at three hours. At 12 hours the mean leucocyte cystine was significantly lower than the pretreatment concentration. Rectal cysteamine did not significantly reduce the mean leucocyte cystine concentration. In conclusion, phosphocysteamine suspension may be administered every 12 hours. Rectal cysteamine administration is feasible but higher doses are required before efficacy can be judged.
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Cistafos/farmacocinética , Cisteamina/farmacocinética , Cistinosis/tratamiento farmacológico , Administración Oral , Administración Rectal , Adolescente , Niño , Preescolar , Ritmo Circadiano , Cistafos/administración & dosificación , Cisteamina/administración & dosificación , Cistina/sangre , Cistinosis/sangre , Cistinosis/metabolismo , Femenino , Humanos , Lactante , Leucocitos/metabolismo , Masculino , Factores de TiempoRESUMEN
In Alzheimer's disease (AD), the relationship between white-matter changes on magnetic resonance images and behavior are unclear. Therefore, magnetic resonance images, cognition, and psychiatric state were assessed in patients with AD with depression (AD/DEP; n = 18) and without depression (AD; n = 45), older depressed patients (n = 12) and older normal individuals (n = 25). High-intensity signals in the cortex and subcortical regions were similar in number and proportions among all groups, even when hypertensive patients were excluded. No correlations to cognitive or psychiatric state were found. Periventricular signals were categorized using a 1- (absent) to 6- (thick, irregular caps and stripes) point scale. The categories were similar among groups except that patients with AD exhibited more category 5 changes than did normal subjects, neuropsychological performance was significantly worse in patients with AD who had category 5 and 6 changes when compared to those in category 1. These results suggest that periventricular changes may predict poor neuropsychological performance in patients with AD. However, neither deep white-matter lesions nor periventricular changes are useful for diagnostic purposes.
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Enfermedad de Alzheimer/diagnóstico , Encéfalo/patología , Cognición , Imagen por Resonancia Magnética , Anciano , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/psicología , Humanos , Hipertensión/complicaciones , Hipertensión/patología , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
Considerable heterogeneity exists in the criteria used for the establishment of stages of impairment for patients with dementia. The valid distinction of stages is important both for clinical interpretation and the study of dementia. This study reports on the use of the Mattis Dementia Rating Scale (DRS) in staging dementia. Using a sample of 42 patients diagnosed with Alzheimer-type dementia, DRS performance and a rating of Instrumental Activities of Daily Living (IADL) were compared with clinical ratings of dementia severity. Total DRS score provides a clinically valid measure of stage of impairment and appeared to provide a better distinction among stages than IADL score. However, use of the IADL score in conjunction with total DRS may improve correspondence with clinical staging over use of the total DRS score alone. Normative data for the DRS are also provided.
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Enfermedad de Alzheimer/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Actividades Cotidianas/psicología , Anciano , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , PsicometríaRESUMEN
Previous studies have been inconclusive as to whether peak flow meter use teaches asthma patients to better perceive their own pulmonary functioning. This investigation utilized a delayed baseline design to determine if pulmonary awareness could be improved among a sample of 24 adult patients who compared daily peak expiratory flow rates (PEFR) with asthma symptom ratings. Results indicated that among this sample of adult patients: (i) perception of pulmonary functioning was poor, (ii) adherence to peak flow meter use was poor, and (iii) among patients who use peak flow meters daily, self-perception of pulmonary functioning did not improve significantly. Summary tables and descriptive statistics for pulmonary functioning are provided, and treatment implications are discussed.
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Asma , Ápice del Flujo Espiratorio , Reología , Autocuidado/instrumentación , Adulto , Asma/psicología , Actitud Frente a la Salud , Femenino , Humanos , Masculino , Educación del Paciente como AsuntoRESUMEN
Ultrashort-lived iridium-191m (Ir-191m, physical half-life = 5.0 seconds) has been used in angiocardiography, primarily in pediatric patients. A theoretical obstacle to more widespread use of Ir-191m is the belief that its physical half-life is too short to permit evaluation of left ventricular function in adult patients. To evaluate its usefulness in adults, first pass ejection fractions of the left and right ventricles determined with use of Ir-191m and technetium-99m (Tc-99m) were compared in 33 adult patients. An osmium-191m----iridium-191m (Os-191----Ir-191m) generator was employed to deliver doses of 150 to 250 mCi (5.5 to 9.2 GBq) of Ir-191m for intravenous injection. The whole body radiation absorbed dose with Ir-191m was 15 to 25 mrad. High quality angiocardiograms were obtained with both Tc-99m and Ir-191m. Total counts per image for the right ventricle were 51,000 +/- 8,000 (mean +/- SD) for Ir-191m and 30,000 +/- 8,000 for Tc-99m. The left ventricular counts were comparable for both radiotracers (25,000 +/- 7,000 for Ir-191m and 25,000 +/- 8,000 for Tc-99m). Right ventricular ejection fractions were similar: 44 +/- 8% for Ir-191m and 47 +/- 9% for Tc-99m. The correlation coefficient was 0.93 with a standard deviation of the regression of 3.1% ejection fraction units. The left ventricular ejection fractions were also similar: 45 +/- 14% for Ir-191m and 46 +/- 13% for Tc-99m. The left ventricular ejection fraction correlation coefficient was 0.96 with a standard deviation of the regression of 3.7%.(ABSTRACT TRUNCATED AT 250 WORDS)