The prevalence of metabolic syndrome and its associated factors in long-term patients in a specialist psychiatric hospital in South Africa

OBJECTIVE

The aims of this study were to determine the prevalence of metabolic disorders in long-term psychiatric patients, and the relationship between known risk factors and these metabolic disorders.

METHODS

All psychiatric in-patients ≥18 years, who had been admitted ≥six months were invited to participate. Eighty-four patients participated. They were interviewed, examined, measured and blood tests conducted to determine several demographic and clinical variables including age, gender, weight, blood pressure and fasting blood glucose.

RESULTS

The prevalence of the metabolic disorders were: metabolic syndrome 32%, hypertension 32%, diabetes mellitus 8%, cholesterol dyslipidaemia 32%, triglyceride dyslipidaemia 29%, low density lipoprotein (LDL) dyslipidaemia 50%, overweight 37%, and obesity 24%. Black African and female patients were more likely to have metabolic syndrome. Female patients were more likely to have cholesterol dyslipidaemia and obesity. Hypertension was associated with age. Ninety-six percent of patients with dyslipidaemia were newly diagnosed during the study. Three out of the seven previously diagnosed diabetic patients had raised fasting blood glucose levels.

CONCLUSION

The prevalence of metabolic syndrome falls towards the lower limits of the expected prevalence rate. Race and gender showed a moderate statistical association with metabolic syndrome. There is a lack of screening for dyslipidaemia in this setting. Diabetic patients should be referred to specialist diabetic clinics for better monitoring and control.

Clinical factors associated with rape victims' ability to testify in court: a records-based study of final psychiatric recommendation to court

OBJECTIVE

A rape victim may encounter professionals in both the health and the legal systems. Unanswered questions remain about clinical factors associated with a rape victim's ability to testify in court, and the quality of care offered to rape victims. The objectives of this study were thus to determine the clinical factors that are associated with a rape victim's ability to testify in court, as well as to undertake a preliminary exploration of the referral system between the court and the mental health services.

METHOD

A retrospective study was conducted of rape victims referred by the court (n=70) to be assessed psycho-legally by psychiatrists. Rape victims who were recommended as able and those recommended as unable to testify in court were compared with regard to their clinical characteristics.

RESULTS

Thirty-seven (53.6%) victims were recommended as able to testify and 32 (46.4%) victims as unable to testify in court. Victims from rural areas and victims with severe mental retardation were statistically significantly more often found to be unable to testify in court. Almost half (49.2%) of the victims were referred by court for first assessment within six months of being raped. Most (63.5%) victims were assessed for the first time within one month of being referred.

CONCLUSION

The decision about a victim's ability to testify should not be based solely on the two statistically significant variables but, rather, individualised. Optimal mental health and legal services should be offered to rape victims. Further studies are required in assessing the collaboration between the health and legal systems.

Questionnaire-based survey on structural quality of hospitals and nursing homes for the elderly, their staffing with infection control personal, and implementation of infection control measures in Germany

From January to May 2012, 1,860 hospitals throughout Germany received a questionnaire encompassing 77 items. Additionally, 300 outpatient care services and 310 nursing homes for elderly in Berlin also received a 10-item questionnaire asking on their implemented infection control practices. All questionnaires were anonymous. A total of 229 completed questionnaires from hospitals, 14 questionnaires from outpatient care services, and 16 questionnaires from nursing homes were eligible for further analysis.

The lack of Infection Control physicians was identified as the largest issue. In hospitals sized 400–999 beds a gap of 71%, and in hospitals sized ≥1,000 beds a gap of 17% was reported. Depending on the number of hospital beds, 13–29% of hospitals sized ≥100 beds reported not havening one infection control nurse. Since based on the number of beds in larger institutions or in facilities caring for high-risk patients several infection control nurses may be required, the deficiency in infection control nurses may even be higher, particularly in secondary and tertiary care facilities. Furthermore, the analysis revealed that the legal requirements for surveillance and reporting of notifiable infectious diseases have not yet been implemented in 11% of the facilities. The implementation of antibiotic strategies did show significant gaps. However, deficiencies in the implemented measures for the prevention of surgical site infections were less frequent. Yet 12% of the participants did not have a dedicated infection control concept for their surgical services. Eight percent of hospitals were not prepared for an outbreak management and 10% did not have established regulations for wearing surgical scrubs. Deficiencies in waste disposal and the control of air-conditioning systems were also noted. Based on the results of this survey, conclusions on the optimal resource allocation for further improvement of patient safety may be drawn.

While all participating nursing homes had some sort of infection control consultation, this only applied to 12 out of 16 outpatient nursing services. However, all 16 nursing services worked on the basis of an implemented infection control plan. Though legally binding hygiene recommendations have not yet been implemented for nursing homes, the necessity of infection control to assure patient safety has obviously been recognised throughout these services.

HIV sero-positivity in recently admitted and long-term psychiatric in-patients: prevalence and diagnostic profile

OBJECTIVE

Research on HIV in South Africa has not reflected the impact of the disease on psychiatric patients. The aims of the study were: to compare the HIV prevalence among patient groups in Weskoppies Hospital; to compare psychiatric diagnoses of infected and non-infected patients; to assess intravenous drug use and high-risk sexual behaviour; to establish HIV-syphilis Association; and to investigate the rapid test performance for screening, compared to the confirmatory ELISA test.

METHOD

Onehundred-and-ninety-five patients were grouped into four categories according to their duration of admission and gender. HIV rapid testing, HIV ELISA, syphilis-RPR and TPHA testing were performed.

RESULTS

The HIV prevalence of 11% in the sample was significantly associated with 'gender-and-duration-of-admission' categories (p = 0.003). No significant association between HIV infection and psychiatric diagnoses or intravenous drug use was found, but a significant association existed between HIV infection and high-risk sexual behaviour (p = 0.002), and between HIV and syphilis (p = 0.012). The HIV rapid screening test had a sensitivity of 91.7% and a specificity of 98.2%.

CONCLUSION

The overall HIV prevalence at Weskoppies Hospital remains lower than the national average, but has increased since a previous local study. The rapid test for HIV had a lower sensitivity than was expected, and it is recommended that HIV ELISA testing be performed as a first line test in the setting of hospitalised patients. Due to the high prevalence of HIV and syphilis in the psychiatric population it is recommended that all patients be tested for both of these diseases.

Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa

OBJECTIVE

The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matched the national and international drive towards deinstitutionalisation. This article investigates patient and social work factors related to successful community placement, in the context of limited community care facilities.

METHOD

Thirty-six long-term patients who were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-term patients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients received the most interventions, and the most common type of interventions.

RESULTS

The most significant patient factors associated with successful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a low frequency of behavioural problems (especially of cannabis abuse, verbal or physical aggression, uncontrolled sexual activity), and agitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients during the study period: The recipients were mostly female, in open wards (higher-functioning); and the social services utilised were mostly related to planning for placement and patient support.

CONCLUSION

The lack of community care facilities in the Pretoria area that are able to care for the more difficult long-term psychiatry patients, limits successful placement and increases the burden of hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context of provincial and national health departments.

Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients

OBJECTIVE

The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence, and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts.

METHOD

Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables, using two-way tables and Chi-Square or Fisher's Exact Tests.

RESULTS

The prevalence of violence among the long-term patients was 16%. Fighting among patients was the most common form of violence (58%). The most significant risk factors of violence among the long-term patients are: A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay >12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement.

CONCLUSION

The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a isproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms, but more in their cognitive ability, coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement.

[The pain situation for residents of nursing homes. Results of a study in Münster]

BACKGROUND

Little is known about the phenomenon of pain in German nursing homes. In particular, it is unknown to what extent and severity pain occurs among residents and how their pain can be described.

MATERIAL AND METHODS

A total of 13 nursing homes located in the city of Münster, Germany, were included as part of the health services research project "Action Alliance Pain-free City Münster." Data were collected from 436 residents over 65 years old via self-report or the observational pain tool pain assessment in advanced dementia, german version (PAINAD-G), according to the cognitive status of the residents.

RESULTS

At the time of the interview, the majority of the residents questioned reported suffering from pain at rest and/or during movement. Approximately one quarter of residents complained about moderate to intolerable pain at rest and nearly 45% during movement. Residents encountered pain most often when standing up, sitting, resting in bed and walking and three quarters of residents had suffered from pain for more than 1 year. Many residents experienced pain in several body regions. Among residents assessed solely by the observational pain scale PAINAD-G, signs indicating pain existed in 21% (≥ 6) or 69% (≥ 2), respectively, depending on the cut-off value chosen on the PAINAD-G scale.

CONCLUSION

Pain in nursing homes is a challenge that needs more attention as it has considerable negative consequences for the persons concerned. The extent of pain in the studied facilities indicates an urgent need for action on the part of all professionals caring for residents in nursing homes.

A survey of HIV-related knowledge among adult psychiatric patients. A South African Study - Part 2

OBJECTIVE

Studies have reported an increased prevalence of HIV infection among psychiatric patients. Inaccurate HIV knowledge is included as a factor in the increased risk of HIV infection in the mentally ill, but few studies have looked specifically at this factor. The aims of the study were to determine the knowledge of HIV and its transmission among adult psychiatric patients at Weskoppies Hospital and to determine the relationship between HIV knowledge and HIV risk behaviour.

METHOD

Structured interviews were conducted with 113 consenting adult patients at Weskoppies Hospital. They were divided into three groups according to their length of hospital stay. The structured interview included questions about demographic data, the diagnoses and the AIDS Risk Behaviour Knowledge Test (AIDS-KT). Scores of 13 out of 13 represented accurate knowledge of HIV (level I); scores of 10-12 represented good knowledge (level II); scores of ≤ 9 represented poor knowledge (level III).

RESULTS

A total of 104 patients (92%) demonstrated excellent knowledge of HIV and its transmission (levels I and II). There was no significant linear association between HIV knowledge and risk-behaviour scores (Pearson's correlation coefficient r= -0.11).

CONCLUSION

The presence of high-risk behaviours despite good HIV-related knowledge in this group of patients, leads us to think that knowledge alone will not limit HIV risk behaviours. For this reason, educational programmes should not be limited to interventions that simply increase knowledge about HIV infection but should extend to clinical factors, including patients' motivation and readiness to change their behaviour.

Vulnerable long-term psychiatric inpatients need screening for physical-health problems: an audit of regular hospital statistics and clinical files

OBJECTIVE

Maintaining physical health in the presence of severe mental illness remains a challenge. The aims of this study were to identify the most pressing physical health problems of long-term psychiatric in-patients and to identify vulnerable subgroups, as part of a multi-phased programme evaluation project to improve service delivery to and quality of care of long-term patients in Weskoppies Hospital.

METHOD

Regular nursing statistics on vital data, infections, injuries, deaths, and adverse incidents, as well as clinical file data, infection-control statistics and dietician statistics were recorded for 268 long-term in-patients at Weskoppies Hospital over six months. Adverse incidents including aggression were recorded because of their potential for injury and nursing implications. Subgroups of patients were compared using two-way tables and Fisher's Exact Tests, or Mann-Whitney-U and Kruskal-Wallis tests.

RESULTS

The blood pressure of hypertensive patients was well controlled. Prevalent problems were epilepsy, respiratory tract infections, and injuries (accidental and from fighting or assault). Most vulnerable are older male patients (prone to respiratory tract infections and lower body weight); patients with cognitive disorders (prone to any injury, especially accidents and falls); and younger male patients (prone to aggression and resultant injury).

CONCLUSION

Increased screening should be conducted for older underweight male patients (for chronic respiratory or infectious diseases that might cause cachexia) and of patients with cognitive disorders or who have fallen (for treatable risk factors for falling and preventative measures). More patients should be referred for special diets. Nursing interventions should be emphasised more with aggressive and irritable patients.