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Haun MH, Girit S, Goldfarb Y, Kalha J, Korde P, Kwebiiha E, Moran G, Mtei R, Niwemuhwezi J, Nixdorf R, Nugent L, Puschner B, Ramesh M, Ryan GK, Slade M, Charles A, Krumm S. Mental health workers' perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study. BMJ Open 2024; 14:e081963. [PMID: 38749688 PMCID: PMC11097849 DOI: 10.1136/bmjopen-2023-081963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE The introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers' (MHWs) experiences with peer support comes from high-income countries. Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) is an international multicentre study, which aims at scaling up peer support for people with severe mental illness in Europe, Asia and Africa. This study investigates MHWs experiences with UPSIDES peer support. DESIGN Six focus groups with MHWs were conducted approximately 18 months after the implementation of the UPSIDES peer support intervention. Transcripts were analysed with a descriptive approach using thematic content analysis. SETTING Qualitative data were collected in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel) and Pune (India). PARTICIPANTS 25 MHWs (19 females and 6 males) from UPSIDES study sites in the UPSIDES Trial (ISRCTN26008944) participated. FINDINGS Five overarching themes were identified in MHWs' discussions: MHWs valued peer support workers (PSWs) for sharing their lived experiences with service users (theme 1), gained trust in peer support over time (theme 2) and provided support to them (theme 3). Participants from lower-resource study sites reported additional benefits, including reduced workload. PSWs extending their roles beyond what MHWs perceived as appropriate was described as a challenge (theme 4). Perceptions about PSWs varied based on previous peer support experience, ranging from considering PSWs as equal team members to viewing them as service users (theme 5). CONCLUSIONS Considering local context is essential in order to understand MHWs' views on the cooperation with PSWs. Especially in settings with less prior experience of peer support, implementers should make extra effort to promote interaction between MHWs and PSWs. In order to better understand the determinants of successful implementation of peer support in diverse settings, further research should investigate the impact of contextual factors (eg, resource availability and cultural values). TRIAL REGISTRATION NUMBER ISRCTN26008944.
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Affiliation(s)
| | - Selina Girit
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Yael Goldfarb
- Department of Social Work, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Eric Kwebiiha
- Butabika National Referral Hospital, Kampala, Uganda
| | - Galia Moran
- Department of Social Work, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Rachel Mtei
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Jackline Niwemuhwezi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Nugent
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Silvia Krumm
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Ben-Dor IA, Kraus E, Goldfarb Y, Grayzman A, Puschner B, Moran GS. Perspectives and Experiences of Stakeholders on Self-Disclosure of Peers in Mental Health Services. Community Ment Health J 2024:10.1007/s10597-024-01287-2. [PMID: 38730076 DOI: 10.1007/s10597-024-01287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
With the movement towards recovery-oriented mental health (MH) services, individuals with MH lived-experience are increasingly employed as peer providers (peers). Peers are unique in that they bring knowledge from experience and eye-level connection to service users that enhance the quality of services and humanize MH systems' culture. In Israel, hundreds of peers are employed in various roles and settings across the MH system. However, peer integration into MH services faces challenges. One issue involves the use of self-disclosure (SD) in MH services which varies with explicitness across roles and settings. This study sought to understand perspectives and experiences regarding peers' SD (use & sharing of knowledge from experience) among different stakeholders in MH health services. Six focus groups and 4 semi-structured interviews (N = 42) were conducted as a part of a larger international project (UPSIDES; ERC Horizon 2020, Moran et al., Trials 21:371, 2020). Data was transcribed verbatim and analyzed using thematic analysis. Four categories and 7 themes were identified regarding current perspectives and experiences with peers' SD in MH organizations: (i) Restrained or cautious organizational approach to SD; (ii) Attitudes of peers to SD approach; (iii) The influence of designated peer roles on SD; and (iv) Unwarranted SD of peers working in traditional roles. The findings reveal that peers' SD in MH services is a complex process. Organizational approaches were often controlling of non-designated peers' SD practices; participants had diverse attitudes for and against peers' SD; SD occurred according to personal preferences, specific peer role and the director's approach to peers' SD; Conflictual SD dilemmas emerged in relation to service users and staff. SD sometimes occurs unwarrantely due to ill mental health. The presence of peer-designated roles positively impacts peers' SD. We interpret the current mix of views and general conduct of peer SD practice in statutory MH services as related to three aspects: 1. The presence of a traditional therapeutic SD model vs. a peer SD model - with the former currently being dominant. 2. Insufficient proficiency and skill development in peers' SD. 3. Stigmatic notions about peer SD among service users and staff. Together, these aspects interrelate and sometimes create a negative cycle create tension and confusion.A need to develop professionalism of peer SD in statutory services is highlighted alongside enhancing staff and service user acknowledgement of the value of peer SD. Developing peer-designated roles can positively impacts peer SD in MH statutory services. Training, support, and organizational interventions are required to further support for peer-oriented SD and the enhancement of a person-centered and recovery orientation of MH services.
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Affiliation(s)
- Inbar Adler Ben-Dor
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel.
| | - Eran Kraus
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel
| | - Yael Goldfarb
- The Academic College of Tel Aviv Yaffo, Tel Aviv-Yaffo, Israel
| | - Alina Grayzman
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Galia S Moran
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel
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Hiltensperger R, Ryan G, Ben-Dor IA, Charles A, Epple E, Kalha J, Korde P, Kotera Y, Mpango R, Moran G, Mueller-Stierlin AS, Nixdorf R, Ramesh M, Shamba D, Slade M, Puschner B, Nakku J. Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach. BMC Health Serv Res 2024; 24:480. [PMID: 38637776 PMCID: PMC11027518 DOI: 10.1186/s12913-024-10990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. METHODS One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. RESULTS The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. CONCLUSIONS UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. TRIAL REGISTRATION ISRCTN26008944 (Registration Date: 30/10/2019).
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Affiliation(s)
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Epple
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Ramesh
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Donat Shamba
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Health and Community Participation Division, Nord University, Namsos, Norway
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
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Peters M, Klein T, Stuber F, Kösters M, Mulfinger N, Stiawa M, Puschner B. Moderators and mediators of effects of interventions to reduce stress in hospital employees: A systematic review. Stress Health 2024; 40:e3314. [PMID: 37702316 DOI: 10.1002/smi.3314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
This systematic review examines moderators and mediators tested in evaluations of stress management interventions for hospital employees to determine their significance for intervention outcomes. To be included, studies had to comprise a moderator or mediator analysis and a quantitative assessment of stress or mental well-being, and to be published in English or German language. Five databases (APA PsycInfo, APA PsycArticles, Embase, Medline, and Web of Science) were searched. Moderators and mediators were categorised thematically and examined using effect direction plots. Study quality was assessed using RoB 2 and ROBINS-I. In fifteen included studies, 22 moderators and ten mediators were identified. Moderators and mediators were categorised into individual psychological factors (14), socio-economic status (6), work situation (5), intervention (3), and duration of employment (3). Two moderators (perceived stressfulness of residency, job control) had a positive, two a negative impact (spirituality, socially desirable responding). One moderator (years of professional experience) had a positive and negative impact. Three moderators measured on categorical scales (gender, profession, and shiftwork) also had effects, favouring women, physicians and night-shift employees. Five mediators (adherence to intervention, mindfulness, non-reactivity to inner experience, total observing, and self-compassion) had a positive impact, while three (isolation, over-identification, psychological inflexibility) had a negative impact. In conclusion, effects of interventions were predominantly driven by individual psychological factors, while the role of other variables seems to be limited. Interventions focussing on primary or tertiary prevention were rare. Also processes through which organisational-level interventions can be most effective have been hardly investigated. Larger and methodologically robust studies are needed to better understand causal pathways and optimise matching of interventions to target groups.
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Affiliation(s)
- Martin Peters
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Markus Kösters
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Nadine Mulfinger
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Maja Stiawa
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Günzburg, Germany
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Nixdorf R, Kotera Y, Baillie D, Garber Epstein P, Hall C, Hiltensperger R, Korde P, Moran G, Mpango R, Nakku J, Puschner B, Ramesh M, Repper J, Shamba D, Slade M, Kalha J, Mahlke C. Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries. PLoS One 2024; 19:e0298315. [PMID: 38408108 PMCID: PMC10896522 DOI: 10.1371/journal.pone.0298315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. METHOD Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. RESULTS 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. DISCUSSION Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.
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Affiliation(s)
- Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dave Baillie
- East London NHS Foundation Trust, London, United Kingdom
| | - Paula Garber Epstein
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, United Kingdom
| | | | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- School of Health Sciences, Soroti University, Soroti, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Haun M, Adler Ben-Dor I, Hall C, Kalha J, Korde P, Moran G, Müller-Stierlin AS, Niwemuhwezi J, Nixdorf R, Puschner B, Ramesh M, Charles A, Krumm S. Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study. BMC Health Serv Res 2024; 24:159. [PMID: 38302955 PMCID: PMC10835950 DOI: 10.1186/s12913-024-10543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Peer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR). METHOD 6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis. RESULTS Across study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting). CONCLUSIONS This study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.
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Affiliation(s)
- Maria Haun
- Department of Psychiatry II, Ulm University, Ulm, Germany.
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, UK
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Silvia Krumm
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Goldfarb Y, Grayzman A, Meir LG, Grundman SH, Rabinian M, Lachman M, Epstein PG, Ben-Dor IA, Naaman A, Puschner B, Moran GS. UPSIDES Mental Health Peer Support in Face of the COVID-19 Pandemic: Actions and Insights. Community Ment Health J 2024; 60:5-13. [PMID: 36508063 PMCID: PMC9743118 DOI: 10.1007/s10597-022-01030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19.
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Affiliation(s)
- Yael Goldfarb
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Alina Grayzman
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Lion Gai Meir
- Enosh the Israeli Mental Health Association, Kfar Saba, Israel
| | | | | | - Max Lachman
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Adi Naaman
- Mental Health Department, Ministry of Health, Jerusalem, Israel
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany.
| | - Galia S Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel.
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Girit S, Müller-Stierlin AS, Hiltensperger R, Wenzel L, Lohner M, Mahlke C, Nixdorf R, Puschner B. [Successful Implementation of Peer Support for People with Severe Mental Illness in Germany: a Theory of Change Approach]. Psychother Psychosom Med Psychol 2023; 73:70-77. [PMID: 35793668 DOI: 10.1055/a-1827-4040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Peer support is an established intervention in which people with mental illness receive support by trained peer support workers who have already overcome a mental health crisis. The implementation of peer support is complex due to interacting factors and can be achieved through the participatory Theory of Change method. Aim of this study is to develop a cross-site Theory of Change for the sustainable implementation of UPSIDES peer support in Germany. METHODS Based on site-specific Theories of Change workshops from Ulm and Hamburg in which 47 participants took part, a cross-site Theory of Change was designed and verified in three follow-up workshops with 12 participants. Participants' professional and experiential backgrounds were diverse, including peer support workers, hospital directors and managers, mental health professionals (psychiatrists, psychotherapists, nurses), and researchers. RESULTS The first pathway of the cross-site Theory of Change focuses on the training of peer support workers, whereas the second pathway emphasizes recognition and integration by mental health institutions and professionals. The third pathway specifies the building of a cross-professional care network to integrate various peer support services. Procedures to approach prospective peer clients are depicted in the fourth pathway. The fifth path addresses the clarification of the role description of peer support workers and the implementation in other institutions through cooperation. DISCUSSION Many of the identified implementation steps have been validated in comparable studies. The development of this Theory of Change by bringing together multiple perspectives of key stakeholders is an important basis for the sustainable implementation of UPSIDES peer support. Furthermore, it may serve as a blueprint for the implementation of similar interventions to advance scaling-up of evidence-based user-led and recovery-oriented interventions. CONCLUSION The Theory of Change approach is a well-accepted and feasible method, which can be recommended for the implementation of complex interventions such as UPSIDES peer support.
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Affiliation(s)
- Selina Girit
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | | | - Ramona Hiltensperger
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Lisa Wenzel
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Manfred Lohner
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Candelaria Mahlke
- AG sozialpsychiatrische und partizipative Forschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- AG sozialpsychiatrische und partizipative Forschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
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9
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Krumm S, Haun M, Hiller S, Charles A, Kalha J, Niwemuhwezi J, Nixdorf R, Puschner B, Ryan G, Shamba D, Epstein PG, Moran G. Mental health workers' perspectives on peer support in high-, middle- and low income settings: a focus group study. BMC Psychiatry 2022; 22:604. [PMID: 36088330 PMCID: PMC9464408 DOI: 10.1186/s12888-022-04206-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers' attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings. METHODS Six focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis. RESULTS Participants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers' views on peer support workers' roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment. CONCLUSIONS Mental health workers' attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers' roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany.
| | - Maria Haun
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Selina Hiller
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Ashleigh Charles
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jasmine Kalha
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Jackie Niwemuhwezi
- grid.461309.90000 0004 0414 2591Butabika National Referral Hospital, Kampala, Uganda
| | - Rebecca Nixdorf
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Grace Ryan
- grid.8991.90000 0004 0425 469XCentre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- grid.414543.30000 0000 9144 642XDepartment of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Paula Garber Epstein
- grid.12136.370000 0004 1937 0546Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Galia Moran
- grid.7489.20000 0004 1937 0511Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
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10
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Stuber F, Seifried-Dübon T, Tsarouha E, Rahmani Azad Z, Erschens R, Armbruster I, Schnalzer S, Mulfinger N, Müller A, Angerer P, Helaß M, Maatouk I, Nikendei C, Ruhle S, Puschner B, Gündel H, Rieger MA, Zipfel S, Junne F. Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital: the results of a mixed-method phase-II study. BMJ Open 2022; 12:e049951. [PMID: 35197332 PMCID: PMC8867373 DOI: 10.1136/bmjopen-2021-049951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Hospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership. DESIGN This is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants' change in everyday work. SETTING A tertiary hospital in Germany. PARTICIPANTS N=93 leaders of different professions. INTERVENTION An interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource 'team', (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention. OUTCOME MEASURES Feasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership. RESULTS After the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants' self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work. CONCLUSIONS This intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre-randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus).
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Affiliation(s)
- Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Zahra Rahmani Azad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Ines Armbruster
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Nadine Mulfinger
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Andreas Müller
- Institute of Psychology, Work and Organisational Psychology, University of Duisburg-Essen, Essen, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Madeleine Helaß
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sascha Ruhle
- Chair of Business Administration, Human Resource Management and Organisation Studies, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Bernd Puschner
- Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
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11
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Charles A, Korde P, Newby C, Grayzman A, Hiltensperger R, Mahlke C, Moran G, Nakku J, Niwemuhwezi J, Nixdorf R, Paul E, Puschner B, Ramesh M, Ryan GK, Shamba D, Kalha J, Slade M. Proportionate translation of study materials and measures in a multinational global health trial: methodology development and implementation. BMJ Open 2022; 12:e058083. [PMID: 35058270 PMCID: PMC8783829 DOI: 10.1136/bmjopen-2021-058083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Current translation guidelines do not include sufficiently flexible translation approaches for different study materials. We aimed to develop a proportionate methodology to inform translation of all types of study materials in global health trials. DESIGN The design included three stages: (1) categorisation of study materials, (2) integration of existing translation frameworks and (3) methodology implementation (Germany, India, Israel, Tanzania and Uganda) and refinement. PARTICIPANTS The study population comprised 27 mental health service users and 27 mental health workers who were fluent in the local language in stage 7 (pretesting), and 54 bilingual mental health service users, aged 18 years or over, and able to give consent as judged by a clinician for step 9 (psychometric evaluation). SETTING The study took place in preparation for the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) randomised controlled trial (ISRCTN26008944). PRIMARY OUTCOME MEASURE The primary outcome measure was the Social Inclusion Scale (SIS). RESULTS The typology identifies four categories of study materials: local text, study-generated text, secondary measures and primary measure. The UPSIDES Proportionate Translation Methodology comprises ten steps: preparation, forward translation, reconciliation, back translation, review, harmonisation, pretesting, finalisation, psychometric evaluation and dissemination. The translated primary outcome measure for the UPSIDES Trial (SIS) demonstrated adequate content validity (49.3 vs 48.5, p=0.08), convergent validity and internal consistency (0.73), with minimal floor/ceiling effects. CONCLUSION This methodology can be recommended for translating, cross-culturally adapting and validating all study materials, including standardised measures, in future multisite global trials. The methodology is particularly applicable to multi-national studies involving sites with differing resource levels. The robustness of the psychometric findings is limited by the sample sizes for each site. However, making this limitation explicit is preferable to the typical practice of not reporting adequate details about measure translation and validation. TRAIL REGISTRATION NUMBER ISRCTN26008944.
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Affiliation(s)
- Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, Maharashtra, India
| | - Chris Newby
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Alina Grayzman
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | | | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Paul
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Morogoro, United Republic of Tanzania
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Morogoro, United Republic of Tanzania
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, Maharashtra, India
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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12
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Rojnic Kuzman M, Slade M, Puschner B, Scanferla E, Bajic Z, Courtet P, Samochowiec J, Arango C, Vahip S, Taube M, Falkai P, Dom G, Izakova L, Carpiniello B, Bellani M, Fiorillo A, Skugarevsky O, Mihaljevic-Peles A, Telles-Correia D, Novais F, Mohr P, Wancata J, Hultén M, Chkonia E, Balazs J, Beezhold J, Lien L, Mihajlovic G, Delic M, Stoppe G, Racetovic G, Babic D, Mazaliauskiene R, Cozman D, Hjerrild S, Chihai J, Flannery W, Melartin T, Maruta N, Soghoyan A, Gorwood P. Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries. Eur Psychiatry 2022; 65:e75. [DOI: 10.1192/j.eurpsy.2022.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe.
Methods
We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice.
Results
SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style.
Conclusions
The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.
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13
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Stiawa M, Peters M, Mulfinger N, Krumm S, Worringer B, Maatouk I, Küllenberg J, Junne F, Genrich M, Gündel H, Puschner B. ["Stress Occurs Every Day" - Reasons for Work-Related Burden in Hospitals and Coping of Staff. A Qualitative Study]. Psychiatr Prax 2021; 49:128-137. [PMID: 34015853 DOI: 10.1055/a-1477-6000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Workplace exposures are considered to be high in hospital staff. Workplace interventions might be an appropriate way to reduce workplace exposures. Therefore, views of hospital staff on reasons and implications of workplace exposures were assessed and consequences for workplace interventions were considered. METHODS Six focus groups and seven semi-structured interviews were conducted with 34 members of hospital staff in total. Qualitative Content Analysis was performed. RESULTS Stress occurs due to a lack of personnel, high workload, missing common-rooms for breaks and lunch, missing communication, a lack of clarity in work processes, team conflicts and a lack of appreciation. Social support, work breaks, reduction of working hours, physical activity and empowerment were mentioned as factors leading to stress reduction. CONCLUSION Possible stress reduction by means of problem-related coping and emotional coping depending on hospital structure and culture.
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Affiliation(s)
- Maja Stiawa
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
| | - Martin Peters
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
| | - Nadine Mulfinger
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm
| | - Silvia Krumm
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
| | - Britta Worringer
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universität Düsseldorf
| | - Imad Maatouk
- Klinik für Allgemeine Innere Medizin und Psychosomatik der Universität Heidelberg
| | - Janna Küllenberg
- Klinik für Allgemeine Innere Medizin und Psychosomatik der Universität Heidelberg
| | - Florian Junne
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Universität Tübingen.,Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Otto-von-Guericke-Universität Magdeburg
| | - Melanie Genrich
- Fakultät für Bildungswissenschaften, Arbeits- und Organisationspsychologie der Universität Duisburg-Essen
| | - Harald Gündel
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm
| | - Bernd Puschner
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
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14
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Charles A, Thompson D, Nixdorf R, Ryan G, Shamba D, Kalha J, Moran G, Hiltensperger R, Mahlke C, Puschner B, Repper J, Slade M, Mpango R. Typology of modifications to peer support work for adults with mental health problems: systematic review. Br J Psychiatry 2020; 216:301-307. [PMID: 31992375 DOI: 10.1192/bjp.2019.264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects. AIMS To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems. METHOD We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications. RESULTS A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues. CONCLUSIONS Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings.
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Affiliation(s)
- Ashleigh Charles
- Research Assistant, School of Health Sciences, Institute of Mental Health, University of Nottingham, UK
| | - Dean Thompson
- Research Fellow, Institute of Applied Health Research, University of Birmingham, UK
| | - Rebecca Nixdorf
- Research Assistant, Department of Psychiatry, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Grace Ryan
- Research Fellow, Centre of Global Mental Health, London School of Hygiene and Tropical Medicine, UK
| | - Donat Shamba
- Researcher, Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Tanzania
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, India
| | - Galia Moran
- Senior Lecturer, Faculty of Humanities and Social Science, Ben Gurion University of the Negev, Israel
| | | | - Candelaria Mahlke
- Researcher, Department of Psychiatry, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Bernd Puschner
- Professor, Department of Psychiatry II, Ulm University, Germany
| | | | - Mike Slade
- Professor of Mental Health Recovery and Social Inclusion, School of Health Sciences, Institute of Mental Health, University of Nottingham, UK
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15
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Moran GS, Kalha J, Mueller-Stierlin AS, Kilian R, Krumm S, Slade M, Charles A, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Mpango R, Ryan G, Shamba D, Ramesh M, Ngakongwa F, Grayzman A, Pathare S, Mayer B, Puschner B. Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic, multicentre, randomised controlled trial (UPSIDES-RCT). Trials 2020; 21:371. [PMID: 32357903 PMCID: PMC7195705 DOI: 10.1186/s13063-020-4177-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peer support is an established intervention involving a person recovering from mental illness supporting others with mental illness. Peer support is an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including service user outcomes (psychosocial and clinical), peer support worker outcomes (work role and empowerment), service outcomes (cost-effectiveness and return on investment), and implementation outcomes (adoption, sustainability and organisational change). METHODS UPSIDES-RCT is a pragmatic, parallel-group, multicentre, randomised controlled trial assessing the effectiveness of using peer support in developing empowering mental health services (UPSIDES) at four measurement points over 1 year (baseline, 4-, 8- and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, UK, Israel, India, Uganda and Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N = 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (using the Empowerment Scale), hope (using the HOPE scale), recovery (using Stages of Recovery) and health and social functioning (using the Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect and the implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers and policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support. DISCUSSION The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centredness, community participation and the realisation of mental health as a human right. TRIAL REGISTRATION ISRCTN, ISRCTN26008944. Registered on 30 October 2019.
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Affiliation(s)
- Galia S. Moran
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
| | | | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Alina Grayzman
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Benjamin Mayer
- Institute for Medical Biometry and Epidemiology, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
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16
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Ibrahim N, Thompson D, Nixdorf R, Kalha J, Mpango R, Moran G, Mueller-Stierlin A, Ryan G, Mahlke C, Shamba D, Puschner B, Repper J, Slade M. A systematic review of influences on implementation of peer support work for adults with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:285-293. [PMID: 31177310 DOI: 10.1007/s00127-019-01739-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. METHODS Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). RESULTS The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. CONCLUSION The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.
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Affiliation(s)
- Nashwa Ibrahim
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.,Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Dean Thompson
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Rebecca Nixdorf
- Department of Psychiatry, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Galia Moran
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Grace Ryan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Julie Repper
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
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Puschner B, Repper J, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Ryan G, Baillie D, Shamba D, Ramesh M, Moran G, Lachmann M, Kalha J, Pathare S, Müller-Stierlin A, Slade M. Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology. Ann Glob Health 2019; 85:53. [PMID: 30951270 PMCID: PMC6634474 DOI: 10.5334/aogh.2435] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, DE
| | - Julie Repper
- ImROC (Implementing Recovery through Organisational Change), Department of Learning and Organisational Development, Nottinghamshire Healthcare Foundation NHS Trust, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, UG
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK
| | | | | | | | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Max Lachmann
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, UK
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Loos S, Walia N, Becker T, Puschner B. Lost in transition? Professional perspectives on transitional mental health services for young people in Germany: a qualitative study. BMC Health Serv Res 2018; 18:649. [PMID: 30134887 PMCID: PMC6104012 DOI: 10.1186/s12913-018-3462-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transition of young patients from child and adolescent to adult mental health services often results in the interruption or termination of care. At this intersection, mental health professionals function as gatekeepers between systems, and their personal views on current clinical practice can contribute to a broader understanding of procedures and help identify reasons for service gaps. This qualitative study investigated the views of mental health professionals on services for young people during the transition from child and adolescent to adult mental health care, as well as on factors which facilitate or hinder continuity of care. METHODS Four group discussions with 24 mental health professionals with various backgrounds were conducted. Groups were audio-taped, transcribed verbatim and analyzed following the reconstructive approach of R. Bohnsack's documentary method. RESULTS A main theme and six subthemes emerged. Participants' overall concern was an increasing lack of patient centeredness in care provision. They criticized the limited flexibility and time constraints of their work, which was held to be incompatible with the time-consuming process of engaging young patients in care and coping with their individual needs. A lack of adequate interprofessional exchange and networking was seen as resulting in a diffuse sense of responsibility and a lack of clarity for all involved parties. Participants focused on the adverse impact of neglecting developmental characteristics in care procedures for young patients and revealed personal issues they experienced in their work with young patients (e. g. personal difficulties with diagnosing). CONCLUSIONS Mental health professionals at this transitional point face a number of complex tasks as well as limitations in terms of time and personal support. An emphasis should be placed on forming and maintaining partnerships within and between systems which could contribute significantly to relieving professionals' workload. Furthermore, an open style of communication to engage young patients in care is essential. Strengthening communicative skills, improving knowledge about this life stage (especially when working in adult services), and promoting interprofessional encounters can help to develop new procedures in clinical practice. On higher system levels, heightened awareness of the need to reduce fragmentation of care and administrative barriers is needed.
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Affiliation(s)
- Sabine Loos
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany.
| | - Naina Walia
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany
| | - Thomas Becker
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany
| | - Bernd Puschner
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany
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Loos S, Walia N, Becker T, Puschner B. Lost in transition? Perceptions of health care among young people with mental health problems in Germany: a qualitative study. Child Adolesc Psychiatry Ment Health 2018; 12:41. [PMID: 30093915 PMCID: PMC6080358 DOI: 10.1186/s13034-018-0249-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The transitioning of young patients from child and adolescent to adult mental health services when indicated often results in the interruption or termination of service. The personal views of young service users on current clinical practice are a valuable contribution that can help to identify service gaps. The purpose of this qualitative study was to explore the perceptions of health care of young people with mental health problems in the transition age range (16-25 years), and to better understand health behaviour, care needs and the reasons for disengaging from care at this point in time. METHODS Seven group discussions and three interviews were conducted with 29 young people in this age range. Discussions were audio-taped, transcribed verbatim and analysed following the reconstructive approach of R. Bohnsack's documentary method. RESULTS An overarching theme and nine subthemes emerged. Participants displayed a pessimistic and disillusioned general attitude towards professional mental health services. The discussions highlighted an overall concern of a lack of compassion and warmth in care. When they come into contact with the system they often experience a high degree of dependency which contradicts their pursuit of autonomy and self-determination in their current life stage. In the discussions, participants referred to a number of unmet needs regarding care provision and strongly emphasised relationship issues. As a response to their care needs not being met, they described their own health behaviour as predominantly passive, with both an internal and external withdrawal from the system. CONCLUSIONS Research and clinical practice should focus more on developing needs-oriented and autonomy-supporting care practice. This should include both a shift in staff training towards a focus on communicative skills, and the development of skills training for young patients to strengthen competences in health literacy.
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Affiliation(s)
- Sabine Loos
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Naina Walia
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Thomas Becker
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Bernd Puschner
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
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Cosh S, Zenter N, Ay ES, Loos S, Slade M, De Rosa C, Luciano M, Berecz R, Glaub T, Munk-Jørgensen P, Krogsgaard Bording M, Rössler W, Kawohl W, Puschner B. Clinical Decision Making and Mental Health Service Use Among Persons With Severe Mental Illness Across Europe. Psychiatr Serv 2017; 68:970-974. [PMID: 28502242 DOI: 10.1176/appi.ps.201600114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness. METHODS Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models. RESULTS A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005). CONCLUSIONS A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.
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Affiliation(s)
- Suzanne Cosh
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Nadja Zenter
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Esra-Sultan Ay
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Sabine Loos
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Mike Slade
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Corrado De Rosa
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Mario Luciano
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Roland Berecz
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Theodora Glaub
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Povl Munk-Jørgensen
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Malene Krogsgaard Bording
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Wulf Rössler
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Wolfram Kawohl
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Bernd Puschner
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
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Schützwohl M, Voß E, Salize HJ, Stiawa M, Puschner B, Koch A. Self- and proxy-rated needs in adults with mild to moderate intellectual disabilities: Perspective matters. J Appl Res Intellect Disabil 2017; 31:285-295. [PMID: 28834006 DOI: 10.1111/jar.12399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adults with an intellectual disability should be supported according to their individual needs. The perception of need, however, is influenced by the values and expectations of the judging person. METHOD Using the Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities, self- and proxy-rated needs of n = 193 adults with mild to moderate intellectual disability were compared. RESULTS Mean total needs and met needs, but not unmet needs, differed significantly between perspectives. As concerns the assessment of specific areas of need, indices revealed a complex and multifaceted pattern of agreement and disagreement. CONCLUSION Different viewpoints should be considered when assessing needs among adults with intellectual disability. With respect to areas other than basic, everyday areas of need, involvement of the adult with intellectual disability is strongly recommended. The assessment of mental health problems requires the involvement of clinical professionals, assessing problem behavior broad diagnostic measures beyond a standardized instrument.
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Affiliation(s)
- Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Elke Voß
- Mental Health Services Research Group, Central Institute of Mental Health, Mannheim, Germany
| | - Hans Joachim Salize
- Mental Health Services Research Group, Central Institute of Mental Health, Mannheim, Germany
| | - Maja Stiawa
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Andrea Koch
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Sethi S, Chen X, Kass PH, Puschner B. Polychlorinated biphenyl and polybrominated diphenyl ether profiles in serum from cattle, sheep, and goats across California. Chemosphere 2017; 181:63-73. [PMID: 28426942 PMCID: PMC5494844 DOI: 10.1016/j.chemosphere.2017.04.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 05/02/2023]
Abstract
It has been previously been shown by our lab and others that persistent organic pollutants, such as polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), are contaminants in milk produced for human consumption. To further this research we determined the concentration of 21 PCB and 14 PBDE congeners in livestock serum, mainly bovine, across California. Congeners were extracted from serum using solid phase extraction (SPE), cleaned up by silica cartridge and quantified using gas chromatography-triple quadruple mass spectrometry. We detected significant differences among species and the production class of cattle (beef or dairy). The sum of all 21 PCB congeners (ΣPCBs) in caprine and ovine sera had a mean value of 9.26 and 9.13 ng/mL, respectively, compared to 3.98 ng/mL in bovine sera. The mean value for the sum of all 14 PBDE congeners (ΣPBDEs) in caprine and ovine sera was 2.82 and 2.39 ng/mL, respectively, compared to 0.91 ng/mL in bovine sera. Mean ΣPCBs in dairy cattle was 5.92 ng/mL compared to 2.70 ng/mL in beef cattle. Mean ΣPBDEs in dairy cattle was 1.33 ng/mL compared to 0.70 ng/mL in beef cattle. There were no regional differences in the ΣPCBs or ΣPBDEs in cattle distributed across California. These results highlight the fact that livestock are still being exposed to these pollutants yet little is known about where this exposure may be coming from.
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Affiliation(s)
- S Sethi
- Department of Molecular Biosciences, University of California, Davis, CA, United States
| | - X Chen
- Department of Molecular Biosciences, University of California, Davis, CA, United States
| | - P H Kass
- Department of Population Health and Reproduction, University of California, Davis, CA, United States
| | - B Puschner
- Department of Molecular Biosciences, University of California, Davis, CA, United States.
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Kraft S, Wolf M, Klein T, Becker T, Bauer S, Puschner B. Text Message Feedback to Support Mindfulness Practice in People With Depressive Symptoms: A Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2017; 5:e59. [PMID: 28465278 PMCID: PMC5434251 DOI: 10.2196/mhealth.7095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 11/22/2022] Open
Abstract
Background It has been shown that mindfulness practice can be helpful in preventing relapse from depression. However, practicing mindfulness regularly at home is often a challenge for people with depression. Mobile phone text messaging (short message service, SMS) may be a feasible approach to assist regular mindfulness home practice. Objective The aim of this study was to evaluate the feasibility of text message–based feedback to support mindfulness practice in people with depressive symptoms after inpatient psychiatric treatment. Methods Participants received a manualized group introduction to three mindfulness exercises during inpatient treatment and were randomized at hospital discharge. All participants were asked to practice the exercises daily during the 4-month follow-up period. Only participants allocated to the intervention group received reinforcing feedback via mobile phone text messages after reporting their mindfulness practice via text message. Participation rates and satisfaction with the interventions were evaluated, and effects on relevant outcomes were explored. Results Of the 176 eligible inpatients invited to participate, 65.9% (116/176) attended the introductory mindfulness group at least once, 33.0% (58/176) were willing to participate in the study, and 41 were randomized. The majority 85% (35/41) of these participants completed the study. Among the participants allocated to the intervention group (n=21), 81% (17/21) used the text message support at least once. The average number of text messages sent during the intervention period was 14 (SD 21, range 0-91). Satisfaction rates were high. Preliminary analyses of the effects of the intervention yielded mixed results. Conclusions Findings indicate that text messaging following inpatient treatment is feasible for some, but not for all people with depressive symptoms. Modest use of the text messaging intervention and its mixed effects imply that dose and ingredients of the intervention should be increased for this group of patients in a future full-size RCT. Such a larger study should also include a process evaluation to investigate moderators of the effect of mindfulness practice and text message feedback on clinical outcome. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 58808893; http://www.controlled-trials.com/ISRCTN58808893 (Archived by Webcite at http://www.webcitation.org/6pmrDRnGt)
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Affiliation(s)
- Susanne Kraft
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Markus Wolf
- Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Thomas Klein
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Thomas Becker
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Bernd Puschner
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
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Loos S, Clarke E, Jordan H, Puschner B, Fiorillo A, Luciano M, Ivánka T, Magyar E, Krogsgaard-Bording M, Østermark-Sørensen H, Rössler W, Kawohl W, Mayer B, Slade M. Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study. BMC Psychiatry 2017; 17:38. [PMID: 28114913 PMCID: PMC5260092 DOI: 10.1186/s12888-017-1207-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery. METHODS Data derived from an observational cohort study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR). Adults (aged 18-60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change. RESULTS Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15-2.94) or passive (OR = 1.71, 95% CI = 1.00-2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery. CONCLUSIONS Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
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Affiliation(s)
- Sabine Loos
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany.
| | - Eleanor Clarke
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Bernd Puschner
- 0000 0004 1936 9748grid.6582.9Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312 Günzburg, Germany
| | - Andrea Fiorillo
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Luciano
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Tibor Ivánka
- 0000 0001 1088 8582grid.7122.6Department of Psychiatry, University of Debrecen Medical Centre, Debrecen, Hungary
| | - Erzsébet Magyar
- 0000 0001 1088 8582grid.7122.6Department of Psychiatry, University of Debrecen Medical Centre, Debrecen, Hungary
| | - Malene Krogsgaard-Bording
- 0000 0004 0646 7349grid.27530.33Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Østermark-Sørensen
- 0000 0004 0646 7349grid.27530.33Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Wulf Rössler
- 0000 0004 1937 0650grid.7400.3Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- 0000 0004 1937 0650grid.7400.3Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Benjamin Mayer
- 0000 0004 1936 9748grid.6582.9Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Mike Slade
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Koslowski N, Klein K, Arnold K, Kösters M, Schützwohl M, Salize HJ, Puschner B. Effectiveness of interventions for adults with mild to moderate intellectual disabilities and mental health problems: systematic review and meta-analysis. Br J Psychiatry 2016; 209:469-474. [PMID: 27198481 DOI: 10.1192/bjp.bp.114.162313] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/29/2015] [Accepted: 08/01/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is a lack of available evidence in relation to the effectiveness of interventions for adults with mild to moderate intellectual disability and mental health problems. AIMS To evaluate the efficacy of interventions for adults with mild to moderate intellectual disabilities and co-occurring mental health problems. METHOD An electronic literature search of the databases Medline, EMBASE, PsycINFO and EBM Reviews aimed at identifying randomised controlled trials (RCTs) and controlled trials testing any type of intervention (psychotherapy, biological or system level) for people with mild to moderate intellectual disabilities (IQ score 35-69) targeting comorbid mental health problems. Additionally a meta-analysis was conducted. RESULTS Twelve studies met the inclusion criteria. No significant effect was found for the predefined outcome domains behavioural problems, depression, anxiety, quality of life and functioning. The effect size for depression (d = 0.49) was moderate but non-significant. Quality of studies was moderate and heterogeneity was high. CONCLUSIONS There is no compelling evidence supporting interventions aiming at improving mental health problems in people with mild to moderate intellectual disability. The number of available trials is too low for definite conclusions. Some interventions are promising and should be evaluated further in larger and more rigorous trials.
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Affiliation(s)
- Nadine Koslowski
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Kristina Klein
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Katrin Arnold
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Markus Kösters
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Matthias Schützwohl
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Hans Joachim Salize
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Bernd Puschner
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
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26
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Kordy H, Wolf M, Aulich K, Bürgy M, Hegerl U, Hüsing J, Puschner B, Rummel-Kluge C, Vedder H, Backenstrass M. Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial. Psychother Psychosom 2016; 85:91-8. [PMID: 26808817 DOI: 10.1159/000441951] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Strategies to improve the life of patients suffering from recurrent major depression have a high relevance. This study examined the efficacy of 2 Internet-delivered augmentation strategies that aim to prolong symptom-free intervals. METHODS Efficacy was tested in a 3-arm, multicenter, open-label, evaluator-blind, randomized controlled trial. Upon discharge from inpatient mental health care, 232 adults with 3 or more major depressive episodes were randomized to 1 of 2 intervention groups (SUMMIT or SUMMIT-PERSON) or to treatment as usual (TAU) alone. Over 12 months, participants in both intervention arms received, in addition to TAU, intense monitoring via e-mail or a smartphone, including signaling of upcoming crises, assistance with personal crisis management, and facilitation of early intervention. SUMMIT-PERSON additionally offered regular expert chats. The primary outcome was 'well weeks', i.e. weeks with at most mild symptoms assessed by the Longitudinal Interval Follow-Up Evaluation, during 24 months after the index treatment. RESULTS SUMMIT compared to TAU reduced the time with an unwell status (OR 0.48; 95% CI 0.23-0.98) through faster transitions from unwell to well (OR 1.44; 95% CI 0.83-2.50) and slower transitions from well to unwell (OR 0.69; 95% CI 0.44-1.09). Contrary to the hypothesis, SUMMIT-PERSON was not superior to either SUMMIT (OR 0.77; 95% CI 0.38-1.56) or TAU (OR 0.62; 95% CI 0.31-1.24). The efficacy of SUMMIT was strongest 8 months after the intervention. CONCLUSIONS The fully automated Internet-delivered augmentation strategy SUMMIT has the potential to improve TAU by reducing the lifelong burden of patients with recurrent depression. The fact that the effects wear off suggests a time-unlimited extension.
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Affiliation(s)
- Hans Kordy
- Center for Psychotherapy Research, University of Heidelberg, Heidelberg, Germany
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27
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Puschner B, Cosh S, Becker T. Patient-Rated Outcome Assessment With the German Version of the Outcome Questionnaire 45 in People With Severe Mental Illness. European Journal of Psychological Assessment 2016. [DOI: 10.1027/1015-5759/a000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract. The purpose of this study was to assess the feasibility and psychometric properties of the German version of the Outcome Questionnaire (Ergebnisfragebogen; EB-45) in people with severe mental illness (N = 294). Reliability and sensitivity to change were assessed. Convergent validity was examined through correlations with the measures Health of the Nation Outcome Scales (HoNOS-D) and Global Assessment of Functioning (GAF), and predictive validity through correlation with length of inpatient stay. The EB-45 showed good reliability and sensitivity to change, as well as good internal consistency for the total score and the subscale “symptom distress.” The EB-45 was found to be acceptable and feasible for use within inpatient psychiatric settings. Also predictive validity was good. However, psychometric properties of the subscales “interpersonal relations” and “social role” were equivocal. Thus, interpreting subscale scores only is not advisable. Also low convergent validity is a concern. Taken together, the EB-45 can be recommended for outcome assessment in a wide range of mental health service settings including inpatient psychiatric services. However, treatment planning and evaluation of effectiveness of services for people with severe mental illness should not be based on EB-45 data alone.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Suzanne Cosh
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Günzburg, Germany
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Schützwohl M, Voss E, Stiawa M, Salize HJ, Puschner B, Koch A. Bedingungsfaktoren psychopharmakologischer Behandlung bei leichter oder mittelgradiger Intelligenzminderung. Nervenarzt 2016; 88:1273-1280. [PMID: 27638741 DOI: 10.1007/s00115-016-0211-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Schützwohl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum C. G. Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - E Voss
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg, Heidelberg, Deutschland
| | - M Stiawa
- Sektion Prozess-Ergebnisforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Ulm, Deutschland
| | - H-J Salize
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg, Heidelberg, Deutschland
| | - B Puschner
- Sektion Prozess-Ergebnisforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Ulm, Deutschland
| | - A Koch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum C. G. Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Abstract
Three horses died as a result of eating grass hay containing summer pheasant's eye ( Adonis aestivalis L.), a plant containing cardenolides similar to oleander and foxglove. A 9-year-old thoroughbred gelding, a 20-year-old appaloosa gelding, and a 5-year-old quarter horse gelding initially presented with signs of colic 24–48 hours after first exposure to the hay. Gastrointestinal gaseous distension was the primary finding on clinical examination of all three horses. Two horses became moribund and were euthanatized 1 day after first showing clinical signs, and the third horse was euthanatized after 4 days of medical therapy. Endocardial hemorrhage and gaseous distension of the gastrointestinal tract were the only necropsy findings in the first two horses. On microscopic examination, both horses had scattered foci of mild, acute myocardial necrosis and neutrophilic inflammation associated with endocardial and epicardial hemorrhage. The third horse that survived for 4 days had multifocal to coalescing, irregular foci of acute, subacute, and chronic myocardial degeneration and necrosis. A. aestivalis (pheasant's eye, summer adonis) was identified in the hay. Strophanthidin, the aglycone of several cardenolides present in Adonis spp., was detected by liquid chromatography-mass spectrometry-mass spectrometry in gastrointestinal contents from all three horses. Although Adonis spp. contain cardiac glycosides, cardiac lesions have not previously been described in livestock associated with consumption of adonis, and this is the first report of adonis toxicosis in North America.
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Affiliation(s)
- L W Woods
- California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, PO Box 1770, Davis, CA 95617-1770, USA.
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Abstract
Vitamin A deficiency was diagnosed in a commercial flock of 13,000 4–6-week-old turkey poults in the summer of 2004. The birds were initially submitted for examination because of a 3% increase in the reported daily mortality of the flock. Clinically, affected birds had stunted growth and ruffled feathers, showed signs of incoordination, and were depressed. At necropsy, pale white pseudomembranous to mucoid material was observed on the mucosal surface of the tongue, oral cavity, portions of the esophagus, and the crop of some birds. Histologically, there was squamous metaplasia of the mucosal epithelium of the oral mucosa, esophagus, sinuses, nasal glands, bronchi, proventriculus, and the bursa of Fabricius. Vitamin A was not detected in the feed sample at a detection limit of 0.5 mg/kg. Serum vitamin A concentrations in 7 birds were very low and ranged from 0.05 to 0.1 mg/L. Vitamin A concentrations in livers were extremely low (0.1 mg/kg wet weight, 1/7 poults) or undetectable (<0.1 mg/kg wet weight, 6/7 poults). A diagnosis of vitamin A deficiency was made based on gross and microscopic lesions and vitamin A concentrations in serum, liver, and feed. To the authors' knowledge, this is the first documented case of vitamin A deficiency in poults submitted from a commercial meat turkey producer comparatively depicting the gross and microscopic lesions with those found in other species of birds and mammals.
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Affiliation(s)
- P L Cortes
- California Animal Health and Food Safety Laboratory System (CAHFS), University of California, Fresno Branch, 2789 South Orange Avenue, Fresno, CA 93725, USA
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Burnett K, Puschner B, Ramsey JJ, Lin Y, Wei A, Fascetti AJ. Lack of glucuronidation products of trans-resveratrol in plasma and urine of cats. J Anim Physiol Anim Nutr (Berl) 2016; 101:284-292. [DOI: 10.1111/jpn.12524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 03/31/2016] [Indexed: 12/31/2022]
Affiliation(s)
- K. Burnett
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - B. Puschner
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - J. J. Ramsey
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - Y. Lin
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - A. Wei
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - A. J. Fascetti
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
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Abstract
The German healthcare system offers comprehensive coverage for people with mental illness including inpatient, day hospital and outpatient services. These services are primarily financed through the statutory health and pension insurances. According to legal regulations, providers are required to base their services on current scientific evidence and to continuously assure the quality of their services. This paper gives an overview of recent initiatives to develop, evaluate and disseminate routine outcome measurement (ROM) in service settings in Germany. A large number of projects have shown outcome monitoring to be feasible, and that feedback of outcome may enhance routine care through an improved allocation of treatment resources. However, none of these initiatives have been integrated into routine care on a nationwide or trans-sectoral level, and their sustainability has been limited. This is due to various barriers in a fragmented mental health service system and to the lack of coordinated national or state-level service planning. The time is ripe for a concerted effort including policy-makers to pick up on these initiatives and move them towards wide-spread implementation in routine care accompanied by practice-oriented research including service user involvement.
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Freidl M, Pesola F, Konrad J, Puschner B, Kovacs AI, De Rosa C, Fiorillo A, Krogsgaard Bording M, Kawohl W, Rössler W, Nagy M, Munk-Jørgensen P, Slade M. Effects of Clinical Decision Topic on Patients' Involvement in and Satisfaction With Decisions and Their Subsequent Implementation. Psychiatr Serv 2016; 67:658-63. [PMID: 26876660 DOI: 10.1176/appi.ps.201500083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Clinical decision making is an important aspect of mental health care. Predictors of how patients experience decision making and whether decisions are implemented are underresearched. This study investigated the relationship between decision topic and involvement in the decision, satisfaction with it, and its subsequent implementation from both staff and patient perspectives. METHODS As part of the Clinical Decision Making and Outcome in Routine Care for People With Severe Mental Illness study, patients (N=588) and their providers (N=213) were recruited from community-based mental health services in six European countries. Both completed bimonthly assessments for one year using the Clinical Decision Making in Routine Care Scale to assess the decision topic and implementation; both also completed the Clinical Decision Making Involvement and Satisfaction Scale. RESULTS Three categories of decision topics were determined: treatment (most frequently cited), social, and financial. The topic identified as most important remained stable over the follow-up. Patients were more likely to rate their involvement as active rather than passive for social decisions (odds ratio [OR]=5.7, p<.001) and financial decisions (OR=9.5, p<.001). They were more likely to report higher levels of satisfaction rather than lower levels for social decisions (OR=1.5, p=.01) and financial decisions (OR=1.7, p=.01). Social decisions were more likely to be partly implemented (OR=3.0, p<.001) or fully implemented (OR=1.7, p=.03) than not implemented. CONCLUSIONS Patients reported poorer involvement, satisfaction, and implementation in regard to treatment-related decisions, compared with social and financial decisions. Clinicians may need to employ different interactional styles for different types of decisions to maximize satisfaction and decision implementation.
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Affiliation(s)
- Marion Freidl
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Francesca Pesola
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Jana Konrad
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Bernd Puschner
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Attila Istvan Kovacs
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Corrado De Rosa
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Andrea Fiorillo
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Malene Krogsgaard Bording
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Marietta Nagy
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Povl Munk-Jørgensen
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Mike Slade
- Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland
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Puschner B, Chen X, Read D, Affolter V. Alfalfa hay induced primary photosensitization in horses. Vet J 2016; 211:32-8. [DOI: 10.1016/j.tvjl.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/17/2016] [Accepted: 03/05/2016] [Indexed: 11/28/2022]
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Schützwohl M, Koch A, Koslowski N, Puschner B, Voß E, Salize HJ, Pfennig A, Vogel A. Mental illness, problem behaviour, needs and service use in adults with intellectual disability. Soc Psychiatry Psychiatr Epidemiol 2016; 51:767-76. [PMID: 26952326 DOI: 10.1007/s00127-016-1197-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/20/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Mental ill health in adults with intellectual disability (ID) is a neglected field in psychiatry and thus still widely understudied. This paper provides data on the prevalence of mental illness and problem behaviour and analyses support needs, mental health service use and psychotropic medication in a representative sample of adults with mild to moderate ID. METHODS A set of well-established instruments was used to assess the main parameters in n = 371 participants recruited within a cross-sectional epidemiological multicentre study using a stratified randomised cluster sampling. RESULTS Point prevalence of mental disorders was 10.8 %, that of problem behaviour 45.3 %. Most study participants needed help in specific lower order need areas (e.g., money budgeting, food, accommodation), and these need areas were mostly rated as met. The highest ratios of unmet to met need were found with respect to sexuality issues and with respect to mental health problems. The focus of psychiatric treatment was psychotropic medication. CONCLUSIONS Referring to ICD-10 based diagnostic criteria and consequently avoiding confusing problem behaviour with mental disorders, point prevalence of mental disorders was lower than in the general population. A systematic deficit in meeting mental health problems in adults with ID indicates the need for implementing strategies to maximise the quality of identification and management of mental disorders.
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Affiliation(s)
- Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Andrea Koch
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | | | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Elke Voß
- Mental Health Services Research Group, Central Institute of Mental Health, Mannheim, Germany
| | - Hans Joachim Salize
- Mental Health Services Research Group, Central Institute of Mental Health, Mannheim, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anke Vogel
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Bär Deucher A, Hengartner MP, Kawohl W, Konrad J, Puschner B, Clarke E, Slade M, Del Vecchio V, Sampogna G, Égerházi A, Süveges Á, Krogsgaard Bording M, Munk-Jørgensen P, Rössler W. Participation in medical decision-making across Europe: An international longitudinal multicenter study. Eur Psychiatry 2016; 35:39-46. [PMID: 27061376 DOI: 10.1016/j.eurpsy.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries. METHODS The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations. RESULTS We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 47.2% of total variance in the desire for participation (P<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, the desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable. CONCLUSIONS This study demonstrates that patients' desire for participation in decision-making varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.
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Affiliation(s)
- A Bär Deucher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland.
| | - M P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Pfingstweidstrasse 96, PO Box 707, 8037 Zurich, Switzerland
| | - W Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland
| | - J Konrad
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - B Puschner
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - E Clarke
- Kings College London, Section for Recovery, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - M Slade
- Kings College London, Section for Recovery, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - V Del Vecchio
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - G Sampogna
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - A Égerházi
- Department of Psychiatry, Medical and Health Science Centre, University of Debrecen, 98, Nagyerdei krt, 4012, Debrecen, Hungary
| | - Á Süveges
- Department of Psychiatry, Medical and Health Science Centre, University of Debrecen, 98, Nagyerdei krt, 4012, Debrecen, Hungary
| | - M Krogsgaard Bording
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, Aalborg, 9000, Denmark
| | - P Munk-Jørgensen
- Department M, Aarhus University Hospital, Skovagervej 2, 8240 Risskov, Denmark
| | - W Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland
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Puschner B, Bautista AC, McKemie DS, Gallego SM, Woods LW, Moore CE, Knych HK. Serum, milk, and tissue monensin concentrations in cattle with adequate and potentially toxic dietary levels of monensin: pharmacokinetics and diagnostic interpretation. J Vet Pharmacol Ther 2016; 39:363-72. [DOI: 10.1111/jvp.12284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- B. Puschner
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
- California Animal Health and Food Safety Laboratory System; School of Veterinary Medicine; University of California; Davis CA USA
| | - A. C. Bautista
- California Animal Health and Food Safety Laboratory System; School of Veterinary Medicine; University of California; Davis CA USA
| | - D. S. McKemie
- Maddy Equine Analytical Chemistry Laboratory; School of Veterinary Medicine; University of California; Davis CA USA
| | - S. M. Gallego
- California Animal Health and Food Safety Laboratory System; School of Veterinary Medicine; University of California; Davis CA USA
| | - L. W. Woods
- California Animal Health and Food Safety Laboratory System; School of Veterinary Medicine; University of California; Davis CA USA
| | - C. E. Moore
- Department of Molecular Biosciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - H. K. Knych
- Maddy Equine Analytical Chemistry Laboratory; School of Veterinary Medicine; University of California; Davis CA USA
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Werner A, Voß E, Salize HJ, Puschner B, Stiawa M, Koch A, Schützwohl M. [Family Burden in the Case of Intellectual Disability and a Comorbid Mental Disorder]. Psychiatr Prax 2015; 43:380-386. [PMID: 26488265 DOI: 10.1055/s-0034-1387697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Within the MEMENTA-study informal caregivers of grown-up persons with an intellectual disability (ID) with and without a comorbid mental disorder were interviewed. Main outcomes were family burden, quality of life, psychiatric symptomatology and problem behavior. Methods: The sample consisted of 123 informal caregivers. Results: Problem behavior was associated with a higher family burden than psychiatric symptomatology. Conclusion: Rather than mental disorders, problem behavior seemed to be more relevant for the experience of family burden.
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Affiliation(s)
- Amelie Werner
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Elke Voß
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Hans Joachim Salize
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Bernd Puschner
- Sektion Prozess-Ergebnisforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm
| | - Maja Stiawa
- Sektion Prozess-Ergebnisforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm
| | - Andrea Koch
- Arbeitsgruppe Psychiatrische Versorgungsforschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Dresden
| | - Matthias Schützwohl
- Arbeitsgruppe Psychiatrische Versorgungsforschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Dresden
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Bozorgmanesh R, Magdesian KG, Rhodes DM, Von Dollen KA, Walter KM, Moore CE, Puschner B, Woods LW, Torrisi K, Voss ED. Hemolytic anemia in horses associated with ingestion of Pistacia leaves. J Vet Intern Med 2015; 29:410-3. [PMID: 25619527 PMCID: PMC4858062 DOI: 10.1111/jvim.12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/29/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- R Bozorgmanesh
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA
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Finno CJ, Estell KE, Katzman S, Winfield L, Rendahl A, Textor J, Bannasch DL, Puschner B. Blood and Cerebrospinal Fluid α-Tocopherol and Selenium Concentrations in Neonatal Foals with Neuroaxonal Dystrophy. J Vet Intern Med 2015; 29:1667-75. [PMID: 26391904 PMCID: PMC4831564 DOI: 10.1111/jvim.13618] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 01/27/2023] Open
Abstract
Background Equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy (NAD/EDM) is a neurodegenerative disorder affecting genetically predisposed foals maintained on α‐tocopherol (α‐TP)‐deficient diet. Objective Intramuscular α‐TP and selenium (Se) administration at 4 days of age would have no significant effect on serum or cerebrospinal fluid (CSF) α‐TP in healthy foals. Serum and CSF α‐TP, but not Se, would be significantly decreased in NAD/EDM‐affected foals during first year of life. Animals Fourteen Quarter horse foals; 10 healthy foals supplemented with 0.02 mL/kg injectable α‐TP and Se (n = 5) or saline (n = 5) at 4 days of age and 4 unsupplemented NAD/EDM‐affected foals. Methods Complete neurologic examinations were performed, blood and CSF were collected before (4 days of age) and after supplementation at 10, 30, 60, 120, 180, 240, and 360 days of age. Additional blood collections occurred at 90, 150, 210, and 300 days. At 540 days, NAD/EDM‐affected foals and 1 unsupplemented healthy foal were euthanized and necropsies performed. Results Significant decreases in blood, CSF α‐TP and Se found in the first year of life in all foals, with most significant changes in serum α‐TP from 4–150 days. Dam α‐TP and Se significantly influenced blood concentrations in foals. Injection of α‐TP and Se did not significantly increase CSF Se, blood or CSF α‐TP in healthy foals. NAD/EDM‐affected foals had significantly lower CSF α‐TP through 120 days. Conclusions and Clinical Importance Injection of α‐TP and Se at 4 days of age does not significantly increase blood or CSF α‐TP. Despite all 14 foals remaining deficient in α‐TP, only the 4 genetically predisposed foals developed NAD/EDM.
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Affiliation(s)
- C J Finno
- Department of Population Health and Reproduction, University of California-Davis, Davis, CA
| | - K E Estell
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - S Katzman
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - L Winfield
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - A Rendahl
- School of Veterinary Medicine, University of California-Davis, Davis, CA.,School of Statistics, University of Minnesota, St. Paul, MN
| | - J Textor
- Anatomy, Physiology and Cell Biology, University of California-Davis, Davis, CA
| | - D L Bannasch
- Department of Population Health and Reproduction, University of California-Davis, Davis, CA
| | - B Puschner
- Molecular Biosciences, University of California-Davis, Davis, CA
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Konrad J, Loos S, Neumann P, Zentner N, Mayer B, Slade M, Jordan H, De Rosa C, Del Vecchio V, Égerházi A, Nagy M, Bording MK, Sørensen HØ, Kawohl W, Rössler W, Puschner B. Content and implementation of clinical decisions in the routine care of people with severe mental illness. J Ment Health 2015; 24:15-9. [PMID: 25734210 DOI: 10.3109/09638237.2014.951478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. AIMS To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. METHOD As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. RESULTS Agreement between patients and staff regarding decision making was moderate (k = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. CONCLUSIONS A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.
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Clarke E, Puschner B, Jordan H, Williams P, Konrad J, Kawohl W, Bär A, Rössler W, Del Vecchio V, Sampogna G, Nagy M, Süveges A, Krogsgaard Bording M, Slade M. Empowerment and satisfaction in a multinational study of routine clinical practice. Acta Psychiatr Scand 2015; 131:369-78. [PMID: 25471821 DOI: 10.1111/acps.12365] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Decision-making between mental health clinicians and patients is under-researched. We tested whether mental health patients are more satisfied with a decision made (i) using their preferred decision-making style and (ii) with a clinician with the same decision-making style preference. METHOD As part of the CEDAR Study (ISRCTN75841675), a convenience sample of 445 patients with severe mental illness from six European countries were assessed for desired clinical decision-making style (rated by patients and paired clinicians), decision-specific experienced style and satisfaction. RESULTS Patients who experienced more involvement in decision-making than they desired rated higher satisfaction (OR=2.47, P=0.005, 95% CI 1.32-4.63). Decisions made with clinicians whose decision-making style preference was for more active involvement than the patient preference were rated with higher satisfaction (OR=3.17, P=0.003, 95% CI 1.48-6.82). CONCLUSION More active involvement in decision-making than the patient stated as desired was associated with higher satisfaction. A clinical orientation towards empowering, rather than shared, decision-making may maximise satisfaction.
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Affiliation(s)
- E Clarke
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Zentner N, Baumgartner I, Becker T, Puschner B. Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records. Int J Health Policy Manag 2015; 4:153-60. [PMID: 25774372 DOI: 10.15171/ijhpm.2015.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/22/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time. METHODS Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self-reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI-EU) for two 6-month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication. RESULTS Sixty-one participants completed both assessments. Over one year, the average patient-reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = -2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status. CONCLUSION Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs.
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Affiliation(s)
- Nadja Zentner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Thomas Becker
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Giacco D, Luciano M, Del Vecchio V, Sampogna G, Slade M, Clarke E, Nagy M, Egerhazi A, Munk-Jørgensen P, Bording MFK, Kawohl W, Rössler W, Zentner N, Puschner B, Fiorillo A. Desire for information of people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1883-91. [PMID: 24907048 DOI: 10.1007/s00127-014-0901-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/26/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity. METHODS 588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the "Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)" study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information. RESULTS 80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977-1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130-1.508) with their clinician. CONCLUSIONS Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.
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Affiliation(s)
- Domenico Giacco
- Department of Psychiatry, Second University of Naples, Largo Madonna delle Grazie, 80138, Naples, Italy,
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Slade M, Jordan H, Clarke E, Williams P, Kaliniecka H, Arnold K, Fiorillo A, Giacco D, Luciano M, Égerházi A, Nagy M, Bording MK, Sørensen HØ, Rössler W, Kawohl W, Puschner B. The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS). BMC Health Serv Res 2014; 14:323. [PMID: 25066212 PMCID: PMC4115477 DOI: 10.1186/1472-6963-14-323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/15/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) - with versions for patients (CDIS-P) and staff (CDIS-S) - for use in mental health services. METHODS An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. RESULTS After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CONCLUSIONS CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. TRIAL REGISTRATION ISRCTN75841675.
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Affiliation(s)
- Mike Slade
- Section for Recovery (Box P029), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
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Koch A, Vogel A, Holzmann M, Pfennig A, Salize HJ, Puschner B, Schützwohl M. MEMENTA-'Mental healthcare provision for adults with intellectual disability and a mental disorder'. A cross-sectional epidemiological multisite study assessing prevalence of psychiatric symptomatology, needs for care and quality of healthcare provision for adults with intellectual disability in Germany: a study protocol. BMJ Open 2014; 4:e004878. [PMID: 24844270 PMCID: PMC4039805 DOI: 10.1136/bmjopen-2014-004878] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The study 'Mental healthcare provision for adults with intellectual disability and a mental disorder' (MEMENTA) is a cross-sectional epidemiological study carried out in three different regions of Germany. Its main aim is to assess the prevalence of mental disorders in adults with intellectual disability (ID) as well as quality of mental healthcare for this population. METHODS AND ANALYSIS The target population are persons aged between 18 and 65 years with a mild or moderate ID. The study population will be recruited through service providers. A representative sample is realised by two-stage sampling. First, institutions providing services for people with ID (sheltered workshops) are selected in a stratified cluster sampling, with strata being (1) types of service-providing non-governmental organisations and (2) sizes of their sheltered workshops. Then persons working in selected sheltered workshops are selected by simple random sampling. An estimated number of 600 adults with ID will be included. Information will be obtained from the group leaders in the sheltered workshops, informal carers or staff members in sheltered housing institutions and the person with ID. Besides the main outcome parameter of psychiatric symptomatology and problem behaviour, other outcome parameters such as needs for care, quality of life, caregiver burden, health services utilisation and costs for care are assessed using well-established standardised instruments. If a comorbid mental disorder is diagnosed, quality of mental healthcare will be assessed with open questions to all interview partners and, in addition, problem-focused interviews with a small subgroup. Analyses will be carried out using quantitative and qualitative methods. ETHICS AND DISSEMINATION Approval of all three local ethics committees was obtained. Research findings will add much needed empirical information in order to improve services provided to this vulnerable group of patients. TRIAL REGISTRATION NUMBER NCT01695395.
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Affiliation(s)
- Andrea Koch
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Anke Vogel
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Marco Holzmann
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Hans Joachim Salize
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
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von Rad K, Puschner B, Spießl H, Grempler J, Janssen B, Becker T, Freyberger H. [High utilisers with affective and schizophrenic disorders in the psychiatric health care system: a comparison between Eastern and Western Germany]. Psychiatr Prax 2014; 41:371-5. [PMID: 24723040 DOI: 10.1055/s-0034-1369867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE High utilisers of psychiatric services are defined as a group of patients showing a great amount of service use, especially inpatient care, consequently causing immense costs. There is a lack of studies investigating differences between East and West Germany. METHODS Service use and psychopathology were examined in 350 high utilisers receiving inpatient treatment in one East German and three West German psychiatric hospitals. RESULTS Whereas current length of stay was higher in participants from West Germany, readmissions were more frequent in the East German participants who also exhibited higher psychopathology. CONCLUSION Presumably, the deficient situation of outpatient health care in East Germany is compensated by increased stationary admission, consequently leading to a structural promotion of high utilisation.
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Affiliation(s)
- Kathrin von Rad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie des Universitätsklinikums Hamburg-Eppendorf
| | - Bernd Puschner
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Günzburg
| | - Hermann Spießl
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Landshut
| | - Julia Grempler
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Ravensburg
| | - Birgit Janssen
- Klinik für Psychiatrie und Psychotherapie der Universität Düsseldorf
| | - Thomas Becker
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Günzburg
| | - Harald Freyberger
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universitätsmedizin Greifswald am HELIOS Hanseklinikum Stralsund
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Chad E, DePeters E, Puschner B, Taylor S, Robison J. Preliminary investigation of the composition of alpaca (Vicugna pacos) milk in California. Small Rumin Res 2014. [DOI: 10.1016/j.smallrumres.2013.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Giannitti F, Higgins RJ, Pesavento PA, Cruz FD, Clifford DL, Piazza M, Struckhoff AP, Valle LD, Bollen AW, Puschner B, Kerr E, Gelberg H, Mete A, McGraw S, Woods LW. Temporal and Geographic Clustering of Polyomavirus-Associated Olfactory Tumors in 10 Free-Ranging Raccoons (Procyon lotor). Vet Pathol 2013; 51:832-45. [DOI: 10.1177/0300985813502817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reports of primary nervous system tumors in wild raccoons are extremely rare. Olfactory tumors were diagnosed postmortem in 9 free-ranging raccoons from 4 contiguous counties in California and 1 raccoon from Oregon within a 26-month period between 2010 and 2012. We describe the geographic and temporal features of these 10 cases, including the laboratory diagnostic investigations and the neuropathologic, immunohistochemical, and ultrastructural characteristics of these tumors in the affected animals. All 9 raccoons from California were found within a localized geographic region of the San Francisco Bay Area (within a 44.13-km radius). The tight temporal and geographic clustering and consistent anatomic location in the olfactory system of tumor types not previously described in raccoons (malignant peripheral nerve sheath tumors and undifferentiated sarcomas) strongly suggest either a common cause or a precipitating factor leading to induction or potentiation of neuro-oncogenesis and so prompted an extensive diagnostic investigation to explore possible oncogenic infectious and/or toxic causes. By a consensus polymerase chain reaction strategy, a novel, recently reported polyomavirus called raccoon polyomavirus was identified in all 10 tumors but not in the normal brain tissue from the affected animals, suggesting that the virus might play a role in neuro-oncogenesis. In addition, expression of the viral protein T antigen was detected in all tumors containing the viral sequences. We discuss the potential role of raccoon polyomavirus as an oncogenic virus.
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Affiliation(s)
- F. Giannitti
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - R. J. Higgins
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - P. A. Pesavento
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - F. Dela Cruz
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - D. L. Clifford
- Wildlife Investigations Laboratory, California Department of Fish and Wildlife, Rancho Cordova, CA, USA
| | | | - A. Parker Struckhoff
- Departments of Medicine and Pathology, Stanley S. Scott Cancer Center, School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - L. Del Valle
- Departments of Medicine and Pathology, Stanley S. Scott Cancer Center, School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - A. W. Bollen
- School of Medicine, University of California, San Francisco, CA, USA
| | - B. Puschner
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - E. Kerr
- Natural Resources DNA Profiling and Forensic Centre, DNA Building, Trent University, Peterborough, Ontario, Canada
| | - H. Gelberg
- Department of Biomedical Sciences and the Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - A. Mete
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - S. McGraw
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - L. W. Woods
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
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Glover AD, Puschner B, Rossow HA, Lehenbauer TW, Champagne JD, Blanchard PC, Aly SS. A double-blind block randomized clinical trial on the effect of zinc as a treatment for diarrhea in neonatal Holstein calves under natural challenge conditions. Prev Vet Med 2013; 112:338-47. [PMID: 24074841 PMCID: PMC7114245 DOI: 10.1016/j.prevetmed.2013.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/24/2013] [Accepted: 09/02/2013] [Indexed: 11/19/2022]
Abstract
Diarrhea is the leading cause of death in neonatal calves and contributes to major economic losses. The objective of this double-blind randomized clinical trial was to evaluate the effect of oral inorganic or organic zinc supplementation as a treatment for neonatal diarrhea in calves. Seventy nine 1 to 8 day old male Holstein calves on a California calf ranch were block randomized to one of 3 treatments within 24h from their first onset of diarrhea. Calves received a daily dose of either a placebo composed of 80 mg of zinc-free powder, 381.54 mg of zinc methionine (Met) (equivalent to 80 mg of zinc), or 99.69 mg of zinc oxide (ZO) (equivalent to 80 mg of zinc) in 2L of a zinc-free oral rehydration solution (ORS). Calves were treated once daily until normal fecal consistency or for a maximum of 14 days. Upon enrollment and exit, calves were weighed, and blood, feces, and liver biopsies were collected for trace mineral analysis. Fecal samples at enrollment and exit were tested for E. coli K99, Cryptosporidium spp., rotavirus and coronavirus. Pre-treatment liver zinc concentrations for the 71 calves in the placebo, zinc Met, and ZO treatment groups were 710.6 (SEM=147.7), 852.3 (SEM=129.6), and 750.7 (SEM=202.9)mg/kg dry weight (DW), respectively. Exit liver zinc concentrations for the calves in the placebo, zinc Met, and ZO treatment groups were 728.9 (SEM=182.9), 1141.0 (SEM=423.8), and 636.8 (SEM=81.5)mg/kg dry weight, respectively. Although statistically non-significant, there were clinically important findings identified for each of zinc Met and ZO treatments. Calves treated with zinc Met gained on average 40 g/day during a diarrhea episode compared to a weight loss of 67 g/day on average in the placebo-treated calves (Power 19.9%). Calves treated with ZO had 1.4 times higher hazard of clinical cure compared to calves in the placebo group (Power 5.3%). Calves that were fecal positive to cryptosporidium spp. at enrollment and treated with zinc Met had higher odds of testing negative at exit compared to placebo calves (Odds Ratio (OR)=16.0). In contrast, calves treated with ZO tended to recover (fecal score=1) one day earlier compared to calves treated with a placebo (8.5 d vs. 9.7 d). The current trial identified clinically important findings that warrant further research to investigate zinc's therapeutic effect for calf diarrhea.
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Affiliation(s)
- A D Glover
- Veterinary Medicine Teaching and Research Center, School of Veterinary Medicine, University of California, Davis, 18830 Road 112, Tulare, CA 93274, United States
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