Hot water immersion acutely increases postprandial glucose concentrations.

Chronic hot water immersion (HWI) confers health benefits, including a reduction in fasting blood glucose concentration. Here we investigate acute glycemic control immediately after HWI. Ten participants (age: 25 ± 6 years, body mass: 84 ± 14 kg, height 1.85 ± 0.09 m) were immersed in water (39°C) to the neck (HWI) or sat at room temperature (CON) for 60 min. One hour afterward they underwent an oral glucose tolerance test (OGTT), with blood collected before and after HWI/CON and during the 2 h OGTT. Glucose incremental area under the curve (iAUC) during the OGTT was higher for HWI (HWI 233 ± 88, CON 156 ± 79 mmol·L-1 ·2 h, P = 0.02). Insulin iAUC did not differ between conditions (HWI 4309 ± 3660, CON 3893 ± 3031 mU·L-1 ·2 h, P = 0.32). Core temperature increased to 38.6 ± 0.2°C during HWI, but was similar between trials during the OGTT (HWI 37.0 ± 0.2, CON 36.9 ± 0.4°C, P = 0.34). Directly following HWI, plasma average adrenaline and growth hormone concentrations increased 2.7 and 10.7-fold, respectively (P < 0.001). Plasma glucagon-like peptide-1, peptide YY, and acylated ghrelin concentrations were not different between trials during the OGTT (P > 0.11). In conclusion, HWI increased postprandial glucose concentration to an OGTT, which was accompanied by acute elevations of stress hormones following HWI. The altered glycemic control appears to be unrelated to changes in gut hormones during the OGTT.

Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: randomised controlled trial.

BACKGROUND: Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent. AIMS: To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively. METHOD: In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria. RESULTS: Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group. CONCLUSIONS: Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the shortterm and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research.

OBJECTIVE: As the use of "day hospitals" increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e.g. randomised controlled) single- or multi-site trials assessing specific models of day hospital care. METHOD: Using a self-developed structured questionnaire, the European Day Hospital Evaluation (EDEN) study group carried out national surveys of the characteristics of day hospitals for general psychiatric patients in Germany, England, Poland, the Slovak Republic and the Czech Republic, during the period 2001--2002. RESULTS: Response rates varied from 52 to 91 %. Findings show that day hospitals have no consistent profile of structural and procedural features. Similarities across countries focus on three main issues: on average, consideration of concepts oriented toward providing acute treatment are equivalent; disorders associated with disabled functioning in everyday life, high risk of somatic complications, and need for behaviour control are excluded to a comparable degree; and some core therapeutic activities are consistent with the main approaches of social psychiatry. Identified according to self-rated conceptions and extended with data from individual hospital's statistics on the clientele in 2000, three clusters of limited selectivity subdivide the services. One category focuses mainly on rehabilitative tasks; two categories are oriented toward providing acute treatment as an alternative to inpatient care, but combine this either with rehabilitative tasks or with equal additional functions of shortening inpatient treatment and providing psychotherapy. The distribution of services across these three clusters varies significantly in the five European countries. CONCLUSION: Future day hospital studies should always clarify the type of services being assessed. To fully consider the impact of their results, the current national and international health policy environment of these services should be taken into account. Such surveys require enhanced methodology, however, in order to identify clear, distinct categories of services characterised by overlapping programme functions, and to increase the generalisability of valid results from single- or multi-site trials.

Inter-rater reliability of the Brief Psychiatric Rating Scale and the Groningen Social Disabilities Schedule in a European multi-site randomized controlled trial on the effectiveness of acute psychiatric day hospitals.

The objectives of this study were to report the inter-rater reliability of the Brief Psychiatric Rating Scale (BPRS 4.0) and the Groningen Social Disabilities Schedule (GSDS-II) as assessed in a randomized controlled trial on the effectiveness of psychiatric day hospitals spanning five sites in countries of Central and Western Europe. Following brief training sessions, videotaped BPRS-interviews and written GSDS-vignettes were rated by clinically experienced researchers from all participating sites. Inter-rater reliability often proved to be poor for items assessing the severity of both psychopathology and social dysfunction, but findings suggest that both instruments allow for the assessment of the presence or absence of specific psychopathological symptoms or social disabilities. Inter-rater reliability at subscale level proved to be good for both instruments. Results indicate that, with a brief training session and proper use of the instruments, psychopathology and social disabilities can be reliably assessed within cross-national research studies. The results are of particular interest given that the need to conduct cross-national multi-site studies including countries with different cultural backgrounds increases.