Gender differences in police encounters among persons with and without serious mental illness.

OBJECTIVE: This study examined the rates, patterns, and types of police contacts among men and women with and without serious mental illness. METHODS: Data on type of contact, type and number of offenses, dispositions, and repeat offenses were extracted from an administrative database of all police encounters in a midsized Canadian city over a six-year period (N=767,365). RESULTS: Men and women with serious mental illness represented, respectively, .5% and .4% of men and women who had at least one contact with the police; however, they were involved in 3.2% and 3.0% of all interactions, respectively. Persons with mental illness were more likely than those without mental illness to be in contact with police as suspected offenders, to have a greater number of offenses, to reoffend more quickly, and to be formally charged for a suspected offense. Among persons without mental illness in contact with police, men were much more likely than women to be offenders, to have a greater number of offenses, and to reoffend more quickly. Among persons with mental illness, however, the gender gap for these measures was significantly smaller. CONCLUSIONS: More resources should be allocated to support persons with mental illness in the community because they tend to have high rates of repeated police contacts for a variety of offenses. The findings highlight the need for gender-specific intervention programs. Administrative databases can be useful tools in examining police contacts among persons with mental illness and monitoring change after policy and program implementation for those at risk of police encounters.

Interhospital transfer of critically ill patients: demographic and outcomes comparison with nontransferred intensive care unit patients.

PURPOSE: We examined the association between access to intensive care services and mortality in a cohort of critically ill patients. MATERIALS AND METHODS: We conducted an observational study involving 6298 consecutive admissions to the intensive care units (ICUs) of a tertiary care hospital. Data including demographics, admission source, and outcomes were collected on all patients. Admission source was classified as "transfer" for patients admitted to the ICU from other hospitals, "ER" for patients admitted from the emergency room, and "ward" for patients admitted from non-ICU inpatient wards. RESULTS: Transfer patients had higher crude ICU and hospital mortality rates compared with emergency room admissions (crude odds ratio [OR], 1.51; 95% confidence interval [CI], 1.32-1.75). After adjusting for age, sex, diagnosis, comorbidities, and acute physiology scores, the difference in ICU mortality remained significant (OR, 1.30; 95% CI, 1.09-1.56); however, hospital mortality did not (OR, 1.19; 95% CI, 1.00-1.41). Compared with ward patients, transfer from other hospitals was associated with lower hospital mortality after adjusting for severity of illness and other case-mix variables (OR, 0.81; 95% CI, 0.68-0.95). CONCLUSIONS: We found some evidence to suggest that differential access to intensive care services impacts mortality within this case mix of patients. These findings may have implications for current efforts to centralize and regionalize critical care services.

Pretrial court diversion of people with mental illness.

Court diversion is a method of administering justice compassionately for persons with mental illness (PMI). Evidence-based practices of this intervention were identified by reviewing the existing literature. Findings suggest that: (a) formal case finding procedures are important for the early identification of mentally ill offenders in need of services, (b) stable housing enhances the possibility that the divertee will remain in regular contact with her or his treatment provider, and (c) active case management improves compliance and reduces the likelihood of recidivism. In summary, research has not yet yielded generalizable knowledge about diversion and thus, it is suggested that evaluations should involve well-defined indicators, benchmarks, and outcomes.

Mental health triage in the ER: a qualitative study.

RATIONALE, AIMS AND OBJECTIVES: The London Health Sciences Centre found that its emergency room (ER) mental health services were affected by people presenting with problems that did not require psychiatric intervention. Consequently, a second triage using a crisis worker (CW) was introduced in the ER to identify those persons with mental illness (PMI) who presented for social stressors related to housing, finances and legal issues. A qualitative, process evaluation study was conducted to capture experiences and perceptions of the new triage and CW. METHOD: Qualitative input was obtained from a broad range of stakeholders in three waves of data-gathering over a 25-month period. This method allowed corroboration of findings from informants with varying interests and backgrounds. The data were collected through interviews, focus groups and surveys. The NUD-ist Qualitative Data Analysis Software Program was used to conduct content analyses. RESULTS: Many PMI seeking ER mental health services are presenting with problems related to social stressors and being referred by the second triage to the CW. The introduction of the second triage CW has had a positive effect on ER functioning, the workload of ER staff and the experience of persons presenting at ER. CONCLUSIONS: A defined triage process coupled with the use of psychiatric nursing staff may be applicable to ERs within general hospital settings to improve ER functioning, focus support for PMI and further integrate ERs within the community mental health model.

Sampling bias in an international internet survey of diversion programs in the criminal justice system.

Despite advances in the storage and retrieval of information within health care systems, health researchers conducting surveys for evaluations still face technical barriers that may lead to sampling bias. The authors describe their experience in administering a Web-based, international survey to English-speaking countries. Identifying the sample was a multistage effort involving (a) searching for published e-mail addresses, (b) conducting Web searches for publicly funded agencies, and (c) performing literature searches, personal contacts, and extensive Internet searches for individuals. After pretesting, the survey was converted into an electronic format accessible by multiple Web browsers. Sampling bias arose from (a) system incompatibility, which did not allow potential respondents to open the survey, (b) varying institutional gate-keeping policies that "recognized" the unsolicited survey as spam, (c) culturally unique program terminology, which confused some respondents, and (d) incomplete sampling frames. Solutions are offered to the first three problems, and the authors note that sampling bias remains a crucial problem.

Process and outcome evaluation of an emergency department intervention for persons with mental health concerns using a population health approach.

PURPOSE: To evaluate an emergency department's use of a mental health triage and mental health crisis counsellor for persons presenting with mental health concerns. METHOD: Mixed method (qualitative and quantitative), multiple measures. RESULTS: Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups with detox decreased post-intervention. CONCLUSIONS: The qualitative and quantitative findings are congruent with other studies supporting the use of properly implemented mental health triage and crisis counsellors to improve the care of persons with mental health concerns.

Pre-arrest diversion of people with mental illness: Literature review and international survey.

Mental health diversion is a process where alternatives to criminal sanctions are made available to persons with mental illness (PMI) who have come into contact with the law. One form of mental health diversion is pre-arrest, in which the police use their discretion in laying charges. Concomitant with the growth of pre-arrest diversion programs is a growing body of research devoted to the phenomenon. The purpose of this paper is to review the existing literature of pre-arrest diversion, and to report the results of an international survey of pre-arrest diversion programs we conducted to identify evidence-based practices. On the basis of our review and survey, we note that successful pre-trial programs appear to integrate relevant mental health, substance abuse and criminal justice agencies by having regular meetings between key personnel from the various agencies. Often, a liaison person with a mandate to effect strong leadership plays a key role in the coordination of various agencies. Streamlining services through the creation of an emergency drop-off center with a no-refusal policy for police cases is seen as crucial. While there is some indication that mentally ill offenders benefit from their participation in this form of diversion, the evaluative literature has not yet achieved the "critical mass" necessary to create generalizable, evidence-based knowledge. The absence of generally agreed-upon outcomes could lead to the inequitable application of basic principles of diversion. We suggest that indicators, benchmarks, and outcomes must be agreed upon if a comprehensive understanding of pre-arrest programs is to emerge.

Telenursing and patients' recovery from bypass surgery.

AIM: This paper reports the qualitative findings of qualitative interviews conducted as part of a study assessing the effectiveness of structured, postdischarge, telephone intervention for patients and their partners recovering from bypass surgery. The data reported here describe the postoperative recovery experiences of a small sample of patients (n = 10) and the intervention role of the specialist nurse delivering the intervention. BACKGROUND: Reduced length of hospital stay for bypass patients means that there are fewer opportunities to provide necessary information and respond to patient concerns in hospital, and much of the process of wound healing and regaining functioning that would once have taken place in hospital now takes place at home and place additional burdens on patients and their caregivers. METHOD: The study was a randomized controlled trial of a telephone intervention aimed at reducing anxiety for patients experiencing a first bypass, and for their caregivers. The intervention consisted of a series of protocols delivered by a nurse with cardiac experience. It was conducted via telephone at discharge and on days 1, 2, 4, 7 and weeks 2 and 7 postdischarge. In the qualitative component of the study, a purposive sample of telephone calls in the treatment group was analysed and data saturation was achieved with 10 transcripts. FINDINGS: Three major patient concerns emerged: physical, affective and lifestyle changes. Anxiety about speed of discharge was a common concern at discharge and at day 1. Otherwise, physical concerns predominated during the first week. At day 7 and after, a shift began to occur to longer term, future-oriented concerns. By week 7, most patients were planning for return to normal activities, and several were making lifestyle changes. The specialist nurse was able to give personalized health promotion information at a time that was appropriate for individual patients. CONCLUSION: Using a qualitative interview method made it possible to understand patients' concerns and study the working of telenursing interventions in terms of providing timely reassurance and health promotion. Further research is needed to test the generalizability of the findings.

Design of an algorithm to identify persons with mental illness in a police administrative database.

North American police maintain a database to track events and information related to their involvement with the public that contain a series of electronic caution/dependency flags attached to an individual's name for internal communication. To identify persons with mental illness in a police administrative database, an algorithm was developed that was composed of (a) caution/dependency flags, (b) addresses, and (c) key search words indicative of mental illness. Based on the level of confidence of the algorithm, persons with mental illness (PMI) were then assigned to one of three categories: Definite, Probable and Possible PMI. Results for 2000 include the sociodemographic characteristics of PMI and non-PMI in the database. The mean number of contacts, types of interactions, re-involvement with a year, charges and dispositions are described. The algorithm provides a cheap, quick method to identify PMI for North American police. It enables police to monitor the effectiveness of pre-arrest diversion programs and allows researchers to analyze questions of criminalization and mental illness.

Rates of claims for cumulative trauma disorder of the upper extremity in Ontario workers during 1997.

Surveillance of work-related cumulative trauma disorder of the upper extremity (CTDUE) requires valid and reliable claim extraction strategies and should examine for confounding and interaction. This research estimated crude and specific rates of CTDUE claims in Ontario workers during 1997 while acknowledging misclassification and testing for confounding and interaction. Lower and upper limit event estimates were obtained by means of an algorithm applied to the Ontario Workplace Safety and Insurance Board (OWSIB) database and were combined with "at-risk" estimates obtained from the Canadian Labour Force Survey (LFS). Poisson regression was used to evaluate confounding and interaction. The method used to identify CTDUE claims had a substantial impact on the magnitude of rates, female to male rate ratios, the most commonly affected part of the upper extremity and the highest risk occupational categories. Poisson regression identified sex interactions. It allowed rigorous evaluation of the data and indicated that rates should be examined separately for men and women. Researchers should clearly define extraction strategies and examine the impact of misclassification.

Identifying cumulative trauma disorders of the upper extremity in workers' compensation databases.

BACKGROUND: Impeding the use of workers' compensation databases for surveillance of cumulative trauma disorder of the upper extremity (CTDUE) is the lack of valid and reliable extraction strategies. METHODS: Using the Z795-96 Coding of Work Injury or Disease Information standard, an algorithm was developed to classify claims as definite, possible, or non-CTDUE. Reliability was assessed with standardized claim reviews. RESULTS: Moderate to substantial agreement (Kappa = 0.48, 95% CI 0.42-0.54, n = 328; weighted Kappa = 0.75, 95% CI 0.70-0.80, n = 328) was demonstrated. The algorithm produced relatively homogeneous groups of definite and non-CTDUE claims but 29.1% of the possible CTDUE claims were categorized as definite CTDUE by claim review. Part of body agreement was almost perfect (Kappa = 0.81-1.00) when determining whether the upper extremity or specific parts of the upper extremity were involved. CONCLUSIONS: The algorithm can be used to estimate the number of CTDUE and extract homogeneous groups of definite and non-CTDUE claims. Furthermore, certain upper extremity part of body codes can be used to target anatomically defined claims.

Integrating knowledge generation with knowledge diffusion and utilization: a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health.

OBJECTIVE: Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a "partnership culture". This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH). METHODS: This qualitative study, using a single-case design, included a number of data sources: proposals, meeting minutes, presentations, publications, reports and curricula vitae of CAREMH members. RESULTS: CAREMH has adopted the following operational strategies to increase KDU capacity: 1) viewing research as a means and not as an end; 2) bringing the university and researcher to the community; 3) using participatory research methods; 4) embracing transdisciplinary research and interactions; and 5) using connectors. Examples of the iterative process between researchers and potential knowledge users in their contribution to knowledge generation, diffusion and utilization are provided. CONCLUSIONS: This case study supports the importance of early and ongoing involvement of relevant potential knowledge users in research to enhance its utilization potential. It also highlights the need for re-thinking research funding approaches.

Work-related cumulative trauma disorders of the upper extremity: navigating the epidemiologic literature.

BACKGROUND: Cumulative trauma disorder of the upper extremity (CTDUE) is an umbrella term used to describe disorders resulting from repeated use of the upper extremity over time rather than a specific incident. The primary purpose of this article is to summarize the literature regarding the rate of work-related CTDUE, while drawing attention to the various factors contributing to the wide range of reported findings. METHODS: The Cumulative Index to Nursing and Allied Health and Medline databases were searched for articles focusing on etiology or rates of occurrence of work-related CTDUE and their findings were summarized. RESULTS: Potential reasons for rising rates, a gender differential, and the substantial range in rates and rate ratios are delineated and important factors to consider when interpreting rates derived from workers' compensation data are detailed. CONCLUSIONS: Future research should attempt to correctly identify more specific categories of CTDUE in well-defined and accurately-quantified "at risk" populations to provide more meaningful information regarding the epidemiology of CTDUE and the effectiveness of control activities.

Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: effects of anxiety.

OBJECTIVE: The purpose of this study was to determine the effectiveness of an information and support telephone intervention for reducing anxiety in patients who have undergone coronary artery bypass graft surgery and their partners. DESIGN: The study is a randomized controlled trial. Intervention began at discharge; 6 telephone calls were made to patients and partners over 7 weeks. Primary outcome was Beck Anxiety Inventory measured at baseline in hospital, at home on day 3, week 4, and week 8. SAMPLE: The subjects were 131 patients who have undergone elective coronary artery bypass graft surgery and their partners. RESULTS: Patients' anxiety was moderate to severe the day before discharge. It was significantly lower in the treatment group than in the control group at day 2 at home. Partners always had lower anxiety than patients. A more sustained decrease in anxiety in the partner treatment group was found at both day 2 and week 4. CONCLUSION: Intervention effect is in the early period after discharge-- the time most affected by reduced lengths of stay.

Estimating the population at risk for Ontario Workplace Safety and Insurance Board-covered injuries or diseases.

Difficulty in quantifying the population at risk for a work-related injury or disease limits the usefulness of workers' compensation data for surveillance. This article presents a method of obtaining estimates of the Ontario Workplace Safety and Insurance Board (OWSIB)- covered workforce using the Canadian Labour Force Survey (LFS). The method involves extracting that class of worker most likely to be insured by the OWSIB and using actual hours worked to estimate full-time equivalents at risk. Compared to population at risk estimates readily available from published tables, the refined crude estimate was 26% lower and ranged from 15 to 79% lower depending on the age group. The percentage decrease from published estimates was generally greater for women compared to men, particularly in the 25 to 39 year age categories. Consequently, the method of deriving population at risk estimates should be considered when comparing rates across sexes, ages, industries or occupations.