ABSTRACT
OBJECTIVES: This study evaluates the prevalence of Multiple Comorbid Chronic Disease (MCCD) within homeless and non-homeless Veterans and the association between MCCD and inpatient medical care. METHODS: All individuals seen in the VA North Texas Health Care System between October 1, 2009 and September 30, 2010 (n = 102,034) were evaluated. Homelessness during the year and the number of common chronic diseases were evaluated for an association with likelihood of medical and psychiatric hospitalizations, bed days of care, inpatient substance treatment, rehabilitation admissions, and emergency department visits. RESULTS: Homeless Veterans had higher all-cause mortality rates and rates of use of almost all resources after controlling for chronic disease burden using the Charlson Comorbidity Index, psychiatric illnesses, substance use disorders, and demographic variables. CONCLUSIONS: Homelessness Veterans are vulnerable to a high use of resources and mortality, independent of medical and psychiatric conditions. This finding should focus additional attention on reducing homelessness.
Subject(s)
Chronic Disease/epidemiology , Health Services/statistics & numerical data , Ill-Housed Persons/statistics & numerical data , Veterans Health/statistics & numerical data , Veterans/statistics & numerical data , Adult , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Texas/epidemiology , Young AdultSubject(s)
Acute-Phase Proteins/metabolism , Cattle Diseases/blood , Inflammation/veterinary , Animals , Biomarkers/blood , Cattle , Cattle Diseases/diagnosis , Female , Fibrinogen/metabolism , Haptoglobins/metabolism , Inflammation/blood , Inflammation/diagnosis , Male , Reference Values , Reproducibility of Results , Serum Amyloid A Protein/metabolismABSTRACT
This study examined the initial reliability and validity of the Behavioral Observation System (BOS). The BOS, which consists of 34 items rating inpatient behaviors and is completed by psychiatric aids, was developed to assess the domains of Psychosis, Mania, Depression, and Behavioral Dyscontrol. Three studies are described. Results of the reliability study suggest adequate intraclass correlations and coefficient alphas. Analyses of the interscale correlations demonstrated appropriate initial discrimination between the scales. A comparison of diagnoses with ratings yielded expected convergent validity. The overall results suggest the BOS is likely to provide reliable and useful information to treatment teams. Directions of future studies also are discussed.
Subject(s)
Behavior/classification , Mental Disorders/diagnosis , Psychiatric Status Rating Scales , Adult , Female , Humans , Inpatients , Male , Observer Variation , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
This study examines the validity rates of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) profiles in a rural inpatient population. The validity scales of 90 MMPI-2 and 90 PAI profiles were analyzed using published criteria for determining validity. Random responding, positive impression management, and negative impression management were also evaluated. The PAI had a higher number of valid profiles compared with the MMPI-2. Evidence suggests the primary source of the invalid profiles within the MMPI-2 is a higher level of endorsement of relatively rare statements. The substitution of the Infrequency-Psychopathology scale (Fp) for the Infrequency scale (F) on the MMPI-2 substantially reduced the number of invalid profiles. Contrary to expectations, the PAI did not demonstrate lower levels of invalid profiles due to random responding. Rates of invalid profiles for each scale are provided.
Subject(s)
MMPI , Mental Disorders/economics , Mental Disorders/rehabilitation , Personality Inventory , Rural Health Services/economics , Rural Health , Adult , Cost-Benefit Analysis , Female , Hospitalization/economics , Humans , Male , Reproducibility of ResultsABSTRACT
Age has been shown to contribute to aggression in inpatient settings. Studies that examine violence in inpatient settings have shown that younger patients have a higher tendency of aggressive behavior toward staff and other patients (Aquilina, 1991; Hillbrand, Foster, & Spitz, 1996; James, Fineberg, Shah, & Priest, 1990; Nijman, Allerti, Merckelbach, a Campo, & Rovelli, 1997; Owen, Tarantello, Jones, & Tennant, 1998).However, though younger age has been associated with higher rates of violence, no studies have been conducted to assess the impact of multiple young adults on the functioning of an inpatient unit. This study evaluates the effect of the number of young adults on unit functioning and whether young adults mix poorly with other age groups.
Subject(s)
Aggression/psychology , Inpatients/psychology , Mental Disorders/psychology , Psychiatric Department, Hospital/statistics & numerical data , Violence/psychology , Adolescent , Adult , Age Factors , Female , Group Processes , Humans , Inpatients/statistics & numerical data , Interpersonal Relations , Male , Middle Aged , Risk Assessment , Risk Factors , Stress, Physiological , Violence/statistics & numerical data , Young AdultABSTRACT
OBJECTIVE: Although the use of token economies has been shown to facilitate patient change and improve program functioning in numerous settings, token economies have received little attention in acute psychiatric settings. A token economy was introduced on an acute care unit in a rural hospital, and rates of negative events were compared before and after implementation. METHODS: Negative events were defined as patient and employee injuries that were not accidents. Unauthorized absences and use of emergency medications were also counted as negative events. Rates of negative events were calculated over two four-month periods, before and after the token economy was introduced on a 24-bed acute care unit that housed the hospital's neo-adult program for patients between the ages of 18 and 20. The unit also served as an admitting unit for patients over age 20. RESULTS: When the analysis controlled for unit census and the number of neo-adults, an analysis of covariance indicated that the number of negative events fell significantly after the token economy was introduced, from 129 in the four months before implementation to 73 after implementation, a 43 percent reduction. Both staff and patient injuries were significantly reduced. A small increase in use of emergency medications was noted, but it was not statistically significant. CONCLUSIONS: Findings support the use of the token economy in acute settings to improve the unit milieu by reducing negative events.
Subject(s)
Psychiatric Department, Hospital/statistics & numerical data , Risk Management/methods , Token Economy , Wounds and Injuries/prevention & control , Adult , Analysis of Variance , Female , Hospitals, Psychiatric , Hospitals, Rural , Humans , Male , United States , Wounds and Injuries/epidemiologyABSTRACT
From the end of 1994 to the beginning of 1995, 49 patients with hemorrhagic symptoms were hospitalized in the Makokou General Hospital in northeastern Gabon. Yellow fever (YF) virus was first diagnosed in serum by use of polymerase chain reaction followed by blotting, and a vaccination campaign was immediately instituted. The epidemic, known as the fall 1994 epidemic, ended 6 weeks later. However, some aspects of this epidemic were atypical of YF infection, so a retrospective check for other etiologic agents was undertaken. Ebola (EBO) virus was found to be present concomitantly with YF virus in the epidemic. Two other epidemics (spring and fall 1996) occurred in the same province. GP and L genes of EBO virus isolates from all three epidemics were partially sequenced, which showed a difference of <0.1% in the base pairs. Sequencing also showed that all isolates were very similar to subtype Zaire EBO virus isolates from the Democratic Republic of the Congo.
