The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study.

BACKGROUND: Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. OBJECTIVE: This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. METHODS: An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. RESULTS: After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). CONCLUSIONS: This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician's underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question.

Diagnostic importance of eosinophilic meningitis in HIV-positive and HIV-negative patients.

The presence of eosinophils in the cerebrospinal fluid (CSF) should always be considered abnormal. This study aimed to evaluate the causes of eosinophils in the CSF of patients who are HIV positive and HIV negative. This is the first study of eosinophils in the CSF of patients who are HIV-positive. This was a retrospective study of CSF reports from 1996 to 2005, patients were selected based on the presence of eosinophils in the CSF. We analyzed 20,008 CSF reports; eosinophils were present in 5%. The median and interquartile range (IQR) of eosinophils was 2% (1%, 4%). Eosinophilic meningitis (CSF eosinophils ≥ 10%) was present in 12% of the samples. The main etiologies were infectious diseases as follows: neurocysticercosis, Cryptococcus sp. meningitis, and acute bacterial meningitis. In HIV-positive cases, all causes were by infectious disease, the main pathogen being Cryptococcus sp. The probability of neurocysticercosis in a patient from an endemic region who is HIV-negative and has CSF eosinophils more than 10% was five times higher compared to a person without eosinophilic meningitis. There was a weak positive correlation between CSF eosinophils and increased serum eosinophils. Among the HIV-negative cases, the most frequent non-infectious causes were cerebrovascular syndromes, of these hemorrhage (91.5%). In the HIV-positive group, there were no cases of non-infectious cerebral disease. CSF eosinophils are suggestive of disease. The causes must be investigated, considering the most prevalent infectious diseases in the region.

Exploração e sofrimento mental de professores: um estudo na rede estadual de ensino do paraná / Exploitation and mental suffering among teachers: a study in the state school system in the state of paraná, brazil / Explotación y sufrimiento mental de los docentes: un estudio en la red estatal de enseñanza del estado de paraná, brasil

Resumo A reestruturação do mundo do trabalho tem exercido forte impacto sobre as condições de vida e saúde da classe trabalhadora. Os professores têm sofrido, assim como os demais trabalhadores, a precarização do trabalho, entre outras consequências da acumulação flexível, com o aumento das exigências sem o incremento suficiente dos recursos necessários para o desempenho do trabalho. A intensa elevação do sofrimento mental dos docentes parece estar ligada às novas condições de trabalho. Visando a fornecer subsídios para o enfrentamento dessa questão, realizou-se pesquisa buscando verificar a associação entre a elevação da exploração no trabalho dos docentes e o sofrimento mental. Efetuou-se estudo transversal por meio da plataforma Limesurvey, em que 1.201 professores da rede estadual responderam a dois questionários on-line: o Self-Reporting Questionnaire-20 e outro, elaborado pelos pesquisadores, sobre as condições de trabalho dos docentes. Carga horária semanal, número de alunos por turma e número de turmas por professor apresentaram associação com transtornos psíquicos menores. A associação de número de alunos por turma com a presença de transtorno psíquico menor foi estatisticamente significativa. Concluiu-se que a prevalência de casos indicativos de distúrbios psíquicos é muito elevada entre os professores, havendo indícios de associação com diversas formas de exploração no trabalho docente.

Abstract The reorganization of the world of labor has a strong impact over the life and health statuses of the working class. Teachers, as well as other workers, have been going through a process of precarization of labor, among other consequences of flexible accumulation, with the increase in the requirements without a sufficient increase in the resources that are needed in order to perform the work. The significant increase in mental suffering among teachers seems to be connected to the new working conditions. With the goal of providing elements in order to face this issue, we developed a research with the aim of observing the association between the increase in exploitation in the work of the teachers and mental suffering. We performed a cross-sectional study using the Limesurvey online survey tool, in which 1,201 teachers of the state school system answered 2 online questionnaires: the Self-Reporting Questionnaire-20 and another one, developed by the researchers, about the working conditions of the teachers. The weekly working hours, the amount of students per classroom and the amount of classes of students per teacher showed an association with minor psychological disorders. The association between the amount of students per classroom and the presence of a minor psychological disorder was statistically significant. We concluded that the prevalence of cases that indicate psychological disorders is very high among teachers, and there are signs of an association with many different kinds of exploitation in the work of teachers.

Resumen La reestructuración del ámbito laboral ha ejercido un fuerte impacto sobre las condiciones de vida y salud de la clase trabajadora. Los docentes, así como los demás trabajadores, han sufrido la precarización del trabajo, entre otras consecuencias de la acumulación flexible, con el aumento de las exigencias sin el incremento suficiente de los recursos necesarios para la ejecución del trabajo. El intenso aumento del sufrimiento mental de los docentes parece estar relacionado a las nuevas condiciones de trabajo. A fin de ofrecer recursos que puedan servir como contribución para enfrentar esta cuestión, se realizó esta investigación buscando constatar la asociación entre el aumento de la explotación de los docentes en su trabajo y el sufrimiento mental. Se efectuó un estudio transversal por medio de la plataforma LimeSurvey, en la que 1.201 docentes de la red estatal respondieron dos cuestionarios en línea: el Self-Reporting Questionnaire-20 y otro, elaborado por los investigadores, sobre las condiciones de trabajo de los docentes. La carga horaria semanal, el número de alumnos por clase y el número de clases por docente, presentaron asociación con trastornos psíquicos menores. La asociación de número de alumnos por clase con la presencia de trastorno psíquico menor fue estadísticamente significativa. Se concluyó que la prevalencia de casos indicativos de disturbios psíquicos es muy alta entre los docentes, existiendo indicios de asociación con diversas formas de explotación en el trabajo docente.