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1.
J Dairy Sci ; 105(1): 684-694, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34756443

ABSTRACT

Understanding how downer cattle are managed allows for the evaluation of strengths and weaknesses in these practices, which is an important step toward improving the care these animals receive. The objective of this cross-sectional study was to analyze factors associated with the care and management of downer cattle by Canadian dairy producers. Data were obtained from the 2015 National Dairy Study, and analysis was limited to the 371 respondents completing the downer cow scenario. The scenario described a downer cow that the producer wanted to keep in their herd but must be moved, and was followed by questions addressing the cow's care and management. Using multivariable logistic regression models, associations between respondent demographics and farm characteristics, and the presence of downer cow protocols, we assessed decisions regarding euthanasia and use of behavioral prognostic indicators. Written downer cow protocols were reported by 18.2% of respondents, 67% indicated that they had a nonwritten protocol, and 14.8% reported that they did not have a protocol (either written or nonwritten). Respondents from western provinces were more likely to have a written protocol than those from Ontario. Nineteen percent of the respondents with a written or unwritten protocol reported veterinary involvement in developing their downer cow protocol, which occurred more commonly on farms with more frequent herd health visits and a good producer-veterinarian relationship. An area to move a downer cow to was present on 88% of farms, with respondents who were farm staff being less likely to report having knowledge of a designated area than respondents who were the farm owner. In addition, approximately half (45%) of respondents reported moving downer cattle with hip lifters as their most common method. Behavioral prognostic indicators chosen by respondents were associated with the respondent's geographic region, age, farm size, and education. Most notably, older respondents were more likely to use appetite, and less likely to use attitude, as a prognostic indicator compared with younger respondents. Using perceived pain as a prognostic indicator was more common among respondents from western and Atlantic provinces compared with respondents from Ontario, and more common among respondents with a college or university education. These results highlighted herd and farmer demographics that were associated with how Canadian dairy producers managed downer cattle in 2015 and could be used as a benchmark for evaluating how these management practices compare with those currently implemented.


Subject(s)
Cattle Diseases , Dairying , Animals , Cattle , Cross-Sectional Studies , Euthanasia, Animal , Farms , Female , Ontario
2.
J Dairy Sci ; 105(3): 2544-2557, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34955243

ABSTRACT

Nonambulatory dairy cattle pose a complex problem due to the challenges associated with prevention, appropriate treatment and management, and arriving at an accurate prognosis. There is a breadth of literature regarding this topic, of which there is currently no formal synthesis. The objective of this scoping review was to describe and characterize the literature investigating risk factors, sequela, preventions, treatments, and prognostic factors for nonambulatory conditions in dairy cattle, with the intent of qualitatively synthesizing knowledge of the topic and identifying gaps in the literature. A literature search was conducted in 6 databases and 2 conference proceeding archives, which returned 7,568 unique articles. Initial screening of abstracts resulted in 1,544 articles reviewed at the full-text stage, of which 379 were included for data extraction. Over 75% of the included literature was published after 1980, and the most common countries in which these studies took place were the United States (n = 72), Canada (18), Sweden (17), and Germany (17). Common eligibility criteria used for inclusion were geographic region (97) and parity (92). Of the 379 studies included in this review, 144 were randomized controlled trials and 235 were observational studies. The majority of the controlled trials assessed prevention of nonambulatory conditions (116), most commonly through supplementation of vitamin D (27) and calcium (25) or the provision of anionic salts (22). Of the 28 studies focusing on treatment of nonambulatory conditions, 26 focused on calcium administration. Becoming nonambulatory was evaluated as an outcome in 165 of the observational studies. Frequently measured risk factors for becoming nonambulatory included hematological variables, such as blood calcium (73), phosphorus (53) and magnesium (42), and other factors such as parity (35) and breed (22). Recovery from a nonambulatory condition was the outcome in 31 of the observational studies, with commonly measured prognostic indicators being calcium (9), phosphorus (9), and duration of recumbency (7). Nonambulatory disorders were measured as risk factors in 53 of the observational studies, with the most commonly assessed outcomes including disorders of the transition period (11), and death or euthanasia (11). The most common terms used to describe nonambulatory conditions were "milk fever" (199) and "parturient paresis" (147). These terms were only further defined with explicit symptomatic criteria in 193 of the 379 studies in this review. Recumbency was the most commonly used of these criteria (144), followed by inability to rise (55). Potential gaps in the literature concerning nonambulatory dairy cattle that were identified in the present review included investigation of prognostic indicators for recovery from nonambulatory conditions that are applicable on farm, treatment alternatives to calcium administration, and guidance regarding the appropriate usage of terms meant to categorize nonambulatory dairy cattle.


Subject(s)
Cattle Diseases , Hypocalcemia , Parturient Paresis , Animals , Cattle , Cattle Diseases/prevention & control , Female , Hypocalcemia/veterinary , Magnesium , Parity , Parturient Paresis/prevention & control , Pregnancy
3.
Physiol Biochem Zool ; 80(6): 619-34, 2007.
Article in English | MEDLINE | ID: mdl-17909998

ABSTRACT

The specific objectives of this study were to determine whether sprint performance in juvenile rainbow trout is correlated with either voluntary swimming activity or aggressive behaviors and to determine the reciprocal: the effect of swimming activity and aggression on sprint performance. Sprint performance was assessed by rapidly accelerating trout (5-7-cm fork length) to a fixed velocity (40, 42, or 45 cm s(-1)) and then holding them at that velocity until fatigue. There was considerable interindividual variation in sprint performance not explained by variations in body size, but intraindividual performance was highly repeatable over at least 2 mo. Voluntary swimming was measured as the frequency of transits (voluntary transit activity, VTA) between two identical tanks via a connecting channel with two different flow regimes: zero or minimum velocity (0 or 2.5 cm s(-1)) and high velocity (84 cm s(-1)). There was a strong correlation between sprint performance and VTA in minimal current but no correlation in high current. Furthermore, sprint performance did not predict the outcome of dominance encounters. Experience with rapid acceleration, especially when voluntary, led to a pronounced improvement in sprint performance in proportion to the number of acceleration events. Social dominance encounters had a more complex effect: a significant reduction in sprint performance in previously high-performance sprinters and the reverse for low performers. We propose that there are four independent axes of interindividual variation in juvenile rainbow trout: spontaneous and rheotaxis-stimulated locomotor activity, aggressive activity, and the trainability of sprint performance. The independence of these axes has the potential to produce a much larger diversity in behavioral and ultimately physiological phenotypes than would be produced if the axes were linked.


Subject(s)
Oncorhynchus mykiss/physiology , Social Dominance , Swimming/physiology , Aggression , Animals , Physical Conditioning, Animal
4.
J Biomater Sci Polym Ed ; 14(10): 1117-33, 2003.
Article in English | MEDLINE | ID: mdl-14661883

ABSTRACT

It is generally accepted that stress causes calcification in both bio-prosthetic and polyurethane heart valves. However, simple uni-axially- and bi-axially-stretched samples did not yield a feasible model for the elaboration of the stress-induced calcification. In this study, heat compaction combined with the incorporation of polyethylene has been explored. Specimens of polyurethane were solution cast onto a porous bi-axially-drawn ultra-high-molecular-weight polyethylene film and then heat compacted under a pressure of 18 MPa at a chosen temperature for 1.5 h. The heat-compaction-induced calcification and physical changes of the polyurethane composite were evaluated using a 28-day in vitro calcification model and Attenuated Total Reflection-Fourier Transform-Infrared (ATR-FT-IR) spectroscopy. The calcification results indicated that heat-compaction-induced calcification was double that achieved without heat compaction. Heat-compacted polyurethane composite showed higher affinity to calcium ions than the non-heat compacted sample. The ATR-FT-IR results showed that the heat-compaction-induced physical changes include distortions of polymeric molecules and permanent changes of microstructures. The distortions of polymeric molecules could be deteriorated in contact with different media. The relaxation of the stressed structures of the polyether moiety might serve as a calcium trap and a heterogeneous nucleation site for calcification. The permanent changes of microstructures resulted from high distortions also served as affinity sites attracting calcification.


Subject(s)
Biocompatible Materials/chemistry , Calcium/chemistry , Polyurethanes/chemistry , Calcium/metabolism , Hot Temperature , Materials Testing/methods , Phosphorus/chemistry , Phosphorus/metabolism , Pressure , Prostheses and Implants , Spectroscopy, Fourier Transform Infrared/methods
5.
Physiol Biochem Zool ; 75(3): 250-9, 2002.
Article in English | MEDLINE | ID: mdl-12177828

ABSTRACT

This study examined fuel depletion in white muscle of juvenile rainbow trout sprinted to fatigue to determine whether the onset of fatigue is associated with a measurable metabolic change within the muscle and whether muscle glycogen levels influence endurance. In this study, "fuels" refer to any energy-supplying compounds and include glycogen, phosphocreatine (PCr), and ATP. Fuel depletion in white muscle was estimated by the calculation of the anaerobic energy expenditure (AEE; in micromol ATP equivalents g(-1)) from the reduction of PCr and ATP and the accumulation of lactate. Progression of fuel use during sprinting was examined by sampling fish before they showed signs of fatigue and following fatigue. Most of the AEE before fatigue was due to PCr depletion. However, at the first signs of fatigue, there was a 32% drop in ATP. Similarly, when fish were slowly accelerated to a fatiguing velocity, the only significant change at fatigue was a 30% drop in ATP levels. Muscle glycogen levels were manipulated by altering ration (1% vs. 4% body weight ration per day) combined with either daily or no exercise. Higher ration alone led to significantly greater muscle glycogen but had no effect on sprint performance, whereas sprint training led to higher glycogen and an average threefold improvement in sprint performance. In contrast, periodic chasing produced a similar increase in glycogen but had no effect on sprint performance. Taken together, these observations suggest that (i) a reduction in ATP in white muscle could act as a proximate signal for fatigue during prolonged exercise in fish and (ii) availability of muscle glycogen does not limit endurance.


Subject(s)
Energy Metabolism , Oncorhynchus mykiss/metabolism , Physical Conditioning, Animal , Adenosine Triphosphate/metabolism , Anaerobiosis , Animal Nutritional Physiological Phenomena , Animals , Diet , Fatigue/metabolism , Glycogen/metabolism , Muscle, Skeletal/metabolism , Swimming/physiology , Time Factors
6.
Article in English | MEDLINE | ID: mdl-11691621

ABSTRACT

Fingerling rainbow trout were supplemented with equal amounts of creatine (Cr) by two routes: dietary (12.5 mg Cr per g food); or intraperitoneal injection (0.5 mg Cr per g fish). Endurance in a fixed velocity sprint test (at a speed of 7 BL s(-1)), and resting levels of white muscle metabolites (total creatine [a measure of free creatine plus phosphocreatine (PCr), ATP, lactate and glycogen] were assessed following 7 days of supplementation and compared to controls. None of the treatments had a significant effect on growth, muscle total creatine, percent phosphorylation of creatine, ATP or lactate. However, resting muscle glycogen was elevated in creatine-supplemented fish. Higher muscle glycogen corresponded to significantly greater endurance in creatine-supplemented fish. Although fish do not actively transport additional creatine into the muscle, a mechanism whereby circulating creatine acts to enhance muscle glycogen is present. These results suggest that the improved endurance may be due to an insulin-dependent mechanism (similar to that elucidated in mammalian studies) that allows fish to supercompensate muscle glycogen stores, thus extending endurance through enhanced glycolytic flux.


Subject(s)
Animal Nutritional Physiological Phenomena , Creatine/pharmacology , Dietary Supplements , Adenosine Triphosphate/metabolism , Animals , Creatine/administration & dosage , Creatine/biosynthesis , Dose-Response Relationship, Drug , Glycogen/biosynthesis , Glycogen/metabolism , Insulin/metabolism , Lactic Acid/metabolism , Muscles/metabolism , Oncorhynchus mykiss , Phosphorylation , Physical Conditioning, Animal , Physical Fitness
7.
Psychiatr Serv ; 52(7): 903-10, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11433107

ABSTRACT

Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness. A core set of characteristics of effective family psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited. Barriers at the level of the consumer and his or her family members, the clinician and the administrator, and the mental health authority reflect the existence of attitudinal, knowledge-based, practical, and systemic obstacles to implementation. Family psychoeducation dissemination efforts that have been successful to date have built consensus at all levels, including among consumers and their family members; have provided ample training, technical assistance, and supervision to clinical staff; and have maintained a long-term perspective.


Subject(s)
Evidence-Based Medicine/methods , Family/psychology , Health Education/methods , Mental Disorders/therapy , Mental Health Services/standards , Health Education/standards , Humans , Mental Disorders/psychology , Regional Medical Programs , United States
8.
Psychiatr Serv ; 52(7): 935-42, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11433111

ABSTRACT

OBJECTIVE: The aim of this study was to determine whether it is possible at the time of staff training to predict whether a mental health center will succeed in implementing family psychoeducation services. METHODS: Fifteen mental health agencies in Maine and 51 in Illinois in which clinicians and administrators were trained in multifamily psychoeducation were studied. Participants were surveyed immediately after their initial training sessions and nine months later. Participants' demographic characteristics, agency characteristics, and principal components derived from the survey data were analyzed to identify factors associated with implementation of family psychoeducation services. RESULTS: The regression model successfully predicted which sites would succeed. Success was more likely at sites where the treatment model was viewed more positively at the outset, where real and perceived resource limitations were addressed, where inducements to implementation were seen as less important, and where attention was paid to the difference between new and existing treatment methods. Nearly all the Maine sites (14, or 93 percent) implemented multifamily psychoeducation services, whereas only five of the Illinois sites (10 percent) implemented this form of treatment. The Maine trainees were less skeptical about family psychoeducation and more interested in receiving supervision and consultation. In Maine there was wide-ranging and local consensus before and during implementation, and more federal funding was available than in Illinois. CONCLUSIONS: Surveys of clinicians allowed prediction of which sites would successfully implement family psychoeducation services. Consensus building and funding appeared to be critical to successful outcomes.


Subject(s)
Caregivers/education , Community Mental Health Centers/organization & administration , Family/psychology , Health Education/organization & administration , Inservice Training , Schizophrenic Psychology , Adult , Caregivers/psychology , Female , Humans , Illinois , Maine , Male , Middle Aged , Outcome Assessment, Health Care/statistics & numerical data , Program Development , Regression Analysis , Surveys and Questionnaires , Workforce
9.
Inorg Chem ; 40(2): 354-60, 2001 Jan 15.
Article in English | MEDLINE | ID: mdl-11170543

ABSTRACT

The self-exchange rate constant (25 degrees C) for parsley plastocyanin is 5.0 x 10(4) M-1 s-1 at pH* 7.5 (I = 0.10 M). This value is quite large for a higher plant plastocyanin and can be attributed to a diminished upper acidic patch in this protein. The self-exchange rate constant is almost independent of pH* in the range 7.5-5.6, with a value (25 degrees C) of 5.6 x 10(4) M-1 s-1 at pH* 5.6 (I = 0.10 M). At this pH*, the ligand His87 is protonated in approximately 50% of the reduced protein molecules (pKa* 5.6), and this would be expected to hinder electron transfer between the two oxidation states. However, this effect is counterbalanced by the enhanced association of two parsley plastocyanins at lower pH* due to the partial protonation of the acidic patch.


Subject(s)
Apiaceae/chemistry , Plastocyanin/chemistry , Copper/chemistry , Hydrogen-Ion Concentration , Models, Molecular , Nuclear Magnetic Resonance, Biomolecular
11.
Am J Orthopsychiatry ; 70(2): 203-14, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10826032

ABSTRACT

Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while negative symptoms declined in the former and increased in the latter. No evidence was found that competitive work presented a significant risk for relapse.


Subject(s)
Assertiveness , Behavior Therapy , Bipolar Disorder/rehabilitation , Depressive Disorder, Major/rehabilitation , Family Therapy , Rehabilitation, Vocational , Schizophrenia/rehabilitation , Adult , Bipolar Disorder/psychology , Depressive Disorder, Major/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Referral and Consultation , Schizophrenic Psychology
12.
Psychiatr Serv ; 51(4): 513-9, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10737828

ABSTRACT

OBJECTIVE: Outcomes for negative symptoms over a one-year period were examined in two groups of patients, one receiving psychoeducational multiple-family group treatment and one receiving standard care. METHODS: A total of 63 outpatients, ages 18 to 45 years, with DSM-IV diagnoses of schizophrenic disorders were randomly assigned to standard care or multiple-family group psychoeducation treatment at a large mental health center in Spokane, Washington. Treatment assignment was stratified by whether patients were taking typical or atypical antipsychotic medications. Negative symptom status was monitored monthly for one year by raters blind to group assignment and measured as a composite of five symptoms using the Modified Scale for the Assessment of Negative Symptoms. RESULTS: When the analysis controlled for baseline negative symptoms, participants in the multiple-family group experienced significantly reduced negative symptoms compared with those receiving standard care. Taking atypical antipsychotic medication or having a diagnosis of substance abuse was not associated with the severity of negative symptoms. An additional analysis of the five individual negative symptoms indicated small but consistent group differences on all dimensions except inattention. Negative symptoms were significantly correlated with relapse to acute illness but not with outpatient or inpatient service use. CONCLUSIONS: The study demonstrated that a psychoeducational multiple-family group intervention was more effective than standard care in managing negative symptoms over a 12-month period. The results are particularly relevant because negative symptoms are associated with relapse, poor social and occupational functioning, cognitive impairment, and lower subjective quality of life.


Subject(s)
Depression/therapy , Family Therapy , Psychotherapy, Group , Schizophrenia/therapy , Adolescent , Adult , Depression/diagnosis , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Recurrence , Schizophrenia/diagnosis , Social Adjustment
14.
Adm Policy Ment Health ; 25(2): 191-8, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9727216

ABSTRACT

Family Psychoeducation and Assertive Community Treatment are both state-of-the-art service systems with rich empirical foundations, demonstrating unusual effectiveness in randomized clinical trials. Recent research suggests a possible additive effect on selected outcomes when the two approaches are integrated. This paper reviews the role of family support and intervention in the care of persons with serious mental illnesses, presents the research literature on psychoeducation, and highlights benefits of merging the multiple-family version of this approach into the work of assertive community treatment programs.


Subject(s)
Community Mental Health Services/organization & administration , Delivery of Health Care, Integrated/organization & administration , Family Therapy/organization & administration , Family/psychology , Health Education/organization & administration , Mental Disorders/rehabilitation , Social Support , Adaptation, Psychological , Cost of Illness , Humans
15.
Psychiatr Serv ; 47(7): 744-50, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8807689

ABSTRACT

OBJECTIVE: The study examined differences in outcomes for patients with schizophrenic disorders who were receiving assertive community treatment based on whether their families were involved in their treatment more intensively in psychoeducational multifamily groups or episodically in crisis family intervention. METHODS: Sixty-eight individuals who met DSM-III-R criteria for schizophrenic disorders and who had at least one other major complicating factor were randomly assigned to the two treatment conditions, and clinical and functional outcomes over a 24-month follow-up period were compared. RESULTS: Both groups had significant reductions in rehospitalization rates and symptom levels and increased participation in treatment. Patients in multifamily group treatment had higher employment rates during the study. Otherwise, few significant differences in the major outcome variables were found. In both treatment conditions family members reported significant improvements in their objective and subjective burden; in friction, dissatisfaction, and overinvolvement with the patient; and in the patient's functioning. CONCLUSIONS: The results suggest that systematic family involvement enhances the rehabilitation and family-related outcomes of assertive community treatment. Patients in multifamily group treatment had better employment outcomes.


Subject(s)
Community Mental Health Services , Crisis Intervention , Family Therapy , Psychotherapy, Group , Schizophrenia/rehabilitation , Schizophrenic Psychology , Adolescent , Adult , Combined Modality Therapy , Family/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Rehabilitation, Vocational , Treatment Outcome
16.
J Exp Zool ; 274(3): 157-62, 1996 Feb 15.
Article in English | MEDLINE | ID: mdl-8882493

ABSTRACT

Plasma 3,5,3'-triiodothyronine (T3) concentration decreased significantly (P < 0.05), during 1-5 days of captivity, from levels in the freshly caught dogfish shark Squalus acanthias. The short-term effects of T3 treatment on the intermediary metabolism of S. acanthias were measured in the gill, kidney, liver, and white muscle. Animals were kept for 1-5 days before experimentation. Three hours after an intraperitoneal injection with either a low T3 dose (8.3 pmol T3/kg fish) or a high T3 dose (830 pmol T3/kg fish), selected enzymes of amino acid metabolism, lipid catabolism, ketone body metabolism, glycolysis, and oxidative metabolism were measured. Activity of enzymes of amino acid metabolism and lipid catabolism increased significantly (P < 0.05) in the liver of fish treated with a low T3 dose. The low dose of T3 apparently influences glycolysis as pyruvate kinase activity significantly increase (P < 0.05) in the kidney and white muscle.


Subject(s)
Dogfish/metabolism , Triiodothyronine/pharmacology , Animals , Enzyme Activation/drug effects
17.
J Biol Chem ; 270(43): 25733-8, 1995 Oct 27.
Article in English | MEDLINE | ID: mdl-7592754

ABSTRACT

The single type 1 copper protein pseudoazurin from Achromobacter cycloclastes gives reversible electrochemical behavior at a (4-pyridyl)disulfide-modified gold electrode. Measurements carried out at 25.0 degrees C indicate a midpoint reduction potential of E 1/2 = 260 mV versus normal hydrogen electrode at pH 7.0 and a peak-to-peak separation of delta Ep = 59 mV. The diffusion coefficient and heterogeneous electron transfer rate constant are estimated to be 2.23 x 10(-6) cm2 s-1 and 3.7 x 10(-2) cm s-1, respectively. Also, controlled potential electrolysis indicates a 1-electron transfer process and a formal reduction potential of 259 mV versus normal hydrogen electrode for the Cu(II)/Cu(I) couple. The heterogeneous electron transfer rate constant determined at the (4-pyridyl)disulfide-modified gold electrode at pH 4.6 is 6.7 x 10(-3) cm s-1, consistent with a slower process at the positively charged electrode surface. At pH 11.3, UV-visible, EPR, and resonance Raman spectra indicate a conversion of the distorted tetrahedral copper geometry to a trigonal structure. The trigonal form has elongated axial bonding and an axial EPR spectrum. At pH 11.3, the reduction potential is further decreased, and Cu-S bands in resonance Raman spectra at 330-460 cm-1 are shifted to higher energy (approximately 10 cm-1), consistent with a stronger Cu-S bond.


Subject(s)
Alcaligenes/chemistry , Azurin/analogs & derivatives , Copper , Metalloproteins/chemistry , Azurin/chemistry , Binding Sites , Electron Spin Resonance Spectroscopy , Electron Transport , Models, Molecular , Oxidation-Reduction , Potentiometry , Spectrophotometry , Spectrum Analysis, Raman
18.
Arch Gen Psychiatry ; 52(8): 679-87, 1995 Aug.
Article in English | MEDLINE | ID: mdl-7632121

ABSTRACT

OBJECTIVE: To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment. METHOD: A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in the state of New York. Psychotic relapse, symptom status, medication compliance, rehospitalization, and employment were assessed independently during 2 years of supervised treatment. RESULTS: The multiple-family groups yielded significantly lower 2-year cumulative relapse rates than did the single-family modality (16% vs 27%) and achieved markedly lower rates in patients whose conditions had not remitted at index hospital discharge (13% vs 33%). The relapse hazard ratio between treatments was 1:3. The relapse rate for both modalities was less than half the expected rate (65% to 80% for 2 years) for patients receiving individual treatment and medication. Rehospitalization rates and psychotic symptoms decreased significantly, and medication compliance was high, to an equal degree in both modalities. CONCLUSION: Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission, especially in patients at higher risk for relapse, with a cost-benefit ratio of up to 1:34.


Subject(s)
Family Therapy/methods , Schizophrenia/therapy , Adolescent , Adult , Caregivers/education , Employment , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Compliance , Patient Readmission , Recurrence , Schizophrenia/prevention & control , Schizophrenia/rehabilitation , Schizophrenic Psychology , Social Support , Treatment Outcome
19.
Fam Process ; 34(2): 127-44, 1995 Jun.
Article in English | MEDLINE | ID: mdl-7589414

ABSTRACT

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of this modality. The advent of family psychoeducational and behavioral management strategies provided the basis for an experimental, three-way comparison of psychoeducational MFGs to psychoeducation in a single-family format and to MFGs without psychoeducation, using symptomatic relapse as the outcome criterion. After 4 years, the psychoeducational MFGs were significantly more effective in extending remission than the single-family format, while the MFGs without psychoeducation approximated outcome in the psychoeducational MFGs. The respective relapse rates at 4 years were 50%, 78%, and 57%; MFGs averaged 12.5% and 14% per year. These results point toward an enhanced and independent, long-term therapeutic effect for multiple family groups, when combined with antipsychotic medication and psychoeducation, with especially promising cost-effectiveness.


Subject(s)
Family Therapy/methods , Psychotherapy, Group/methods , Schizophrenia/rehabilitation , Schizophrenic Psychology , Adult , Behavior Therapy/methods , Caregivers/psychology , Cost-Benefit Analysis , Family/psychology , Family Therapy/economics , Female , Follow-Up Studies , Humans , Male , Patient Readmission/economics , Psychotherapy, Group/economics , Recurrence , Schizophrenia/economics , Social Support , Treatment Outcome
20.
New Dir Ment Health Serv ; (62): 13-22, 1994.
Article in English | MEDLINE | ID: mdl-7935283

ABSTRACT

Recent studies suggest that the multiple-family group is a preferable vehicle for assisting families and treating and rehabilitating persons with schizophrenia within a psychoeducational clinical framework. This approach is probably the most cost-effective treatment for schizophrenia developed since antipsychotic medication.


Subject(s)
Caregivers/education , Family Therapy/methods , Psychotherapy, Group/methods , Schizophrenia/rehabilitation , Schizophrenic Psychology , Caregivers/psychology , Hostility , Humans , Social Isolation , Treatment Outcome
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