Engineering n-p junction for photo-electrochemical hydrogen production.

The generation of hydrogen from water and sunlight offers a promising approach for producing scalable and sustainable carbon free fuels. One of the challenges of solar-to-fuel technology is the design of efficient, long-lasting and low-cost photocathodes, which are responsible for absorbing sunlight and driving catalytic hydrogen evolution. We report on the protection of a Cu/Cu2O/CuO photoelectrode against photocorrosion by a 200-300 nm-thick BaTiO3 perovskite layer, deposited using the sol-gel method. This photoelectrode mediates H2 production with a current density of ∼3.1 mA cm-2 at 0 V versus RHE under 3 Sun irradiation and in a pH = 6 aqueous electrolyte. While the unprotected Cu/Cu2O/CuO photoelectrodes show a rapid decay of activity, the BaTiO3-protected photoelectrodes exhibit ∼10% current decay over 20 min.

Unmet needs in the community: can existing services meet them?

OBJECTIVE: This prospective study of community cases examined: (a) needs for care; (b) whether services meet the needs; and (c) personal factors associated with unmet needs. METHOD: Two separate 'Needs for Care Assessment Schedule Community version' evaluations identified 38 subjects with No Need (NN), 19 with Met Needs (MN) and 25 with Unmet Needs (UNM). Other instruments included the Diagnostic Interview Schedule-Abridged Version (DISSA) and repeated measures of symptoms and social functioning. RESULTS: (a) Cases did not equate needs. (b) Services utilization did not equate having met needs. (c) Respondents with UNM were more likely to present high rates of lifetime DSM-II-R disorders, no marital relationship ever, no employment, high rates of life events, and physical or sexual abuse in childhood. They have worse outcome in terms of distress and social functioning. CONCLUSION: Personal factors may prevent respondents from seeking, engaging and benefiting from treatment.

Cognitive and familial contributions to conduct disorder in children.

Although young children with conduct disorder (CD) are suspected of having verbal and executive function deficits, most studies that investigated this hypothesis did not control for attention deficit hyperactivity disorder (ADHD). Furthermore, relatively little is known about the interaction between cognitive deficits and familial factors in explaining the onset and persistence of CD in children. The participants in this study were 57 children with CD and 35 controls aged 7 to 12 years. At 1-year follow-up, 41 of the participants with CD were reassessed. Children with CD were found to be significantly impaired in four of five executive function measures after ADHD symptoms and socioeconomic status (SES) were controlled. Executive function test performance, number of ADHD symptoms, and familial characteristics (SES, parental punishment) together correctly classified 90% of the participants. Only the number of ADHD symptoms was found to significantly improve prediction of CD 1 year later beyond that afforded by number of CD symptoms a year earlier. Findings indicate that children with CD and ADHD symptoms are especially at risk for persistent antisocial behaviour. Results also highlight the importance of treatment programs that cover both cognitive and familial aspects associated with CD.

Neuropsychological characteristics of adolescents with conduct disorder: association with attention-deficit-hyperactivity and aggression.

The purpose of this study was to determine whether an association exists between neuropsychological deficits and conduct disorder (CD) with and without concurrent attention-deficit-hyperactivity disorder (ADHD). In addition, we explored the differential neuropsychological performance of aggressive and nonaggressive CD adolescents and the combined effect of this behavioral status and ADHD on performance. Fifty-nine adolescents (mean age of 15.4 years) who met the criteria for CD were compared with 29 controls comparable in age, gender, and socioeconomic status. A neuropsychological battery of current tests measuring executive functions and a battery of language tests were used in the study. Multivariate analyses showed that, compared with controls, CD adolescents had significantly lower verbal skills but did not differ on executive function measures. However, the lower verbal performance of CD adolescents is not explained by the existence of a CD subgroup with concomitant ADHD or aggressiveness. The study confirms with a sample of CD adolescents the association between verbal deficits and antisocial behavior when socioeconomic status is controlled. Our results also demonstrate that CD per se can be a sufficient condition for such deficits.

Criminal activities and substance use of patients with major affective disorders and schizophrenia: a 2-year follow-up.

BACKGROUND: Compelling findings demonstrate that persons who develop major mental disorders, as compared to those who do not, are at increased risk to commit non-violent and violent crimes. This conclusion has recently been shown to apply to persons with major affective disorders. METHODS: Thirty males with major affective disorders and 74 with schizophrenia were followed for 2 years. At discharge, patients were intensively assessed including diagnoses using SADs and RDC. During follow-up, alcohol and drug use were measured, subjectively and objectively. At discharge, the two groups were similar as to secondary diagnoses of antisocial personality disorder, drug abuse/dependence, socio-demographic characteristics, and criminal history, but more of the patients with major affective disorders than those with schizophrenia had a history of alcohol abuse/dependence. During the follow-up period, the two groups were similar as to rehospitalization, treatment intensity, and substance use. RESULTS: By the end of the follow-up period, 33% of the patients with major affective disorders and only 15% of those with schizophrenia had committed crimes, most violent. Co-morbid antisocial personality disorder was associated with criminality among the patients with schizophrenia but not among those with major affective disorders. Among these latter patients, drug use and the intensity of out-patient care were associated with violent criminality. LIMITATIONS: The small number of subjects limited the conclusions. CONCLUSIONS: Violent behavior among patients with major affective disorders may not be uncommon and may be preventable by out-patient treatment which limits drug use.

Factors related to utilization of services for mental health reasons in Montreal, Canada.

This study examines factors related to the utilization of services for mental health reasons by Montreal residents. Data were drawn from telephone interviews. A random sample of 893 respondents completed a questionnaire on service utilization and the Diagnostic Interview Schedule Self Administered to assess DSM-III-R psychiatric disorders. Results indicate that 12.8% of the population had used such services in the past year. Medical doctors and psychiatrists, whose services are free of charge under universal health coverage, were consulted, respectively, by 4.1% and 2.0% of respondents. Psychologists, whose services are not free, were seen by 3.4% of respondents. In all, 42.0% of respondents who presented a current diagnosis used services in the past year. The highest proportion of users (48.0%) was found among respondents who presented both current and lifetime diagnoses and among respondents with comorbidity. The choice of caregiver was related also to pattern of disorders: respondents with current and comorbid disorders tended to consult general practitioners, while respondents with lifetime disorders or with lifetime and current disorders favoured specialized care. In line with other studies, self-perception of mental health, gender and marital status were related to utilization; unlike other studies, attitudes and age were not. It is argued that particularities found in this study stem not only from methodological considerations, but also from the configuration of the mental health system in Quebec, where the greater availability of psychologists may facilitate service utilization.

Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: a Montreal catchment area study.

BACKGROUND: Large-scale mental health surveys have provided invaluable information regarding the prevalence of specific mental disorders and service use for mental health reasons. Unfortunately, because vast surveys conducted face to face are very costly, many countries and provinces do not embark upon this path of research, thus depriving themselves of a rich source of data useful for service planning. METHOD: As an alternative, the authors undertook a telephone survey with a sample of 893 residents from a Montreal catchment area. Mental disorders were assessed by the Composite International Diagnostic Interview Simplified (CIDIS), an instrument especially designed to be used in mail or telephone surveys. Service utilization was measured by an instrument similar to those used in recent large Canadian or American surveys. RESULTS: The prevalence rate for any mental disorder was lower in this study than in some large-scale epidemiological surveys reviewed. This could be explained by methodological differences, such as number of disorders covered and period of reference. With regard to specific mental disorders, results appeared very similar to those of other studies. Concerning service utilization, rates tended to be higher than in other studies, and this finding could reflect real differences between Quebec and other Canadian provinces or the United States. CONCLUSIONS: Aside from being lower in cost, telephone surveys can yield results comparable to those obtained in large-scale epidemiological surveys conducted by means of face-to-face interviews.

[Post-traumatic epiphysiodesis of the distal end of the tibia in children]. / Epiphysiodèses post-traumatiques de l'extrémité inférieure du tibia de l'enfant.

PURPOSE OF THE STUDY: Thirteen distal traumatic epiphyseal closures of the lower end of the tibia are studied. A bony bridge resection was performed in nine cases. The aim of this study was to define the kind of injury that drives to epiphysiodesis in this localisation, and secondly to define the factors that may influence the results of de-epiphysiodesis. MATERIALS AND METHODS: One hundred and eighty-eight children were hospitalized between 1981 and 1995 for the treatment of a fracture of the lower end of the tibia. Six epiphysiodesis followed a Mac Farland lesion. Six epiphysiodesis followed a Salter and Harris Type-II injury. One epiphysiodesis followed a triplane fracture. The diagnostic of epiphysiodesis was performed at an average of 12 months after injury. The bony bridge interested less than 50 per cent of the growth plate in all cases. There was a varus deformation between 7 degrees and 20 degrees in six cases (average 13.8 per cent). Ten surgical procedures were performed: one fibular bi-focal epiphysiodesis and nine tibial de-epiphysiodesis including a resection of the bony bridge filled with acrylic cement. Two children were not operated because they were close to the end of growth and there was no varus deformation. One child was not reviewed. RESULTS: There was a significant correlation between the children age and the importance of the ankle varus deformation. The younger the children were and the more important the varus deformation was. Only three de-epiphysiodesis had a good clinical and radiological result. In five cases, a second surgical procedure was necessary. Fibular bi-focal epiphysiodesis gave a good clinical result. DISCUSSION: In this location, Harris and Salter type II fractures may have a poor prognosis for growth if the injury occurred with high energy. Varus deformation is a common way to discover epiphysiodesis in this location. There was no correlation between the children age and the result of the de-epiphysiodesis, and between the delay since injury and the de-epiphysiodesis result. There was a correlation between the result and the presence of a varus dexasation in the ankle. The more important the varus was and the poorer the result was. CONCLUSION: Mac Farland lesion and Salter and Harris type II lesion drive to epiphysiodesis more often than any other distal tibial fracture. Varus desaxation is more important in younger children and seems to determine de-epiphysiodesis results. But over all, de-epiphysiodesis has a poor prognosis in more than 60 per cent of cases.

[Osteochondral fractures of the external femoral condyle after traumatic patellar dislocation during physical exercise in children]. / Fractures ostéochondrales du condyle fémoral externe après luxation traumatique de la rotule de l'enfant sportif.

PURPOSE OF THE STUDY: Nineteen osteochondral fractures of the lateral femoral condyle associated with acute traumatic patellar dislocation resulting from sport injury in children were studied. The purpose of this study was to specify clinical and radiological features. MATERIAL AND METHOD: This study was led with special care to injury circumstances, fracture visibility on X-rays, size and location of the fracture, treatment delay, presence of femoro-patellar dysplasia signs. Treatment results were evaluated on knee pain, bone consolidation and recurrent dislocation. RESULT: Thirteen boys and six girls aged 8 to 16 years (average 14 years) were included. The injury resulted from a rotatory-compression stress in 75 per cent cases. The patella was always in place at the time of examination. Thirteen fractures were diagnosed within 24 hours and 5 fractures were diagnosed within 1 week after injury. One fracture was not visible on X-rays and was diagnosed 6 weeks after injury. Only the lateral view showed the fracture in more than one case out of two. Seven patients whose fracture was less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, were treated by knee arthroscopy and removal of the osteochondral fragment. Twelve patients were treated by arthrotomy and excision (one case) or replacement of the osteochondral fragment (11 cases). The replaced fracture was fixed with biological glue ten times, and screwed once. The knee was immobilised in a cylinder cast and weight-bearing prohibited for six weeks. Bone consolidation was obtained in 9 cases out of 11, in an average of 8 weeks. Knee pain occurred 5 times. Recurrence of the dislocation occurred 3 times within 6 months. Eighty per cent of these children showed patello-femoral dysplasia. DISCUSSION: This fracture complicated 31.6 per cent of traumatic patellar dislocation resulting from sport injury in children which we observed during the last ten years. It may be overlooked if it is suspected and carefully looked for by radiographic examination including antero-posterior, lateral, oblique and true skyline views of the patella. The presence of fat in the hemarthrosis may help. Early surgery is recommended. Arthroscopy may be performed to evaluate fracture location and size. After ten days, host area begins to fill in and free fragment will not fit back well. Fragments less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, may be removed. CONCLUSION: Lateral femoral condyle osteochondral fractures are associated with nearly one third of traumatic patellar dislocation resulting from sport injury in children. A detailed radiographic examination can help diagnosis. Treatment depends on the delay after injury, the size and location of the fracture.

Micromotion, fit, and fill of custom made femoral stems designed with an automated process.

This study presents an automated process for the design of custom made femoral stems. Two software programs have been developed to obtain the inner bone contours from computed tomography scan images and to design the optimal stem that can be inserted into the femur. This process requires only 2 hours of computer use, therefore reducing the price of the stem. It is also possible to control the amount of bone sacrifice necessary to facilitate the insertion of the stem. Micromotion for 6 specimens was measured using a special machine simulating the load supported by the hip joint during single-limb stance. Three prostheses were tested successively: anatomic cementless stem, custom made stem, and modified custom made stem in which the distal part was thinned out. To be stabilized, the anatomic prosthesis required a greater number of cycles than custom made stems associated with a more important total vertical migration. The micromotion of custom made prostheses was significantly less than that of the other prostheses. The fill of custom made stems also was measured, having a range from 93% to 100% (mean, 97.5%-98.8%) of the medullary canal. The metaphyseal fill was significantly linked with the vertical and rotational components of instability. These results showed that it was possible, using a computerized automated and controlled process, to obtain low price femoral stems well fitted to the medullary canal that provide an excellent primary stability.

The reliability of the community version of the MRC Needs for Care Assessment.

One hundred and nine adults were screened in the community using the abridged version of the CIDI (CIDIS). The subjects comprised DSM-III-R current cases (N = 48), lifetime cases (N = 31) and non-cases (N = 30). The interviews with the 109 subjects were conducted by one of two pairs of clinicians and videotaped. Each interviewer-pair included a psychiatrist and a clinical psychologist. They rated the community version of the Needs for Care (NFCAS-C) by consensus. The other pair of judges then viewed the video and rated the NFCAS-C independently. The agreement on overall needs was excellent (kappa = 0.75), and very good for four of the seven specific sections (from kappa = 0.61 to 0.81). One section could not be rated because of low prevalence, and agreement was less good for the remaining two sections. Agreement was good on specific interventions (medication, kappa = 0.60; specific psychotherapy, kappa = 0.55), but poor on non-specific interventions. The majority of disagreements were due to differences in clinical judgement rather than to technical errors. A new instruction manual has been produced and should help training as well as stabilizing reliability. In devising reliable and valid instruments based on clinical judgement, a balance must be achieved between enhancing reliability with more precise rules and constraining clinical judgement so tightly that validity is lost.

[Selective indications of skull radiography after head injury in children]. / Indications sélectives de la radiographie du crâne après traumatisme de la voûte chez l'enfant.

PURPOSE OF THE STUDY: Skull X-rays are systematically performed on children after head injuries in most hospitals. However, the discovery of a skull fracture as an isolated finding rarely warrants intervention. In february 1994, we stopped performing systematical skull X-rays in children after head injuries. We report the results of this experience. MATERIALS AND METHODS: Since February 1994, only children with possible skull penetration, depressed fracture, or presenting signs of basilar fracture had X-ray examination. Facial injuries were excluded in this study. In case of focal neurologic signs, neurosurgical consultation, or emergency CT examination, or both were performed. In case of change of consciousness at the time of injury or subsequently, the child was hospitalised for clinical observation for 48 hours, but no X-ray examination was performed. Children without any neurological signs or change of consciousness were discharged to their homes after they were given a head-injury instruction sheet, and if a second person could observe them for signs indicating that they belong to a higher risk group, but no X-ray examination was performed. RESULTS: An average of 241 children per month were presented at the Children Emergency Unit after head trauma. An average of twenty-one X-ray examinations per month were performed instead of 194/month before february 1994. This represented a decrease of 2000 X-ray examinations per year. There was no undiagnosed neurological complication, and the number of children staying in the hospital for clinical supervision did not increase. DISCUSSION: Skull radiographies only show fractures and do not afford visibility of either brain or blood to demonstrate an intracranial injury. The presence of a skull fracture without neurological abnormalities is of little significance. Harwood-Nash reported that 60 per cent of the children with extradural hematoma, 85 per cent of the children with subdural hematoma and 35 per cent of the children with brain damage did not have any associated skull fracture. Clinical examination is essential, and it would be a mistake to be reassured about the severity of a head trauma because skull X-rays are normal. CONCLUSION: Routine skull X-rays after head trauma are not justified either for financial or radioprotection reasons. In this study, more than half of the children were less than five years old and ran a higher risk of irradiation.

[Socioprofessional integration of users of a service teaching work habits]. / L'intégration socioprofessionnelle des usagers d'un service d'apprentissage d'habitudes de travail.

Programs for the social and professional rehabilitation of people suffering from mental illness are more or less successful. A substantial proportion of people cannot with this help, find or maintain a job; moreover many prematurely leave their rehabilitation program. This retrospective study attempts to identify variables associated to 1) the fact of completing the program and related to 2) maintaining a working activity in a regular environment, once the program is completed. The research is conducted with 67 people registered in an apprenticeship of working habilities program. The study shows that the fact of being in a first stage of socioprofessional rehabilitation is associated with participants staying in the program. The time spent in the program and the participants' level of education are also related to the success of integration. Variables regarding diagnosis are not associated to the different trajectories of the people. Suggestions to adjust intervention are proposed in this paper.

Neurological soft signs in schizophrenia: are they related to negative or positive symptoms, neuropsychological performance, and violence?

This investigation was carried out on 31 unemployed schizophrenic outpatient men. The general purpose was to explore new aspects of neurological soft signs in schizophrenia. A 108-item version of the Nathan Kline Institute scale of soft signs, the Schedule for Affective Disorders and Schizophrenia psychiatric interview, the negative and positive symptom scale (PANSS), a comprehensive scale of life-time history of violence, and a large set of neuropsychological tests were administered. It was found that "motor" soft signs were significantly more prevalent than "sensory-perceptual" signs, but that each body side manifested equal numbers of neurological signs. Before and after statistical correction for age, education, alcoholism, drug abuse disorder, and daily and cumulative neuroleptic dosage, orbitofrontal-type neuropsychological tasks measuring "impulsivity" related very robustly to the soft signs. Furthermore, before and after the same statistical corrections, right body-side signs correlated significantly with the same neuropsychological tests, whereas left body-side signs did not. The PANSS scores and levels of lifetime violence generally did not correlate significantly with neurological soft signs. The latter negative findings, we think relate to the fact that these were relatively high-functioning (i.e., outpatient) schizophrenics. Overall, the results support notions of frontal lobe and left hemisphere involvement in schizophrenia, these two dysfunctional systems being apparently linked at the level of the orbitofrontal area of the brain.

[Correlation between symptoms and social adjustment in patients suffering from schizophrenia or major affective disorder]. / Liens entre les symptômes et le fonctionnement social chez des personnes souffrant de schizophrénie ou de trouble affectif majeur.

With a view to examining the appropriateness of relying solely on pharmacotherapy rather than on a program of multimodal therapy, the goal of this study is to test the hypothesis that there is little relationship between psychotic and affective symptoms on the one hand, and life skills and social functioning on the other. Eighty-four male subjects presenting a diagnosis of schizophrenia, mania or severe depression were therefore recruited in hospitals in the Montreal region. The relationships previously identified were studied, while factors likely to affect them, such as the chronicity of the disorder, the level of intellectual functioning, and the presence of additional symptoms, were controlled as necessary. The results suggest poorer social functioning among the schizophrenics having a high level of negative symptoms. In addition, the relationship between negative symptoms and IQ suggests that the intellectual functioning of these individuals can potentially affect the acquisition of skills required for adequate social functioning. Among subjects with a major affective disorder, the results reveal poor social functioning even during quasi-asymptomatic periods. These results suggest that patients suffering from schizophrenia or a major affective disorder require interventions aimed at increasing their level of psychosocial functioning.

Neuropsychological correlates of violence in schizophrenia.

Thirty-one outpatient men with schizophrenia were assessed with various measures of lifelong history of physical violence as well as psychopathology, neuropsychological performance, and neurological intactness. Most of the results consisted of nonsignificant positive relationships between physical aggression and neuropsychological performance in these schizophrenia subjects. Some neuropsychological test performances did show significant positive correlations with levels of aggressivity. In contrast with previous studies that have established a relation between neuropsychological impairment (as opposed to performance) and violence in schizophrenia, subjects of the present study were high-functioning outpatients who may not have attained a level of neurological impairment inducing constant uncontrollable outbursts of irritative aggression in their daily living. The importance of defining in detail the clinical characteristics of the subjects studied and the type of violence assessed is discussed, and an ecological interpretation of these counterintuitive results is provided.

[Recent post-traumatic luxation of the trapeziometacarpal joint. Apropos of 8 cases]. / Luxation trapezo-métacarpienne post-traumatique récente. A propos de 8 cas.

PURPOSE OF THE STUDY: Eight cases of acute traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning without ligamentoplasty are reported in order to evaluate this method. MATERIAL: Eight patients, two women aged 32 to 38 and six men aged 17 to 43, were treated for acute traumatic dislocation of the trapezio-metacarpal joint between 1986 and 1993. The injury happened in a road traffic accident in five cases, during a fight in one case, and in a fall in two cases. The mechanism of injury could be determined only twice as a longitudinal force applied on the first metacarpal bone with the trapeziometacarpal joint in flexion. The dominant hand was injured in five cases. The metacarpal base was always dislocated dorsally. Closed reduction was always easy but remained unstable. On the initial radiographs, one patient had a small fragment avulsed from the volar aspect of the metacarpal base, another had a small osteochondral fragment avulsed from the joint surfaces and two patients presented asymptomatic degenerative changes with osteophytes. METHODS: All patients were treated on the day of injury by reduction and stabilization by one (in four cases) or two (in four cases) percutaneous Kirchner wires followed by a scaphoid-type cast for six weeks. In only one case an arthrotomy was performed to remove a small osteochondral fragment lodged in the joint, and showed a disruption of the dorsal ligament. All patients were followed-up until the tenth postoperative week, and five of them were reviewed for this study between eight and seventy-eight months (mean 27.5 months) after injury. Enquiries were made about return to work, pain, stability, and range of motion, keypinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. RESULTS: One patient with a dislocation of the five carpometacarpal joints had reflex algodystrophy; she was not seen for review. Five patients had a completely satisfactory early result at ten week's follow-up examination that maintained at late review for this study. There were no symptoms, no subluxations on the radiographs, and the patients had returned to work between ten to sixteen weeks (mean 11 weeks) post injury. The two patients with degenerative changes on the initial radiographs had early unsatisfactory results with early dorsal subluxation, loss of strength of 30 per cent, but no limitation of joint motion and pain in one case. DISCUSSION: Acute traumatic dislocation of the trapezio-metacarpal joint is an uncommon injury; it may be associated with a small fragment of bone avulsed from the volar aspect of the metacarpal base or from the articular surfaces. Péquignot and coll. in 1988, and Fontes in 1992 recommended opened reduction and ligamentous reconstruction in acute injuries. Our experience indicates that closed reduction followed by stabilization by percutaneous pinning gives satisfactory results. An arthrotomy may be necessary when an osteochondral fragment avulsed causes incoercibility. CONCLUSION: Closed reduction followed by stabilization by percutaneous pinning gives good results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint. It finds its limits with patients with degenerative changes on the initial radiographs, and in this case ligamentous reconstruction, arthrodesis or arthroplasty might be advocated.

Problems and needs for care of patients suffering from severe mental illness.

Recently, evaluative research has yielded a procedure, the Needs for Care Assessment Schedule (NFCAS), which articulates the problems and the corresponding interventions required by psychiatric patients in a systematic and reproducible manner that is of interest to both administrators and clinicians. Although the NFCAS decisions are ultimately subjective and there is no absolute standard, the procedure limits variation and offers a framework for comparison and further elaboration. A group of 98 patients who were receiving treatment at the Louis-Hippolyte Lafontaine Psychiatric Hospital in Montréal, Québec and who were suffering from severe mental disorders were assessed with the NFCAS procedure. Subjects were selected from four treatment settings representing different levels of problems and needs: long-term in- and outpatients and short-term in- and outpatients. Results of the NFCAS were examined, along with those of standardized questionnaires. The NFCAS allowed a comprehensive understanding of the clinical realities for problem and need assessment. There was an average of 3.9 clinical problems and 4.5 social problems per patient. Long-term patients and patients residing in the hospital had more problems. A total of 76% of the problems assessed were rated as receiving appropriate interventions, whereas 17% of the problems assessed were considered in need of an assessment or in need of treatment. A greater need for intervention was found for social problems than for clinical problems.

Assessment of independent living skills for psychotic patients. Further validity and reliability.

It is well known that psychotic patients have severe social and life-skill deficits. Psychiatric rehabilitation programs are designed to teach these skills to patients. Before implementing such a program, patient deficits should be evaluated with reliable measures. The present study assessed the psychometric properties of the French version of the "Independent Living Skills Survey" (ILSS) developed by Wallace, Kochanowicz and Wallace (Wallace C J, Kochanowicz N, Wallace J [1985] Independent living skills survey. Unpublished manuscript, Mental Health Clinical Research Center for the Study of Schizophrenia, West Los Angeles Veterans Administration Medical Center, Rehabilitation Medicine Service [Brentwood Division], Los Angeles, CA). Although widely used, the patient version of this scale has unknown psychometric properties. The ILSS was composed of 75 items, rated as present or absent and distributed in 10 scales. The French version was administered to 145 patients with a psychotic diagnosis who were living in the community. All scales had very good psychometric qualities with the exception of the job-maintenance scale. The test-retest reliability varied from .48 to .85, and alpha coefficients were good for seven of the nine scales. Various aspects of construct validity were explored. The scales discriminated between patients as a function of their subgroups, sex, and diagnosis. Concurrent validity confirmed the specificity of the ILSS dimensions. Factor analysis revealed two factors, one for basic skills and one representing higher order skills. Recommendations for future development of the ILSS are proposed.

Further reliability and validity studies of a procedure to assess the needs for care of the chronically mentally ill.

The Needs for Care Assessment Schedule (NFCAS; Brewin et al. 1987) is an itemized and systematic procedure that aims to evaluate the needs for care of long-term mentally ill patients. The present study pursues reliability and validity related issues with the NFCAS in a different cultural context applying the procedure to 98 severely mentally ill patients belonging to different patient groups: short-term, long-term, in-patient and out-patient. Inter-rater reliability was found to be excellent. The results suggest that a clinician with little practical experience and adequate training may effectively use the procedure. The assessment of clinical relevance suggested that the procedure is both applicable and pertinent to all the patients in the study. Additional guidelines were developed for its use with long-term in-patients.