Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2013-2017.

Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in human suffering and dollar cost expense. International research through 2012 documented the frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five year period of 2013-2017. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s, even with new policy initiatives in place meant to reduce such violence. Nursing personnel continued to be at greater risk. The findings by continents and an updated methodological inquiry are presented.

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2013-2017.

Since the 1960s, empirical research has worked toward a better understanding of the characteristics of assaultive psychiatric patients. International research through 2012 indicated that male and female patients with schizophrenia and other diagnoses presented the greatest risk for assault. This present review of studies that presented raw assault sought to assess the latest research findings on assaultive patients for the most recent 5 year period, 2013-2017. It was hypothesized that male patients with schizophrenia would present the greatest risk. The findings indicated a sharp increase in the total number of reported assault incidents over the proceeding decade. These assaults were committed largely by male patients with a diagnosis of schizophrenia. Explanations for these findings and an updated methodological inquiry are presented.

Income and Subjective Well-Being: New Insights from Relatively Healthy American Women, Ages 49-79.

The interests of economists, psychologists, social scientists and others on the relations of income, demographics, religion and subjective well-being, have generated a vast global literature. It is apparent that biomedical research has focused on white with men. The Women's Health Initiative and Observational Study (WHI OS) was initiated in 1992. The OS represents the scientific need for social priorities to improve the health and welfare of women; it includes 93.676 relatively healthy postmenopausal women, 49 to 79, from diverse backgrounds. The objective of this study is to examine how lifestyle and other factors influence women's health. Data from the WHI OS questionnaire were analyzed. Statistical methods included descriptive statistics square, correlations, linear regression and analyses of covariance (GLM). New findings and insights relate primarily to general health, religion, club attendance, and likelihood of depression. The most important predictor of excellent or very good health is quality of life and general health is a major predictor of quality of life. A great deal of strength and comfort from religion was reported by 62.98% of the women, with little variation by denomination. More from religion related to poorer health, and less likelihood of depression. Religion and lower income are in accord with of across country studies. Attendance at clubs was associated with religion and with all factors associated with religion, except income. Though general health and likelihood of depression are highly correlated, better health is associated with higher income; however, likelihood of depression is not associated with income--contrary to conventional wisdom about socioeconomic disparities and mental health. Subjective well-being variables, with the exception of quality of life, were not associated with income. Social networks--religion and clubs--among a diverse population, warrant further attention from economists, psychologists, sociologists, and others.

Characteristics of international staff victims of psychiatric patient assaults: review of published findings, 2000-2012.

Psychiatric patient assaults on staff are a worldwide occupational hazard that results in human suffering and dollar cost expense. International research in the 1990s documented the frequent occurrence of these assaults. This present paper reviewed the published, international literature on staff victim assaults during the first decade of the new century. The findings indicate assaults on staff remain a serious worldwide issue as it was in the 1990s, even with new policy initiatives in place meant to reduce such violence. The findings by continents and a detailed methodological inquiry are presented.

Height, socioeconomic and subjective well-being factors among U.S. women, ages 49-79.

BACKGROUND: A vast literature has associated height with numerous factors, including biological, psychological, socioeconomic, anthropologic, genetic, environmental, and ecologic, among others. The aim of this study is to examine, among U.S. women, height factors focusing on health, income, education, occupation, social activities, religiosity and subjective well-being. METHODS/FINDINGS: Data are from the Women's Health Initiative (WHI) Observational Study. Participants are 93,676 relatively healthy women ages 49-79; 83% of whom are White, 17% Non-White. Statistical analyses included descriptive statistics, chi-square and multivariable covariance analyses. The mean height of the total sample is 63.67 inches. White women are significantly taller than Non-White women, mean heights 63.68 vs. 63.63 inches (p= 0.0333). Among both Non-White and White women height is associated with social behavior, i.e. attendance at clubs/lodges/groups. Women who reported attendance 'once a week or more often' were taller than those who reported 'none' and 'once to 3 times a month'. Means in inches are respectively for: White women-63.73 vs. 63.67 and 63.73 vs. 63.67, p = 0.0027. p = 0.0298; Non-White women: 63.77 vs. 63.61 and 63.77 vs. 63.60, p = 0.0050, P = 0.0094. In both White and Non-White women, income, education and subjective well-being were not associated with height. However, other factors differed by race/ethnicity. Taller White women hold or have held managerial/professional jobs-yes vs. no-63.70 vs. 63.66 inches; P = 0.036; and given 'a little' strength and comfort from religion' compared to 'none' and 'a great deal', 63.73 vs. 63.66 P = 0.0418 and 63.73 vs. 63.67, P = 0.0130. Taller Non-White women had better health-excellent or very good vs. good, fair or poor-63.70 vs. 63.59, P = 0.0116. CONCLUSIONS: Further research in diverse populations is suggested by the new findings: being taller is associated with social activities -frequent attendance clubs/lodges/groups", and with 'a little' vs. 'none' or 'great deal' of strength and comfort from religion.

Characteristics of international assaultive psychiatric patients: review of published findings, 2000-2012.

In international reviews of psychiatric inpatient violence, one study of all types of patient violence found hostility, involuntary admission, and longer hospital stays associated with violence. A second study of comparison-group papers of patient assaults found younger males with schizophrenia, past violence, and substance abuse assaultive. The present review of raw assault data studies assessed characteristics of assaultive patients worldwide. It was hypothesized that patients with schizophrenia would present greatest assault risk. There were three analyses: International/no American studies (reviewed earlier), European studies, and merged International/American studies. Results revealed that male and female patients with schizophrenia, affective disorders, personality disorders, and other diagnoses presented greatest worldwide risk. Results partially support earlier findings. Given that individual institutional studies in this review reported significant assailant characteristics, a second finding is the absence of most of these institutional characteristics in this international review. Possible explanations for findings and a detailed methodological review are presented.

Characteristics of American assaultive psychiatric patients: review of published findings, 2000-2012.

Previous reviews of the literature from 1976 to 2000 documented two categories of assaultive psychiatric patients: (1) male patients with schizophrenic illness and histories of violence toward others and substance use disorder and (2) male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use. The present study reviewed the published findings on American assaultive patients from 2000 to 2012. The present findings partially supported the earlier findings in that patients with schizophrenic illness continued to present the greatest risk for assault. However, personality disordered patients were not equal in assault risk to patients with affective disorders. Possible explanations for these findings and a detailed methodological review are presented.

Predictors of custody and visitation decisions by a family court clinic.

Children's psychological adjustment following parental separation or divorce is a function of the characteristics of the custodial parent, as well as the degree of postdivorce parental cooperation. Over time, custody has shifted from fathers to mothers and currently to joint arrangements. In this retrospective chart review of family court clinic records we examined predictors of custody and visitation. Our work improves on previous studies by assessing a greater number of predictor variables. The results suggest that parental emotional instability, antisocial behavior, and low income all decrease chances of gaining custody. The findings also show that income predicts whether a father is recommended for visitation rights and access to his child or children. Furthermore, joint custody is not being awarded as a function of parental postdivorce cooperation. At issue is whether parental emotional stability, antisocial behavior, and income are appropriate markers for parenting capacity and whether visitation rights and joint custody are being decided in a way that serves the child's best interests.

Health disparities paradoxes: depression and chronic back pain in college alumnae and U.S. women, 39-49.

AIMS: In the US, higher SES (socio-economic status) groups and white Americans tend to be "healthier" than less advantaged groups. Elimination of disparities is a major public health goal. This study examines disparities for two highly prevalent medical conditions--depression and chronic back pain--and selected medical conditions and behavioral practices. The aim is to provide evidence that may have public health implications for prevention as well as for treatment. METHODS: Data from two groups of women: 1) 1704 college-educated women who responded to a self-report questionnaire; and 2) women whose data are reported in the U.S. Health Interview survey and in epidemiologic studies of depression and chronic back pain were compared for depression, chronic back pain and selected behavioral practices and medical conditions reported by the two groups of women. RESULTS: The percentages reporting depression were 17.6 and 16.6; for chronic back pain 9.6 and 10.2--non statistically-significant differences. For other conditions, the higher SES women had significantly more favorable outcomes. CONCLUSIONS: The paradox of no SES disparities for depression and low back pain raises a number of questions regarding the underlying mechanisms; and also has implications for prevention and treatment strategies of the two highly prevalent conditions.

Changing trends in inpatient care for psychiatrically hospitalized youth: 1991-2008.

Research has focused on changes in the psychiatric treatment of youth in outpatient settings, but less is known about trends in inpatient care. This study documents changes in the lengths of stay (LOS), clinical profiles of youth, and medication use within an inpatient setting in Massachusetts between 1991 and 2008. A chart review of 233 medical records of psychiatrically hospitalized youth was conducted at three points in time (1991, 1998, and 2008). Sample includes youth between ages 4 and 18. Clinical data, including LOS, diagnoses and other clinical variables, and number and type of medications prescribed were compared across sample years. Findings indicate a significant decrease in the LOS coupled with a concurrent increase in psychotropic medication use between each successive sample year. The prescription of anti-psychotic medications, in particular, increased significantly. On clinical indices, findings show that there was an increase in the diagnosis of bipolar spectrum disorders and a concurrent decrease in unipolar diagnoses in the 2008 sample. Attention-deficit and developmental disorders showed little change. Trauma-related disorders were significantly less frequently diagnosed in 2008. Children hospitalized in 1998 and 2008 had more prior hospitalizations and presented with greater acuity than those in the 1991 sample. Results highlight important changes that have occurred in child/adolescent inpatient settings over the past two decades. Data suggest that these changes have not resulted in decreased rates of inpatient hospitalization for youth with more severe psychiatric disorders.

Intrapartum temperature elevation, epidural use, and adverse outcome in term infants.

OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores <7, and early-onset seizures. In regression analyses, infants born to women with fever >101°F had a two- to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied.

Depression and percent body fat in American women, ages 39-49.

I investigated the association between depression and percent body fat, two major global problems. Participants are 1,704 American women, ages 39-49, who responded to a detailed self-administered mailed questionnaire. My results showed a positive correlation; the adjusted OR = 1.70, 95% CI (1.20, 2.39), p = .002. Percent body fat was estimated from age, height, and weight, a cost-free method that may be useful in areas in which dual energy X-ray absorptiometry, or other procedures are too costly or unavailable. My findings may aid health and mental health care providers in the management and treatment of patients seen in settings with limited resources.

The utilization of home care by the elderly in Brazil's primary health care system.

OBJECTIVES: We assessed the utilization of home care by the elderly in Brazil after implementation of the Family Health Strategy (FHS). METHODS: Data were derived from a cross-sectional study in a southern city in Brazil. Using the χ(2) test and a logistic regression with different levels of determination, we tested the hypothesis that the FHS increased the utilization of home care compared with utilization under the Traditional Primary Health Care (TPHC) system. RESULTS: We interviewed 1593 residents aged 60 years and older. Home care utilization under the FHS was 2.7 times the rate of utilization under the TPHC (95% confidence interval = 1.5, 4.7; P = .001), and utilization increased among the older group, the less educated, those with history of hospitalization, and those with functional limitations. CONCLUSIONS: Improvement in access to care resulted in greater utilization of home care. Our findings have policy implications that include expanding the coverage of the FHS throughout big cities where coverage is limited. These findings are important because the population is aging and the family strategy operates in poorer areas; thus, it can promote equity in access to home health care among the elderly.

Risk factors of alcohol problem drinking among female bar/hotel workers in Moshi, Tanzania: a multi-level analysis.

There is limited information on alcohol problem drinking, which has been associated with sexually transmitted infections (STIs), including HIV, among female bar/hotel workers in Africa. This paper aimed to identify the individual- and facility-level determinants of alcohol problem drinking in this setting. Problem drinking was defined based on the CAGE alcohol screening scale. Multi-level logistic regression was used to identify individual- and facility-level factors associated with problem drinking. About 37.3% of women (N = 1629) were classified as having probable or definite problem drinking. In multi-level analysis, main characteristics associated with problem drinking included: having 3-4 partners in the past 5 years compared to having 1-2, used a condom in the last sex comparing to non-use, history of transactional sex, having more pregnancies, and facilities whose employees do not live on the premises. Interventions which combine alcohol and sexual risk reduction counseling are urgently needed in this population.

Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe.

Little is known about the psychosocial impact of antiretroviral therapy (ART) among women in sub-Saharan Africa. Therefore, we conducted a cross-sectional study in Zimbabwe to assess the impact of ART on HIV-positive women's health-related quality of life, using the Medical Outcomes Study-HIV Quality of Life (QOL) questionnaire. Additionally, we assessed socio-demographics, reproductive and sexual health, HIV-related history, disclosure, social stigma, self-esteem, and depression. Structured interviews were conducted with 200 HIV-positive women and categorized into three groups by treatment: (1) Group 1 (n=31) did not meet clinical or laboratory criteria to begin treatment; (2) Group 2 (n=73) was eligible to begin treatment but awaiting initiation of treatment; and (3) Group 3 (n=96) was on ART for a median of 13 months. The women had similar socio-demographic characteristics but varied significantly in clinical characteristics. Women on ART reported fewer AIDS-related symptoms in the last week and year and had higher current and lower baseline CD4 counts compared to women not on ART. On most QOL domains women on ART reported higher mean scores as compared to women not on ART (p<0.01). Additionally, women on ART reported less depression compared to women not on ART (p<0.001). Between the two groups of women not on ART, unexpectedly, there were no significant differences in their scores for QOL or depression. Thus, Zimbabwean women living with HIV experience better overall QOL and lower depression on ART. Altogether, our findings suggest that ART delivery in resource-poor communities can enhance overall QOL as well as psychosocial functioning, which has wide-ranging public health implications.

Yoga ameliorates performance anxiety and mood disturbance in young professional musicians.

Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians.

Weight change, obesity, mental health, and health perception: self-reports of college-educated women.

BACKGROUND: Overweight, weight cycling, and obesity are major health risks with psychological effects that should not be overlooked by mental health professionals. METHOD: This article examines behavioral and other factors associated with weight, weight changes, and obesity in 3940 college-educated women, using data from responses to self-administered mailed questionnaires received from fall 1996 to winter 1997. RESULTS: The mean age of the women was 53.6 years, SD = 12.2. Body mass indexes, prevalence of obesity, and behavioral practices were more favorable than those of women in the general U.S. population. The mean body mass index of the sample was 23.3; median, 22.5; 6.5% were obese, 5% currently smoked, and 68% exercised regularly. Over the past 10 years, 31% maintained the same weight, 11% lost weight, 48% gained weight, and 10% gained and lost weight. Women who both gained and lost weight were more likely to report physician-diagnosed depression, alcoholism, and/or drug dependencies compared to women in the other 3 categories; the multivariable odds ratios are 1.48 (95% CI = 1.07, 2.05) versus those who maintained their weight, 1.38 (95% CI = 1.06, 1.80) versus those who gained weight, and 1.53 (95% CI = 1.06, 2.21) versus those who lost weight. Those who both lost and gained weight were also more likely to report having to forgo mental health care for financial reasons; the respective multivariable odds ratios versus those who maintained their weight, gained weight, and lost weight are 2.01 (95% CI = 1.28, 3.16), 2.21 (95% CI = 1.52, 3.22), and 2.19 (95% CI = 1.23, 3.89). CONCLUSION: These findings affirm the view that mental health care deserves attention in the treatment of patients with problems with weight changes and weight control.

Prevalence of primary infertility in China: in-depth analysis of infertility differentials in three minority province/autonomous regions.

Following the 1994 UN International Conference on Population and Development, there was a shift in emphasis on women's reproductive health and there emerged a need for more knowledge about levels and differentials of infertility. Using the data from the 1988 National Two-Per-Thousand Sample Survey on Fertility and Contraception, this paper estimated the prevalence of primary infertility in China. To determine the predictors of primary infertility, multiple logistic regression analyses were done on three minority province/autonomous regions where primary infertility was the highest. A non-contracepting, sexually active woman was considered to have primary infertility if she had not reported a recognized pregnancy after at least seven years of marriage. The analysis shows that the national level of primary infertility was relatively low (1.3%). Primary infertility was higher in Qinghai (2.3%), Tibet (3.7%) and Xinjiang (3.7%) compared with other provinces. Tibetans in Qinghai and Uygurs in Xinjiang had a higher level of primary infertility than the Han Chinese. Ethnic differences remained after adjusting for other background characteristics. Divorced and remarried women had significantly higher odds of primary infertility compared with first-married women in Qinghai and Xinjiang. The elevated level of primary infertility in Qinghai, Tibet and Xinjiang and its disproportionate prevalence among Tibetans and Uygurs highlight the need for further work to understand the causes and social consequences of infertility for the minority population in China.

The confluence of violence towards an intimate partner, substance misuse and mental health: a worldwide problem affecting women.

Violence towards an intimate partner, substance misuse and other mental health disorders are problems that tend to cluster together and result in multiple burdens for afflicted individuals (Desjarlais et al, 1995; Wyshak & Modest, 1996; Wyshak, 2000). They are prevalent not only in high-risk groups but also among members of the general public seeking primary healthcare (Bauer et al, 2000; World Health Organization, 2001), where their afflictions often go undiagnosed and untreated (Edlund et al, 2004; Kramer et al, 2004). Furthermore, violence towards an intimate partner, substance misuse and other mental health disorders involve common symptom pathways, such as psychiatric distress, headache, abdominal pain, gastrointestinal problems and multiple somatic complaints (Berwick et al, 1991), which suggests that the use of an integrated set of screening instruments may lead to early detection and treatment for patients who are suffering from one or more of these problems.

Tubal ligation and the risk of vertebral fractures.

Osteoporosis is a major public problem. More than 35 million Americans are at risk of developing osteoporosis. Nearly half of all women will have an osteoporotic fracture in their lifetime. Tubal ligation (tubal sterilization) is used more than any other single method of contraception in the USA and worldwide. In 1995, 34.6% (approximately 7 million) of ever-married US women between ages 35-44 years had undergone tubal ligation. Tubal sterilization may disturb ovarian function and be associated with more menstrual and menopausal symptoms and, thus, may be a risk factor for osteoporosis. The objective of this paper is to examine the possible association between tubal sterilization and osteoporotic fractures. Data are from a questionnaire mailed to a previously identified cohort of college/university alumnae who had graduated between 1926 and 1981. This study was performed during 1996 and 1997, 15 years after the initial study. The subjects were 3,940 women participants in the follow-up study. Their mean age was 53.7 years at time of reporting, ranging from 37 to over 80 years. Excluding deaths and non-deliverables the response rate was 85%. Of the 3,940 subjects, 491 (12.5%), and, of the ever-pregnant women, 15.5%, had undergone tubal sterilization (TS); 899 (22.8%) reported at least one fracture after age 20, and 70 (1.8%) at least one vertebral fracture after age 20, which had been confirmed by X-ray. TS was strongly associated with self-reports of vertebral fractures that had been confirmed by X-ray. The multivariable adjusted odds ratios and 95% confidence intervals for women 50 years and over and for women 55 years and over were, respectively, 2.7 (1.4, 5.0) and 3.3 (1.5, 7.0). Having had any fracture was not significantly associated with TS: odds ratio (OR) = 1.1 for women 50 years and older and OR = 1.3 for those 55 years and older. This epidemiological study in a cohort of highly educated, mostly Caucasian women shows an association between past tubal sterilization and self-reported X-ray-confirmed vertebral fractures. These results need to be confirmed in other cohorts--the pathophysiology of this association is worthy of further study.