RESUMEN
Reliability of well-known instruments was examined in 202 people with severe mental illness participating in a multisite vocational study. We examined interrater reliability of the Positive and Negative Syndrome Scale (PANSS) and the internal consistency and test-retest reliability of the PANSS, the Rosenberg Self-Esteem Scale, the Medical Outcomes Study Short Form-36 (SF-36), and the Quality of Life Interview. Most scales had good levels of reliability, with intraclass correlation coefficients (ICCs) and coefficient alphas above .70. However, the SF-36 scales were generally less stable over time, particularly Social Functioning (ICC = .55). Test-retest reliability was lower among less educated respondents and among ethnic minorities. We recommend close monitoring of psychometric issues in future multisite studies.
Asunto(s)
Conducta Cooperativa , Empleos Subvencionados , Trastornos Mentales/diagnóstico , Trastornos Mentales/rehabilitación , Adulto , Femenino , Humanos , Masculino , Calidad de Vida , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The objective of this study was to investigate providers' knowledge, attitudes and service provision patterns for Bosnian refugees with PTSD and to consider the overall implications for trauma-related mental health services. A survey instrument was developed and administered to 30 randomly selected service providers working with Bosnian refugees in Chicago. This sample includes primary medical care providers (n = 7), community social service providers (n = 12), and mental health service providers (n = 11). Results showed that knowledge about PTSD is highest in mental health service providers, as is amount of previous training and education about PTSD. Less than half of all providers systematically assess for PTSD, and standardized instruments for PTSD are rarely used. The top three overall recommendations for services were ranked as: 1. Psychotherapy; 2. No intervention; 3. Psychiatric evaluation. In general, less than half of providers hold attitudes toward refugees as suffering from illnesses or mental disorders, or that "something" is wrong with them. Likewise, only half of the providers reported providing education to refugees and their families about the possible mental health consequences of trauma. In conclusion, assessment, intervention and educational activities of providers are not consistent with literature documenting that PTSD is highly prevalent in refugee populations. New training programs, model development, and research initiatives are needed to address the needs of refugees.
Asunto(s)
Actitud del Personal de Salud/etnología , Competencia Profesional/estadística & datos numéricos , Relaciones Profesional-Paciente , Refugiados/psicología , Trastornos por Estrés Postraumático/terapia , Análisis de Varianza , Bosnia y Herzegovina/etnología , Distribución de Chi-Cuadrado , Chicago , Servicios Comunitarios de Salud Mental , Femenino , Humanos , Entrevistas como Asunto , Masculino , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Servicio Social , Recursos HumanosRESUMEN
The objective of this study was to profile trauma related psychiatric symptoms in a group of refugees not seeking mental health services and to consider the services implications. The study involved research assessments of two groups of Bosnian refugees: those who have not presented for mental health services and those who have. A total of 28 of 41 nonpresenters (70%) met symptom criteria for posttraumatic stress disorder (PTSD) diagnosis. All service presenters (N = 29) met symptom criteria for PTSD diagnosis. The group that did not present for services reported substantial but lower trauma exposure, PTSD symptom severity, and depression symptom severity. They had significant differences on all subscales of the MOS SF-36, indicating better health status. We concluded that those who do not seek services have substantial symptom levels, but their self-concept appears to be less oriented toward illness and help seeking. Innovative access, engagement, and preventive interventions are needed to address those who have symptoms but do not readily seek help for trauma mental health services.
Asunto(s)
Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud , Refugiados/psicología , Trastornos por Estrés Postraumático/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Bosnia y Herzegovina , Chicago/epidemiología , Femenino , Estado de Salud , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Política , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/epidemiología , ViolenciaRESUMEN
This article presents research-based principles of vocational rehabilitation that have emerged from the study of diagnostically heterogeneous populations of persons with severe mental illness. Employment and vocational functioning outcomes of people with schizophrenia from recently published followup studies are described. In addition, we present research conducted over the past decade concerning differential outcomes of vocational rehabilitation services for people with schizophrenia versus other psychotic and nonpsychotic disorders. We then explore studies of people with schizophrenia that may illuminate the links between specific features of this disorder--including symptomatology, social skills, and neuropsychological impairments--and poorer vocational outcome. We conclude with a set of recommendations for clinical practice that draw upon the most recent discoveries and insights in this field.
Asunto(s)
Rehabilitación Vocacional , Esquizofrenia/rehabilitación , Empleo , Estudios de Seguimiento , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Because an increasing number of chronically mentally ill individuals are HIV-positive, continuing education must include AIDS content to ensure psychiatric nurses provide competent care. The Fundamentals of Mental Health and HIV/AIDS Program was tested to determine its effectiveness in augmenting the AIDS knowledge of mental health professionals. METHOD: Two hundred forty RNs attended the Fundamental of Mental Health and HIV/AIDS Program. They completed pretest and posttest measures. RESULTS: The program significantly increased AIDS knowledge. The increase in AIDS knowledge was more dramatic for psychiatric nurses than for non-psychiatric nurses. CONCLUSION: This study reinforces the need for AIDS continuing education.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/enfermería , Educación Continua en Enfermería , Enfermería Psiquiátrica/educación , Evaluación Educacional , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estados UnidosRESUMEN
Tarsal tunnel intracompartment pressures were determined in 10 fresh-frozen normal human adult cadaver specimens. With the foot and ankle held in mild plantarflexion and neutral eversion-inversion, mean tarsal tunnel pressure was minimal (2 +/- 1 mmHg). However, when the foot and ankle were positioned in full eversion, mean tarsal tunnel pressure increased to 32 +/- 5 mmHg (P < or = 0.005); in full inversion, mean pressure increased to 17 +/- 5 mmHg (P < or = 0.05). There was no significant difference in mean tarsal tunnel pressure between the everted and inverted positions. These results support the hypothesis that increased pressure within the tarsal tunnel when the foot is moved into the everted or inverted position may aggravate posterior tibial nerve entrapment. These findings may also provide an explanation for clinically observed aggravation of symptoms in these positions, night pain, and improvement of symptoms with neutral immobilization in some patients with tarsal tunnel syndrome.
Asunto(s)
Tobillo/fisiología , Pie/fisiología , Síndrome del Túnel Tarsiano/fisiopatología , Adulto , Fenómenos Biomecánicos , Cadáver , Humanos , Modelos Biológicos , Presión , Síndrome del Túnel Tarsiano/terapiaRESUMEN
Preliminary evidence suggests that mental health consumers can successfully serve as peer companions, case management aides, case managers, job coaches, and drop-in center staff. However, few empirical investigations have addressed the use of consumers to train mental health professionals. This project employed a randomized design to test the effects of using consumers as trainers for mental health service providers. Fifty-seven state mental health professionals participated in a two-day training designed to acquaint trainees with the attitudes and knowledge necessary for delivering assertive case management services. Participants were randomly assigned to one of two conditions: one in which they received the second day of training from a consumer and the other involving training by a nonconsumer. Analyses revealed that post-training attitudes were significantly more positive for those participants trained by the consumer. Subjective evaluations also reflected positive reactions to the use of consumers as trainers. Implications for further use of mental health consumers as trainers are explored.
Asunto(s)
Servicios Comunitarios de Salud Mental , Participación de la Comunidad , Capacitación en Servicio , Trastornos Mentales/rehabilitación , Adulto , Actitud del Personal de Salud , Curriculum , Femenino , Humanos , Masculino , Programas Controlados de Atención en Salud , Trastornos Mentales/psicología , Persona de Mediana EdadRESUMEN
OBJECTIVE: The purpose of the study was to determine whether use of inpatient services at a state hospital was reduced by implementation of an assertive community treatment program among persons in one of the hospital's catchment areas who were at high risk for rehospitalization. METHODS: Bed-day utilization by program participants during the fiscal year before the program was implemented (1986) and three subsequent fiscal years was compared with utilization by persons in catchment areas not served by the program. For the 66 program participants, hospital use during the year before program intake was compared with use in the year after intake using t tests. RESULTS: Utilization of bed-days by persons in the program's catchment area was reduced by 28 percent in the third fiscal year after program implementation, compared with an increase of 15 percent among persons in the hospital's other catchment areas. In the year after the program was implemented, participants were hospitalized a mean of 27.7 days, compared with a mean of 80 days in the year before the program. CONCLUSIONS: The assertive community treatment program significantly reduced use of inpatient days and improved continuity of care.