Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia.

BACKGROUND: Increasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless. METHODS: In a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument. RESULTS: Although the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets. CONCLUSIONS: Less intrusive questions, more readily understandable vocabulary and greater relevance to subjects' living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward.

Mental health outreach and street policing in the downtown of a large French city.

CONTEXT: Marseille, the second largest city in France, has a large population of homeless persons. A mental health outreach team was created in 2005 as a response to high rates of mental illness among this group. In a national political context where security is a government priority, a new central police station was created in Marseille in 2006 to address robberies, violence and illegal traffic in the downtown area of the city. While not directly related to such crimes, police also are responsible for public safety or behavioral issues related to the presence of individuals who are homeless in this area. OBJECTIVE: This report on a two-year pilot study (2009-2011) addresses collaborative work between a mental health outreach team and the police department responding to the clinical needs of persons who are homeless with serious psychiatric disorders. It also describes the homeless persons' interactions with, and perceptions of the presence of, police and mental health professionals on the streets. METHODS: Investigators adopted a mixed-methods approach. Data were collected on 40 interactions using brief standardized report for each interaction. Focus groups were conducted with police officers, outreach team members, peer workers, and service users. Minutes of partnership meetings between police officers and outreach workers also served as a source of qualitative data. RESULTS: Outreach workers initiated just over half (n=21) of the encounters (n=40) between police and outreach workers. Interactions mainly involved persons with psychosis (77%), the vast majority (80%) of which involved persons in an acute phase of psychosis. Two key themes that emerged from data analysis included the violent nature of life on the streets and the high percentage of ethnic minorities among subjects of the interactions. In addition, it was found that the practices of the outreach workers are sometimes similar to those of the police, especially when outreach workers use coercive methods. "Users" (homeless persons) described police as sometimes using less coercion than the outreach team, and noted that they were more fearful of psychiatrists than police. CONCLUSION: Formal initiatives between mental health outreach teams and police departments involve some common street practices. This study demonstrates the potential for closer working relationships between the two parties to help persons who are homeless with mental illnesses receive needed care, and to reduce inappropriate coercion including involuntary hospitalization and arrests.

[Validation of the French version of the Health of the Nation Outcome Scales (HoNOS-F)]. / Validation de la version française du Health of the Nation Outcome Scales (HoNOS-F).

OBJECTIVE: This study reports the validation of the French version of the Health of the Nation Outcome Scales (HoNOS-F), a questionnaire developed to measure health and social functioning of people with mental illness. METHOD: Once each statement was tested for readability, the scale was administered to 3 samples of people suffering from severe mental disorders to estimate its reliability and validity. More specifically, tests were run to establish the internal consistency, the stability, and the interrater reliability of the HoNOS-F. Confirmative factor analyses and mean differences according to age, sex, and diagnosis were also conducted to evaluate respectively construct- and criterion-related validity. RESULTS: Coefficients obtained from the various tests show that the scale is reliable only when the total score is used. The confirmatory factor analyses indicate that the observed data do not fit the 2 proposed models, a unidimensional model and a 4-dimension model. However, the scale did show criterion-related validity. CONCLUSIONS: Results of the present study converge with those obtained on the original widely used English version. Therefore, we suggest that clinicians use the questionnaire by referring to each item separately and by considering such patient characteristics as age, sex, and diagnosis. We also suggest that researchers wishing to evaluate health and social functioning of persons with serious mental disorders use the total score. Caution is, however, warranted when interpreting the total score for a French-speaking population, because the factorial solution 1-dimension model did not prove to be satisfactory.

[Assessment of quality of life and needs of homeless mentally ill people: perceptions of an outreach team.]. / Évaluation de la qualité de vie et des besoins des personnes itinérantes atteintes de troubles mentaux graves : perceptions d'une équipe itinérance-outreach.

This project established by an outreach team from the CLSC des Faubourgs in autumn 1998, studies how the members of this team perceive the impact of their clinical intervention with homeless people suffering of severe mental illness. A convenience sample (n=52) was selected within the team's clientele. The clientele's needs were evaluated with the Camberwell Assessment of Needs (CAN-F, Phelan et al., 1995). Quality of life was measured twice with the Wisconsin Quality of Life Questionnaire (Becker et al., 1993). The project shows that clinical intervention is associated with an improvement in quality of life of severely mentally ill homeless people and this despite the existence of numerous other needs that are not met. The study suggests the work done by the outreach team touches the clinical aspects and is associated with the improvement of social problems of severely mentally ill homeless people.

Factors associated with burden in primary caregivers of mentally ill patients.

The objectives of this study are to describe caregivers' subjective burden and to identify the predictors of burden in primary caregivers of mentally ill outpatients recruited from eight hospitals in Montreal, Quebec, Canada. Patient and primary caregiver variables, were regressed on perceived burden using hierarchical regression analysis. The variables describing the patient's current state contributed the most to explaining variance in subjective burden. The variables related to psychiatric history and to outpatient treatment also explained a significant proportion of the variance in the burden scores. Better understanding of the factors associated with subjective burden will enable researchers and practitioners to identify those caregivers that are at greater risk for higher levels of burden, and to develop more focused and appropriate interventions.

[Psychosocial determinants of lithium compliance in patients with bipolar disorder]. / Déterminants psychosociaux de l'assiduité au lithium chez des clients présentant un trouble bipolaire.

Physical, cognitive, and social factors play a central role in the lithium compliance of people with bipolar disorder. However, studies provide only a partial understanding of this phenomenon and there is currently no nursing model that takes into consideration a combination of factors. This study, based on Pender's preventive health beliefs model, was intended to identify the psychosocial determinants of lithium compliance. A random sample (n = 149) of outpatients at a large Montreal psychiatric hospital was used to measure lithium compliance on the basis of 5 criteria: compliance according to the nurse and according to the patient, appointment compliance, and compliance according to two criteria related to hyperuricemia. Polytomous logistic regression analyses were computed by regressing a composite of these criteria on sociodemographic variables and on the variables of the Pender model: susceptibility, seriousness, control over health, motivation to be healthy, perceived benefits and obstacles, and triggering factors. It appears that being female, being elderly, living with a partner, and perceived treatment benefits and obstacles are determining factors in lithium compliance. These results are all the more important in light of Quebec's newly implemented drug insurance plan, which could increase the obstacles to medication. Nurses will have to be increasingly vigilant with respect to these new obstacles and will have to adjust their interventions accordingly.

Empirical verification of a theoretical model derived from the Roy adaptation model: findings from five studies.

This article presents a theoretical model derived from the Roy adaptation model and the findings of an empirical verification of this model from five studies. Four groups of subjects were included in the studies: informal caregivers of demented relatives at home, informal caregivers of psychiatrically ill relatives at home, professional caregivers of elderly institutionalized patients, and aged spouses in the community. In at least three studies, a number of theoretical propositions derived from the Roy adaptation model were supported using LISREL VIII, thus adding credence to some tenets of Roy's model. Particularly, the focal stimulus of perceived stress, the contextual stimulus of conflicts in the exchange of social support, and one component of the coping mechanisms (the passive/avoidance coping strategies) were positively linked directly or indirectly with psychological distress, which is an indicator of adaptation in the self-concept mode. Given their importance, these elements should be considered in the development of a middle-range theory of psychological adaptation derived from the Roy adaptation model.

Effects of sino-atrial ischaemia on the heart rate response to phasic burst stimulation of the right cervical vagus in the dog.

The effects of occluding sinus node arteries on the pacemaker responses to graded phasic burst stimulation of the right cervical vagus were studied in anaesthetised dogs. In six dogs (Group I), phase response curves (vagally affected atrial cycle plotted against the phase of the stimulus in the cycle) to 1, 3 and 5 pulse burst stimulations were determined at control and hourly for 3 h after the occlusion. In four dogs, the occlusion produced a slowing of the heart rate, a shift of pacemaker outside sinus node region and a displacement of the phase response curves upward and to the right. Identical stimulation bursts resulted in significantly longer atrial cycles than at control, and bursts introduced with a longer phase remained effective and resulted in significantly longer atrial cycles than the maximum one reached at control. However, when the vagal responses were corrected for occlusion-induced changes in spontaneous PP intervals, the occlusion was found not to significantly affect the vagal responses except to increase their variability. Time-related differences in the effects of the occlusion were not statistically significant. In six control dogs (Group II) submitted to the same protocol, occlusion excepted, the vagal response curves changed very little over the 3 h experiments, thus confirming the stability of the experimental preparation used and of the vagal responses obtained in the absence of ischaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute ischemic sinus node dysfunctions in dogs.

The effects of the occlusion of the two main atrial arteries irrigating the sinus node on sinus rhythm and postpacing sinus recovery were studied in 12 anesthetized dogs. Records of spontaneous rhythm and of postpacing sinus recovery were taken at control and hourly for 6 hours after the occlusion. The spontaneous cycle length (AA interval) was 335 +/- 11 ms at control and 416 +/- 17 ms (mean +/- SE) (p less than 0.005) one hour after the occlusion. It remained nearly unchanged during the following 5 hours of observation. The occlusion also shortened atrioventricular conduction time (AV interval) and reduced P-wave amplitude in ECG lead II in 9 of these dogs. While the control postpacing sinus recovery time was 397 +/- 13 ms, the 1-hour value was 715 +/- 165 ms. This prolongation persisted during the first four postocclusion hours but was less marked during the last two hours of observation. Moreover, the postpacing mode of return of the AA intervals to their prepacing value (sinus recovery pattern) became characteristically slow and progressive after occlusion, complete postpacing recovery often occurring only after 100 or more beats. Sequences of escape atrial and/or AV junctional rhythms were frequently seen during this recovery. Atrial extrasystoles and short sequences of atrial tachycardias were observed in most dogs after occlusion. Conversely, none of these changes occurred during a 6-hour experimental time in 5 control dogs in which the same protocol, occlusion excepted, was repeated. These observations show that the sinus node function in the dog is consistently affected by impairing its blood supply. Ischemic dysfunctions include sinus slowing, pacemaker shift, prolonged sinus recovery time, delayed postpacing recovery and supraventricular tachyarrhythmias.