Peer Academic Supports for Success (PASS) for College Students with Mental Illness: Open Trial.

Increasing numbers of college students have serious mental health conditions, but their dropout rates are high and debt accrual is common. A well-specified intervention that colleges can directly offer their undergraduates with serious mental health conditions that sustains their academic persistence is greatly needed. The Peer Academic Supports for Success (PASS) coaching model was developed to address this need. This study's goal was to conduct an open trial of the initial PASS model to test the feasibility of the model and research methods in preparation for more rigorous testing. Ten college juniors and seniors, with and without lived mental health experience, were hired, trained, and supervised to be PASS peer coaches. Twelve undergraduate students with academically impairing mental health conditions served as study participants and received PASS. Student data were collected at baseline and two semesters post baseline. Intervention feasibility data were assessed through coach report. Results indicate PASS can be delivered with fidelity by peer coaches, can attract and retain students, and is safe. Results also suggest that PASS has significant effects on most of the targeted proximal outcomes. The PASS findings are promising as a college-based intervention to support young adult students with mental health conditions.

The recovery education center: an integrated health promotion and wellness program.

TOPIC: This brief report describes a recovery education program that is designed to develop health as a foundation for recovery from psychiatric illnesses. PURPOSE: Using readiness to change theory, health promotion, and psychiatric rehabilitation processes that are bundled in an adult education model of service, participants learn the knowledge, skills, and supports they want and need to increase their domains of wellness that will support their recovery. SOURCES USED: Author's relevant knowledge and citations of health and behavioral health evidence. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Health promotion that is delivered in a healthy environment enhances people's quality of life, promotes readiness for role change and in the end, works to ensure that people with mental illnesses have a right to optimal health. To support rehabilitation and recovery, practitioners are encouraged to review this program model and select elements described to replicate in various mental health settings.

Results of an innovative university-based recovery education program for adults with psychiatric disabilities.

This study examined the effectiveness of an educational approach to psychiatric rehabilitation called the Recovery Center. Using a quasi-experimental design we recruited 97 intervention and 81 comparison participants and examined the intervention's impact on health, mental health, subjective, and role functioning outcomes. Results suggested that this intervention was effective in improving subjective outcomes, especially empowerment and recovery attitudes, both of which received primary emphasis in the intervention. The Recovery Center, which integrates a bio-psychosocial framework with psycho-educational interventions shows promise as a complement to traditional mental health services in developing readiness for rehabilitation and promoting recovery among individuals with severe psychiatric disabilities.

[Alveolar ridge augmentation with hip corticocancellous allogenic block graft prior to implant placement].

The use of autogenous block bone grafts in bone regeneration procedures for alveolar ridge augmentation can be limited by donor-site morbidity and complications. In this study, allogeneic block grafts were used for ridge augmentation prior to implant placement. Thirty six patients with severe ridge width and height deficiency underwent augmentation using an allogeneic corticocancellous iliac block bone graft. After rigid fixation of the graft, the site was covered with a freeze dried allogeneic dura mater membrane or restorable collagen membrane and then tension-free closure was performed. Implants were placed three to four months after surgery. Three to six months after implant placement, panoramic radiographs were taken and implants were uncovered for prosthetic restoration. Out of the 70 implants placed, one implant failed to integrate. Out of the 49 grafts placed one graft showed three millimeters of bone resorbtion at the superior buccal aspect of the graft. No other clinical problems were observed. The block grafts were clinically well integrated into the recipient site. The augmented bone remained stable throughout implant placement procedures. Clinical outcome evidence demonstrates that allogeneic block bone grafts in conjunction with G.B.R principles might be a viable alternative to autogenous grafts in selected patients with alveolar ridge deficiencies.

A framework for health promotion services for people with psychiatric disabilities.

The concepts of wellness and its complement, health promotion, have popularized the notion that health itself is more than simply the absence of disease. Furthermore, the wellness concept has advanced the idea of the importance of engaging in certain health promoting behaviors within healthy environments, not simply for the purpose of preventing or better managing a disease, but also to enhance one's well-being and quality of life (Green & Kreuter, 1991; Mullen, 1986). Encouraging this emphasis on wellness is Healthy People 2010 (U.S. Department of Health and Human Services, 2000), a national ten-year plan intended to increase quality and years of life and eliminate disparities which for the now features a new area that recognizes the importance of health promotion and disease prevention in the lives of people with disabilities. Increasingly, the value of promoting wellness--including for people with disabilities--is being recognized (Rimmer & Braddock, 2002).

The personal and vocational impact of training and employing people with psychiatric disabilities as providers.

OBJECTIVE: This study examined the feasibility of a structured peer provider training program and its effect on peer providers with respect to their own personal and vocational recovery. METHODS: Sixty-six individuals participated in an evaluation of a 60-hour, 5-week long peer training program. Participants were assessed prior to and after the training on scales to measure recovery, empowerment and self-concept. Analyses of variance were used to examine subjective changes in these measures. Job acquisition and retention data were also examined at posttest. RESULTS: Participants experienced gains in perceived empowerment, attitudes toward recovery and self-concept. Trainees went on to obtain peer provider positions within the mental health agency in which they received the training and 89% of those trained retained employment at 12 months. Twenty-nine percent of the initial jobs into which the peer providers were placed were full-time; 52% were part-time and 19% were hourly. CONCLUSIONS: Findings suggest that a standardized program designed to provide peer training was used successfully and participants' recovery and employability were improved. Further studies are recommended to rigorously test peer providers' impact on their clients and to examine the advantages that accrue to the agency when mental health recipients are employed as peer providers.

The role of a fitness intervention on people with serious psychiatric disabilities.

The purpose of this study was to determine the effects a health education and exercise program would have in limiting weight gain and in improving fitness and psychological parameters in adults with mood or psychotic disorders. Thirty volunteers were randomly assigned to the healthy lifestyle group (HL) or a control group. The HL group engaged in exercise for 12 weeks. Pre- and post-exercise testing was conducted to assess body fat, lipid profile, and cardiovascular fitness. Educational seminars were held weekly. The intervention group evidenced greater weight loss than the control group, although not statistically significant. Significant differences were observed in ratings of general health (p < .05) and empowerment (p < .01). Trends suggest that exercise interventions may encourage weight loss, particularly if barriers to full participation can be addressed. Additionally, such interventions may contribute to "perceived" well-being even among those with subclinical participation.

Integrating physical activity into mental health services for persons with serious mental illness.

This article reviews evidence supporting the need for interventions to promote physical activity among persons with serious mental illness. Principles of designing effective physical activity interventions are discussed along with ways to adapt such interventions for this population. Individuals with serious mental illness are at high risk of chronic diseases associated with sedentary behavior, including diabetes and cardiovascular disease. The effects of lifestyle modification on chronic disease outcomes are large and consistent across multiple studies. Evidence for the psychological benefits for clinical populations comes from two meta-analyses of outcomes of depressed patients that showed that effects of exercise were similar to those of psychotherapeutic interventions. Exercise can also alleviate secondary symptoms such as low self-esteem and social withdrawal. Although structured group programs can be effective for persons with serious mental illness, especially walking programs, lifestyle changes that focus on accumulation of moderate-intensity activity throughout the day may be most appropriate. Research suggests that exercise is well accepted by people with serious mental illness and is often considered one of the most valued components of treatment. Adherence to physical activity interventions appears comparable to that in the general population. Mental health service providers can provide effective, evidence-based physical activity interventions for individuals with serious mental illness.

[Intraoral autogenous onlay block bone grafting for implant dentistry].

The use of autogenous bone graft with endosseous implant for the reconstruction of alveolar ridge deficiencies has been reported with increasing frequency in the past two decades. These bone grafts were harvested mainly from extra oral sites. Various donor sites have been described in the literature including the calvarium, tibia and iliac crest, the latter being most common. Due to the need for hospitalization, general anesthesia and the great morbidity of surgery associated with these donor sites, alternative intra oral sources for graft harvest have been suggested. The most common sites for, being the mandibular symphysis and the mandibular ramus. For the repair of localized alveolar bone defects these donor sites are advantageous. In addition to the ease of donor site access and minimal morbidity, membranous bone grafts show less resorption, good incorporation and shorter healing times. The use of these bone grafts allow us to correct the alveolar ridge height, width and trajectory prior to implant placement thus not only enable a better surgical success, but also should enhance a better prosthetic results as well.

Pretreatment prevalence of hypothyroidism in patients with head and neck carcinoma.

BACKGROUND: Hypothyroidism in the normal population age > 60 years is encountered in the range of 0.5-5% clinically, and 5-20% have subclinical hypofunction. Hypothyroidism is recognized as a common complication of treatment in patients with head and neck carcinoma (HNC) and is reported in up to 75% of patients who receive combined treatment. Surprisingly, base-line pretreatment measurements of thyroid function in large series of patients have not been reported. METHODS: Serum thyroid-stimulating hormone, free T4, and total T3 levels were recorded in 110 patients with nonthyroid HNC prior to treatment in a prospective, controlled study. RESULTS: The mean patient age (+/- standard deviation) was 65 years +/- 13.8 years, and 82% of patients had squamous cell carcinoma. A diagnosis of hypothyroidism already was established in 4.5% of patients, and subclinical hypothyroidism was discovered in an additional 6.4% of patients. Sixteen patients had other equivocal anomalies in thyroid function and were referred for further endocrine evaluation. No patients with formerly unrecognized clinical hypothyroidism were found. CONCLUSIONS: Hypothyroidism in patients with head and neck carcinoma in Israel corresponds with the reported incidence in the general population. Hypothyroidism after treatment for head and neck carcinoma stems from the effects of treatment. The need for pretreatment evaluation of thyroid function should be considered.

Salivary flow dynamics after parotid surgery: a preliminary report.

BACKGROUND: Tumors in the parotid gland may affect salivary flow. The effects of tumor on glandular function and postoperative changes in both resected gland and contralateral gland were not formerly reported. We prospectively evaluated salivary flow rates and composition in patients undergoing parotidectomy preoperatively and postoperatively. METHOD: Stimulated parotid saliva from 17 patients undergoing parotidectomy was collected bilaterally preoperatively and postoperatively by using a parotid cup. Subjective complaints were recorded. Salivary flow rates, sodium, potassium, and amylase levels were evaluated. RESULTS: None of the patients complained of "dry mouth" before or after surgery. Analysis of the individual results revealed 3 patterns of preoperative and postoperative response, compatible with either a preoperative or postoperative compensatory mechanism in the contralateral gland. The postoperative decrease in flow rate corresponds with the amount of gland removed. Salivary electrolyte composition was unchanged. CONCLUSION: This study is the first to demonstrate the effects of parotid tumors and their surgery on salivary flow and a compensatory response and its different patterns in human parotid glands after their excision.

Immunohistochemical evaluation of estrogen and progesterone receptors in adenoid cystic carcinoma of salivary gland origin.

Adenoid cystic carcinoma (ACC) is a malignant tumor of salivary gland origin, which is characterized by a high rate of local recurrence and distant metastasis even after aggressive surgical treatment. In several studies using various immunohistochemical techniques, estrogen and progesterone receptor (ER and PgR) proteins in salivary gland ACC have been identified and the possible use of endocrine therapy as a treatment modality suggested. On this basis, 27 samples of formalin-fixed paraffin-embedded salivary gland ACC were immunohistochemically evaluated for the presence of ER and PgR. ER was not detected in any of the tumors and PgR was identified in only two cases. Thus, application of hormone therapy to salivary gland ACC is not supported by the results of the present study.

Brown tumour of hyperparathyroidism in the mandible associated with atypical parathyroid adenoma.

The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 x 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.

Salivary flow and its relation with oral symptoms in terminally ill patients.

BACKGROUND: Patients with terminal malignant disease commonly report hyposalivation or xerostomia. This leads to "dry mouth," fungal infection, and mucosal abnormalities. To the authors' knowledge oral symptomatology and findings have not been correlated previously with accurate salivary flow measurements. METHODS: Measurement of stimulated parotid salivary flow rate and clinical recording of oral symptoms within 24 hours from the time of hospital admission were obtained in 48 terminally ill cancer patients. Subjective reporting of symptoms by patients, parotid salivary flow rate, clinical recording of dental status, presence of candidiasis, angular cheilitis, and dryness of the floor of the mouth were obtained. RESULTS: A clinical diagnosis of oral candidiasis was made tentatively in 94% of patients, and 50% of the patients were found to have angular cheilitis. Thirty-one of 45 evaluable patients (68%) reported a sensation of oral dryness. Sixteen of the 48 patients (33%) had no saliva at the floor of the mouth. Analysis of individual salivary flow rates was stratified into 3 levels of secretion: 0, < 0.2, and > or= 0.2 mL/minute. Symptoms were found to correlate with salivary flow rates. CONCLUSIONS: In the current study, symptoms were found to be most severe in the patients with xerostomia followed by those patients with hyposalivation. Treatment should be directed individually to each group of patients using either salivary substitutes or stimulants. The rate of incidence of oral pathologic findings may be higher than formerly recognized.

The prediction of recommended energy expenditure for an 8 h work-day using an air-purifying respirator.

Thirty railway workers executed maximal, or near maximal, stress tests with and without the use of a half mask air-purifying respirator (Spasciani 85 A1 P1) fitted with two combined filters for simultaneous protection from organic vapours and particulate matter. The pressure-flow characteristics of inspiratory and expiratory resistance at airflows in the range 0-90 l.min-1 were established by a continuous flow method on one test mask. Significant differences were found by paired t-test between the two exercises (with and without use of mask), showing reduced values with use of the mask, for breath frequency, ventilation rate, oxygen uptake, carbon dioxide production, maximal oxygen uptake, percentage of maximal voluntary ventilation used at the maximal exercise ventilation. No significant differences were found for tidal volume, respiratory quotient, heart rate, systolic blood pressure, oxygen uptake at anaerobic threshold, and duration of exercise. The predicted energy expenditure recommended for an 8 h work shift, corresponding to 40% of maximal oxygen uptake, is found to be reduced working with respirator and is significantly different from that observed during stress test without mask. The average ventilation rate at this workload is below 25 l.min-1, with predicted inspiratory mouth pressure equal to, or less than, 20 mm H2O. This maximal inspiratory mouth pressure is proposed as a safety limit for prolonged work using a respirator, with a recommended energy expenditure close to 40% of maximal oxygen uptake.