A programme theory for liaison mental health services in England

Background: Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. Method: We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems. Results: We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred. Conclusions: Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control

Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90)

<p>Abstract</p> <p>Background</p> <p>Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions.</p> <p>Methods</p> <p>Using the Self-Report Symptom Inventory (SCL-90), we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females) aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence.</p> <p>Results</p> <p>A total of 150 (14.2%) patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4%) had somatisation symptoms, 205 (19.4%) interpersonal sensitivity and psychotic symptoms, 235 (22.3%) panic symptomatology, 208 (19.7%) violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology.</p> <p>Conclusions</p> <p>This study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.</p

Orientação sobre o uso de vitamina A na saúde escolar: comparação de técnicas pedagógicas Orientation on the use of vitamin A in school health: comparision of pedagogical techniques

O trabalho tem por objetivo comparar a eficácia de técnicas de ensino em motivar a criança em assimilar a importância dos alimentos ricos em vitamina A, e as conseqüências da falta desses nutrientes para o organismo. Foi elaborado material didático com 2 técnicas pedagógicas: uma baseada em um texto de conotação literária e outra, em teatro de fantoches. O estudo foi desenvolvido com alunos da 3ª série do ciclo básico da Escola Municipal Orlando Paulino da Costa, na zona rural de Alfenas, através da aplicação de questionários. Os resultados demonstraram que as técnicas pedagógicas empregadas promoveram aprendizagem de conceitos em relação à vitamina A e incentivo para o consumo de alimentos ricos nesses nutrientes. Não se verificaram diferenças significativas entre as técnicas pedagógicas (Teste de Comparação das Proporções, com p<0,05), uma vez que ambas utilizam os mesmos princípios metodológicos. Concluímos que a aplicação de métodos lúdicos é um incentivador para a reeducação alimentar. Propõe-se, então, o uso desses recursos nas escolas para a aprendizagem de conteúdos de saúde e alimentação.<br>Compare the efficiency teaching techniques with respect to their ability to motivate children in the assimilation of the importance of foods rich in vitamin A and the consequences of the absence of these nutrients for the organism. A didactic material comprising two pedagogical techniques was drawn up: one was based on a text with literary connotation and the other with theater marionettes. The study was developed by third grade students in an elementary school - Escola Municipal Orlando Paulino da Costa (local governement school) - located in the rural area of Alfenas, Minas Gerais, by applying questionnaires. Results demonstrated that the pedagogical techniques used provided learning of concepts related to vitamin A and that they incentivated the consumption of food products containing this vitamin. No significant differences were detected between the pedagogical techniques (Proportion Comparison Test, with p< 0.05), since they both make the use of the same methodological principles. We conclude that the application of playing methods was a stimulus to nourishing education. Thus, we propose to use these resources in schools so that children can learn health and nourishment issues

Rasputin Functions as a Positive Regulator of Orb in Drosophila Oogenesis

The determination of cell fate and the establishment of polarity axes during Drosophila oogenesis depend upon pathways that localize mRNAs within the egg chamber and control their on-site translation. One factor that plays a central role in regulating on-site translation of mRNAs is Orb. Orb is a founding member of the conserved CPEB family of RNA-binding proteins. These proteins bind to target sequences in 3′ UTRs and regulate mRNA translation by modulating poly(A) tail length. In addition to controlling the translation of axis-determining mRNAs like grk, fs(1)K10, and osk, Orb protein autoregulates its own synthesis by binding to orb mRNA and activating its translation. We have previously shown that Rasputin (Rin), the Drosophila homologue of Ras-GAP SH3 Binding Protein (G3BP), associates with Orb in a messenger ribonucleoprotein (mRNP) complex. Rin is an evolutionarily conserved RNA-binding protein believed to function as a link between Ras signaling and RNA metabolism. Here we show that Orb and Rin form a complex in the female germline. Characterization of a new rin allele shows that rin is essential for oogenesis. Co-localization studies suggest that Orb and Rin form a complex in the oocyte at different stages of oogenesis. This is supported by genetic and biochemical analyses showing that rin functions as a positive regulator in the orb autoregulatory pathway by increasing Orb protein expression. Tandem Mass Spectrometry analysis shows that several canonical stress granule proteins are associated with the Orb-Rin complex suggesting that a conserved mRNP complex regulates localized translation during oogenesis in Drosophila