Racial and Ethnic Differences in Diabetes Mellitus among People with and without Psychiatric Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Objective: This study examined racial/ethnic differences in the prevalence of diabetes mellitus in a nationally representative sample of adults with and without common psychiatric disorders. Method: Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N= 34,653). Logistic regression models adjusting for sociodemographic variables and diabetes risk factors were used to examine racial/ethnic differences in 12-month prevalence rates of diabetes by psychiatric status. Results: Among people without psychiatric disorders, African Americans, Hispanics, and American Indians/Alaska Natives, but not Asians/Pacific Islanders, had significantly higher rates of diabetes than non-Hispanic whites even after adjusting for socio-demographic variables and diabetes risk factors. In the presence of psychiatric disorders, these health disparities persisted for African Americans and Hispanics, but not for American Indians/Alaska Natives. No significant interactions between race/ethnicity and psychiatric disorders in the odds of diabetes were found across any group. Conclusion: Policies and services that support culturally appropriate prevention and treatment strategies are needed to reduce racial/ethnic disparities in diabetes among people with and without psychiatric disabilities

Institutional abuse and societal silence : an emerging global problem

No abstract available.http://anp.sagepub.com/2015-01-31hb201

The role of clinical experience, diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders : a vignette and survey investigation

Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients’ vignettes influenced clinicians’ preference for phase-oriented treatment and whether clinicians’ treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients’ deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.http://www.tandfonline.com/loi/wjtd202018-09-27Psychiatr

Involving underrepresented groups: How unpaid carers influenced our data analysis

Objectives The recent census found that five million people in England and Wales provide unpaid care. With social services struggling, unpaid carers face increasing pressure. The North West London Networked Data Lab aimed to understand unpaid carers’ needs, health issues, and care pathways through public involvement and analysis of linked datasets. Methods We used the Discover dataset containing primary, secondary, mental health, and social care data of 2.5 million North West Londoners to explore our aims. To ensure the questions asked of the data mattered locally, we interviewed five unpaid carers to understand the issues they faced. One carer worked more closely with the data analyst to define the questions. The interim results were presented to a diverse group of unpaid carers to see whether anything resonated with them, surprised them, or required further research. The group also helped develop an engaging and accessible infographic to communicate our findings. Results The unpaid carer cohort in our dataset were, on average, older females from deprived areas, highlighting gender and socioeconomic inequities in caring responsibilities. Unpaid carers had a higher prevalence of long-term conditions before they were identified as a carer (e.g. hypertension, depression, anxiety and diabetes) and were more likely to use healthcare services than non-carers. Through speaking to unpaid carers, we learned that many hadn’t identified as a carer or mentioned it to their GP for many years. In fact, they had only had their carer status recorded after visiting their GP for an issue linked to their caring responsibilities. Our public involvement helped to highlight a major limitation of the data, particularly as men are less likely to interact with their GPs. Conclusion Our analysis found unpaid carers were more likely to have certain conditions and more likely to have multiple long-term conditions. Public involvement was critical in making sense of these findings and identifying policy and practice recommendations. Giving people a meaningful voice in population data research can also build public trust

Evolutive Unification in Composite Active Galactic Nuclei

In this paper we explore an evolutionary Unified scenario involving super massive black hole and starburst with outflow, that seems capable of explaining most of the observational properties of at least part of AGNs. Our suggestion is explored inside the expectations of the Starburst model close associated with the AGN where the NLR, BLR and BAL region are produced in part by the outflow process with shells and in compact supernova remnants. The outflow process in BAL QSOs with extreme IR and Fe II emission is studied. In addition, the Fe II poblem regarding the BLR of AGN is analysed. Neither the correlations between the BAL, IR emission, FeII intensity and the intrinsic properties of the AGN are clearly understood. We suggest here that the behaviour of the BAL, IR and FeII emission in AGNs can be understood inside an evolutionary and composite model for AGNs. In our model, strong BAL systems and Fe II emission are present (and intense) in young IR objects. Orientation/ obscuration effects take the role of a second parameter providing the segregation between Sy1/Sy2 and BLRG/NLRG.Comment: 14 pages, 6 figures (submitted MNRAS

The Main Belt Comets and ice in the Solar System

We review the evidence for buried ice in the asteroid belt; specifically the questions around the so-called Main Belt Comets (MBCs). We summarise the evidence for water throughout the Solar System, and describe the various methods for detecting it, including remote sensing from ultraviolet to radio wavelengths. We review progress in the first decade of study of MBCs, including observations, modelling of ice survival, and discussion on their origins. We then look at which methods will likely be most effective for further progress, including the key challenge of direct detection of (escaping) water in these bodies

Collaborative planning approach to inform the implementation of a healthcare manager intervention for hispanics with serious mental illness: a study protocol

Background: This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD). Methods: The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention. Discussion: The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients