Rationale, component description and pilot evaluation of a physical health promotion measure for people with mental disorders across Europe

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact

Verbal-Performance Activities for Optimizing Foreign Language Education

The modern world, characterized by dynamic changes, rapid development of ICT and globalization processes sets new challenges to present-day education. This research aims at investigating the influence of applying verbal-performance activities in foreign language education. A pedagogical experiment was conducted in authentic environment with the participation of 99 pupils aged 10 to 11 who formed an experimental and a control group. The study combined qualitative and quantitative approach. It measured pupils’ entry and exit levels of practical English knowledge and communicative skills and also traced the effect of the experimental education on the pupils from the experimental group. The interpretative analyses of the results revealed that applying verbal-performance activities in foreign language education led to higher achievements in terms of knowledge and communicative competence for the pupils from the experimental group compared to the progress of the children from the control group. A measurement of the attitude of the pupils from the experimental group towards applying verbal-performance activities in the educational process proved the potential of the method to increase children’s motivation for learning. The findings of this research confirm the need of further studies on the influence of applying verbal-performance activities in a broader context of school education

Verbal-Performance Activities for Optimizing Foreign Language Education

The modern world, characterized by dynamic changes, rapid development of ICT and globalization processes sets new challenges to present-day education. This research aims at investigating the influence of applying verbal-performance activities in foreign language education. A pedagogical experiment was conducted in authentic environment with the participation of 99 pupils aged 10 to 11 who formed an experimental and a control group. The study combined qualitative and quantitative approach. It measured pupils’ entry and exit levels of practical English knowledge and communicative skills and also traced the effect of the experimental education on the pupils from the experimental group. The interpretative analyses of the results revealed that applying verbal-performance activities in foreign language education led to higher achievements in terms of knowledge and communicative competence for the pupils from the experimental group compared to the progress of the children from the control group. A measurement of the attitude of the pupils from the experimental group towards applying verbal-performance activities in the educational process proved the potential of the method to increase children’s motivation for learning. The findings of this research confirm the need of further studies on the influence of applying verbal-performance activities in a broader context of school education

PRO/ANTIOXIDANT STATUS OF BLOOD IN PATIENTS WITH ACUTE INTRACEREBRAL HEMORRHAGE - POSSIBLE CORRELATION WITH THE NEUROLOGICAL DEFICIT AND CLINICAL OUTCOME // Про/антиоксидантен статус на кръвта на болни с остър паренхимен мозъчен кръвоизлив - възможна връзка с неврологичния дефицит и клиничен изход

Spontaneous intracerebral hemorrhage (sICH) accounts for only 15-20 of all strokes, but is the cause of severe disability and is associated with the highest mortality rate. Growing evidence suggests that inflammatory and oxidative mechanisms play a crucial role in the complex pathogenesis of sICH. The identification of oxidative stress markers improving outcome prediction and offering new therapeutic approaches in sICH is a real challenge in the modern neurology. The aim of the present study was to examine blood pro/antioxidant changes following acute sICH, to evaluate their correlations with the neurological deficit severity and to define significant predictors of the clinical outcome. Case material and methods: For that purpose 171 patients were studied: 101 with sICH, 19 with vascular risk factors and 51 healthy controls. Biochemical parameters, serum level of CRP, some antioxidant components, TAS and markers of oxidative damage were examined. Neurological assessment and measurement of hematoma volume were performed. Data received were managed with SPSS 19.0. Results: Leukocyte count, neutrophils and fibrinogen were found significantly increased in patients with sICH and correlated with the neurological deficit severity and the clinical outcome. Serum CRP level correlated with the neurological state and hematoma volume. Antioxidant parameters, TAS and ROOH were found also correlated with the neurological state and functional outcome. Only serum CRP level and hematoma volume were significant predictors of short term mortality after sICH, while serum ROOH concentration predicted poor outcome after sICH. Patients with serum CRP level 4.5 times greater than the reference range had significantly lower chance to survive the third month after sICH onset regardless of their age and sex. Conclusion: Pro/antioxidant changes in the blood of patients with sICH were found important prognostic markers, reliable indicators of the neurological deficit severity. The examined inflammatory and oxidative stress markers were significantly correlated with the clinical outcome. A different constellation of prognostic factors, associated with short-term and long-term survival of the patients with sICH was found. Oxidative stress markers could be used as additional objective criteria in the complex predictive assessment of sICH thus providing an excellent opportunity for therapeutic interventions while the patient is still in clinic. Contributions: This is the first complex study in Bulgaria simultaneously assessing the prognostic value of clinical, neuroimaging and pro/antioxidant parameters for the neurological deficit severity and the clinical outcome of patients with sICH. Based on this research’s results a routine measurement of serum hs-CRP is recommended to be included in the mandatory laboratory battery approved by the national guidelines for the diagnosis and treatment of patients with sICH.Паренхимният мозъчен кръвоизлив (ПМК) представлява 15-20 от всички инсулти и предизвиква най-висока степен на инвалидизация и смъртност. Нарастващ брой експериментални и клинични доказателства утвърждават критичната роля на възпалителни и оксидативни механизми в сложната патогенеза на ПМК. Изследването на маркери за оксидативен стрес в острата фаза на ПМК предоставя нови възможности за обективизиране степента на постхеморагичното увреждане и оптимизиране на комплексната прогностична оценка на заболяването. Цел: Цел на настоящето проучване е да се изследват про/антиоксидантните промени на кръвта след оПМК, да се определи връзката им с тежестта на неврологичния дефицит и да се оцени прогностичната им стойност за крайния изход от заболяването. Клиничен контингент и методи: При 171 пациенти: 101 с оПМК, 19 със съдови рискови фактори и 51 здрави контроли са определяни биохимични показатели на кръвта, серумни нива на CRP, компоненти от антиоксидантната защита и показатели за оксидативно увреждане. При пациентите с ПМК е оценен неврологичния статус и е извършено обемно измерване на хематома. Получените резултати са обработени със SPSS 19.0. Резултати: Резултатите от проучването показват сигнификантно повишени стойности на периферни левкоцити, гранулоцити и фибриноген, свързани с тежестта на неврологичния дефицит и клиничния изход от ПМК. При пациентите с ПМК се установява по-високо серумно ниво на CRP, което корелира с неврологичния статус и обема на хеморагичната лезия. Настъпват промени в нивата на някои антиоксиданти, TAS и ROOH, които са значимо свързани с тежестта на неврологичния дефицит и функционалния изход от ПМК. Значими предиктори за летален изход през първата седмица на ПМК са повишеното серумно ниво на CRP и обемът на хематома, докато серумната концентрация на ROOH предсказва неблагоприятен функционален изход на преживелите първата седмица на кръвоизлива. Увеличаването на серумното ниво на hs-CRP над 4.5 пъти указва по-ниска преживяемост на пациентите на третия месец от ПМК, независимо от възрастта и пола. Заключение: Про/антиоксидантни промени в кръвта на пациенти с оПМК са важни прогностични маркери, надежден индикатор за тежестта на неврологичния дефицит. Установяват се значими връзки между някои маркери за възпаление и оксидативно увреждане и крайния изход от мозъчния кръвоизлив, които дават нови идеи за подобряване на ранната прогностична оценка на ПМК и терапевтичния подход. Приноси: За първи път у нас е проведено комплексно сравнително проучване на пациенти с оПМК, пациенти с рискови фактори за МСБ и клинично здрави доброволци и е оценена прогностичната стойност на клинични, невроизобразяващи и про/антиоксидантни показатели на кръвта за тежестта на неврологичния дефицит и крайния изход от ПМК. Открива се различна констелация от прогностични фактори за ранна и късна преживяемост на пациентите с оПМК. Предлага се включване определянето на hs-CRP в задължителния набор от изследвания, утвърдени в лечебно-диагностичния алгоритъм на националния консенсус за мозъчно-съдови заболявания

Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys

BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.This work was supported by the National Institute of Mental Health (Grant Nos. R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (Grant Nos. R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (Grant No. FIRCA R03-TW006481).The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation Thematic Project Grant No. 03/00204-3. The European Study of the Epidemiology of Mental Disorders (ESEMeD) project is funded by the European Commission (Contracts QLG5-1999-01042, Health and Consumer Affairs (SANCO) 2004123, and Executive Agency for Health and Consumers (EACH) 20081308); the Piedmont Region, Italy; Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (Grant No. Fund for Health of Spain (FIS) 00/0028); Ministerio de Ciencia y Tecnología, Spain (Grant No. SAF 2000-158-CE); Departament de Salut, Generalitat de Catalunya, Spain; Instituto de Salud Carlos III (Grant Nos. Networked Biomedical Research Centres (CIBER) CB06/02/0046 and Cooperative Health Research Thematic Networks (RETICS) RD06/0011 REM-TAP).The World Mental Health Japan Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (Grant Nos. H13-SHOGAI-023, H14-TOKUBETSU-026, and H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare.The Mexican National Comorbidity Survey is supported by The National Institute of Psychiatry Ramon de la Fuente (Grant No. INPRFMDIES 4280) and by the National Council on Science and Technology (Grant No. CONACyT-G30544-H).The U.S. National Comorbidity Survey Replication is supported by the National Institute of Mental Health (Grant No. U01-MH60220) with supplemental support the Robert Wood Johnson Foundation (Grant No. 044708)

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

Background: People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion: A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities