Education in mental health promotion and its impact on the participants' attitudes and perceived mental health

<p>Abstract</p> <p>Background</p> <p>Although the promotion of mental health (MHP) through education and training is widely accepted, there is scarce evidence for its effectiveness in the literature from outcome studies worldwide. The present study aimed to assess the effect of a three-semester MHP educational program on the recipients' opinions towards mental illness and on their own self-assessed health.</p> <p>Methods</p> <p>Respondents were 78 attendees who completed the assessment battery at the first (baseline) and the last session (end) of the training course. They were primary care physicians or other professionals, or key community agents, working in the greater Athens area. The course consisted of 44 sessions (4 h each), over a 3-semester period, focusing on the principles and methods of mental health promotion, the main aspects of major psychiatric disorders, and on relevant to health skills. Assessment instruments included the Opinion about Mental Illness (OMI) scale and the General Health Questionnaire (GHQ-28).</p> <p>Results</p> <p>The mean scores of three OMI factors, that is, social discrimination, social restriction and social integration, and the two GHQ-28 subscales, that is, anxiety/insomnia and social dysfunction, were significantly improved by the end of the training course.</p> <p>Conclusions</p> <p>The results of this study provide evidence, with limitations, for the short-term effectiveness of the implemented educational MHP program on an adult group of recipients-key agents in their community. Because interventions for strengthening positive opinions about mental illness and enhancing self-assessed health constitute priority aims of mental health promotion, it would be beneficial to further investigate the sustainability of the observed positive changes. In addition it would be useful to examine (a) the possible interplay between the two outcome measures, that is, the effect of opinions of recipients about mental health on their perceived health, and (b) the applicability of this intervention in individuals with different sociodemographic profiles.</p

Securing sustainable funding for viral hepatitis elimination plans

The majority of people infected with chronic hepatitis C virus (HCV) in the European Union (EU) remain undiagnosed and untreated. During recent years, immigration to EU has further increased HCV prevalence. It has been estimated that, out of the 4.2 million adults affected by HCV infection in the 31 EU/ European Economic Area (EEA) countries, as many as 580\xC2\xA0000 are migrants. Additionally, HCV is highly prevalent and under addressed in Eastern Europe. In 2013, the introduction of highly effective treatments for HCV with direct-acting antivirals created an unprecedented opportunity to cure almost all patients, reduce HCV transmission and eliminate the disease. However, in many settings, HCV elimination poses a serious challenge for countries' health spending. On 6 June 2018, the Hepatitis B and C Public Policy Association held the 2nd EU HCV Policy summit. It was emphasized that key stakeholders should work collaboratively since only a few countries in the EU are on track to achieve HCV elimination by 2030. In particular, more effort is needed for universal screening. The micro-elimination approach in specific populations is less complex and less costly than country-wide elimination programmes and is an important first step in many settings. Preliminary data suggest that implementation of the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis can be cost saving. However, innovative financing mechanisms are needed to raise funds upfront for scaling up screening, treatment and harm reduction interventions that can lead to HCV elimination by 2030, the stated goal of the WHO

Extra care burden in comorbid mental-somatic illnesses

Purpose of review Caregivers play a fundamental role in the lives of mental patients with whom they have an interdependent relationship. The current review provides evidence supporting the association between providing care for a mentally ill person and an often unrecognized burden on the life of the caregiver. Recent findings Caregivers often sustain a significant physical, emotional, social, and financial stress related to providing care for a loved one with a mental disease. Caregiver-oriented psychoeducational programs and caregiver participation in mutual support groups are among interventions that could assist in relief from this burden. Summary Further work needs to be done regarding the burden experienced by caregivers who are responsible for mental patients with somatic symptoms. Participation of the caregiver in programs that target this burden should be encouraged. Physicians should take into consideration caregivers’ needs and worries and incorporate them in the healing process

Opioid substitution therapy: lowering the treatment thresholds

Background: Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of “treatment thresholds”, and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes. Method: We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: “opioid substitution”, “OST”, “low threshold”, “high threshold” were searched alone and in combination, up to June, 2015. Results: Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs. Conclusion: Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients

Magnitude and object-specific hazards of aspiration and ingestion injuries among children in Greece.

OBJECTIVE: To assess the public health impact of injuries due to foreign body aspirations and ingestions among children in terms of overall magnitude and estimation of object-specific incidence. METHODOLOGY: Two thousand two hundred and seven injuries due to aspiration and ingestion of foreign bodies were identified among 110 066 records of children (less than 15 years old) collected by the Hellenic Emergency Department Injury Surveillance System (EDISS) during the 5-year study period 1996-2000. Countrywide estimates of overall and object-specific injury incidence rates were computed using appropriate age and place of residence-sampling ratios. Simple cross-tabulations were performed along with a free text description analysis of injury events, whereas a composite score using (1) frequency of injury occurrence, (2) hospitalisation rate and (3) average length of hospitalisation was developed to measure the overall object-specific burden of injuries. RESULTS: Aspirations and ingestions of foreign bodies accounted for 2% of the total burden of accident and emergency department visits, corresponding to an annual incidence of approximately 2.3 accidents per 1000 children. Fish bones and nuts prevailed among the high (44%) proportion of aspirations and ingestions due to edible foreign bodies, while the main inedibles involved were small objects. Toddlers, boys and migrant children were over-represented among children sustaining injuries due to inedibles. As expected, the vast majority of food-related injuries occurred in the kitchen, in most instances under parental supervision. Injuries due to edibles were of minor severity and treatment was provided in the emergency departments, while those due to inedibles were responsible for injuries resulting in higher hospitalisation rates, albeit of relatively short duration. The composite impact score was highest for nuts and other food, nails, pins and sharp instruments. X-rays were performed in nearly all cases; upper gastrointestinal endoscopy was required in about 1 out of 10 instances and laryngoscopy or bronchoscopy in 1 out of 20, whereas the object was spontaneously removed in less than 3% of the cases. CONCLUSIONS: Depending on whether caused by edible or inedible objects, injuries due to foreign body aspirations and ingestions showed distinct epidemiological patterns. Composite scores taking into account measures of injury frequency and severity, seemed to reflect a country-specific spectrum of this type of injuries and provided useful information for the design of targeted public health oriented interventions

Problem gambling and concurrent emotional/behavioral problems among Greek adolescents

Aim: Problem gambling in adolescents constitutes a major health problem. Very few studies have investigated the relationship of adolescent gambling with emotional/behavioral problems. The aim of this study was to examine the association between adolescent problem gambling and emotional/behavioral problems using data from a school survey in the greater Athens area. Material and Methods: The total sample consisted of 2159 high school students (45.4% males and 54.6% females) from a random and representative sample of public and private schools in the greater Athens area. Data were collected in the form of self-reported questionnaires during one school hour. To access problem gambling the Diagnostic and Statistical Manual of Mental Disorders-IV Multiple Response Adapted for Juveniles questionnaire was administered to the study population. The presence of emotional/behavioral problems was assessed via the Strengths and Difficulties Questionnaire. Full data from 2141 participants were analyzed. Eighteen questionnaire with incomplete data were excluded. Results: Problem gambling in adolescence is in line with the presence of emotional/behavioral problems. All Strengths and Difficulties Questionnaire subscales were significantly associated with problem gambling. Specifically, emotional symptoms, conduct problems, attention/hyperactivity, and social dysfunction were all significantly and independently associated with adolescent pathologic gambling. The prosocial scale had lower scores in problem gamblers. Conclusion: This article aims to highlight and discuss the coexistence of adolescent problem gambling with other symptoms. The significant association of emotional/behavioral problems among adolescents with problem gambling indicates a need to screen for these symptoms and for their subsequent treatment among adolescents with problem gambling

Magnitude and object-specific hazards of aspiration and ingestion injuries among children in Greece

Objective: To assess the public health impact of injuries due to foreign body aspirations and ingestions among children in terms of overall magnitude and estimation of object-specific incidence. Methodology: Two thousand two hundred and seven injuries due to aspiration and ingestion of foreign bodies were identified among 110 066 records of children (less than 15 years old) collected by the Hellenic Emergency Department Injury Surveillance System (EDISS) during the 5-year study period 1996-2000. Countrywide estimates of overall and object-specific injury incidence rates were computed using appropriate age and place of residence-sampling ratios. Simple cross-tabulations were performed along with a free text description analysis of injury events, whereas a composite score using (1) frequency of injury occurrence, (2) hospitalisation rate and (3) average length of hospitalisation was developed to measure the overall object-specific burden of injuries. Results: Aspirations and ingestions of foreign bodies accounted for 2% of the total burden of accident and emergency department visits, corresponding to an annual incidence of approximately 2.3 accidents per 1000 children. Fish bones and nuts prevailed among the high (44%) proportion of aspirations and ingestions due to edible foreign bodies, while the main inedibles involved were small objects. Toddlers, boys and migrant children were over-represented among children sustaining injuries due to inedibles. As expected, the vast majority of food-related injuries occurred in the kitchen, in most instances under parental supervision. Injuries due to edibles were of minor severity and treatment was provided in the emergency departments, while those due to inedibles were responsible for injuries resulting in higher hospitalisation rates, albeit of relatively short duration. The composite impact score was highest for nuts and other food, nails, pins and sharp instruments. X-rays were performed in nearly all cases; upper gastrointestinal endoscopy was required in about 1 out of 10 instances and laryngoscopy or bronchoscopy in 1 out of 20, whereas the object was spontaneously removed in less than 3% of the cases. Conclusions: Depending on whether caused by edible or inedible objects, injuries due to foreign body aspirations and ingestions showed distinct epidemiological patterns. Composite scores taking into account measures of injury frequency and severity, seemed to reflect a country-specific spectrum of this type of injuries and provided useful information for the design of targeted public health oriented interventions. (C) 2006 Elsevier Ireland Ltd. All rights reserved

Education in mental health promotion and its impact on the participants&apos; attitudes and perceived mental health

Background: Although the promotion of mental health (MHP) through education and training is widely accepted, there is scarce evidence for its effectiveness in the literature from outcome studies worldwide. The present study aimed to assess the effect of a three-semester MHP educational program on the recipients’ opinions towards mental illness and on their own self-assessed health. Methods: Respondents were 78 attendees who completed the assessment battery at the first (baseline) and the last session (end) of the training course. They were primary care physicians or other professionals, or key community agents, working in the greater Athens area. The course consisted of 44 sessions (4 h each), over a 3-semester period, focusing on the principles and methods of mental health promotion, the main aspects of major psychiatric disorders, and on relevant to health skills. Assessment instruments included the Opinion about Mental Illness (OMI) scale and the General Health Questionnaire (GHQ-28). Results: The mean scores of three OMI factors, that is, social discrimination, social restriction and social integration, and the two GHQ-28 subscales, that is, anxiety/insomnia and social dysfunction, were significantly improved by the end of the training course. Conclusions: The results of this study provide evidence, with limitations, for the short-term effectiveness of the implemented educational MHP program on an adult group of recipients-key agents in their community. Because interventions for strengthening positive opinions about mental illness and enhancing self-assessed health constitute priority aims of mental health promotion, it would be beneficial to further investigate the sustainability of the observed positive changes. In addition it would be useful to examine (a) the possible interplay between the two outcome measures, that is, the effect of opinions of recipients about mental health on their perceived health, and (b) the applicability of this intervention in individuals with different sociodemographic profiles

The gender dimension of non medical use of prescription drugs in Europe and the mediterranean region.

Understanding gender as it relates to drug use and drug use disorders is a critical requirement to developing effective policy and practice responses. This study aims to explore the gender dimension of non-medical use of prescription drugs (NMUPD) in Europe and the Mediterranean region and continues to build on the corpus of knowledge on the subject and also help identify gaps. Results The literature review identifies women as a high risk category for NMUPD and shows how gender is not predictive in the same direction across different drug categories. It highlights how the telescoping phenomenon is evident for females in their NMUPD career path and that females manifest different patterns of use then males. It highlights how trauma and interpersonal violence may be causal factors for NMUPD among women. The submitted data indicates that in the general population, the use of prescription drugs is higher for females than for males. Prescription drug use increases with age, with the 30’s constituting a risk period. No conclusions about gender influences on the use of a class of prescription medication were reached. While rates for prescription drug use have been shown to be clearly higher for women, the picture for NMUPD is less clear. Few countries reported on NMUPD: Greece and Lithuania register higher levels for females while the opposite is true for Lebanon and Israel. The initiation into NMUPD is marginally later for females than for males. The most common source of prescription medication for both males and females is a licit one (from a doctor), followed by ‘from a friend or a relative’ indicating the relative ease of diversion. Youth survey data indicate that rates of NMUPD for lifetime are higher for females in a number of countries and age of onset coincides with middle adolescence. In Germany and Serbia the number of fatal overdoses related to the use of psychotropics is higher for females than for males. The data on treatment is too limited to make any reliable conclusions according to gender. Disparity in the type of drug use surveyed in relation to prescription drug use and NMUPD makes comparison of prevalence rates particularly problematic. This does not allow for a clear documentation of the full extent of NMUPD and does not allow researchers to highlight gender differences. Data collection instruments such as general population drug prevalence surveys, do not always distinguish between ‘medical use’ and ‘non-medical use’. The national data concerning the use and misuse of medicines among general populations should, therefore, be interpreted very cautiously. Not all the countries in the survey report on the source of the prescription drugs. While the monitoring of prescribing practices among young people is an important area of research, youth surveys in Europe mainly explore NMUPD. All countries have legislation in place to control prescription drugs (psychotropics). Not all participating countries have a system in place to register the number of prescriptions for psychotropic substances and were unable to provide data in this regard. Participating countries reported a number of scientific studies on NMUPD. Most participating countries reported that the issue of NMUPD was addressed in their country’s National Drugs Policy. Recommendations For monitoring and research: The report recommends the Permanent Correspondents of the Pompidou Group to undertake the following actions: • Ask researchers in their respective member states to contribute to the development of monitoring systems of general population drug use in those European and Mediterranean countries where they do not exist (with technical advice from the EMCDDA). • Recommend to researchers in their respective countries that in addition to the use of ‘sedatives and tranquillisers’, the use of other categories of prescription medication be included as items in General Population Surveys. • Ask researchers in their respective countries to ensure that the item on the source of the prescription medication is included in General Population Surveys as a core item. • Ask researchers in the Member States to develop mechanisms for the monitoring of the Emergency Department indicator. • Ask the EMCDDA to include, in the common core general population survey, items relating to the use 11 • of prescription medication and to the non medical use of prescription medication and that the defining and reporting on the extent of NMUPD becomes a priority. • Ask the EMCDDA to develop a clear method of distinguishing the monitoring of both prescription practices and NMUPD. • Ask the ESPAD to expand the categories of prescription drugs monitored and to consider including ‘prescription drug use’ not only ‘use without a prescription’. For practice (prevention and treatment): The report recommends the Permanent Correspondents of the Pompidou Group to undertake the following actions: • Ask Member States to offer differentiated responses to the different needs of women in relation to prevention, harm reduction and treatment. • Ask Member States to develop guidelines for prescription practices that, while securing that individuals who need psychotropic medication, for the relief of pain, for example, have access to it, this does not result in unnecessary prescription and potential diversion of controlled substances. • Ask Member States to develop educational programs targeted towards patients on how to safely use, store and dispose of prescribed medicines. • Ask Member States to train medical practitioners to be able to screen and identify those individuals who are at risk of dependence to hinder movement along the addictive career. For policy: The report recommends the Permanent Correspondents of the Pompidou Group to undertake the following actions: • Ask Member States to develop coherent policies that also address the use and misuse of prescription medications and make specific reference to gender. • Ask Member States to commission studies dedicated exclusively to NMUPD and addressing such specific issues as the initiation, escalation, physical and psychosocial consequences in relation to women as an ‘at risk’ category. • Ask Member States to develop state level prescription drug monitoring programs. • Ask Member States to develop educational programs targeted towards patients on how to safely use, store and dispose of prescribed medicines. After consultation by the PG Secretariat, the Gender Equality Commission Secretariat suggests: • Further exploration of the relationship between experiences of physical, sexual and psychological violence and NMPUD. • Asking Member States to hold a round table bringing together international organisations active in the field to present their practices/good examples on this issue. • Asking Member states to commission a study on the relationship between violence against women and NMPUD