A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents

BACKGROUND: Excessive use of the Internet has been associated with attention deficit hyperactivity disorder (ADHD), but the relationship between video games and ADHD symptoms in adolescents is unknown. METHOD: A survey of adolescents and parents (n = 72 adolescents, 72 parents) was performed assessing daily time spent on the Internet, television, console video games, and Internet video games, and their association with academic and social functioning. Subjects were high school students in the ninth and tenth grade. Students were administered a modified Young's Internet Addiction Scale (YIAS) and asked questions about exercise, grades, work, and school detentions. Parents were asked to complete the Conners' Parent Rating Scale (CPRS) and answer questions regarding medical/psychiatric conditions in their child. RESULTS: There was a significant association between time spent playing games for more than one hour a day and YIAS (p < 0.001), overall grade point average (p ≤ 0.019), and the "Inattention" and "ADHD" components of the CPRS (p ≤ 0.001 and p ≤ 0.020, respectively). No significant association was found between body mass index (BMI), exercise, number of detentions, or the "Oppositional" and "Hyperactivity" components of CPRS and video game use. CONCLUSION: Adolescents who play more than one hour of console or Internet video games may have more or more intense symptoms of ADHD or inattention than those who do not. Given the possible negative effects these conditions may have on scholastic performance, the added consequences of more time spent on video games may also place these individuals at increased risk for problems in school

Clinicians’ Perceptions of Telemedicine for Conducting Family Conferences Prior to Transfer to a Tertiary Care Center Intensive Care Unit

Objectives: Critically ill patients are often transferred from rural to tertiary care medical centres for further higher levels of care. The transportation process may delay family conferences during which prognosis and goals of care are discussed. These conferences typically occur when family members meet the treating physicians for the first time in person after transport. Telemedicine is a tool that may be used to bridge this gap in communication by enabling these family conferences before transport. There are no data on perceptions of telemedicine used in this setting. We conducted a qualitative study assessing provider perceptions regarding the use of telemedicine for conducting family conferences prior to transport. Methods: Critical care physicians and nurses were invited to view an educational video demonstrating the process of conducting a family conference via telemedicine. Immediately following viewing of the video, physicians and nurses filled out an open-ended questionnaire regarding their thoughts and perceptions of the video and the telemedicine family conference approach. Results: There was a 68% response rate to the surveys. Responses were categorised into two major themes: benefits and barriers. Within the theme of benefits, three sub-themes were identified: satisfaction, knowledge and quality of care. We identified four domains within the theme of barriers: time, perception, technology and logistics. Conclusions: Respondents believe that there may be several benefits including increased satisfaction, improved communication and empowerment of families by dissemination of knowledge. Barriers to the use of this intervention identified include costs, time, technology and negative perceptions of the telemedicine conference

Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment

Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. Conclusions The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.http://deepblue.lib.umich.edu/bitstream/2027.42/112590/1/12913_2012_Article_2419.pd

Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

Objective: The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Materials and Methods: Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. Results: An ethnically diverse sample of 48 English- and Spanish-only- speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the markedly severe range at baseline and in the mild range at follow-up. Conclusions: Results of this pilot support the feasibility of using homecare\u27s existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed

The interRAI suite of mental health assessment instruments: an integrated system for the continuum of care

The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems

Cross-ancestry genome-wide association analysis of corneal thickness strengthens link between complex and Mendelian eye diseases

Central corneal thickness (CCT) is a highly heritable trait associated with complex eye diseases such as keratoconus and glaucoma. We perform a genome-wide association meta-analysis of CCT and identify 19 novel regions. In addition to adding support for known connective tissue-related pathways, pathway analyses uncover previously unreported gene sets. Remarkably, >20% of the CCT-loci are near or within Mendelian disorder genes. These included FBN1, ADAMTS2 and TGFB2 which associate with connective tissue disorders (Marfan, Ehlers-Danlos and Loeys-Dietz syndromes), and the LUM-DCN-KERA gene complex involved in myopia, corneal dystrophies and cornea plana. Using index CCT-increasing variants, we find a significant inverse correlation in effect sizes between CCT and keratoconus (r =-0.62, P = 5.30 × 10-5) but not between CCT and primary open-angle glaucoma (r =-0.17, P = 0.2). Our findings provide evidence for shared genetic influences between CCT and keratoconus, and implicate candidate genes acting in collagen and extracellular matrix regulation

Cross-ancestry genome-wide association analysis of corneal thickness strengthens link between complex and Mendelian eye diseases.

Central corneal thickness (CCT) is a highly heritable trait associated with complex eye diseases such as keratoconus and glaucoma. We perform a genome-wide association meta-analysis of CCT and identify 19 novel regions. In addition to adding support for known connective tissue-related pathways, pathway analyses uncover previously unreported gene sets. Remarkably, >20% of the CCT-loci are near or within Mendelian disorder genes. These included FBN1, ADAMTS2 and TGFB2 which associate with connective tissue disorders (Marfan, Ehlers-Danlos and Loeys-Dietz syndromes), and the LUM-DCN-KERA gene complex involved in myopia, corneal dystrophies and cornea plana. Using index CCT-increasing variants, we find a significant inverse correlation in effect sizes between CCT and keratoconus (r = -0.62, P = 5.30 × 10-5) but not between CCT and primary open-angle glaucoma (r = -0.17, P = 0.2). Our findings provide evidence for shared genetic influences between CCT and keratoconus, and implicate candidate genes acting in collagen and extracellular matrix regulation

The resident assessment instrument-mental health (RAI-MH): Inter-rater reliability and convergent validity

An important challenge facing behavioral health services is the lack of good quality, clinically relevant data at the individual level. The article describes a multinational research effort to develop a comprehensive, multidisciplinary mental health assessment system for use with adults in facilities providing acute, long-stay, forensic, and geriatric services. The Resident Assessment Instrument-Mental Health (RAI-MH) comprehensively assesses psychiatric, social, environmental, and medical issues at intake, emphasizing patient functioning. Data from the RAI-MH are intended to support care planning, quality improvement, outcome measurement, and case mix-based payment systems. The article provides the first set of evidence on the reliability and validity of the RAI-MH.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45775/1/11414_2005_Article_BF02287348.pd