Identifying social participation subgroups of individuals with severe mental illnesses:a latent class analysis

Purpose To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). Methods A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. Results Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. Conclusions Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning

Physical, social and societal functioning of children with congenital adrenal hyperplasia (CAH) and their parents, in a Dutch population

<p>Abstract</p> <p>Background</p> <p>Most research concerning congenital adrenal hyperplasia (CAH) and related conditions caused by primary adrenal insufficiency, such as Addison's or Cushing's disease, has focused on medical aspects rather than on patients' quality of life. Therefore, our objective was to investigate the physical, social and societal functioning of children with CAH and their parents in a Dutch population.</p> <p>Methods</p> <p>The study is descriptive and cross-sectional. Self-designed questionnaires, based on questionnaires developed in the Netherlands for different patient groups, were sent to parents of children with CAH between 0 and 18 years old. Participants were recruited through the Dutch patient group for Adrenal Disease (NVACP) and six hospitals in the Netherlands. Three different questionnaires were designed for parents: for children aged 0 - 4, aged 4 - 12 and aged 12 - 18. Additionally, a fourth questionnaire was sent to adolescents with CAH aged 12 - 18. Main outcome measures were experienced burden of the condition, self-management and participation in several areas, such as school and leisure time.</p> <p>Results</p> <p>A total of 106 parents returned the questionnaire, 12 regarding pre-school children (0-4 years), 63 regarding primary school children (4-12 years), and 32 regarding secondary school children (12-18 years), combined response rate 69.7%. Also, 24 adolescents returned the questionnaire. Children and adolescents with CAH appear to be capable of self-management at a young age. Experienced burden of the condition is low, although children experience several health related problems on a daily basis. Children participate well in school and leisure time. Few children carry a crisis card or emergency injection with them.</p> <p>Conclusions</p> <p>Overall, our research shows that, according to their parents, children with CAH experience few negative effects of the condition and that they participate well in several areas such as school and leisure time. However, improvements can be made concerning the measures parents and children must take to prevent an adrenal crisis.</p

Who benefits from individual placement and support?:A meta-analysis

Aims Individual placement and support (IPS) is an evidence-based service model to support people with mental disorders in obtaining and sustaining competitive employment. IPS is increasingly offered to a broad variety of service users. In this meta-analysis we analysed the relative effectiveness of IPS for different subgroups of service users both based on the diagnosis and defined by a range of clinical, functional and personal characteristics. Methods We included randomised controlled trials that evaluated IPS for service users diagnosed with any mental disorder. We examined effect sizes for the between-group differences at follow-up for three outcome measures (employment rate, job duration and wages), controlling for methodological confounders (type of control group, follow-up duration and geographic region). Using sensitivity analyses of subgroup differences, we analysed moderating effects of the following diagnostic, clinical, functional and personal characteristics: severe mental illness (SMI), common mental disorders (CMD), schizophrenia spectrum disorders, mood disorders, duration of illness, the severity of symptoms, level of functioning, age, comorbid alcohol and substance use, education level and employment history. Results IPS is effective in improving employment outcomes compared to the control group in all subgroups, regardless of any methodological confounder. However, IPS was relatively more effective for service users with SMIs, schizophrenia spectrum disorders and a low symptom severity. Although IPS was still effective for people with CMD and with major depressive disorder, it was relatively less effective for these subgroups. IPS was equally effective after both a short and a long follow-up period. However, we found small, but clinically not meaningful, differences in effectiveness of IPS between active and passive control groups. Finally, IPS was relatively less effective in European studies compared to non-European studies, which could be explained by a potential benefits trap in high welfare countries. Conclusions IPS is effective for all different subgroups, regardless of diagnostic, clinical, functional and personal characteristics. However, there might be a risk of false-positive subgroup outcomes and results should be handled with caution. Future research should focus on whether, and if so, how the IPS model should be adapted to better meet the vocational needs of people with CMD and higher symptom severity

Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

IntroductionThis randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities.MethodsA total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured.ResultsIntent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively.ConclusionEither with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups.Clinical trial registrationTrialregister.nl Identifier: Trial NL9120

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace

antigos e novos desafios

The 1982 United Nations Convention on the Law of the Sea has driven the evolution of the international law of the sea, both in the academic field and in jurisprudence. With the creation of the Exclusive Economic Zone in 1982, the 1960 Luso-French Agreement, which delimited the maritime border between Guinea-Bissau and Senegal left out this new space, as it did not exist at the time the agreement was concluded. Thus, due to the importance of the delimitation of the border between states with opposite or adjacent coasts, we propose the elaboration of the present dissertation entitled "The delimitation of maritime borders between Guinea-Bissau and Senegal: Old and New Challenges". The aim of this theme is to analyze the problems surrounding the delimitation of maritime boundaries between these states and examine the delimitation possible for the EEZ created in 1982. From this study we see that Guinea-Bissau and Senegal, as coastal states, have economic interests in the sea. The maritime dispute between these two states to extend their jurisdiction in the area adjacent to their land territory is linked to technological availability and the possibility of exploiting the vast resources that the sea holds, some of which are still unknown. Due to the utis possidetis principle these two newly independent states could not dissociate themselves from the Luso-French agreement of 1960, which delimited the maritime border in t We can also verify through our research that, in the delimitation of the maritime boundary in the EEZ between Guinea-Bissau and Senegal, if they do not reach an agreement to renegotiate the entire boundary, the criterion of equidistance/special circumstances is applied in three phases. Consequently, as we have tried to demonstrate, the delimitation of the border in the EEZ will create a "gray zone" in part of the EEZ of Guinea-Bissau and the continental shelf of Senegal. Indeed, in order to overcome the difficulties related to legal and practical conflicts in developing the resources of the "gray zone", the parties may conclude a new agreement for the joint exploration and exploitation of the resources of the "gray zone".A Convenção das Nações Unidas sobre o Direito do Mar de 1982, impulsionou a evolução do direito internacional do mar, tanto na área académica quanto na jurisprudência. Com a criação da Zona Económica Exclusiva em 1982, o Acordo luso-francês de 1960, que delimitou a fronteira marítima entre a Guiné-Bissau e o Senegal deixou de fora este novo espaço, pois não existia na época da celebração do acordo. Assim, devido a importância da delimitação de fronteira entre Estados com costas opostas ou adjacentes, nos propomos a elaboração da presente dissertação intitulada “A delimitação de fronteiras marítimas entre a Guiné-Bissau e o Senegal: Antigos e Novos desafios”. Pretende-se com esta temática analisar a problemática em torno da delimitação de fronteiras marítimas entre estes Estados e examinar a delimitação possível para a Zona Económica Exclusiva (ZEE) criado em 1982. A partir deste estudo constatamos que a Guiné-Bissau e o Senegal, enquanto Estados costeiros, têm interesses económicos no mar. A disputa marítima entre estes dois Estados no sentido de alargar a sua jurisdição na área adjacente ao seu território terrestre está ligada a disponibilidade tecnológica e a possibilidade de poderem explorar vastos recursos que o mar encerra, alguns ainda desconhecidos. Devido ao princípio utis possidetis estes dois Estados recém-independente não puderam desvincular-se do acordo luso-francês de 1960, que delimitou a fronteira marítima nos seus espaços marítimas sem ter em consideração o título jurídico dos Estados costeiros. Ainda podemos verificar através da pesquisa realizada, que na delimitação de fronteira marítima, na ZEE entre a Guiné-Bissau e o Senegal, caso não cheguem a uma anuência para a renegociação de toda a fronteira aplica-se o critério da linha equidistância/circunstancias especiais feita em três fases. Em consequência, conforme procuramos demostrar, com a delimitação da fronteira na ZEE vai se criar uma “zona cinzenta” numa parte da ZEE da Guiné-Bissau e plataforma continental do Senegal. Com efeito, as partes para suprir as dificuldades referente aos conflitos jurídicos e práticos no desenvolvimento dos recursos da “zona cinzenta” podem celebrar um novo acordo de exploração e aproveitamento conjunto dos recursos da “zona cinzenta

Trabalho em equipe e integralidade num cenário hospitalar

The present research aims to understand and analyze how a team of a hospital unit works on the prospect of a full attendance. The option was for an exploratory and qualitative case study, whose production data was collected by means of observations recorded in field journal and meetings with professionals with semi structured interviews and conversation, as well as informal conversations with patients and documentary analysis. In the meetings, were discussed issues related to the organization of work, the mode of operation of the team, the problems involved for the production of integral care and continuity of care. Our study showed that the team working in this hospital scenario presents many difficulties and is still a challenge. The organization of the work process, vertical and fragmented, does not contribute to joint performances of professionals. The professional area has an organization of its own and, in general, performs their work in a isolated manner from other areas. There are very few spaces for exchange of information, to discussions of cases and planning joint interventions. The care of patients is more focused on performing procedures than listen and dialogue with their living conditions. The issues that emerged from the investigation indicate the need for changes in the organization of the work process in the hospital, with the deployment of strategies that contribute to better coordination between the different professionals who work there, among them we highlight the deployment of team meetings and moments of permanent education. Also indicate the importance of the participation of management in these transformations for producing integral care.O presente trabalho de pesquisa visa compreender e analisar como ocorre o trabalho em equipe de uma unidade hospitalar na perspectiva de um atendimento integral. A opção foi por um estudo de caso, exploratório, qualitativo, cuja produção de dados foi realizada por meio de observações registradas em diário de campo e de encontros com profissionais com a realização de entrevistas semi estruturadas e rodas de conversa, além de conversas informais com os pacientes e também análise documental. Questões relacionadas à organização do trabalho, ao modo de funcionamento da equipe, à problemática envolvida para a produção de cuidados integrais e para a continuidade da assistência foram abordadas nos encontros. Nosso estudo demonstrou que a atuação em equipe neste cenário hospitalar apresenta muitas dificuldades e ainda é um desafio. A organização do processo de trabalho, verticalizada e fragmentada, não contribui para atuações conjuntas dos profissionais. As áreas profissionais tem uma organização própria e, em geral, realizam seu trabalho de maneira isolada das demais áreas. Existem poucos espaços para troca de informações, para discussões de casos e planejamento de intervenções conjuntas. O cuidado aos pacientes está muito focado em realizar procedimentos com pouco espaço de escuta e de diálogo com suas condições de vida. As questões que emergiram da investigação indicam a necessidade de mudanças na organização do processo de trabalho no hospital, com a implantação de estratégias que contribuam para melhor articulação entre os diferentes profissionais que ali atuam, entre elas destacamos a implantação de reuniões de equipe e momentos de educação permanente. Indicam ainda a importância da participação da gestão nestas transformações para a produção do cuidado integral.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016)https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=240493

Crescimento, ciclo fenológico e produção de cinco cultivares de bananeira em condições subtropicais

This study aimed to evaluate the growth, the phenological cycle and the production of five banana cultivars in São Manuel-SP. For the planting, held in November 2012, were used plantlets originated from the micropropagation process. The spacing adopted was of the 4m between rows of planting and 2,5 m between plants, with an area of 10 m2 / plant. We evaluated the first production cycle (mother plant) of the cultivars: Nanicão-IAC-2001 (AAA), Grand Naine (AAA), Maçã (AAB), Prata Anã (AAB) and FHIA 18 (AAAB). The experimental design was completely randomized with five treatments (cultivars), 10 repetitions and a useful plant by experimental plot. Vegetative and yield variables in addition to the production cycle, measured by the number of days from planting to flowering, flowering to harvesting and planting to harvesting, were evaluated. With the obtained results, it was found that the Nanicão-IAC-2001 and Grande Naine cultivars presented similar vegetative behavior and stood out from the other evaluated cultivars for yield variables. The cultivars Prata Anã e Maçã presented low yield (10.77 and 10.37 t ha-1), however, 'Prata Anã' had one of the earliest cultural cycles, along with 'Nanicão-IAC-2001' and 'Grande Naine'. 'FHIA 18' presented the largest production cycles being the latest cultivar, however, presents potential for cultivation by the appropriate yield performance in the evaluated conditions.Este trabalho teve como objetivo avaliar o crescimento, o ciclo fenológico e a produção de cinco cultivares de bananeira, em São Manuel-SP. Para o plantio, realizado no mês de novembro de 2012, foram utilizadas mudas oriundas do processo de micropropagação. O espaçamento adotado foi de 4m entre as linhas de plantio e 2,5m entre plantas, com uma área de 10 m2 /planta. Foram avaliadas as plantas do primeiro ciclo de produção (planta mãe) dos cultivares: Nanicão-IAC-2001 (AAA), Grande Naine (AAA), Maçã (AAB), Prata Anã (AAB) e FHIA 18 (AAAB). O delineamento experimental utilizado foi o inteiramente casualizado, com 5 tratamentos (cultivares), 10 repetições e uma planta útil por parcela experimental. Foram avaliadas as variáveis vegetativas e produtivas, além do ciclo de produção, mensurado através do número de dias do plantio ao florescimento, florescimento à colheita e plantio à colheita. Com os resultados obtidos, verificou-se que os cultivares Nanicão-IAC-2001 e Grande Naine apresentaram comportamento vegetativo semelhante e se destacaram dos demais avaliados quanto às variáveis produtivas. Os cultivares Prata Anã e Maçã apresentaram baixa produtividade (10,77 e 10,37 t ha-1 ), porém, ‘Prata Anã’ foi um dos mais precoces quanto ao ciclo cultural, juntamente com ‘Nanicão-IAC-2001’ e ‘Grande Naine’. ‘FHIA 18’ apresentou o maior ciclo de produção sendo o cultivar mais tardio, no entanto, apresenta potencial de cultivo pelo adequado desempenho produtivo nas condições avaliadas

Identifying social participation subgroups of individuals with severe mental illnesses: a latent class analysis

PURPOSE: To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). METHODS: A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. RESULTS: Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. CONCLUSIONS: Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning

Feasibility and outcomes of narrative enhancement and cognitive therapy (NECT) for reducing self-stigma among people with severe mental illness in the Netherlands:A pilot study

Objective: The narrative enhancement and cognitive therapy (NECT) intervention aims to reduce self-stigma among people with severe mental illness. Based on previous studies that showed the intervention’s beneficial outcomes, we conducted an uncontrolled pilot study of NECT in the Netherlands to assess both feasibility in delivering NECT and outcomes of the intervention for self-stigma, hope, recovery, and self-concept clarity. Methods: Feasibility was assessed through uptake and implementation data that included an assessment of enhancing and impeding factors according to surveys with NECT facilitators, and interviews with participants. Outcomes of NECT were studied through scales that assess self-stigma, self-concept clarity, hope, personal recovery, and quality of life. Results: Forty-one participants from five treatment sites participated in the pilot study, among whom 78% were considered “exposed” (i.e., attended at least six sessions). The analysis of enhancing and impeding factors indicated that support from the organization, sense of ownership, expectations of outcomes, and content of the intervention were reported as important in the implementation process. Participants reported decreases in self-stigma and increases in hope during the intervention. Conclusions and Implications for Practice: Assessments of feasibility provided valuable insights regarding ways to improve implementation of the intervention (such as increasing facilitators’ sense of ownership of the intervention). Outcomes of NECT showed a decrease in self-stigma and improvement of hope among participants in this pilot study, supporting the previously found positive effects of the intervention