International variations in mental-health law regulating involuntary commitment of psychiatric patients as measured by the Mental Health Legislation Attitudes Scale

Previous research illustrated that the laws regulating involuntary placement and treatment of people with mental-health problems are diverse across countries. International studies comparing satisfaction levels between countries are rare. We compared the opinions of professionals and family members about the operation of the national mental-health law regulating forcibly admission and treatment of psychiatric patients in 11 countries: Ireland, Iceland, England and Wales, Romania, Slovenia, Denmark, Germany, Sweden, Norway and India. An online survey design was adopted using a Mental Health Legislation Attitudes Scale (MHLAS). This brief nine-item questionnaire was distributed via email to psychiatrists, general practitioners, acute and community mental-health nurses, tribunal members, police officers and family members in each collaborating country. The levels of agreement/disagreement were measured on a Likert scale. Data were analysed both per question and with regard to a total MHLAS ‘approval’ score computed as a sum of the nine questions. We found that respondents in England and Wales and Denmark expressed the highest approval for their national legislation (76% and 74%, respectively), with those in India and Ireland expressing the lowest approval (65% and 64%, respectively). Almost all countries had a more positive attitude in comparison to Ireland on the admission criteria for involuntary placement and the way people are transferred to psychiatric hospitals. There are significant variations across Europe and beyond in terms of approval for how the national mental-health law framework operates in each country

Methods for Forecasting the Business Cycle

The main aim of the undertaking is to define and implement a methodology for forecasting the business cycle and particularly the leading composite indicator. This methodology consolidates some elements recognized in the literature with some new elements of estimating and ranging of forecasts. It uses all the effective information from the numerous forecasts and synthesises them into one combined forecast.

Violent thoughts and violent behavior following hospitalization for mental disorder

Using a standardized schedule of questions, this study examined (a) the prevalence of self-report of violent thoughts by patients hospitalized for mental disorders compared with nonpatients, (b) the persistence of violent thoughts after discharge, and (c) the relation between patients\u27 violent thoughts while hospitalized and violent acts within 20 weeks after hospital discharge. About 1/3 of the patients reported thoughts of violence while hospitalized, more than twice the proportion found among nonpatients. Reporting violent thoughts in hospital was significantly related to engaging in violent acts within 20 weeks after discharge for non-White patients, patients without major mental disorder but with substance abuse diagnoses, patients with high symptom severity, and patients whose reports of violent thoughts persisted after discharge. Reporting violent thoughts was significantly related to measures of psychopathy, anger, and impulsiveness

Resource Utilization in Non-Academic Emergency Departments with Advanced Practice Providers

Introduction: Advanced practice providers (APP), including physicians’ assistants and nurse practitioners, have been increasingly incorporated into emergency department (ED) staffing over the past decade. There is scant literature examining resource utilization and the cost benefit of having APPs in the ED. The objectives of this study were to compare resource utilization in EDs that use APPs in their staffing model with those that do not and to estimate costs associated with the utilized resources.Methods: In this five-year retrospective secondary data analysis of the Emergency Department Benchmarking Alliance (EDBA), we compared resource utilization rates in EDs with and without APPs in non-academic EDs. Primary outcomes were hospital admission and use of computed tomography (CT), radiography, ultrasound, and magnetic resonance imaging (MRI). Costs were estimated using the 2014 physician fee schedule and inpatient payments from the Centers for Medicare and Medicaid Services. We measured outcomes as rates per 100 visits. Data were analyzed using a mixed linear model with repeated measures, adjusted for annual volume, patient acuity, and attending hours. We used the adjusted net difference to project utilization costs between the two groups per 1000 visits.Results: Of the 1054 EDs included in this study, 79% employed APPs. Relative to EDs without APPs, EDs staffing APPs had higher resource utilization rates (use per 100 visits): 3.0 more admissions (95% confidence interval [CI], 2.0–4.1), 1.7 more CTs (95% CI, 0.2–3.1), 4.5 more radiographs (95% CI, 2.2–6.9), and 1.0 more ultrasound (95% CI, 0.3–1.7) but comparable MRI use 0.1 (95% CI, -0.2–0.3). Projected costs of these differences varied among the resource utilized. Compared to EDs without APPs, EDs with APPs were estimated to have 30.4 more admissions per 1000 visits, which could accrue $414,717 in utilization costs.Conclusion: EDs staffing APPs were associated with modest increases in resource utilization as measured by admissions and imaging studies.

The Influence of Country-Level Governance on Business Environment and Entrepreneurship: a Global Perspective

The main purpose of this study is to analyze the influence of country-level governance on business environment and entrepreneurship for an international large sample of countries for a period of six years (2007-2012). The dimensions of country-level governance at macroeconomic level will be captured by using the following six indicators developed by the World Bank: 1. Voice and accountability; 2. Political stability and absence of violence; 3. Government effectiveness; 4. Regulatory quality; 5. Rule of law; 6. Control of corruption. To capture the quality of business environment we use the Ease of doing business index developed by the World Bank in its Doing Business report series. To measure entrepreneurship we use the World Bank Group Entrepreneurship Survey where the number of new registered businesses, as a percentage of the working age population is defined as a measure of formal entrepreneurship. In order to capture the extent to which country-level governance does influence business environment and entrepreneurship, we analyze the data using cross-sectional time-series random effects generalized least square (GLS) models. The results of this panel data analysis clarifies and quantifies the influence that various characteristics of country-level governance could have on business environment and entrepreneurship. Therefore, this study could have significant implications for policy-makers as well as for businesses

Perceived coercion at hospital admission and adherence to mental health treatment after discharge

The authors investigated whether mental health inpatients\u27 perceptions of coercion were associated with later treatment adherence. Psychiatric inpatients receiving acute care at three sites were interviewed during their hospitalization and up to five times after discharge. Patients\u27 perceptions of coercion were measured at admission. Adherence to medication and clinical treatment was measured every ten weeks for one year after discharge. Among the 825 patients who had a perceived coercion score and ten-week follow-up data and who reported that outpatient treatment was prescribed, perceived coercion scores were not associated with treatment adherence. The authors concluded that perceived coercion neither increases nor decreases psychiatric inpatients\u27 medication adherence or use of treatment services after discharge

Treating Visual Speech Perception to Improve Speech Production in Nonfluent Aphasia

BACKGROUND AND PURPOSE: Several recent studies have revealed modulation of the left frontal lobe speech areas not only during speech production, but also for speech perception. Crucially, the frontal lobe areas highlighted in these studies are the same ones that are involved in non-fluent aphasia. Based on these findings, this study examined the utility of targeting visual speech perception to improve speech production in non-fluent aphasia. METHODS: Ten patients with chronic non-fluent aphasia underwent computerized language treatment utilizing picture-word matching. To examine the effect of visual peech perception upon picture naming, two treatment phases were compared – one which included matching pictures to heard words and another where pictures were matched to heard words accompanied by a video of the speaker’s mouth presented on the computer screen. RESULTS: The results revealed significantly improved picture naming of both trained and untrained items following treatment when it included a visual speech component (i.e. seeing the speaker’s mouth). In contrast, the treatment phase where pictures were only matched to heard words did not result in statistically significant improvement of picture naming. CONCLUSIONS: The findings suggest that focusing on visual speech perception can significantly improve speech production in non-fluent aphasia and may provide an alternative approach to treat a disorder where speech production seldom improves much in the chronic phase of stroke