Does mental health service integration affect compulsory admissions?

Abstract. BACKGROUND: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. METHODS: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. RESULTS: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. CONCLUSIONS: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions

Improved Acid Stress Survival of Lactococcus lactis Expressing the Histidine Decarboxylation Pathway of Streptococcus thermophilus CHCC1524

Background: Degradative amino acid decarboxylation pathways in bacteria have diverse physiological functions. Results: A histidine decarboxylation pathway introduced in L. lactis improves acid stress survival, and synergy with the glycolytic pathway is demonstrated. Conclusion: The physiological benefit of the new pathway is strongly dependent on the properties of the host organism. Significance: Acquisition of the histidine decarboxylation pathway mimics successful horizontal gene transfer

Psycho-immunology and HIV infection : biopsychosocial determinants of distress, immunological parameters, and disease progression in homosexual men infected with human immunodeficiency virus-1

Subjects who have tested positive for the presence of antibodies against Human Immunodeficiency Virus Type I (further abbreviated as HIV), have to live with a lifethreatening infection. At present, no definite medical cure is available that prevents progression of HIV infection. Therefore, knowledge of being infected with this virus puts a heavy burden on one's coping capabilities. Although some subjects find a way to live with their HIV infection, others have great difficulties in adjusting to it and may suffer from psychological distress. Whether or not HIV-infected subjects develop psychological distress is determined by several factors. These include for instance the experience of other stressful life events, the type of coping style that is used, and the quality of the social network. However, little is known about the relative importance of each of these variables and the way they interact in predicting distress levels. HIV -infected individuals may benefit from psychosocial interventions that aim at increasing social support and improving coping strategies. Although several types of psychosocial intervention may be effective, the relative effectiveness of different psychotherapeutic intervention strategies is unknown. We investigated factors that determine the level of distress and the effectiveness of two different psychosocial interventions in decreasing distress levels in asymptomatic and early symptomatic HIV-infected homosexual men. These studies are described in Part L In Part IT studies pertaining to the associations between psychosocial factors and progression of HIV infection are described. The length of the period until the development of Acquired Immunodeficiency Syndrome (AIDS) varies considerably among individuals and it is hypothesized that some of the variation is due to psychosocial factors. These factors may include stressful life events, psychological distress, coping styles and social support. In the event that psychosocial factors have an influence, psychosocial interventions may slow down the rate of progression, and enhance the effectiveness of medical treatments. Studying the effect of psychosocial factors on disease progression is therefore of clinical relevance. It is of theoretical relevance because insights are gained into psychoneuroimmunological relationships in a virologically and immunologically mediated disease

Evaluation of behavioral changes and subjective distress after exposure to coercive inpatient interventions

BACKGROUND: There is a lack of evidence to underpin decisions on what constitutes the most effective and least restrictive form of coercive intervention when responding to violent behavior. Therefore we compared ratings of effectiveness and subjective distress by 125 inpatients across four types of coercive interventions. METHODS: Effectiveness was assessed through ratings of patient behavior immediately after exposure to a coercive measure and 24 h later. Subjective distress was examined using the Coercion Experience Scale at debriefing. Regression analyses were performed to compare these outcome variables across the four types of coercive interventions. RESULTS: Using univariate statistics, no significant differences in effectiveness and subjective distress were found between the groups, except that patients who were involuntarily medicated experienced significant less isolation during the measure than patients who underwent combined measures. However, when controlling for the effect of demographic and clinical characteristics, significant differences on subjective distress between the groups emerged: involuntary medication was experienced as the least distressing overall and least humiliating, caused less physical adverse effects and less sense of isolation. Combined coercive interventions, regardless of the type, caused significantly more physical adverse effects and feelings of isolation than individual interventions. CONCLUSIONS: In the absence of information on individual patient preferences, involuntary medication may be more justified than seclusion and mechanical restraint as a coercive intervention. Use of multiple interventions requires significant justification given their association with significant distress

Family Complexity and Parents’ Migration:The Role of Repartnering and Distance to Non-Resident Children

Recent research suggests that the increasing complexity of family life could be a factor in declines in internal migration (long-distance moves within countries). As many separated parents continue to share childcare responsibilities or have visiting arrangements, their mobility is naturally constrained. However, the relationship between family complexity and individual migration behaviour has never been studied explicitly. We compare separated parents with parents in two-parent families in their likelihood of migrating within the Netherlands. We use detailed records of parents’ partnership status and children’s residential situation. An event-history analysis was performed using register-based population data (N = 442,412). We find that separated, single parents are more likely to migrate than those in two-parent families. The same is true for repartnered mothers, while repartnered fathers are about as likely to migrate as fathers in two-parent families. Separated parents’ migration behaviour depends on where their children live. Having non-resident children who live some distance away is associated with a much higher likelihood of migrating than having resident children or non-resident children who live nearby. Having both resident and non-resident children who live nearby—shared residence (i.e. joint physical custody) is likely common in this situation—is associated with a considerably lower likelihood of migrating than having resident children only. Based on our findings, one would expect family complexities stemming from parental separation to be associated with higher rather than lower levels of migration. However, potential future increases in the number of parents who share physical custody after separation might lead to lower migration levels