Social service and disability in immigrant families: professionals views and strategies

Immigrant families with a member with disability represent a social group particularly at risk: their vulnerability, in fact, depends on both the disability and the migration experience. The paper presents a research work starting from a scoping study (Arksey & O'Malley, 2005), realized by analysing 94 scientific works collected through Scopus with the aim of highlighting the specific problems which immigrant families with disabilities have to deal with, what to do and the culturally sensitive intervention strategies effectively used by the services. Often, they lack informal support networks, they have social and/or economic disadvantages, they do not know how the educational, social and health institutions work. Therefore, they live in a multi-problem situation that requires health and social services to activate personalized assistance that takes into account cultural difference. Results from a quanti-qualitative research study conducted in the context of the Adult Disability Service in Padova will be also presented

Otitis Media, Behavioral and Electrophysiological Tests, and Auditory Rehabilitation

For speech and language to develop, an intact and active auditory system is of fundamental importance. The central auditory nervous system (CANS) can be hampered by several occurrences, including otitis media (OM) originating from inflammation in the middle ear and which is often associated with the accumulation of infected (or sometimes noninfected) fluid. OM can have a diffuse effect on cognitive and linguistic abilities, affecting both speech and phoneme perception through a failure to discriminate, store, and reproduce the acoustic contrasts necessary for comprehension. It is especially common in the first years of school. In addition, OM can generate internal noise from the presence of middle ear fluid near the cochlea, which can lead to changes in speech perception, distortion in acoustic images, and a reduction in the speed and accuracy of decoding speech. Evaluating the effectiveness of the CANS is recommended in cases where there have been repeated episodes of OM. Very useful information can be gained from behavioral and electrophysiological tests. The tests allow functional diagnoses to be made and can also reveal clinical and subclinical changes. In this way, they allow information to be collected, which can help in making a prognosis and planning intervention strategies

Incongruent Views of Functioning between Patients and Gastroenterologists : A Mixed Methods Study

Gastrointestinal patients, especially those diagnosed with functional digestive disorders (FGIDs), usually present a complex clinical picture that poses a challenge for their management in primary care. The main objective of the current research was to examine the relationship of the congruence of the perception of severity and quality of life between gastroenterologists and their patients with psychological distress and the helping attitude experienced by the latter attended in primary care centres. Additionally, we wanted to explore patients' and practitioners' perceptions. We performed a cross-sectional study with a total of 2261 patients (1562 analysed) that attended three primary care centres. Patients completed questionnaires that measured physical functioning, distress, and perception of helping attitude. Gastroenterologists registered the functional status of each participating patient. Patients were then invited to take part in the qualitative part of the study if they were considered to have incongruent views on their functioning with their gastroenterologist. In total, 52 patients took part in one of eight focus groups. Additionally, four individual interviews were carried out with three gastroenterologists and one consultation-liaison psychiatrist specialised in FGIDs. Both incongruence and functional diagnosis correlated with distress. However, incongruent views between patients and gastroenterologists explained more variance. Statistically significant differences in patients' helping attitude perception were detected between diagnostic but no incongruence groups. In the second stage of the study, a total of five themes were identified from the patient focus groups and the gastroenterologist interviews: illness-emotional and personal problems, disease-health system interaction, health system, intervention, and patients. The current research allowed us to confirm that incongruence in the perception of severity and quality of life between gastroenterologists and patients is related to psychological distress and that this occurs in a multifactorial context where the characteristics of the disorder interact with those of the health system

Connecting the Mind-Body split: Understanding the relationship between symptoms and emotional well-being in Chronic Pain and Functional Gastrointestinal Disorders

Paediatric chronic conditions, e.g. chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated with an increased experience of psychological distress by both the ill child and their parents. While pain and embarrassing symptoms can induce increased distress, evidence is also accumulating in support of a reciprocal relationship between pain and distress. This reciprocal relationship is nicely illustrated in the fear avoidance model of pain, which has recently been found to be applicable to childhood pain experiences. The purpose of this article is to illustrate how mind (i.e. emotions) and body (i.e. physical symptoms) interact using chronic pain and gastrointestinal disorders as key examples. Despite the evidence for the connection between mind and body, the mind-body split is still a dominant position for families and health care systems, as evidenced by the artificial split between physical and mental health care. In a mission to overcome this gap, this article will conclude by providing tools on how the highlighted evidence can help to close this gap between mind and body

Heterogeneity in psychiatric diagnostic classification

The theory and practice of psychiatric diagnosis are central yet contentious. This paper examines the heterogeneous nature of categories within the DSM-5, how this heterogeneity is expressed across diagnostic criteria, and its consequences for clinicians, clients, and the diagnostic model. Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma- and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties. Wider variations across diagnostic categories examined symptom overlap across categories, and the role of trauma. Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary. Individual experiences and specific causal pathways within diagnostic categories may also be obscured. A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system

A case of hysteria: anti-N-methyl-D-aspartate receptor encephalitis resulting from a mature ovarian teratoma

Anti-N-methyl-D-aspartate receptor encephalitis in young healthy women while rare may be the result of an ovarian teratoma that produces anti-NMDA receptor antibodies. Symptoms from this encephalitis can be severe enough to result in hypoventilation, autonomic instability, and coma. Although treatable with tumor removal via oophorectomy and immunosuppression, median time to diagnosis is 8 weeks, which may lead to the onset of severe symptoms. The case presented highlights the severity of symptoms including rhabdomyolysis and respiratory distress in a female who had a previous history of functional somatic syndromes, which possibly resulted in a delayed diagnosis. This case demonstrates the importance of a thorough evaluation for causes of new onset neurological symptoms when the patient’s clinical status continues to deteriorate. This includes an evaluation for anti-N-methyl-D-aspartate receptor encephalitis. Following salpingo-oophorectomy, IVIG/methylprednisolone, and rituximab/cyclophosphamide treatment, this patient demonstrated improvement although she continues to require rehabilitation therapy, maintenance Keppra and low-dose Prednisone

Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning.

BACKGROUND: Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost. METHODS: The study employed a 'Balance of Care approach' in three areas of North-West England. This long-standing strategic planning framework identifies people whose needs can be met in more than one setting, and compares the costs and consequences of the possible alternatives in a simulation modelling exercise. Information was collected about a six-month cohort of admissions in 2010/11 (n = 216). The sample was divided into groups of people with similar needs for care, and vignettes were formulated to represent the most prevalent groups. A range of key staff judged the appropriateness of these admissions and suggested alternative care for those considered least appropriate for hospital. A public sector costing approach was used to compare the estimated costs of the recommended care with that people currently receive. RESULTS: The findings suggest that more than a sixth of old age psychiatry inpatient admissions could be more appropriately supported in other settings if enhanced community services were available. Such restructuring could involve the provision of intensive support from Care Home Outreach and Community Mental Health Teams, rather than the development of crisis intervention and home treatment teams as currently advocated. Estimated savings were considerable, suggesting local agencies might release up to £1,300,000 per annum. No obvious trade-off between health and social care costs was predicted. CONCLUSIONS: There is considerable potential to change the mix of institutional and community services provided for older people with mental health problems. The conclusions would be strengthened by further studies and the incorporation of evidence about relative outcomes. However, the utility of the approach in challenging established patterns of resource allocation and building local ownership for change is apparent