A pharmacy led program to review anti-psychotic prescribing for people with dementia

Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics. Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search. Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p?psychotics. Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review. Conclusions: In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

Is there life in the old dogs yet? Making break-tests work on financial contagion

Many tests of financial contagion require a definition of the dates separating calm from crisis periods. We propose to use a battery of break search procedures for individual time series to objectively identify potential break dates in relationships between countries. Applied to the biggest European stock markets and combined with two well established tests for financial contagion, this approach results in break dates which correctly identify the timing of changes in cross-country transmission mechanisms. Application of break search procedures breathes new life into the established contagion tests, allowing for an objective, data-driven timing of crisis periods.

One date, one break?

This paper demonstrates that the conventional approach of using official liberalisation dates as the only existing breakdates could lead to inaccurate conclusions as to the effect of the underlying liberalisation policies. It also proposes an alternative paradigm for obtaining more robust estimates of volatility changes around official liberalisation dates and/or other important market events. By focusing on five East Asian emerging markets, all of which liberalised their financial markets in the late, and by using recent advances in the econometrics of structural change, it shows that (i) the detected breakdates in the volatility of stock market returns can be dramatically different to official liberalisation dates and (ii) the use of official liberalisation dates as breakdates can readily entail inaccurate inference. In contrast, the use of data-driven techniques for the detection of multiple structural changes leads to a richer and inevitably more accurate pattern of volatility evolution emerges in comparison with focussing on official liberalisation dates.

Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis:results from the WHO World Health Survey

This study explored whether physical health problems are related to psychotic symptoms independently of a mental disorder diagnosis. A total of 224,254 subjects recruited for the World Health Organization World Health Survey were subdivided into those with both a lifetime diagnosis of psychosis and at least one psychotic symptom in the 12 months prior to the evaluation, those with at least one psychotic symptom in the past 12 months but no lifetime diagnosis of psychosis, and those without psychotic symptoms in the past 12 months and without a lifetime diagnosis of psychosis. The three groups were compared for the presence of medical conditions, health problems, and access to health care. Medical conditions and health problems (angina, asthma, arthritis, tuberculosis, vision or hearing problems, mouth/teeth problems, alcohol consumption, smoking, and accidents), medication consumption, and hospital admissions (but not regular health care visits) were more frequent in individuals with psychotic symptoms but no psychosis diagnosis, compared to those with no symptoms and no diagnosis. The number of medical conditions increased with the number of psychotic symptoms. Given the sample analyzed, this trend seems to be independent from the socio-economic development of the country or the specific health care system.

The continuum of psychotic symptoms in the general population:a cross-national study

OBJECTIVE: To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status. METHOD: The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains. RESULTS: Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55). CONCLUSIONS: The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.

Increased risk of diabetes mellitus among persons with psychotic symptoms:results from the WHO World Health Survey

OBJECTIVE: To analyze with a symptom-based approach the relationship between psychosis and diabetes mellitus in the general population. METHOD: Nationally representative samples from the World Health Organization (WHO) World Health Survey, totaling 224,743 randomly selected adults 18 years and older from 52 countries worldwide, were interviewed to establish the presence of psychotic symptoms and diabetes mellitus. Presence of psychotic symptoms was established using questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Presence of diabetes was established with a response of "yes" to the question, "Have you ever been diagnosed with diabetes (high blood sugar)?" The World Health Survey was conducted between 2002 and 2004. RESULTS: An increasing number of psychotic symptoms was related to increasing likelihood of diabetes mellitus (OR = 1.27; 95% CI, 1.24-1.30). As compared to no symptoms, at least 1 psychotic symptom substantially elevated the risk (OR = 1.71; 95% CI, 1.61-1.81). In people with a lifetime diagnosis of schizophrenia or psychosis, the prevalence of diabetes was higher in those with current psychotic symptoms (7.3% vs 5.2%; OR = 1.65; 95% CI, 1.21-2.26), suggesting that the persistence of symptoms over time could play a central role. After controlling for different potential confounders, there was a clear increase in the probability of having diabetes as the number of psychotic symptoms increased. The relationship between psychotic symptoms and diabetes was tested with multiple mediation models and path analyses for categorical outcomes. Only body mass index appeared as a relevant mediator in a model with a good fit (ie, χ21 = 3.2, P = .0742; comparative fit index = 0.999). CONCLUSIONS: Psychotic symptoms are related to increased rates of diabetes mellitus in nonclinical samples, independent of several potential confounders-including a clinical diagnosis of psychosis or schizophrenia, previous antipsychotic treatment, depression, lifestyle, and individual or country socioeconomic status. The findings highlight the worldwide relevance of the problem and the importance of identifying the specific paths of this association.

Hogyan bonthatók le a látható és láthatatlan falak? – Kooperatív kutatás a megváltozott munkaképességűek foglalkoztatásával kapcsolatos mentális gátak lebontásáról (How to break down the visible and unvisible walls? – A cooperative research about the breaking down of mental barriers of the employment of disabled people)

A szerzők tanulmányukban egy kooperatív kutatási projekt eredményeit mutatják be, melyet emberierőforrás- menedzsment szakos master hallgatókkal folytattak megváltozott munkaképességűek foglalkoztatásával kapcsolatban. Magyarországon rendkívül magas a munkanélküliség a fogyatékkal élők körében, és a szerzők úgy vélik, hogy a HR-szakértőknek kulcsfontosságú szerepük van abban, hogy a foglalkoztatási korlátokat fenntartják-e, vagy változtatnak a jelenlegi helyzeten. A kritikai emberierőforrás-fejlesztés és a kritikai pedagógia hagyományait követve kutatásuk kettős célt tűzött ki. Céljuk volt egyrészt a jövő HRszakembereinek megváltozott munkaképességűek foglalkoztatásával kapcsolatos mentális mintázatainak, attitűdjeinek és hiedelmeinek feltárása, amelyek az elnyomás, diszkrimináció vagy kizsákmányolás gyökerei lehetnek. Másrészt pedig a kooperatív kutatás alkalmazásával a hallgatók emancipációját szándékoztak előmozdítani, továbbá az üzleti felsőoktatást uraló pozitivista filozófiát és értékrendszert kívánták kihívás elé állítani, s ily módon segíteni egy kritikusabb világnézet kibontakozását. ________ In this paper we present the results of a cooperative inquiry research project undertaken with Master students specialized in Human Resource Management on the employment of disabled people. Unemployment among people with disabilities is very high in Hungary and HR professionals have a key role in maintaining or reducing employment barriers and modifying the present situation. Following the tradition of critical Human Resource Development and critical pedagogy, the aim of the research project was twofold. First, we aimed to reveal the mental patterns, attitudes and beliefs of future HR professionals to the employment of people with disabilities, which might become roots causes of domination, discrimination or exploitation. Secondly, through applying cooperative inquiry, researchers aimed to emancipate students and challenge the positivist philosophy and value system which usually dominate business education and thereby engender a more critical worldview.

Értékteremtés e-kereskedelemmel – kitörési lehetőség a recesszió sújtotta magyar kiskereskedelemben? (Value creation of e-commerce – Chance to break out for the recession-hit Hungarian retail sector?)

Kimutatható-e az e-kereskedelem hatása a vállalati teljesítményre a recesszióval küzdő magyar kiskereskedelmi piacon? A hagyományos bolti értékesítés vagy on-line kereskedelem vezet hazánkban jobb pénzügyi teljesítményhez? Ezekre a kérdésekre a magyar IKT (infokommunikációs technológiai) kiskereskedők 187 elemű mintáján igyekeznek a szerzők választ keresni, az adatgyűjtést újszerű módon részben automatizált webpókokra bízva, következtetéseiket pedig elsősorban klaszterelemzési technikákra építve. Megállapítják, hogy bár a legjobb bolti kereskedők többnyire valamivel nagyobb és stabilabb profitrátákkal jellemezhetők a válság éveiben is, a piac megtartása és növelése terén már egyértelműen az e-kereskedők jeleskedtek. Eredményeik szerint az e-kereskedelem hozzásegítheti a kiskereskedőket a munkaerő-hatékonyság növeléséhez is, ám ha gyors rendelkezésre állással vagy alacsony árakkal csábítják vevőiket, akkor a profittöbblet egy részét felőrölheti a magasabb készlettartási igény vagy az árverseny. _____ The study examines whether e-commerce has a significant impact on corporate performance on the Hungarian retail market struggling with the effects of economic downturn. Is it brick-and-mortal retail or e-commerce that leads to a better financial performance? Using the innovative data gathering tools of automotive web crawlers the authors seek answers to these questions on a sample of 187 Hungarian ICT retailers. Based on cluster analysis they conclude that while the best traditional retailers have somewhat higher and more stable profitability ratios even during the years of recession, e-tailers are more successful in retaining and increasing their market share. E-commerce is also associated with higher human resource productivity, but the possible profit surplus originating from this advantage could be jeopardized in the long run as new electronic traders typically attract their customers by shorter service time or lower prices.

Evaluation of a mentored self -help intervention for the management of psychotic symptoms

Cognitive behavioral therapy has been shown to be promising for the treatment of individuals experiencing psychotic symptoms, who are often diagnosed with schizophrenia. Using a non-random non-equivalent comparison group design (n = 26), this study explores whether an individually mentored self-help and self-paced intervention based upon cognitive behavioral approaches to auditory hallucinations or "hearing voices" makes a significant positive difference for individuals with major mental disorder diagnoses and psychotic symptoms who are residing in the community and receiving community mental health services. The mentored self-help intervention uses a workbook (Coleman & Smith, 1997) that stemmed from the British psychiatric survivor and "voice hearers"' movements and from cognitive behavioral approaches to treating psychotic symptoms. Thirty individuals entered the study. Pre- and post-intervention assessments of 15 participants in the intervention group and 11 participants in the comparison group were carried out using standardized instruments, including the Rosenberg Self-Esteem Scale, the Brief Psychiatric Rating Scale, and the Hoosier Assurance Plan Inventory - Adult. Four specific research questions address whether levels of self-esteem, overall psychotic symptoms, depression-anxiety, and disruption in life improved in the intervention group, relative to the comparison group. Pre- and post-assessment scores were analyzed using repeated measures analysis of variance. Results showed no significant difference on any measure, with the exception of the Brief Psychiatric Rating subscale for Anxious Depression, which showed a statistically significant pre-post difference with a strong effect size. A conservative interpretation of this single positive result is that it is due to chance. An alternative interpretation is that the mentored self-help intervention made an actual improvement in the level of depression-anxiety experienced by participants. If so, this is particularly important given high levels of depression and suicide among individuals diagnosed with schizophrenia. This alternative interpretation supports further research on the intervention utilized in this study. ^

Gimme' A Break: Offering Sabbaticals as an Optional Leave Benefit in the Lodging Industry

ABSTRACT The purpose of this study is to investigate the extended leave programs offered by lodging companies in the United States and to suggest a model that could be used in the lodging industry. This model mirrors successful sabbatical leave programs offered by leading companies featured in the annual report, 100 Best Companies to Work For (from this point forward, referred to as 100 Best), published on-line by Fortune Magazine, 2013 (CNN, 2013). While extended leave programs are not entirely lacking in the industry, our research discovered that such leave systems are rare. According to the companies investigated that offer a sabbatical leave program, this benefit offers highly sought after time away from work for top performing employees at the management and higher levels. The benefits reported include happier employees who have increased feelings of company loyalty, job satisfaction, and overall better attitudes. The sponsoring companies stated that those who take part in such leave contribute at a higher level upon their return, bringing fresh ideas and a renewed commitment to the company’s success.

Tequila at Sunrise: Spring Break Travel Motivations and Risk Behaviors of American Students in Acapulco, Mexico

Little research has been completed regarding spring break motivations and behaviors of American students in foreign destinations, specifically in Mexico. This paper looks at push and pull motivations in relation to drug and alcohol consumption and findings indicate greater drug and alcohol use among those who selected “party reputation” and “to go wild” as travel motivations. Binge drinking, sexual activity, and drug use among students on spring break in Acapulco, Mexico were also analyzed and compared to past findings within the United States. Results suggest that students are involved in heavy alcohol consumption and significant drug use. Additionally, high rates of sexual activity occur on spring break and results suggest low condom use, placing students at higher risks for the contraction of sexually transmitted infections.

Looking At Residents’ Attitudes towards Spring Break Tourism in Texas through the Lens of Community Attachment

The growth of spring break tourism in many destinations has become problematic, predominantly due to the excessive behaviour of college students. This paper examines residents’ attitudes toward spring break tourism in South Padre Island (located in Texas, USA) through the lens of community attachment. By understanding the attitudes of residents of the host communities, tourism planners and policy-makers can create policies to shape the character of tourism according to the residents’ needs. The findings suggest that, at this point in time, community residents perceive that the benefits of spring break tourism benefits exceed its’ costs. Also, the short and intense season of spring break tourism allows residents to better deal with social costs.

Gondwana break-up related magmatism in the Falkland Islands

Peer reviewed

Gondwana break-up related magmatism in the Falkland Islands

Peer reviewed