Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units : a register study over 10 years

Objective: There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. Design, setting and participants: This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. Results: From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). Conclusions: In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

Richard Yates: re-writing postwar American culture

This thesis explores the fiction of American author Richard Yates to propose that his work provides an insistent questioning and alternative vision of postwar American culture. Such an approach is informed by a revisionist account of four distinct yet interconnected areas of postwar culture: the role of the non-heroic soldier stepping in and out of World War II; suburbanisation and fashioning of anti-suburban performance; demarcation of gender roles and unraveling of sexual conservatism in the 1950s; consideration of what constituted the normative within postwar discourse and representations of mental illness in Yates’ work. These four spheres of interest form the backbone to this study in its combined aim of reclaiming Yates’ fiction in line with a more progressive historical framework while shaping a new critical appreciation of his fiction. Such analysis will be primed by an opening discussion that illustrates how Yates’ fiction has frequently been ensconced in a limited interpretative lens: an approach, that I argue, has kept Yates on the periphery of the canon and ultimately resulted in the neglect of an author who provided a rich, progressive and historically significant dialogue of postwar American life. This PhD arrives at a point when Yatesian scholarship is finally gaining momentum after the cumulative impact of a comprehensive biography, a faithful film adaptation of his seminal text Revolutionary Road (1961), plus the recent re-issue of his catalogue of work. An assessment as to why he remained on the margins of success for the duration of his career is therefore of pressing interest in light of this recent critical and commercial recognition.

Depresión en pacientes con epilepsia: Revisión sistemática de la literatura

Esta revisión sistemática de la literatura tuvo como objetivo investigar sobre la depresión en personas con epilepsia en la última década (2005-2015), enfocándose en identificar en el paciente con epilepsia: características sociodemográficas, prevalencia de la depresión, tipos de intervención para el manejo de la depresión, factores asociados con la aparición y el mantenimiento de la depresión y por último, identificar las tendencias en investigación en el estudio de la depresión en pacientes con epilepsia. Se revisaron 103 artículos publicados entre 2005 y 2015 en bases de datos especializadas. Los resultados revelaron que la prevalencia de depresión en pacientes con epilepsia es diversa y oscila en un rango amplio entre 3 y 70 %, por otro lado, que las principales características sociodemográficas asociadas a la depresión está el ser mujer, tener un estado civil soltero y tener una edad comprendida entre los 25 y los 45 años. A esto se añade, que los tratamientos conformados por terapia psicológica y fármacos, son la mejor opción para garantizar la eficacia en los resultados del manejo de la depresión en los pacientes con epilepsia. Con respecto a los factores asociados a la aparición de la depresión en pacientes con epilepsia, se identificaron causas tanto neurobiológicas como psicosociales, asimismo los factores principales asociados al mantenimiento fueron una percepción de baja calidad de vida y una baja auto-eficacia. Y finalmente los tipos de investigación más comunes son de tipo aplicado, de carácter descriptivo, transversales y de medición cuantitativa.

Aportes a la revisión de literatura sobre la relación entre el arte y la psicosis desde una perspectiva psicoanalítica.

El presente trabajo tiene como propósito hacer una revisión crítica de dos de los trabajos más relevantes que abordan la relación entre salud mental y arte, a saber: Artistry of the Mentally Ill, de Hans Prinzhorn (1922/1972) y Madness and Art, de Walter Morgenthaler (1921/1992). Para ello, se presenta primero un recuento de estos textos, y en un segundo momento, su respectivo análisis. De esta manera, llevo a cabo una revisión crítica de los ya mencionados libros a la luz de diferentes teorías psicoanalíticas que abordan algunos temas cruciales dentro de esta relación, como lo son la psicosis, y desde otras perspectivas, el arte marginal y la creatividad, aportando así a la investigación teórica de este tema particular.

Accompanied selfrehabilitation

"Every once in a great while, there arises a young psychiatrist with entirely new rehabilitation ideas for helping patients retrieve their lives from psychosiso Usually such ideas initially cause significant negative reactions from peers but a handful of sturdy physicians continued on to show the world that something different is possible such as George Brooks of Vermont in the U.S., E.E. Antinnen of Finland, and Franco Basaglia of Italy. Now we have to add to this illustrious list, the name of Alberto Fergusson of Colombia, South America". (Extrae of the "Forward") Prof Courtenay M. Harding

Cartas imaginarias a Freud y otros ensayos

"Las cinco cartas imaginarias a Freud recogidas en este libro son su columna vertebral y los efectos que producirán en la comunidad psicoanalítica están aún por verse. Pero las cartas no agotan los aportes de esta obra. Alberto Fergusson, médico, psiquiatra y psicoanalista, tiene toda una historia vital dedicada al estudio y el tratamiento de pacientes psicóticos. En los años ochenta creó el Instituto de Autorrehabilitación Acompañada, inspirado en las premisas del freudomarxismo de la Escuela de Frankfurt y en el mal llamado "movimiento antipsiquiátrico" (mal llamado en la medida en que no se opone a la psiquiatría, sino más bien a una mala práctica psiquiátrica) y en los trabajos y experiencias de Laing, Cooper, Basaglia y Szasz. La materialización de los conceptos del Instituto se produjo en una singular experiencia denominada Fungrata, pero conocida en el mundo académico y profesional como "La granja". Esa institución, pionera en nuestro país, sigue produciendo asombro en varias partes del mundo por haber llegado, desde ya hace décadas, adonde muchos otros dispositivos dedicados a la intervención psicosocial con pacientes psicóticos hoy aspiran llegar". (Extracto del "prólogo") Miguel Gutiérrez-Peláez

Solastalgia y conductas pro-ambientales en un conflicto socioambiental por la construcción de una hidroeléctrica

Introducción: La construcción de megaproyectos hídricos implica una reconfiguración territorial donde se ven afectadas las fuentes de agua dulce, la biodiversidad terrestre y acuática, y los asentamientos humanos que colindan con dichas construcciones. Objetivo: estimar la asociación entre las conductas proambientales con la solastalgia entre las personas que se encuentran ejerciendo un proceso de resistencia social contra la Central Hidrosogamoso en el departamento de Santander, Colombia. Metodología: se utilizó un diseño de estudio transversal en el que se entrevistaron integrantes y no integrantes de grupos ambientalistas de las zonas de influencia del proyecto. Se realizó un análisis descriptivo de las variables sociodemográficas de los dos grupos de comparación presentando frecuencias absolutas y relativas y diferencias significativas por medio de la prueba ji cuadrado, exacta de Fisher y U de Mann Whitney. Se utilizó un modelo de regresión lineal múltiple en el que la variable dependiente fue el puntaje de solastalgia y las variables independientes fueron las escalas de las conductas proambientales: altruismo, austeridad, equidad, conducta ecológica, deliberación, indignación y aprecio por lo natural, además, se ajustó por algunas variables sociodemográficas de interés. Resultados: los grupos comparados presentaron diferencias importantes en cuanto a la zona de procedencia, condiciones económicas y organización social. El incremento de 5 puntos en la escala del sentimiento de indignación incrementó 0.98 la escala de solastalgia (IC95%: 0.19; 1.78). Las personas sin pareja estable tuvieron 3.02 puntos menos de solastalgia comparadas con personas casadas o en unión libre (IC95%: -4.96; -1.44), mientras que aquellas con alto nivel educativo obtuvieron 2.02 puntos menos que las personas con primaria y bachillerato (IC95%: -3.99; -0.06). Un modelo alterno mostró que no pertenecer a un grupo ambientalista disminuye en 2.29 puntos la solastalgia, comparado con pertenecer a un grupo (IC95%: -4.31; -0.28),. Conclusión: posiblemente las motivaciones por las cuales los actores involucrados se resisten a las transformaciones territoriales ocasionadas por la construcción de las represas son más un reflejo de la condición socioeconómica que de la preocupación de los actores por el daño del medio ambiente y además, esta resistencia es un fenómeno que se limita a aquellos que están afectados directamente en el área de influencia del proyecto

Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk

Although suicidality is associated with mental illness in general and depression in particular, many depressed individuals do not attempt suicide and some individuals who attempt to or do die by suicide do not present depressive symptoms. This article aims to contribute to a more psychosocial approach to understanding suicide risk in nonclinical populations. In advocating a psychosocial perspective rather than a depression-focused approach, this article presents four diverse studies that demonstrate sampling and measurement invariance in findings across different populations and specific measures. Study 1 tests the mediation effects of 2 interpersonal variables, thwarted belongingness and perceived burdensomeness, in the association between depressive symptoms and recent suicidality. Studies 2 and 3 evaluate the contribution of hopelessness and psychache, beyond depressive symptoms, to suicidality. Study 4 tests the contribution of life events behind depressive symptoms, and other relevant sociodemographic and clinical variables, to the estimation of “future suicidality.” Overall, results demonstrate that depressive symptoms do not directly predict suicidality in nonclinical individuals, but that other psychosocial variables mediate the association between depressive symptoms and suicidality or predict suicidality when statistically controlling for depressive symptoms. The article contributes to understanding some of the nonpsychopathological factors that potentially link depressive symptoms to suicide risk and that might themselves contribute to suicidality, even when controlling for depressive symptoms.

La fede assoluta. Monomania religiosa, medicina legale e diritto penale nell'Italia postunitaria

Questo studio si concentra su tre direttrici fondamentali: la monomania religiosa, la medicina legale e il diritto penale nell'Italia postunitaria. Nell’ambito di un contesto temporale ben definito, i cui estremi cronologici coincidono con l’Unificazione italiana (1861) e con i primi anni del XX secolo, si sono approfondite le numerose implicazioni mediche e giuridiche della malattia mentale nella forma di monomania religiosa. In particolare, prendendo spunto da una serie di condotte criminali frutto di suggestione religiosa o di deliri ascetici in soggetti diagnosticati come ‛monomani’, si sono indagati i risvolti giuridico-processuali di alcune vicende fortemente rappresentative di tali percorsi. L'ampia documentazione d'archivio recuperata consente di verificare l'orientamento della magistratura all'indomani dell'entrata in vigore del Codice penale per il Regno d'Italia (1889). Nei casi esaminati, alla diagnosi di alienazione mentale degli imputati seguiva la dichiarazione di non imputabilità e l'affidamento degli stessi all'Autorità amministrativa che ne disponeva il ricovero in manicomio.

The burden of mental disorders: a comparison of methods between the Australian burden of disease studies and the Global Burden of Disease study

The national and Victorian burden of disease studies in Australia set out to examine critically the methods used in the Global Burden of Disease study to estimate the burden of mental disorders. The main differences include the use of a different set of disability weights allowing estimates in greater detail by level of severity, adjustments for comorbidity between mental disorders, a greater number of menta I disorders measured, and model ling of substance use disorders, anxiety disorders and bipolar disorder as chronic conditions. Uniform age-weighting in the Australian studies produces considerably lower estimates of the burden due to mental disorders in comparison with age-weighted disability-adjusted life years. A lack of follow-up data on people with mental disorders who are identified in cross-sectional surveys poses the greatest challenge in determining the burden of mental disorders more accurately.

The role of economic evaluation in mental health care

Objective: A consequence of the integration of psychiatry into acute and public health medicine is that psychiatrists are being asked to evaluate their services. There is pressure on mental health-care systems because it is recognized that funds should be directed where they can provide the best health outcomes, and also because there are resource constraints which limit our capacity to meet all demands for health care. This pressure can be responded to by evaluation which demonstrates the effectiveness and efficiency of psychiatric treatment. This paper seeks to remind psychiatrists of the fundamental principles of economic evaluation in the hope that these will enable psychiatrists to understand the methods used in evaluation and to work comfortably with evaluators. Method: The paper reviews the basic principles behind economic evaluation, illustrating these with reference to case studies. It describes: (i) the cost of the burden of illness and treatment, and how these costs are measured; (ii) the measurement of treatment outcomes, both as changes in health status and as resources saved; and (iii) the various types of economic evaluation, including cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis. Results: The advice in the paper provides psychiatrists with the necessary background to work closely with evaluators. A checklist of the critical questions to be addressed is provided as a guide for those undertaking economic evaluations. Conclusions: If psychiatrists are willing to learn the basic principles of economic evaluation and to apply these, they can respond to the challenges of evaluation.

AGE DIFFERENCES IN THE PREVALENCE AND CO-MORBIDITY OF DSM-IV MAJOR DEPRESSIVE EPISODES: RESULTS FROM THE WHO WORLD MENTAL HEALTH SURVEY INITIATIVE

Background: Although depression appears to decrease in late life, this could be due to misattribution of depressive symptoms to physical disorders that increase in late we. Methods: We investigated this issue by studying age differences in co-morbidity of DSM-IV major depressive episodes (MDE) with chronic physical conditions in the WHO World Mental Health (WMH) surveys, a series of community epidemiological surveys of respondents in 10 developed countries (n = 52,485) and 8 developing countries (n = 37,265). MDE and other mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). Organic exclusion rules were not used to avoid inappropriate exclusion of cases with physical co-morbidity. Physical conditions were assessed with a standard chronic conditions checklist. Results: Twelve-month DSM-IV/CIDI MDE was significantly less prevalent among respondents ages 65+ than younger respondents in developed but not developing countries. Prevalence of co-morbid mental disorders generally either decreased or remained stable with age, while co-morbidity of MDE with mental disorders generally increased with age. Prevalence of physical conditions, in comparison, generally increased with age, while co-morbidity of MDE with physical conditions generally decreased with age. Depression treatment was lowest among the elderly in developed and developing countries. Conclusions: The weakening associations between MDE and physical conditions with increasing age argue against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. Future study is needed to investigate processes that might lead to a decreasing impact of physical illness on depression among the elderly. Depression and Anxiety 27:351-364, 2010. (C) 2009 Wiley-Liss, Inc.

Psychologists as mental health case managers

The results of two independent surveys of professionals working in government-funded adult community mental health services were examined with a view to considering how psychologists rate their capacities as mental health case managers. Professional competency and personal efficacy self-report profiles for psychologists were compared with those of other professionals in related roles. The results obtained suggested that psychologists identified their strengths as being in traditional practice roles as individual clinicians. Relative to other professions, psychologists reported weaknesses in team and community-focused practice roles. The implications for professional practice and training are discussed.