Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

[EN] Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.

The Blue Of

When I first started my thesis, I intended for my finished project to be a compilation of poems that aims to reflect and reveal several repeating themes of our society's collective unconscious, such as the relationship between the physical and spiritual aspects of being and the representation of women's lives, organized religion,adolescence, and mental illness. I proposed writing a chapbook of poetry that reflects an exploration of, and sensitivity to, the human unconscious mind, fears, and desires. Consulting other works of surreal, lyric, and confessional poetry, I sought to personallydevelop as both a poet and a psychology student. I made a conscious effort to avoid trying to attach a specific 'meaning' to each poem. I understand that, in poetry, the reader is never entirely aware of exactly what the poet is trying to convey. All the reader knows is what he or she sees in a given poem and how he or she responds to that poem. However, through working on my thesis I discovered that, while meaning may not be intentional in the drafting process, developing what the poem meant to me was central to the process of revision. Furthermore, I realized that I unconsciously returned to specific themes across various poems, something that was not apparent to me until I re-read my entire collection ...

Changing ‘Multi-Problem Families’ – Developing a Multi-Contextual Systemic Approach

Over the past 30 years the Marlborough Family Service in London has pioneered multi-family work with marginalized families presenting simultaneously with abuse and neglect, family violence, substance misuse, educational failure and mental illness. The approach is based on a systemic multi-contextual mode and this chapter describes the evolving work, including the establishment of the first permanent multiple family day setting, specifically designed for and solely dedicated to the work with seemingly ‘hopeless’ families. The ingredients of ‘therapeutic assessments’ of parents and families are outlined and the importance of initial network meetings with professionals and family members is emphasized.

Percepção de professores sobre a influência genética e ambiental em comportamentos relevantes no processo educacional

Como as pessoas percebem as outras é relevante no processo de ensino aprendizagem e nas interações sociais como um todo. Essas percepções definem a maneira com que as pessoas reagem umas às outras. Em particular, a avaliação da percepção de professores colabora na compreensão das atitudes do professor diante dos comportamentos de seus alunos. O objetivo do presente estudo foi avaliar a percepção de professores sobre a influência genética e ambiental em comportamentos relevantes no processo educacional: personalidade, inteligência, dificuldades de aprendizagem, problemas de comportamento e doenças mentais. Para tanto, o questionário The NatureNurture Question:Teachers perceptions of how genes and the environment influence educationally relevant behavior foi adaptado à língua portuguesa do Brasil e aplicado para 501 professores de todos os níveis de ensino, do estado de São Paulo. Os resultados demonstraram que os professores atribuíram influências genéticas e ambientais em proporções aproximadamente iguais considerando todos os domínios, personalidade e dificuldades e aprendizagem. Atribuíram maior influência genética à inteligência e doenças mentais, bem como maior influência ambiental aos problemas de comportamento. Metade dos participantes afirmou ter estudado aspectos da genética em sua formação para professor. A maioria dos professores declarou que ter um aluno com dificuldade de aprendizagem geneticamente influenciada afetaria seu método de instruí-lo. Os professores percebem que genes e ambiente criação são imprescindíveis nos comportamentos de seus alunos, reconhecendo, inclusive, a interatividade dos dois fatores, informações importantes para o delineamento de ações na formação dos mesmos possíveis intervenções no âmbito educacional.

Marginalised Mothers: Exploring Working Class Experiences

Successive moral panics have cast poor or socially excluded mothers - associated with social problems as diverse as crime, underachievement, unemployment and mental illness - as bad mothers. Their mothering practices are held up as the antithesis of good parenting and are associated with poor outcomes for children. Marginalised Mothers provides a detailed and much-needed insight into the lived experience of mothers who are frequently the focus of public concern and intervention, yet all too often have their voices and experiences overlooked. The book explores how they make sense of their lives with their children and families, position themselves within a context of inequality and vulnerability, and resist, subvert and survive material and social marginalisation. This controversial text uses qualitative data from a selection of working class mothers to highlight the opportunities and choices they face and to expose the middle class assumptions that ground much contemporary family policy. It will be of interest to students and researchers in sociology, social work and social policy, as well as social workers and policymakers.

Headline Annual Report 2007

Headline is Ireland's national media monitoring programme, working to promote responsible and accurate coverage of mental health and suicide related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage.

Headline Annual Report 2008

Headline is Ireland's national media monitoring programme, working to promote responsible and accurate coverage of mental health and suicide related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage.

Headline Annual Report 2010

Headline is Ireland's national media monitoring programme, working to promote responsible and accurate coverage of mental health and suicide related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage.

Headline Annual Report 2011

Headline is Ireland's national media monitoring programme, working to promote responsible and accurate coverage of mental health and suicide related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage.

Headline Annual Report 2012

Headline is Ireland's national media monitoring programme, working to promote responsible and accurate coverage of mental health and suicide related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage.

Headline Annual Report 2013

Headline is Ireland's national media monitoring programme, working to promote responsible and accurate coverage of mental health and suicide related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage.

Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys

Background Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders. Aims To examine joint associations of 12 childhood adversities with first onset of 20 DSM-IV disorders in World Mental Health (WMH) Surveys in 21 countries. Method Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM-IV disorders with the WHO Composite International Diagnostic Interview (CIDI). Results Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries. Conclusions Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

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.

Effects of a mental health training program on health care worker's knowledge and attitude and practice in Belize

ABSTRACT This study was conducted to assess mental health knowledge, attitude and practices among health care workers in Belize before and immediately after a competency based training program in mental health. A baseline Knowledge, Attitudes and Practices (KAP) survey was given to health personnel, mainly nurses, working primary and secondary care. The intervention was a 13-week face-to-face training course for health care professionals with the objective of increasing their competency in mental health and reducing stigma. After the training a post intervention KAP survey was conducted among the original respondents. 88 health care workers completed the baseline survey and 61 of those respondents completed the post-intervention questionnaire. The results showed that the level of knowledge of the participants had improved by the training intervention and that in general, the intervention was effective in correcting some misconceptions about mental illness and reducing stigmatizing attitudes among the participants.