Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

La biblioteca recombinada: portals i persones

Aquest article explora el disseny i l'ús dels portals en un entorn bibliotecari. Tracta les motivacions per construir portals, així com l'estructura i la tipologia d'aquests. A més, examina l'entorn de l'usuari en què es desenvolupen aquests portals. També argumenta que aporten serveis útils d'integració i presentació, però que s'han de considerar com a component d'un conjunt de serveis més ampli que la biblioteca està construint per tal d'introduir aquests recursos útils als usuaris. Així mateix, considera breument els serveis que els portals ofereixen: consulta distribuïda o metacerca, personalització, demandes, resolució OpenURL, avisos, etc. També considera l'emergent necessitat de serveis de directori o de registre per a coses com la descripció de col·leccions i serveis, dades de drets i polítiques, etc. Tracta l'impacte dels serveis web i el canvi en els models d'investigació i aprenentatge en relació al subministrament i ús d'informació en xarxa. Finalment, considera els serveis bibliotecaris com a part d'un entorn de sistemes, cada vegada més ric, que inclou els sistemes de gestió d'aprenentatge i de programari educatiu, portals de campus, serveis compartits com l'autenticació, i altres sistemes i serveis.

An Inquiry Into The Theory, Causes And Consequences Of Monitoring Indicators Of Health And Safety At Work

This paper engages in an interdisciplinary survey of the current state of knowledge related to the theory, determinants and consequences of occupational safety and health (OSH). First, it synthesizes the available theoretical frameworks used by economists and psychologists to understand the issues related to the optimal provision of OSH in the labour market. Second, it reviews the academic literature investigating the correlates of a comprehensive set of OSH indicators, which portray the state of OSH infrastructure (social security expenditure, prevention, regulations), inputs (chemical and physical agents, ergonomics, working time, violence) and outcomes (injuries, illnesses, absenteeism, job satisfaction) within workplaces. Third, it explores the implications of the lack of OSH in terms of the economic and social costs that are entailed. Finally, the survey identifies areas of future research interests and suggests priorities for policy initiatives that can improve the health and safety of workers.

Social Housing Policies in Latin America and Singapore: Lessons for China

This paper addresses the challenges facing China in accelerating the pace of rural-urban migration as part of its on-going economic development programme. It explains the push and pull influences on migration and in particular explains why a continuing focus on urbanisation is justified by the very large gap between rural and urban incomes and the relatively higher income elasticity of demand for urban-based goods and services. The provision of affordable housing is an integral part of this structural shift programme. The paper thus considers the most appropriate ways in which housing finance can be mobilised, and thence how both the quality and the affordability of the housing stock can be increased. Positive and negative lessons for China are offered from the different urbanisation experiences of Latin America (especially Colombia) and Singapore.

Asset Prices, Business Cycles, and Markov-Perfect Fiscal Policy when Agents are Risk-Sensitive

We study a business cycle model in which a benevolent fiscal authority must determine the optimal provision of government services, while lacking credibility, lump-sum taxes, and the ability to bond finance deficits. Households and the fiscal authority have risk sensitive preferences. We find that outcomes are affected importantly by the household's risk sensitivity, but not by the fiscal authority's. Further, while household risk-sensitivity induces a strong precautionary saving motive, which raises capital and lowers the return on assets, its effects on fluctuations and the business cycle are generally small, although more pronounced for negative shocks. Holding the stochastic steady state constant, increases in household risk-sensitivity lower the risk-free rate and raise the return on equity, increasing the equity premium. Finally, although risk-sensitivity has little effect on the provision of government services, it does cause the fiscal authority to lower the income tax rate. An additional contribution of this paper is to present a method for computing Markov-perfect equilibria in models where private agents and the government are risk-sensitive decisionmakers.

The Electoral Determinants of Collective Remittances: The Mexican 3x1 Program for Migrants

The 3x1 Program for Migrants is a matching grant scheme that seeks to direct the money sent by migrant organizations abroad to the provision of public and social infrastructure, and to productive projects in migrants’ communities of origin. To do so, the municipal, state, and federal administrations match the amount sent by hometown associations by 3 to 1. This opens the door to the political manipulation of the program. We explore the impact of a particular facet of Mexican political life on the operation of the 3x1: its recent democratization and the increasing political competition at the municipal level. Relying on the literature on redistributive politics, we posit that an increasing number of effective parties in elections may have two different effects. On the one hand, the need to cater to more heterogeneous constituencies may increase the provision of public projects. On the other hand, since smaller coalitions are needed to win elections under tighter competition, fewer public and more private (clientelistic) projects could be awarded. Using a unique dataset on the 3x1 Program for Migrants for over 2,400 municipalities in the period 2002 through 2007, we find a lower provision of public goods in electorally competitive jurisdictions. Thus, we remain sceptical about the program success in promoting public goods in politically competitive locations with high migration levels.

Current concepts of snail control

Schistosomiasis control was impossible without effective tools. Synthetic molluscicides developed in the 1950s spearheaded community level control. Snail eradication proved impossible but repeated mollusciciding to manage natural snail populations could eliminate transmission. Escalating costs, logistical complexity, its labour-intensive nature and possible environmental effects caused some concern. The arrival of safe, effective, single-dose drugs in the 1970s offered an apparently better alternative but experience revealed the need for repeated treatments to minimise reinfection in programmes relying on drugs alone. Combining treatment with mollusciciding was more successful, but broke down if mollusciciding was withdrawn to save money. The provision of sanitation and safe water to prevent transmission is too expensive in poor rural areas where schistosomiasis is endemic; rendering ineffective public health education linked to primary health care. In the tropics, moreover, children (the key group in maintaining transmission) will always play in water. Large scale destruction of natural snail habitats remains impossibly expensive (although proper design could render many new man-made habitats unsuitable for snails). Neither biological control agents nor plant molluscicides have proved satisfactory alternatives to synthetic molluscicides. Biologists can develop effective strategies for using synthetic molluscicides in different epidemiological situations if only, like drugs, their price can be reduced.

Repeated Interaction and the Revelation of the Monitor's Type: A Principal-Monitor-Agent Problem

This paper studies a dynamic principal-monitor-agent relation where a strategic principal delegates the task of monitoring the effort of a strategic agent to a third party. The latter we call the monitor, whose type is initially unknown. Through repeated interaction the agent might learn his type. We show that this process damages the principal's payoffs. Compensation is assumed exogenous, limiting to a great extent the provision of incentives. We go around this difficulty by introducing costly replacement strategies, i.e. the principal replaces the monitor, thus disrupting the agent's learning. We found that even when replacement costs are null, if the revealed monitor is strictly preferred by both parties, there is a loss in efficiency due to the impossibility of bene…tting from it. Nonetheless, these strategies can partially recover the principal's losses. Additionally, we establish upper and lower bounds on the payoffs that the principal and the agent can achieve. Finally we characterize the equilibrium strategies under public and private monitoring (with communication) for different cost and impatience levels.

IPH response to Northern Ireland Utility Regulator's Social Action Plan 2009-2014

IPH welcomes the Regulator’s Social Action Plan as one of a range of policy measures needed to tackle escalating fuel poverty in Northern Ireland. The Social Action Plan relates to how energy suppliers and networks respond to the needs of vulnerable customers. The submission discusses the definition of vulnerable customers used by energy suppliers and calls for special consideration of householders with multiple vulnerabilities. IPH also calls for special attention to be paid to the development of appropriate social tarrifs and supports for debt management. Key messages •    The Institute of Public Health in Ireland (IPH) views this social action plan as a welcome contribution to the range of policy measures needed to tackle escalating fuel poverty in Northern Ireland. •    The activities and ethos of energy suppliers plays a significant role in alleviating fuel poverty and the threats posed to health when living in a cold, damp and energy inefficient home. •    IPH shares the view of the World Health Organisation that more evidence is needed to demonstrate the real impact of corporate social responsibility in the provision of goods and services vital to health and well-being, such as fuel and water.

IPH response to the HIQA consultation on the National Demographic Dataset and Guidance for use in health and social care settings in Ireland

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. IPH have previously responded to consultations to the Department of Health’s Discussion Paper on the Proposed Health Information Bill (June 2008), the Health Information and Quality Authority on their Corporate Plan (Oct 2007), and the Road Safety Authority of Ireland Road Safety Strategy (Jul 2012). IPH supports the development of a national standard demographic dataset for use within the health and social care services. Provided necessary safeguards are put in place (such as ethics and data protection) and the purpose of collecting the information is fully explained to subjects, mandatory provision of a minimum demographic dataset is usually the best way to achieve the necessary coverage and data quality. Demographic information is needed in several forms to support the public health function: Detailed aggregated information for comparison to population counts in order to assess equity of access to healthcare as well as examining population patterns and trends in morbidity and mortality Accurate demographic information for the surveillance of infectious disease outbreaks, monitoring vaccination programmes, setting priorities for public health interventions Linked to other data outside of health and social care such as population data, survey data, and longitudinal studies for research and analysis purposes.   Identify and address public health issues to tackle health inequalities, and to monitor the success of such efforts to tackle them.

Developing Eyecare Partnerships

Improving the Commisioning and Provision of Eyecare Services in Northern Ireland.

Regional Advisory Committee on Cancer - Report on Endocrine Cancer (September 2004) (PDF 144 KB)

There is already a good infrastructure for the management of endocrine cancer in Northern Ireland but to develop and strengthen it we recommend the following: • Increasing the already close cooperation between the individual parts of the service for endocrine cancer by use of shared protocols for assessment and follow up: • The main hub of management should remain at the RGH focussed on The Regional Centre for Endocrinology and Diabetes and the Endocrine Surgery department where there has been a long-term interest in the management of these patients. This includes a close working relationship between the endocrinologists and surgeon at the Belfast City Hospital. • This does not suggest that current developments of shared follow-up should not be encouraged. They should but with the provision of adequately resourced registers to allow adequate audit and to ensure adequate assessment of follow-up attendance. The issues regarding informed consent for such registers are currently being discussed for all forms of cancer. In the rarer conditions follow-up should remain central to allow adequate numbers and experience to maintain internationally recognisable outcomes and to allow training of future specialists to continue åÊ

Informatització d'una empresa tradicional

Aquest projecte consisteix en la informatització d'una empresa tradicional dedicada a la fabricació i venda de productes de pastisseria. El projecte es divideix en dos parts essencials: millora i dotació de la nova xarxa informàtica amb tots el serveis necessaris pels nous requeriments de creixement de l'empresa en l’obertura de nous punts de venda i la seva gestió, i proporcionar presència a Internet, a través d’una botiga on‐line.

A palliative care needs assessment for children

The development of a children’s hospice is not seen as a priority by the respondents in this study, some of whom raised concerns regarding accessibility and cost. There is a degree of ambiguity however, regarding the role of ‘hospice’ in paediatric palliative care with some respondents associating it only with end-of-life care. There is a substantial need for ongoing education, training and development of healthcare professionals caring for children with life-limiting conditions. Palliative care services currently provided to children in Ireland with life-limiting conditions are seen to be inequitable, differing significantly according to diagnosis (malignant versus nonmalignant) and according to geographic location. This poses challenges, particularly for parents of children with non-malignant diseases. Both families and professionals often deem the physical environment for adolescents in hospitals unsuitable. The difficulties encountered in the transition from children’s services to adult services have been identified as an issue for adolescents. The provision of bereavement support varies between services. Professionals have identified the need for a broader range of bereavement services.

North South Survey of Children's Oral Health 2002

North South Survey of Children’s Oral Health 2002 This report presents the results of the first contemporaneous North South study of the oral health of children and adolescents on the island of Ireland. The last National Survey of Childrenâ?Ts Oral Health in the Republic of Ireland was carried out in 1984. The present study describes the oral health experience of children and adolescents in Ireland today. The results are of interest to the public, to policymakers and to service providers and will be of assistance in the evaluation of current oral health services and the planning of services for the next decade. Click here to download PDF 666kb