Differential effectiveness of integrated cognitive remediation therapy for schizophrenbia outpatients: The impact oft he duration of illness

Background Nowadays there is extensive evidence available showing the efficacy of cognitive remediation (CR). To date, only limited evidence is available about the impact of the duration of illness on CR effects. The Integrated Neurocognitive Therapy (INT) represents a new developed CR approach. It is a manualized group therapy targeting all 11 NIMH-MATRICS domains. Methods In an international multicenter study, 166 schizophrenia outpatients (DSM-IV-TR) were randomly assigned either to INT or to Treatment-As-Usual (TAU). 60 patients were defined as Early Course group (EC) characterized by less than 5 years of illness, 40 patients were in the Long-Term group (LT) characterized by more than 15 years of illness, and 76 patients were in the Medium-Long-Term group (MLT) characterized by an illness of 5-15 years. Treatment comprised of 15 biweekly sessions. Assessments were conducted before and after treatment and at follow up (1 year). Multivariate General Linear Models (GLM) examined our hypothesis, whether EC, LT, and MLT groups differ under INT and TAU from each other in outcome. Results First of all, the attendance rate of 65% was significantly lower and the drop out rate of 18.5% during therapy was higher in the EC group compared to the other groups. Interaction effects regarding proximal outcome showed that the duration of illness has a strong impact on neurocognitive functioning in speed of processing (F>2.4) and attention (F>2.8). But INT intervention compared to TAU only had a significant effect in more chronically ill patients of MLT and LT, but not in younger patients in EC. In social cognitive domains, only the EC group showed a significant change in attribution (hostility; F>2.5), LT and MLT groups did not. However, no differences between the 3 groups were evident in memory, problem solving, and emotion perception. Regarding more distal outcome, LT patients had more symptoms compared to EC (F>4.4). Finally, EC patients showed higher improvements in psychosocial functioning compared to LT and MLT (F=1.8). Conclusions Against common expectations, long-term, more chronically ill patients showed higher effects in basal cognitive functions compared to younger patients and patients without any active therapy (TAU). On the other hand, early-course patients had a greater potential to change in attribution, symptoms and psychosocial functioning. Consequently, more integrated therapy offers are also recommended for long-term course schizophrenia patients.

Spirituality of Thai Buddhists with chronic cardiovascular disease

Background. Advances in medical technology contribute to the survival rate of a growing number of persons with chronic illnesses. Individuals with chronic cardiovascular disease (chronic CVD) are among other chronically ill persons who add to the need for healthcare services. They need to cope and live with the chronic conditions and find a new balance to make sense of their lives. Thai Buddhists with chronic CVD may use their religious resources to cope with their illnesses because religious beliefs are reflected in patterns of living. The aims of the study were to: (a) explore how Thai Buddhists with chronic CVD construct the spiritual aspects of the illness experience, (b) explore how Thai Buddhists with chronic CVD may use their spiritual/religious resources as a means of coping with the illness, and (c) explore the impacts of spiritual/religious beliefs and/or practices on the daily lives of Thai Buddhists with chronic CVD. ^ Methods. Ethnography was employed and data were collected from December 1, 2007 to May 31, 2008 using in-depth interviews with 20 participants. Field notes were also recorded. ^ Findings. Three categories emerged from the study data: set of spiritual and biomedical beliefs and practices, integrated meanings, and positive consequences of the integration of spiritual and biomedical beliefs and practices. ^ Conclusions. The findings of the study suggest the importance of understanding and integrating spiritual needs into care of patients with chronic CVD. The findings revealed that the participants constructed ideas of their illness and meanings for living and coping with the illness, and integrated spiritual and biomedical beliefs and practices, resulting in positive outcomes. Further research could test interventions which facilitate such coping; for example, using reflective thinking and group support. Other studies might explore how age affects Buddhist views of the illness. ^

THE USE OF ARM CIRCUMFERENCE FOR SIMPLIFIED SCREENING FOR MALNUTRITION BY MINIMALLY TRAINED HEALTH WORKERS

Because of its simplicity and low cost, arm circumference (AC) is being used increasingly in screening for protein energy malnutrition among pre-school children in many parts of the developing world, especially where minimally trained health workers are employed. The objectives of this study were as follows: (1) To determine the relationship of the AC measure with weight for age and weight for height in the detection of malnutrition among pre-school children in a Guatemalan Indian village. (2) To determine the performance of minimally trained promoters under field conditions in measuring AC, weight and height. (3) To describe the practical aspects of taking AC measures versus weight, age and height.^ The study was conducted in San Pablo La Laguna, one of four villages situated on the shores of Lake Atitlan, Guatemala, in which a program of simplified medical care was implemented by the Institute for Nutrition for Central America and Panama (INCAP). Weight, height, AC and age data were collected for 144 chronically malnourished children. The measurements obtained by the trained investigator under the controlled conditions of the health post were correlated against one another and AC was found to have a correlation with weight for age of 0.7127 and with weight for height of 0.7911, both well within the 0.65 to 0.80 range reported in the literature. False positive and false negative analysis showed that AC was more sensitive when compared with weight for height than with weight for age. This was fortunate since, especially in areas with widespread chronic malnutrition, weight for height detects those acute cases in immediate danger of complicating illness or death. Moreover, most of the cases identified as malnourished by AC, but not by weight for height (false positives), were either young or very stunted which made their selection by AC better than weight for height. The large number of cases detected by weight for age, but not by AC (false negative rate--40%) were, however, mostly beyond the critical age period and had normal weight for heights.^ The performance of AC, weight for height and weight for age under field conditions in the hands of minimally trained health workers was also analyzed by correlating these measurements against the same criterion measurements taken under ideally controlled conditions of the health post. AC had the highest correlation with itself indicating that it deteriorated the least in the move to the field. Moreover, there was a high correlation between AC in the field and criterion weight for height (0.7509); this correlation was almost as high as that for field weight for height versus the same measure in the health post (0.7588). The implication is that field errors are so great for the compounded weight for height variable that, in the field, AC is about as good a predictor of the ideal weight for height measure.^ Minimally trained health workers made more errors than the investigator as exemplified by their lower intra-observer correlation coefficients. They consistently measured larger than the investigator for all measures. Also there was a great deal of variability between these minimally trained workers indicating that careful training and followup is necessary for the success of the AC measure.^ AC has many practical advantages compared to the other anthropometric tools. It does not require age data, which are often unreliable in these settings, and does not require sophisticated subtraction and two dimensional table-handling skills that weight for age and weight for height require. The measure is also more easily applied with less disturbance to the child and the community. The AC tape is cheap and not easily damaged or jarred out of calibration while being transported in rugged settings, as is often the case with weight scales. Moreover, it can be kept in a health worker's pocket at all times for continual use in a widespread range of settings. ^

THE RELATIONSHIP OF PRESCRIPTION RECEIPT AND EXPECTATION OF SICK-ROLE LEGITIMATION BY AMBULATORY VETERANS

This study explored the relationship of attitudes, needs, and health services utilization patterns of elderly veterans who were identified and categorized by their expectation for and receipt of sick-role legitimation. Three prescription types (new, change, renewal) were defined as the operational variables. A population of 676 ambulatory, chronically ill (average age 60 years) veterans were sent a questionnaire (74% response rate). In addition, retrospective medical and prescription record review was performed for a 45% sample of respondents. The results were analyzed using discriminant function and regression analysis. Fewer than 20% of the veterans responding expected to receive more prescriptions than were presently prescribed, whereas over 80% expected refill authorizations. Distinct attitudinal, need, and utilization patterns were identified. ^

The cost effective management of Central Line-Associated Bloodstream Infections (CLABSIs) comparing the central line bundle to antimicrobialcoated central venous catheters: A systematic review

Central Line-Associated Bloodstream Infections (CLABSIs) are one of the most costly and preventable cases of morbidity and mortality among intensive care units (ICUs) in health care today. In 2008, the Centers for Medicare and Medicaid Services Medicare Program, under the Deficit Reduction Act, announced it will no longer reimburse hospitals for such adverse events among those related to CLABSIs. This reveals the financial burden shift onto the hospital rather than the health care payer who can now withhold reimbursements. With this weighing more heavily on hospital management, decision makers will need to find a way to completely prevent cases of CLABSI or simply pay for the financial consequences. ^ To reduce the risk of CLABSIs, several clinical, preventive interventions have been studied and even instituted including the Central Line (CL) Bundle and Antimicrobial Coated Central Venous Catheters (AM-CVCs). I carried out a formal systematic review on the topic to compare the cost-effectiveness of the Central Line (CL) Bundle to the commercially available antimicrobial coated central venous catheters (AM-CVCs) in preventing CLABSIs among critically and chronically ill patients in the U.S. Evidence was assessed for inclusion against predefined criteria. I, myself, conducted the data extraction. Ten studies were included in the review. Efficacy in reducing the mean incidence rate of CLABSI by the CL Bundle and AM-CVC interventions were compared with one another including costs. ^ The AM-CVC impregnated with antibiotics, rifampin-minocycline (AI-RM) is more clinically effective than the CL Bundle in reducing the mean rate of CLABSI per 1,000 catheter days. The lowest mean incidence rate of CLABSI per 1,000 catheter days among the AM-CVC studies was as low as zero in favor of the AI-RM. Moreover, the review revealed that the AI-RM appears to be more cost-effective than the CL Bundle. Results showed the adjusted incremental cost of the CL Bundle per ICU patient requiring a CVC to be approximately $196 while the AI-RM at only an additional cost of $48 per ICU patient requiring a CVC. ^ Limited data regarding the cost of the CL Bundle made it difficult to make a true comparison to the direct cost of the AM-CVCs. However, using the result I did have from this review, I concluded that the AM-CVCs do appear to be more cost-effective in decreasing the mean rate of CLABSI while also minimizing incremental costs per CVC than the CL Bundle. This review calls for further research addressing the cost of the CL Bundle and compliance and more effective study designs such as randomized control trials comparing the efficacy and cost of the CL Bundle to the AM-CVCs. Barriers that may face health care managers when implementing the CL Bundle or AM-CVCs include additional costs associated with the intervention, educational training and ongoing reinforcement as well as creating a new culture of understanding.^

Factores que afectan la emisión de escapo floral y producción de bulbillos aéreos en ajo (Allium sativum L.)

El ajo constituye el principal producto agrícola no transformado destinado a la exportación en Mendoza. En la Argentina, la ausencia de cultivares específicas de ajo y producción de semilla fiscalizada han sido unas de las principales debilidades del sistema exportador. Para que los materiales provenientes de los planes de mejoramiento y saneados lleguen rápidamente al productor es necesario acelerar la tasa de multiplicación de los mismos. Con esta finalidad, los bulbillos aéreos que se forman en el extremo del escapo de ajo tipo “colorado" (Grupo IV, Argentina) libre de virus, pueden ser utilizados como propágulos en la producción de ajo “semilla". El objetivo general del presente trabajo fue establecer la influencia del: genotipo, liberación de virus (OYDV y LYSV), tamaño de “diente" empleado como propágulo, fertilización nitrogenada y conservación de los escapos luego de la cosecha, en la producción de bulbillos aéreos. En Mendoza, Argentina, se evaluaron durante el ciclo 1994, 32 introducciones de ajo tipo “colorado" de distinto origen, por su hábito de floración y producción de bulbillos aéreos. Se llevaron a cabo durante los años 1995 y 1996 dos ciclos de ensayos, en los que se evaluó en una población clonal de ajo “colorado criollo" (AR-I-051) y una de ajo “ruso" (AR-I-033) el efecto del saneamiento viral sobre la floración y producción de bulbillos aéreos, trabajando con material crónicamente enfermo y libre de OYDV y LYSV. En AR-I-051 además se estudió el efecto del tamaño de “diente" (2; 3,5 y 5 g ó 1,2; 3,2 y 5,2 g) e influencia de la fertilización nitrogenada (0, 50 y 100 kg.ha-1 de N como SO4(NH4)2). Entre 1995 y 1998, se compararon diversas métodos de “curado" de los escapos luego de la cosecha de las plantas (en planta entera, cortados de distintas longitudes, mantenidos en seco o con inmersión de sus bases en agua o en solución nutritiva con o sin el regulador del crecimiento CCC). Se concluye que la producción de bulbillos aéreos depende del genotipo considerado. En ajo “colorado" se distinguen 5 grupos por su modalidad de floración y potencialidad de producción de bulbillos. La producción de bulbillos aéreos útiles (>2,4 mm de diámetro) depende del tiempo transcurrido entre floración y cosecha y no entre plantación y floración. Se puede predecir la cantidad de bulbillos aéreos útiles (Numa) sobre la base del diámetro de espata (espa) y la longitud de escapo (long) al momento de cosecha, según la ecuación: Numa = - 81,62 + 4,79 espa + 1,05 long (r2 = 0,88). v La capacidad de cada genotipo de emitir escapos, disminuye con la liberación de OYDV y LYSV, por lo que la producción por hectárea de bulbillos aéreos útiles es menor en el material saneado. El empleo de material saneado, “dientes" grandes, como la fertilización con N producen plantas de mayor tamaño y con mayor área foliar, lo que se traduce en un mayor rendimiento en la producción de bulbos. Sin embargo, la producción de bulbillos aéreos por hectárea disminuye, debido al menor porcentaje de plantas que emiten escapos y no a la disminución del número de bulbillos por planta. En cambio, todas aquellas condiciones que favorecen menor expresión vegetativa de las plantas aumentan la emisión de escapos. El “curado" de los escapos separados de la planta madre se puede llevar a cabo sin necesidad de realizar la inmersión de la base de los mismos en agua o en solución nutritiva con o sin CCC. La longitud a la cual se deben cortar los escapos, de manera de no afectar la producción de bulbillos, depende del grado de crecimiento de los bulbillos en el campo. La longitud de corte del escapo en ajo “criollo", con escaso crecimiento de los bulbillos aéreos en el campo, no debe ser inferior a 50 cm. En ajo “ruso", que presenta al momento de cosecha de las plantas un desarrollo avanzado de los bulbillos aéreos, los escapos pueden cortarse de menor longitud, sin afectar la producción de bulbillos aéreos. La longitud del escapo, en planta o separado de ella, afecta la producción de bulbillos aéreos en forma directamente proporcional.

The need for long-term health care [microform] : the Michigan perspective : hearing before the Subcommittee on Health and Long-Term Care of the Select Committee on Aging, House of Representatives, One Hundredth Congress, second session, September 20, 1988, Warren, MI.

"Comm. pub. no. 100-708."

The need for long-term home care [microform] : the Massachusetts perspective : hearing before the Subcommittee on Health and Long-Term Care of the Select Committee on Aging, House of Representatives, One Hundredth Congress, second session, August 1, 1988, Somerville, MA.

"Comm. pub. no. 100-684."

Mental illness in the family.

Reprinted from: Families today, a research sampler on families and children, v. 2.

Comparison of budget request to 1961-63 biennium executive budget.

Caption title.

Annual report /

Includes appendices.

Annual report /

Description based on: July 1, 1986 to June 30, 1987.

Illinois prekindergarten program report ... /

This report is prepared in response to the requirements of Section 2-3-7(a)(6) of the Illinois School Code: The State Board of Education shall report to the General Assembly by November 1, 2010, and every three years thereafter on the results and progress of students who are enrolled in preschool educational programs, including an assessment of which programs have been most successful in promoting academic excellence and alleviating academic failure. The State Board of Education shall assess the academic progress of all students who have been enrolled in preschool education programs.

Nursing Home Care Reform Act of 1979, Abused and Neglected Long-Term Care Facility Residents Reporting Act, and Life Care Facilities Act, as amended and effective as of July 1, 1988.

"May 1988."--P. 78.

Secure child care facility report /

Illinois Public Act 90-608 authorized the establishment of secure facilities in Illinois to provide intensive mental health treatment mainly to seriously disturbed youth ages 13-18 who would otherwise be sent out-of-state to receive such services. This document contains the report of the Secure Child Care Advisory Committee and the Dept. of Children and Family Services' proposed rules on the licensing standards for creating such facilities.