A nationwide survey of mental health and correctional institutions for adult mentally disordered offenders

Mode of access: Internet.

Dental health in children with phenylketonuria PKU and other inborn errors of amino acid metabolism managed by diet /

"Supported in part by Maternal and Child Health, Grant No. MCS-000252-16 and by contributions to Friends of Metabolic Research."

Assessment of volume depletion in children with malaria

Background The degree of volume depletion in severe malaria is currently unknown, although knowledge of fluid compartment volumes can guide therapy. To assist management of severely ill children, and to test the hypothesis that volume changes in fluid compartments reflect disease severity, we measured body compartment volumes in Gabonese children with malaria. Methods and Findings Total body water volume (TBW) and extracellular water volume (ECW) were estimated in children with severe or moderate malaria and in convalescence by tracer dilution with heavy water and bromide, respectively. Intracellular water volume (ICW) was derived from these parameters. Bioelectrical impedance analysis estimates of TBW and ECW were calibrated and bioelectrical impedance analysis measurements were taken daily against dilution methods, until discharge. Sixteen children had severe and 19 moderate malaria. Severe childhood malaria was associated with depletion of TBW (mean [SD] of 37 [33] ml/kg, or 6.7% [6.0%]) relative to measurement at discharge. This is defined as mild dehydration in other conditions. ECW measurements were normal on admission in children with severe malaria and did not rise in the first few days of admission. Volumes in different compartments (TBW, ECW, and ICW) were not related to hyperlactataemia or other clinical and laboratory markers of disease severity. Moderate malaria was not associated with a depletion of TBW. Conclusions Significant hypovolaemia does not exacerbate complications of severe or moderate malaria. As rapid rehydration of children with malaria may have risks, we suggest that fluid replacement regimens should aim to correct fluid losses over 12-24 h.

Pilot study: Intranet communication among chronically ill hospitalized pediatric individuals

Hospitalization can be a very stressful experience, especially for children. With the use of technology, Intranet communication can be successful in obtaining interaction that these individuals lack to accomplish a positive adjustment to the hospital setting. The purpose of this exploratory, pilot project is to examine the use of networking chronically ill, hospitalized children with other hospitalized chronically ill children through Intranet communication.^ A target population of chronically ill hospitalized children, in at least Piaget's concrete operational stage, was asked to use the Intranet system to network with other chronically ill hospitalized children during their hospital stay, for one month or until discharge. The length of time of usage was recorded on a log sheet, and questionnaires were filled out at the end of the study.^ Statistical analysis was utilized to determine frequency of network usage, duration, demographics, and the impact on hospitalization. Results indicated that Intranet communication between chronically ill hospitalized children was utilized by the participants from 7-15 age groups; and had a positive impact on their hospitalization. ^

O estigma das perturbações mentais: Um estudo qualitativo pela voz das crianças.

Dissertação de Mestrado apresentada ao ISPA – Instituto Universitário

Suicide and community psychiatric care

A preliminary survey of 34 suicides among patients attending community services for the chronically mentally ill revealed a rate of 520 per 100,000 admitted. In contrast to earlier hospital surveys, no risk variables were identified for patients dying by suicide. Thirty-four percent of suicides occurred within one week of the last treatment and 59% within 3 months of service entry. It appears that early and intensive follow-up may be necessary to prevent suicide among patients receiving community psychiatric care.

Settings for mental health care

The quality of the environment is important to client recovery and rehabilitation. • The preferred environment for the care of the mentally ill over time has been the home. • Environmental strategies in the care of the mentally ill became more important in the eighteenth century, when it was noticed that patients were more manageable in a pleasant environment. • Confinement of the mentally ill in large public asylums was largely an innovation of the nineteenth century. • The therapeutic milieu is a consciously organised environment. • Maxwell Jones in the United States and Thomas Main in the United Kingdom pioneered the concept of the hospital and environment as treatment tools. • The goals of the therapeutic milieu are containment, structure, support, involvement, validation, symptom management, and maintaining links with family and the community. • The principles on which the therapeutic milieu is based include: open communication, democratisation, reality confrontation, permissiveness, group cohesion and the multidisciplinary team. • The principle guiding the care of clients in the community is that of the least-restrictive alternative. • The therapeutic community residence is an environment that encourages the development of the client as a person in interaction with others, rather than as someone suffering from a health problem or disability. • The preferred contemporary setting for the provision of mental health care is the community. • The predominant form of service delivery in the community is case management, which has been found to be most effective for people with severe mental illnesses. • The principles of caring in the community are self-determination, normalisation, a focus on client strengths, and the community as a resource

Trans digital storytelling : everyday activism, mutable identity and the problem of visibility

Mainstream representations of trans people typically run the gamut from victim to mentally ill and are almost always articulated by non-trans voices. The era of user-generated digital content and participatory culture has heralded unprecedented opportunities for trans people who wish to speak their own stories in public spaces. Digital Storytelling, as an easy accessible autobiographic audio-visual form, offers scope to play with multi-dimensional and ambiguous representations of identity that contest mainstream assumptions of what it is to be ‘male’ or ‘female’. Also, unlike mainstream media forms, online and viral distribution of Digital Stories offer potential to reach a wide range of audiences, which is appealing to activist oriented storytellers who wish to confront social prejudices. However, with these newfound possibilities come concerns regarding visibility and privacy, especially for storytellers who are all too aware of the risks of being ‘out’ as trans. This paper explores these issues from the perspective of three trans storytellers, with reference to the Digital Stories they have created and shared online and on DVD. These examplars are contextualised with some popular and scholarly perspectives on trans representation, in particular embodied and performed identity. It is contended that trans Digital Stories, while appearing in some ways to be quite conventional, actually challenge common notions of gender identity in ways that are both radical and transformative.

Journalism at the movies

Welcome to the first of what will be a regular review essay on films about journalism, covering recent releases as well as looking back at established classics and under-rated obscurities. And there is plenty to write about. Since 2008, and the end of the research period which informed my 2010 book on Journalists in Film there has been a steady stream of films in which a journalist is a primary character, and in which the nature and functioning of journalism is a theme. Morning Glory (Roger Michell, 2010), the story of a ‘serious’ news man (Harrison Ford) having to adapt to the infotainment environment of breakfast news, came out early in 2011 in the United Kingdom. The well-received UK indie Monsters (Gareth Edwards, 2010), a sci-fi with a journalist at its heart, was released in 2010. In The Soloist (Joe Wright, 2009) Robert Downey Jr played a feature journalist who befriends a mentally ill street musician and seeks to rescue him through his writing. Stieg Larsson’s Millennium trilogy has produced three Swedish films, all of them focused on the campaigning journalist Mikael Blomkvist. The first of these is being remade by Hollywood as of this writing.

Legal duties following the discharge of mental health patients

In the recent decision of Hunter and New England Local Health District v McKenna; Hunter and New England Local Health District v Simon, the High Court of Australia held that a hospital and its medical staff owed no common law duty of care to third parties claiming for mental harm, against the background of statutory powers to detain mentally ill patients. This conclusion was based in part on the statutory framework and in part on the inconsistency which would arise if such a duty was imposed. If such a duty was imposed in these circumstances, the consequence may be that doctors would generally detain rather than discharge mentally ill persons to avoid the foreseeable risk of harm to others. Such an approach would be inconsistent with the policy of the mental health legislation , which favours personal liberty and discharge rather than detention unless no other care of a less restrictive kind is appropriate and reasonably available.

The architecture of the psychiatric milieu

The last time a peer-reviewed volume on the future of mental health facilities was produced was in 1959, following a symposium organised by the American Psychological Association. The consensus was easy enough to follow and still resonates today: the best spaces to treat psychiatric illness will be in smaller, less restrictive units that offer more privacy and allow greater personalisation of space – possibly a converted hotel (Goshen, 1959). In some way, all those ideals have come to pass. An ideal typology was never established, but even so, units have shrunk from thousands of beds to units that typically house no more than 50 patients. Patients are generally more independent and are free to wander (within a unit) as they please. But the trend toward smaller and freer is reversing. This change is not driven by a desire to find the ideal building nor better models of care, but by growing concerns about budgets, self-harm and psychiatric violence. This issue of the Facilities comes at a time when the healthcare design is increasingly dominated by codes, statutes and guidelines. But the articles herein are a call to stop and think. We are not at the point where guidelines can be helpful, because they do not embody any depth of knowledge nor wisdom. These articles are intended to inject some new research on psychiatric/environmental interactions and also to remind planners and managers that guidelines might not tackle a core misunderstanding: fear-management about patient safety and the safety of society is not the purpose of the psychiatric facility. It is purpose is to create spaces that are suitable for improving the well-being of the mentally ill.

Quando os médicos julgam e os juízes tratam psiquiatria e normalização no sistema penal brasileiro

Esta dissertação discute as funções desempenhadas pelo psiquiatra no sistema penal brasileiro, que são a assistência aos transtornos mentais, a avaliação da responsabilidade sobre um ato delituoso e a elaboração de laudos para a concessão do benefício da libertação progressiva a presos comuns. São apresentados os impasses advindos do contato entre justiça e ciência, demonstrando-se como, nos dois últimos casos, o psiquiatra não lida com seu objeto habitual, o doente mental, mas com um outro diverso, o indivíduo perigoso. Para conhecer e controlar este novo objeto a psiquiatria forma, junto com o judiciário, um outro poder denominado, conforme Michel Foucault, normalizador que, sob uma ótica genealógica, transcende o seu objeto original, transformando-se em meio de controle de todo o corpo social. Tendo por principal referencial teórico a obra daquele pensador francês, notadamente os textos vindos à luz nos últimos anos, com a publicação da transcrição de cursos e de outros artigos dispersos, este mecanismo de controle social é analisado, discutindo-se as transformações por que vem passando nas últimas décadas. Paralelamente, é defendida a extinção da necessidade do referendo psiquiátrico à progressão do regime prisional, como forma de corrigir um sistema que não funciona satisfatoriamente.

Chico Xavier e o mundo dos espíritos: um estudo de representações sociais

O médium Chico Xavier (1910-2002) impôs-se no cenário religioso brasileiro como uma das personalidades mais admiradas e polêmicas do país dada a sua postura de afirmar se comunicar com espíritos de pessoas falecidas, atribuindo a elas seus mais de 400 livros psicografados, assim como pelas atividades assistenciais desempenhadas. As comemorações, em 2010, do centenário de seu nascimento teve ampla repercussão, com numerosas matérias na mídia, (re)lançamentos de livros e produção de filmes. Foi nesse contexto que se desenvolveu esta pesquisa sobre as representações sociais produzidas sobre ele por pessoas com ou sem religião, de acordo com a Abordagem Estrutural da Teoria das Representações Sociais. A coleta de dados foi feita através de um questionário padronizado, aplicado via "web", ao qual se associou uma tarefa de evocação livre ao termo indutor "Chico Xavier". Foram analisadas as respostas de 1960 sujeitos, dentre espíritas (56,6%), católicos (15,5%), teístas (12,1%), umbandistas (4,6%), ateus (4,2%), evangélicos (4,1%) e agnósticos (2,8%). A análise das evocações permitiu identificar os seguintes termos, possivelmente centrais, mais compartilhados por esses grupos: amor, caridade e humildade evocado por espíritas, umbandistas, teístas e católicos; espiritismo, mediunidade-psicografia por teístas, católicos, agnósticos e ateus; católicos e teístas distinguiram-se pela referência à bondade e paz; e evangélicos e ateus referiram-se a engano-mentira; agnósticos evocaram ainda o termo caridade; e ateus, os termos charlatão-fraude e doente mental. A construção de árvores de co- ocorrências confirmou os temas "amor" e "espiritismo" como mais característicos de Chico Xavier, sugerindo a existência de duas representações distintas. Nesse sentido, "amor" parece organizar as representações de católicos, espíritas, umbandistas, teístas, e "espiritismo", as de evangélicos, agnósticos e ateus. A análise do questionário revelou o seguinte ranking decrescente dos grupos quanto à sua proximidade com relação a Chico Xavier: espíritas, umbandistas, teístas, católicos, agnósticos, evangélicos e ateus. Em seu conjunto, os dados revelaram afinidades de representação entre os grupos, sendo principalmente semelhantes as representações dos espíritas e umbandistas, e dos teístas e católicos. Observamos uma representação de Chico Xavier construída a partir de três planos de significação: o da "virtude", o do "pertencimento" e o da "verdade". No primeiro, caracteriza-se pela valorização de "amor", que o situa numa ordem de sentido mais abrangente, reconhecendo-o como alguém capaz de ter vivido e demonstrado tal virtude de forma irrecusável, tornando-se dela um exemplo; no segundo, pela valorização de "espiritismo" ocorre sua identificação dentro de limites grupais, como alguém que viveu segundo sua crença e dela se tornou uma figura de destaque. E o terceiro, atravessando esses dois planos, pela atribuição de um sentido de "verdade" ou "mentira" sobre o que ele viveu/ensinou quanto à vida após a morte e a comunicação com espíritos. Desse modo, Chico Xavier, em geral, é representado pelos espíritas, umbandistas, teístas e católicos como alguém virtuoso que viveu/ensinou a verdade; e pelos evangélicos e ateus como um espírita não-virtuoso que viveu/ensinou mentiras. Os agnósticos posicionaram-se, principalmente, de modo ambivalente, mas com pequena tendência a enfatizar a virtude e a verdade em Chico Xavier.

Fatores de risco para infecções hospitalares em crianças críticas

O objetivo desta tese foi avaliar a influências da exposição a diversos fatores de risco e ocorrência de infecção hospitalar (IH) e examinar fatores de risco relacionados às pneumonias associadas ao uso de ventilador mecânico (PAV) em crianças críticas. Usamos os métodos de estudo prospectivo envolvendo uma coorte de 268 crianças menores de três anos, realizado em unidade de pacientes graves, de janeiro de 1997 e setembro de 2000. Aplicou-se técnica de regressão de Poisson para estimar razões de risco e estratégia de abordagem hierárquica para identificar fatores de risco associados à IH. Apenas para 179 crianças críticas que usaram ventilador mecânico, aplicou-se a regressão de Cox para estimar razões de risco e identificar fatores de risco associados à PAV. Os resultados apresentaram 74 infecções hospitalares diagnosticadas no total, com taxa de incidência de 48,1 IH por 1000 pacientes-dia. Foi determinante para ocorrência de infecção hospitalar, idade superior a dois anos (Razão de Risco) [RR]: 2,66; intervalo de confiança [IC]: 95%: 1,46-4,58), uso de sonda vesical (RR: 2,92; IC 95%: 1,47-5,80), uso de nutrição parenteral (RR: 1,90; IC 95%: 1,15-3,13), realização de broncoscopia (RR: 1,84; IC 95%: 1,03-3,27), tempo de exposição ao cateter vascular central (RR: 2,36; IC 95%: 1,18-4,71) e ao ventilador mecânico (RR: 1,72; IC 95%: 0,94-3,15). Observou-se PAV em 29 crianças (16,3%), com taxa de incidência de 29,3 casos por 1000 dias de ventilação mecânica (IC 95%: 20,34-42,11), dos quais 50% dos eventos ocorreram até o quinto dia de ventilação. A taxa de risco diária aumentou até um máximo de 2,3%, observada no 7 dia de ventilação, e reduziu a partir daí. Foram fatores de risco para PAV na análise multivariada hierarquizada, idade acima de 1 ano (RR: 3,49; IC 95%; 1,64-7,45), cirurgia do aparelho digestivo (RR: 5,05; IC 95%; 2,17-11,78) e nutrição parenteral (RR: 2,68; IC 95%: 1,24-5,8). /exposição a antibióticos antes da internação conferiu proteção (RR: 0,29; IC 95%: 0,13-0,66). Concluímos que os resultados encontrados neste estudo indicam que a influência do tempo de exposição é determinante para a ocorrência de infecções hospitalares e está associado aos processos de cuidados do paciente crítico. Políticas institucionais direcionadas ao controles e prevenção das IH devem fazer de estratégias fundamentais para a qualidade da assistência e segurança do paciente internado. Vigilância de Saúde Pública e componentes longitudinais de estudo de fatores de risco para infecções hospitalares e para pneumonias associadas ao ventilador podem ajudar avaliar prognósticos e planejar e testar medidas preventivas, concentrando-se esforços na primeira semana de ventilação.