A systems perspective on the integrative child psychiatry approach. Discussion of paper: "Working here and now with the individual and family system: A case of a traumatized child"

In this discussion, after a few general comments, I will propose a systems reading of the intervention so elegantly described by Kaija Puura. I will draw parallels between the therapeutic and the family groups as framing-developing systems and formalize the steps taken by the family toward healing under the influence of the therapist's team. En esta discusión, después de algunos comentarios generales, propongo una lectura sistemática de la intervención tan elegantemente descrita por Kaija Puura. Buscaré paralelos entre los grupos terapéuticos y de familia como sistemas de desarrollo enmarcado y formalizaré los pasos tomados por la familia hacia la cicatrización bajo la influencia del equipo del terapista. Après quelques commentaires généraux, je proposerai dans cette discussion une lecture systémique de l'intervention si élégamment décrite par Kaija Puura. J'établirai des parallèles entre les groupes thérapeutiques et familiaux en tant que systèmes d'encadrement-développement et je formaliserai les étapes de guérison franchies par la famille grâce à l'influence de l'équipe thérapeutique. In dieser Diskussion, werde ich nach einigen allgemeineren Aussagen, eine systemische Lesart der von Kaija Puura so eingängig beschriebenen Intervention vorschlagen. Ich werde darin Parallelen zwischen der therapeutischen und Rahmengebenden Familiengruppen ziehen, und die Schritte der Familien hin zu einer Heilung unter dem Einfluss des Therapeutenteams formalisieren.

Long-Term Community Recovery Report, Parkersburg, Iowa, December 2008

At approximately 5pm on May 25, 2008, City of Parkersburger was struck by a powerful EF5 tornado, estimated to be three-quarters of a mile wide. As it moved across the southern half of the City, the tornado cased severe damage, destroying at least twenty businesses and over two hundred fifty homes along with city Hall and Aplington-Parkersburg High School. Numerous other homes, businesses and civic buildings were damaged. Approximately two weeks later, Beaver Creek was among the many Iowa streams to flood. While Parkersburg was not affected significantly by flooding, a number of properties were damaged, including Beaver Meadows Golf Course and a City park with athletic fields.

Psychiatric co-morbidities and cardiovascular risk factors in people with lifetime history of epilepsy of an urban community.

OBJECTIVES: Depression has been consistently reported in people with epilepsy. Several studies also suggest a higher burden of cardiovascular diseases. We therefore analysed psychosocial co-morbidity and cardiovascular risk factors in patients with a lifetime history of epilepsy in the PsyCoLaus study, a Swiss urban population-based assessment of mental health and cardiovascular risk factors in adults aged between 35 and 66 years. PATIENTS AND METHODS: Among 3719 participants in the PsyCoLaus study, we retrospectively identified those reporting at least 2 unprovoked seizures, defined as epilepsy. These subjects were compared to all others regarding psychiatric, social, and cardiovascular risk factors data using uni- and multivariable assessments. RESULTS: A significant higher need for social help (p<0.001) represented the only independent difference between 43 subjects with a history of epilepsy and 3676 controls, while a higher prevalence of psychiatric co-morbidities (p=0.015) and a lower prevalent marital status (p=0.01) were only significant on univariate analyses. Depression and cardio-vascular risk factors, as well as educational level and employment, were similar among the groups. CONCLUSIONS: This analysis confirms an increased prevalence of psychosocial burden in subjects with a lifetime history of epilepsy; conversely, we did not find a higher cardiovascular risk. The specific urban and geographical location of our cohort and the age span of the studied population may account for the differences from previous studies.

Violator Program: Community Aftercare is Key, Data Download, Iowa Department of Corrections, November 2008

Through an act of the Iowa Legislature, the Violator Program came into existence some 20 years ago, the purpose of which was to provide an alternative to long-term imprisonment for those offenders whose probation/parole had been suspended. This 4-6 month program is currently administered at three locations: Luster Heights, Newton Correctional Release Center,and the Iowa Correctional Institution for Women.

Mentally Ill Offenders in Community-Based Corrections, Research in Brief, Iowa Department of Corrections, April 2008

A survey of offenders supervised by the eight district departments of correctional services. This report was commissioned by the Iowa Department of Corrections Focus Group on Mental Health in Community-Based Corrections.

Audit report on Clay Central/Everly Community School District in Royal, Iowa for the year ended June 30, 2011

Audit report on Clay Central/Everly Community School District in Royal, Iowa for the year ended June 30, 2011

Scale decisions can reverse conclusions on community assembly processes.

AIM: Phylogenetic diversity patterns are increasingly being used to better understand the role of ecological and evolutionary processes in community assembly. Here, we quantify how these patterns are influenced by scale choices in terms of spatial and environmental extent and organismic scales. LOCATION: European Alps. METHODS: We applied 42 sampling strategies differing in their combination of focal scales. For each resulting sub-dataset, we estimated the phylogenetic diversity of the species pools, phylogenetic α-diversities of local communities, and statistics commonly used together with null models in order to infer non-random diversity patterns (i.e. phylogenetic clustering versus over-dispersion). Finally, we studied the effects of scale choices on these measures using regression analyses. RESULTS: Scale choices were decisive for revealing signals in diversity patterns. Notably, changes in focal scales sometimes reversed a pattern of over-dispersion into clustering. Organismic scale had a stronger effect than spatial and environmental extent. However, we did not find general rules for the direction of change from over-dispersion to clustering with changing scales. Importantly, these scale issues had only a weak influence when focusing on regional diversity patterns that change along abiotic gradients. MAIN CONCLUSIONS: Our results call for caution when combining phylogenetic data with distributional data to study how and why communities differ from random expectations of phylogenetic relatedness. These analyses seem to be robust when the focus is on relating community diversity patterns to variation in habitat conditions, such as abiotic gradients. However, if the focus is on identifying relevant assembly rules for local communities, the uncertainty arising from a certain scale choice can be immense. In the latter case, it becomes necessary to test whether emerging patterns are robust to alternative scale choices.

Community pharmacist intervention in depressed primary care patients (PRODEFAR study): randomized controlled trial protocol.

Background: Treatment of depression, the most prevalent and costly mental disorder, needs to be improved. Non-concordance with clinical guidelines and non-adherence can limit the efficacy of pharmacological treatment of depression. Through pharmaceutical care, pharmacists can improve patients' compliance and wellbeing. The aim of this study is to evaluate the effectiveness and costeffectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. Methods/design: A randomized controlled trial, with 6-month follow-up, comparing patients receiving a pharmaceutical care support programme in primary care with patients receiving usual care. The total sample comprises 194 patients (aged between 18 and 75) diagnosed with depressive disorder in a primary care health centre in the province of Barcelona (Spain). Subjects will be asked for written informed consent in order to participate in the study. Diagnosis will be confirmed using the SCID-I. The intervention consists of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring patients about side-effects and stressing the importance of carrying out general practitioners' advice. Measurements will take place at baseline, and after 3 and 6 months. Main outcome measure is compliance with antidepressants. Secondary outcomes include; clinical severity of depression (PHQ-9), anxiety (STAI-S), health-related quality of life (EuroQol-5D), satisfaction with the treatment received, side-effects, chronic physical conditions and sociodemographics. The use of healthcare and social care services will be assessed with an adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This trial will provide valuable information for health professionals and policy makers on the effectiveness and cost-effectiveness of a pharmaceutical intervention programme in the context of primary care. Trial registration: NCT00794196

Audit report on Starmont Community School District near Arlington, Iowa for the year ended June 30, 2010

Audit report on Starmont Community School District near Arlington, Iowa for the year ended June 30, 2010

Impact of stressful life event on the global functioning outcome after an assertive community treatment

Background: Assertive community treatment (ACT) was reported to be an effective treatment to improve global functioning of ultra-high risk (UHR) adolescents. However, the infl uence of stressful life event (SLE) was not extensively studied which represent our objective. Method: The SLE (encompassing adoption, migration, family member's deceased, sexual or physical abuse, etc.) of 20 UHR adolescents, treated with an ACT model, were rated. 10 adolescents having 0 to 1 SLE (mainly parents' divorce; low SLE group) were compared 10 adolescents with 2 to 5 SLE (high SLE group). The adolescents were assessed at baseline and after treatment with the Health of Nation Outcome Scale for Children and Adolescents (HoNOSCA). The HoNOSCA allowed rating different diffi culties such as behavior, symptoms, disorders and social. Results: First, results on the whole sample indicated signifi cant improvement after ACT (compared to baseline) on the total (P = .04), symptoms (P = .025) and social (P = .009) scores of the HoNOSCA. Second, the improvement on the HoNOSCA's score of the high SLE group were signifi cantly higher for the total (P = .016), symptoms (P = .019) and behavior (P = .033) scores compared to the low SLE group. Discussion/Conclusion: Globally, ACT seems to be an appropriate treatment to enhance global functioning and more specifi cally the social and symptoms diffi culties of UHR adolescents. Additionally, UHR adolescents with a high numbers of SLE were observed to have a better benefi t of the ACT on global, symptoms and behavioral diffi culties.

Investigation of Earlham Community School District Employee’s Personal Use of a School Vehicle, July 6, 2012

We received a complaint in late September 2011 that an Earlham School District employee had borrowed a school vehicle for her personal use for one month, with the Superintendent’s permission. The school board had discussed the circumstances of the borrowed district vehicle in closed session. The complainant believed this was contrary to Iowa law and also believed no action had been taken against the school employee who borrowed the vehicle or the superintendent who allowed the personal use of the vehicle. He was aware the school district’s attorney reviewed the matter and determined the employee and superintendent violated no law or district policies. Since the school board discussed the matter only in closed session, it was unknown what, if any, discipline was taken against the employees and whether such actions were condoned by the district. We agreed to investigate to determine if the actions of school officials or employees violated Iowa law and if the response from the school board was appropriate.

Reaudit report on the Centerville Community School District for the period July 1, 2009 through June 30, 2010

Reaudit report on the Centerville Community School District for the period July 1, 2009 through June 30, 2010

Penser la médecine communautaire s'apprend avec les pairs. [The spirit of community medicine: students learning from students].

At the University of Lausanne third-year medical students are given the task of spending a month investigating a question of community medicine. In 2009, four students evaluated the legitimacy of health insurers intervening in the management of depression. They found that health insurers put pressure on public authorities during the development of legislation governing the health system and reimbursement for treatment. This fact emerged during the scientific investigation led jointly by the team in the course of the "module of immersion in community medicine." This paper presents each step of their study. The example chosen illustrates the learning objectives covered by the module.

Analysis of the association between chondrocalcinosis and osteoarthritis: a community based study

To analyse the association between chondrocalcinosis and osteoarthritis (OA) of the hands and knees in an unselected elderly rural population. METHODS--A community based cross sectional study was performed in individuals randomly selected from a previous epidemiological survey on the prevalence of chondrocalcinosis in people older than 60 years from Osona county, Catalonia, northeastern Spain. Radiological OA (grade 2 or more of Kellgren's classification) was evaluated in 26 individuals with chondrocalcinosis and in 104 controls. A total of 18 articular areas of both knees (medial and lateral tibiofemoral compartments) and hands (first, second and third metacarpophalangeal (MCP), first carpometacarpal, trapezium-scaphoid, radiocarpal and distal radioulnar joints) were studied. RESULTS--Radiological changes of OA in the knees were more common in subjects with chondrocalcinosis than in those without it, with an odds ratio adjusted for age and gender (aOR) of 4.3 (95% confidence interval (CI) 1.6 to 11.8, p = 0.005). OA was also more frequent in almost all areas of the hands in individuals with chondrocalcinosis, though the difference reached statistical significance only in the MCP joints (aOR 3.1; 95% CI 1.1 to 8.8; p = 0.033). However, taking into account the side and the different joint compartments analysed, the association between chondrocalcinosis and OA was significant only in the lateral tibiofemoral compartment and the left MCP joints. CONCLUSIONS--In an elderly population unselected for their rheumatic complaints, there was a real association between OA and chondrocalcinosis. This association was particularly relevant in the lateral tibiofemoral compartment of the knee and in the first three left MCP joints.