Increased risk of diabetes mellitus among persons with psychotic symptoms:results from the WHO World Health Survey

OBJECTIVE: To analyze with a symptom-based approach the relationship between psychosis and diabetes mellitus in the general population. METHOD: Nationally representative samples from the World Health Organization (WHO) World Health Survey, totaling 224,743 randomly selected adults 18 years and older from 52 countries worldwide, were interviewed to establish the presence of psychotic symptoms and diabetes mellitus. Presence of psychotic symptoms was established using questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Presence of diabetes was established with a response of "yes" to the question, "Have you ever been diagnosed with diabetes (high blood sugar)?" The World Health Survey was conducted between 2002 and 2004. RESULTS: An increasing number of psychotic symptoms was related to increasing likelihood of diabetes mellitus (OR = 1.27; 95% CI, 1.24-1.30). As compared to no symptoms, at least 1 psychotic symptom substantially elevated the risk (OR = 1.71; 95% CI, 1.61-1.81). In people with a lifetime diagnosis of schizophrenia or psychosis, the prevalence of diabetes was higher in those with current psychotic symptoms (7.3% vs 5.2%; OR = 1.65; 95% CI, 1.21-2.26), suggesting that the persistence of symptoms over time could play a central role. After controlling for different potential confounders, there was a clear increase in the probability of having diabetes as the number of psychotic symptoms increased. The relationship between psychotic symptoms and diabetes was tested with multiple mediation models and path analyses for categorical outcomes. Only body mass index appeared as a relevant mediator in a model with a good fit (ie, χ21 = 3.2, P = .0742; comparative fit index = 0.999). CONCLUSIONS: Psychotic symptoms are related to increased rates of diabetes mellitus in nonclinical samples, independent of several potential confounders-including a clinical diagnosis of psychosis or schizophrenia, previous antipsychotic treatment, depression, lifestyle, and individual or country socioeconomic status. The findings highlight the worldwide relevance of the problem and the importance of identifying the specific paths of this association.

Planning a Medical School to Serve an Educationally and Medically Underserved Area: Florida International University in Miami, FL

This paper provides the historic background of the Florida International University College of Medicine planning process.

An evaluation of coping ability as a guide to the treatment of persons diagnosed with schizophrenia and substance abuse

This dissertation introduced substance abuse to the Dynamic Vulnerability Formulation (DVF) and the social competence model to determine if the relationship between schizophrenic symptomatology and coping ability in the DVF applied also to the dually diagnosed schizophrenic or if these variables needed to be modified. It compared the coping abilities of dually and singly diagnosed clients in day treatment and identified, examined, and assessed the relative influence of relevant mediating variables on two dimensions of coping ability of the dually diagnosed: coping skills and coping effort. These variables were: presence of negative and nonnegative symptoms, duration of mental illness, type of substance used, and age of first substance use.^ A priori effect sizes based on previous empirical research were used to interpret the results related to the comparison of demographic, socioeconomic, and treatment characteristics between the singly and dually diagnosed study samples. The data suggested that the singly diagnosed group had higher coping skills than the dually diagnosed group, particularly in the areas of housing stability, work affect, and total social adjustment. The dually diagnosed group had lower scores on one aspect of coping effort--agency or self-efficacy. The data supported the presence of an inverse relationship between symptom severity and coping skills, particularly for the dually diagnosed group. The data did not support the presence of an inverse relationship between symptom severity and coping effort, but did suggest a positive relationship between symptom severity and one measure of coping effort, agency, for the dually diagnosed group. Regression equations using each summary measure of coping skill--social adjustment and role functioning--yielded statistically significant F-ratios. Thirty-six percent of the variance in social adjustment and thirty-one percent of the variance in role functioning were explained by the relative influence of the relevant variables. Both negative and non-negative symptoms were the only significant predictors of social adjustment. The non-negative symptoms variable was the sole significant predictor of role functioning. The results of this study provided partial support for the use of the Dynamic Vulnerability Formulation (DVF) with the dually diagnosed. ^

The effect of self-operated prompts on leisure participation by persons with mental retardation

The use of permanent prompts for individuals with severe disabilities has been shown to be effective in acquiring new skills, improving the accuracy and maintenance of existing skills, and in eliminating the need for trainer prompts. However, this technology has not been evaluated for its potential impact in promoting leisure participation. In this study, two men with mental retardation were administered auditory and/or visual prompts to investigate their effect on increasing participation in a leisure activity. In addition, their performance was evaluated to establish whether continuous versus intermittent schedules of the prompts would influence participation. The data were collected using a partial interval observation system and evaluated using a multiple baseline and an alternating treatment design. While both men increased their participation modestly in the leisure activity, there was no substantial difference between the two prompting schedules. ^

Design of an automated book reader as an assistive technology tool for blind persons

This dissertation introduces a novel automated book reader as an assistive technology tool for persons with blindness. The literature shows extensive work in the area of optical character recognition, but the current methodologies available for the automated reading of books or bound volumes remain inadequate and are severely constrained during document scanning or image acquisition processes. The goal of the book reader design is to automate and simplify the task of reading a book while providing a user-friendly environment with a realistic but affordable system design. This design responds to the main concerns of (a) providing a method of image acquisition that maintains the integrity of the source (b) overcoming optical character recognition errors created by inherent imaging issues such as curvature effects and barrel distortion, and (c) determining a suitable method for accurate recognition of characters that yields an interface with the ability to read from any open book with a high reading accuracy nearing 98%. This research endeavor focuses in its initial aim on the development of an assistive technology tool to help persons with blindness in the reading of books and other bound volumes. But its secondary and broader aim is to also find in this design the perfect platform for the digitization process of bound documentation in line with the mission of the Open Content Alliance (OCA), a nonprofit Alliance at making reading materials available in digital form. The theoretical perspective of this research relates to the mathematical developments that are made in order to resolve both the inherent distortions due to the properties of the camera lens and the anticipated distortions of the changing page curvature as one leafs through the book. This is evidenced by the significant increase of the recognition rate of characters and a high accuracy read-out through text to speech processing. This reasonably priced interface with its high performance results and its compatibility to any computer or laptop through universal serial bus connectors extends greatly the prospects for universal accessibility to documentation.

Sources of nutrition information for persons living in Trinidad and Tobago

Health consumers worldwide obtain nutrition information from various sources; however, the sources Trinidadians and Tobagonians accessed were unclear. This cross-sectional, descriptive study ascertained from which sources Trinidadians and Tobagonians obtained nutrition information. Participants (n = 845) were surveyed with questions regarding demographics and nutrition information sources. Nearly 100% agreed nutrition information was important. Persons 18-64 years old mainly accessed print media (p<0.01) and ≥ 65years old predominantly accessed the non-print media. Significantly more tertiary educated people, ≥ 35 years old, retrieved information from print media (p=0.001), health care professionals (p=0.001), food labels (p=0.006), and non-print media (p=0.03) when compared to those < 35 years with similar education. Tertiary educated people (67%), selected the Internet when compared to those with without tertiary education (33%) (p<0.001). Knowing the nutrition information sources accessed, dietitians will be able to provide consistent, accurate, age specific nutrition information and promote healthy eating among Trinidadians and Tobagonians.

Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

Acknowledgements This study was funded by the Chief Scientist Office of the Scottish Government, grant CZH_4_495.

The development and validity of a functional assessment instrument for persons with major mental disorders

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

A psychophysical assessment of visual motion processing among high-functioning persons with autism

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

The development and validity of a functional assessment instrument for persons with major mental disorders

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

A psychophysical assessment of visual motion processing among high-functioning persons with autism

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy): Consensus Validation

Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriate medications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensus survey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinical pharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.
Methods: STOPPFrail criteria was initially created by the authors based on clinical
experience and appraisal of the available literature. Criteria were organised according to physiological system. Each criterion was accompanied by an explanation. Panellists ranked their agreement with each criterion on a 5-point Likert scale and invited to provide written feedback. Criteria with a median Likert response of 4/5 (agree/strongly agree) and a 25th centile of ≥4 were included in the final criteria.
Results: Three Delphi rounds were required. All panellists completed all rounds. Thirty criteria were proposed for inclusion; 26 were accepted. No new criteria were added. The first two criteria suggest deprescribing medications with no indication or where compliance is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers for hypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antagonists, anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, bone anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal antiinflammatories, corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers, muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics. Anticoagulants and anti-depressants were excluded. Despite incorporation of panellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remained inconclusive.
Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad consensus, to be potentially inappropriate in frailer older patients with limited life expectancy. STOPPFrail may assist in deprescribing medications in these patients.