Prevalence of mental health problems among adolescents varies from 10 to 30%. Therefore, mental health promotion in school has risen as a very important developing area in public health services. The need is international. Despite the large number of projects and recommendations on the promotion of schoolchildren's mental health, the literature does not offer a comprehensive theoretical description of what mental health work with people of this particular age really is as a whole. The theory can be constructed by combining and comparing the viewpoints of the different parties--the employees, the schoolchildren and their families--as well as previous knowledge of the subject. The purpose of this research was to produce a description of the concepts used by employees when addressing the subject of promoting mental health in the upper level of comprehensive schools (grades 7-9). The description has been produced by analysing interviews with nine people who work with schoolchildren, as well as workgroup memos related to the development work. The respondents work in the fields of primary healthcare, specialised healthcare, the education authority and social services. The analysis was conducted by applying the grounded theory method. The research target was a Finnish upper-level comprehensive school with 446 pupils. Four key concepts were found: The concept of a school environment comprises the physical and social conditions in the school, the curricula and other instructions. Human resources comprise representatives of various organisations, their competencies and time-consumption opportunities. The schoolchildren and their families and also their friends are key operators and partners. The concept of work to promote mental health is related to enhancing the school's conditions, recognising problems and offering help, co-operation and joint agreement. The produced description clarifies the overall picture of mental health work in schools and facilitates the finding of key development areas.
The purpose of this study was to describe communicative patterns about change in demanding physiotherapy treatment situations.
A multiple case study of eleven treatment courses was carried out, based on in-depth individual interviews, focus group interview, personal notes and repeated video-recordings. To compare communication within and over sessions, a two-step procedure was applied: identification of communication patterns and detailed analysis of selected dialogues from video-recorded sequences.
One main communicative pattern was identified: Seeking for common ground--demanding negotiating process. This pattern was interrupted by short episodes of two types of challenges; the pattern of ambivalence and uncertainty, and the pattern of impatience and disagreement. Communication between the participants appeared as a demanding and complex process of negotiations during the treatment processes. The physiotherapists' sensitivity of and ability to negotiate the tasks, the emotions related to tasks and the nature of the relationships, seemed to facilitate change. The patients' and the physiotherapists' capacity to bear and come through demanding situations created new ways of interaction.
The demanding situations may generate a potential for the development and the improvement of treatment outcomes. Understanding such episodes as open and dynamic, in contrast to defining the patient as demanding, suggests a useful perspective for treatment.
The aim of the study was to describe the experiences of different types of domestic violence among adolescents and associations between the family background and different types of domestic violence.
The survey included 1393 ninth-graders from one Finnish municipality.
Domestic violence is fairly common in the lives of adolescents. Sixty-seven percent of respondents had experienced parental symbolic aggression, 55% mild violence and 9% severe violence during their childhood. Twelve percent of adolescents had witnessed parent-to-parent violence. Witnessing domestic violence and exposure to parental violence is associated with a number of adolescents' background factors such as self-perceived health, satisfaction with life, family relationships, parenting practice, school bullying and sexual activity.
The findings stress the relevance of corporal punishment and witnessing domestic violence as a risk factor for more severe domestic violence and sexual abuse. Different types of domestic violence have a major effect on adolescent well-being and risk behaviours. To break the negative cycle, nurses and other professionals working with adolescents in different settings should pay attention to all forms of violence, including the milder ones.
Adipocere is a postmortem decomposition product consisting of mostly a mixture of free fatty acids (FFAs) that are formed because of the hydrolysis of triglycerides in adipose tissues. This article describes a simple and robust method for the extraction, identification, and quantification of FFA commonly found in adipocere using gas chromatography-mass spectrometry (GC/MS). This method was applied to analyze tissues from Kwäday Dän Ts'ìnchí, ancient remains discovered in a retreating glacier in the Tatshenshini-Alsek Park, British Columbia, Canada in August 1999. The lyophilized tissues were grinded and extracted with hexane. The trimethylsilyl fatty acid derivatives were analyzed by GC/MS, and the relative abundances of myristic acid, palmitic acid, oleic acid, and stearic acid were determined. Milligram per gram levels of saturated fatty acids were found in the tissues of the ancient remains, while the levels of unsaturated fatty acids, such as palmitoleic acid, were found to be negligible. The results provided further evidence of the existence of adipocere found during forensic examination of the Kwäday Dän Ts'ìnchí ancient remains.
The early mutans streptococci (MS) bacteria colonization is connected to early childhood caries. The aim of this study is to examine associations between the MS-colonization and background factors in young children, in order to enhance the oral health program in a low caries prevalence community.
An age cohort of 512 children was screened for MS in the oral biofilm at the age of 18 months. The caretakers were, using a structured form, interviewed of demographical factors and habits connected to oral health: antibiotic treatments, child's appetite, frequency of night feeding, use of sugary products or drinks, and maternal xylitol use. The associations were evaluated with logistic regression analysis.
Mutans streptococci colonization was significantly associated with both the occupation of the caretaker and the non-Finnish background.
The early MS-colonization, in preschool children, strongly associates with the socioeconomic status of the family.
This paper is a report of a study of Registered Nurses' attitudes and beliefs towards discussing sexuality with patients.
The World Health Organization regards sexuality as an essential and integrated part of being human. Studies show that diseases and treatments can affect sexuality and that a positive and respectful attitude towards sexuality is important to achieving sexual health.
The study had a correlative and comparative design. The Sexual Attitudes and Beliefs Survey was distributed to a convenience sample of 100 Swedish nurses in 2006, with a response rate of 88%.
Over 90% of nurses understood how patients' diseases and treatment might affect their sexuality. About two-thirds felt comfortable talking about sexual issues and agreed that it was their responsibility to encourage talk about sexual concerns. However, 80% did not take time to discuss sexual concerns, and 60% did not feel confident in their ability to address patients' sexual concerns. Older nurses felt more confident in their ability to address patients' sexual concerns, and the older the nurses, the more positive were their attitudes towards discussing sexuality. Nurses with further education also had a more positive attitude towards discussing sexuality.
Education is essential to improve nurses' ability to give patients the holistic care they deserve. Studies are needed to understand fully what mechanisms underlie the barriers that clearly prevent nurses from addressing patients' sexuality.
This paper is a report of a study examining the effect of supportive counselling by public health nurses on postpartum depression.
Depression is a common condition following childbirth and may have negative consequences for the child's development, the woman's health and the relationship between the parents. Psychological intervention is a treatment alternative to biological treatment options and may prevent longer-term postpartum depression.
The study was designed as a pragmatic trial. The study population comprised postpartum women, residing in two Norwegian municipalities, who had delivered a live-born child between June 2005 and December 2006. A total of 228 women were included in the study: 64 in the comparison municipality and 164 in the experimental municipality. Public health nurses (26) in the experimental municipality were trained in identifying postpartum depression and in providing supportive counselling. Pre-tests were conducted using the Edinburgh Postnatal Depression Scale at 6 weeks postpartum. Post-tests using the same Scale were performed at 3 and 6 months postpartum.
The depression score decreased statistically significantly in the experimental group compared to the comparison group both at 3 and 6 months postpartum.
Supportive counselling based on a non-directive counselling method provided by public health nurses is an effective treatment method for postpartum depression. Further research is required to assess the mothers' evaluation of the treatment and appraise methods used for management of postpartum depression in primary health care.
The aim of the study was to describe critical thinking dispositions among newly graduated nurses in Norway, and to study whether background data had any impact on critical thinking dispositions.
Competence in critical thinking is one of the expectations of nursing education. Critical thinkers are described as well-informed, inquisitive, open-minded and orderly in complex matters. Critical thinking competence has thus been designated as an outcome for judging the quality of nursing education programmes and for the development of clinical judgement. The ability to think critically is also described as reducing the research-practice gap and fostering evidence-based nursing.
A cross-sectional descriptive study was performed. The data were collected between October 2006 and April 2007 using the California Critical Thinking Disposition Inventory. The response rate was 33% (n = 618). Pearson's chi-square tests were used to analyse the data.
Nearly 80% of the respondents reported a positive disposition towards critical thinking. The highest mean score was on the Inquisitiveness subscale and the lowest on the Truth-seeking subscale. A statistically significant higher proportion of nurses with high critical thinking scores were found among those older than 30 years, those with university education prior to nursing education, and those working in community health care.
Nurse leaders and nurse teachers should encourage and nurture critical thinking among newly graduated nurses and nursing students. The low Truth-seeking scores found may be a result of traditional teaching strategies in nursing education and might indicate a need for more student-active learning models.
To examine the prognosis and incidence of social fears and phobia in an elderly population sample followed for 5 years.
A general population sample (N = 612) of non-demented men (baseline age 70) and women (baseline age 70 and 78-86) was investigated in 2000-2001 and in 2005-2006 with semi-structured psychiatric examinations including the Comprehensive Psychopathological Rating Scale, and the Mini International Neuropsychiatric Interview. Social phobia was diagnosed according to the DSM-IV criteria.
Among nine individuals with DSM-IV social phobia in 2000, 5 (55.6%) had no social fears in 2005, and 1 (11.1%) still met the criteria for DSM-IV social phobia. Among individuals without DSM-IV social phobia in 2000 (N = 603), 12 (2.0%) had DSM-IV social phobia in 2005.
These findings challenge the notion that social phobia is a chronic disorder with rare occurrence in old age.
Health-related quality-of-life (HRQoL) data are often included in Phase III clinical trials. We evaluate and classify the value added to Phase III trials by HRQoL outcomes, through a review of the National Cancer Institute of Canada Clinical Trials Group clinical trials experience within various cancer patient populations. HRQoL may add value in a variety of ways, including the provision of data that may contrast with or may support the primary study outcome; or that assess a unique perspective or subgroup, not addressed by the primary outcome. Thus, HRQoL data may change the study's interpretation. Even in situations where HRQoL measurement does not alter the clinical interpretation of a trial, important methodologic advances can be made. A classification of the added value of HRQoL information is provided, which may assist in choosing trials for which measurement of HRQoL outcomes will be beneficial.
Currently available prognostic models for noncancer patients lack high levels of discrimination. Therefore, the quest for additional prognostic factors must continue. To date, none have utilized the occurrence of wounds as a prognostic factor.
As a prospective observational study, based on a sequential case series of 189 advanced noncancer patients, all wounds were documented. One hundred seventy patients were followed until their deaths. Univariate and multivariate survival analyses were performed using hazard ratios (HRs) derived from Cox proportional hazard models.
Seventy-eight percent of patients presented with at least one wound at referral. Patients with wounds displayed worse overall survival than those without wounds (p = 0.009). Survival analysis for the full postreferral period revealed a violation of the proportional hazards assumption for pressure ulcers and the Palliative Performance Scale version 2 (PPSv2). In order to address this finding, early deaths (within 14 days of referral) were assessed separately from later deaths (more than 14 days after referral). After controlling for the co-occurrence of wounds, age, gender, Charlson comorbidity index, and PPSv2, pressure ulcers were associated with statistically significant increased risk of death for patients of sufficient health to survive at least 2 weeks after referral (HR 2.42, p = 0.003), while other wounds were associated with greater levels of mortality over the full postreferral period (HR 1.96, p = 0.0001).
The occurrence of pressure ulcers and other wounds are correlated with reduced survival in patients with advanced noncancer illness. These data merit incorporation into existing prognostic models or used in conjunction with them to enhance prognostic accuracy.
Several traditional cardiovascular risk factors assessed in the middle-aged are associated with the risk of dementia, but they are known to lose much of their prognostic value when measured in the elderly. The aim of the study was to compare B-type natriuretic peptide (BNP) with previously known risk markers for dementia in their association with cognitive decline and dementia during a follow-up.
A total of 464 subjects free of dementia aged 75 years or more were examined and followed up for 5 years in a prospective population-based stratified cohort study. The association of clinical variables to base-line Mini Mental State Examination score (MMSE), the decline of MMSE, and onset of dementia during the follow-up were examined.
The only variable to significantly associate with the decline of MMSE was BNP (beta 0.140; P = 0.019). A total of 59 new cases of dementia were diagnosed after the follow-up. Significant predictors of the occurrence of dementia over the study period were BNP (adjusted odds ratio (OR) 1.53; 95% confidence interval (CI) 1.09-2.16; P = 0.013), length of education (OR 0.50; 95% CI 0.33-0.77; P = 0.001), and diagnosis of hypertension (OR 0.53; 95% CI 0.27-0.95; P = 0.036). BNP remained as a significant predictor of dementia and the decline of MMSE even after adjustment to the base-line MMSE.
BNP is an independent harbinger of the cognitive decline and incidence of new onset of dementia in an elderly general population. This is a ground for testing the impact of antihypertensive treatment in the prevention of cognitive impairment in those with elevated BNP.
A common approach for dose assessment during cone beam computed tomography (CBCT) acquisition is to use thermoluminescent detectors for skin dose measurements (on patients or phantoms) or ionization chamber (in phantoms) for body dose measurements. However, the benefits of a daily CBCT image acquisition such as margin reduction in planning target volume and the image quality must be weighted against the extra dose received during CBCT acquisitions.
The authors describe a two-dimensional reference dosimetry technique for measuring dose from CBCT scans using the on-board imaging system on a Varian Clinac-iX linear accelerator that employs the XR-QA radiochromic film model, specifically designed for dose measurements at low energy photons. The CBCT dose measurements were performed for three different body regions (head and neck, pelvis, and thorax) using humanoid Rando phantom.
The authors report on both surface dose and dose profiles measurements during clinical CBCT procedures carried out on a humanoid Rando phantom. Our measurements show that the surface doses per CBCT scan can range anywhere between 0.1 and 4.7 cGy, with the lowest surface dose observed in the head and neck region, while the highest surface dose was observed for the Pelvis spot light CBCT protocol in the pelvic region, on the posterior side of the Rando phantom. The authors also present results of the uncertainty analysis of our XR-QA radiochromic film dosimetry system.
Radiochromic film dosimetry protocol described in this work was used to perform dose measurements during CBCT acquisitions with the one-sigma dose measurement uncertainty of up to 3% for doses above 1 cGy. Our protocol is based on film exposure calibration in terms of "air kerma in air," which simplifies both the calibration procedure and reference dosimetry measurements. The results from a full Monte Carlo investigation of the dose conversion of measured XR-QA film dose at the surface into dose to water (or water kerma) at the surface of the phantom indicate that, for typical beam qualities used in CBCT, this conversion can be approximated by simple mass-energy absorption coefficient ratios water-to-air.
To test 2 systems developed to prioritize patients on waiting lists for cataract surgery, the Western Canadian Waiting List (WCWL), and the Catalan Agency for Health Technology Assessment and Research Cataract Priority System (CCPS), as tools for judging the appropriateness of the intervention.
Cross-sectional study with follow-up.
A total of 1723 prospective patients awaiting cataract extraction in 5 hospitals were included in the study.
Priority scores using the WCWL and the CCPS systems were calculated and compared with visual acuity (VA) and visual function, measured by the Visual Function-14 index, before and after surgery. The sensitivity of each priority system to different groups was evaluated using a validated appropriateness of indications tool for cataract extraction. One-way analysis of variance and the Jonckheere-Terpstra test were used to detect differences in group scores. Spearman correlation coefficients were also examined.
The WCWL and CCPS systems produced different mean values according to the preoperative levels of VA and visual function (p
The various major American and European guidelines for the treatment of depression provide similar basic principles of treatment, which include individualizing the treatment plan, preparing the patient for potential long-term treatment, providing measurement-based care, and treating to remission. While the guidelines are all evidence-based, certain factors can influence differences in specific recommendations, such as the consensus group's composition, underlying mandates, and cultural attitudes. The similarities and differences among 6 sets of guidelines from Europe and the Americas published in the past decade are reviewed here (American Psychiatric Association, British Association for Psychopharmacology, Canadian Network for Mood and Anxiety Treatments, National Institute for Health and Clinical Excellence, Texas Medication Algorithm Project, and World Federation of Societies of Biological Psychiatry). In the guidelines, mild depression has the most variance in treatment recommendations; some, but not all, guidelines suggest that it may resolve with exercise or watchful waiting, but psychotherapy or antidepressants could be used if initial efforts fail. Moderate and severe major depression carry broadly similar recommendations among the guidelines. First-line treatment recommendations for moderate major depressive disorder include antidepressant monotherapy, psychotherapy, and the combination of both. Severe depression may require the combination of an antidepressant and an antipsychotic, electroconvulsive therapy, or the combination of an antidepressant and psychotherapy. Benzodiazepines play a very limited role in the treatment of depression; if the patient has catatonic depression, acutely suicidal depression, or depression with symptoms of anxiety, agitation, or insomnia, benzodiazepines are recommended by some guidelines for short-term treatment only.
The aim of this study was to determine gender and clinical phenotype frequencies in pulmonary nontuberculous mycobacterial (NTM) infection and the frequency of disease in NTM isolates.
The study is a retrospective observational cohort study of two overlapping cohorts: population cohort and clinical cohort. Setting The study was conducted at the University Health Network and Ontario Mycobacteriology Laboratory in Toronto, Ontario, Canada.
The population cohort consisted of all patients with one or more pulmonary NTM isolates in Ontario in 2003. The clinical cohort consisted of all patients with one or more pulmonary NTM isolates at our hospital in 2002-2003. Interventions The study entailed the review of laboratory records and demographics (both cohorts) and detailed clinical records (clinical cohort).
In the population cohort (N = 1651), females comprised 48% overall and 51% with microbiological disease criteria. In the clinical cohort (N = 552), females comprised 48% overall and 55% with NTM disease. In the population cohort, 45% fulfilled microbiological disease criteria, and in the clinical cohort 46% of patients had disease. Patients with MAC isolates fulfilled microbiological disease criteria in 51% of population cohort cases and all disease criteria in 52% of clinical cohort cases. Women more commonly fulfilled microbiological disease criteria in the population cohort (51 vs. 45%, P = 0.02) and all disease criteria in the clinical cohort (53 vs. 40%, P = 0.03). Among clinical cohort patients, 26% (13 women, 44 men) had fibrocavitation, while 62% (101 women, 37 men) had nodular bronchiectasis.
Women comprised a small majority with disease. Nodular bronchiectasis in women was most common, but significant proportions of each gender with each radiographic type were observed. NTM isolation, particularly MAC, was frequently associated with disease.
In pain conditions, active coping has been found to be associated with less severe depression, increased activity level, and less functional impairment. Studies indicate that Canadians have a high expectation for chronic pain following whiplash injury. Expectation of recovery has been shown to predict recovery in whiplash victims. The objective of this study was to compare both the expectations and the coping style for whiplash injury in injury-naive subjects. The Vanderbilt Pain Management Inventory was administered to university students. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviors indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Subjects (57%) held an expectation of chronic pain after whiplash injury. The mean active coping style score was 28.5±6.6 (40 is the maximum score for active coping). The mean passive coping style score was 28.5±6.6 (50 is the maximum score for passive coping). Those with high passive coping styles had a higher mean expectation score. The correlation between passive coping style score and expectation score was 0.62, while the correlation between active coping style score and expectation was -0.48. Both expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in whiplash victims. Further studies of coping style as an etiologic factor in the chronic whiplash syndrome are needed.