System-Linked Research Unit on Health and Social Service Utilization, School of Nursing, McMaster University, Room 3N46, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. mreid@mcmaster.ca
This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.
To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission.
We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured.
More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up.
Legal admission status per se did not seem to influence treatment adherence and outcome.
BACKGROUNDS. A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on health and wellbeing, there is a lack of research regarding the model called the Psychiatric Rehabilitation Approach from Boston University (BPR).
The aim was to investigate the outcome of the BPR intervention regarding changes in life situation, use of healthcare services, quality of life, health, psychosocial functioning and empowerment.
The study has a prospective longitudinal design and the setting was seven mental health services who worked with the BPR in the county of Halland in Sweden. In total, 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments.
The most significant finding was an improved psychosocial functioning at the follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up. There were significant differences with regard to health, empowerment, quality of life and psychosocial functioning for those who reported that they had mainly/completely had achieved their self-formulated rehabilitation goals compared to those who reported that they only had to a small extent or not at all reached their goals.
Our results indicate that the BPR approach has impact on clients' health, empowerment, quality of life and in particular concerning psychosocial functioning.
The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain.
Secondary prevention is an important component of a structured rehabilitation programme following a cardiac event. Comprehensive programmes have been developed in many European countries, the vast majority of which are hospital based. In Sweden, all patients with cardiac disease are also given the opportunity to participate in secondary prevention activities arranged by the National Association for Heart and Lung Patients [The Heart & Lung School (HL)]. The aim of this 3-year longitudinal study was to compare persons who attended the HL after a cardiac event and those who declined participation, with regard to health aspects, life situation, social network and support, clinical data, rehospitalisation and mortality. Totally 220 patients were included in the study. The patients were asked to fill in a questionnaire on four occasions, in addition to visiting a health care center for physical examination. After 3 years, 160 persons were still participating, 35 of whom attended the HL. The results show that persons who participated in the HL exercised more regularly, smoked less and had a denser network as well as more social support from nonfamily members than the comparison groups. This study contributes to increased knowledge among healthcare professionals, politicians and decision makers about peer support groups as a support strategy after a cardiac event.
The four-step system for the treatment of traumatological patients contributes to earlier rehabilitation and shortens the time fo staying in hospitals. It also decreases the invalidism percentage.
The aim of the present 5-year follow-up was to clarify the nature of occlusal support status and radiographic changes in condyles of the elderly, and the association between these two variables.
The present study is part of a comprehensive medical survey of a random sample born in 1904, 1909, and 1914. A total of 364 subjects living in Helsinki participated in the dental part of the examination during 1990 to 1991, and after 5 years a total of 103 were reexamined. Comprehensive data on occlusal support status were available for 94 subjects, and radiographic data were available for 88 subjects. Occlusal support status was assessed on the basis of the Eichner index, radiographic changes were assessed from panoramic radiographs, and symptoms of temporomandibular disorders were assessed using Helkimo's anamnestic index.
The most frequent radiographic finding in the mandibular joint was flattening of the articular surface of the condyle associated with osteoarthrosis, found at baseline in 17% and during follow-up in 13% of the subjects. During the 5-year follow-up, Eichner index for natural dentition remained unaltered in 94% of the subjects and in 85% of the subjects when removable dentures were included. There were no radiographic changes in 92% of the cases. No differences based on age or gender were found. A logistic regression model revealed associations between the selected baseline factors. The odds ratio for baseline Helkimo's anamnestic index was 4.1, 5.7 for Eichner index with the support of removable dentures, and 356 for radiographic findings.
Radiographic changes in condyles of elderly people were small during the 5-year follow-up, but baseline radiographic findings, Helkimo's anamnestic index, and Eichner index with removable dentures were risk factors for radiographic findings at the end of the follow-up.
