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1.
Nature ; 583(7814): 39-42, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32612222

RESUMO

The interiors of giant planets remain poorly understood. Even for the planets in the Solar System, difficulties in observation lead to large uncertainties in the properties of planetary cores. Exoplanets that have undergone rare evolutionary processes provide a route to understanding planetary interiors. Planets found in and near the typically barren hot-Neptune 'desert'1,2 (a region in mass-radius space that contains few planets) have proved to be particularly valuable in this regard. These planets include HD149026b3, which is thought to have an unusually massive core, and recent discoveries such as LTT9779b4 and NGTS-4b5, on which photoevaporation has removed a substantial part of their outer atmospheres. Here we report observations of the planet TOI-849b, which has a radius smaller than Neptune's but an anomalously large mass of [Formula: see text] Earth masses and a density of [Formula: see text] grams per cubic centimetre, similar to Earth's. Interior-structure models suggest that any gaseous envelope of pure hydrogen and helium consists of no more than [Formula: see text] per cent of the total planetary mass. The planet could have been a gas giant before undergoing extreme mass loss via thermal self-disruption or giant planet collisions, or it could have avoided substantial gas accretion, perhaps through gap opening or late formation6. Although photoevaporation rates cannot account for the mass loss required to reduce a Jupiter-like gas giant, they can remove a small (a few Earth masses) hydrogen and helium envelope on timescales of several billion years, implying that any remaining atmosphere on TOI-849b is likely to be enriched by water or other volatiles from the planetary interior. We conclude that TOI-849b is the remnant core of a giant planet.

2.
Small ; : e2406671, 2024 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-39402790

RESUMO

Prebiotically-plausible compartmentalization mechanisms include membrane vesicles formed by amphiphile self-assembly and coacervate droplets formed by liquid-liquid phase separation. Both types of structures form spontaneously and can be related to cellular compartmentalization motifs in today's living cells. As prebiotic compartments, they have complementary capabilities, with coacervates offering excellent solute accumulation and membranes providing superior boundaries. Herein, protocell models constructed by spontaneous encapsulation of coacervate droplets by mixed fatty acid/phospholipid and by purely fatty acid membranes are described. Coacervate-supported membranes form over a range of coacervate and lipid compositions, with membrane properties impacted by charge-charge interactions between coacervates and membranes. Vesicles formed by coacervate-templated membrane assembly exhibit profoundly different permeability than traditional fatty acid or blended fatty acid/phospholipid membranes without a coacervate interior, particularly in the presence of magnesium ions (Mg2+). While fatty acid and blended membrane vesicles are disrupted by the addition of Mg2+, the corresponding coacervate-supported membranes remain intact and impermeable to externally-added solutes. With the more robust membrane, fluorescein diacetate (FDA) hydrolysis, which is commonly used for cell viability assays, can be performed inside the protocell model due to the simple diffusion of FDA and then following with the coacervate-mediated abiotic hydrolysis to fluorescein.

3.
Qual Health Res ; : 10497323241263261, 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39213134

RESUMO

While previous research explored the utilization of culturally supportive resources in multiethnic communities, there is a paucity of information regarding culturally relevant resources for Black Canadian family members. The study explored Black family members' experiences and interpretations regarding access to culturally supportive resources for family members and their relatives who suffer from substance use disorders. Black family members are defined as African Canadians, Caribbean Canadians, or Caribbean Blacks. A focused ethnography was conducted with a purposive sample of 26 Black family members in Ontario, Canada. The interviews were conducted from June to September 2021. Seventeen participants originated from parts of Africa, and nine were from different parts of the Caribbean. The participants comprised mothers (n = 5), fathers (n = 2), step-fathers (n = 1), husbands (n = 1), wives (n = 2), uncles (n = 5), aunties (n = 2), siblings (n = 5), in-laws (n = 2), and guardians (n = 1). Leininger's four Phases of Ethnonursing Qualitative Data Analysis were used for data analysis. Three themes were generated: (1) Navigating Existing Options and Resources for Families and Their Relatives; (2) Drawing upon Religion and Spirituality as Perceived Resources; and (3) Call for Culturally Relevant Programs for Substance Use Disorders Harm Reduction. Participants described experiencing a lack of culturally relevant resources and subsequently opting to navigate other resources. One such option was to send their relatives back to their country of origin to access cultural rehabilitation treatment options. There is a significant need for guidelines and policies regarding creating timely access to culturally relevant resources in Canada that support families and their relatives towards harm reduction and recovery outcomes.

4.
Community Ment Health J ; 60(5): 898-907, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38441824

RESUMO

Family physicians (FPs) play an important but underappreciated role in the pathways to care for people with early psychosis. We conducted a mixed-methods study to describe the knowledge, attitudes, preferences, and needs of FPs towards the recognition and management of early psychosis. We sent a cross-sectional postal survey to a random sample of FPs in Ontario, Canada, and conducted in-depth qualitative interviews with twenty. FPs were generally aware of important early psychosis symptoms, however, there were some knowledge gaps. Among surveyed FPs, 25% were unsure of the availability of early psychosis intervention services in their region, and most (80%) would prefer to co-manage with specialists. In the qualitative interviews, FPs expressed varied comfort levels in recognizing psychosis, and that timely access to psychiatry was a main concern. Our findings suggest that FPs require better support in recognizing and managing early psychosis and facilitating connections with specialized care.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Médicos de Família , Atenção Primária à Saúde , Transtornos Psicóticos , Humanos , Transtornos Psicóticos/terapia , Transtornos Psicóticos/psicologia , Masculino , Feminino , Estudos Transversais , Ontário , Adulto , Pessoa de Meia-Idade , Médicos de Família/psicologia , Pesquisa Qualitativa , Atitude do Pessoal de Saúde , Inquéritos e Questionários , Intervenção Médica Precoce , Entrevistas como Assunto
5.
Issues Ment Health Nurs ; 45(6): 589-596, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38683964

RESUMO

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline-spring 2018 and post-implementation - winter 2019). Data analysis guided by Leininger's ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.


Assuntos
Serviços Comunitários de Saúde Mental , Pessoas Mal Alojadas , Humanos , Ontário , Pessoas Mal Alojadas/psicologia , Serviços Comunitários de Saúde Mental/organização & administração , Grupos Focais , Lares para Grupos/organização & administração , Feminino , Masculino , Atitude do Pessoal de Saúde , Adulto , Pesquisa Qualitativa
6.
J Ethn Subst Abuse ; : 1-31, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38557270

RESUMO

Research explored substance use in Black communities in Canada, but a gap exists about the experiences of Black family members, caring for relatives with substance misuse within the Canadian context. Black family members are defined as African Canadians, Caribbean Canadian or Caribbean Blacks. This paper explores Black family members' beliefs and experiences regarding their relatives' psychoactive substance use and misuse. A focused ethnography was conducted with 26 Black family members with 17 participants originated from various parts of Africa, and nine participants originated from parts of the Caribbean. Participants comprised of mothers (n = 5), fathers (n = 2), step-fathers (n = 1), husbands (n = 1), wives (n = 2), uncles (n = 5), aunties (n = 2), siblings (n = 5), in-laws (n = 2), and guardians (n = 1). Three themes were generated: cultural beliefs and perceptions regarding substance use and misuse of family relatives; "When he starts drinking, hell breaks loose": Perceived impact of substance misuse on family safety and stability; and, the experiences of stigma and the keeping of secrets. Prioritizing public health approaches, such as public policies and campaigns that dismantle stigma and systemic barriers, and increase awareness about substance use and harm reduction interventions among Black communities.

7.
BMC Public Health ; 23(1): 287, 2023 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-36755251

RESUMO

BACKGROUND: Recovery-oriented programs provide individuals with opportunities for well-being through community integration processes that enhance the degree to which individuals could live, work, and recreate in their community. The current evaluation assessed how tenants experience their home environment after the modernization of Homes for Special Care (HSC) to Community Homes for Opportunity (CHO) in Southwest Ontario, Canada. Our study identifies existing policies and practices that could interfere with or promote the modernization process. METHODS: We applied ethnographic qualitative techniques to purposefully recruit 188 participants with severe mental illness from 28 group homes. Focus groups were conducted at three time points, i.e., at pre-implementation/Baseline/Time I - spring 2018; Transition/Time II - fall 2018, and Final/Time III - winter 2019. RESULTS: Study findings suggest that the transition of HSC to CHO supports activities that empower tenants towards personal growth and development. Participants were largely satisfied with the support they were getting in relation to the program-related services. Tenants disclosed that their quality of life and well-being had been enhanced through participating in the program, and that their social interaction and support for each other had also improved. Most tenants demonstrated autonomy in terms of personal and financial independence. The enhanced financial support for tenants did not only improve their quality of life, but also helped to raise their purchasing power, decision making, sense of responsibility and accountability towards healthy spending of their resources. Despite tenants' good impression about the CHO, some still encountered problems and provided suggestions to further improve the program. CONCLUSION: It is expected that a more effective and expanded CHO will lead to tenant empowerment and successful social integration.


Assuntos
Transtornos Mentais , Qualidade de Vida , Humanos , Ontário , Lares para Grupos , Nível de Saúde
8.
BMC Public Health ; 23(1): 585, 2023 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-36991379

RESUMO

BACKGROUND: The global extant literature acknowledge that housing serves as a key social determinant of health. Housing interventions that involve group homes have been found to support the recovery of persons with mental illness and those with addiction issues. The current study explored the views of homeowners in relation to a supportive housing program called Community Homes for Opportunity (CHO) that modernised a provincial group home program (Homes for Special Care [HSC]) and provided recommendations for improving the program implementation in other geographical areas of Ontario. METHODS: We applied ethnographic qualitative techniques to purposefully recruit 36 homeowner participants from 28 group homes in Southwest Ontario, Ontario Canada. Focus group discussions were conducted at two time points, during CHO program implementation (Fall 2018, and post implementation phases (Winter 2019) respectively. RESULTS: Data analysis yielded 5 major themes. These include: (1) general impressions about the modernization process, (2) perceived social, economic and health outcomes, (3) enablers of the modernization program, (4) challenges to implementation of the modernization program, and (5) suggestions for implementation of the CHO in future. CONCLUSIONS: A more effective and expanded CHO program will need the effective collaboration of all stakeholders including homeowners for successful implementation.


Assuntos
Lares para Grupos , Serviços de Assistência Domiciliar , Humanos , Ontário , Habitação , Pesquisa Qualitativa
9.
J Dairy Sci ; 106(4): 2461-2474, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36797181

RESUMO

Preweaning calves are kept in a range of housing types that offer variable protection against the weather and provide differing internal environments. This cross-sectional observational study assessed the effect of housing type (shed, polytunnel, or hutches) on internal environmental parameters, using 2 blocks of 8-wk measurements from 10 commercial dairy farms in the south of England, covering both summer and winter periods. Continuous measurements for internal and external temperature and humidity were recorded by data logger placed within the calf housing and used to calculate the temperature-humidity index (THI). Weekly point readings were also taken for temperature, humidity, light, air speed, ammonia level, and airborne particulate matter. Airborne bacterial levels were determined at wk 2, 5, and 8 by incubating air samples at 35°C for 24 h in aerobic conditions. Data were analyzed using linear mixed models. Housing type influenced THI significantly in both seasons. In summer, calves were exposed to heat stress conditions (THI ≥72) for 39, 31, and 14 of 46 d in polytunnel housing, hutches, and sheds, respectively. The maximum summer temperature (37.0°C) was recorded in both hutch and polytunnel housing, with sheds remaining consistently cooler (maximum 31.0°C). In winter, the lowest minimum internal temperature recorded was in hutches at -4.5°C, with both the sheds and polytunnel, but not hutches, providing a significant increase in temperature compared with the external environment. Hutches remained ≤ 10°C for 86% of the winter study period. Light levels were reduced in all housing types compared with the external environment. The particulate matter in air that is capable of reaching the lungs (particulate matter <10 µm) was highest in sheds, intermediate in hutches, and lowest in polytunnel housing (0.97 ± 3.75, 0.37 ± 0.44, and 0.20 ± 0.24 mg/m3, respectively). This was mirrored by airborne bacterial numbers, which were also highest in sheds (8,017 ± 2,141 cfu/m3), intermediate in hutches (6,870 ± 2,084 cfu/m3), and lowest in the polytunnel (3,357 ± 2,572 cfu/m3). Round, white, catalase-positive, and oxidase-negative colonies were most prevalent, likely indicating Staphylococcus species. This study demonstrated that UK calves are routinely exposed to either heat or cold stress, especially when housed in hutches or polytunnels. Sheds had the highest levels of particulate matter and airborne bacteria, both known contributory factors for respiratory disease. These findings demonstrate that all calf housing systems result in environmental compromises that could have long-term impacts on calf health and growth; therefore, further studies should identify husbandry and housing modifications to mitigate these factors.


Assuntos
Abrigo para Animais , Animais , Bovinos , Estudos Transversais , Umidade , Temperatura , Reino Unido
10.
BMC Nurs ; 22(1): 85, 2023 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-36991388

RESUMO

OBJECTIVE: To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. METHOD: A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. RESULTS: Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. DISCUSSION: This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. CONCLUSION: For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).

11.
Adm Policy Ment Health ; 50(2): 212-224, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36403173

RESUMO

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.


Assuntos
Transtornos Psicóticos , Humanos , Masculino , Estudos Retrospectivos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Ontário/epidemiologia , Diagnóstico Precoce , Atenção Primária à Saúde
12.
Synthese ; 201(2): 64, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36819963

RESUMO

In this paper we present a modal logic framework to reason about the expertise of information sources. A source is considered an expert on a proposition φ if they are able to correctly refute φ in any possible world where φ is false. Closely connected with expertise is a notion of soundness of information: φ is said to be "sound" if it is true up to lack of expertise of the source. That is, any statement logically weaker than φ on which the source has expertise must in fact be true. This is relevant for modelling situations in which sources make claims beyond their domain of expertise. Particular attention is paid to the connection between expertise and knowledge: we show that expertise and soundness admit precise interpretations in terms of S4 and S5 epistemic logic, under certain conditions. We go on to extend the framework to multiple sources, defining two notions of collective expertise. These also have epistemic interpretations via distributed and common knowledge from multi-agent epistemic logic. On the technical side, we give several sound and complete axiomatisations of various classes of expertise models.

13.
Gut ; 2022 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-35820780

RESUMO

Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.

14.
Sensors (Basel) ; 23(1)2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36617004

RESUMO

Appropriate support in the home may not be readily available for people living in the community with mental illness and physical comorbidities. This mixed-method study evaluated a smart home technology intervention for individuals within this population as well as providing health care providers with health monitoring capabilities. The study recruited 13 participants who were offered a smartphone, a touchscreen monitor, and health devices, including smartwatches, weigh scales, and automated medication dispensers. Healthcare providers were able to track health device data, which were synchronized with the Lawson Integrated DataBase. Participants completed interviews at baseline as well as at 6-month and 12-month follow-ups. Focus groups with participants and care providers were conducted separately at 6-month and 12-month time points. As the sample size was too small for meaningful statistical inference, only descriptive statistics were presented. However, the qualitative analyses revealed improvements in physical and mental health, as well as enhanced communication with care providers and friends/family. Technical difficulties and considerations are addressed. Ethics analyses revealed advancement in equity and fairness, while policy analyses revealed plentiful opportunities for informing policymakers. The economic costs are also discussed. Further studies and technological interventions are recommended to explore and expand upon in-home technologies that can be easily implemented into the living environment.


Assuntos
Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Tecnologia , Smartphone , Saúde Mental , Grupos Focais
15.
Qual Health Res ; 32(12): 1915-1931, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36036205

RESUMO

Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics-the good, the bad, and the vision-and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Adulto , Idoso , Criança , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental , Adulto Jovem
16.
Issues Ment Health Nurs ; 43(6): 507-515, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35025711

RESUMO

The transition from adolescence to adulthood is a tumultuous time riddled with stress, confusion, and uncertainty. An abrupt shift in biobehavioural development between the ages of 16 and 24 corresponds with an increase in mental health challenges; thereby necessitating comprehensive and coordinated psychiatric services that bridge pediatric and adult care realms. Unfortunately, this transition is often unsupportive and disjointed, leaving many transitional-aged youth (TAY) overwhelmed and ill-equipped to cope with the increased demands of adulthood independently. Eight TAY with mental health challenges were invited to participate in a PhotoVoice study that explored the strengths and shortcomings of this transition process, through a combination of photography and photo-elicitation focus group discussions. A descriptive qualitative approach was used to analyze all participant dialogue. Four themes emerged from the data: accessibility, coordination, independence, and support. Participant insights illuminated critical gaps in mental health care delivery, but also revealed novel solutions and opportunities for transformational change.


Assuntos
Serviços de Saúde Mental , Transição para Assistência do Adulto , Adolescente , Adulto , Idoso , Criança , Humanos , Saúde Mental , Pesquisa Qualitativa , Adulto Jovem
17.
Healthc Q ; 24(4): 7-10, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35216642

RESUMO

Homelessness is a significant social issue within Canada but is difficult to quantify at the population level. In this paper, we discuss the development and use of a case ascertainment algorithm that identifies people experiencing homelessness through health administrative data. We highlight the appropriateness of various uses of this method given its key strengths and limitations. Finally, we discuss plans to improve this methodology and broaden its use through the addition of linkable administrative data from non-health sectors, such as emergency shelters and social services organizations.


Assuntos
Pessoas Mal Alojadas , Humanos , Ontário/epidemiologia , Serviço Social
18.
Can J Psychiatry ; 66(4): 406-417, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33016113

RESUMO

BACKGROUND: Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. METHODS: We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. RESULTS: People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. DISCUSSION: We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.


Assuntos
Transtornos Psicóticos , Adolescente , Humanos , Saúde Mental , Ontário , Atenção Primária à Saúde , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Estudos Retrospectivos
19.
J Med Internet Res ; 22(5): e16540, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32452809

RESUMO

BACKGROUND: Instagram is a social media platform that enables users to share images and videos worldwide. Some nurses have used Instagram to document their experiences as a nurse and have subsequently gained microcelebrity status-that is, a user who purposefully seeks to amass a substantive Web-based following and has become recognized as a niche area of interest. OBJECTIVE: This study aimed to identify the characteristics and behaviors of microcelebrity nurses who act as influencers on Instagram and use their nursing profile to gain attention and presence on the Web. METHODS: A qualitative, exploratory, nonparticipatory content analysis of media and text generated by a purposeful sample of 10 registered nurses who use Instagram and sustain a definable microcelebrity status was conducted. In this study, manifest and latent data were examined to gain an understanding of the characteristics and behaviors of nurses who have attained microcelebrity status on Instagram. RESULTS: Data analysis revealed 5 themes of Instagram posts: (1) engaging Instagram users, (2) educational opportunities and insights, (3) nursing-related humor, (4) emotions experienced by nurses, and (5) media and narratives including patient details or work context. Messages were primarily positive in nature; however, multiple potential privacy, ethical, and professional issues were noted throughout the posted content. CONCLUSIONS: The findings of this study help to expand the current knowledge related to the use of social media platforms such as Instagram, especially in regard to the emergence of nurses who use this form of technology to achieve or maintain a microcelebrity status. This study calls for additional research on nurses' attainment of microcelebrity status on social media as well as further policy development to adequately prepare nurses to navigate social media.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Mídias Sociais/normas , Humanos
20.
Community Ment Health J ; 56(2): 238-250, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31673877

RESUMO

We describe a naturally occurring, real-world comparison of outcomes following 6 months in standalone DBT skills training group for adults with Borderline Personality Disorder (BPD) without recent suicidal or severe self-harming behaviours and standard (i.e. all modes) DBT for BPD including patients with recent high-risk behaviours. 34 patients chose standalone skills over waiting for standard DBT and 54 were offered standard DBT. Dropout was higher for standalone skills than standard DBT (38.2% vs. 16.7%). No statistically or clinically significant differences were found among completers between conditions on borderline symptoms, general psychopathology, and suicide ideation. There was a moderate effect for standalone skills on hopelessness and emotion regulation difficulties which may have reflected non-equivalence of treatment groups. Significant methodological factors limit generalisability of findings which offer support for feasibility of standalone DBT skills as an effective alternative to waitlist for standard DBT for at least some patients with BPD in the community.


Assuntos
Transtorno da Personalidade Borderline , Comportamento Autodestrutivo , Adulto , Terapia Comportamental , Transtorno da Personalidade Borderline/terapia , Humanos , Comportamento Autodestrutivo/terapia , Ideação Suicida , Resultado do Tratamento
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