Demographic Moderators of the Relationship Between Adverse Childhood Experiences and Cigarette Smoking.

Background: Research suggests that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking, such that as ACE score increases, so do the odds of smoking behavior, but little is known about what factors moderate this relationship. Objectives: The goal of this study was to examine demographic characteristics as potential moderators of relationship between ACE score and cigarette smoking. Methods: A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10). We used multinomial logistic regression to test sex, race, income, and education as moderators of the relationship between ACE score and smoking. Results: ACEs were not significantly associated with smoking behavior. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. Conclusions/Importance: Results suggest that there may not be a relationship between ACEs and smoking later in life. Additionally, the relationship between ACEs and smoking in adulthood may not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.

Innovating dementia care; implementing characteristics of green care farms in other long-term care settings.

ABSTRACTBackground:People with dementia at green care farms (GCFs) are physically more active, have more social interactions, are involved in a larger variety of activities, and come outdoors more often than those in other long-term dementia care settings. These aspects may positively affect health and well-being. This study explored which and how characteristics of GCFs could be implemented in other long-term dementia care settings, taking into account possible facilitators and barriers. METHODS: Semi-structured interviews were conducted with 23 professionals from GCFs, independent small-scale long-term care facilities, and larger scale long-term care facilities in the Netherlands. The framework method was used to analyze the data. RESULTS: Several characteristics of GCFs (e.g. homelike aspects, domestic activities, and access to outdoor environments) have already been applied in other types of long-term dementia care settings. However, how and the extent to which these characteristics are being applied differ between GCFs and other types of long-term dementia care settings. Facilitators and barriers for the implementation of characteristics of GCFs were related to the physical environment in which the care facility is situated (e.g. the degree of urbanization), characteristics and competences of staff members (e.g. flexibility, creativity), characteristics and competences of managers (e.g. leadership, vision), and the political context (e.g. application of risk and safety protocols). CONCLUSION: Several characteristics can be implemented in other dementia care settings. However, to realize innovation in dementia care it is important that not only the physical environment but also the social and organizational environments are supporting the process of change.

Impact of antipsychotic review and non-pharmacological intervention on health-related quality of life in people with dementia living in care homes: WHELD-a factorial cluster randomised controlled trial.

BACKGROUND: Very few interventional studies have directly examined the impact of treatment approaches on health-related quality of life (HRQL) in people with dementia. This is of particular importance in therapies to address behavioural symptoms, where HRQL is often severely affected. METHODS: Analysis within the WHELD cluster randomised factorial study in 16 UK care homes examining the impact of person-centred care in combination with antipsychotic review, social interaction and exercise interventions. This study analysed impact on HRQL through the DEMQOL-Proxy. RESULTS: Data on HRQL were available for 187 participants. People receiving antipsychotic review showed a significant worsening in two DEMQOL-Proxy domains (negative emotion: p = 0.02; appearance: p = 0.04). A best-case scenario analysis showed significant worsening for total DEMQOL-Proxy score. Social interaction intervention resulted in a significant benefit to HRQL (p = 0.04). There was no deterioration in HRQL in groups receiving both antipsychotic review and social interaction (p = 0.62). CONCLUSIONS: This demonstrates an important detrimental impact of discontinuation of antipsychotics in dementia on HRQL, highlighting the need for careful review of best practice guidelines regarding antipsychotic use and emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review. Copyright © 2016 John Wiley & Sons, Ltd.

The effectiveness of an outdoor adventure programme for young children with autism spectrum disorder: a controlled study.

AIM: Outdoor adventure programmes aim to improve interpersonal relationships using adventurous activities. The current study examined the effectiveness of an outdoor adventure programme in children with autism spectrum disorders (ASD). METHOD: The study included 51 participants (40 males, 11 females; age 3y 4mo-7y 4mo) enrolled in ASD special education kindergartens. Only the intervention group (n=30) participated in the outdoor adventure programme for 13 weeks, completing challenging physical activities that required cooperation and communication with peers and instructors. The control group (n=21) was not significantly different from the research group in age, sex, cognitive, and adaptive behaviour measures. RESULTS: Outcomes after the intervention revealed significant improvement in social-communication and different directions in the two groups in the social cognition, social motivation, and autistic mannerisms subdomains of the Social Responsiveness Scale. While the group that received an outdoor adventure programme showed a tendency toward a reduction in severity, the control group showed the opposite (p<0.010). INTERPRETATION: The outdoor adventure programme required problem-solving skills and forced the child to communicate in exciting situations. This study suggests that an outdoor adventure programme may be an effective intervention in addition to traditional treatments in young children with ASD. Future studies should examine the outcome of outdoor adventure programmes delivered for longer periods of time and maintenance of the achievements over time.

Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility.

OBJECTIVES: The study examined the effect of an individualized social activities intervention (ISAI) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. METHOD: This randomized control trial consisted of 52 older adults (M = 70.63, SD = 5.62) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility. A 2 (group condition) × 2 (time of measurement) design was used to compare the control (treatment-as-usual) and intervention (treatment-as-usual plus ISAI) conditions at pre- and post-treatment. ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days. The Dementia Quality of Life instrument and Neurobehavioral Rating Scale-Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment. RESULTS: Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life, with this effect remaining when only completer data were included. There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia. CONCLUSION: Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric inpatients.

Standardised detoxification in cases of polydrug use. / Standardisert avrusning ved blandingsmisbruk.

BACKGROUND: In recent decades the pattern of substance use among patients admitted for detoxification has changed from predominantly single-substance use to simultaneous multi-substance use. The evidence base for pharmacological treatment of polydrug users remains inadequate. MATERIAL AND METHOD: A non-experimental cohort study was conducted with 284 polydrug users in the Detoxification Unit of Sørlandet Hospital in 2013. The therapeutic approach was standardised, and was based on social therapy and symptomatic treatment of withdrawal symptoms with valproate and clonidine as key medications. RESULTS: Three quarters of the patients were male and they had used more than three different substances on average. The average age was 39 years. In total, 75 % of patients completed the detoxification programme, and for 95 % detoxification occurred without complications. In 89 % of cases, the standard treatment protocol was followed. There was a weak but significant correlation between treatment discontinuation and the number of substances used (OR = 1.42, p < 0.05). In terms of complications, 1.1 % experienced delirium tremens, 1.1 % epileptic seizures and 1.4 % substance-induced psychosis. Transfer to a somatic ward was necessary for 2.1 % of patients, and to a psychiatric ward for 1.4 %. INTERPRETATION: The completion rate in this study was considerably higher than in previous detoxification studies, and the complication rate was lower. In view of the good results observed and the high degree of standardised treatment, the regimen can be considered a safe treatment option for other detoxification units.

Social rhythm disrupting events increase the risk of recurrence among individuals with bipolar disorder.

OBJECTIVES: As outlined in the social zeitgeber hypothesis, social rhythm disrupting (SRD) life events begin a cascade of social and biological rhythm disruption that may lead to the onset of affective episodes in those vulnerable to bipolar disorder. Thus, the study of SRD events is particularly important in individuals with this chronic condition. The purpose of the current study was to evaluate (i) the extent to which SRD life events increased the risk of recurrence of a bipolar mood episode, and (ii) whether the social rhythm disruption associated with the event conferred an increased risk of recurrence, after accounting for the level of threat associated with the life event. METHODS: We examined the effect of SRD events on recurrence during preventative treatment in a sample of 118 patients with bipolar disorder who achieved remission from an acute episode after receiving psychotherapy and pharmacotherapy. Life events were measured with the Bedford College Life Events and Difficulty Schedule and were rated for degree of SRD and threat. RESULTS: Time-dependent Cox proportional hazards models showed that having a higher SRD rating was significantly associated with an increased risk of recurrence, even when accounting for the threat effect of a life event and psychosocial treatment (hazard ratio = 1.33, 95% confidence interval: 1.04-1.70, p = 0.023). However, this finding fell below conventional levels of statistical significance when accounting for other covariates. CONCLUSIONS: Our findings lend partial support to the social zeitgeber hypothesis.

Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke.

Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework.

BACKGROUND: In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined. METHODS: A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. RESULTS: Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance). CONCLUSIONS: This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.

Participation in a social and recreational day programme increases community integration and reduces family burden of persons with acquired brain injury.

PRIMARY OBJECTIVE: To describe and evaluate a new day programme for persons living with an acquired brain injury (ABI), including persons exhibiting challenging behaviours. Activities were designed to reduce participants' social isolation, increase participation in community activities and increase social and leisure skills. It was expected that community integration would increase and challenging behaviours and family burden would decrease for day programme participants. METHODS AND PROCEDURES: Pre-post convenience sample design. Sixty-one participants and family members completed questionnaires before starting the day programme and after 6-month participation. MEASURES: Community Integration Questionnaire, Overt Behaviour Scale, Burden Assessment Scale, Goal Attainment Scaling. RESULTS: Participants had increased community integration (p = 0.000) and decreased family burden (p = 0.006). There was a trend to decreased severity of challenging behaviour. Participants and family members were very satisfied. Results suggest that the programme was effective in reducing participants' social isolation and increasing appropriate interpersonal behaviours. CONCLUSIONS: Participation increased community integration and reduced burden on family caregivers. ABI day programmes help fill the void left after other rehabilitation services end and provide survivors with opportunities to engage in a variety of activities. Persons living with ABI have need for ongoing social, recreational and life skill coaching services after formal rehabilitation has been completed.

Improving Awareness of an Acute Psychiatric Unit's Capacity for Admission.

New admissions to psychiatric inpatient units can significantly impact the environment and level of safety. Maintaining safety is a core and critical responsibility of nursing, but nurses are often overlooked in the decision to admit a patient. Missed opportunities for dialogue between nurses and the admitting physician challenge nurses' ability to proactively manage the therapeutic environment. When nurses are limited in this ability, the outcome can be an unpredictable and unstable milieu. In a 25-bed acute psychiatric inpatient unit, a formalized communication system among the multidisciplinary admission team was developed. Data collected over 1 year demonstrated improved safety. Increasing the admitting provider's awareness of the current unit acuity and involving the nursing staff early in the admission process improved collaboration among care team members and reduced risks to maintaining milieu safety.

[Behavioral and psychological symptoms of dementia (BPSD): how to proceed]. / Behaviorale und psychologische Symptome der Demenz (BPSD): Was tun?

The prevalence of the behavioral and psychological symptoms of dementia (BPSD) is very high in dementia patients. Alterations in multiple neurotransmitter systems are involved in the pathogenesis of BPSD. These symptoms complicate the therapy and outcome. Because of multimorbidity and polpharmacy the therapy of BPSD is difficult and needs continuous clinical observation of the patients. Non-pharmacological interventions must be the first choice of therapy before medication and may accompany the pharmacological treatment. Several non-pharmacological interventions are available and summarized in the following therapy recommendations of the Swiss medical societies. Pharmacological interventions are often accompanied by severe adverse events in dementia patients. Their use must be limited in time and quantity. A critical survey of pharmacological therapy options in dementia is necessary.

Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials.

BACKGROUND: Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. AIMS: To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). RESULTS: Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. CONCLUSIONS: There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.

Gendering inequality: a note on Piketty's Capital in the twenty-first century.

Thomas Piketty's Capital in the Twenty-First Century is remarkable for moving inequality from the margins to mainstream debate through detailed analysis of longitudinal statistics and, for an economist, by advocating an interdisciplinary perspective and writing in a witty and accessible style. With reference to the post 1970 period, when wage increases are largely responsible for the increase in inequality, Piketty shows how patrimonial capitalists (elite managers) in the top decile and centile of the distribution appropriate a growing share of social wealth as a consequence of their 'power to set their own remuneration' in the context of tolerant social norms rather than through their productive contributions. Piketty raises but defers the question of where these social norms come from to other disciplines. A Feminist Economics perspective indicates that these questions are central to a more inclusive form of economic analysis and such an approach would enrich Piketty's analysis in two main ways. First, by paying greater attention to the processes and social norms through which inequalities are produced and justified and second by highlighting the ways in which inequality is experienced differently depending not only on class, but also on other aspects of identity including gender. This approach also suggests that it is necessary to supplement the ex-post redistributive policies recommended by Piketty: a global wealth tax and more steeply progressive income tax, with ex-ante measures to stop the rise in wage inequality in the first place, especially by bridging the huge gulf that exists between those who care for people and those who manage money.

[Characteristics of psychotherapeutic support for patients with traumatic encephalopathy].

As a result of psychological research on 127 patients with traumatic encephalopathy and complex treatment methods with the inclusion of psychotherapy marked positive dynamics of the psychological status, and found three main syndromes (asthenic, hypochondriac, hysterical) and concluded the most effective methods of psychotherapy.

Trauma in Canada: a spirit of equity & collaboration.

BACKGROUND: The delivery of equitable trauma care in Canada is not without challenges within our universal health care system. Notably, the tyranny of geography is intermittently at odds with adequate access for our rural, indigenous, and impoverished populations. Other differences exist when compared with neighbouring trauma systems, for example in the United States. METHODS: As a critical review, we chose to compare and critique the overall system of trauma organization and perceived societal expectations of a high-income, North American country (Canada) to assist with discussions on trauma systems for the future. RESULTS: Tele-technology is providing some early solutions. Trauma systems and delivery of care in Canada differ from the United States due to our single-payer system, regionalization and universal provision. Care for injured Canadians has a long history of being multidisciplinary, with collaborative research programs. Canada also has a history of global surgical endeavours, beginning with Dr. Norman Bethune and his recognition of the political causes of trauma and continuing as a global public health concern for all. CONCLUSIONS: While challenges continue to exist for the provision of equitable trauma care in Canada, unique multidisciplinary, collaborative and technology-based solutions continue to be developed, both locally and globally, to address this critical public health issue.

Sexual transgression and social disconnection: healing through community-based sociotherapy in Rwanda.

A distinguishing feature of the 1994 genocide against the Tutsi and the preceding 1990-1994 war in Rwanda was the social intimacy of the crimes committed. The legacy of this kind of violence includes distrust in social relations within communities and families, an increase of violence in everyday social interaction, transgressive sexual engagements, and a range of psychological problems. Many people feel nostalgia for their past social life, but are unable to change their current situation. In 2005, a community-based sociotherapy programme was introduced into this context of mental and social distress. The goal was to help people regain feelings of dignity and safety and to reduce distress. This paper is based on qualitative research, in particular, case studies. It explores how sociotherapy, as a specific form of peer group counselling, may facilitate the healing of suffering related to issues of sexuality, violence within the family and the breakdown of social connections on a community level.

[The newest therapeutic directions in the rehabilitation of patients with mental disorders]. / Najnowsze kierunki terapeutyczne w rehabilitacji pacjentów z zaburzeniami psychicznymi.

In this paper, the authors attempted to present the comprehensive literature review on the newest therapeutic interventions such as cognitive remediation therapy (CRT), mindfulness-based cognitive therapy (MBCT), social cognition and interaction training (SCIT), and acceptance and commitment therapy (ACT) which appeared promising whilst their implementing among schizophrenic patients, patients with anxiety disorders, eating disorders, and affective disorders. In the presented work particular attention was focused on two kinds of psychotherapeutic interventions: social cognitive trainings and cognitive remediation therapy (CRT) and their effectiveness in the rehabilitation process of schizophrenic patients. The growing body of research based on application of the above mentioned techniques in psychiatric population gives remarkable hope to improve quality of cognitive and psychosocial therapeutic interventions and to set up both complex and comprehensive therapeutic programme for patients with mental disorders.

Fertility treatment response: is it better to be more optimistic or less pessimistic?

OBJECTIVE: To evaluate the prospective relation between dispositional traits of optimism and pessimism and in vitro fertilization (IVF) treatment failure among women seeking medical intervention for infertility. METHODS: Among 198 women (aged 24-45 years, mean [standard deviation] = 35.1 [4.1] years; white, 77%), the outcome of each participant's first IVF treatment cycle was examined. Treatment outcome was classified as being successful (versus failed) if the woman either delivered a baby or was pregnant because of the cycle by the end of the 18-month study period. At baseline, optimism and pessimism were measured as a single bipolar dimension and as separate unipolar dimensions according to the Life Orientation Test total score and the optimism and pessimism subscale scores, respectively. RESULTS: Optimism/pessimism, measured as a single bipolar dimension, predicted IVF treatment failure initially (B = -0.09, p = .02, odds ratio [OR] = 0.917, 95% confidence interval [CI] = 0.851-0.988), but this association attenuated after statistical control for trait negative affect (B = -0.06, p = .13, OR = 0.938, 95% CI = 0.863-1.020). When examined as separate unipolar dimensions, pessimism (B = 0.14, p = .04, OR = 1.146, 95% CI = 1.008-1.303), not optimism (B = -0.09, p = .12, OR = 0.912, 95% CI = 0.813-1.023), predicted IVF treatment failure independently of risk factors for poor IVF treatment response and trait negative affect. CONCLUSIONS: Being pessimistic may be a risk factor for IVF treatment failure. Future research should attempt to delineate the biological and behavioral mechanisms by which pessimism may negatively affect treatment outcomes.

A decade of published evidence for psychiatric and mental health nursing interventions.

Current psychiatric nursing practice remains grounded in tradition, unsystematic trial and error, and authority. Although some of the wisdom that has been passed down over time is questionable, it continues to influence nursing practice today. This state-of-the-evidence review examined features of intervention studies published between January 2006 and December 2010 in five psychiatric nursing journals; it compared findings with those from a previous study of comparable literature published between 2000 and 2005. The analysis included studies that evaluated strategies, procedures, or practices that promote mental health or prevent mental illness. Of the 553 data-based articles, 71% tested interventions; 54% were conducted in the United States. Intervention studies reflected psychological (38%) social (17%), and biological (1%) dimensions of the biopsychosocial model. Some studies involved two dimensions and 17% included all three dimensions. Studies involved nurses, students, or staff (15%), mentally ill (50%), or mentally healthy persons (35%) ranging in age from childhood through older adulthood. The 10 year review showed continuing progress toward increased dissemination compared to earlier years; less focus on nurses, students, and staff; an increase in international studies; and greater emphasis on holistic interventions. In this article, the authors note a need for more randomized, controlled trials and studies to compare effectiveness across interventions.