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1.
J Intellect Disabil Res ; 63(5): 429-440, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30609156

RESUMEN

BACKGROUND: Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). OBJECTIVE: The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. METHODS: The all-inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE-related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. RESULTS: A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE-related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14-year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE-related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio-economic disadvantage and less private insurance coverage, suffered with less severe but different co-morbid clinical conditions and incurred more challenges in the acute hospital care setting. CONCLUSION: Although the pattern of ADE-related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.


Asunto(s)
Analgésicos Opioides/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Hospitalización/estadística & datos numéricos , Trastornos del Neurodesarrollo/tratamiento farmacológico , Trastornos del Neurodesarrollo/epidemiología , Psicotrópicos/efectos adversos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Estudios Retrospectivos , Adulto Joven
2.
J Intellect Disabil Res ; 62(12): 1018-1029, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29607562

RESUMEN

BACKGROUND: Self-injurious behaviour (SIB) is a prevalent form of challenging behaviour in people with intellectual developmental disorders (IDD). Existing research has yielded conflicting findings concerning the major risk factors involved, and in addition, SIB shows multiple topographies and presentations. Although presence of autism spectrum disorders (ASD) and severity of intellectual disability (ID) are known risk factors for SIB, there are no studies comparing SIB topographies by severity degrees of ID and ASD. The purpose of the present paper has been to identify risk factors and topographies for SIB in a representative, stratified and randomised sample of adults with IDD. METHOD: This study was conducted on the basis of data collected by the POMONA-ESP project, in a sample of 833 adults with IDD. Data concerning demographic and health information, ASD symptoms, psychopathology and ID, have been analysed to determine the presence of risk factors for SIB among participants and to explore the occurrence and topographies of SIB across different severity levels of ID and ASD symptoms. RESULTS: Self-injurious behaviour prevalence in the sample was 16.2%. Younger age, oral pain, greater severity of ID, presence of dual diagnosis, psychiatric medication intake and higher scores on Childhood Autism Rating Scale were risk factors for SIB among participants, whereas number of areas with functioning limitations, place of residence, diagnosis of epilepsy and sex were not. SIB was more frequent in participants with ASD symptoms regardless of its severity level, and they displayed a higher number of different topographies of SIB. People with profound ID without co-morbid ASD symptoms showed similar results concerning SIB prevalence and topographies. CONCLUSIONS: Knowledge on risk factors and topographies of SIB might play a vital role in the development of prevention strategies and management of SIB in people with IDD. The mere presence of ASD symptoms, regardless of its severity level, can be a crucial factor to be taken into account in assessing SIB. Accordingly, the presence of SIB in people with ID, especially when presented with a varied number of topographies, might provide guidance on ASD differential diagnosis.


Asunto(s)
Trastorno del Espectro Autista/epidemiología , Discapacidad Intelectual/epidemiología , Conducta Autodestructiva/epidemiología , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Características de la Residencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología , Adulto Joven
3.
Expert Rev Pharmacoecon Outcomes Res ; 23(1): 135-141, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36472303

RESUMEN

BACKGROUND: Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. METHODS: The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. RESULTS: The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. DISCUSSION: The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.


Asunto(s)
Costos de la Atención en Salud , Humanos , Análisis Costo-Beneficio , Europa (Continente) , Escolaridad
4.
Epidemiol Psychiatr Sci ; 31: e59, 2022 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-35993182

RESUMEN

AIMS: Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. METHODS: This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. RESULTS: The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. CONCLUSIONS: Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.


Asunto(s)
Investigación sobre Servicios de Salud , Salud Mental , Sesgo , Necesidades y Demandas de Servicios de Salud , Humanos , Reproducibilidad de los Resultados
6.
J Intellect Disabil Res ; 55(9): 858-72, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21726319

RESUMEN

BACKGROUND: Despite progress in the process of deinstitutionalisation, very little is known about the health conditions of people with intellectual disability (PWID) who live in large institutions and PWID living in small residential services, family homes or independent living within the community. Furthermore, there are no international comparison studies at European level of the health status and health risk factors of PWID living in fully staffed residential services with formal support and care compared with those living in unstaffed family homes or independent houses with no formal support. METHODS: A total of 1269 persons with ID and/or their proxy respondents were recruited and face-to-face interviewed in 14 EU countries with the P15, a multinational assessment battery for collecting data on health indicators relevant to PWID. Participants were grouped according to their living arrangements, availability of formal support and stage of deinstitutionalisation. RESULTS: Obesity and sedentary lifestyle along with a number of illnesses such as epilepsy, mental disorders, allergies or constipation were highly prevalent among PWID. A significantly higher presence of myocardial infarctions, chronic bronchitis, osteoporosis and gastric or duodenal ulcers was found among participants in countries considered to be at the early stage of deinstitutionalisation. Regardless of deinstitutionalisation stage, important deficits in variables related to such medical health promotion measures as vaccinations, cancer screenings and medical checks were found in family homes and independent living arrangements. Age, number of people living in the same home or number of places in residential services, presence of affective symptoms and obesity require further attention as they seem to be related to an increase in the number of illnesses suffered by PWID. DISCUSSION: Particular illnesses were found to be highly prevalent in PWID. There were important differences between different living arrangements depending on the level of formal support available and the stage of deinstitutionalisation. PWID are in need of tailored primary health programs that guarantee their access to quality health and health promotion and the preventative health actions of vaccination programs, systematic health checks, specific screenings and nutritional controls. Extensive national health surveys and epidemiological studies of PWID in the EC member states are urgently needed in order to reduce increased morbidity rates among this population.


Asunto(s)
Desinstitucionalización/estadística & datos numéricos , Estado de Salud , Vivienda/estadística & datos numéricos , Discapacidad Intelectual/epidemiología , Personas con Discapacidades Mentales/estadística & datos numéricos , Instituciones Residenciales/estadística & datos numéricos , Actividades Cotidianas , Adulto , Europa (Continente)/epidemiología , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Apoyo Social , Factores Socioeconómicos , Adulto Joven
7.
J Intellect Disabil Res ; 54(11): 981-91, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20825552

RESUMEN

BACKGROUND: Health disparities between adults with intellectual disabilities (ID) and the general population have been well documented but, to date, no dedicated assessment battery for measuring health disparity has been available. This paper reports on the development and testing of a multinational assessment battery for collecting data on a range of health indicators relevant to adults with ID. METHODS: An assessment battery (the P15) was developed following piloting, and administered to samples of adults with ID, in 14 EU countries. Samples were neither random, nor representative of the countries from which they were drawn. However, within the local health administration areas selected in each country, efforts were made to ensure samples were broadly representative of the typical living circumstances, ages and ability levels of the administrative population of adults with ID. The total sample comprised 1269 adults with ID, of whom 49% were female. The mean age was 41 years (range 19 to 90). RESULTS: Overall, feasibility, internal consistency and face validity of the P15 was acceptable. CONCLUSIONS: With some refinement the P15 could be useful for collecting data on health indicators known to be particularly important for adults with ID. It is useable in a range of countries and has the potential to highlight health inequity for adults with ID at a national or local level. Larger scale epidemiological studies are needed to exploit the potential of the P15 to address health inequity in this group.


Asunto(s)
Disparidades en el Estado de Salud , Encuestas Epidemiológicas , Discapacidad Intelectual/epidemiología , Discapacidad Intelectual/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Encuestas Epidemiológicas/métodos , Encuestas Epidemiológicas/normas , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo , Adulto Joven
10.
Epidemiol Psychiatr Sci ; 28(2): 210-223, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28918762

RESUMEN

AIMS: There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. METHODS: A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. RESULTS: The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. CONCLUSIONS: There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Trastornos Mentales/psicología , Servicios de Salud Mental/normas , Instituciones Residenciales/normas , Adulto , Eficiencia Organizacional , Europa (Continente) , Humanos , Trastornos Mentales/terapia , Salud Mental
11.
Epidemiol Psychiatr Sci ; 29: e6, 2018 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-30328401

RESUMEN

AIMS: Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. 'Core health care' refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. 'Other care' is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, 'other care' does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify 'core health' and 'other care' services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services. METHODS: The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or 'Main Types of Care' (MTC) as the standard for international comparison, following the DESDE-LTC system. RESULTS: In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as 'other care', significant variation was found in the typology and characteristics of these services across the eight study areas. CONCLUSIONS: The functional distinction between core health and other care overcomes the traditional division between 'health' and 'social' sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.


Asunto(s)
Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Trastornos Mentales/terapia , Adulto , Europa (Continente) , Investigación sobre Servicios de Salud , Humanos , Trastornos Mentales/psicología , Salud Mental , Población Urbana
12.
Epidemiol Psychiatr Sci ; 26(2): 105-114, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28290273

RESUMEN

Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer's experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as 'Greek temple' could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.


Asunto(s)
Medicina Basada en la Evidencia , Guías como Asunto , Discapacidad Intelectual/terapia , Salud Mental , Atención Primaria de Salud , Implementación de Plan de Salud , Humanos , Discapacidad Intelectual/psicología , Garantía de la Calidad de Atención de Salud
13.
Eur. j. psychiatry ; 36(2): 120-129, apr.-june 2022.
Artículo en Inglés | IBECS (España) | ID: ibc-203060

RESUMEN

Background and objectives. This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods. Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase 'case-finding' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results. Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions. This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015.


Asunto(s)
Humanos , Ciencias de la Salud , Hospitales Psiquiátricos , Depresión , Alta del Paciente , Atención Primaria de Salud , Estudios Multicéntricos como Asunto/psicología
14.
Int J Public Health ; 61(7): 797-807, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27364779

RESUMEN

OBJECTIVES: Universities are dynamic environments. But university life presents challenges that may affect the mental health of its community. Higher education institutions provide opportunities to promote public health. Our objective is to summarise the current evidence on strategies to promote mental health at the university, following a setting-based model. METHODS: We conducted a systematic literature review following standard methods. Published literature that evaluated structural and organizations strategies to promote mental health at the university was selected. RESULTS: 19 papers were included. The majority of the studies were targeting the students, with only four aiming to promote employees' mental health. The most promising strategies to promote mental wellbeing included changes in the way students are taught and assessed. On the other hand, social marketing strategies had not impact on mental health. There is inconclusive evidence related to the effectiveness of policies to promote mental health. CONCLUSIONS: Universities should invest in creating supportive physical, social and academic environments that promote student and staff mental wellbeing. However, the current body of evidence is scarce and more research is needed to recommend what are the best strategies.


Asunto(s)
Docentes/psicología , Promoción de la Salud/organización & administración , Salud Mental , Estudiantes/psicología , Universidades , Curriculum , Humanos , Políticas , Apoyo Social
15.
Epidemiol Psychiatr Sci ; 25(6): 562-572, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26467185

RESUMEN

AIMS: In a background of interest in staging models in psychiatry, we tested the validity of a simple staging model of cognitive impairment to predict incident dementia. METHOD: A large community sample of adults aged ≥55 years (N = 4803) was assessed in the baseline of a longitudinal, four-wave epidemiological enquiry. A two-phase assessment was implemented in each wave, and the instruments used included the Mini-Mental Status Examination (MMSE); the History and Aetiology Schedule and the Geriatric Mental State-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. A panel of psychiatrists diagnosed cases of dementia according to DSM-IV criteria, and cases and sub-cases of dementia were excluded for the follow-up waves. Competing risk regression models, adjusted by potential confounders, were used to test the hypothesised association between MMSE levels and dementia risk. RESULTS: Out of the 4057 participants followed up, 607 (14.9%) were classified as 'normal' (no cognitive impairment), 2672 (65.8%) as 'questionable' cognitive impairment, 732 (18.0%) had 'mild' cognitive impairment, 38 (0.9%) had 'moderate' cognitive impairment and eight (0.2%) had 'severe' impairment. Cognitive impairment was associated with risk of dementia, the risk increasing in parallel with the level of impairment (hazard ratio: 2.72, 4.78 and 8.38 in the 'questionable', 'mild' and 'moderate' level of cognitive impairment, respectively). CONCLUSIONS: The documented gradient of increased risk of dementia associated with the severity level of cognitive impairment supports the validity of the simple staging model based on the MMSE assessment.


Asunto(s)
Disfunción Cognitiva/complicaciones , Demencia/epidemiología , Trastornos del Conocimiento , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Riesgo
16.
Epidemiol Psychiatr Sci ; 24(6): 512-24, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25226091

RESUMEN

BACKGROUND: This paper aims to present the Integrated Atlas of Mental Health of Catalonia (2010) focusing on: (a) the importance of using a taxonomy-based coding and standard system of data collection when assessing health services; and (b) its relevance as a tool for evidence-informed policy. METHOD: This study maps all the care-related services for people with mental disorders available in Catalonia in 2010, using the 'Description and Evaluation of Services and Directories in Europe for long-term care' (DESDE-LTC). The unit of analysis is the Basic Stable Input of Care (BSIC), which is the minimal organisation unit composed by a set of inputs with temporal stability. We presented data on: (a) availability of BSICs and their capacity; (b) the adequacy of the provision of care, taking into account availability and accessibility; (c) the evolution of BSCIs from 2002 to 2010; and (d) the perceived relevance of Atlas of Mental Health as a tool for evidence-informed policy. RESULTS: We identified a total of 639 BSICs. A lack of Health services was detected in highly rural areas, although there was moderate availability of Social Services. Overall, more than 80% of the small mental health areas in Catalonia had an adequate core mental health service. Since 2002 the availability of mental health services has increased. Decision makers found the Atlas a useful and relevant tool for evidence informed policy. CONCLUSIONS: Policy makers can use Atlases to detect gaps and inequities in the provision of care for people with mental health needs.

17.
Epidemiol Psychiatr Sci ; 24(6): 503-11, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24905936

RESUMEN

BACKGROUND: To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment. METHOD: A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages. RESULTS: Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the 'mild' degree of impairment; HR: 1.29 in the 'moderate' degree; and HR: 2.08 in the 'severe' degree). The PAF of mortality due to severe cognitive impairment was 3.49%. CONCLUSIONS: A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

18.
J Affect Disord ; 54(1-2): 109-17, 1999 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-10403154

RESUMEN

BACKGROUND: Although panic disorder (PD) begins typically in adulthood, an earlier onset is not uncommon. Recent studies on early-onset PD indicate that this subgroup of patients may display distinct clinical characteristics. OBJECTIVE: To compare a subgroup of early-onset PD patients with the rest of the sample. METHOD: A consecutive series of 442 patients with PD were included. Family histories were investigated, and clinical assessment employed the following instruments: Hamilton's scales, Global Functioning Scale, Marks-Mathews' Fears and Phobia Scale, and Panic-Associated Symptom Scale. The age threshold for 'early-onset' was considered at 18 years. RESULTS: A total of 45 patients (10.2%) exhibited early-onset PD, with a mean age at onset of 14.6. They were younger and had a longer duration of illness than later-onset patients. No differences were found in severity of panic symptoms, anxiety or depressive symptoms, and social functioning. They had more comorbidity with simple phobia, social phobia, and substance dependence. Rates of PD among first-degree relatives were higher in the early-onset group. CONCLUSION: Early-onset PD patients displayed a greater familial loading, but clinical severity of their panic-agoraphobia symptoms was not higher. Comorbidity was greater with phobic and substance-related disorders.


Asunto(s)
Trastorno de Pánico/diagnóstico , Adulto , Factores de Edad , Trastorno Depresivo/complicaciones , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Trastorno de Pánico/complicaciones , Trastorno de Pánico/genética , Trastornos Fóbicos/complicaciones , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Trastornos Relacionados con Sustancias/complicaciones
19.
J Affect Disord ; 57(1-3): 115-24, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-10708823

RESUMEN

OBJECTIVES: The aim was to analyse the sociodemographic and clinical characteristics of panic disorder (PD) in patients with a PD onset after 60 years of age, at two outpatient psychiatric clinics in Barcelona (northeastern Spain). MATERIAL AND METHODS: All patients presenting with PD at two outpatient clinics over a 4-year period were assessed by the same team. Patients with PD onset at 60 or after were grouped (late-onset), and compared with the group with an earlier onset. The instruments administered to the sample were: Global Assessment of Functioning scale, Panic-Associated Symptom Scale, Hamilton's Depression and Anxiety Scales and Marks-Matthews' Fear and Phobia scale. RESULTS: Of 5301 patients attended over a 4-year period, 64 (1.2%) were PD patients aged 60 or above. Age at PD onset was over 60 in 27 cases (0.4% of the total population, and 6.1% of all PD patients). The mean age in the late-onset group was 67.0+/-4.9 years. Late-onset PD patients were less likely to report family history of PD. They scored lower on most scales assessing clinical severity (excepting GAF and agoraphobia scores), and they exhibited fewer and milder panic symptoms during the attacks. However, dysthymic disorder, but not major depressive disorder, was more common among late-onset PD patients (P<0.05). COMMENTS: The most notable findings in our late-onset PD subgroup of patients were: lesser severity of the disorder, greater comorbidity with dysthymia, and less family history of PD. Prevalence rates of late-onset PD in our sample appeared to be rather high. Physical illness and less severe panic symptoms may contribute to underdiagnosing PD in this particular subpopulation.


Asunto(s)
Trastorno de Pánico/diagnóstico , Trastorno de Pánico/psicología , Edad de Inicio , Anciano , Áreas de Influencia de Salud , Trastorno Distímico/diagnóstico , Trastorno Distímico/epidemiología , Trastorno Distímico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , España , Encuestas y Cuestionarios
20.
Eur Psychiatry ; 13(7): 333-41, 1998 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19706262

RESUMEN

Whilst steady progress has been made in the development and dissemination of valid and reliable instruments for evaluation of patient outcomes, progress in establishing standard methodologies for description and classification of mental health services has been limited. Valid and reliable methods of describing and classifying services are needed in mental health services research for purposes including; i) comparison of levels of provision between catchment areas and countries; ii) reaching an understanding of the relationship between socio-demographic indicators and service use; iii) investigation of the degree to which one service may be substituted for another; iv) evaluating programme implementation; and v) understanding why different outcomes are observed from apparently similar treatment programmes. Where programmes of research encompass different countries, the need for methods of comparing the local service contexts is particularly acute. In this paper, the various contributions which have been made to the somewhat fragmented body of research in this area are reviewed, and the problems which have hampered the development of satisfactory instruments are discussed. A set of criteria for satisfactory service measurement methodologies is proposed: these include development of standard nomenclature and operational definitions of service types; clear demonstration of validity and reliability; comprehensiveness; and applicability and similar interpretation in a range of countries.

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