RESUMO
BACKGROUND: Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences. METHOD: This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder. RESULTS: The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35 years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners. CONCLUSIONS: The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison.
Assuntos
Pessoas Mal Alojadas/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Transtornos Mentais/epidemiologia , Prisioneiros/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Adulto , Comorbidade , Estudos Transversais , Humanos , Londres/epidemiologia , Masculino , Adulto JovemRESUMO
BACKGROUND: Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS). However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs. This study aimed to identify prisoners with NDD and compare their characteristics with prisoners without NDD on a range of socio-demographic and social functioning measures. METHOD: This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ADHD, ASD and ID. RESULTS: The study identified 87 prisoners who screened positive for one or more type of NDD. Participants with NDD were significantly younger and more likely to be single [(odds ratio) OR = 2.1], homeless (OR = 3.4) or unemployed (OR = 2.6) before they came into prison. They also had poorer educational achievements that those without NDD. Over 80% of those with NDD had a previous conviction or imprisonment. CONCLUSIONS: The findings confirm the presence of significant numbers of people with NDD in a male prison. Services across the CJS are required for this group; specifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD. Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Deficiência Intelectual/epidemiologia , Prisioneiros/estatística & dados numéricos , Adulto , Estudos Transversais , Humanos , Londres/epidemiologia , Masculino , Prisões/estatística & dados numéricosRESUMO
Maturation along the brainstem acoustic pathway, as well as the integrity of these structures, has been shown to be reflected in brainstem evoked potential recordings. Trajectories formed from repeated sequential measurements of several brainstem response variables reveal distinct developmental curves for healthy and high-risk infants. Longitudinal analysis offers a means of determining temporary or permanent maturational effects on the central nervous system in early life.
Assuntos
Tronco Encefálico/fisiologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Prematuro/diagnóstico , Fatores Etários , Lesões Encefálicas/diagnóstico , Tronco Encefálico/crescimento & desenvolvimento , Tronco Encefálico/fisiopatologia , Doenças do Sistema Nervoso Central/etiologia , Potenciais Evocados , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/fisiopatologiaRESUMO
After creating "fontanelles" in infant rhesus monkeys, we measured intracranial pressure of these monkeys directly with an indwelling cannula and indirectly with a Ladd 1700 sensor. Values obtained with the Ladd sensor placed over the shaven fontanelle closely approximate directly measured pressure in acute experiments in these animals and in human cadavers. Application of the device is simple and application pressure need not always be the same for multiple determinations. The response time is 1.6 cm H2O/sec, which is adequate to record changes in intracranial pressure caused by changes in the partial pressure of CO2 in arterial blood.
Assuntos
Pressão Intracraniana , Animais , Haplorrinos , Macaca mulatta , Métodos , TransdutoresRESUMO
Between 1969 and 1978 we treated 22 low birth weight infants for delayed onset posthemorrhagic hydrocephalus. All developed clinical signs of hydrocephalus after 2 weeks of age. The diagnosis was determined in 12 infants before August 1974, and they were treated by surgical placement of a shunt. In the ten infants born after September 1974, an attempt was first made to control the hydrocephalus with repeated lumbar puncture and diuretics prior to placing a shunt. In seven of the ten the hydrocephalus was successfully arrested by medical therapy alone. Follow-up assessments at 1 to 8 years of age were done on 18 infants. Two of the 12 treated by permanent shunts and three of six treated medically had an IQ score of 85 or greater. These results indicate a poor long-term outlook for the low birth weight infant who develops clinically overt hydrocephalus after intracranial bleeding.
Assuntos
Hemorragia Cerebral/complicações , Derivações do Líquido Cefalorraquidiano , Diuréticos/uso terapêutico , Hidrocefalia/terapia , Doenças do Prematuro/terapia , Punção Espinal , Acetazolamida/uso terapêutico , Dano Encefálico Crônico/etiologia , Criança , Pré-Escolar , Drenagem , Feminino , Seguimentos , Furosemida/uso terapêutico , Humanos , Hidrocefalia/etiologia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , PrognósticoRESUMO
Brainstem auditory evoked potentials (BAEPs) were recorded from healthy and high-risk infants at selected ages throughout their first year of life. Amplitude and latency measurements of peaks I, III and V were treated in a series of multivariate analyses of variance. Significant main effects for age (newborn, 3 wk, 6 wk, 3 mth, 6 mth and 1 yr), group (healthy, risk) and peaks (amplitude and latency of BAEP waves I, III and V) were observed. In addition, the interaction between these factors proved statistically significant. As expected, the pattern of response amplitude and latency for the various peaks differed as a function of age. Moreover, healthy and risk infants revealed different maturational trends. These results indicate that infants born 'at risk' but free of severe auditory deficits and major neurological difficulties can be distinguished from healthy (age-matched) controls in terms of the BAEP throughout the first postnatal year.
Assuntos
Tronco Encefálico/fisiologia , Potenciais Evocados Auditivos , Humanos , Lactente , Recém-Nascido , Tempo de Reação/fisiologia , RiscoRESUMO
A total of 110 of the 175 patients examined had symptomatic carpal tunnel syndrome. We were able to isolate 10 patients with carpal tunnel syndrome and electrical evidence of an associated peripheral neuropathy from these 110 patients. We feel that patients with peripheral neuropathies probably warrant an extensive laboratory evaluation for primary and treatable disorders. In contrast, we feel patients with isolated carpal tunnel syndrome, normal ulnar latencies, and normal ankle jerk reflexes do not warrant initial erythrocyte sedimentation rates, thyroid profiles, or blood sugars unless there are other historical or physical factors that suggest a predisposition to diabetes mellitus, thyroid disease, or rheumatic disorders.
Assuntos
Síndrome do Túnel Carpal/sangue , Adulto , Idoso , Glicemia/análise , Sedimentação Sanguínea , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Hormônios Tireóideos/sangue , Nervo Ulnar/fisiopatologiaRESUMO
Like many organizations, Continental Rehabilitation Hospital of San Diego designs and communicates templates and targets for desired changes in behaviors and tracks results. It recognizes and celebrates successes and struggles with its failures. A recent case example demonstrates the importance of generating immediate feedback and consequences as a strategy for increasing effectiveness in changing behavioral patterns.
Assuntos
Retroalimentação , Sistemas de Medicação no Hospital/normas , Avaliação de Processos em Cuidados de Saúde/métodos , Centros de Reabilitação/normas , Ansiolíticos/uso terapêutico , Terapia Comportamental , California , Comunicação , Documentação/normas , Humanos , Hipnóticos e Sedativos/uso terapêutico , Participação nas Decisões , Auditoria Médica , Corpo Clínico Hospitalar/normas , Recursos Humanos de Enfermagem Hospitalar/normas , Centros de Reabilitação/economia , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/normasRESUMO
Occupationally related dysfunction of the peripheral nervous system is a common problem. The signs and symptoms of neurologic problems of the upper extremity and neck that can alter hand function and sensation are described in detail.
Assuntos
Mãos/inervação , Doenças Profissionais/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Diagnóstico Diferencial , Eletromiografia , Humanos , Nervo Mediano/patologia , Condução Nervosa , Nervo Radial/lesões , Nervo Radial/patologia , Nervo Ulnar/lesões , Nervo Ulnar/patologiaRESUMO
As the market becomes more saturated and matures, keeping people healthy will become a bigger source of profits and true health maintenance will become increasingly important. Right now, however, the name of the game is restricting services, particularly in new markets. What is sorely needed is a balance between the individual and organizational agendas, between the individual and society. There is a tremendous opportunity for hospital-physician groups contracting directly with employers using Medical Savings Accounts (MSAs) and catastrophic insurance as a core strategy. Are MSAs a viable insurance vehicle? Some argue that those enrolled in MSAs will put off receiving needed medical care. But it can also be viewed that MSAs, by their very nature, put costs back into the negotiation phase between patients as customers and physicians and hospitals as providers--and save money and resource consumption as patients shop around for competitive prices to do what needs to be done.
Assuntos
Doença Catastrófica/economia , Custo Compartilhado de Seguro , Financiamento Pessoal , Reforma dos Serviços de Saúde/economia , Convênios Hospital-Médico/economia , Comportamento do Consumidor , Controle de Custos , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/tendências , Sistemas Pré-Pagos de Saúde/economia , Convênios Hospital-Médico/tendências , Humanos , Assistência Médica , Medicare , Modelos Organizacionais , Cultura Organizacional , Estados UnidosAssuntos
Hemoglobina Fetal/análise , Doenças do Recém-Nascido/sangue , Hemorragia Subaracnóidea/sangue , Sangue , Transfusão de Sangue , Hemorragia Cerebral/sangue , Líquido Cefalorraquidiano/análise , Diagnóstico Diferencial , Enterocolite Pseudomembranosa/complicações , Cardiopatias Congênitas/complicações , Humanos , Doença da Membrana Hialina/complicações , Hidrocefalia/sangue , Concentração de Íons de Hidrogênio , Recém-Nascido , Hemorragia Subaracnóidea/complicaçõesAssuntos
Terapia por Estimulação Elétrica/instrumentação , Locomoção/fisiologia , Junção Neuromuscular/fisiopatologia , Paraplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Adolescente , Adulto , Idoso , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Microcomputadores , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Andadores , Suporte de Carga/fisiologiaRESUMO
The author discusses the general problem of the small but significant population of people in whom pain persists for months or years after a precipitating event, such as a hand injury. The nature of pain, the perception of pain, and characteristics of chronic pain patients are discussed, as well as evaluation and treatment of chronic pain.
Assuntos
Doenças Profissionais/fisiopatologia , Dor/fisiopatologia , Doença Crônica , Humanos , Doenças Profissionais/psicologia , Doenças Profissionais/reabilitação , Dor/psicologia , Dor/reabilitaçãoRESUMO
Three premature infants with post-haemorrhagic hydrocephalus were treated by removing large volumes of cerebrospinal fluid with repeated lumbar punctures. After this treatment, a computerised tomographic brain scan showed that ventricle size had decreased, and subsequent head growth was normal in all three patients. The results suggest that acquired hydrocephalus in premature infants may be transient and that ventricular shunts may not be necessary in all cases.
Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia/cirurgia , Doenças do Prematuro/cirurgia , Punção Espinal , Cefalometria , Hemorragia Cerebral/complicações , Líquido Cefalorraquidiano/análise , Proteínas do Líquido Cefalorraquidiano/análise , Drenagem , Seguimentos , Glucose/análise , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Pressão Intracraniana , Masculino , Cintilografia , Fatores de TempoRESUMO
BACKGROUND: Health care has a number of historical barriers to capturing the voice of the customer and to incorporating customer wants into health care services, whether the customer is a patient, an insurer, or a community. Quality function deployment (QFD) is a set of tools and practices that can help overcome these barriers to form a process for the planning and design or redesign of products and services. The goal of the project was to increase referral volume and to improve a rehabilitation hospital's capacity to provide comprehensive medical and/or legal evaluations for people with complex and catastrophic injuries or illnesses. HIGH-LEVEL VIEW OF QFD AS A PROCESS: The steps in QFD are as follows: capture of the voice of the customer, quality deployment, functions deployment, failure mode deployment, new process deployment, and task deployment. The output of each step becomes the input to a matrix tool or table of the next step of the process. CASE STUDY EXAMPLE: In 3 1/2 months a nine-person project team at Continental Rehabilitation Hospital (San Diego) used QFD tools to capture the voice of the customer, use these data as the basis for a questionnaire on important qualities of service from the customer's perspective, obtain competitive data on how the organization was perceived to be meeting the demanded qualities, identify measurable dimensions and targets of these qualities, and incorporate the functions and tasks into the delivery of service which are necessary to meet the demanded qualities. DISCUSSION: The future of providing health care services will belong to organizations that can adapt to a rapidly changing environment and to demands for new products and services that are produced and delivered in new ways.