ABSTRACT
ARCHI - Development of a questionnaire on architecture of child and adolescent psychiatric facilities Abstract. Objective: Studies from various disciplines have pointed to a connection between the structural characteristics of hospitals, in particular psychiatric hospital wards, and various parameters in the recovery process of patients treated there. To date, however, no current studies have further investigated whether individual architectural aspects of clinical complexes are more relevant in everyday practice than others. Method: To link theory with practice in the context of this study, we developed a questionnaire to explore which architectural aspects in hospitals or utilities for child and adolescent psychiatry, psychosomatics, and psychotherapy are perceived by those working in therapy as helpful or detrimental to therapeutic treatment. We based the selection and development of several items on an extensive literary analysis and several expert rounds, and then analyzed and categorized the data acquired by those expert interviews conducted online according to Mayring. Results: The resulting categories demonstrate the aspects perceived as relevant to practice in everyday hospital life and thus form the basis for the 20 open and closed items of the questionnaire. Conclusion: The results of the expertise survey confirm the aspects found in the literature analyzed, including generosity of space, family orientation, age appropriateness, and positive atmosphere.
Subject(s)
Mental Disorders , Adolescent , Adolescent Psychiatry , Child , Hospitals, Psychiatric , Humans , Mental Disorders/diagnosis , Mental Disorders/psychology , Mental Disorders/therapy , Psychotherapy , Surveys and QuestionnairesABSTRACT
BACKGROUND: Impaired energy metabolism is a possible mechanism that contributes to insulin resistance and ectopic fat storage. OBJECTIVE: We examined whether meal ingestion differently affects hepatic phosphorus metabolites in insulin-sensitive and insulin-resistant humans. DESIGN: Young, lean, insulin-sensitive humans (CONs) [mean ± SD body mass index (BMI; in kg/m(2)): 23.2 ± 1.5]; insulin-resistant, glucose-tolerant, obese humans (OBEs) (BMI: 34.3 ± 1.7); and type 2 diabetes patients (T2Ds) (BMI: 32.0 ± 2.4) were studied (n = 10/group). T2Ds (61 ± 7 y old) were older (P < 0.001) than were OBEs (31 ± 7 y old) and CONs (28 ± 3 y old). We quantified hepatic γATP, inorganic phosphate (Pi), and the fat content [hepatocellular lipids (HCLs)] with the use of (31)P/(1)H magnetic resonance spectroscopy before and at 160 and 240 min after a high-caloric mixed meal. In a subset of volunteers, we measured the skeletal muscle oxidative capacity with the use of high-resolution respirometry. Whole-body insulin sensitivity (M value) was assessed with the use of hyperinsulinemic-euglycemic clamps. RESULTS: OBEs and T2Ds were similarly insulin resistant (M value: 3.5 ± 1.4 and 1.9 ± 2.5 mg · kg(-1) · min(-1), respectively; P = 0.9) and had 12-fold (P = 0.01) and 17-fold (P = 0.002) higher HCLs, respectively, than those of lean persons. Despite comparable fasting hepatic γATP concentrations, the maximum postprandial increase of γATP was 6-fold higher in OBEs (0.7 ± 0.2 mmol/L; P = 0.03) but only tended to be higher in T2Ds (0.6 ± 0.2 mmol/L; P = 0.09) than in CONs (0.1 ± 0.1 mmol/L). However, in the fasted state, muscle complex I activity was 53% lower (P = 0.01) in T2Ds but not in OBEs (P = 0.15) than in CONs. CONCLUSIONS: Young, obese, nondiabetic humans exhibit augmented postprandial hepatic energy metabolism, whereas elderly T2Ds have impaired fasting muscle energy metabolism. These findings support the concept of a differential and tissue-specific regulation of energy metabolism, which can occur independently of insulin resistance. This trial was registered at clinicaltrials.gov as NCT01229059.
