Discharge interventions from inpatient child and adolescent mental health care: a scoping review.

The post-discharge period is an extremely vulnerable period for patients, particularly for those discharged from inpatient children and adolescent mental health services (CAMHS). Poor discharge practices and discontinuity of care can put children and youth at heightened risk for readmission, among other adverse outcomes. However, there is limited understanding of the structure and effectiveness of interventions to facilitate discharges from CAMHS. As such, a scoping review was conducted to identify the literature on discharge interventions. This scoping review aimed to describe key components, designs, and outcomes of existing discharge interventions from CAMHS. Nineteen documents were included in the final review. Discharge interventions were extracted and summarized for pre-discharge, post-discharge, and bridging elements. Results of this scoping review found that intervention elements included aspects of risk assessment, individualized care, discharge preparation, community linkage, psychoeducation, and follow-up support. Reported outcomes of discharge interventions were also extracted and included positive patient and caregiver satisfaction, improved patient health outcomes, and increased cost effectiveness. Literature on discharge interventions from inpatient CAMHS, while variable in structure, consistently underscore the role of such interventions in minimizing patient and family vulnerability post-discharge. However, findings are limited by inadequate reporting and heterogeneity across studies. There is a need for further research into the design, implementation, and evaluation of interventions to support successful discharges from inpatient child and adolescent mental health care.

Groundwater contamination by nitrates associated with intensive potato culture in Québec.

In rural areas, groundwater contamination by nitrates is a problem related to the spreading of organic and chemical fertilizers by farmers and, to some extent, to effluents from domestic sewage systems. Health effects of groundwater contamination by nitrates have been assessed several times and may lead to important consequences for infants. Following pressures from citizens in 1990, a survey of well water quality around potato fields of the Portneuf county (Québec) found that nitrate contamination was frequently above the 10 mg-N/1 standard. Because this first survey was limited to areas of intensive potato culture, it was not possible to evaluate the real impact on the groundwater quality for the whole county and the subsequent public health intervention was spread over the entire region. A second survey was carried out in 1995 to reevaluate the situation using random sampling methods. This latter study took into account drinking water habits of the population, the relative importance of potato culture as a source of nitrogen loading, the effects of soil types, and waste-water disposal systems as well as land use on nitrate concentration in private well water. The data analysis was carried out by combining GIS and statistical methods to test hypotheses about the spatial relationship linking measured nitrate concentrations with their immediate environment. This paper presents the major findings from this second study which confirm the impact of intensive potato culture on groundwater nitrate concentrations, mainly localized in sandy soil areas within 2 km of fields. Finally, it illustrates the usefulness of GIS to focus public health interventions.

Speech recognition in noise for hearing-impaired subjects: effects of an adaptive filter hearing aid.

Speech-recognition thresholds (SRTs) were obtained in nine sensorineural hearing-impaired subjects wearing an adaptive-filter hearing aid under four separate listening conditions. The SRT was obtained with the filter in and out of the circuit in order to relate the effects of noise reduction to speech recognition performance. The noise level was held constant while the speech level varied (transformed up-down method). For the majority of the subjects tested, the activation of the noise-suppression circuit in the aid resulted in performance equivalent to or worse than that obtained without the circuit activated. For the group, a significant improvement (less than 0.05) in recognition was observed only in low-frequency noise competition.