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1.
J Am Osteopath Assoc ; 119(8): 520-532, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31355891

RESUMO

Context: National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students. Objective: To develop national norms for the assessments of osteopathic medical students' empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education. Methods: Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year. Results: A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data. Conclusions: National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.

2.
Acad Med ; 94(8): 1103-1107, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31135402

RESUMO

Collaboration among the national organizations responsible for self-regulation in medicine in the United States is critical, as achieving the quadruple aim of enhancing the patient experience and improving population health while lowering costs and improving the work life of clinicians and staff is becoming more challenging. The leaders of the national organizations responsible for accreditation, assessment, licensure, and certification recognize this and have come together as the Coalition for Physician Accountability. The coalition, which meets twice per year, was created in 2011 as a discursive space for group discussion and action related to advancing health care, promoting professional accountability, and improving the education, training, and assessment of physicians. The coalition offers a useful avenue for members to seek common ground and develop constructive, thoughtful solutions to common challenges. Its members have endorsed consensus statements about current topics relevant to health care regulation, advanced innovation in medical school curricula, encouraged a plan for single graduate medical education accreditation for physicians holding MD and DO degrees, supported interprofessional education, championed opioid epidemic mitigation strategies, and supported initiatives responsive to physician workforce shortages, including the Interstate Medical Licensure Compact, an expedited pathway by which eligible physicians may be licensed to practice in multiple jurisdictions.

3.
Health Qual Life Outcomes ; 17(1): 66, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992012

RESUMO

BACKGROUND: School-based interventions offer the opportunity to increase physical activity, health-related quality of life (HRQOL) and nutritional behaviours, yet methodological limitations hinder current research, particularly among under-represented children from low socio-economic status (SES). The aim was to determine the effect of a 12-week physical activity programme, Sport for LIFE: All Island (SFL:AI), on physical activity levels, HRQOL, and nutritional attitudes and behaviours in children of low SES across the island of Ireland. METHODS: A 2 (groups) × 4 (data collection points) clustered randomised controlled trial was conducted comprising an intervention group who received SFL:AI for 12 weeks, and a waiting-list control condition. In total 740 children (381 boys, 359 girls) aged 8-9 years (mean = 8.7; SD = .50) from 27 schools across four regions of Ireland (Ulster, Leinster, Connacht and Munster) took part. Physical activity was measured by accelerometers, and children completed a validated questionnaire at baseline, mid (i.e. 6-weeks), post-intervention (i.e. 12 weeks) and follow-up (i.e. 3 months post-intervention). RESULTS: No significant interaction effects for the intervention were found on any of the study outcomes. Main effects were reported for physical well-being, parental relations and autonomy and financial resources, as well as sweetened beverages, environment and intake, and attitude to vegetables. However, these changes were not statistically attributable to the intervention. CONCLUSIONS: It remains unclear if school-based physical activity interventions can improve HRQOL through physical activity with children from low SES. Logistical and methodological considerations are outlined to explore the null effect of the programme, and to provide suggestions for future research and practice. TRIAL REGISTRATION: Trial registration number: ISRCTN76261698 . Name of registry: ICRCTN. Date of registration: 23/08/2017. Date of enrolment: September 2014.


Assuntos
Exercício , Qualidade de Vida , Serviços de Saúde Escolar , Esportes , Acelerometria , Criança , Feminino , Humanos , Irlanda , Masculino , Classe Social , Inquéritos e Questionários
4.
J Phys Act Health ; 16(5): 333-339, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30971160

RESUMO

Background: The purpose of this study was to investigate daily physical activity (PA) patterns of 8- to 9-year-old Irish children from socially disadvantaged areas. Methods: Children (N = 408) were asked to wear an ActiGraph accelerometer for a minimum of 4 days. Based on mean daily moderate- to vigorous-intensity PA accumulation, participants were grouped into sex-specific quartiles (Q4, most active; Q1, least active). Principal component analysis was used to identify distinct time blocks for weekdays and weekend days. Results: Overall, 213 participants (8.7 [0.5] y) met accelerometer inclusion criteria. Of these, 56.7% met the 60 minutes of moderate- to vigorous-intensity PA per day guidelines, with males statistically significantly more likely to do so than females (P < .01). Principal component analysis revealed 3 distinct time periods on weekdays and 4 distinct periods on weekends that children were active. The total difference in moderate- to vigorous-intensity PA accumulation between Q4 (most active) and Q1 (least active) was greatest in the after-school time period (male: 49 min and female: 33 min) on weekdays and in the evening time period on weekends (male: 33 min and female: 19 min). Conclusions: After-school and weekend evenings are critical "activity rich" time periods in terms of the gap between our most and least active disadvantaged children.

5.
Eye Contact Lens ; 2018 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-30138250

RESUMO

PURPOSE: To compare the antimicrobial effects of CLEAR CARE, a 3% hydrogen peroxide (H2O2) solution formulated for simultaneous cleaning, daily protein removal, disinfection, and storage of soft (hydrophilic) hydrogel, silicone hydrogel, and gas-permeable contact lenses, and CLEAR CARE PLUS, consisting of the 3% H2O2 solution plus a novel wetting agent, polyoxyethylene-polyoxybutylene (EOBO-21). METHODS: Three lots each of the 2 solutions were incubated with 5 compendial microorganisms required by the Food and Drug Administration (FDA) 510(k) and International Organization for Standardization (ISO) 14729 stand-alone procedures, 4 clinical isolates of Gram-positive and Gram-negative bacteria, and trophozoites and cysts of 2 Acanthamoeba strains that are associated with microbial keratitis. Microbial loads were evaluated after disinfection and neutralization. RESULTS: Both solutions exceeded the FDA/ISO stand-alone primary criteria against Gram-positive and Gram-negative compendial bacteria, yeast, and mold after only 1.5-hr disinfection/neutralization. At the recommended minimum disinfection time, bacteria were reduced by 4.4 to 5.1 logs, yeast by 4.4 to 4.9 logs, and mold by 2.9 to 3.5 logs with and without organic soil. In addition, both solutions eliminated or effectively reduced populations of clinically relevant ocular bacterial isolates (4.5-5.0 logs), Acanthamoeba trophozoites (3.4-4.2 logs), and cysts (1.5-2.1 logs). CONCLUSION: Both solutions eliminated or reduced populations of FDA/ISO compendial bacteria and fungi as well as clinically relevant microorganisms and Acanthamoeba trophozoites and cysts. The addition of EOBO-21 to the 3% H2O2 lens care solution had no impact on antimicrobial activity.

6.
Adv Health Sci Educ Theory Pract ; 23(5): 899-920, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29968006

RESUMO

The Jefferson Scale of Empathy (JSE) is a broadly used instrument developed to measure empathy in the context of health professions education and patient care. Evidence in support of psychometrics of the JSE has been reported in health professions students and practitioners with the exception of osteopathic medical students. This study was designed to examine measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants at U.S. colleges of osteopathic medicine, and to develop a national norm table for the assessment of JSE scores. A web-based survey was administered at the beginning of the 2017-2018 academic year which included the JSE, a scale to detect "good impression" responses, and demographic/background information. Usable surveys were received from 6009 students enrolled in 41 college campuses (median response rate = 92%). The JSE mean score and standard deviation for the sample were 116.54 and 10.85, respectively. Item-total score correlations were positive and statistically significant (p < 0.01), and Cronbach α = 0.82. Significant gender differences were observed on the JSE scores in favor of women. Also, significant differences were found on item scores between top and bottom third scorers on the JSE. Three factors of Perspective Taking, Compassionate Care, and Walking in Patient's Shoes emerged in an exploratory factor analysis by using half of the sample. Results of confirmatory factor analysis with another half of the sample confirmed the 3-factor model. We also developed a national norm table which is the first to assess students' JSE scores against national data.

7.
Regul Toxicol Pharmacol ; 97: 24-32, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29885342

RESUMO

Medical device biocompatibility testing is used to evaluate the risk of adverse effects on tissues from exposure to leachates/extracts. A battery of tests is typically recommended in accordance with regulatory standards to determine if the device is biocompatible. In vitro cytotoxicity, a key element of the standards, is a required endpoint for all types of medical devices. Each validated cytotoxicity method has different methodology and acceptance criteria that could influence the selection of a specific test. In addition, some guidances are more specific than others as to the recommended test methods. For example, the International Organization for Standardization (ISO1) cites preference for quantitative methods (e.g., tetrazolium (MTT/XTT), neutral red (NR), or colony formation assays (CFA)) over qualitative methods (e.g., elution, agar overlay/diffusion, or direct), while a recent ISO standard for contact lens/lens care solutions specifically requires a qualitative direct test. Qualitative methods are described in United States Pharmacopeia (USP) while quantitative CFAs are listed in Japan guidance. The aim of this review is to compare the methodologies such as test article preparation, test conditions, and criteria for six cytotoxicity methods recommended in regulatory standards in order to inform decisions on which method(s) to select during the medical device safety evaluation.


Assuntos
Materiais Biocompatíveis/farmacologia , Segurança de Equipamentos , Teste de Materiais , Animais , Sobrevivência Celular/efeitos dos fármacos , Humanos
8.
Sports Med Open ; 4(1): 16, 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29679164

RESUMO

BACKGROUND: Self-determination theory (SDT) has been used to predict children's physical activity and well-being. However, few school-based SDT intervention studies have been conducted, and no research exists with children of low socio-economic status (SES). Therefore, SDT-derived needs-supportive teaching techniques informed the design and analyses of the Healthy Choices Programme (HCP). The aim was to determine if the HCP could enhance moderate-to-vigorous physical activity (MVPA) and well-being among children of low SES through increasing autonomy-support, needs satisfaction and intrinsic motivation. METHOD: A mixed factorial two (group) × two (time) wait-list controlled trial was conducted and reported using the TREND guidelines. A total of 155 children (56% females; intervention n = 84, control n = 71) took part and completed measures at baseline (week 0) and post-intervention (week 11). The effect of the intervention on MVPA (model 1) and well-being (model 2) was tested through serial mediation models with three mediators (i.e. autonomy-support, needs satisfaction and intrinsic motivation). RESULTS: In comparison to the control group, the intervention was related to increases in MVPA (ß = .45) and autonomy-support (ß = .17). In model 1, analyses revealed partial mediation of the MVPA change through autonomy-support (ß = .14), intrinsic motivation (ß = .51) and all three SDT mediators in sequence (total r 2 = .34). In model 2, well-being was indirectly enhanced through autonomy-support (ß = .38) and autonomy-support and needs satisfaction in sequence (total r 2 = .21). CONCLUSIONS: The HCP enhanced MVPA and well-being by engendering a needs-supportive physical activity environment. The scientific and practical contribution of this study was the application of SDT in all aspects of the HCP intervention's design and analyses. Practitioners may consider integrating SDT principles, as implemented in the HCP, for health promotion. TRIAL REGISTRATION: This study is registered on Research Registry (number researchregistry2852 ).

9.
Syst Rev ; 6(1): 177, 2017 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-28859666

RESUMO

BACKGROUND: The aim of the current study was to conduct a systematic review determining the effect of sport-specific mental health awareness programs to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. The second aim was to review the study quality and to report on the validity of measures that were used to determine the effectiveness of programs. METHODS: Sport-specific mental health awareness programs adopting an experimental or quasi-experimental design were included for synthesis. Six electronic databases were searched: PsycINFO, MEDLINE (OVID interface), Scopus, Cochrane, CINAHL and SPORTDiscus. Each database was searched from its year of inception to October 2016. Risk of bias was assessed using the Cochrane and QATSQ tools. RESULTS: Ten studies were included from the 1216 studies retrieved: four comprising coaches or service providers, one with officials, four with athletes, and one involved a combination of coaches and athletes. A range of outcomes was used to assess indices of mental health awareness and well-being. Mental health referral efficacy was improved in six studies, while three reported an increase in knowledge about mental health disorders. However, seven studies did not report effect sizes for their outcomes, limiting clinically meaningful interpretations. Furthermore, there was substantial heterogeneity and limited validity in the outcome measures of mental health knowledge and referral efficacy. Seven studies demonstrated a high risk of bias. CONCLUSIONS: Further, well-designed controlled intervention studies are required. Researchers, practitioners and policy makers should adhere to available methodological guidance and apply the psychological theory of behaviour change when developing and evaluating complex interventions. TRIAL REGISTRATION: PROSPERO CRD42016040178.


Assuntos
Atletas/psicologia , Conscientização , Saúde Mental , Tutoria , Esportes/normas , Humanos , Transtornos Mentais/prevenção & controle
10.
Acad Med ; 92(8): 1066, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28742556
11.
Artigo em Inglês | MEDLINE | ID: mdl-28207193

RESUMO

Vitamin A and its active metabolite retinoic acid are essential for embryonic development and adult homeostasis. Surprisingly, excess or deficiency of vitamin A and retinoic acid can cause similar developmental defects. Therefore, strict feedback and other mechanisms exist to regulate the levels of retinoic acid within a narrow physiological range. The oxidation of vitamin A to retinal has recently been established as a critical nodal point in the synthesis of retinoic acid, and over the past decade, RDH10 and DHRS3 have emerged as the predominant enzymes that regulate this reversible reaction. Together they form a codependent complex that facilitates negative feedback maintenance of retinoic acid levels and thus guard against the effects of dysregulated vitamin A metabolism and retinoic acid synthesis. This review focuses on advances in our understanding of the roles of Rdh10 and Dhrs3 and their impact on development and disease. WIREs Dev Biol 2017, 6:e264. doi: 10.1002/wdev.264 For further resources related to this article, please visit the WIREs website.


Assuntos
Desenvolvimento Embrionário/fisiologia , Homeostase/fisiologia , Vitamina A/metabolismo , Animais , Humanos , Transdução de Sinais
12.
BMC Cancer ; 17(1): 121, 2017 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-28187762

RESUMO

BACKGROUND: Dispersal of glioblastoma (GBM) cells leads to recurrence and poor prognosis. Accordingly, molecular pathways involved in dispersal are potential therapeutic targets. The mitogen activated protein kinase/extracellular signal regulated kinase (MAPK/ERK) pathway is commonly dysregulated in GBM, and targeting this pathway with MEK inhibitors has proven effective in controlling tumor growth. Since this pathway also regulates ECM remodeling and actin organization - processes crucial to cell adhesion, substrate attachment, and cell motility - the aim of this study was to determine whether inhibiting this pathway could also impede dispersal. METHODS: A variety of methods were used to quantify the effects of the MEK inhibitor, PD0325901, on potential regulators of dispersal. Cohesion, stiffness and viscosity were quantified using a method based on ellipsoid relaxation after removal of a deforming external force. Attachment strength, cell motility, spheroid dispersal velocity, and 3D growth rate were quantified using previously described methods. RESULTS: We show that PD0325901 significantly increases aggregate cohesion, stiffness, and viscosity but only when tumor cells have access to high concentrations of fibronectin. Treatment also results in reorganization of actin from cortical into stress fibers, in both 2D and 3D culture. Moreover, drug treatment localized pFAK at sites of cell-substratum adhesion. Collectively, these changes resulted in increased strength of substrate attachment and decreased motility, a decrease in aggregate dispersal velocity, and in a marked decrease in growth rate of both 2D and 3D cultures. CONCLUSIONS: Inhibition of the MAPK/ERK pathway by PD0325901 may be an effective therapy for reducing dispersal and growth of GBM cells.


Assuntos
Benzamidas/farmacologia , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Difenilamina/análogos & derivados , MAP Quinases Reguladas por Sinal Extracelular/antagonistas & inibidores , Actinas/metabolismo , Adesão Celular/efeitos dos fármacos , Técnicas de Cultura de Células , Linhagem Celular Tumoral , Difenilamina/farmacologia , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Glioblastoma/metabolismo , Glioblastoma/patologia , Humanos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Microscopia Confocal , Fosforilação/efeitos dos fármacos , Esferoides Celulares/efeitos dos fármacos , Esferoides Celulares/metabolismo
13.
Qual Life Res ; 26(4): 1081-1089, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27757774

RESUMO

BACKGROUND: Kidscreen-27 was developed as part of a cross-cultural European Union-funded project to standardise the measurement of children's health-related quality of life. Yet, research has reported mixed evidence for the hypothesised 5-factor model, and no confirmatory factor analysis (CFA) has been conducted on the instrument with children of low socio-economic status (SES) across Ireland (Northern and Republic). METHOD: The data for this study were collected as part of a clustered randomised controlled trial. A total of 663 (347 male, 315 female) 8-9-year-old children (M = 8.74, SD = .50) of low SES took part. A 5- and modified 7-factor CFA models were specified using the maximum likelihood estimation. A nested Chi-square difference test was conducted to compare the fit of the models. Internal consistency and floor and ceiling effects were also examined. RESULTS: CFA found that the hypothesised 5-factor model was an unacceptable fit. However, the modified 7-factor model was supported. A nested Chi-square difference test confirmed that the fit of the 7-factor model was significantly better than that of the 5-factor model. Internal consistency was unacceptable for just one scale. Ceiling effects were present in all but one of the factors. CONCLUSIONS: Future research should apply the 7-factor model with children of low socio-economic status. Such efforts would help monitor the health status of the population.


Assuntos
Qualidade de Vida , Criança , Serviços de Saúde da Criança , Análise Fatorial , Feminino , Humanos , Irlanda , Funções Verossimilhança , Masculino , Pobreza , Reprodutibilidade dos Testes , Classe Social
15.
PLoS One ; 10(8): e0135951, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26284619

RESUMO

Despite resection and adjuvant therapy, the 5-year survival for patients with Glioblastoma multiforme (GBM) is less than 10%. This poor outcome is largely attributed to rapid tumor growth and early dispersal of cells, factors that contribute to a high recurrence rate and poor prognosis. An understanding of the cellular and molecular machinery that drive growth and dispersal is essential if we are to impact long-term survival. Our previous studies utilizing a series of immortalized GBM cell lines established a functional causation between activation of fibronectin matrix assembly (FNMA), increased tumor cohesion, and decreased dispersal. Activation of FNMA was accomplished by treatment with Dexamethasone (Dex), a drug routinely used to treat brain tumor related edema. Here, we utilize a broad range of qualitative and quantitative assays and the use of a human GBM tissue microarray and freshly-isolated primary human GBM cells grown both as conventional 2D cultures and as 3D spheroids to explore the role of Dex and FNMA in modulating various parameters that can significantly influence tumor cell dispersal. We show that the expression and processing of fibronectin in a human GBM tissue-microarray is variable, with 90% of tumors displaying some abnormality or lack in capacity to secrete fibronectin or assemble it into a matrix. We also show that low-passage primary GBM cells vary in their capacity for FNMA and that Dex treatment reactivates this process. Activation of FNMA effectively "glues" cells together and prevents cells from detaching from the primary mass. Dex treatment also significantly increases the strength of cell-ECM adhesion and decreases motility. The combination of increased cohesion and decreased motility discourages in vitro and ex vivo dispersal. By increasing cell-cell cohesion, Dex also decreases growth rate of 3D spheroids. These effects could all be reversed by an inhibitor of FNMA and by the glucocorticoid receptor antagonist, RU-486. Our results describe a new role for Dex as a suppressor of GBM dispersal and growth.


Assuntos
Neoplasias Encefálicas/patologia , Adesão Celular/fisiologia , Agregação Celular/fisiologia , Dexametasona/farmacologia , Fibronectinas/metabolismo , Glioblastoma/patologia , Anti-Inflamatórios/farmacologia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/metabolismo , Matriz Extracelular/metabolismo , Glioblastoma/tratamento farmacológico , Glioblastoma/metabolismo , Humanos , Integrina alfa5beta1/metabolismo , Invasividade Neoplásica , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Esferoides Celulares/metabolismo , Células Tumorais Cultivadas
16.
Psychiatry Res ; 229(1-2): 602-5, 2015 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-26189340

RESUMO

Voluntarily admitted service users can report levels of perceived coercion comparable to those admitted involuntarily, yet little is known of this groups longer term outcome. The 'coerced voluntary' had a score of 4 or above on the MacArthur perceived coercion scale and one year after discharge, they had a better therapeutic relationship compared to involuntarily admitted service users. There was no difference between the coerced voluntary, uncoerced voluntary and involuntary groups in engagement, satisfaction and functioning.


Assuntos
Coerção , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Admissão do Paciente/tendências , Percepção , Adulto , Feminino , Seguimentos , Hospitalização/tendências , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Alta do Paciente/tendências , Satisfação do Paciente , Resultado do Tratamento
17.
Psychiatr Serv ; 66(8): 883-7, 2015 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-25873025

RESUMO

OBJECTIVES: The study aimed to determine the number of accumulated coercive events experienced by patients during inpatient admission, the patients' functioning and quality of life (QOL) one year after discharge, and associations between these variables and patient characteristics and between follow-up outcomes and number of accumulated coercive events. METHODS: A prospective cohort study was undertaken at three community services and an independent hospital in Ireland (N=162). Accumulated coercive events scores were based on patients' legal status, perceived coercion, and exposure to physical restraint, seclusion, or forced medication. RESULTS: Most (68%) experienced at least one coercive event. Lower functioning predicted more coercive events. At follow-up, the mean subjective QOL score was 63% of the highest possible score, objective QOL improved for 15% of participants, and functioning improved for 70%. Accumulated coercive events did not predict these outcomes. CONCLUSIONS: Coercive events during psychiatric admission appeared unrelated to functioning and QOL at follow-up.


Assuntos
Coerção , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Mentais/terapia , Qualidade de Vida/psicologia , Restrição Física/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Irlanda , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade
20.
Psychiatry Res ; 215(1): 120-6, 2014 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-24210740

RESUMO

The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. Individuals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixty-one individuals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. Individuals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that individual's rights are respected.


Assuntos
Coerção , Hospitais Psiquiátricos , Admissão do Paciente , Percepção , Transtornos Psicóticos/terapia , Adulto , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria , Transtornos Psicóticos/psicologia
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