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1.
Clin Ter ; 170(6): e421-e424, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696903

RESUMO

Personalized medicine is an emerging approach to medicine that applies scientific knowledge to predict individual susceptibility to certain pathologies and to identify their response to pharmacological treatments. The aim of the study is to analyze the ethical implications of the use of personalized medicine in the prevention of psychiatric disorders, through the study of specific genetic variations and epigenetic modifications. However, the use of technologies aimed at studying the human genome, in order to prevent these pathologies, cause many bioethical questions.


Assuntos
Transtornos Mentais/prevenção & controle , Medicina de Precisão/ética , Epigênese Genética , Humanos , Transtornos Mentais/genética
2.
BMC Public Health ; 19(1): 1309, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623597

RESUMO

BACKGROUND: Mental health promotion programs have been shown to reduce the burden associated with mental distress and prevent the onset of mental disorders, but evidence of cost-effectiveness is scarce. OBJECTIVE: To evaluate the cost-effectiveness of a mindfulness-based mental health prevention program provided by health coaches in a multi-site field setting in Germany. METHODS: The single-study based economic evaluation was conducted as part of a nonrandomized controlled trial, comparing the effects of a group-based prevention program to usual care based on propensity score matching. Participants (N = 1166) were recruited via a large statutory health insurance fund. Health outcome was assessed with the Hospital Anxiety and Depression Scale (HADS). Cost outcomes were actually incurred costs compiled from the health insurance' records. Incremental cost-effectiveness ratios (ICER) were analyzed from a societal and a health care perspective for a 12-month time horizon with sampling uncertainty being handled using nonparametric bootstrapping. A cost-effectiveness acceptability curve was graphed to determine the probability of cost-effectiveness at different willingness-to-pay ceiling ratios. RESULTS: From a societal perspective, prevention was cost-effective compared to usual-care by providing larger effects of 1.97 units on the HADS (95% CI [1.14, 2.81], p < 0.001) at lower mean incremental total costs of €-57 (95% CI [- 634, 480], p = 0.84), yielding an ICER of €-29 (savings) per unit improvement. From a health care perspective, the incremental health benefits were achieved at additional direct costs of €181 for prevention participants (95% CI [40, 318], p = 0.01) with an ICER of €91 per unit improvement on the HADS. Willingness-to-pay for the prevention program to achieve a 95% probability of being cost-effective compared to usual-care, was estimated at €225 per unit improvement on the HADS score from a societal, and €191 from a health care perspective respectively. Sensitivity analyses suggested differential cost-effect-ratios depending on the initial distress of participants. LIMITATIONS: Due to the complexity of the field trial, it was not feasible to randomize participants and offer an active control condition. This limitation was met by applying a rigorous matching procedure. CONCLUSIONS: Our results indicate that universal mental health promotion programs in community settings might be a cost-effective strategy to enhance well-being. Differences between the societal and health care perspective underline the call for joint funding in the dissemination of preventive services. TRIAL REGISTRATION: German Clinical Trials Registration ID: DRKS00006216 (2014/06/11, retrospective registration).


Assuntos
Promoção da Saúde/economia , Transtornos Mentais/prevenção & controle , Atenção Plena , Adulto , Análise Custo-Benefício , Feminino , Alemanha , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão
3.
BMC Med ; 17(1): 187, 2019 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-31623620

RESUMO

BACKGROUND: Many agree that the biopsychosocial contributions to psychopathology are complex, yet it is unclear how we can make sense of this complexity. One approach is to reduce this complexity to a few necessary and sufficient biopsychosocial factors; although this approach is easy to understand, it has little explanatory power. Another approach is to fully embrace complexity, proposing that each instance of psychopathology is caused by a partially unique set of biopsychosocial factors; this approach has high explanatory power, but is impossible to comprehend. Due to deficits in either explanatory power or comprehensibility, both approaches limit our ability to make substantial advances in understanding, predicting, and preventing psychopathology. Thus, how can we make sense of biopsychosocial factor complexity? MAIN TEXT: There is a third possible approach that can resolve this dilemma, with high explanatory power and high comprehensibility. This approach involves understanding, predicting, and preventing psychopathology in terms of a small set of psychological primitives rather than biopsychosocial factors. Psychological primitives are the fundamental and irreducible elements of the mind, mediating all biopsychosocial factor influences on psychopathology. All psychological phenomena emerge from these primitives. Over the past decade, this approach has been successfully applied within basic psychological science, most notably affective science. It explains the sum of the evidence in affective science and has generated several novel research directions. This approach is equally applicable to psychopathology. The primitive-based approach does not eliminate the role of biopsychosocial factors, but rather recasts them as indeterminate causal influences on psychological primitives. In doing so, it reframes research away from factor-based questions (e.g., which situations cause suicide?) and toward primitive-based questions (e.g., how are suicidality concepts formed, altered, activated, and implemented?). This is a valuable shift because factor-based questions have indeterminate answers (e.g., infinite situations could cause suicide) whereas primitive-based questions have determinate answers (e.g., there are specific processes that undergird all concepts). CONCLUSION: The primitive-based approach accounts for biopsychosocial complexity, ties clinical science more directly to basic psychological science, and could facilitate progress in understanding, predicting, and preventing psychopathology.


Assuntos
Transtornos Mentais/etiologia , Transtornos Mentais/prevenção & controle , Psicologia , Psicopatologia/métodos , Fatores Sociológicos , Pesquisa Biomédica/métodos , Previsões , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Fatores de Risco , Ideação Suicida
4.
Lakartidningen ; 1162019 Sep 27.
Artigo em Sueco | MEDLINE | ID: mdl-31573669

RESUMO

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Assuntos
Mortalidade Materna , Adolescente , Adulto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Morte Materna , Transtornos Mentais/mortalidade , Transtornos Mentais/prevenção & controle , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde , Sociedades Médicas , Suicídio/prevenção & controle , Suécia/epidemiologia , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
5.
J Nurs Adm ; 49(10): 487-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31517756

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the effects of the MINDBODYSTRONG for Healthcare Professionals Program on stress, anxiety, depressive symptoms, healthy lifestyle behaviors, and job satisfaction on newly licensed RNs (NLRNs) participating in a nurse residency program. BACKGROUND: The constellation of burnout, depression, and suicide in clinicians is a public health epidemic that affects the quality and safety of healthcare. The National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience has called for an increase in evidence-based interventions to combat this alarming problem. The MINDBODYSTRONG Program is a novel adaptation of an evidence-based cognitive behavioral skills-building intervention that provides a theory-based approach to improve the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction of NLRNs. METHODS: A 2-group, cluster randomized controlled trial was used with 89 new nurses participating in a new-graduate nurse residency program. The experimental intervention, MINDBODYSTRONG, consisted of 8 manualized weekly 45-minute sessions. Data were collected at baseline, immediately following, and 3 months after intervention that measured stress, depressive symptoms, anxiety, healthy lifestyle beliefs and behaviors, and job satisfaction. Repeated-measures analysis of variance was used for data analysis. RESULTS: The intervention group scored significantly better with moderate to large positive effects on the mental health variables as well as healthy lifestyle beliefs and healthy lifestyle behaviors at both follow-up time points compared with the attention control group. Moderate to large positive effects also were found for job satisfaction. CONCLUSIONS: The MINDBODYSTRONG Program has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction, in NLRNs.


Assuntos
Terapia Comportamental/métodos , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Estilo de Vida Saudável , Transtornos Mentais/prevenção & controle , Transtornos Mentais/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Satisfação no Emprego , Masculino , Adulto Jovem
6.
Int Health ; 11(5): 324-326, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31529114

RESUMO

We need to radically reframe our conversations about mental health to address the massive global prevention, care and quality gaps to reduce the global burden of mental health problems. This commentary looks at mental health over the past decade and what more we need to do to tackle this priority global health issue.


Assuntos
Saúde Global , Transtornos Mentais/prevenção & controle , Prioridades em Saúde , Humanos
7.
Bol. latinoam. Caribe plantas med. aromát ; 18(5): 459-479, sept. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1008268

RESUMO

Neuronal cell damage is often caused by prolonged misuse of Methylphenidate (MPH). Topiramate (TPM) carries neuroprotective properties but its assumed mechanism remains unclear. The present study evaluates in vivo role of various doses of TPM and its mechanism against MPH-induced motor activity and related behavior disorder. Thus, we used domoic acid (DOM), bicuculline (BIC), Ketamine (KET), Yohimibine (YOH) and Haloperidole (HAL) as AMPA/kainite, GABAA, NMDA, ɑ2 adrenergic and D2 of dopamine receptor antagonists respectively. Open Field Test (OFT), Elevated Plus Maze (EPM) and Forced Swim Test (FST) were used to study motor activity, anxiety and depression level. TPM (100 and 120 mg/kg) reduced MPH-induced rise and inhibited MPH-induced promotion in motor activity disturbance, anxiety and depression. Pretreatment of animals with KET, HAL, YOH and BIC inhibited TPM- improves anxiety and depression through the interacting with Dopaminergic, GABAA, NMDA and ɑ2-adrenergic receptors.


El daño a las células neuronales a menudo es causado por el uso prolongado de metilfenidato (MPH). El topiramato (TPM) tiene propiedades neuroprotectoras, pero su mecanismo de acción no es claro. El presente estudio evalúa el papel in vivo de varias dosis de TPM y su mecanismo contra la actividad motora inducida por MPH y el trastorno de comportamiento relacionado. Utilizamos ácido domoico (DOM), bicuculina (BIC), ketamina (KET), yohimbina (YOH) y haloperidol (HAL), así como antagonistas AMPA/kainato, GABAA, NMDA, ɑ2-adrenérgico y D2 dopaminérgicos, respectivamente. Se utilizaron las pruebas de campo abierto (OFT), elevación de laberinto (EPM) y natación forzada (FST) para estudiar la actividad motora, la ansiedad y el nivel de depresión. El TPM (100 y 120 mg/kg) redujo el aumento inducido por MPH e inhibió la promoción inducida por MPH en la alteración de la actividad motora, la ansiedad y la depresión. El tratamiento previo de animales con KET, HAL, YOH y BIC inhibió el TPM, mejora la ansiedad y la depresión a través de la interacción con los receptores dopaminérgicos, GABAA, NMDA y ɑ2-adrenérgico.


Assuntos
Animais , Masculino , Ratos , Comportamento Animal/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , /farmacologia , Transtornos Mentais/prevenção & controle , Metilfenidato/efeitos adversos , Ratos Wistar , Neurotransmissores/metabolismo , Transtornos Mentais/induzido quimicamente , Atividade Motora/efeitos dos fármacos
8.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31427462

RESUMO

CONTEXT: Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions. OBJECTIVE: To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY. DATA SOURCES: PubMed, PsycINFO, and Education Resources Information Center. STUDY SELECTION: Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY. DATA EXTRACTION: Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor. RESULTS: With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority-specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority-specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies' results must be interpreted cautiously because of suboptimal methodologic quality. LIMITATIONS: There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY. CONCLUSIONS: The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.


Assuntos
Vítimas de Crime/psicologia , Transtornos Mentais/prevenção & controle , Minorias Sexuais e de Gênero/psicologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Violência/prevenção & controle , Política de Saúde , Disparidades em Assistência à Saúde , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Serviços de Saúde Mental , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos , Violência/psicologia
9.
Psicothema (Oviedo) ; 31(3): 284-291, ago. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185355

RESUMO

Background: Parental separation is a stressful experience that can lead to parents suffering mental health problems (MHPs). Parental separation education programs for coping with post-separation adjustment have proven to be effective in reducing conflict and improving co-parenting. However, the effects of these programs on MHPs have not been assessed. A field study was carried out to assess the impact of a parental separation education program on parental MHPs. Method: A total of 116 separated parents who completed the program “Parental separation, not family breakdown” completed the Brief Symptom Inventory (BSI) pre- and post-intervention. Results: Separated parents had significantly higher pre-intervention scores on the nine symptom dimensions and the global indexes of distress in comparison to the normative population. The intervention yielded a significant improvement (i.e., reduction of clinical symptoms) in all MHPs, ranging from 19% in phobic anxiety to 36% in depression and general anxiety; and in the global indexes of distress (36% in the global severity index; 28% in the positive symptom distress index; and 33% in the positive symptom total). Approximately 45% of parents significantly improved through the intervention. Conclusions: The implications of the outcomes of the separation and intervention in parents’ MHPs and children wellbeing are discussed


Antecedentes: la ruptura de pareja, como evento estresante, puede derivar en Problemas en la Salud Mental (PSM) de los progenitores. Para afrontar esta contingencia se han desarrollado programas educativos que han mostrado su eficacia en la reducción del conflicto y la mejora de la coparentalidad. Pero los efectos en los PSMs no han sido estudiados. Así, nos planteamos un estudio campo para conocer los efectos de un programa educativo para la ruptura de pareja en los PSMs. Método: 116 progenitores separados que cumplimentaron el programa “Ruptura de Pareja, no de Familia” respondieron, pre- y post-intervención, al Brief Symptom Inventory (BSI). Resultados: los resultados mostraron, en contraste con la población normativa, que los progenitores separados puntuaban significativamente más alto en los PSMs. La intervención implicó una mejora significativa en todos PSMs, oscilando desde el 19% en ansiedad fóbica al 36% en depresión y ansiedad generalizada, así como en los índices generales de malestar (36% en el Índice de Severidad Global; 28% en el Índice de Malestar referido a Síntomas Positivos; y el 33% en el Total de Síntomas Positivos). Conclusiones: se discuten las implicaciones de los resultados de la ruptura e intervención en los PSMs de los padres separados y el bienestar de los hijos


Assuntos
Humanos , Masculino , Feminino , Criança , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Adaptação Psicológica , Estado Civil , Transtornos Mentais/diagnóstico , Pais/educação , Custódia da Criança/estatística & dados numéricos , Transtornos Mentais/prevenção & controle , Transtornos Mentais/psicologia , Saúde Mental/educação , Pais/psicologia , Avaliação de Programas e Projetos de Saúde , Fatores Sexuais , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia
10.
Psicothema ; 31(3): 284-291, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31292043

RESUMO

BACKGROUND: Parental separation is a stressful experience that can lead to parents suffering mental health problems (MHPs). Parental separation education programs for coping with post-separation adjustment have proven to be effective in reducing conflict and improving co-parenting. However, the effects of these programs on MHPs have not been assessed. A field study was carried out to assess the impact of a parental separation education program on parental MHPs. METHOD: A total of 116 separated parents who completed the program "Parental separation, not family breakdown" completed the Brief Symptom Inventory (BSI) pre- and post-intervention. RESULTS: Separated parents had significantly higher pre-intervention scores on the nine symptom dimensions and the global indexes of distress in comparison to the normative population. The intervention yielded a significant improvement (i.e., reduction of clinical symptoms) in all MHPs, ranging from 19% in phobic anxiety to 36% in depression and general anxiety; and in the global indexes of distress (36% in the global severity index; 28% in the positive symptom distress index; and 33% in the positive symptom total). Approximately 45% of parents significantly improved through the intervention. CONCLUSIONS: The implications of the outcomes of the separation and intervention in parents' MHPs and children wellbeing are discussed.


Assuntos
Adaptação Psicológica , Estado Civil , Transtornos Mentais/diagnóstico , Pais/educação , Adulto , Criança , Custódia da Criança/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/prevenção & controle , Transtornos Mentais/psicologia , Saúde Mental/educação , Pessoa de Meia-Idade , Pais/psicologia , Avaliação de Programas e Projetos de Saúde , Fatores Sexuais , Estresse Psicológico/diagnóstico , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Adulto Jovem
11.
Am J Health Syst Pharm ; 76(13): 953-963, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361885

RESUMO

PURPOSE: This study presents a medication-associated altered mental status (AMS) risk model for real-time implementation in inpatient electronic health record (EHR) systems. METHODS: We utilized a retrospective cohort of patients admitted to 2 large hospitals between January 2012 and October 2013. The study population included admitted patients aged ≥18 years with exposure to an AMS risk-inducing medication within the first 5 hospitalization days. AMS events were identified by a measurable mental status change documented in the EHR in conjunction with the administration of an atypical antipsychotic or haloperidol. AMS risk factors and AMS risk-inducing medications were identified from the literature, drug information databases, and expert opinion. We used multivariate logistic regression with a full and backward eliminated set of risk factors to predict AMS. The final model was validated with 100 bootstrap samples. RESULTS: During 194,156 at-risk days for 66,875 admissions, 262 medication-associated AMS events occurred (an event rate of 0.13%). The strongest predictors included a history of AMS (odds ratio [OR], 9.55; 95% confidence interval [CI], 5.64-16.17), alcohol withdrawal (OR, 3.34; 95% CI, 2.18-5.13), history of delirium or psychosis (OR, 3.25; 95% CI, 2.39-4.40), presence in the intensive care unit (OR, 2.53; 95% CI, 1.89-3.39), and hypernatremia (OR, 2.40; 95% CI, 1.61-3.56). With a C statistic of 0.85, among patients scoring in the 90th percentile, our model captured 159 AMS events (60.7%). CONCLUSION: The risk model was demonstrated to have good predictive ability, with all risk factors operationalized from discrete EHR fields. The real-time identification of higher-risk patients would allow pharmacists to prioritize surveillance, thus allowing early management of precipitating factors.


Assuntos
Transtornos da Consciência/epidemiologia , Transtornos Mentais/epidemiologia , Adulto , Idoso , Comorbidade , Transtornos da Consciência/induzido quimicamente , Transtornos da Consciência/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Florida , Hospitalização , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/prevenção & controle , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
12.
Rev Assoc Med Bras (1992) ; 65(5): 586-588, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166430

RESUMO

Surgeons are becoming aware that surgical outcomes are not only based on technical skills. The impact of psychological problems on outcomes must be studied from both the patient's and the health care provider's viewpoint. Psychological problems may affect up to 20% of the population, with almost half of them non-treated. Surgeons have to deal with a significant number of patients with psychological problems, which affect surgical outcomes changing how symptoms, results and side effects are interpreted. Surgeons also face psychological problems at a significant rate. Although there are no studies on the effect of chronic psychological problems of the surgeon on outcomes, in simulated scenarios, acute stress usually leads to worse performance. Some initiatives can be implemented to improve outcomes based on the effect of psychological problems.


Assuntos
Transtornos Mentais/complicações , Pacientes/psicologia , Cirurgiões/psicologia , Procedimentos Cirúrgicos Operatórios/psicologia , Humanos , Transtornos Mentais/prevenção & controle , Resultado do Tratamento
16.
J Am Acad Dermatol ; 81(3): 709-716, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31054973

RESUMO

BACKGROUND: Psoriasis and biologic therapies have been associated with psychiatric illnesses. OBJECTIVE: To determine if persons with psoriasis or those exposed to biologics are more likely to develop a psychiatric illness. METHODS: Retrospective electronic medical records cohort study. RESULTS: Individuals with psoriasis were significantly more likely to have a history of several medical (eg, cardiovascular illnesses) and psychiatric (eg, depression, suicide) illnesses than those without psoriasis. Those with psoriasis who were prescribed a biologic therapy were significantly less likely than those with psoriasis not prescribed a biologic agent to receive a psychiatric illness diagnosis (hazard ratio for any psychiatric illness 0.52, 95% confidence interval 0.51-0.53, P < .0001). With respect to any psychiatric illness, this finding was confirmed when comparing biologic therapy versus methotrexate treatment (0.80, 95% confidence interval 0.76-0.84, P < .0001). LIMITATIONS: These findings were likely attributable to treatment selection bias. CONCLUSION: Individuals with psoriasis have an increased risk of several medical and psychiatric illnesses. Individuals with psoriasis prescribed biologic agents are less likely than those not prescribed biologic agents to develop psychiatric illnesses. Most likely because of treatment selection, individuals with psoriasis prescribed biologic therapy are not currently at increased risk of a psychiatric outcome.


Assuntos
Produtos Biológicos/efeitos adversos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Psoríase/tratamento farmacológico , Adulto , Idoso , Produtos Biológicos/administração & dosagem , Feminino , Humanos , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/prevenção & controle , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/psicologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Infant Ment Health J ; 40(4): 523-540, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31095763

RESUMO

This article describes an infant-toddler court team in Michigan, the community-based participatory research approach to the implementation evaluation, and the resulting changes in parenting. Like other court teams, Michigan's Baby Court is led by a science-informed jurist, and all service providers are knowledgeable about the developmental needs of young children and engage in collaborative communication throughout the case. Relationship-based treatment in the form of infant mental health home-visiting was provided to families. Sixteen parents participated in pre- and posttest evaluation visits to assess changes in parents' reflective functioning and interactions with their child. Findings suggest improvements in parents' responsiveness, positive affect, and reflective functioning, with moderate effects. Higher risk parents demonstrated significant changes in reflective functioning, as compared to those at lower risk. These findings add to and support the limited literature on the effectiveness of infant-toddler court teams, which include relationship-based and trauma-informed services.


Assuntos
Bem-Estar da Criança/psicologia , Visita Domiciliar/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Transtornos Mentais/prevenção & controle , Relações Pais-Filho , Poder Familiar/psicologia , Adolescente , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos Mentais/psicologia , Michigan , Pais/psicologia , Adulto Jovem
19.
J Trauma Acute Care Surg ; 87(2): 463-482, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31145380

RESUMO

BACKGROUND: The recovery and rehabilitation of trauma survivors may be long and challenging. Patients may be prone to psychiatric disorders, cognitive impairments, and decreased quality of life. The objective of this review was to determine whether there is a role for psychological interventions in reducing the incidence and severity of psychiatric sequelae in trauma survivors. METHODS: MEDLINE, PubMed, SCOPUS, and Google Scholar were searched for published articles. We searched for articles published between 1990 and 2018 with adult subjects, and limited our search to articles published in English. Randomized controlled trials that evaluated various psychiatric interventions in trauma patients on the effects of psychiatric outcomes were included for analysis. The articles were independently reviewed for eligibility by two different reviewers. A meta-analysis was performed on nine studies with similar interventions, outcomes measured, and patient populations. RESULTS: Nine hundred thirty-four articles were identified [830 articles identified through database search, and 107 through article references]. Sixty-nine full-text articles were reviewed for eligibility. Of these, 33 were included for qualitative analysis. Thirteen studies evaluating the effect of cognitive behavioral therapy (CBT)-based interventions on the severity of posttraumatic stress disorder (PTSD), anxiety, and depression symptoms underwent meta-analysis. While CBT-treated patients experienced clinically significant decreases in symptom severity, there were no statistically significant differences between treatment and control groups at follow-up for PTSD, anxiety, and depression. CONCLUSION: Compared with usual care, CBT-based interventions may not be effective in decreasing or preventing PTSD, anxiety, or depression symptoms in trauma survivors. LEVEL OF EVIDENCE: Systematic Review, level III.


Assuntos
Transtornos Mentais/prevenção & controle , Ferimentos e Lesões/psicologia , Terapia Cognitivo-Comportamental , Humanos , Transtornos Mentais/etiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
20.
BMC Public Health ; 19(1): 638, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126273

RESUMO

BACKGROUND: Poor psychosocial work environments, such as those with low psychological support and high demands, can be harmful to the mental health of workers. In Canada, the National Standard for Psychological Health and Safety in the Workplace (the Standard) provides a comprehensive framework for organizations to identify hazards that may contribute to the psychological harm of employees. This study examines the association between a multi-faceted community intervention, the Superior Mental Wellness @ Work program designed to increase awareness of mental health and the National Standard, and outcomes assessing increased awareness and response to the Standard. These outcomes included the 1) prioritization of workplace mental health; 2) familiarity with the Standard; and 3) knowledge of mental health. METHODS: A quasi-experimental design was used to assess the associations of interest. Surveys were sent to two random samples of employer representatives pre-and post-intervention. Intervention participants were also compared to non-participants at the post-intervention stage. T-tests and chi-square tests were used to compare differences between pre- and post-intervention outcomes and also between intervention participants and non-participants identified at the post-intervention survey. RESULTS: The multi-faceted community intervention was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. When comparing those companies who participated in the intervention versus those who did not, participants were more likely to prioritize mental health in the workplace. Participants reported a greater need for support to address workplace mental health, poorer perceived mental health of employees, and greater stigma than non-participants. However, participants were more likely to be familiar with the Standard, have an action plan to implement the Standard, and be prepared to champion mental health in the workplace. Participants also had greater knowledge of workplace mental health in general compared to non-participants. CONCLUSIONS: The multi-faceted community intervention, the Superior Mental Wellness @ Work project, was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. Such a multi-faceted intervention has the capacity to improve mental health literacy and awareness of the Standard.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Transtornos Mentais/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Local de Trabalho/psicologia , Adolescente , Adulto , Canadá , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/prevenção & controle , Saúde Mental , Pessoa de Meia-Idade , Estigma Social , Inquéritos e Questionários , Adulto Jovem
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