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– It is commonly assumed that reforms in the sector of psychiatric care have contributed to reducing the stigma attached to mental illness. In order to examine whether a relation between the psychiatric care set-up and stigmatisation of the patients exists we compared public attitudes towards mental patients in three countries at differing stages of progress in psychiatric reform.
Methods
– Population surveys on public attitudes towards mental patients were conducted in Novosibirsk (Russia) and Bratislava (Slovakia). The data were compared with those from a population survey that had recently been carried out in Germany. In all three surveys the same sampling procedure and fully structured interview were used. Public attitude towards mental patients was elicited using a perceived devaluation-discrimination measure.
Results
– Psychiatric patients face considerable rejection in all three locations in question. Overall, the degree of perceived devaluation and discrimination was similar in all countries with a significant, but marginal tendency towards stronger devaluation of mental patients in Germany.
Conclusion
– Our results do not support a strong relationship between psychiatric reform and mental illness stigma.
To quantify and compare the resource consumption and direct costs of medical mental health care of patients suffering from schizophrenia in France, Germany and the United Kingdom.
Methods
In the European Cohort Study of Schizophrenia, a naturalistic two-year follow-up study, patients were recruited in France (N = 288), Germany (N = 618), and the United Kingdom (N = 302). Data about the use of services and medication were collected. Unit cost data were obtained and transformed into United States Dollar Purchasing Power Parities (USD-PPP). Mean service use and costs were estimated using between-effects regression models.
Results
In the French/German/UK sample estimated means for a six-month period were respectively 5.7, 7.5 and 6.4 inpatient days, and 11.0, 1.3, and 0.7 day-clinic days. After controlling for age, sex, number of former hospitalizations and psychopathology (CGI score), mean costs were 3700/2815/3352 USD-PPP.
Conclusions
Service use and estimated costs varied considerably between countries. The greatest differences were related to day-clinic use. The use of services was not consistently higher in one country than in the others. Estimated costs did not necessarily reflect the quantity of service use, since unit costs for individual types of service varied considerably between countries.
– The aim of the study is to examine to what extent the public is willing to allocate financial resources to the care of people with mental disorders.
Methods.
– In 2001, a representative survey was conducted among the adult population of Germany (n = 5025). The respondents were asked to select three out of nine conditions for which available resources should on no account be shortened. For data analysis, multiple unidimensional unfolding was used.
Results.
– Compared with medical diseases, the respondents were far less willing to allocate financial resources to the care of people with psychiatric disorders, making a clear distinction between the two types of diseases. While familiarity with mental illness had the effect of decreasing the reluctance to spend money for psychiatric patients, the endorsement of traditional values increased it.
Conclusion.
– Our findings point to both the chances and the limitations of efforts aimed at reducing the structural discrimination of people with mental illness.
To examine the evolution of the perception of the stigma attached to mental illness in Germany since 1990 up to the present.
Subjects and methods
Population surveys were conducted in the old German States (former Federal Republic of Germany) in 1990, 2001, and 2011. The perception of stigma attached to people with mental illness was assessed with the help of Link's perceived discrimination and devaluation scale.
Results
In the 2011 survey, less mental illness stigma was perceived by respondents than in the previous surveys. In the eyes of the German public, the devaluation and rejection of people with mental illness has substantially decreased since 1990.
Discussion
The perception of a decline of the stigmatization is in contrast to the development of the German public's attitudes towards persons with mental disorders, which remained unchanged or even worsened.
Conclusion
Perceived and personal attitudes towards persons with mental illness have developed differently, and it remains to be seen whether perceptions of less public stigma will ultimately be followed by improved personal attitudes.
Competency research in the rehabilitation profession and that of rehabilitation counselling in particular, has an extensive pedigree. This article reviews the significant research in the field and details several of the instruments used in competency research to date. Issues concerning the current use of competency research and the future role of such research are discussed.
Alzheimer's disease and related dementias are associated with increasing health burden in low- and middle-income countries. Less well-recognized is the potential health burden experienced by other affected individuals, such as family caregivers. In this study, we sought to profile the burden of care and its association with symptoms of depression and anxiety among informal caregivers of people living with dementia in rural southwestern Uganda.
Method
We conducted a cross-sectional study of 232 family caregivers of people with dementia. The key measured variables of interest were caregiving burden (Zarit Burden Index) and symptoms of depression and anxiety (Depression Anxiety Stress Scales). We fitted multivariable regression models specifying depression and anxiety symptoms as the primary outcomes of interest and caregiving burden as the primary explanatory variable of interest.
Results
Family caregivers of people with dementia experience significant caregiving burden, with each item on the Zarit Burden Index endorsed by more than 70% of study participants. Nearly half [108 (47%)] of caregivers had Zarit Burden Interview scores >60, suggestive of severe caregiving burden. In multivariable regression models, we estimated a statistically significant positive association between caregiving burden and symptoms of both depression [b = 0.42; 95% confidence interval (CI) 0.34–0.49] and anxiety (b = 0.37; 95% CI 0.30–0.45).
Conclusion
Family caregivers of people with dementia in rural Uganda experience a high caregiving burden, which is associated with symptoms of depression and anxiety. Interventions aimed at reducing caregiving burden may have important collateral mental health benefits.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Getting a better understanding of the evolution and nucleosynthetic yields of the most metal-poor stars (Z ≲ 10−5) is critical because they are part of the big picture of the history of the primitive universe. Yet many of the remaining unknowns of stellar evolution lie in the birth, life, and death of these objects. We review stellar evolution of intermediate-mass Z ≤ 10−5 models existing in the literature, with a particular focus on the problem of their final fates. We emphasise the importance of the mixing episodes between the stellar envelope and the nuclearly processed core, which occur after stars exhaust their central He (second dredge-up and dredge-out episodes). The depth and efficiency of these episodes are critical to determine the mass limits for the formation of electron-capture SNe. Our knowledge of these phenomena is not complete because they are strongly affected by the choice of input physics. These uncertainties affect stars in all mass and metallicity ranges. However, difficulties in calibration pose additional challenges in the case of the most metal-poor stars. We also consider the alternative SN I1/2 channel to form SNe out of the most metal-poor intermediate-mass objects. In this case, it is critical to understand the thermally pulsing Asymptotic Giant Branch evolution until the late stages. Efficient second dredge-up and, later, third dredge-up episodes could be able to pollute stellar envelopes enough for the stars to undergo thermal pulses in a way very similar to that of higher initial Z objects. Inefficient second and/or third dredge-up may leave an almost pristine envelope, unable to sustain strong stellar winds. This may allow the H-exhausted core to grow to the Chandrasekhar mass before the envelope is completely lost, and thus let the star explode as an SN I1/2. After reviewing the information available on these two possible channels for the formation of SNe, we discuss existing nucleosynthetic yields of stars of metallicity Z ≤ 10−5 and present an example of nucleosynthetic calculations for a thermally pulsing Super-Asymptotic Giant Branch star of Z = 10−5. We compare theoretical predictions with observations of the lowest [Fe/H] objects detected. The review closes by discussing current open questions as well as possible fruitful avenues for future research.
Complementary chemical and isotopic relationships between chondrules and matrix have the potential to distinguish between categories of chondrule forming mechanisms, e.g., exclude all mechanisms that require different reservoirs for chondrules and matrix. The complementarity argument is, however, often misunderstood. Complementarity requires different average compositions of an element or isotope ratio in each of the two major chondrite components chondrules and matrix, and a solar or CI chondritic bulk chondrite ratio of the considered elements or isotopes. For example, chondrules in carbonaceous chondrites typically have superchondritic Mg/Si ratios, while the matrix is subchondritic. Another example would be the Hf/W ratio, which is superchondritic in chondrules and subchondritic in matrix. We regard these ratios to be complementary in chondrules and matrix, because the bulk chondrite has solar Mg/Si and Hf/W ratios. In contrast, Al/Na ratios are also different in chondrules and matrix, but the bulk is not solar; therefore, Al/Na does not have a complementary relationship. A number of publications over the past decade have reported complementary relationships for many element pairs in different types of chondrites. Recently, isotopic complementarities have also been reported. A related, though different, argument can be made for volatile depletion patterns in chondrules and matrix, which can then also be considered as being complementary. The various models for chondrule formation require either that chondrules and matrix formed from a single (i.e., common) parental reservoir, or that chondrules and matrix formed in separate regions of the protoplanetary disk and were later mixed together. As chondrules and matrix have different compositions, mixing of these two components would result in a random bulk chondrite composition. The observation of complementary chondrule–matrix relationships together with a CI chondritic, element or isotope ratio is unlikely to be the result of a random mix of chondrules and matrix. It seems much more likely that chondrules and matrix formed in a single reservoir with initially CI chondritic element or isotope ratios. Incorporation of different minerals in chondrules and matrix together with volatile element depletion of the entire reservoir then resulted in chondrule-matrix complementarities and bulk chondrite volatile depletion. This excludes any chondrule formation mechanism that requires separate parental reservoirs for these components. Any chondrule forming mechanism must explain complementarity. Chondrules and matrix must have formed from a common reservoir.
We present a model for the scaling of mixing in weakly rotating stratified flows characterized by their Rossby, Froude and Reynolds numbers
$Ro,Fr$
,
$Re$
. This model is based on quasi-equipartition between kinetic and potential modes, sub-dominant vertical velocity,
$w$
, and lessening of the energy transfer to small scales as measured by a dissipation efficiency
$\unicode[STIX]{x1D6FD}=\unicode[STIX]{x1D716}_{V}/\unicode[STIX]{x1D716}_{D}$
, with
$\unicode[STIX]{x1D716}_{V}$
the kinetic energy dissipation and
$\unicode[STIX]{x1D716}_{D}=u_{rms}^{3}/L_{int}$
its dimensional expression, with
$w,u_{rms}$
the vertical and root mean square velocities, and
$L_{int}$
the integral scale. We determine the domains of validity of such laws for a large numerical study of the unforced Boussinesq equations mostly on grids of
$1024^{3}$
points, with
$Ro/Fr\geqslant 2.5$
, and with
$1600\leqslant Re\approx 5.4\times 10^{4}$
; the Prandtl number is one, initial conditions are either isotropic and at large scale for the velocity and zero for the temperature
$\unicode[STIX]{x1D703}$
, or in geostrophic balance. Three regimes in Froude number, as for stratified flows, are observed: dominant waves, eddy–wave interactions and strong turbulence. A wave–turbulence balance for the transfer time
$\unicode[STIX]{x1D70F}_{tr}=N\unicode[STIX]{x1D70F}_{NL}^{2}$
, with
$\unicode[STIX]{x1D70F}_{NL}=L_{int}/u_{rms}$
the turnover time and
$N$
the Brunt–Väisälä frequency, leads to
$\unicode[STIX]{x1D6FD}$
growing linearly with
$Fr$
in the intermediate regime, with a saturation at
$\unicode[STIX]{x1D6FD}\approx 0.3$
or more, depending on initial conditions for larger Froude numbers. The Ellison scale is also found to scale linearly with
$Fr$
. The flux Richardson number
$R_{f}=B_{f}/[B_{f}+\unicode[STIX]{x1D716}_{V}]$
, with
$B_{f}=N\langle w\unicode[STIX]{x1D703}\rangle$
the buoyancy flux, transitions for approximately the same parameter values as for
$\unicode[STIX]{x1D6FD}$
. These regimes for the present study are delimited by
${\mathcal{R}}_{B}=ReFr^{2}\approx 2$
and
$R_{B}\approx 200$
. With
$\unicode[STIX]{x1D6E4}_{f}=R_{f}/[1-R_{f}]$
the mixing efficiency, putting together the three relationships of the model allows for the prediction of the scaling
$\unicode[STIX]{x1D6E4}_{f}\sim Fr^{-2}\sim {\mathcal{R}}_{B}^{-1}$
in the low and intermediate regimes for high
$Re$
, whereas for higher Froude numbers,
$\unicode[STIX]{x1D6E4}_{f}\sim {\mathcal{R}}_{B}^{-1/2}$
, a scaling already found in observations: as turbulence strengthens,
$\unicode[STIX]{x1D6FD}\sim 1$
,
$w\approx u_{rms}$
, and smaller buoyancy fluxes together correspond to a decoupling of velocity and temperature fluctuations, the latter becoming passive.
This paper presents the results of Phase 3 of The RETURN Project, a European Study which aimed to reduce long term absenteeism in the workplace. Phases 1 and 2 have been described in detail elsewhere. The study adopted an iterative approach that explored LTA from three different perspectives: the System, the Expert and the Employer. This paper describes how the outputs of both the System and the Expert phases in combination with other tools focused on Disability Management (DM) were used to generate an interactive multi-jurisdictional assessment protocol tool for evaluating company based responses in managing employees on long term absence. The RETURN Protocol was field tested in different regulatory contexts using a company case study approach. Results of the field test carried out in six European companies are presented and the future and appropriate use of the protocol tool is discussed.
Leishmaniasis are diseases caused by parasites of the genus Leishmania and transmitted to humans by the bite of infected insects of the subfamily Phlebotominae. Current drug therapy shows high toxicity and severe adverse effects. Recently, two oligopeptidases (OPBs) were identified in Leishmania amazonensis, namely oligopeptidase B (OPB) and oligopeptidase B2 (OPB2). These OPBs could be ideal targets, since both enzymes are expressed in all parasite lifecycle and were not identified in human. This work aimed to identify possible dual inhibitors of OPB and OPB2 from L. amazonensis. The three-dimensional structures of both enzymes were built by comparative modelling and used to perform a virtual screening of ZINC database by DOCK Blaster server. It is the first time that OPB models from L. amazonensis are used to virtual screening approach. Four hundred compounds were identified as possible inhibitors to each enzyme. The top scored compounds were submitted to refinement by AutoDock program. The best results suggest that compounds interact with important residues, as Tyr490, Glu612 and Arg655 (OPB numbers). The identified compounds showed better results than antipain and drugs currently used against leishmaniasis when ADMET in silico were performed. These compounds could be explored in order to find dual inhibitors of OPB and OPB2 from L. amazonensis.
Acceptance of chronic pain is associated with positive health outcomes. The study examined participants’ chronic pain experiences by exploring two acceptance factors: pain willingness and activity engagement. Eleven participants (seven women and four men) participated in semi-structured interviews. Interview transcripts were analysed to identify pain willingness and activity engagement in participants’ experiences. The study found that participants demonstrated some pain willingness and activity engagement, but that avoidance and control could result in unwanted activity restrictions. Three themes were identified in participants’ accounts of getting on with their lives: making necessary adjustments, taking control and finding purpose and meaning. To improve outcomes for people with chronic pain, counsellors and rehabilitation professionals should encourage pain acceptance, and educate their clients about the effects of social withdrawal, and avoidance and control of pain.
Exploring cultural differences may improve understanding about the social processes underlying the stigmatisation of people with mental illness.
Aims
To compare public beliefs and attitudes about schizophrenia in Central Europe and North Africa.
Method
Representative national population surveys conducted in Germany (2011) and in Tunisia (2012), using the same interview mode (face to face) and the same fully structured interview.
Results
In Tunisia, respondents showed a stronger tendency to hold the person with schizophrenia responsible for the condition. At the same time they expressed more prosocial reactions and less fear than their German counterparts. In Germany, the desire for social distance was greater for more distant relationships, whereas in Tunisia this was the case for close, family-related relationships.
Conclusions
Stigma differs between Tunisia and Germany more in form than in magnitude. It manifests particularly in those social roles which ‘matter most’ to people within a given culture.
Originally presented at the National Injury Management and Prevention Conference: Transition and Change, on April 27, 2006, which was held at the Hyatt Regency, Adelaide, South Australia. Reprinted with the permission of the authors.
Work in the Australian construction industry is fraught with risk and the potential for serious harm. The industry is consistently placed within the three most hazardous industries to work along with other industries such as mining and transport (National Occupational Health and Safety Commission, 2003). In the 2001 to 2002 period, construction work killed 39 people and injured 13,250 more. Hence, more effort is required to reduce the injury rate and maximise the value of the rehabilitation/back-to-work process.
Therapeutic intervention usually begins with a detailed description of the presenting problem and its antecedent history. Through the process of communicating their problem the client presents a story, potentially laden with their experiences, attitudes, beliefs and understandings. The topic and manner in which a story is relayed provides direct and indirect sources of information that help the therapist to both understand the client's problem and formulate goals and approaches to therapy. Rather than simply using the client's story as a guide to understanding and treatment, narrative therapy focuses on the client's story or ‘narrative’ as a medium through which change can be effected. During the process of narrative therapy the client is encouraged to deconstruct and critically appraise their story in the search for new meanings (White & Epston, 1990). The client is encouraged to retell their story with new language and new insights. Thus, the implementation of narrative therapy may be construed as a natural extension of taking the client's problem history, where the story told serves as the content foundation for the therapeutic process. The purpose of the present article is to provide a brief overview of narrative therapy techniques and their application in counselling.
Landowners and game reserve managers are often faced with the decision whether to undertake consumptive (such as hunting) and/or non-consumptive (such as tourism) use of wildlife resources on their properties. Here a theoretical model was used to examine cases where the game reserve management allocated the amount of land devoted to hunting (trophy hunting) and tourism, based on three scenarios: (1) hunting is separated from tourism but wildlife is shared; (2) hunting and tourism co-exist; and (3) hunting and tourism are separated by a fence. The consumptive and non-consumptive uses are not mutually exclusive; careful planning is needed to ensure that multiple management objectives can be met. Further, the analysis indicates that the two uses may be undertaken in the same area. Whether they are spatially, or temporally separated depends on the magnitude of the consumptive use. When consumptive use is not dominant, the two are compatible in the same shared area, provided the wildlife population is sufficiently large.
In this investigation of rehabilitation professionals in Australasia, where the profession of rehabilitation counselling might be described as emerging, the appropriateness of the Rehabilitation Skills Inventory for use in Australasian settings was evaluated. This resulted in an amendment to the original instrument and the development of the RSI (Amended) instrument. The instrument validation is discussed and the four component solution described.