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On-call and crisis psychiatry is a very challenging aspect of psychiatric training. This study aimed to describe the experiences of psychiatric trainees on-call in hospitals, emergency departments and psychiatric units in Ireland.
In total, 193 psychiatric trainees in Ireland were emailed a survey in 2017. The survey included questions regarding the duties expected of the trainee, frequency of on-call obligations, un-rostered hours worked, level of senior support, assessment facilities available and doctors’ satisfaction with the on-call experience.
Overall, 68 trainees responded to the survey. In total, 35% of respondents reported dissatisfaction with their experience of on-call and crisis psychiatry, 46% reported that they were not provided with training in risk assessment and 21% of respondents stated that there was not a suitable room available to perform their assessments.
This survey has raised important issues facing those on the frontline of psychiatric services in Ireland. Of particular concern are resource issues faced by trainees and the need for further training and support related to risk assessment when on-call. Remedying these issues may lead to a decreased rate of dropout as well as a safer and better environment for patients and doctors alike.
There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication.
This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery.
There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001).
This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.
The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.
Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.
Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.
EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.
There are high rates of psychiatric morbidity associated with refractory epilepsy. It is unclear whether seizure frequency or comorbid psychiatric illness impacts more upon patients’ quality of life in epilepsy. The objective of this study was to establish which of these two factors impacted more upon patients.
Patients with medically refractory epilepsy who were admitted to the National Neurological Centre in Beaumont Hospital were recruited to the study. Structural Clinical Interview for DSM IV (Axis I) (SCID I) and SCID II (Axis II) were the objective measures and HADS, and QOLIE-89 were the subjective measures utilized.
A total of 138 patients had SCIDs conducted over the four year study. 75 patients (54.4%) had an Axis I disorder. Of these 30 patients (21.7%) had a mood disorder, 18 patients (13%) had an anxiety disorder and 49 patients (35.5%) were diagnosed with a psychotic disorder. There was no relationship between patient seizure frequency and HADS (p=0.94) or QOLIE-89 (p=0.93) scores. Patients having a high number of seizures were not more likely to have a SCID Axis I diagnosis than patients with a low number of seizures (p=0.246). Patients with a mood disorder were more likely to have a lower QOLIE-89 score than patients without a mood disorder (p=0.0001).
Patients with medically refractory epilepsy have high rates of psychopathology. Seizure frequency is not correlated with the presence, severity of psychiatric symptoms or quality of life. The presence of a psychiatric disorder and its severity is strongly correlated with quality of life.
Populations of native North American parasitoids attacking Agrilus Curtis (Coleoptera: Buprestidae) species have recently been considered as part of an augmentative biological control programme in an attempt to manage emerald ash borer, Agrilus planipennis Fairmaire, a destructive wood-boring beetle discovered in North America in 2002. We evaluate trapping methods to detect and monitor populations of two important native larval parasitoids, Phasgonophora sulcata Westwood (Hymenoptera: Chalcididae) and Atanycolus Förster (Hymenoptera: Braconidae) species, attacking emerald ash borer in its introduced range. We found that purple prism traps captured more P. sulcata than green prism traps, yellow pan traps, and log samples and thus were considered better for detecting and monitoring P. sulcata populations. Trap type did not affect the number of captures of Atanycolus species. Surprisingly, baiting prism traps with a green leaf volatile or manuka oil did not significantly increase captures of P. sulcata or Atanycolus species. Based on these results, unbaited purple prism traps would be optimal for sampling these native emerald ash borer parasitoids in long-term management programmes.
SDG3, Health and Wellbeing for All, depends on many other SDGs but there are also potential conflicts and trade-offs. In this chapter, ee stress the importance of forests to global health and well-being as well as for Indigenous and local populations. In contrast, short-term economic and human health gains from further forest conversion (e.g. deforestation for food production) will create direct and indirect health risks for humans, as well as for other biota. Controlling indiscriminate burning and clearing of forests can reduce significant harm to health and well-being, via improved quality of water, soil and air, by reducing exposure to some infectious diseases, through preservation of traditional (and future) medicines, and by supporting other forest resources and services, including climate regulation. Many infectious diseases are associated with forest disturbance and intrusions and some may be prevented or modified through forest management. Universal access to sexual and reproductive health-care services, including family planning, is a critical SDG3 target to decrease demographic pressures on forests at local, regional and global scales, and to enhance well-being. Greater exposure to green space, including the ‘urban forest’, is likely to have many benefits for mental, social and physical health for the increasingly urban global population.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
A design and manufacturing method is described for creating a motor tendon–actuated soft foam robot. The method uses a castable, light, and easily compressible open-cell polyurethane foam, producing a structure capable of large (~70% strain) deformations while requiring low torques to operate (<0.2 N·m). The soft robot can change shape, by compressing and folding, allowing for complex locomotion with only two actuators. Achievable motions include forward locomotion at 13 mm/s (4.3% of body length per second), turning at 9◦/s, and end-over-end flipping. Hard components, such as motors, are loosely sutured into cavities after molding. This reduces unwanted stiffening of the soft body. This work is the first demonstration of a soft open-cell foam robot locomoting with motor tendon actuators. The manufacturing method is rapid (~30 min per mold), inexpensive (under $3 per robot for the structural foam), and flexible, and will allow a variety of soft foam robotic devices to be produced.
Lithium-treated patients with polyuria are at increased risk of lithium toxicity. We aimed to describe the clinical benefits and risks of different management strategies for polyuria in community lithium-treated patients.
This is a naturalistic, observational, prospective 12-month cohort study of lithium-treated patients with polyuria attending a community mental health service in Dublin, Ireland. When polyuria was detected, management changed in one of four ways: (a) no pharmacological change; (b) lithium dose decrease; (c) lithium substitution; or (d) addition of amiloride.
Thirty-four participants were diagnosed with polyuria and completed prospective data over 12 months. Mean 24-hour urine volume decreased from 4852 to 4344 ml (p = 0.038). Mean early morning urine osmolality decreased from 343 to 338 mOsm/kg (p = 0.823). Mean 24-hour urine volume decreased with each type of intervention but did not attain statistical significance for any individual intervention group. Mean early morning urine osmolality decreased in participants with no pharmacological change and increased in participants who received a change in medication but these changes did not attain statistical significance. Only participants who discontinued lithium demonstrated potentially clinically significant changes in urine volume (mean decrease 747 ml in 24 hours) and early morning urine osmolality (mean increase 31 mOsm/kg) although this was not definitively proven, possibly owing to power issues.
Managing polyuria by decreasing lithium dose does not appear to substantially improve objective measures of renal tubular dysfunction, whereas substituting lithium may do so. Studies with larger numbers and longer follow-up would clarify these relationships.
To assess community mental health in suburban Dublin in 2018, 5 years after Ireland’s economic recession ended.
A cross-sectional, face-to-face, household survey was conducted in a random cluster sample of 351 households in Tallaght, a deprived suburb of Dublin.
A majority of respondents (61.3%) reported stress over the previous 12 months, with a higher rate in areas of high (66.9%) compared to lower deprivation (55.5%). Deprivation was not related to rates of loneliness (20.2%), feeling depressed (20.2%), loss of interest (19.7%) or anxiety (22.5%). Mean score for positive mental health (59.3/100, with a higher score indicating better mental health) was lower than that reported in a national sample in 2007 (68/100); positive mental health was associated with not living with a person with chronic illness, self-identifying as ‘non-Irish’ and greater age. Mean score for psychological distress (76.7/100, with a higher score indicating less distress) was also lower than that in 2007 (82/100); less psychological distress was associated with not living with a person with chronic illness or disability, greater age and identifying as non-Irish. The rate of ‘probable mental illness’ over the previous 4 weeks (13.1%) was higher than in 2007 (7%).
Our findings emphasise the high prevalence of stress, especially in deprived suburban areas; the centrality of carer burden in determining mental wellbeing; and associations between positive mental health on the one hand and greater age and identifying as non-Irish on the other.
Knowing the burden of influenza is helpful for policy decisions. Here we estimated the contribution of influenza-like illness (ILI) visits associated with laboratory-confirmed influenza among all clinic visits in a Senegal sentinel network. ILI data from ten sentinel sites were collected from January 2013 to December 2015. ILI was defined as an axillary measured fever of more than 37.5 °C with a cough or a sore throat. Collected nasopharyngeal swabs were tested for influenza viruses by rRT-PCR. Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza. For the influenza disease burden estimation, we used all-case outpatient visits during the study period who sought care at selected sites. Of 4030 ILI outpatients tested, 1022 were influenza positive. The estimated proportional contribution of influenza-associated ILI was, per 100 outpatients, 1.2 (95% CI 1.1–1.3), 0.32 (95% CI 0.28–0.35), 1.11 (95% CI 1.05–1.16) during 2013, 2014, 2015, respectively. The age-specific outpatient visits proportions of influenza-associated ILI were higher among children under 5 years (0.68%, 95% CI: 0.62–0.70). The predominant virus during years 2013 and 2015 was influenza B while A/H3N2 subtype was predominant during 2014. Influenza viruses cause a substantial burden of outpatient visits particularly among children under 5 of age in Senegal and highlight the need of vaccination in risk groups.
Prenatal programming models have rarely been applied to research on children with prenatal substance exposure, despite evidence suggesting that prenatal drug exposure is a form of stress that impacts neurodevelopmental outcomes and risk for psychopathology. Utilizing data from two longitudinal multisite studies comprising children prenatally exposed to substances as well as a nonexposed comparison group (Maternal Lifestyle Study, n = 1,388; Infant Development, Environment, and Lifestyle study, n = 412), we tested whether early phenotypic indicators of hypothesized programming effects, indexed by growth parameters at birth and infant temperament, served as a link between prenatal substance exposure and internalizing and externalizing behavior at age 5. Latent profile analysis indicated that individual differences in reactivity and regulation for infants prenatally exposed to substances was best characterized by four temperament profiles. These profiles were virtually identical across two independent samples, and demonstrated unique associations with adjustment difficulties nearly 5 years later. Results of path analysis using structural equation modeling also showed that increased prenatal substance exposure was linked to poorer growth parameters at birth, profiles of temperamental reactivity in infancy, and internalizing and externalizing behavior at age 5. This pathway was partially replicated across samples. This study was among the first to link known individual-level correlates of prenatal substance exposure into a specific pathway to childhood problem behavior. Implications for the developmental origins of a child's susceptibility to psychopathology as a result of intrauterine substance exposure are discussed.
We used a randomized crossover design with a washout period of 3–4 weeks to compare health literacy scores obtained using the computerized version with scores obtained using the standard interviewer-administered NVS. ANOVA models and McNemar’s tests assessed differences in outcomes assessed with each version of the NVS and order effects of the testing.
Participants were recruited from multicultural catchment areas in Ontario and Nova Scotia.
English- and French-speaking adults aged 18 years or older.
A total of 180 (81 %) of the 222 adults (112 English/110 French) initially recruited completed both the interviewer-NVS and computer-NVS. Scores for those who completed both assessments ranged from 0 to 6 with a mean of 3·63 (sd 2·11) for the computerized NVS and 3·41 (sd 2·21) for the interview-administered NVS. Few (n 18; seven English, eleven French) participants’ health literacy assessments differed between the two versions.
Overall, the computerized Canadian NVS performed as well as the interviewer-administered version for assessing health literacy levels of English- and French-speaking participants. This Canadian adaptation of the NVS provides Canadian researchers and public health practitioners with an easily administered health literacy assessment tool that can be used to address the needs of Canadians across health literacy levels and ultimately improve health outcomes.
The ‘Landscapes of Production and Punishment’ project aims to examine how convict labour from 1830–1877 affected the built and natural landscapes of the Tasman Peninsula, as well as the lives of the convicts themselves.
Although hospital emergency preparedness efforts have been recognized as important, there has been growing pressure on cost containment, as well as consolidation within the US health care system. There is little data looking at what health care emergency preparedness functions have been, could be, or should be centrally coordinated at a system level.
We developed a questionnaire for academic health systems and asked about program funding, resources provided, governance, and activities. The questionnaire also queried managers’ opinions regarding the appropriate role for the system-level resources in emergency response, as well as about what is most helpful at the system-level supporting preparedness.
Fifty-two of 97 systems (54%) responded. The most frequently occurring system-wide activities included: creating trainings or exercise templates (75%), promoting preparedness for employees in the system (75%), providing access to specific subject matter experts (73%), and developing specific plans for individual member entities within their system (73%). The top resources provided included a common mass notification system (71%), arranging for centralized contracts for goods and services (71%), and providing subject matter expertise (69%).
Currently, there is wide variation in the resources, capabilities, and programs used to support and coordinate system-level emergency preparedness among academic health systems. (Disaster Med Public Health Preparedness. 2018;12:574–577)