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Why do present-day mental health professionals practice the way that they do? Over the past fifty years, a number of landmark court holdings have changed such basic principles as what material is confidential, how civil commitment and involuntary treatment are conducted, and when a therapist has a duty to protect the public from a dangerous patient. Unlike most legal texts, this volume explores these complex principles through the human stories of the litigants involved.
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred. Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit. Salmonella Heidelberg was identified in six of seven stool specimens and coagulase-positive S. aureus in three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection with Salmonella Heidelberg, but additional factors, such as dual aetiology that included S. aureus or the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.
It is a well known fact that qualified health professionals generally migrate to high-income, developed regions. Nevertheless, the perceptions of this immigrant skilled health workforce on access to opportunities or feeling discriminated in their host countries, have not yet been explored or adequately addressed.
This work has focused on the perceptions of immigrant psychiatry trainees in several European countries about their views on having equal access to opportunities as natives or feeling discriminated.
A semi-structured 61-item questionnaire was circulated by National Coordinators in each country and was completed by 2281 psychiatric trainees from 33 European countries between year 2013 and 2014. Data has been analysed using the Software Package for Social Sciences for Windows v. 22.0 (SPSS Inc. Chicago, IL).
In these findings, more than one in ten psychiatry trainees across Europe were immigrants, with top host countries being Switzerland, Sweden and UK. Satisfaction with migration and the perception of having equal opportunities as the native trainees varied depending on the host country they migrated to. More than one-third of the trainees felt discriminated, not having the same opportunities as the local colleagues, especially concerning the work opportunities and the academic conditions. Still, nearly two-thirds considered having the same opportunities than natives.
A high number of immigrant psychiatry trainees subjectively feels they do not have the same opportunities as local trainees. Further research about factual and perceived discrimination by immigrant workforce should be done.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Pragmatic abilities play a crucial role in daily functioning and have been suggested to be impaired in schizophrenia. Nevertheless, patterns of such deficits at the onset of the illness still needs to be elucidated.
To outline pragmatic abilities in the first episode of psychosis (FEP).
To evaluate pragmatic verbal performance and its relationship with pre-frontal abilities in FEP subjects recruited in a large randomized multi-center controlled study (GET UP).
58 FEP (mean age±SD:34±9 years; 46% males) and 58 1:1 matched healthy controls (HC) were assessed on the metaphor and idiom comprehension subtask of the MEC Protocol and with WCST. A PAF Analysis with Promax rotation of open (=spontaneous explanations) and closed (=multiple choice) metaphors/idioms and WCST variables was conducted.
A 3-factor latent structure emerged in both groups but partially different patterns emerged. As for FEP, open metaphor/idiom explanations loaded into Factor 1 (Self-generated inferences); Factor 2 (Feedback-generated inferences) was loaded by WCST perseverative errors and by closed metaphor explanations. Finally, closed metaphors/idioms loaded into Factor 3 (Inhibition). As for HC, Factor 1 was similarly loaded but explained less variance; Factor 2 was qualitatively different (Reasoning, self+feedback-generated inferences), being loaded by the WCST number of categories and by open metaphors/idioms. Factor 3 was loaded by closed metaphors.
Findings suggest a shared underlying cognitive construct in self-generating perceptual inferences both for verbal pragmatics and pre-frontal skills in HC and patients, while a failure to integrate different sources of perceptual evidence is found only in FEP.
In schizophrenia about 40% of patients have an additional diagnosis of metabolic syndrome (MetS). In this present study the effect of MetS on cognition in a relatively young group of patients with schizophrenia was examined.
290 schizophrenia patients (age/sd = 30/6.37 years old) were included in the study. Patients were divided into two groups, those with and those without MetS (MetS+/MetS-). Neuropsychological performance was assessed with the Wechsler Adult Intelligence Scale-III, the Continuous Performance Test-HQ, the Word Learning Task and the Response Shifting Task.
124 (42%) patients with schizophrenia met the criteria for MetS. MetS+ and MetS- groups did not differ on amount of cigarettes, alcohol, drug use, severity of illness, socioeconomic status and antipsychotic medication. MetS+ had a significantly lower estimated IQ (sd) 94.9 (17.4) compared to MetS- 100.1(16.3) (t=2,54; p=0.012). MetS+ performed significantly worse on immediate (t=3,12; p=0.002) and delayed recall (t=2,92; p=0.004) and processing speed (t=-2,80; p=0.006) as compared to MetS-. Linear regression analyses revealed that WAIS IQ scores (p=0.026) and immediate memory (p=0.003) were associated with waist circumference.
Patients with schizophrenia and an additional diagnosis of MetS had lower IQ, performed worse on immediate and delayed recall and processing speed as compared to patients without MetS. This suggests that, even at a relatively young age, metabolic abnormalities are related to poor cognition in schizophrenia. Future studies are needed to examine whether treatment of MetS will also have a beneficial effect on cognitive performance in schizophrenia.