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Background: Telemedicine has been defined as the use of technology to provide healthcare when the provider and patient are geographically separated. Use of telemedicine to meet the needs of specific populations has become increasingly common across Canada. The current study employs the Ontario Telemedicine Network (OTN) to connect the emergency departments of a community hospital system and a pediatric tertiary care hospital. OTN functions through a two-way video conferencing system, allowing physicians at the tertiary site to see and hear the patient being treated in the community hospitals. Aim Statement: The aim of this project is to ensure essential care is provided to CTAS 1 and 2 pediatric patients who present to Niagara Health emergency departments, to increase the number of appropriate patient transfers. Measures & Design: Data for this project include a) description of common diagnoses, b) time of call, c) occurrence of transfers, and d) professional perceptions of the technology. A descriptive design was used together with the implementation of quality improvement cycles as the intervention occurred. Quality improvement methodologies including plan-do-study-act (PDSA) cycles ensured continuous improvement to the process of OTN use and therefore patient safety throughout the study. Evaluation/Results: Since the intervention was employed on December 17, 2018 there have been a total of 19 cases for which 4 transfers were requested. Changes to the process were made including the addition of weekly technology tests and feedback to health professionals involved to garner further support for the use. Results have indicated that seizure was the most common diagnosis, accounting for 37% of cases. The majority of calls were placed after 19:00 hours with no calls being placed between 24:00 and 10:00. Discussion/Impact: Healthcare providers had positive perceptions of the technology agreeing that decision making between on-site and remote teams was timely and collaborative, as well as that patient care and outcomes were improved with its use. The results of this study will be used to determine the benefits of employing telemedicine in the emergency departments of other hospital systems.
The VISCACHA (VIsible Soar photometry of star Clusters in tApii and Coxi HuguA†) Survey is an ongoing project based on deep and spatially resolved photometric observations of Magellanic Cloud star clusters, collected using the SOuthern Astrophysical Research (SOAR) telescope together with the SOAR Adaptive Module Imager. So far we have used >300h of telescope time to observe ∼150 star clusters, mostly with low mass (M < 104M⊙) on the outskirts of the LMC and SMC. With this high-quality data set, we homogeneously determine physical properties using deep colour-magnitude diagrams (ages, metallicities, reddening, distances, mass, luminosity and mass functions) and structural parameters (radial density profiles, sizes) for these clusters which are used as a proxy to investigate the interplay between the Magellanic Clouds and their evolution. We present the VISCACHA survey and its initial results, based on our first two papers. The project’s long term goals and expected legacy to the community are also addressed.
The objective was to determine the longitudinal associations between callous-unemotional (CU) and oppositional defiant (OD) behaviors from the first to fourth grades for Spanish children. Four possible outcomes were evaluated: (a) CU behaviors in the first grade predict increases in OD behaviors in the fourth grade, controlling for OD behaviors in the first grade; (b) OD behaviors in the first grade predict increases in CU behaviors in the fourth grade, controlling for CU behaviors in the first grade; (c) both unique effects are significant; and (d) neither unique effect is significant. A longitudinal panel model with two latent variables (CU and OD behaviors), three sources (mothers, fathers, teachers), and two occasions (spring of the first and fourth grades) was used to evaluate the four possibilities among 758 (54% boys) first grade and 469 (53% boys) fourth grade Spanish children. For mother-, father-, and teacher-reports, OD behaviors in the first grade predicted increases in CU behaviors in the fourth grade, after controlling for CU behaviors in the first grade, whereas CU behaviors in the first grade did not predict increases in OD behaviors in the fourth grade, after controlling for OD behaviors in the first grade. OD behaviors thus conferred independent vulnerability to increases in CU behaviors 3 years later among young children.
The sponges may be the oldest group of Metazoa, with a long and successful evolutionary history. Despite their intermittent fossil record quality, the group has been considered reliable for paleoecological and paleobiogeographic analyses because they have inhabited various types of aquatic environments, forming a significant part of benthic communities. We have presented a detailed description of a new species from the genus Teganiella, Teganiella finksi new species, which expands the chronologic range and classifies the genus as endemic to the paleoequatorial regions of Laurentia associated with arid climate conditions linked to hypersaline periods. Combining the paleoecological and paleoenvironmental features of the Teganiella species, our findings also suggest a trend toward more closed-inlet conditions, which may be related to competition and/or specific habitat supplies, for example, heavy metals such as vanadium, zinc, and molybdenum.
A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.
In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.
An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6–17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.
CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.
20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).
We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
Sexual assault is a global concern with post-traumatic stress disorder (PTSD), one of the common sequelae. Early intervention can help prevent PTSD, making identification of those at high risk for the disorder a priority. Lack of representative sampling of both sexual assault survivors and sexual assaults in prior studies might have reduced the ability to develop accurate prediction models for early identification of high-risk sexual assault survivors.
Data come from 12 face-to-face, cross-sectional surveys of community-dwelling adults conducted in 11 countries. Analysis was based on the data from the 411 women from these surveys for whom sexual assault was the randomly selected lifetime traumatic event (TE). Seven classes of predictors were assessed: socio-demographics, characteristics of the assault, the respondent's retrospective perception that she could have prevented the assault, other prior lifetime TEs, exposure to childhood family adversities and prior mental disorders.
Prevalence of Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD associated with randomly selected sexual assaults was 20.2%. PTSD was more common for repeated than single-occurrence victimization and positively associated with prior TEs and childhood adversities. Respondent's perception that she could have prevented the assault interacted with history of mental disorder such that it reduced odds of PTSD, but only among women without prior disorders (odds ratio 0.2, 95% confidence interval 0.1–0.9). The final model estimated that 40.3% of women with PTSD would be found among the 10% with the highest predicted risk.
Whether counterfactual preventability cognitions are adaptive may depend on mental health history. Predictive modelling may be useful in targeting high-risk women for preventive interventions.
Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.
Data came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.
The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.
Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20–40% range in disaster-focused studies but considerably lower (3–5%) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies.
Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income countries had enough respondents for a risk factor analysis. Predictors considered were socio-demographics, disaster characteristics, and pre-disaster vulnerability factors (childhood family adversities, prior traumatic experiences, and prior mental disorders).
Disaster-related PTSD prevalence was 0.0–3.8% among adult (ages 18+) WMH respondents and was significantly related to high education, serious injury or death of someone close, forced displacement from home, and pre-existing vulnerabilities (prior childhood family adversities, other traumas, and mental disorders). Of PTSD cases 44.5% were among the 5% of respondents classified by the model as having highest PTSD risk.
Disaster-related PTSD is uncommon in high-income WMH countries. Risk factors are consistent with prior research: severity of exposure, history of prior stress exposure, and pre-existing mental disorders. The high concentration of PTSD among respondents with high predicted risk in our model supports the focus of screening assessments that identify disaster survivors most in need of preventive interventions.
The nonlinear property of SiC multilayer devices under Ultra Violet (UV) irradiation is used to design an optical processor for indoor positioning. The transducers combine the simultaneous demultiplexing operation with the photodetection and self-amplification. Moreover, we present a way to achieve indoor positioning using the parity bits and the navigation syndrome. A 4 bit representation with the original string colour message and the transmitted 7 bit string, the encoding and decoding accurate positional information processes and the design of SiC navigation syndrome generators are discussed. The visible multilateration method estimates the device’s position by using the MUX signal received from several, non-collinear transmitters. The location and motion information is found by mapping position and estimates the location areas.
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.
General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.
Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.
Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Case management is defined as an evidence-based practice used to help patients in the recovery process. The experiences of several countries show that progress towards case management implementation is slow and complex, depending not only from the degree of effectiveness or the complexity of the practice, but also from regional and local barriers to implementation.
To study the differences in the case management barriers to implementation, between Portuguese specialised mental health teams.
Data was collected in 26 public and private mental health services of mainland Portugal. Barriers were assessed using the BaFAI - Barriers and Facilitators Assessment Instrument (Peters, 2001). Services profiles were made using a specific questionnaire.
Significant differences between mental health teams were found in the following barriers to implementation: 1. Resistance to use treatment protocols was higher in teams that routinely don’t use clinical guidelines (p=0,028). This barrier was also higher in services without research activity (p=0,034); 2. Barriers linked with space availability to implement the practice were higher in teams without liaison with the primary health care (p=0,045). 3. Barriers associated with professional’s difficulty to change were found in less specialised mental health teams (p=0,006).
Special attention is needed to regional and local barriers to implementation in the process of mental health services quality improvement and innovation. Implementation protocols should include prior barriers assessment so that implementation plans can incorporate the strategies to tackle differences between mental health teams.
The financial crisis we are currently facing in Portugal brought additional challenges for the implementation of the national mental health strategy.
Those challenges include an increased pressure in the mental health services management that is accompanied by an increased demand by populations. The current constraints also call for the reworking of some aspects of the strategy, highlighting some of its goals.
1. To update the National Mental Health Strategy 2007-2016 considering the challenges emerged from the European economical crisis and subsequent budgetary constrains. 2. Define high priorities to proceed with the plan implementation.
A multidimensional evaluation was conducted by the National Mental Health Programme and included the following dimensions: structure of care and activity of public mental health services, SWOT analysis and WHO evaluation committee report.
Several high priorities were defined for the update, including the following: 1. Create a new financing and management model, 2. Resume the deinstitutionalisation process, 3. Proceed with the implementation of the long-term integrated mental health care, 4. Launch the project for the monitoring of human rights and promotion of care quality, to be developed in cooperation with the WHO.
Whilst the economic crises poses many challenges regarding the implementation of health policies and plans, the impact and the burden associated with mental disorders demands for a continuity in the improvement of all dimensions of care through coordinated plans.
Strategies to implement evidence-based practices are critical to improve services. There are many barriers to their implementation, despite all available knowledge. Even geographically small countries like Portugal (92.152 km2)can have substantial regional variations in evidence-based practices implementation.
Evaluate the regional variation of mental health case management fidelity during a systematic implementation process, according to the measurement of techniques and resources used by mental health professionals.
The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a case management course, in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009).
Mental health professional’s assessment in 26 mental health public and private services (n=71) showed that there are significant differences in the proportion of case management adequate implementation between country regions (North = 35,7% / Centre = 57,5 / Lisbon and Tagus Valley = 65,3%, Alentejo 72,7% and Algarve = 50%).
The results show that even in a geographically small country there are big differences in the quality and degree of effective practices implementation. This happens despite the fact that the implementation process was developed nationwide by the same training and implementation team, working with regional groups.
Locally and regionally designed implementation programs are needed to balance the unevenness of evidence based practices fidelity and quality.
Despite recent improvements in the Portuguese mental health services (MHS), the low priority given for a long time to mental health within the general context of the country's health services, illustrated by inadequacies in planning and funding models, led to a significant delay in the improvement of MHS, when compared to other European countries.
To compare the profile of MHS in Portugal 7 years after the launching of the National Mental Health Plan in the following dimensions: capacity (adults and child/adolescents), human resources and use of services (discharges, appointments, day hospital).
A full evaluation was conducted by the National Mental Health Programme, under the auspices of the General Directorate of Health, by means of a cross-sectional evaluation of national data.
Comparing the situation between 2005 and 2012, the most significant aspect is the reduction of the total number of beds in public MHS, mainly due to the elimination of 40% of beds in the decommissioned psychiatric hospitals. Regarding human resources, there was decrease in the number of psychiatrists working in public MHS. There was a significant increase in the number of outpatient appointments, both in child psychiatry (+30%) and adult psychiatry (+22%).
Tough the development of new MHS in general hospitals, some geographic areas are still not covered by these services, namely in the southern region of the country. There is also a significant scarcity of other professionals, which prevents the improvement of multidisciplinary and comprehensive work.
Over the past decades, the organisation and management of mental health services in Portugal underwent an evolution similar to that of other European countries, going from an initial psychiatric hospital-centred phase, gradually establishing integration with primary healthcare, to the adoption of the current model, based on the principles of community psychiatry.
To assess the implementation of the Mental Health Plan 2007-2016 in Portugal trough the perspective of the involved stakeholders.
A SWOT analysis was carried out by professionals working at public, private and social institutions in mainland Portugal. Participants focused on structural reforms and on the identification of barriers to implementation.
The SWOT analysis showed (in short summary): Strengths - Plan based on solid scientific and epidemiological grounds, collaboration with social sector; Weaknesses - Lack of dedicated task force, budget allocation; Opportunities - Integration with other health reforms, link with primary care, link with WHO, participation in the EU Joint Action; Threats - Stigma, reduced autonomy, political priorities.
Notwithstanding multiple efforts, some issues remain unresolved and pose powerful and persistent challenges to the advancement of mental health care in Portugal. These include problems related to a funding system that encourages institutionalisation and rejects the promotion of care provided within the community, as well as those resulting from a management model for mental health services that continues to hamper the rational and responsible management of existing resources.
As stated by WHO in 2003 the perspective in which services are organised helps to define the effectiveness not only of care but also of access to care. Mental Health Services organisation should be based on principles of accessibility, coordination, continuity, effectiveness and equity of care, in a clear respect for human rights.
To do this, service planners and providers have to determine the exact mix of different types of mental health services and the treatment gap levels.
1. Estimate the treated prevalence of mental disorders in the mental health specialised services. 2. Estimate the existing treatment gap.
An analysis of the patterns of use in mental health secondary care services was made using data from the national information health system, compiled by the Directorate General of Health - Information Analysis Unit.
22.146 patients were treated in the specialised services for mental health disorders, in 2013. This group represents 1,43% of the total patients treated for all health problems and 0,21% of total population. Average length of stay was 16,46 days.
Depression was the main diagnosis in 33% of all patients treated, representing 22% of total inpatient days.
Taking in account that the global annual prevalence of mental disorders in Portugal is 22,9% and that 6,3% are severe mental disorders, there is still a big treatment gap in Portugal. In addition, depression still accounts for a substantial proportion of patients treated in the specialised services inpatient units.
To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD).
Nationally or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in the WHO World Mental Health (WMH) Surveys. DSM-IV MDD, a wide range of comorbid DSM-IV anxiety disorders, and a number of correlates were assessed with the WHO Composite International Diagnostic Interview (CIDI).
45.7% of respondents with lifetime MDD (32.0–46.5% inter-quartile range (IQR) across surveys) had one of more lifetime anxiety disorders. A slightly higher proportion of respondents with 12-month MDD had lifetime anxiety disorders (51.7%, 37.8–54.0% IQR) and only slightly lower proportions of respondents with 12-month MDD had 12-month anxiety disorders (41.6%, 29.9–47.2% IQR). Two-thirds (68%) of respondents with lifetime comorbid anxiety disorders and MDD reported an earlier age-of-onset (AOO) of their first anxiety disorder than their MDD, while 13.5% reported an earlier AOO of MDD and the remaining 18.5% reported the same AOO of both disorders. Women and previously married people had consistently elevated rates of lifetime and 12-month MDD as well as comorbid anxiety disorders. Consistently higher proportions of respondents with 12-month anxious than non-anxious MDD reported severe role impairment (64.4 v. 46.0%; χ21 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ21 = 71.6, p < 0.001). Significantly more respondents with 12-month anxious than non-anxious MDD received treatment for their depression in the 12 months before interview, but this difference was more pronounced in high-income countries (68.8 v. 45.4%; χ21 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ21 = 11.7, p < 0.001).
Patterns and correlates of comorbid DSM-IV anxiety disorders among people with DSM-IV MDD are similar across WMH countries. The narrow IQR of the proportion of respondents with temporally prior AOO of anxiety disorders than comorbid MDD (69.6–74.7%) is especially noteworthy. However, the fact that these proportions are not higher among respondents with 12-month than lifetime comorbidity means that temporal priority between lifetime anxiety disorders and MDD is not related to MDD persistence among people with anxious MDD. This, in turn, raises complex questions about the relative importance of temporally primary anxiety disorders as risk markers v. causal risk factors for subsequent MDD onset and persistence, including the possibility that anxiety disorders might primarily be risk markers for MDD onset and causal risk factors for MDD persistence.
The ability of early bovine embryos to produce prostaglandins (PGs) and progesterone (P4), and the role of these mediators in embryonic development and survival are poorly understood. In this study we tested the hypothesis that day 7 bovine embryos are able to transcribe genes coding for enzymes of the PGs (PTGS2, PGES, PGFS) and P4 (StAR, P450scc, 3β-HSD) synthesis pathways, and that transcription levels of these genes are associated with developmental progression and heifer age-related [pre-pubertal (PP) versus post-pubertal cyclic (C)] oocyte competence. Compared with C heifer oocytes, PP heifer oocytes showed a lower (P < 0.0001) in vitro blastocyst rate, but in embryos developing until day 7, heifer age had no effect on quality grade. Day 7 quality grade 1–2 embryos were selected for RNA extraction and gene transcription analysis by qRT-PCR, in a 2 × 2 factorial design [age (PP or C) × embryonic stage (compact morulae and early blastocysts, CM + EBL, or blastocysts and expanded blastocysts, BL + BEX); 15 embryos/group]. Transcription levels of PTGS2, PGES, PGFS, P450scc and 3β-HSD were not affected by heifer age but were higher (P < 0.01) in BL + BEX than in CM + EBL. In conclusion, the main limiting factor for embryo production from PP heifers is oocyte competence. Day 7 bovine embryos evidence transcription of genes coding for enzymes of PGs and P4 synthesis pathways, and transcription levels are associated with blastocyst differentiation. This prompts for an autocrine/paracrine action of PGs and P4 in early bovine embryonic development.
Negative attitudes towards mental illness or the psychiatrist's role have repeatedly been reported in the literature among pregraduate medical students. Although a clerkship may improve the student's attitudes, negative perceptions regarding mental illness remained unchanged in about one-third of the students. When recovery is being assumed as a central concept of care, the presence of stigma among students represents an ethical challenge that the medical schools cannot avoid.
to implement a programme aiming i. to assess the stigma towards mental illness among pregraduate medical students, and ii. to tackle negative attitudes regarding mental illness and psychiatry.
The authors, targeting the 6th year medical students, have developed a one half-day program to be held before the 4-weeks psychiatric clerkship. The program offers sequentially an initial overview about the concept of stigma, several examples from experiences reported by patients, videos and role-playing exercises. Attitudes towards mental illness were assessed by the Kassam‘s et al Mental Illness: Clinicians’ Attitudes Scale MICA-2’ self-reported questionnaire.
106 students were evaluated. The acceptance was very good, with no refusals to participate in the program. After the clerkship, perceptions about patients’ dangerousness, the need for social protection, the assets and the role of psychiatry were significantly improved.
The good acceptance from the students and the preliminary results were very encouraging, suggesting that this program could change attitudes towards mental illness favorably. Given we’ve just evaluated a time span of one month, further studies are needed to assess the temporal stability of the changes.