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There is today considerable enthusiasm for public options, notably in the health care and banking sectors. A compromise between entirely private commercial provisions and wholly bureaucratic, tax-and-transfer government provisions, public options are designed to offer citizen-consumers greater choice and protection. In blending (rather than choosing between) market ordering and state welfare, government must cross over. Government officials must step out of their sovereign lane, forgoing legislative and regulatory tools in favor of commercial ones.
To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals.
Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol.
Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship.
Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.
Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was 1 of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a “Swiss Cheese” risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from August 1 to December 8, 2020. There were 62,970 COVID-19 tests conducted with 1435 people testing positive for a positivity rate of 2.28%. A total of 1670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3500 with approximately 80 of these positive (11/d). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of 1 per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.
In this chapter the major conservation issues bears face is reviewed and management actions that can address these conservation issues are highlighted. The future of bears across the world is bright for some species but dark for others. In some areas such as North America and in parts of Europe and Asia, bear populations have increased and stabilized because of increased management effort and increasing support for bears and their needs by the humans who share habitat with them. However, for most bear species, the future is uncertain. Andean bears continue to be threatened by habitat loss and human encroachment. In much of Asia outside Japan, Asiatic black bear, sloth bear, and sun bear populations are increasingly threatened by unmanaged excessive mortality combined with habitat loss to timber harvest, plantation agriculture, and human encroachment. The long-term future for polar bears is threatened by the unmanageable threat of climate change. Giant pandas are fragmented into small populations despite intense conservation efforts. Improving public and political support for bears is the most important need if we are to realize successful bear conservation and management.
This chapter comprises the following sections: names, taxonomy, subspecies and distribution, descriptive notes, habitat, movements and home range, activity patterns, feeding ecology, reproduction and growth, behavior, parasites and diseases, status in the wild, and status in captivity.
Impairment in reciprocal social behavior (RSB), an essential component of early social competence, clinically defines autism spectrum disorder (ASD). However, the behavioral and genetic architecture of RSB in toddlerhood, when ASD first emerges, has not been fully characterized. We analyzed data from a quantitative video-referenced rating of RSB (vrRSB) in two toddler samples: a community-based volunteer research registry (n = 1,563) and an ethnically diverse, longitudinal twin sample ascertained from two state birth registries (n = 714). Variation in RSB was continuously distributed, temporally stable, significantly associated with ASD risk at age 18 months, and only modestly explained by sociodemographic and medical factors (r2 = 9.4%). Five latent RSB factors were identified and corresponded to aspects of social communication or restricted repetitive behaviors, the two core ASD symptom domains. Quantitative genetic analyses indicated substantial heritability for all factors at age 24 months (h2 ≥ .61). Genetic influences strongly overlapped across all factors, with a social motivation factor showing evidence of newly-emerging genetic influences between the ages of 18 and 24 months. RSB constitutes a heritable, trait-like competency whose factorial and genetic structure is generalized across diverse populations, demonstrating its role as an early, enduring dimension of inherited variation in human social behavior. Substantially overlapping RSB domains, measurable when core ASD features arise and consolidate, may serve as markers of specific pathways to autism and anchors to inform determinants of autism's heterogeneity.
OBJECTIVES/GOALS: In 2016, more than 3,100 children died, and an estimated 17,000 children had non-fatal injuries, from firearms in the United States. In this study, we used hospital charges as a proxy for medical resource utilization, and compared differences in charges by intent of firearm injury among children. METHODS/STUDY POPULATION: In this cross-sectional study of the 2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged 19 years or younger using ICD-10-CM external cause of morbidity codes. Injury intent was characterized as unintentional, assault, self-inflicted, undetermined, or due to legal intervention. We included patients treated and released from the emergency department (ED) or admitted alive to the hospital, and excluded those who were transferred or died in the ED. We used linear regressions with survey weighting to compare differences in mean healthcare charges by firearm injury intent, with and without adjustment for ED disposition. RESULTS/ANTICIPATED RESULTS: Among 12,469 cases in the weighted sample, mean age was 16.5 years, a majority were male (88.2%) and Medicaid-insured (57.8%), and 64% were discharged from the ED and 36% admitted. Injuries were 49.0% unintentional, 45.1% assault-related, and 1.8% self-inflicted. Compared to children with self-inflicted injuries (charges $115,224), children with assault-related injuries (charges $55,052; p<0.007) and unintentional injuries (charges $38,643; p<0.001) had lower mean charges per visit. Differences in charges were no longer significant after adjusting for ED disposition, as 85.8% of self-inflicted injuries were admitted, compared to 46.5% of assault-related and 24.3% of unintentional injuries. DISCUSSION/SIGNIFICANCE OF IMPACT: Although the majority of pediatric firearm-related injuries resulting in emergency department care are unintentional or assault-related, self-inflicted injuries result in greater per visit hospital charges, attributable to higher hospitalization rates, and likely due to more severe injuries.
We examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology.
Prior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (<40 v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic).
Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men.
Our study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.
The aim of this study was to evaluate theprevalence of night eating syndrome (NES) and its correlates in schizophrenicoutpatients.
The 14 items of self-reported night eatingquestionnaire (NEQ) was administered to 201 schizophrenic patients in psychiatricoutpatient clinic. We examined demographic and clinical characteristics, bodymass index (BMI), subjective measures of mood, sleep, binge eating, andweight-related quality of life using Beck's Depression Inventory (BDI),Pittsburgh Sleep Quality Index (PSQI), Binge Eating Scale (BES) and Koreanversion of Obesity-Related Quality of Life Scale (KOQoL), respectively.
The prevalence of night eaters in schizophrenicoutpatients was 10.4% (21 of 201). Comparisons between NES group and non-NES grouprevealed no significant differences in sociodemographic characteristics, clinical status and BMI. Compared to non-NES, patients with NES reportedsignificantly greater depressed mood and sleep disturbance, more binge eatingpattern, and decreased weight-related quality of life. While 'morning anorexia'and 'delayed morning meal' (2 of 5 NES core components in NEQ) were notdiffered between groups, 'nocturnal ingestions', 'evening hyperphagia', and'mood/sleep' were more impaired in NES group.
These findings are the first to describe theprevalence and its correlates of night eaters in schizophrenic outpatients. These results suggest that NES has negative mental health implications, although it was not associated with obesity. Further study to generalize theseresults is required.
There have been many changes in the treatment of bipolar disorder.
It is necessary to develop guidelines that can more aptly respond to cultural issues and specifics in different countries.
The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder.
The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts.
Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Combination of MS and AAP was the treatment of choice for management of mixed features. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options.
Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
This cross-sectional study was aimed to investigate the factors associated with bipolar disorder in pregnant female, including sociodemographic parameters, social support, social conflict, suicidal idea and sleep.
A total of 84 pregnant female were recruited. They filled out self-completing questionnaires on sociodemographic factors, obstetric history, depressive symptoms and bipolarity. Depressive symptoms were assessed using the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Bipolarity was assessed using the Korean version of the Mood Disorder Questionnaire (K-MDQ).
Nineteen participants (22.6%) had positive K-MDQ scores, suggesting the present of bipolarity. Positive EPDS group had twenty subjects (25%) who had depressive symptoms. The diathesis of bipolar disorder was associated with marital dissatisfaction, social conflict, depression and sleep. The multiple logistic regression analysis revealed that the only poor sleep was a risk of bipolarity.
Pregnant female with bipolarity were more depressed and sleep problems than those without bipolarity. The results showed that the most important factor of influencing bipolarity was sleep.
This study aimed to explore thedifference in emotional recognition of musical auditory stimulation and artfulvisual stimulation between helathy people and patients with schizophrenia.
20 songs and 20 paintings thatcontained sad or cheerful emotions were presented to 123 patients withschizophrenia and 224 healthy people as control group. The subjects were askedto tell about their emotions that they had felt from each musical auditorystimulation and artful visual stimulation. To measure such emotions, the Emotional Empathy Scale was used. The level of psychopathology in patientsgroup were evaluated with the Positive and Negative Syndrome Scale and the Formal Thought Disorder Rating Scale.
The correct answer rate to musical auditoryand artful visual stimulation of the patient group was significantly lower than that of thecontrol group. Thepatient group showed lower emotional empathic ability compared to the controlgroup. In the patient group, the correct answer rate to musical and artfulstimulation showed a negative correlation with score with Formal ThoughtDisorder Rating Scale.
Patients with schizophrenia have difficulties inprecise emotional recognition to auditory and visual stimulations, and this isassociated with lowered empathic ability and thinking disorder of patients withschizophrenia. If an psychosocial rehabilitation program or psychotherapy isimplemented to patients with schizophrenia, it is deemed to be necessary to make a mediation to improve the emotional recognition and expression ability of patients with schizophrenia.
This study was aimed to discover the correlation between those getting tattoos and their psychopathology relating to their delinquent behavior and emotional problems.
Date for this study was collected from 19-year-old men who were receiving a physical examination for conscription at the Korea Military Manpower Administration. 400 data sheets were collected among them. All of sjubjects were evaluated on the following measures: sociodemographic variants, Juvernile delinquency scale, State-trait anger expression inventory, Beck depression inventory, State-triat anxiety inventory, and Positive affect and negative affect schedule.
In comparison with those without tattooes, those with a tattoo scored higher in the scales that were related to delinquency, anger, depression, and negateive emotion. Furthermore, there were positive correlations between the number of tattoos and the scores for the Juvenile delinquent tendency and behavior scale as well as on the State-triat anxiety scale.
Those with tattoos had experienced anger, anxiety, and depression more strongly in comparison with those without tattoos. These reults recommended that tattooed males should be evaluated more on their regrading psychopathology compared to those without tattoos.
Thisstudy was to assess the prevalence and its correlates of restless legs syndrome(RLS) in outpatients with bipolar disorder.
A total of 100clinical stabilized bipolar outpatients were examined. The presence of RLS andits severity were assessed using the International Restless Legs Sydrome StudyGroup (IRLSSG) diagnostic criteria. Beck's Depression Inventory (BDI), Spielberg's StateAnxiety Inventory (STAI-X-1), Pittsburgh Sleep Quality Index (PSQI), Koreanversion Drug Attitude Inventory (KDAI-10), Subjective Well-Beings under NeurolepticTreatment Scale-Short Form(SWN-K) and Barnes Akathisia Rating Scale (BARS) wereused to evaluate the depressive symptomatology, level of anxiety, subjectivequality of sleep, subjective feeling of well-being, drug attitude, presence ofakathisia, respectively.
Of the 100 bipolar outpatients,7 (7%) were met to full criteria of IRLSSG and 36 (36%) have at least one ofthe 4 IRLSSG criterion. Because of relatively small sample size, non-parametricanalysis were done to compare the characteristics among 3 groups (full-RLS, 1≥positiveRLS-symptom and Non-RLS). There were no significant differences in sex, age, and other sociodemographic and clinical data among 3 groups. BDI, STAI-X-1 andPSQI are tended to be impaired in RLS and 1≥positive RLS-symptomgroups.
This is the first preliminarystudy for studying the prevalence and its correlates of RLS in bipolardisorder. The results shows that RLS was relatively smaller presentin bipolar disorder than schizophrenia. Sametendencies shown in schizophrenic patients were found that bipolar patientswith RLS had more depressive symptoms, state anxiety and poor subjective sleepquality.
The aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital.
A retrospective chart review was performed and data of 188 cases (2009–2012) and 118 cases (1998–2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed.
The proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased.
Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.
Despite the advance in pharmacotherapy for posttraumatic stress disorder (PTSD), poor treatment adherence to pharmacotherapy for PTSD is a critical issue.
We intended to evaluate the predictors of premature discontinuation of psychiatric outpatient treatment after discharge for noncombat-related PTSD.
This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with non-combat-related posttraumatic stress disorder.
We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder.
Fifty-five percent of subjects prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge.
The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge.
This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics.
Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics.
In 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity.
The development of bipolar disorder's psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.
The purpose of this study was to evaluate the occurrence of the suicidal ideation and associated factors with self-reported suicidal ideation within the last 12 months among Korean adolescents.
A total of 1533 adolescents were recruited from middle schools (age range: 13-14 years) in Korea. According to existence of suicidal ideation, they were divided 2 group – suicidal ideation group and non-suicidal ideation group, and the differences between groups in terms of various characteristics, including depression (Kovacs’ Children’s Depression Inventory), school and family factors, and health related conditions.
A total of 501 (32.7%) middle school students reported suicidal ideation, and the rate of suicidal attempt was 6.9% (n=106). The associated factors of suicidal ideation were female (OR= 2.42, p<0.001), below average academic achievement (OR=1.43, p=0.007), perceived low parental support (OR=2.09, p=0.001), depression (OR=3.25, p<0.001), current alcohol use (OR=2.37, p=0.003), self reported poor health (OR=1.54, p =0.043), and school bullying (OR=1.91, p =0.005).
These results may have important implications for the strategies and specified intervention in preventing suicidal ideation in Korean adolescents.
We evaluated the difference in sleep skills between patients with and without need of hypnotics after sleep CBT.
Total 131 insomnia patients' sleep disturbances were assessed by visual analogue scales. Patients received 9 sessions of sleep CBT and were prescribed hypnotics for prn during 3 months. Sleep CBT was focused on the sleep hygiene and sleep stimulus-control guidelines. Sleep hygiene guidelines were Limit the time spent in bed (SH1), Get regular exercise (SH2), Avoid light at night (SH3), Avoid heavy meals or drinking (SH4), Quiet, dark, and comfortable bedroom (SH5), Avoid caffeine, alcohol, and nicotine (SH6), Relaxing bedtime routine (SH7),Llight bedtime snack (SH8), Remove the bedroom clock (SH9). Sleep stimulus-control guidelines were Go to bed only when sleepy (SSC1), Use the bed for sleeping or sex (SSC2), Get out of bed when unable to sleep (SSC3), Get up at the same time (SSC4), Avoid napping (SSC5). Each sleep skill state was evaluated by Likert scale, and they were compared between before and after CBT. Patients were divided into two groups: still need of hypnotics and no need of hypnotics after 3 months.
Forty-six (35.1%) patients replied they needed not hypnotics any more, but 85 (64.9%) patients replied they still needed hypnotics after CBT. Sleep VAS (25.26±8.52 vs. 32.64±8.95, p<0.001), SH2 (3.67±0.92 vs. 2.76±1.06, p=0.030), SH7 (4.08±0.55 vs. 2.76±0.76, p<0.001) were different in two groups.
Among several CBT skills, regular moderate exercise in daytime and a relaxing bedtime routine seem to be key components.