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The recent World Health Organization (WHO) blueprint for dementia research and Lancet Commission on ending stigma and discrimination in mental health has identified a gap around dementia-related measures of stigma and discrimination that can be used in different cultural, language and regional contexts.
We aimed to characterise experiences of discrimination, and report initial psychometric properties of a new tool to capture these experiences, among a global sample of people living with dementia.
We analysed data from 704 people living with dementia who took part in a global survey from 33 different countries and territories. Psychometric properties were examined, including internal consistency and construct validity.
A total of 83% of participants reported discrimination in one or more areas of life, and this was similar across WHO Regions. The exploratory factor analysis factor loadings and scree plot supported a unidimensional structure for the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia). The instrument demonstrated excellent internal consistency, with most of the construct validity hypotheses being confirmed and qualitative responses demonstrating face validity.
Our analyses suggest that the DISCUS-Dementia performs well with a global sample of people living with dementia. This scale can be integrated into large-scale studies to understand factors associated with stigma and discrimination. It can also provide an opportunity for a structured discussion around stigma and discrimination experiences important to people living with dementia, as well as planning psychosocial services and initiatives to reduce stigma and discrimination.
It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS).
We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively.
Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively).
This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.
Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations – incorporating a task-shifting approach and modifying the mode of community-based service delivery – are examined from users' perspectives.
A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS.
Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil.
CTI-TS’ major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.
Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling.
We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as ‘successfully completed’ or ‘incomplete’. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China.
In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age (‘educated-younger’ v. ‘undereducated-older’) show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant.
We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully.
The authors developed a practical and clinically useful model to predict the risk of psychosis that utilizes clinical characteristics empirically demonstrated to be strong predictors of conversion to psychosis in clinical high-risk (CHR) individuals. The model is based upon the Structured Interview for Psychosis Risk Syndromes (SIPS) and accompanying clinical interview, and yields scores indicating one's risk of conversion.
Baseline data, including demographic and clinical characteristics measured by the SIPS, were obtained on 199 CHR individuals seeking evaluation in the early detection and intervention for mental disorders program at the New York State Psychiatric Institute at Columbia University Medical Center. Each patient was followed for up to 2 years or until they developed a syndromal DSM-4 disorder. A LASSO logistic fitting procedure was used to construct a model for conversion specifically to a psychotic disorder.
At 2 years, 64 patients (32.2%) converted to a psychotic disorder. The top five variables with relatively large standardized effect sizes included SIPS subscales of visual perceptual abnormalities, dysphoric mood, unusual thought content, disorganized communication, and violent ideation. The concordance index (c-index) was 0.73, indicating a moderately strong ability to discriminate between converters and non-converters.
The prediction model performed well in classifying converters and non-converters and revealed SIPS measures that are relatively strong predictors of conversion, comparable with the risk calculator published by NAPLS (c-index = 0.71), but requiring only a structured clinical interview. Future work will seek to externally validate the model and enhance its performance with the incorporation of relevant biomarkers.
Although outcomes among people with schizophrenia differ by social context, this has rarely been examined across rural v. urban settings. For individuals with schizophrenia, employment is widely recognised as a critical ingredient of social integration.
To compare employment for people with schizophrenia in rural v. urban settings in China.
In a large community-based study in four provinces representing 12% of China's population, we identified 393 people with schizophrenia (112 never treated). We used adjusted Poisson regression models to compare employment for those living in rural (n = 297) v. urban (n = 96) settings.
Although rural and urban residents had similar impairments due to symptoms, rural residents were three times more likely to be employed (adjusted relative risk 3.27, 95% Cl 2.11-5.07, P<0.001).
People with schizophrenia have greater opportunities to use their capacities for productive work in rural than urban settings in China. Contextual mechanisms that may explain this result offer a useful focus for future research.
Gattini and CSTAR have been installed at Dome A, Antarctica, which provide time-series photometric data for a large number of pulsating variable stars. We present the study for several variable stars with the data collected with the two facilities in 2009 to demonstrate the scientific potential of observations from Dome A for asteroseismology.
At the summit of the Antarctic plateau, Dome A offers an intriguing location for future large scale optical astronomical observatories. The Gattini Dome A project was created to measure the optical sky brightness and large area cloud cover of the winter-time sky above this high altitude Antarctic site. The wide field camera and multi-filter system was installed on the PLATO instrument module as part of the Chinese-led traverse to Dome A in January 2008. This automated wide field camera consists of an Apogee U4000 interline CCD coupled to a Nikon fisheye lens enclosed in a heated container with glass window. The system contains a filter mechanism providing a suite of standard astronomical photometric filters (Bessell B, V, R) and a long-pass red filter for the detection and monitoring of airglow emission. The system operated continuously throughout the 2009, and 2011 winter seasons and part-way through the 2010 season, recording long exposure images sequentially for each filter. We have in hand one complete winter-time dataset (2009) returned via a manned traverse. We present here the first measurements of sky brightness in the photometric V band, cloud cover statistics measured so far and an estimate of the extinction.
Dome A on the Antarctic plateau is likely one of the best observing sites on Earth (Saunders et al. 2009). We used the CSTAR telescope (Yuan et al. 2008) to obtain time-series photometry of 104 stars with i>14.5 mag during 128 days of the 2008 Antarctic winter season (Wang et al. 2011). During the 2010 season we observed 2 × 104 stars with i>15 mag for 183 days (Wang et al. 2012). We detected a total of 262 variables, a 6 × increase relative to previous surveys of the same area and depth carried out from temperate sites (Pojmanski 2004). Our observations show that high-precision, long-term photometry is possible from Antarctica and that astronomically useful data can be obtained during 80% of the winter season.
PLATO is a fully-robotic observatory designed for operation in
Antarctica. It generates its own electricity (about 1 kW), heat
(sufficient to keep two 10-foot shipping containers comfortably above
0°C when the outside temperature is at -70°C), and
connects to the internet using the Iridium satellite system (providing
~30 MB/day of data transfer). Following a successful first year of
operation at Dome A during 2008, PLATO was upgraded with
new instruments for 2009.
In January 2005, members of a Chinese expedition team were the first
humans to visit Dome A on the Antarctic plateau, a site
predicted to be one of the very best astronomical sites on earth. In 2006, the Chinese Center for Antarctic Astronomy (CCAA) was founded
to promote the development of astronomy in Antarctica, especially at
Dome A. CCAA has since taken part in two traverses to Dome A, organized
by the Polar Research Institute of China (PRIC), in the austral
summers of 2007/2008 and 2008/2009. These traverses resulted in the
installation of many site-testing and science instruments, supported
by the PLATO observatory. The Chinese Small Telescope ARray (CSTAR)
has produced excellent results from Dome A. Our future plans include further site-testing work, and the following
full-scale science instruments: three 0.5-m Antarctic Schmidt
Telescopes (AST3), and a proposed 4-m telescope for wide-field
infrared high spatial-resolution surveys. The first AST3 telescope is
under construction and is scheduled for installation in 2011.
The THz spectral region includes a number of important transitions which
allow us to trace the evolution of the interstellar medium. Because of the
opacity of the atmosphere in this spectral range, the best sites for
ground-based THz observations are on the Antarctic Plateau; of these sites,
Dome A is expected to be the best. THz survey science can be carried out
with small telescopes, easing logistical constraints. By deploying a
submillimetre-wave tipper/ telescope to Dome A, we have trialled several
technologies for such an instrument, and we are able to test whether the
site quality is sufficient for THz surveys.
PLATO is a 6 tonne completely self-contained robotic observatory that provides its own heat, electricity, and satellite communications. It was deployed to Dome A in Antarctica in January 2008 by the Chinese expedition team, and is now in its second year of operation. PLATO is operating four 14.5cm optical telescopes with 1k × 1k CCDs, a wide-field sky camera with a 2k × 2k CCD and Sloan g, r, i filters, a fibre-fed spectrograph to measure the UV to near-IR sky spectrum, a 0.2m terahertz telescope, two sonic radars giving 1m resolution data on the boundary layer to a height of 180m, a 15m tower, meteorological sensors, and 8 web cameras. Beginning in 2010/11 PLATO will be upgraded to support a Multi Aperture Scintillation Sensor and three AST3 0.5m schmidt telescopes, with 10k × 10 CCDs and 100TB/annum data requirements.
Dome A, the summit of the Antarctic plateau, is expected to have even
better atmospheric conditions for ground-based astronomy than Dome C.
Instruments to evaluate and exploit Dome A's astronomical potential
must operate within logistical constraints, which are currently
very stringent. Instrumentation now at Dome A exemplifies the
techniques and solutions required by this environment. Future
instrumentation and infrastructure will allow the qualities of the site
to be exploited much more fully.
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