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The Delphi exercies carried out in Poland constituted part of DEMoB.inc project founded by EC and conducted within 10 European countries. Polish part of Delphi exercise fulfils major method's assumptions and aims to define items of long-term psychiatric care in recovery model of treatment.
Delphi method has not been widely applied in research across Poland. Method is characterized by defined panel of experts (EP), information flow, regular feedback and participants’ anonymity. Delphi has proven prognostic potential in health care, social sciences, new technologies and policy forecasting. However informality of EP selection and limited complex forecasts with multiple factors and downward responses-rate tendencies in following rounds constitute its crucial shortcomings. Criticized basic statistics has been lately overcome by implementation of sophisticated fuzzy logic theory. Three stages Delphi exercise has been carried out in four groups of respondents: service users, carers, advocates and professionals. Wide range of EP representatives has promoted indication of diverse elements of care within partner sites.
Polish mental health care network varies from developed European countries. Out of 11 initially appointed domains only 2 (SPHRandA; SMA) have been underrepresented. Advocates achieved significant consensus in the largest number of items: 23 out of 104 which covered 9 domains whereas professionals in the lowest number: 11 out of 130 which covered only 4 domains. Moreover domains supported with advocates’ opinions fully overlapped with domains pointed by service users. The surprising outcome might be due to diversity of professions in “professional group”, differences in occupational responsibilities and work experience.
Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in psychiatric institutions. Research constitutes a part of international project funded by European Commission.
Polish language version of QuIRC has been tested in 20 psychiatric units across 3 districts in Poland. Selected facilities differed in employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.
Manager of only 1 out of 21 units refused to participate in interview. QuIRC usage was simple but time-consuming. The most common hardships in data collection referred to numbers of staff and trainings the employees participated in. It might be due to round-the-clock care in Polish units and common work in the shift system. Moreover ward managers in Poland in vast majority of the units were medical doctors and the facilities’ economics was often obscure for them. Development of web version of the toolkit will facilitate its implementation in research projects but as well internal assessments for units’ own purposes.
Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in longer term mental health institutions. Research constitutes a part of international project funded by European Commission.
Polish version of QuIRC has been tested in 20 psychiatric units across 3 regions in Poland. Selected facilities differed in terms of employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.
Manager of only 1 out of 21 units refused to participate in interview. The most common difficulties in data collection were in relation to the number of staff and staff training. These difficulties may be due to differences in the work patterns and training of staff in Polish units compared to other countries. In comparison to international results important differences in preliminary assessments of long term mental health care were found in several areas probably due to the early stage of deinstitutionalisation process in Eastern Europe. Development of the web based version of the toolkit will facilitate its implementation in research as well as internal assessments for units’ restructuring purposes.
Sleep disorders are significant problem in hemodialysis patients, contributing to psychosocial disability and decline in qualiy of life. Aim of this study was to assess the quality of sleep disorders in relation to various clinical and sociodemographic factors in patients undergoing hemodialysis.
The preliminary study group included 55 persons selected at random from 150 patients treated by hemodialysis. The mean age was 60,31±12,14, mean time of dialysis 3,49 ± 4,53 years. 20 women and 35 men were interviewed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) sleep disorders section and additional sociodemographic interview. In each case psychiatric examination has been performed. Medical comorbidity including restless legs syndrome (RLS), suffering from pain, blood and urine tests were analyzed for potential impact on sleep disturbance.
In studied group sleep disturbences did not show significant correlation with presence of mental disorders, somatic comorbidity other than RLS or most laboratory data (blood or urine tests). The following differences were observed:
1. Positive correlation between overall sleep impairment, night wakefulness and nPCR index related to nutrition and metabolism (p-value 0.047),
2. Greater sleep satisfaction in the group with higher calcium level before hemodialysis (p-value 0.045),
3. Higher nightmares occurence in the group with lower calcium level before hemodialysis (p-value 0.023).
In the population of patients with end-stage renal disease after adaptation period to hemodialysis more important role in sleep disorders may play factors related to the somatic state and metabolism rather than psychiatric comorbidity.
The attempt was made to investigate the relationship between patients' impaired role performance within their families and the burden on caregivers.
128 patients suffering either from schizophrenia, depression or anxiety were interviewed upon admission to the mental hospital using Groningen Social Disability Schedule (GSDS). Their caregivers who lived with them were asked to fill in the Involvement Evaluation Questionnaire (IEQ). The following GSDS roles were considered: “self-care”, “contribution to family atmosphere and economic independence”, “kinship – parents and siblings”, “parental role”, “relationship with partner”, “quality of social contacts”. Patients were classified as disabled/not disabled in a given role. Caregivers' burden dimensions i.e.: “worrying”, “tension”, “urging” and “supervision” were measured according to patients' disability status. Statistics included Mann-Whitney's and t Student's tests.
Only disabilities in some roles were associated with higher caregiver's burden: neglected personal care resulted in higher “urging”, withdrawal from family life led to higher “tension” whereas lack of adequate contribution to the family's economic independence did not. Disability in parental role proved to be a family's “trouble spot” and led to high “tension” and “supervision” in spouses. Surprisingly, impaired relationships with partner, siblings and parents as well as disturbed social contacts were not associated with higher burden.
Disability in parental role may be an important factor contributing to the higher burden on patient's spouse. Helping strategies for families with mental illness and children should consider this fact, should also aim at improving patient's self-care and their emotional input to family climate.
This is the first cross-national study of intermittent explosive disorder (IED).
A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition.
Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13–23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset.
Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.
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