Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics

Abstract Background Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. Methods Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. Results Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1–3.0 for patients < 65 years; OR 8.0, CI 3.1–20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7–3.9). Conclusions The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.

Download Full-text

Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers

BioMed Research International ◽

10.1155/2014/928740 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

E. Girela ◽

A. López ◽

L. Ortega ◽

J. De-Juan ◽

F. Ruiz ◽

...

Keyword(s):

Mentally Ill ◽

Psychiatric Patients ◽

Psychiatric Inpatient ◽

Psychiatric Hospitals ◽

Coercive Measure ◽

Coercive Measures ◽

External Assessment ◽

Mechanical Restraint ◽

The Family ◽

Inpatient Units

We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.

Download Full-text

The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS): application and psychometric analysis in a post-COVID-19 syndrome cohort

10.1101/2021.06.28.21259613 ◽

2021 ◽

Author(s):

Nick J Preston ◽

Amy Parkin ◽

Sophie Makower ◽

Denise H Ross ◽

Jeremy Gee ◽

...

Keyword(s):

Psychometric Properties ◽

Prospective Observational Study ◽

Reliability And Validity ◽

Epidemiological Studies ◽

Preliminary Evidence ◽

Good Concordance ◽

Rehabilitation Clinic ◽

Perception Of Health ◽

The Impact ◽

Health Question

Background: As our understanding of the nature and prevalence of Post-COVID-19 syndrome (PCS) is increasing, a measure of the impact of COVID-19 could provide valuable insights into patients' perceptions in clinical trials and epidemiological studies, as well as routine clinical practice. Objective: To evaluate the clinical usefulness and psychometric properties of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) in patients with PCS. Design: A prospective, observational study of 187 consecutive patients attending a post-COVID-19 rehabilitation clinic. The C19-YRS was used to record patients' symptoms, functioning and disability. A global health question was used to measure the overall impact of PCS on health. Classical psychometric methods (data quality, scaling assumptions, targeting, reliability and validity) were used to assess the C19-YRS. Results: For the overall scale, missing data were low, scaling and targeting assumptions were satisfied, and internal consistency was high (Cronbach's alpha = 0.891). Relationships between perception of health and patients' reports of symptoms, functioning and disability demonstrated good concordance. Conclusions: This is the first study to examine the psychometric properties of an outcome measure in patients with PCS. In this sample of patients, the C19-YRS was clinically useful and satisfied standard psychometric criteria, providing preliminary evidence of its suitability as a measure of PCS.

Download Full-text

Glutamate theory of depression-new elements

European Psychiatry ◽

10.1016/s0924-9338(11)72966-2 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1261-1261

Author(s):

A.G. Mititelu

Keyword(s):

Clinical Trials ◽

Drug Dependence ◽

Pharmaceutical Compounds ◽

Epidemiological Studies ◽

The Other ◽

Nmda Antagonists ◽

Site Of Action ◽

Putative Site ◽

Chemical Products ◽

The Impact

IntroductionIt is well known that actual mechanisms which explain depression are very exhaustive and at same time extremely limited. Among these ones, it had been given the priority, maybe too quick, to serotonin hypothesis. Even so, the actual SSRI and SRNI classes doesn’t do. really, a lot in alleviating the course of the disease. Recent randomised clinical trials and clinic -epidemiological studies support the idea that something more effective must be offered. On the other side addiction reveals more and more in depth correlations with all major psychiatric disorders.ObjectivesIt is possible to develop in the close future new chemical products which could act in more effective way for the reduction or even cancelling of the symptoms determined by the alteration of major neurotransmitters-, GABA and glutamate.AimsBased on huge interconnection which exists between depression and drug dependence at various levels-especially through the effects exerted by particular anti depressant and some of anti craving medications, it is possible to evaluate the impact which some new pharmaceutical compounds -derivated from glutamate type of receptor NMDA-might exert upon various types of depression elicited by patients with associated drug dependence.MethodsHad been realised a thematical reanalysis of the studies published on Medline, EMBASE and OVID about this subject.ResultsThe conclusion of the studies reveals the huge potential represented by treatment with some types of NMDA antagonists-Ketamine. The putative site of action is prefrontal cortex and is had been proved highly efficient in MDD patients.

Download Full-text

Prognostic biomarkers of risk and progression of coronary heart disease in patients with chronic obstructive pulmonary disease

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2019-23(4)-03 ◽

2019 ◽

Vol 23 (4) ◽

pp. 573-578

Author(s):

A.A. Lilevska ◽

V.K. Sierkova ◽

O.O. Savytska

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Pulmonary Disease ◽

Statistical Processing ◽

Binary Logistic Regression ◽

Epidemiological Studies ◽

Chronic Obstructive ◽

Severe Condition ◽

Rate Of Increase ◽

The Impact

Annotation. Currently, the problem of associated pathology of bronchopulmonary and cardiovascular systems will be considered not only as a combination of different diseases, but also as severe condition with common pathogenetic links. This fact is increasingly recognized in the context of “the cardio-pulmonary continuum”. The aim of the study is to determine the significance of biomarkers characterizing the role of lipid disorders and the processes of destruction of atherosclerotic plaques for early diagnosis of CHD in patients with COPD. 197 men were examined, including 153 people with COPD and 44 patients with stable СHD II, III FC (mean age of 56,4±3,8 years). The level of LP (a) and PAPP-A were determined using ELISA. Statistical processing of results was performed using software “Statistica” V. 10.0 and “Microsoft Office Excel 2010”. There were the differences in the lipid spectrum of blood in patients with isolated pulmonary disease and COPD in combination with CHD. The average level of LP (a) in the group of patients with isolated COPD was 18,53±3,73 mg/dL (p>0,05), CHD patients — 46,27±2,78 mg/dL (p<0,05), in patients with comorbidity pathology 49,43±3,11 mg/dL (p<0,05). This allowed us to identify the level of LP (a) more than 17 mg/dL as a possible predictor of CHD. Method binary logistic regression established a highly significant impact of having CHD on the level of PAPP-A in patients with combined pathology: OR=14,516; CI=6,627-31,798; while the impact of COPD on the rate of increase in the level of PAPP-A was not significant. Confirmed the importance of introducing a definition of biomarkers of risk and progression of СHD in patients with COPD, namely the level of LP (a) and of PAPP-A. There is a need to conduct epidemiological studies to better understand the mechanisms, diagnostic and prognostic value of PAPP-A and LP (a) in asymptomatic subjects and in subjects with well-documented coronary heart disease in the presence of cardiorespiratory pathology.

Download Full-text

Reduction of coercive measures under routine conditions in psychiatric hospitals 2004–2019: Strong effects in old age psychiatry, much less in general psychiatry

European Psychiatry ◽

10.1192/j.eurpsy.2020.104 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

Tilman Steinert ◽

Sophie Hirsch ◽

Rita Goebel ◽

Brendan Snellgrove ◽

Erich Flammer

Keyword(s):

Old Age ◽

Substantial Reduction ◽

Psychiatric Hospitals ◽

Federal State ◽

Coercive Measures ◽

General Psychiatry ◽

Icd 10 ◽

Cumulative Duration ◽

Old Age Psychiatry ◽

The Mean

Abstract Background Many interventions to reduce the use of seclusion and restraint have been suggested in the last decades. Evidence-based interventions in old age psychiatry are different from those in general psychiatry. A common database for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint over 16 years under routine conditions. Methods A registry for coercive measures in the Federal State of Baden-Wuerttemberg has been available since 2015, and comprises all 32 hospitals licensed to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2004 to 2019 among a total of 1,038,239 admissions. Results The proportion of cases affected by coercive measures dropped significantly from 28.4 to 10.5% in patients with ICD-10 F0 disorders, while rates in patients with other diagnoses decreased insignificantly from 7.0 to 5.4%. The cumulated duration of coercive measures per affected case also dropped significantly among patients with F0 disorders, while changes in patients with other diagnoses remained insiginficant. Conclusions The use of coercive measures in patients with organic disorders could be reduced by about 50% in a State of 11 million inhabitants within 15 years, while in contrast no substantial reduction occurred among all other diagnostic groups. Specific interventions to reduce coercive interventions seem to be particularly successful for this patient group.

Download Full-text

Hospitalized older adult: predictors of functional decline

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.3612.3399 ◽

2021 ◽

Vol 29 ◽

Author(s):

João Paulo de Almeida Tavares ◽

Lisa Alexandra Nogueira Veiga Nunes ◽

Joana Catarina Gonçalves Grácio

Keyword(s):

Social Support ◽

Cognitive Deficit ◽

Functional Decline ◽

Binary Logistic Regression ◽

Demographic Variables ◽

Binary Logistic Regression Model ◽

Mechanical Restraint ◽

Previous Hospitalization ◽

The Impact

Objective: to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up. Method: a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model. Results: the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up. Conclusion: the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.

Download Full-text

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals—An Exploratory Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17239121 ◽

2020 ◽

Vol 17 (23) ◽

pp. 9121

Author(s):

Jakub Lickiewicz ◽

Katarzyna Piotrowicz ◽

Patricia Paulsen Hughes ◽

Marta Makara-Studzińska

Keyword(s):

Aggressive Behavior ◽

Meteorological Data ◽

Rank Correlation ◽

Psychiatric Hospitals ◽

Weather Conditions ◽

Mental Illnesses ◽

Weather Factors ◽

Coercive Measures ◽

The Impact ◽

The Relationship

Background: The number of meteoropaths, or people negatively affected by weather conditions, is rising dramatically. Meteoropathy is developing rapidly due to ever poorer adaptations of people to changes in weather conditions. Strong weather stimuli may not only exacerbate symptoms in people with diseases of the cardiovascular and respiratory systems but may also induce aggressive behavior. Researchers have shown that patients suffering from mental illnesses are most vulnerable to changes in the weather and postulate a connection between the seasons and aggressive behavior. Methods: The goal of the study was to analyze the relationship between coercive measures and weather factors. The researchers identified what meteorological conditions prevailed on days with an increased number of incidents of aggressive behavior leading to the use of physical coercion towards patients in a psychiatric hospital in Poland. In order to determine the impact of weather conditions on the frequency at which physical coercion measures were used, the hospital’s “coercion sheets” from 1 January 2015 to 31 March 2017 were analyzed. The data were correlated with meteorological data. In order to determine the relationship between the occurrence of specific weather conditions and the number of coercive interventions (N), researchers utilized Spearman’s rank correlation analysis together with two-dimensional scatter diagrams (dependency models), multiple regression, stepwise regression, frequencies, and conditional probability (%). Results: Lower barometric pressure and foehn wind increased aggressive behavior in patients that led to coercive measures. For temperature (positive correlation) and humidity (negative correlation), there was a poor but statistically significant correlation. Conclusions: Monitoring weather conditions might be useful in predicting and preventing aggression by patients who are susceptible to weather changes

Download Full-text

Modernism, Empiricism, and Rationalism

Irish University Review ◽

10.3366/iur.2016.0199 ◽

2016 ◽

Vol 46 (1) ◽

pp. 38-47

Author(s):

Geoffrey Squires

Keyword(s):

Twentieth Century ◽

The Other ◽

Modern Poetry ◽

Philosophical Perspective ◽

Irish Poetry ◽

Dimensional Spectrum ◽

Culture History ◽

The World ◽

The Impact ◽

Rule Out

Modernism is usually defined historically as the composite movement at the beginning of the twentieth century which led to a radical break with what had gone before in literature and the other arts. Given the problems of the continuing use of the concept to cover subsequent writing, this essay proposes an alternative, philosophical perspective which explores the impact of rationalism (what we bring to the world) on the prevailing empiricism (what we take from the world) of modern poetry, which leads to a concern with consciousness rather than experience. This in turn involves a re-conceptualisation of the lyric or narrative I, of language itself as a phenomenon, and of other poetic themes such as nature, culture, history, and art. Against the background of the dominant empiricism of modern Irish poetry as presented in Crotty's anthology, the essay explores these ideas in terms of a small number of poets who may be considered modernist in various ways. This does not rule out modernist elements in some other poets and the initial distinction between a poetics of experience and one of consciousness is better seen as a multi-dimensional spectrum that requires further, more detailed analysis than is possible here.

Download Full-text

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

Journal of Advances in Social Science and Humanities ◽

10.15520/jassh.v6i5.483 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1183-1189

Author(s):

Dr. Tridibesh Tripathy ◽

Dr. Umakant Prusty ◽

Dr. Chintamani Nayak ◽

Dr. Rakesh Dwivedi ◽

Dr. Mohini Gautam

Keyword(s):

Large Scale ◽

National Level ◽

Uttar Pradesh ◽

Life Time ◽

Structured Interview ◽

The Other ◽

Registration System ◽

Action Group ◽

Current Article ◽

The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period. The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents. A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study. Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs. Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

Download Full-text

Wacana Kolonial dalam Novel Max Havelaar: Sebuah Kajian Poskolonial

Metahumaniora ◽

10.24198/metahumaniora.v7i3.18862 ◽

2017 ◽

Vol 7 (3) ◽

pp. 411

Author(s):

Abu Bakar Ramadhan Muhamad

Keyword(s):

Point Of View ◽

The Other ◽

The Novel ◽

Colonial Discourse ◽

The Impact ◽

The Voice

AbstrakHegemoni kolonialisme dalam budaya poskolonial merupakan alasan penelitian inikemudian mengkaji wacana kolonial dalam novel Max Havellar (MH) khususnya dampakditimbulkannya. Dampak dimaksud adalah posisi keberpihakan pemikiran tersirat darikarya tersebut. Hasil pembahasan menunjukkan, secara temporal maupun permanen MHmenyuarakan ketidakadilan dalam kondisi-kondisi kolonial menyangkut penindasan sangpenjajah terhadap terjajah. Hanya saja, upaya mengatasnamakan atau mewakili suarakaum terjajah terbukti mengimplikasikan ciri ideologis statis kerangka kolonialisme(orientalisme); yakni cara pandang Eropasentris, di mana “Barat” sebagai self adalah superior,dan “Timur” sebagai other adalah inferior. Dalam konteks poskolonialisme, MH dengan sifatkritisnya yang berupaya “menyuarakan” nasib pribumi terjajah, justru menampilkan stigmapenguatan kolonialitas itu sendiri secara hegemonik. Artinya, “menyuarakan” nasib pribumidimaknai sebagai keberpihankan kolonial yang kontradiktif, di mana stigma penguatankolonialitas justru lebih terasa, ujung-ujungnya melanggengkan hegemoni kolonial. Tidakmembela yang terjajah, tetapi memperhalus cara kerja mesin kolonial.AbstractThe hegemony of colonialism in the culture of postcolonial society is the reason this studythen examines the colonial discourse in the novel Max Havellar (MH) in particular the impactit brings. The impact in question is the implied position of thought in the work. The resultsof the discussion show that, temporarily or permanently, MH voiced injustice in the colonialconditions regarding the oppression of the colonist against the colonized. However, the effort toname or represent the voice of the colonized has proven to imply a static ideological characterin the framework of colonialism (orientalism); ie Eropacentric point of view, in which “West” asself is superior, and “East” as the other is the inferior. In the context of postcolonialism, MH withits critical nature that seeks to “voice” the fate of the colonized natives, actually presents thestigma of strengthening coloniality itself hegemonicly. That is, “voicing” the fate of the pribumiis interpreted as a contradictory colonial flare, where the stigma of strengthening colonialityis more pronounced, which ultimately perpetuates the hegemony of colonialism. No longerdefending the colonized, but refining the workings of the colonial machinery.

Download Full-text