Nowadays 450 million of people in the world have mental and neurological diseases and behavioural disorders. A quarter of all people who are connected with the health car services require assistance in the area of mental health. Four out of six most frequent reasons of disablement are connected with neuropsychic diseases (depression, alcoholism, schizophrenia, bipolar disorders). In a quarter of families some family member has a mental disease. About 873 000 people each year commit a suicide. These data proves the topicality of the problem of mental disorders worldwide, and each country tries to search for their solutions. One of the recommendations of the World Health Organization for improvement of the situation in the area of mental health is to develop mental health enforcement policy in each country. Such a plan is only for 59.5 % of the world and 67.3 % of the European countries. Unfortunately Latvia is not among those countries, which contrary to the recommendations of the World Health Organization have not enforced a policy in the area of mental health, and this makes this scientific paper topical.
After regaining of independence, Latvia during the last 15 years both politically and economically was subject to material changes and over a short period of time is trying to find the most correct way of development. These changes impact all areas of economics, also medicine and psychiatry. Growth of other branches of medicine is connected mainly with development of science and introduction of new technologies in diagnostics and treatment, whereas in psychiatry larger attention is paid to social and economic situation, approach of the state to certain problems and opinion regarding the methods of its solution.
Different countries, which are in the transitional stage from the totalitarian regime to a democratic society, are looking for their way of development in psychiatry, and each of them is unique and specific.
The essence of the paper is to show scientific basis of the Latvian mental health policy and raise issues significant for the operational program in order to create at maximum realizable policy proper for the Latvian situation, which could be enforced in life in the future.
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
Abstract—Prevalence of degenerative dementias and dementias associated with cerebrovascular disease is increasing with the time. Dementia is one of the most significant public health problems. Demographic data, medical history, general biochemical data and serum total homocysteine (tHcy) levels was used in this study to examine the differences between dementia and normal control groups. A cross-sectional study was conducted on 236 individuals who were above the age of 65 years. These participants went through the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), demographic characteristics, biochemical data and tHcy level. Each of the above mentioned factors was assessed. There were significant differences in the history of hypertension, diabetes mellitus, marital status, alcohol consumption (AC), BMI value, and triglyceride (TG) and serum tHcy levels. The logistic regression analysis showed significant differences in marital status, AC and tHcy. So it can be concluded that elevated serum tHcy, no AC and no partner are associated with the risk of dementia in elders of Southern Taiwan. It needs further researches to identify and reduce the risk of dementia.
Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
ABSTRACT- Background: The occurrence of psychiatric disorders is more in the prisoners than in general population. Co-morbidity is seen to be an important and complex entity in clinical assessment of mental state competence (diminished mental capacity, temporary insanity and insanity) in the offenders at the time of the offence. It has a great role in determining all possible options in future treatment of violent offenders. Aim: This research article is focused on the co-morbid psychiatric diagnoses and the treatment outcomes in the mentally ill prisoners referred to the tertiary care mental health facility. Materials and Method: Total 100 mentally ill prisoners referred to the tertiary care psychiatric hospital during the study period (Jan 2015 - Dec 2015) was the sample size. It was a prospective study and the sampling method was of the purposive type. Results: Besides their primary diagnosis, the referred prisoners had more than one co-morbid psychiatric diagnosis in 46% of the cases. The most frequent co-occurring conditions were learning disabilities, personality disorders, and substance use disorders. The outcomes for the psychiatric conditions were positive as patients responded well to the line of management. Conclusion: The study provides valuable data to understand the mental health needs and the treatment gaps in this population so as to plan adequate services to tackle these issues. Key-words- Mentally ill prisoners, Psychiatric co-morbidities, Treatment outcomes, Substance use disorders, Personality disorders
HIDDEN BURDENS OF CONFLICT Issues of mental health and access to services amo...DonbassFullAccess
Reliable epidemiological data on the burden of mental disorders, key risk factors and access to health services is crucial in helping to design appropriate trauma-informed mental health and psychosocial support responses for the at least 1.6 million internally displaced persons (IDPs) in Ukraine. The aim of this study was to collect scientifically rigorous evidence on the mental health and psychosocial support needs of IDPs in Ukraine in order to help inform relevant policies and programmes. This study found a prevalence of post-traumatic stress disorder (PTSD) of 32% (22% men, 36% women), while the prevalence of depression was 22% (16% men, 25% women) and the prevalence of anxiety was 17% (13% men, 20% women). This study recommends that IDPs be considered as one of the target groups for mental healthcare provision by the relevant agencies in Ukraine. The findings support the need for a scaled-up, comprehensive and traumainformed approach to the provision of mental healthcare for IDPs in the country.
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
Abstract—Prevalence of degenerative dementias and dementias associated with cerebrovascular disease is increasing with the time. Dementia is one of the most significant public health problems. Demographic data, medical history, general biochemical data and serum total homocysteine (tHcy) levels was used in this study to examine the differences between dementia and normal control groups. A cross-sectional study was conducted on 236 individuals who were above the age of 65 years. These participants went through the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), demographic characteristics, biochemical data and tHcy level. Each of the above mentioned factors was assessed. There were significant differences in the history of hypertension, diabetes mellitus, marital status, alcohol consumption (AC), BMI value, and triglyceride (TG) and serum tHcy levels. The logistic regression analysis showed significant differences in marital status, AC and tHcy. So it can be concluded that elevated serum tHcy, no AC and no partner are associated with the risk of dementia in elders of Southern Taiwan. It needs further researches to identify and reduce the risk of dementia.
Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
ABSTRACT- Background: The occurrence of psychiatric disorders is more in the prisoners than in general population. Co-morbidity is seen to be an important and complex entity in clinical assessment of mental state competence (diminished mental capacity, temporary insanity and insanity) in the offenders at the time of the offence. It has a great role in determining all possible options in future treatment of violent offenders. Aim: This research article is focused on the co-morbid psychiatric diagnoses and the treatment outcomes in the mentally ill prisoners referred to the tertiary care mental health facility. Materials and Method: Total 100 mentally ill prisoners referred to the tertiary care psychiatric hospital during the study period (Jan 2015 - Dec 2015) was the sample size. It was a prospective study and the sampling method was of the purposive type. Results: Besides their primary diagnosis, the referred prisoners had more than one co-morbid psychiatric diagnosis in 46% of the cases. The most frequent co-occurring conditions were learning disabilities, personality disorders, and substance use disorders. The outcomes for the psychiatric conditions were positive as patients responded well to the line of management. Conclusion: The study provides valuable data to understand the mental health needs and the treatment gaps in this population so as to plan adequate services to tackle these issues. Key-words- Mentally ill prisoners, Psychiatric co-morbidities, Treatment outcomes, Substance use disorders, Personality disorders
HIDDEN BURDENS OF CONFLICT Issues of mental health and access to services amo...DonbassFullAccess
Reliable epidemiological data on the burden of mental disorders, key risk factors and access to health services is crucial in helping to design appropriate trauma-informed mental health and psychosocial support responses for the at least 1.6 million internally displaced persons (IDPs) in Ukraine. The aim of this study was to collect scientifically rigorous evidence on the mental health and psychosocial support needs of IDPs in Ukraine in order to help inform relevant policies and programmes. This study found a prevalence of post-traumatic stress disorder (PTSD) of 32% (22% men, 36% women), while the prevalence of depression was 22% (16% men, 25% women) and the prevalence of anxiety was 17% (13% men, 20% women). This study recommends that IDPs be considered as one of the target groups for mental healthcare provision by the relevant agencies in Ukraine. The findings support the need for a scaled-up, comprehensive and traumainformed approach to the provision of mental healthcare for IDPs in the country.
the importance of epidemiological studies, important historical research on mental health, techniques and processes, and epidemiological research findings on mental health during covid 19 are included.
Psychiatric readmissions and their association with environmental and health system characteristics: A systematic review of the literature.Jorid Kalseth, Eva Lassemo SINTEF Health Research, Norway
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Epidemiology and Social demographics of Mental disorders.pptSonamManoj1
Epidemiology in teh context of mental disorders refers to the study of the distribution of mental conditions within specific populations. This ppt covers the data on India.
25 years of Psycho-Oncology in Poland: past, present and futureNata Chalanskaya
Marzena Samardakiewicz, Assistant Professor; Clinical Psychologist; Department of Applied Psychology; Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland; President of The Polish Psycho-Oncology Society (PPOS), presentation at the Second International Scientific and Practical Conference «Improving the quality of life of cancer patients through the development of cooperation between state, commercial and non-profit organizations». 2018-01-24, Minsk. Belarus.
A general overview on Social Work in Psychiatric Settings.
Global and National Statistics on Mental Health.
Role and Challenges of Psychiatric Social Worker.
Integrated Care Model: Interventions and Strategies for Addressing Co-Morbidities in Early Recovery by Dr. Alkesh Patel, M.D., M.R.O. Addiction Psychiatrist and Assistant Clinical Professor Icahn School of Medicine at Mount Sinai, NYC.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Objective: To describe the professional stance and opinion of the attendees of the 1st Conference on Primary Care (PC) in rural areas (Berga, May 6th, 2011)
Design: Descriptive cross-sectional study
Participants: Conference attendees were invited to participate. A total of 77
(58.3%) responded.
Primary method of measurement: Self-completed questionnaire of 22 closed-ended questions about the profession, employment situation in PC, and their opinions about PC.
Results:Of the respondents, 61% were family medicine physicians and 75% worked in rural PC. The majority worked at PC clinics more than 10km or 20min from their reference hospital. Almost 59% did not encounter other professionals of their field more than once a week. About 96% thought a rural medicine rotation was necessary for family medicine and community medicine residents, while 80.4% believe it was necessary for other specialties as well. The most important advantage to rural medicine is the integrated approach to patients, and the main inconvenience is professional isolation. Rural PC professionals feel more valued by their patines (4.43/5) than their colleagues in other settings (2.48) or in administration (2.32).
Conclusions: The main disadvantage of rural PC is the greater feeling of isolation. One positive aspect of rural PC is the integrated approach to patients.
Rural PC professionals feel more valued by patients than their counterparts in urban settings or in administration.
Effectiveness of Gardening Therapy in Intergrating People with Mental illness into the Society
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
How to Answer The 64 Toughest Interview Questionssuzi smith
THIS BOOK IS DESIGNED TO PROVIDE ACCURATE INFORMATION ON THE SUBJECTS COVERED. HOWEVER, IT IS DONE WITH THE UNDERSTANDING THAT THE PUBLISHER IS NOT ENGAGED IN RENDERING LEGAL, ACCOUNTING OR PROFESSIONAL SERVICES. IF LEGAL ADVICE OR OTHER PROFESSIONAL ASSSTANCE IS REQUIRED, THE SERVICES OF A COMPETENT, PROFESSIONAL PERSON SHOUID BE SOUGHT. ANY NAMES USED IN THE TEXT ARE FICTITIOUS AND FOR ILLUSTRATIVE PURPOSES ONLY. ANY RESEMBLANCE TO ACTUAL PERSONS OR COMPANIES IS PURELY COINCIDENTAL AND UNINTENTIONAL.
Dedication:
This report is dedicated to courage and knowledge,
the two qualities most needed
to succeed in any human challenge,
especially a job search.
Very few would dispute the fact that we live in a global world, where local economy, politics and culture do not longer belong to and influence their immediate surroundings alone, but a large extent of the rest of the globe. This context of merging borders has entailed drastic changes in the way goods and services are produced and distributed and in how information and ideas are transmitted. Fashion, both a business and a cultural good, has not been impervious to that: on the one hand, fashion is a multi-billion dollar industry that has to survive in a more and more competitive global market and produce for a trans-continental audience; and, on the other hand, it is also an immaterial good and the way it is transmitted, shared and created changes along with society. Both fashion and globalization are complex and multidimensional phenomena, and the analysis of their connection can be approached by a wide variety of disciplines. Throughout this essay I will analyse what and how has changed in fashion with globalization, focusing on the influence economical and cultural globalization have had in the transmission of trends and the structure and behaviour of the industry. Firstly, fashion is one of the few cultural goods that we carry with us every day and have a role in our daily life, so the way trends are created and transmitted is affected both by changes in the diffusion of culture –as it happened with cultural globalization- and by changes in society. Secondly, fashion industry has, as every other, been affected by economic globalization. However, unlike any other industry, fashion produces ephemeral cultural goods, and so the production of clothes has also been affected by the new model of transmission of trends with cultural globalization.
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the importance of epidemiological studies, important historical research on mental health, techniques and processes, and epidemiological research findings on mental health during covid 19 are included.
Psychiatric readmissions and their association with environmental and health system characteristics: A systematic review of the literature.Jorid Kalseth, Eva Lassemo SINTEF Health Research, Norway
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Epidemiology and Social demographics of Mental disorders.pptSonamManoj1
Epidemiology in teh context of mental disorders refers to the study of the distribution of mental conditions within specific populations. This ppt covers the data on India.
25 years of Psycho-Oncology in Poland: past, present and futureNata Chalanskaya
Marzena Samardakiewicz, Assistant Professor; Clinical Psychologist; Department of Applied Psychology; Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland; President of The Polish Psycho-Oncology Society (PPOS), presentation at the Second International Scientific and Practical Conference «Improving the quality of life of cancer patients through the development of cooperation between state, commercial and non-profit organizations». 2018-01-24, Minsk. Belarus.
A general overview on Social Work in Psychiatric Settings.
Global and National Statistics on Mental Health.
Role and Challenges of Psychiatric Social Worker.
Integrated Care Model: Interventions and Strategies for Addressing Co-Morbidities in Early Recovery by Dr. Alkesh Patel, M.D., M.R.O. Addiction Psychiatrist and Assistant Clinical Professor Icahn School of Medicine at Mount Sinai, NYC.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Objective: To describe the professional stance and opinion of the attendees of the 1st Conference on Primary Care (PC) in rural areas (Berga, May 6th, 2011)
Design: Descriptive cross-sectional study
Participants: Conference attendees were invited to participate. A total of 77
(58.3%) responded.
Primary method of measurement: Self-completed questionnaire of 22 closed-ended questions about the profession, employment situation in PC, and their opinions about PC.
Results:Of the respondents, 61% were family medicine physicians and 75% worked in rural PC. The majority worked at PC clinics more than 10km or 20min from their reference hospital. Almost 59% did not encounter other professionals of their field more than once a week. About 96% thought a rural medicine rotation was necessary for family medicine and community medicine residents, while 80.4% believe it was necessary for other specialties as well. The most important advantage to rural medicine is the integrated approach to patients, and the main inconvenience is professional isolation. Rural PC professionals feel more valued by their patines (4.43/5) than their colleagues in other settings (2.48) or in administration (2.32).
Conclusions: The main disadvantage of rural PC is the greater feeling of isolation. One positive aspect of rural PC is the integrated approach to patients.
Rural PC professionals feel more valued by patients than their counterparts in urban settings or in administration.
Effectiveness of Gardening Therapy in Intergrating People with Mental illness into the Society
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
How to Answer The 64 Toughest Interview Questionssuzi smith
THIS BOOK IS DESIGNED TO PROVIDE ACCURATE INFORMATION ON THE SUBJECTS COVERED. HOWEVER, IT IS DONE WITH THE UNDERSTANDING THAT THE PUBLISHER IS NOT ENGAGED IN RENDERING LEGAL, ACCOUNTING OR PROFESSIONAL SERVICES. IF LEGAL ADVICE OR OTHER PROFESSIONAL ASSSTANCE IS REQUIRED, THE SERVICES OF A COMPETENT, PROFESSIONAL PERSON SHOUID BE SOUGHT. ANY NAMES USED IN THE TEXT ARE FICTITIOUS AND FOR ILLUSTRATIVE PURPOSES ONLY. ANY RESEMBLANCE TO ACTUAL PERSONS OR COMPANIES IS PURELY COINCIDENTAL AND UNINTENTIONAL.
Dedication:
This report is dedicated to courage and knowledge,
the two qualities most needed
to succeed in any human challenge,
especially a job search.
Very few would dispute the fact that we live in a global world, where local economy, politics and culture do not longer belong to and influence their immediate surroundings alone, but a large extent of the rest of the globe. This context of merging borders has entailed drastic changes in the way goods and services are produced and distributed and in how information and ideas are transmitted. Fashion, both a business and a cultural good, has not been impervious to that: on the one hand, fashion is a multi-billion dollar industry that has to survive in a more and more competitive global market and produce for a trans-continental audience; and, on the other hand, it is also an immaterial good and the way it is transmitted, shared and created changes along with society. Both fashion and globalization are complex and multidimensional phenomena, and the analysis of their connection can be approached by a wide variety of disciplines. Throughout this essay I will analyse what and how has changed in fashion with globalization, focusing on the influence economical and cultural globalization have had in the transmission of trends and the structure and behaviour of the industry. Firstly, fashion is one of the few cultural goods that we carry with us every day and have a role in our daily life, so the way trends are created and transmitted is affected both by changes in the diffusion of culture –as it happened with cultural globalization- and by changes in society. Secondly, fashion industry has, as every other, been affected by economic globalization. However, unlike any other industry, fashion produces ephemeral cultural goods, and so the production of clothes has also been affected by the new model of transmission of trends with cultural globalization.
HEALTH MANAGEMENT EDUCATION IN RUSSIA IN THE CONTEXT OF HEALTH CARE POLICY ...suzi smith
Head, Centre for Social Studies, Institute of International Economic and Political Studies, Russian Academy of Sciences, Moscow, Russia.
Moscow 2003
Overview
The aim of this paper is to analyse the current state of health management education in Russia. It is discussed in the context of
-- recent public sector initiatives and
-- health policy and management
Traditionally in Russian health care public sector plays a leading role that makes particularly important the developments that take place in public administration as reflected in health care. Such an approach is not common to Russian experts for the variety of reasons that will be also examined further in this chapter.
• Please keep your three-day food record for three consecutive days.
• The days should include two weekdays and one weekend day.
• Select days that closely resemble your child’s usual eating habits.
• Each time he/she eats or drinks anything (meals, snacks, etc.) during the three days, write down what and how much was served and what and how much was eaten.
• To measure how much was eaten, use a set of measuring cups and spoons to help estimate amounts. Also see the examples below to estimate portion sizes.
• Note if food choices are homemade or purchased. Please include brand names whenever possible.
Healthy food is food considered to be beneficial to health in ways that go beyond a normal healthy diet required for human nutrition. Because there is no precise, authoritative definition from regulatory agencies such as the U.S. Food and Drug Administration, different dietary practices can be considered healthy depending on context.
Foods considered "healthy" may be natural foods, organic foods, whole foods, and sometimes dietary supplements. Such products are sold in health food stores or in the health/organic sections of supermarkets.
I. INTRODUCTION: WHAT IS INTERNATIONAL LAW? WHY DO STATES COMPLY WITH IT?
1. Defining International Law
Definition from Restatement Section 101:
- “‘International law,’ as used in this Restatement, consists of rules and principles of general application dealing with the conduct of states and of international organizations and with their relations inter se, as well as with some of their relations with persons, whether natural or juridical.”
Public International Law
- governs the activities of governments in relation to other governments
Private International Law
- governs the activities of individuals, corporations, and other private entities when they cross national borders
Entities that create international law:
- States
- International organizations (which are composed of states)
Purpose
Article 1: The purpose of this Law, in view of rights and obligations stemming from international and national law in matters of assuring marine safety and preventing marine pollution, is to establish;
a) The principles concerning response and preparedness for eliminating the risk of pollution, or for reducing, containing, or eliminating pollution in emergency incidences stemming from ships or operations of coastal facilities,
b) The principles for determining and compensating for damages resulting from an incident,
c) The principles concerning fulfillment of international commitments, and
d) Powers, duties, and responsibilities of the officials of institutions, organizations, ships, and facilities as stipulated in the Law, along with those of any (other) persons subject to the Law.
Scope
Article 2: This Law includes the authorities , duties and responsibilities of the Ministries , Public Authorities and liable parties of the ships of 500 gross tons or larger, that are carrying petroleum or other harmful substances and are already in or are requesting to enter an area of enforcement for any reason; along with the liable parties of coastal facilities performing operations that might cause pollution with petroleum or other noxious substances.
War ships, auxiliary war ships, along with any ships owned or operated by a state and used for noncommercial activities, shall not be subject to this Law.
HEALTH AND SAFETY AT WORK ACT (ZVZD-1) GENERAL PROVISIONSsuzi smith
(introductory provision)
This Act shall lay down the rights and duties of employers and workers with respect to healthy and safe work and measures to ensure health and safety at work.
(2) This Act transposes into the legal order of the Republic of Slovenia the Council Directive 89/391/EEC of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work, which was amended by Regulation (EC) No 1137/2008 of the European Parliament and of the Council of 22 October 2008 adapting a number of instruments subject to the procedure laid down in Article 251 of the Treaty to Council Decision 1999/468/EC, with regard to the regulatory procedure with scrutiny — Adaptation to the regulatory procedure with scrutiny — Part One (OJ L 311, 21.11.2008, p. 1). Furthermore, this Act also partially transposes into the Slovene legal order the Directive of the European Parliament and of the Council 2006/123/EC of 12 December 2006 on services in the internal market (OJ L 376, 27.12.2006, p. 36).
(3) This Act shall also determine the competent bodies in the field of health and safety at work.
(4) Implementing regulations concerning health and safety at work shall be enacted by the minister competent for labour and the minister competent for the field to which a given implementing regulation shall pertain, after consultation with social partners within the Economic and Social Council.
(5) The employer shall ensure health and safety at work in accordance with this Act, other regulations and guidelines.
REPUBLIC OF LITHUANIA LAW AMENDING THE LAW ON COURTSsuzi smith
The Law on Courts shall establish the court system of the Republic of Lithuania, the jurisdiction, organisation, activities, administration and self-governance of courts, their principles, the status of judges, the procedure of selection of candidates to judges, appointment of judges, their promotion and liability, the social guarantees of judges and other issues relating to courts.
Legal regulation of the organisation and activities of courts, legal regulation of the status of judges and related issues shall be based on the universally recognised principles of law laid down in the Constitution of the Republic of Lithuania, other laws and international agreements to which the Republic of Lithuania is a party - respect for human rights and freedoms, the right of everyone to judicial remedy, to a fair and public hearing by an independent and impartial tribunal, the principles of separation of powers under which justice in the Republic of Lithuania is administered only by courts, the rule of law, independence of courts and judges, the autonomy of courts, their financial independence from other government institutions and decisions of the officials, self-regulation and self-governance of courts, other principles of court structuring, the status of judges and judicial process.
Introduction
1. Rights shall be exercised and duties performed in good faith.
2. This Law is applicable to all legal issues, to which its text or interpretation relates.
Rights based on custom may neither set aside nor vary law. Rights based on custom are applicable in the cases specified by law.
3. Every civil legal relation shall be adjudged in accordance with the laws, which are in force at the time when such legal relations are created, varied or terminated. Previously acquired rights shall not be affected.
4. The provisions of this Law shall be interpreted firstly in accordance with their direct meaning; where necessary, they may also be interpreted in accordance with the structure, basis and purposes of this Law; and, finally, they may also be interpreted through analogy.
5. Where a matter is required to be decided in the discretion of a court or on the basis of good cause, the judge shall decide the matter in accordance with a sense of justice and the general principles of law.
6. The general provisions regarding obligations are applicable mutatis mutandis to family, inheritance and property legal relations.
IMPROVING YOUR COMPETITIVE EDGE
A Marketing Plan is a written strategy for selling the products/services of a new business. It is a reflection of how serious a company is in meeting the competition head on, with strategies and plans to increase market share and attract customers. An effective Marketing Plan is backed by carefully collected market, consumer and competitor information, sometimes citing professional advice.
Social Networking Tools for Academic Librariessuzi smith
Social Networking Tools for Academic Libraries
Abstract
This is an exploratory study investigating the use of social networking tools in academic libraries. The major areas examined include the extent of use of social networking tools, library staff’s perceptions of their usefulness, and perceived challenges in using them. Considerations that influenced decisions to use or not to use social networking tools were also examined. Invitations to participate in a web-based survey were sent to the libraries of 140 universities from Asia, North America and Europe. Responses were received from 38 libraries, yielding a response rate of 27.1%. Twenty-seven libraries (71.1%) used social networking tools, five (13.1%) were potential users who planned to use these tools and six (15.8%) did not plan to use these tools at all. Facebook and Twitter were the most commonly adopted tools in university libraries. Most library staff had generally positive perceptions on the usefulness of social networking tools, but hesitancy among some library staff and limited participation of library users (i.e., students) were perceived to be hindrances. The findings of this study offer insights for academic librarians to use as basis for informed decisions in applying social networking tools.
Dividing the Debts in a California Divorcesuzi smith
My spouse ran up huge credit card debts during the marriage. In dividing assets and debts in the settlement agreement, who should be responsible for these debts?
In California, Family Code section 910 provides that the community is liable for all debts incurred during the marriage and prior to separation. It doesn’t matter whether the debt was incurred by one spouse for his or her own benefit or for the family. It also doesn't matter whose name appears on the bill or the credit card statements. If it was incurred during the marriage and prior to separation, it’s a community property debt and both spouses are equally liable. This means that when the parties are negotiating a settlement and tallying the marital balance sheet such debts should be divided equally. A better option might be that one spouse agrees to pay off the joint debts in return for a greater share of the community property. The spouse paying off the debts can at least make sure that joint debts are paid, because as long as debts are jointly owed both spouses are financially responsible to the creditors.
Credit Cards 101:
Teaching Young People the
Truth about the Plastic Peril
1. Results of Personal Finance Quiz (5 – 10 min)
a. Discuss with the students how they did as a group compared to the national averages. Questions you could ask them:
- Why do you think our class did better/worse than other students?
- What do you think these results indicate about your understanding of personal finance?
2. Credit Card Introductory Activity (10 min)
a. The goal of this activity is to see what students know and don’t know about Credit Cards…
b. Put up poster paper with the following questions. Give them 10 minutes to walk around the room and write either a response to the question, or a response to someone else’s answer.
- What is a credit card?
- Who can get credit cards?
- What are the advantages to having a credit card?
- What are the disadvantages to using a credit card?
- What should you look for when trying to choose the right credit card?
- What do I want to know about credit cards?
Law No. : 5411
Adoption Date : October 19, 2005
Official Gazette : November 1, 2005, 25983 re.
PART ONE
General Provisions
Objective
Article 1-The objective of this law is to regulate the principles and procedures of ensuring confidence and stability in financial markets, the efficient functioning of the credit system and the protection of the rights and interests of depositors.
Scope
Article 2- The deposit banks, participation banks, development and investment banks, the branches in Turkey of such institutions established abroad, financial holding companies, Banks Association of Turkey, Participation Banks Association of Turkey, Banking Regulation and Supervision Agency, Savings Deposit Insurance Fund and their activities shall be subject to provisions of this law.
The provisions of this law shall also apply to banks that have been established as per their special laws, on the condition to preserve the provisions of their special laws
The general provisions shall apply to cases for which provisions are not set out in this law.
Definitions and abbreviations
Article 3- For the implementation of this Law, the following terms shall have the meanings indicated below:
Relevant Minister: The Prime Minister or State Minister to be authorized by the Prime Minister,
Board: Banking Regulation and Supervision Board,
Agency: Banking Regulation and Supervision Agency,
Chairman: The Chairman of the Banking Regulation and Supervision Board,
Central Bank: Central Bank of Turkish Republic Inc. Co.,
Fund: Savings Deposit Insurance Fund,
Fund Board: Savings Deposit Insurance Fund Board,
Fund Chairman: The Chairman of Savings Deposit Insurance Fund Board,
Credit institution: Deposit banks and participation banks,
LAW ON STATE AND LOCAL PROPERTY CHAPTER ONE. GENERAL PROVISIONSsuzi smith
The purpose of this Law is to regulate relations arising
from the matters of powers of the legislative and
executive organs concerning ownership rights on state and
local property, level of authority of a legal person with
state property and its administration, principle and
regulations of activity of an organ implementing policy on
state property.
Article 2. Law's scope of effect
1. This law effects to the regulation of matters concerned
to the enjoying ownership rights on state and local
properties, specified in the Constitution and the Civil
Law of Mongolia.
2. This law shall not effect to the regulation of matters
concerning the composition, distribution and expenditure
of the State central and local budgets and State treasury
fond.
CHAPTER TWO. STATE PROPERTY ITEMS
Article 3. Concept and classification of state property
items
State property consists of state property for public use
and state's own property. State property for public use
and state's own property divides to immovable and movable
properties in accordance with the article 77 of the Civil
Law.
Article 1. Purpose of the Law
1.1. The purpose of this law is to regulate possession and use of state-owned land and other related issues.
Article 2. Legislation on Land
2.1. The legislation on land shall consist of the Constitution of Mongolia, this law and other legislative acts issued in conformity with them.
2.2. Issues related to use and protection of underground resources, forests, water, air, flora, fauna and other natural resources shall be regulated by relevant legislative acts.
Article 3. Legal Definitions
3.1. The following terms used in this law shall be interpreted as follows:
3.1.1. "land" means a piece of space including the land surface, its soil, forests, water and plants;
3.1.2. "to own land" means to be in legitimate control of land with the right to dispose of this land;
3.1.3. "to possess land" means to be in legitimate control of land in accordance with purpose of its use and terms and conditions specified in respective contracts;
3.1.4. "to use land" means to undertake a legitimate and concrete activity to make use of some of the land's characteristics in accordance with contracts made with owners and possessors of land;
Outline (Fall 2006)
I. Judicial Review
A. The Nature and Sources of the Supreme Court’s Authority
- It is the Supreme Court, not Congress, which has the authority and duty to review the constitutionality of the statutes passed by Congress, and to invalidate the statute if it violates the Constitution
o Marbury v. Madison
- U.S. Supreme Court is the main interpreter of the Constitution
- Most of the justices’ ruling are consistent with their past opinions
- the USSC’s last word makes it the most important judicial voice and the final decider of what is Constitutional
Constitution
- Supremacy Clause (Article 6, Section 2)
o The Constitution is the Supreme Law of the Land.
- We know that the constitution is supreme, but what if one branch decides something the other branch does is unconstitutional?
o None of this is explicitly stated in the Constitution
- What gives the Supreme Court the power of judicial review?
o Justice Marshall did in Marbury v. Madison
- constitution is the primary law—extending to acts of the president and acts of congress
- the power of judicial review also extends to lower federal courts
o they have the power to declare acts of Congress unconstitutional
Marbury v. Madison
- this case decided which branch of the fed gov. should have the final say in interpreting the constitution
- if the USSC identifies a conflict b/w a constitutional provision and a congressional statute, the Court has the authority and the duty to declare the statute unconstitutional and to refuse to enforce it
HOW UKRAINIAN AMBER IS ILLEGALLY TRANSPORTED TO POLANDsuzi smith
Raw amber, which is illegally mined in Ukraine, is unlawfully transported abroad. And it is successfully sold in Poland. These precious stones of organic origin are also popular in Russia and China.
The Volyn customs unit of the State Fiscal Service of Ukraine said that people, in the majority of cases, have been hiding amber from customs control in their personal belongings. They are also using specially created storage units that are hidden in the frames of cars. These hiding places were previously taken apart.
According to information from the customs unit, amber that becomes the property of the state on the basis of a court decision is transferred to the “State Storage of Precious Metals and Precious Stones of Ukraine.”
What Should be the Christian View of Anime?Joe Muraguri
We will learn what Anime is and see what a Christian should consider before watching anime movies? We will also learn a little bit of Shintoism religion and hentai (the craze of internet pornography today).
The Chakra System in our body - A Portal to Interdimensional Consciousness.pptxBharat Technology
each chakra is studied in greater detail, several steps have been included to
strengthen your personal intention to open each chakra more fully. These are designed
to draw forth the highest benefit for your spiritual growth.
Exploring the Mindfulness Understanding Its Benefits.pptxMartaLoveguard
Slide 1: Title: Exploring the Mindfulness: Understanding Its Benefits
Slide 2: Introduction to Mindfulness
Mindfulness, defined as the conscious, non-judgmental observation of the present moment, has deep roots in Buddhist meditation practice but has gained significant popularity in the Western world in recent years. In today's society, filled with distractions and constant stimuli, mindfulness offers a valuable tool for regaining inner peace and reconnecting with our true selves. By cultivating mindfulness, we can develop a heightened awareness of our thoughts, feelings, and surroundings, leading to a greater sense of clarity and presence in our daily lives.
Slide 3: Benefits of Mindfulness for Mental Well-being
Practicing mindfulness can help reduce stress and anxiety levels, improving overall quality of life.
Mindfulness increases awareness of our emotions and teaches us to manage them better, leading to improved mood.
Regular mindfulness practice can improve our ability to concentrate and focus our attention on the present moment.
Slide 4: Benefits of Mindfulness for Physical Health
Research has shown that practicing mindfulness can contribute to lowering blood pressure, which is beneficial for heart health.
Regular meditation and mindfulness practice can strengthen the immune system, aiding the body in fighting infections.
Mindfulness may help reduce the risk of chronic diseases such as type 2 diabetes and obesity by reducing stress and improving overall lifestyle habits.
Slide 5: Impact of Mindfulness on Relationships
Mindfulness can help us better understand others and improve communication, leading to healthier relationships.
By focusing on the present moment and being fully attentive, mindfulness helps build stronger and more authentic connections with others.
Mindfulness teaches us how to be present for others in difficult times, leading to increased compassion and understanding.
Slide 6: Mindfulness Techniques and Practices
Focusing on the breath and mindful breathing can be a simple way to enter a state of mindfulness.
Body scan meditation involves focusing on different parts of the body, paying attention to any sensations and feelings.
Practicing mindful walking and eating involves consciously focusing on each step or bite, with full attention to sensory experiences.
Slide 7: Incorporating Mindfulness into Daily Life
You can practice mindfulness in everyday activities such as washing dishes or taking a walk in the park.
Adding mindfulness practice to daily routines can help increase awareness and presence.
Mindfulness helps us become more aware of our needs and better manage our time, leading to balance and harmony in life.
Slide 8: Summary: Embracing Mindfulness for Full Living
Mindfulness can bring numerous benefits for physical and mental health.
Regular mindfulness practice can help achieve a fuller and more satisfying life.
Mindfulness has the power to change our perspective and way of perceiving the world, leading to deeper se
In Jude 17-23 Jude shifts from piling up examples of false teachers from the Old Testament to a series of practical exhortations that flow from apostolic instruction. He preserves for us what may well have been part of the apostolic catechism for the first generation of Christ-followers. In these instructions Jude exhorts the believer to deal with 3 different groups of people: scoffers who are "devoid of the Spirit", believers who have come under the influence of scoffers and believers who are so entrenched in false teaching that they need rescue and pose some real spiritual risk for the rescuer. In all of this Jude emphasizes Jesus' call to rescue straying sheep, leaving the 99 safely behind and pursuing the 1.
The Book of Joshua is the sixth book in the Hebrew Bible and the Old Testament, and is the first book of the Deuteronomistic history, the story of Israel from the conquest of Canaan to the Babylonian exile.
Discover various methods for clearing negative entities from your space and spirit, including energy clearing techniques, spiritual rituals, and professional assistance. Gain practical knowledge on how to implement these techniques to restore peace and harmony. For more information visit here: https://www.reikihealingdistance.com/negative-entity-removal/
The Good News, newsletter for June 2024 is hereNoHo FUMC
Our monthly newsletter is available to read online. We hope you will join us each Sunday in person for our worship service. Make sure to subscribe and follow us on YouTube and social media.
Why is this So? ~ Do Seek to KNOW (English & Chinese).pptxOH TEIK BIN
A PowerPoint Presentation based on the Dhamma teaching of Kamma-Vipaka (Intentional Actions-Ripening Effects).
A Presentation for developing morality, concentration and wisdom and to spur us to practice the Dhamma diligently.
The texts are in English and Chinese.
2 Peter 3: Because some scriptures are hard to understand and some will force them to say things God never intended, Peter warns us to take care.
https://youtu.be/nV4kGHFsEHw
The PBHP DYC ~ Reflections on The Dhamma (English).pptxOH TEIK BIN
A PowerPoint Presentation based on the Dhamma Reflections for the PBHP DYC for the years 1993 – 2012. To motivate and inspire DYC members to keep on practicing the Dhamma and to do the meritorious deed of Dhammaduta work.
The texts are in English.
For the Video with audio narration, comments and texts in English, please check out the Link:
https://www.youtube.com/watch?v=zF2g_43NEa0
Latvian psychiatry and perspectives of its development Speciality - psychiatry
1. Latvian psychiatry and
perspectives of
its development
Speciality - psychiatry
Summary of promotional work
Scientific research reviewer
The work was done at
Riga Stradiņš University, Department of Psychiatry
and Narcology and Mental Health State agency
2. Topicality of the paper
Nowadays 450 million of people in the world have mental and neurological
diseases and behavioural disorders. A quarter of all people who are connected with
the health car services require assistance in the area of mental health. Four out of
six most frequent reasons of disablement are connected with neuropsychic
diseases (depression, alcoholism, schizophrenia, bipolar disorders). In a quarter of
families some family member has a mental disease. About 873 000 people each
year commit a suicide. These data proves the topicality of the problem of mental
disorders worldwide, and each country tries to search for their solutions. One of the
recommendations of the World Health Organization for improvement of the
situation in the area of mental health is to develop mental health enforcement
policy in each country. Such a plan is only for 59.5 % of the world and 67.3 % of
the European countries. Unfortunately Latvia is not among those countries, which
contrary to the recommendations of the World Health Organization have not
enforced a policy in the area of mental health, and this makes this scientific paper
topical.
After regaining of independence, Latvia during the last 15 years both politically
and economically was subject to material changes and over a short period of time
is trying to find the most correct way of development. These changes impact all
areas of economics, also medicine and psychiatry. Growth of other branches of
medicine is connected mainly with development of science and introduction of
new technologies in diagnostics and treatment, whereas in psychiatry larger
attention is paid to social and economic situation, approach of the state to certain
problems and opinion regarding the methods of its solution.
Different countries, which are in the transitional stage from the totalitarian regime
to a democratic society, are looking for their way of development in psychiatry,
and each of them is unique and specific.
The essence of the paper is to show scientific basis of the Latvian mental health
policy and raise issues significant for the operational program in order to create at
maximum realizable policy proper for the Latvian situation, which could be
enforced in life in the future.
3. Purpose and tasks of the scientific work
To develop scientifically justified improvement policy of Latvian psychiatry
service and public mental health, as well as recommendations and scenarios
for its practical realization in the country.
Research tasks necessary for reaching the purpose of scientific work:
1) to assess the living conditions, educational level and sources of basic living
income of people registered in Latvia with mental and behavioural disorders,
as well as estimate the interrelation of these data with mental diseases of
patients;
2) in connection with issues of medical care, to assess the income level of
patients being under in-patient treatment, whether they have a home of their
own and occupation/business;
3) to assess the social situation of Latvian psychiatry patients and their
possibilities to work;
4) to determine mutual interrelation of narcological and mental diseases in
Latvian circumstances.
Scientific novelty of the paper
1) historical and social/psychiatric assessment of Latvian psychiatry;
2) improvement of Latvian population's mental health and development of
enforcement policy for psychiatric assistances.
Structure and scope of the paper
The paper consists of the introduction, literature survey, description of methods
used in the research, highlight of the results gained, discussion, conclusions,
practical recommendations and a list of literature used. The scope of the paper is
96 pages and 25 tables.
4. Research material
1) Information contained in the Mental disorders and mental diseases state
register on living conditions, education, sources of basic living income of 60
924 patients, as well as the fixed social diagnoses according to ICD-10 (the
data of April 2003).
2) Patients of 11 wards of the non-profit in-patient company VSIA ,,Psychiatry
Centre" from Riga and Riga district who were there due to aggravation and
acuity of mental diseases in 2003 and 2004.
3) Out-patient patients of a Riga micro district in 1995/1996 and 1999/2000 (the
researched environment comprised 60 000 inhabitants).
4) Information on 6385 treatment episodes in 2000 in the non-profit company
VSIA ,,Psychiatry Centre" (Riga Psycho-Neurological Hospital).
Research methods
1) Statistical analysis was made of the information on living conditions,
education, basic living income sources of 60 924 patients included in the
Mental disorders and mental diseases state register, as well as the fixed social
diagnoses according to ICD-10 (the data available in April 2003 were used).
2) One-time registration of 335 patients in 11 wards of the non-profit company
VSIA ,,Psychiatry Centre", which admitted patients with aggravations and
acuity of diseases from Riga city and Riga district. In this way the composition
of patients was fixed in hospitals, and afterwards psychiatric examination of
patients was made, as well as clarification of the most critical social data.
3) A pilot research was made in the form of a fixed interview or free discussion
by questioning out-patient patients of one Riga micro district (the environment
of research comprised 60 000 inhabitants). In 1995/1996, 640 patients were
interviewed and analyzed, but in 1999/2000 - 429 patients.
4) Statistical analysis was made of the data on 6385 treatments episodes in 2000
in the non-profit company BO VSIA ,,Psychiatry Centre" (Riga Psycho-
Neurological Hospital).
5. Statistical processing of research results
Break-down analysis was made of the ratios of the material in connection with
social and clinic characteristics. For checking the statistical significance of
differences in the gained results, the Student and McNemar test was used. Only
those differences where p<0.05 were considered as significant.
Results
1) The data obtained on living conditions of psychiatry patients in the Social
psychiatric statistical research show that 47 789 patients or 78.5% of all
registered patients live in a family, 6357 or 10.4% live alone, 4512 or 7.4% reside
in social care establishments.
Another ratio, which gives a possibility to make certain conclusions on the ability
of patients to successfully function in the social environment, is education. It has
been clarified that most part of the patients have not studied, have attended school
for mentally retarded, studied, but not finished an educational course in primary
school or have finished primary school (See the table No. 1).
Most significant and informative data on the social status of patients are provided
by the information available in the Mental disorders and mental diseases state
register regarding living income of patients. 17 656 or 29% of the registered
patients live on their disablement pension, 15 997 or 26.3 % of patients are under
custody of other persons, 7953 or 13% of patients live on the old-age pension,
8907 or 14.6% of patients gain living income otherwise - mainly in non-regular
occasional works.
6. Another aspect, which was analyzed, was the interrelation of living conditions,
educational and living income with different diagnose groups. For assessment and
comparison, a group of organic, including symptomatic, mental disorders (F 0)
was chosen, where 14 340 or 23.5% of patients are registered, as well as a group
of schizophrenic disorders (F 2), where 17 373 or 28.5% of patients are registered.
These two groups are the largest in number and include patients with severe
mental and behavioural disorders. For comparison, also a group of affective
disorders was chosen (F 3), where 3678 or 6% of patients are registered. This
group is less in number, but there is a tendency of growth in patients observed in
this group. The patients of this group, compared to the patients of organic
disorders and schizophrenic disorders, more frequently are socially more adapted
and working, and it is seen in table No. 2.
7. 2) Breakdown of patients involved in the Clinic social psychiatric
research in the non-profit in-patient company VSIA ,,Psychiatry Centre"
according to the age and sex is given in table No. 5, but breakdown in the main
diagnostic groups -in table No. 6.
8. As manifested by the table, most frequent patients involved in the research were
schizophrenic patients. The group ,,other" included cases of adaptation
disorders, personality disorders, reactions to stress and mental disorders for
mentally retarded. Only 54 (16.1 %) patients of all in-patients in the hospital
were there for the first time. Dependence phenomena as comorbide diagnose
was observed in 46 cases (13.7%), mainly dependence on alcohol, but suicidal
attempts and intentions
9. were observed in 28 cases (12.8%). 222 (66.3 %) patients had admitted
disablement (2nd
disablement group) or they received old-age pension. 46 patients
(13.7%) were searching for work, but could not find it. Employed patients from all
hospitalized patients (including also part-time job) were 67 (20%). Personal
income (disablement or old-age pension, social allowances, remuneration for work)
gained on average per one of the 335 hospitalized patients amounted to Ls 56.48, but
per one family member (or person with whom co-habits) more - Ls 76,01. In 57.3%
of cases the patients received the necessary additional financing from other family
members, relatives or people, which whom they co-habited. A contrary tendency, i.e.,
that the patients shared their income with family members (mainly children) could be
detected in 15.8% of cases. When checking with the so-called criterion of signs, in
each of 11 wards the dominating tendency (with p<0,05) was the one confirming that
the patient received assistance from relatives.
As evidenced by table No. 7, the number of those patients, who had small personal
income - up to Ls 60 per month, prevail: 18.5% + 6.9% + 23.8% + 19.7 % =
68.9%. Analogous calculation about small income per one family member reaches
49.6%. Income, which is larger than 60 Ls per month per one family member, was for
50.4% of patients (personal income > 60 Ls - 31.1%). This reflects the
compensatory and equalizing tendencies of the family and relatives. When
calculating income per one family member in the main, most represented
10. diagnostic basic categories, it appeared that this income on average was least for
the patients with organic mental disorders and schizophrenic patients
-respectively Ls 62.34 and Ls 73.25, but the highest - for affective disorders group
— Ls 97.40. This difference was mainly creating on the basis of those persons
whose income was above 80 Ls (See the table No. 8).
The following fact was discovered: if schizophrenia was continuous, chronic
progredients, the average monthly income per one family member was only Ls
59.12, but for the group of schizophrenia patients whose process of disease had a
tendency to remitting, the respective ratio reached Ls 95.76, thus being very close
to the income of patients with affective disorders (Ls 97.40). The breakdown of
schizophrenia patients depending on the specific characteristics of the process of
disease (See the table No. 9) shows that the main difference is manifested in that
group where the income exceeds Ls 100 per one family member.
11. patients, were noted in 51 cases. 14 patients out of all 335 were homeless (4.2%),
the cases when due to debts people faced with threat of being evicted from their
homes, which provoked and aggravated depressions, were 23 (6.9%), 14 (4.2%)
suffered from serious psychological incompatibility problems in their places of
habitation - those are persons who due to their material and psychological status
cannot change the situation.
103 patients in their process of disease had dominating depressive inflictions
(phases or components in the mental status, also in remissions) and their treatment
would require up-to-date antidepressants and neuroleptics, however only in 19
cases income per one family member exceeded Ls 100, which would give a
possibility to buy expensive medicaments (only nine out of 35 were affective
patients).
3) In the research regarding occupations/employment of mentally ill persons,
it was noted that 17 656 or 29% of the registered patients live on disablement
pension, 15 997 or 26.3% of patients are under custody of other persons, 8907 or
14.6% of patients gain sources of income in irregular occasional jobs. Only 22%
of the persons with mental and behavioural disorders as a result of different
successfully realized project had been employed in some work. 75-80% of women
and 25% of men want to engage in business therapy, 56-69% of patients want to
work.
12. 4) In the psychiatry research of narcological comorbidity it was noted that in
808 episodes (12.7%) dual diagnoses were set (psychiatric and narcological). Out
of comorbid narcological pathologies, the first place is taken by mental and
behavioural disorders due to alcohol, 79.5% (n = 642), the second place - due to
opioid substances, 12.3% (n = 99), the third place - many narcotic and
psychoactive substances, 4.5% (n = 36).
Analysis of results
o Latvian psychiatry before gaining of independence
In order to assess properly the situation of psychiatry nowadays, it is material to
make a minor highlight in the history of Latvian psychiatry.
A significant feature of psychiatry services in the times of Soviet Latvia was the
attitude towards patients. A patient was treated like a person who is unable to
solve his problem of life normally.
Taking into account the custody of the state, also the diagnostics and treatment
was frequently subjective, based on the intuition of doctor, his experience and
analogies, rather than strictly determined and discovered diagnostic criteria,
13. verified treatment methods. Given this subjective approach, sometimes a patient
received help by fixing the so-called easier rehabilitation diagnosis so that it is
easier for the patient to adapt, or a more severe diagnosis so that the patient would
have the reason for allowance, i.e., the pension.
Insufficient and formal was the respect of patients' human rights, overall
conditions in the hospitals and attitude of the staff towards the patients was
humiliating. Humane attitude towards patients was not a generally accepted norm,
but the issue of want, intelligence and humaneness of each individual. Psychiatry
service was established on centralized basis, of course, there was nothing like
competition among the providers of services, although it should be admitted that
for modern psychiatry it is more important to develop different types of services
and agree their enforcement rather than compete. During the time when Latvia was
a part of the USSR, a major component of the work of the service was recording
of patients and the system for the prevention and treatment of disease. The task of
the system was to ensure regular treatment of patients, in a way- forced attachment
to psychiatry.
During the Soviet times, in the same way as now, there were psycho-neurological
doctor's services operating. In this way it was an attempt to create a possibility for
the patient to receive treatment as far as close to his place of residence, as well as
ensure realization of the principles of prevention and treatment of disease. The
number of visits of patients to a psychiatrist over a year's time in the 80-ties of the
XXth century was close to the number of nowadays, and this evidences a similar
service to out-patients, similar composition of patients, with whom the
psychiatrists worked before regaining of Latvia's independence and now. During
the Soviet times, psychiatric care was based only on psychiatrists. Currently
there is tendency to base the care of persons with mental disorders on other
specialists, mainly - on psychiatry nurses.
An interest peculiarity was marked in the 80-ties of the XXth century when a
service telephone line started to operate, a social psychological assistance service
room, even a separate suicide service. In 1988 and 1989, there was a sufficient
number of psycho-therapeutic service rooms operated both in Riga's clinics, as
well as elsewhere in Latvia. In this way the state tried to solve the problems of
those patients who are ill with conditionally light disorders and who have
14. communication problems with people. It should be added that the quality of
provided services was low, the wish to integrate patients in society - formal, it was
more about statistical reports.
When analyzing the in-patient care, we see that this form of care was the
dominating one. In the 80-ties of the XXth century, the number of "beds" in
hospitals and clinics grew, also the number of "beds" for narcological profile. The
situation connected with consumption of alcohol remained unfavourable. The
number of psychiatric profile "beds" was large. Compared to 2004, in 1989 it was
larger by 30%. It should be added that the large number of patients were
practically in the same premises as now, therefore the living conditions of patients
were poor, even 20-30 patients were living in one room, co-habited areas were miserable.
In the 80-ties, there was a tendency observed to decrease the workload of doctors,
dynamically the number of "beds" for in-patients per one psychiatrist decreased.
The re-hospitalization ratio did not become much worse, which is usually taken
into account when analyzing the quality of the services. The re-hospitalization
ratio was similar to today's ratio of about 30%.
In the psychiatry system of Soviet Latvia a significant role was given to
specialized workshops, which acted at psychiatric hospitals. The workshops were
mainly used for the fact that the patients had to be busy, would be under
supervision of specialists. The purpose of workshops was to ensure that the
patients would not be disturbing to the society, and as a matter of fact this was a
way how to isolate the patients rather than prepare them for work in life and
include them in society.
After fall of the ,,iron curtain", there was a possibility to compare psychiatry in
Latvia and in Western Europe. A very material characteristic was the poverty of
our psychiatry, as well as our medicine. Western psychiatric establishments
worked in much better circumstances (spacious, sanitary norms compliant
premises), more staff employed, staff receiving better salaries, modern
medicaments available. Also different types of assistance possible to the patients,
especially in chronic cases, appeared to be vast and at higher level because work
with patients was more differentiated specialized and expansive. It especially
refers to overall rehabilitation, especially ergotherapy, work therapy, places of
residence of patients (disabled persons), social assistance, different type of
15. consultations and possibilities corrections (team work) by involving different
specialists. Compared to Western Europe, out-patient work was not developed,
non-differentiated.
The status in Riga in the area of forensic psychiatric expertise and forced treatment
could be evaluated as a catastrophe. In the expertise ward, it was tense, sanitary
conditions were poor and similar to imprisonment. Forced treatment was carried
out in common wards. The number of staff was not sufficient, the process of
forced treatment was not oriented to rehabilitation, ergotherapy.
In the area of education and raising of qualification there were some typical
drawbacks: 1) excessive ideology of psychiatry, 2) improper psychological
preparedness of doctors and other staff and insufficient use of knowledge in
diagnostics, treatment, rehabilitation, as well as in simple communication with the
patients, and 3) weakness and primitiveness of psychotherapy.
Social psychiatric problems were treated only as a problem of capitalism.
Educational programs were prepared centrally in Moscow and could not be
changed on spot in Latvia.
With the Western assistance, especially the German colleagues (president of
Oberfranken county Mr. E. Sitzmann and the head of Bayreuth clinic of psychiatry
and psychotherapy prof. M. Wolfersdorf) by organizing a lecture and a cycle of
consultations in Riga, exchange-of-experience trips of about 70 Latvian
psychiatrists to Bayreuth, as well as by receiving support and educational
possibilities (especially in rehabilitation, ergotherapy, patients' care) from
Sweden, Denmark and Norway, gradually promoted positive changes in education
and practical work - the psychological climate in Latvian psychiatry has changed,
professional knowledge of doctors and other staff has improved, establishment and
de-institutionalization of a clinic for forensic psychiatrics and forced treatment has
been much promoted, as well as differentiation and specialization of out-patient
treatment has been started.
o Epidemiologic situation in mental and behavioural disorders in present
Latvia
Mental diseases and mental disorders in Latvia have been registered for 4.4% of
population (total number of disorders connected with use of psychoactive
substances - 5.6%), on active basis, i.e., at least once a year the psychiatry
16. services are used by 2.6% of population. These numbers are small and evidence
both about the insufficient availability of the services and their use, as well as
about shortcomings in records (there are no data from family doctors, etc.). When
analyzing the prevalence and incidence ratios of patients, it should be concluded
that a large share of these ratios is taken by schizophrenic and organic mental
disorders.
Latvia takes one of the first places in the world regarding the number of suicides.
The number of suicides is connected with psycho-social factors and this is
confirmed by observations in Eastern European countries. The number of suicides
decreased before regaining of independence when hopes and bright future plans
were in the air. The number of suicides rapidly grew in the first years of
independence when there was a social and economic crisis in the country. Over the
last years, when the economic situation in the country is improving and social
issues are started to be treated, the number of suicides is decreasing. The reasons
of all changes in the number of suicides have not been clarified, it is too early to
speak about a stable reduction in the number of suicides over a longer period of time,
o Organization of psychiatry service in present Latvia
a) Out-patient assistance
In Latvia, out-patient assistance is ensured by out-patient psychiatric departments
or ambulances at psychiatric hospitals in Rīga, Jelgava, Daugavpils, and Liepāja,
as well as regional psychiatrist doctor rooms in the whole Latvia. For children, out-
patient psychiatric assistance is provided by children's psychiatrists in outpatient
departments in Daugavpils, Liepaja, Jelgava, as well as children's department
at wide profile children's hospital in Riga, as well as a minor number of
children's psychiatrist rooms in the regions.
In these establishments, the patients can receive a consultation of psychiatrist,
prescriptions for purchase of medicaments, if necessary - a confirmation on the
health condition, as well as the psychiatrist prepares the necessary documents for
work of expertise and other commissions.
In out-patient establishments, besides a psychiatrist there is also a psychiatry nurse
who mainly performs the documentation work, assists to the doctor, but is not
independently working with patients. Other specialists (psychologist, social
workers, ergotherapeutist) involve in the work in episodes, more frequently in out-
17. patient wards at psychiatric hospital because they have larger financial
possibilities to involve additional specialists, as well as a possibility to involve in-
patient specialists.
When assessing diagnoses for patients who are under out-patient psychiatric
assistance care, it should be concluded that 83% of adult patients have
schizophrenic, organic mental disorders and diagnoses of mental retardness. For
children and teenagers, neurotic disorders prevail and it is connected with
diagnostic approach to children in psychiatry. It should be admitted that the
psychiatric out-patient service is engaged in treatment of a certain, severe, chronic
composition of patients.
When analyzing the number of patients who visit a psychiatrist in out-patient
treatment at least once a year, the regional psychiatrists care for 700-1500
patients, whereas more patients are in the psychiatric care in out-patient wards of
psychiatric hospitals.
55 private doctor's companies were operating in Latvia in 2004, which have no
agreement with the State Compulsory Health Insurance Agency. It is not clear
what is the scope of work carried out by these doctors, but the author assumes that
they are engaged in those diagnostic categories, which are not comprised by the
state psychiatry.
Family doctors in Latvia are little involved in correction of serious mental diseases
and disorders, as they lack proper knowledge, conviction about their capabilities,
as well as time to be devoted to patients. If possible, in case of suspicion about a
mental disease, family doctors send their patients to a psychiatrist. Persons with
mental and behavioural disorders frequently arrive at the social services care in
connection with loss of apartment, insufficient living income.
Development possibilities of out-patient services
A variant. One of the variants of out-patient services development is to strengthen
the psychiatric out-patient services on the basis of municipal psychiatric rooms or
as separate structures. In this variant, it is necessary to offer the patients wider
services - social workers assistance, ergotherapy, psychologist's consultations or
at least conditions for spending time properly. The operation of such psychiatric
centres should be closer related to the specialists of primary care, thus attracting
other groups of patients, which would be sent to a psychiatrist by their family doctors.
18. B variant. In the second variant, it is possible to involve family doctors in
patients' care with mental and behavioural disorders by improving the knowledge
of family doctors and placing larger liability for treatment of mental patients. In
this variant, the role of psychiatrist would be mainly only consulting. This variant
would ensure patients' integration in society and overall health care system, would
possibly attract more persons with mental and behavioural disorders, which
especially refers to neurotic and depressive patients (those patients who are not
willing to attend a psychiatrist or a psychiatric establishment).
b) In-patient assistance
Currently patients in Latvia with acute and severe chronic mental disorders are
treated in psychiatric hospitals. In hospital conditions in Latvia, psychiatric
assistance is ensured by psychiatric hospitals in Riga, Jelgava, Liepaja,
Daugavpils, Streņči. These hospitals can be considered acute hospitals as here the
patients arrive not only with psychiatrist's prescription for planned treatment and
investigation, but also in acute, emergency cases with ambulance assistance
transport or police assistance. There are still the so-called chronic hospitals in
Latvia where the patients practically live, rarely leave the hospitals. Such hospitals
are in Vecpiebalga and Aknīste. Hospital assistance is provided also by a
psychiatric hospital in Jūrmala where specialists work with neurotic, depressive
group of patients by ensuring the care of health resort — rehabilitation. Hospital
psychiatric treatment for children is ensured by children's psychiatric ward in the
general type children's hospital in Riga, as well as children's wards in Jelgava,
Liepaja and Daugavpils psychiatric hospitals. Treatment and care of chronic
children is carried out in the children's hospital in Ainaži. Almost a quarter of all in-
patient "beds" are permanent accommodation "beds". Latvia differently from other
countries is characteristic of weak specialization of in-patient "beds", which would
include specific mental disorders and diseases treatment of the ward - eating
disorders, depression, schizophrenia, etc. The data show that psychiatric hospitals
are sufficiently loaded. Similarly as when analyzing out-patient care, it should be
concluded that hospitals are mainly involving the treatment of schizophrenic and
organic mental disorders' patients. A third of the patients are treated longer than a
year, which means that a hospital has become a place of residence for a patient. It
should be concluded that there is a
19. certain part of the patients treated in hospitals who have problems to live in
society. This is evidenced also by the large number of patients (51.6%) who over a
year's time return to the hospital.
Forensic psychiatry and expertise departments in present Latvia comply with the
international standards. These departments are located in Riga. Patients' treatment
and expertise with court judgments are generally carried out in psychiatric hospitals.
Development possibilities of in-patient care
A variant. One of the in-patient service development variants is to improve in-
patient establishments by ensuring acute psychiatry services in a certain statistical
region (Riga, Vidzeme, Latgale, Kurzeme, Zemgale). hi in-patient establishments,
the rehabilitations services should be developed at maximum, as well as the
employment possibilities improved, i.e., ergo therapy and specialized workshops.
B variant. In the second variant, it would be necessary to establish acute
psychiatric wards at general-type multi-profile in-patient establishments thus
ensuring the same treatment standards as for patients with other diseases and
decreasing prejudice against people with mental diseases. In these wards, highly
qualified diagnostics should be carried out using also all examination and
treatment possibilities, which are provided by the general profile in-patient
establishments. Establishment of such wards is considered as a progressive
development of these services.
c) Availability of medicaments
Medicaments are an essential part of psychiatric assistance, which frequently
determine the interest of patients to receive the services. There is a medicament
compensation system operating in Latvia. Up to the year 2005, only adult
schizophrenia (F 20) patients, but children - with wider range of diagnoses had a
possibility to receive medicaments with compensation. The list of diagnoses
includes both the medicaments of latest recipes, as well as older neuroleptics and
antidepressants, mood stabilizators. This in a way explains also the fact that
schizophrenic patients more often and more regularly attend a psychiatrist. Since
2005, medicaments with 75% compensation may also be received by the patients
who are ill with Alzheimer dementia, bipolar affective, recurrently depressive,
schizoaffective, schizotypical disorders and mentally retarded patients. Possibly
supplementing of the list with these diagnoses will be able to attract other groups
20. of patients for treatment and care. Maybe a part of patients come to the hospital
only because they want to receive medicaments, for whose purchase they lack proper financing.
Solutions of improvement in availability of medicaments
It is necessary to include additional diagnoses in the list of compensated
medicaments, to assess the current list and remove those medicaments, which are
not practically used and as far as possible include in the list non-original
preparations whose prices are lower. It is essential to assess the need to renew
social categories, which are due free of charge medicaments in order to ensure at
least minimum assistance for socially non-protected persons.
o Significance of social issues in psychiatry
The situation of social patients and its interrelation with the process of mental and
behavioural disorders are very critical issues, which frequently are underestimated
when organizing psychiatry services and making reforms. Therefore one of the
most essential parts in this work, which was researched, was social issues. The data
acquired during the social psychiatry statistical research show that a large
number of patients live in families, and this is a positive fact, as the family creates
a basic support system for patients, although the statistical information gained
does not give a possibility to judge about the structure of this family and
relationship in it — whether the microclimate of family is favourable, whether the
patient receives the necessary support or is used as means for providing for the
family (disablement pension). Large number of patients live alone or in social care
establishments.
Insufficient education does not ensure the patients' ability to integrate flexibly in
the employment market, does not create a possibility for successful competition.
Here it is of major importance to correspond the patients' abilities with his
education, adapt to the status of illness, establishment of support system from
society (fixed work places, etc.).
Most troubling were the data acquired in the research regarding the number of
patients who are under custody of other persons, as such a status least promotes
the integration of patients in social environment, does not stimulate self-esteem of
patients. These results in the context with living conditions indicate that possible
theopinion aboutthe large number of patients who successfullylive infamilies isdeceptive.
21. There are a large number of patients who live on disablement pension. These data
evidence that so far there are no preconditions appearing in society for successful
integration in social environment.
Comparing the living conditions for different groups of diseases, we can see that
these ratios are similar for organic mental disorders and schizophrenia disorders
groups. It is understandable because both of these disease groups are different,
however there are similar according to their severity and impact on the social
status. Differently from the mentioned groups the largest part of mood (affective)
disorders patients live in a family, and this evidences of better social adaptation of
the patients of these disease groups.
When analyzing the interrelation of the level of education with groups of mental
disorders diagnoses, a lower level of education for patients is marked in the
organic mental disorders group and it arises also from the essence of mental
disorders - morphological damage of brain.
Larger number of affective disorders' patients work in public offices and this
indicates to possible hardships to work more intensive work in private structures.
Organic disorders and schizophrenic disorders groups involve more patients who
receive disablement or old-age pension, and this evidences of problems to
integrate in the labour market.
When looking upon the results gained in the Clinic social psychiatric research
carried out in the non-profit in-patient company VSIA ,,Psychiatry Centre",
attention is first caught by the large number of patients with very low and low
income. The data show that patients' income depends on the type of process of the
diseases. Affective and schizophrenic patients, which in one or the other level are
able to remit, better adapt, are longer able to keep adequate interpersonal
relationship, establish occupations and they have higher income levels. 51 out of
surveyed patients due to insufficient income forced the problems with apartment,
and it promoted adverse process of diseases, their aggravation. Free of charge
antidepressants and stabilizing medicaments for affective patients (F 3) during the
process of disease were not planned, therefore a part of patients with low income
search for rescue in hospital, although on the basis of clinic assumptions the
treatment could be carried in out-patient manner. The low income, real threat
to lose the apartment, as well as threat of
22. unemployment negatively impact the mental status of patients and process of
disease as they cause additional mental traumatization, disadaptation and due to
lack of financing patients are unable to purchase more modern, more effective
(expensive) medicaments for coping of depressive disorders. Social problems are
connected not only with insufficient financing of psychiatric and social care, but
also with clinic factors - nosologic diagnosis and variant of the process of
disease. The worst social situation is for patients with continuous process of disease
(schizophrenia) and organic pathology of cerebrum for whom assistance is required
most.
In the current situation, the problem with dwelling is especially topical for patients
with low income: establishment of cohabited apartments or hostels or group
apartments with closer psychiatric care, which would help to survive with lower
expenses and would promote introduction of rehabilitation elements. The results
gained in the Mentally ill persons' employment research indicate that the
psychiatry reform in our country is generally carried according to the so-called
Canada model. According to this model, the out-patients care system should be
planned not only in medical care establishments by making them closer to the
place of residence of their patients, but also in Day Centres, in which the business
therapy is possible, specialized workshops are opened, in which patients learn and
perform simple work. The supported work should be planned and performed in
coordination with the Ministry of Welfare, the State Employment Agency and the
Associations and Unions of employers.
The quality of remissions of schizophrenic patients has improved, and the patients
more actively search for a possibility to find work. 15% are patients with neurotic
and depressive disorders, which after a respective therapy course retain their
professional working ability, but unfortunately during the treatment (4-8 weeks)
have lost their jobs.
o Personnel resources, educational standards and interrelation between
psychiatry and other branches of medicine
The most significant progress after regaining of independence in Latvia has been
reached exactly in the improvement of personnel qualification and change of
attitude towards patients, strengthening of knowledge about psychology,
rehabilitation and ergotherapy, about which a special thanks should be said to the
23. Western - especially German colleagues. This knowledge and materially different
approach to patients' treatment have a possibility to realize minimum standards of
human resources, which are required by the status of a European Union member country.
One of the aspects, which the author of the paper wanted to look upon, is the
available personnel resources, educational standards and interrelation between
psychiatry with other branches of medicine. This issue is topical when planning
development of the area and making it closer to the Western standards. The
Latvian psychiatric assistance is based mainly on psychiatrists. Such an
approach is traditional, although during the last years there are attempts to involve
other specialists in the treatment and care, i.e., psychiatry nurses, social workers,
ergotherapists. The main focus currently in Latvian psychiatry is laid on the
treatment, such approach is clear both to the patients, as well as medical persons.
Also the patients of other medical areas want to receive assistance from a
specialist of the given area of medicine, receive medicaments or a fixed procedure
for health improvement.
The number of social workers and ergotherapists is not sufficient in the country.
The most material aspect, which ensures successful operation and development of
any area by special reorganization or start of new types of activities, is the
personnel motivation. Real motivation for the work of personnel is proper
remuneration and satisfactory work environment.
During the psychiatric research of narcological comorbidity it appeared that
overall comorbide pathologies in local (Riga) circumstances are diagnosed less
than they are observed in clinic practice (Riga Psychoneurological Hospital) and
are described in the literature.
From comorbide narcological pathologies, the most prevailing dependence in
Latvia is that of alcohol and opioids. When analyzing the literature data and the
common mechanisms of narcological and psychiatric disorders, larger share
should be taken by Indian hemp alkaloids, cocaine and amphetamines. Also
mental and behavioural disorders due to use of caffeine, tobacco, sedatives, sleep
tablets, tranquilizers and correctors (cyclodoli) have not been sufficiently studied.
Affective symptoms have been little diagnosed, most probably, it is "hiding" in the
neurotic disorders group, as well as included in the diverse schizophrenia symptoms.
24. The share of organic disorders among comorbide organic mental disorders can be
explained by the comparatively rapid impact of opioids on the central nervous
system, subsequent changes in behavior and personality.
When analyzing local (Riga) circumstances, dependence on alcohol is dominantly
prevailing among schizophrenic comorbide pathologies. This dependence has been
clinically and theoretically proved. Other comorbide narcological dependences
have not been sufficiently diagnosed (hemp alkaloids, cocaine, sedative and sleep
tablets, tranquilizers, correctors).
Comorbidity of neurotic, stress-related and somatophorm disorders are related
with dependence on alcohol due to spread of the use of alcohol in the country.
This group of diagnoses comprises a wide range of mental disorders, including
also reactive, adaptation disorders, temporary depressive reactions.
o Financing of psychiatry services
Issues regarding finances are always very complex. Money is always too little,
also in the countries, which have had sufficient financing, periodically the use and
effectiveness of money is discussed again and again. Financing of psychiatry
services differs from financing of other areas of medicine because differently from
other areas, there are no expensive technologies, high costs of equipment in
psychiatry, which are easy to calculate. It is neither clear what is the result of
treatment, which would be understandable to society, i.e., the patient does not
recover, no one can guarantee long-lasting stable improvement, safety for society
or the very patient, return to work, life, etc. The result can frequently be treated as
improvement of life quality, however it is not understandable for people -
especially for the poorest part of society.
In Latvia, 79.6% of financing for psychiatry is used for in-patient care.
One of the positive aspects declared by the psychiatry or mental health reform
when transiting from in-patient care to out-patient or community-based care, is
economy of finances. However, one should take into account that for qualitative
development of out-patient assistance we need financing not only for creation of
infrastructure, but also for remuneration of personnel.
25. Conclusions
1. Living conditions for persons with mental and behavioural disorders are
not fairly favourable, because, irrespective of the large share of patients living in
families, the patients are under custody of other persons or survive on minimum
pensions. Insufficient educational level limits the ability of patients to integrate in
society. The large number of disabled people indicates to a situation that there are
no preconditions appearing for successful integration in society and employment
environment, but disablement is the only means for ensuring elementary survival.
There is interrelation between living conditions, education, basic living income
sources and the diagnoses of patients - better family integrated, more educated
and well-off people are the patients of depressions, it is less observed among
patients with organic mental disorders and schizophrenia.
2. The in-patient patients of the non-profit company VSIA 'Psychiatry
Centre" have serious social problems (low income, threat to lose dwelling,
unemployment). The low availability of most modern, effective medicaments
obstructs deinstitutionalization process. Social problem psychiatry patients are
connected with nosologic form of mental diseases, worse social situation is a
continuous drawback for schizophrenic and organic mental disorders patients.
3. The possibilities to work of Latvian psychiatry patients are very limited,
and it is connected with lack of motivation for employers, changes in behaviour
and thinking of patients after getting ill.
4. Narcological comorbides pathologies for psychiatry patients have not been
sufficiently diagnosed, and it may adversely impact the treatment and patients'
care. Special attention in development of psychiatry should be paid to the problem
of use of alcohol by mental patients, and the work of narcological and psychiatry
services should be coordinated and combined.
26. Practical recommendations
Taking into account the research results and conclusions developed in the
promotional work, the author of the paper has developed the basic guidelines
,,Mental health improvement of population in 2006-2016", updated them given
the recommendations of the work group members set up by the Health Minister
(order No. 159 of the Health Minister of September 14, 2004 ,,On Setting up of a
Work Group") and the World Health Organization's experts. The basic guidelines
have been published on the home page of the Ministry of Health www.vm.gov.lv
for public discussion.
Approbation of research
1. Scientific conference of medicine area of Riga Stradiņš University in Riga
(Latvia) - 2002.
2. Ill Baltic Region Biological psychiatry symposium in Klaipeda (Lithuania)
- 2002.
3. International scientific conference ..Statistical research - basis of social
sciences and education" Riga (Latvia) - 2003.
4. Scientific conference of medicine area of Riga Stradiņš University in Riga
(Latvia) - 2004.
5. International scientific conference ,,Equal possibilities to all" in Riga
(Latvia) - 2004.
6. Congress of the World Psychiatrist Association in Florence (Italy) - 2004.
7. Congress of the Baltic Psychiatrists in Riga (Latvia) - 2005.
27. Scientific publications
1. Taube M. Narcological comorbidity in psychiatry. // Scientific articles. -
Riga: Riga Stradiņš University, 2003: 61-64.
2. Andrezina R., Taube M. Psychological and Motivation Difficulties of
Fixing Up Mentally 111 People. // Collection of Articles. - Riga:
Information Systems management Institute, 2004: 87-90.
3. Taube M., Lāce V. Social psychiatry and statistics. // Conference news. —
Riga: Latvia University, 2004: 89-92.
4. Andrēziņa R., Taube M. Employment of mentally ill persons - a
significant community-based psychiatry development problem. // Scientific
articles. - Riga: Riga Stradiņš University, 2005: 218-221.
5. Caune M., Taube M. Results of clinic social and psychiatric research in
BO VSIA ,,Psychiatry Centre". // Scientific articles. - Riga: Riga Stradiņš
University, 2005: 121-125.
Gratitude
The author would like to express major gratitude for support, practical
assistance in performance of research and persistence to the Scientific
Research Reviewer professor Mintauts Caune and the Scientific Consultant
professor Raisa Andrēziņa, as well as the Director of the Mental Health
Agency Jānis Buģins and other employees for support in performance of
research.
28. „ Latvian psychiatry and perspectives of its development"
SUMMARY
Nowadays 450 million of people in the world have mental and neurological
diseases and behavioural disorders. A quarter of people who face health care
services, need assistance in the area of mental health. Four of six most frequent
disablement reasons are connected with neuropsychic diseases. In a quarter of
families some family member has a mental disease. About 873 000 people each
year commit a suicide.
Contrary to the recommendations of the World Health Organization, Latvia
currently has no mental health or psychiatry development policy and action plan.
Both the European and world countries develop their mental health policies and
realize them in practical work. Reforms in each country proceed differently,
individual experience of each country, social and economic he situation,
differences in the state health care-system and other aspects are respected. Overall
a generally accepted and acknowledged mental health care model is the so-called
community-based mental health care or balanced mental health care. Such a
mental health care system comprises persons with mental and behavioural
disorders in order to ensure maximum care in the place of their residence, shorter
time, which the patients spend in psychiatric hospitals, diversity of care forms
outside hospitals, as well as involvement of different specialists in medical
treatment and care (psychiatrists, family doctors, psychiatry nurses, social
workers, ergotherapists, etc.). After reforming the psychiatrics assistances system,
the social issues are very significant, as well as interdisciplinary cooperation and
overall issues of keeping the public mental health, which are currently very topical
also in the world.
The objective of the paper is to develop scientifically justified Latvian psychiatry
services and public mental health improvement policy, as well as
recommendations and scenarios for their practical realization in the country. The
paper consists of four researches: 1) Analysis of the data of Mental disorders and
mental diseases state register comprising living conditions, education, basic
29. living income of 60 924 patients, as well as interrelation of these data with the
fixed diagnoses, 2) assessment of social situation of 335 patients of the non-profit
in-patient company VSIA ,,Psychiatry Centre" in 11 wards, 3) survey of social
situation and employment possibilities of Riga out-patient patients in 1995/1996
and 1999/2000, 4) assessment of registered comorbide diagnoses of 6385
treatment episodes in the non-profit in-patient company VSIA ,,Psychiatry Centre"
in 2000 (psychiatric un narcological).
The results gained in the Social psychiatric statistical research give a possibility to
conclude that living conditions of persons with mental and behavioural disorders
might be adverse - although many patients live in families, patients are under
custody of other persons or survive on the minimum pensions. Insufficient
educational level limits the patients' ability to integrate in society. The large
number of disabled persons indicates to the situation that there are no
preconditions creating for successful integration in society and labor environment,
but disablement is the only means of ensuring elementary survival. There is an
interrelation between living conditions, education, basic living income sources and
the patients' diagnoses - better integrated in the family, educated and well-off
people are patients of depressions, it is less observed for patients with organic
mental disorders and schizophrenic patients.
The results of the Clinic social psychiatric research in the in-patient company BO
VSIA ..Psychiatry Centre" indicate to serious social problems for in-patient
patients (low income, threat to lose dwelling, unemployment). The low availability
of most modern and effective medicaments obstructs deinstitutionalization
process. Social problems for psychiatry patients are connected with the nosologic
form of mental diseases, worse social situation is a continuous drawback for
schizophrenic and organic mental disorders patients.
The research of employment possibilities for mentally ill people showed that work
feasibility of Latvian psychiatry patients is very limited and it is connected with
lack of motivation for employers, changes in behaviour and thinking of patients
after getting ill.
The results of the research of Narcological comorbidity in psychiatry evidenced
that comorbides pathologies for psychiatry patients have not been sufficiently
diagnosed, and it may adversely impact the treatment and patients' care. Special
30. attention in development of psychiatry should be paid to the problem of use of
alcohol by mental patients, and the work of narcological and psychiatry services
should be coordinated and combined.
In the framework of results gained, also the situation in Latvian psychiatry before
regaining of independence was assessed by marking the most essential problems of
those times — poverty of the service, focus on hospital assistance, non-
observance of human rights of patients, formal introduction of different
innovations in patients' care, miserable situation in forensic psychiatry. In order to
achieve the objective of the research in a more successful manner, major
significance is paid not only to proper evaluation of social issues, but also to
establishment of out-patient assistance service, supply of medicaments for as far as
possible larger number of patients, involvement of sufficient and qualified mental
health specialists, as well as ensuring of adequate financing and consolidation of
services.
Taking into account the results gained in the research, their assessment and
conclusions made, according to the order No. 159 of the Health Minister of
September 14, 2004 ,,On Setting up of a Work Group") and in cooperation with the
World Health Organization, a policy document was developed and submitted to the
Ministry of Health: ,,Mental health improvement of population in 2006— 2016".
The above mentioned document includes such mental health ensuring elements as
solution of mental health problems in the primary care level, ensuring of
psychotropic medicaments, development of community-based mental health service,
ensuring of personnel resources, ensuring of financing, involvement of the
community stakeholders, mental health service users and their family members in the
medical care, preparation of legislative support in the area of mental health, ensuring
of information system, enforcement of a special program for risk group patients -
children, teenagers and old people, prevention of mental health problems and
suicides, promotion of researches and enforcement of mental health campaigns.
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