Research Objectives: Osteoporosis has become a significant public health problem in recent years, especially with the growth of the elderly population. Osteoporotic fractures exact a terrible toll on the population with respect to morbidity, cost, and to a lesser extent mortality. These effects can lead to psychological problems, social consequences, functional limitations, and poor quality of life. Thus, knowledge regarding osteoporotic fractures is needed to evaluate the impact of osteoporotic fractures on society, to identify high-risk populations, and to help policymakers to allocate resources accordingly. This study aims to investigate the influence factors of hospital readmissions among osteoporotic fractures patients in Taiwan, and the study results are expected to increase our understanding of the magnitude of the elderly population suffering from osteoporotic fractures and to urge policymakers to develop effective national prevention strategies. Study Design: Using Taiwan¡¦s National Health Insurance database, we identified elderly patients with a hospitalization for osteoporotic fractures between 2001 and 2007. We divided readmissions into different groups (14-day, 30-day, 180-day and over 180-day) and evaluated each group¡¦s demographic, hospital characteristics, and Charlson Comorbidity Index. The claims data are also used to calculate the health services utilization of osteoporotic fractures among those elderly patients with or without readmission of osteoporotic fractures. The data analyses were carried out by Chi-square test, t test, multiple linear regression and multivariate logistic regression. Population Studied: Patients aged 50 or older with osteoporotic fractures were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Principle Findings: Among 5483 osteoporotic fractures patients, 6.9% of them were readmitted within 14 days, 34.7% were readmitted within 30 days and 13.9% were readmitted within 180 days. The medical resource utilizations were significantly higher in patients with readmissions than those without readmission. Age and Charlson Comorbidity Index were significantly affected the probabilities of readmissions. Conclusion: From the perspective of health policy, the issue of osteoporotic fractures will become increasingly important in the future. This national study will help raise awareness of osteoporotic fractures and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent osteoporotic fractures.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2002. / Vita. Includes bibliographical references (leaves 94-104).

Pediatric OCD is frequently complicated by co-occurrences with ADHD, mood and anxiety disorders. Although each of these disorders is associated with impaired self-regulation, there has been little examination of impaired self-regulation (i.e., dysregulation) in youth with OCD. Dysregulation is characterized by affective, behavioral and cognitive problems, and can be assessed using the Child Behavior Checklist-Dysregulation Profile (CBCL-DP). Dysregulation may help account for the varied yet related findings identified for symptom severity, impairment and treatment outcome in pediatric OCD. This study examined the role of dysregulation on symptom severity, impairment and treatment outcome in a large sample of youth with OCD. A total of 144 youth with primary OCD participated in this study. Clinicians administered the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Clinical Global Impression of Severity (CGI-S) and a 13-item scale of family accommodation. Children completed the Multidimensional Anxiety Scale for Children (MASC), and the Child Depression Inventory (CDI). Parents completed the CBCL, with both children and parents completing parallel versions of the Child OCD Impact Scale (COIS-C/P). Within this sample, 97 of these youth received exposure-based CBT and completed the same assessment battery along with the Clinical Global Impression of Improvement (CGI-I) after treatment. Twenty-nine youth (20%) with OCD met categorical criteria for dysregulation. Dysregulated youth had greater obsessive-compulsive symptom severity, depressive mood, and exhibited greater rates of family accommodation and impairment than children without dysregulation. Hierarchical regressions revealed that the level of dysregulation predicted child-and-parent rated impairment, above and beyond obsessive-compulsive severity. Additionally, dysregulation predicted clinician-rated family accommodation above and beyond obsessive-compulsive severity. When examining treatment outcome to exposure-based CBT, a logistic regression indicated that baseline dysregulation did not predict treatment responder status. Although not predicting treatment response, it was found that youth who discontinued treatment (18%) had significantly higher dysregulation than youth who completed treatment (p < .02). For youth who completed exposure-based CBT, a significant decrease in obsessive-compulsive symptom severity and dysregulation was observed (p < .01). Collectively, these findings suggest that youth with OCD and dysregulation experience more severe symptoms and have greater impairment than youth with more regulated functioning. As dysregulation was associated with treatment discontinuation, dysregulated youth with OCD may require more individualized interventions to treat dysregulated behavior prior to receiving exposure-based CBT. For youth who complete treatment, exposure-based CBT reduces obsessive-compulsive symptom severity and its benefits generalize to reductions in dysregulated behaviors as well.

Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n=3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.

The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings. The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals. The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness. The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ. The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.

Introduction: This thesis examined the impact of PTSD with Major Depressive Disorder on PTSD severity among Toronto Transit Commission employees who were exposed to a workplace traumatic event, and also the predictors of PTSD severity, mental health treatment seeking, and return to work over the six month study period. Methods: This study utilized data that was collected prospectively from the APT study participants. Information about Axis-I diagnosis and PTSD severity were collected from the SCID-I and the Modified PTSD Symptom Scale respectively. Results: PTSD without MDD (N=29) and PTSD with MDD (N=37) groups were compared. The variables: depression severity (p=0.01), female (p=0.01), non-Caucasian (p=0.01), workplace related stress (p=0.02), and lifetime trauma (p=0.01) significantly predicted PTSD severity. The BPI group significantly predicted mental health treatment seeking (p<0.01) after controlling other variables. Conclusion: This study highlights the substantial risk for experiencing greater PTSD severity after a workplace traumatic event in TTC employees.

Introduction: This thesis examined the impact of PTSD with Major Depressive Disorder on PTSD severity among Toronto Transit Commission employees who were exposed to a workplace traumatic event, and also the predictors of PTSD severity, mental health treatment seeking, and return to work over the six month study period. Methods: This study utilized data that was collected prospectively from the APT study participants. Information about Axis-I diagnosis and PTSD severity were collected from the SCID-I and the Modified PTSD Symptom Scale respectively. Results: PTSD without MDD (N=29) and PTSD with MDD (N=37) groups were compared. The variables: depression severity (p=0.01), female (p=0.01), non-Caucasian (p=0.01), workplace related stress (p=0.02), and lifetime trauma (p=0.01) significantly predicted PTSD severity. The BPI group significantly predicted mental health treatment seeking (p<0.01) after controlling other variables. Conclusion: This study highlights the substantial risk for experiencing greater PTSD severity after a workplace traumatic event in TTC employees.

The current study examined the efficacy of various neuropsychological measures for differentiating ADHD and comorbid ADHD from malingered ADHD in a large state university sample. The sample consisted of 23 nonclinical individuals assigned to malinger ADHD (NLM), 9 nonclinical individuals responding honestly (NLH), 22 individuals with diagnoses of ADHD only (ADHD-H), 9 individuals with comorbid ADHD/Learning Disorder presentations (ADHD-LD), and 13 individuals with comorbid ADHD/Anxiety presentations (ADHD-ANX). Due to limited sample sizes, the ADHD-LD and ADHD-ANX participants were pooled to create a comorbid ADHD group (ADHD-CO n = 22). The study utilized a simulation design with a NLM group instructed to feign ADHD while the other groups responded under standard instructions. The TOMM, LMT, NV-MSVT, and CTIP variables performed well, but the DMT did not. The WAIS-IV and WJ-III variables did not adequately differentiate malingered and comorbid ADHD.

The focus of this study was on common psychiatric comorbidities of depression and anxiety in people with epilepsy (PWE). While international published data show that up to 60% of PWE suffer from depression and/or anxiety, most primary care (PHC) settings in developed countries display some oversight in this area. The study was conducted in Zambia, in three phases; which each culminated in submissions for publication in an internationally peer reviewed journal. Phase one involved chart review to establish the rate of detection of depression and/or anxiety in PWE at the outpatient clinic of Chainama Hills College Hospital. The detection rate was only 1%. This formed the basis for phase two where we developed a ten item screening tool for depression and/or anxiety for use by PHC workers in busy clinical settings. The tool was validated, its sensitivity and specificity were determined and the inter-rater reliability was also calculated. Phase three involved implementation of the tool validated screening tool. We measured the ability of PHC workers to use and interpret the screening tool in busy clinical settings. One month after training and implementing the use of the screening tool, a retrospective chart review was undertaken using the same tool that was employed in phase one chart review. There was a marked improvement when 120 files of PWE were reviewed as the percentage of screening for depression and anxiety increased from 1% to 49%. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2014.