(Abstract) This thesis is called "The importance of activation in seniors in field and outpatient social services" includes the theoretical part as a conceptualization of the empirical part. It describes the activities and services contained in the questionnaire survey. The results of the surfy, by using the questionnaires, confirmed the hypothesis. It can now be said that seniors are using outreach social services, they are more interested in activities more than seniors are using outpatient social services - in particular it is the physical activities of women over 85 years of age. In conclusion, the greatest interest was in physical activities which support the maintenance of mobility and hence the promotion of self-sufficiency.

BACKGROUND: Despite the high number of methamphetamine users in the Czech Republic, the treatment is still only abstinent. Pharmacotherapy in terms of substitution treatment is not yet in place. No study has yet been conducted to examine the views of workers working with methamphetamine users on the possibility of introducing substitution treatment for methamphetamine dependence in the Czech Republic. OBJECTIVE: The aim of the practical part was to map the opinions of outpatient staff on the possibility of introducing substitution treatment for methamphetamine dependence. The monitored area included the evaluation of the success of the treatment of methamphetamine dependence in outpatient settings, disparity in working with users by substance use, percentage of methamphetamine users in the facilities, the suitability of drug addiction to methamphetamine for clients of outpatient facilities and position of substitution treatment for methamphetamine, according to respondents. METHOD: The sample was elected on the basis of deliberate targeted selection through the institutions. Data capture was performed using a semi-structured interview method, which was recorded using audio recording and then transcribed. The data capture method was used to analyze the data. FILES: The research team consisted of...

A depressão tem sido associada a um maior absenteísmo e uso de serviços de saúde e, sua prevalência em pacientes de atenção primária no momento da avaliação é em torno de 10%. Este estudo teve como objetivo, investigar em uma amostra de uma ambulatório de clínica médica de um hospital escola (Ambulatório Geral e Didático do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo), a associação entre: a) transtorno depressivo maior e utilização de serviços de saúde, b) outras depressões e utilização de serviços de saúde, c) transtorno depressivo maior e absenteísmo, d) outras depressões e absenteísmo. MÉTODOS: Dezenove médicos clínicos gerais aplicaram o Primary Care Evaluation of Mental Disorders (Prime-Md) e questões para avaliar o uso de serviços de saúde e absenteísmo no período de 12 meses antes da entrevista, em 414 pacientes. O Prime-Md é uma entrevista para diagnosticar os transtornos mentais mais comuns em atenção primária, desenvolvido para entrevistadores não especialistas. Os transtornos depressivos pesquisados pelo Prime-MD são: transtorno depressivo maior, transtorno depressivo distímico, transtorno depressivo menor, remissão parcial de transtorno depressivo maior, transtorno depressivo bipolar e transtorno depressivo devido a doenças ou uso de substâncias. O diagnóstico segue os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) da Associação Psiquiátrica Americana. A análise estatística comparou três grupos: pacientes com transtorno depressivo maior (N=144), pacientes com outras depressões (N=82) e pacientes sem depressão (N=188). As comparações foram feitas pelo teste do Qui-quadrado ou Mann-Whitney. Dois modelos de regressão logística foram gerados com absenteísmo como variável dependente. A variável independente em um modelo foi o transtorno depressivo maior e no outro o grupo com outras depressões. O modelos foram ajustados para: idade, sexo, estado civil e presença de doença clínica. RESULTADOS: Pacientes com transtorno depressivo maior procuram serviços de saúde em um número significativamente maior do que aqueles sem depressão (p=0,0005). O grupo de pacientes com transtorno depressivo maior e o grupo com outras depressões apresentaram mais absenteísmo (sim/não) ao trabalho, atividades domésticas ou à escola, do que aqueles sem depressão, as diferenças também foram significativas para o número de dias perdidos. De acordo com a análise de regressão logística, pacientes com transtorno depressivo maior apresentaram uma razão de chance (odds ratio) de 1,80 (p=0,015; 95% IC, 1,12-2,90) vezes maior de ter absenteísmo quando comparados com aqueles sem depressão; para pacientes com outras depressões a razão de chance em relação àqueles sem depressão foi de 1,89 (p=0,026; 95%IC, 1,05-5,17) vezes maior. Não encontramos diferenças significativas entre os três grupos quanto ao sexo, idade, estado civil, tipo de serviço procurado (pronto-socorro ou ambulatório/posto de saúde), ocorrência de hospitalização ou doenças crônicas. CONCLUSÕES: O transtorno depressivo maior se associou significativamente com uma maior procura por serviços de saúde. Ambos, o transtorno depressivo maior e o grupo com outras depressões se associaram significativamente com absenteísmo. Nosso estudo não é prospectivo, o que restringe conclusões etiológicas. Entretanto, de acordo com dados da literatura, nossos resultados provavelmente indicam que a presença de transtornos depressivos acarreta maior uso do sistema de saúde e maior absenteísmo ao trabalho ou a atividades acadêmicas. Alem disso, o impacto sobre absenteísmo se estende para formas mais leves de depressão e é independente da idade, sexo, estado civil ou presença de doenças clínicas / Depression has been associated with increased absenteeism and use of health care services, and its current prevalence in primary care patients is around 10%. This study aimed to investigate in outpatients at their first visit in a general medical unit of a teaching hospital (Ambulatório Geral Didático do Hospital das Clínicas da Universidade de São Paulo) the association of: a) major depressive disorder and use of health care services, b) other depressive disorders and the use of health care services, c) major depressive disorder and absenteeism, d) other depressive disorders and absenteeism. METHODS: Nineteen clinicians used the Prime-Md and questions to assess absenteeism and the use of health care facilities in the period of 12 months before the study evaluation in 414 outpatients. The Prime-Md is an interview targeted for most common mental disorders in primary care, and developed for non-specialized interviewers. The depressive disorders evaluated by Prime-Md are: major depressive disorder, dysthymic disorder, minor depression, partial remission of a major depressive disorder, depressive disorder in bipolar, and depressive disorder due to general medical conditions or substance use. The diagnosis is based on the Diagnostic and Statistical Manual of Mental Disorders-3rd Edition (DSM -III-RAmerican Psychiatric Association). The statistical analysis compared three groups: patients with major depressive disorders (N=144), patients with other depressions (N=82), and patients without depression (N=188). The comparisons were done with the Chi-square or the Mann-Whitney test. Two logistic regression models were generated with absenteeism as the dependent variable. The independent variable in one model was the presence of major depressive disorder and in the other the presence of presence of other depressions. The models were adjusted for age, gender, marital status and presence of general medical condition. RESULTS: Patients with major depressive disorder presented a significantly higher number of visits to health care services compared to those without depression (p=0.0005). The group of patients with major depressive disorder and the group with other depressive disorders presented more absenteeism (yes/no) from work, home duties, or school compared to patients without depression; the differences were also significant for the number of lost days. According to the logistic regression analysis, patients with major depressive disorder presented an odds ratio of 1.80 (p=0.015; 95%CI, 1.12-2.90) to have absenteeism compared to patients without depression; the odds ratio to have absenteeism for patients with other depressions compared to those without depression was 1.89 (p=0.026; 95%CI, 1.05-5.17). We did not find significant differences among the three groups regarding gender, age, marital status, type of visited service (i.e. emergency room or outpatient clinic), hospitalizations, or presence of general medical conditions. CONCLUSIONS: Major depressive disorder was significantly associated with an increased number of visits to health services. Either major depressive disorder or the group with other depressions were significantly associated with increased absenteeism. Our study is not prospective, which restricts etiologic conclusions. However, based on the literature, our results probably indicate that the presence of depressive disorders leads to an increased use of the health system and increased absenteeism from work, home duties or school. Moreover, the impact on absenteeism extends to milder depressive disorders and is independ of age, gender, marital status or the presence of general medical condition

Abstract The purpose of this study was to investigate treatment adherence among adolescents receiving mental health care, with a special focus on psychiatric inpatient treatment. Key goals were to derive a general definition of adherence suitable for this purpose and to assess adolescents’ adherence to medication and non-pharmacological treatments. This study had two phases; phase one involved conducting systematic literature reviews, and phase two was based on empirical research in which data were collected by analyzing notes on hospital patients. The aim of the reviews were to review current research evidence into treatment adherence in adolescents and factors relating adherence among adolescents receiving mental health care (original publication n=15 and original publication n=17). Phase two was part of a clinical follow-up project called STUDY-70 conducted at the Department of Psychiatry at Oulu University Hospital in Finland. This phase yielded two further original publications – papers III and IV. Paper III examined adherence among adolescents receiving psychiatric inpatient care (n=72), focusing on both medication and non-pharmacological treatments. Paper IV examined factors affecting treatment adherence among these 72 inpatient adolescents, including family- and clinic-related variables. The systematic reviews demonstrated that many different definitions of adherence have been used in the literature. A concept synthesis was applied to these definitions to establish a basis for empirical research. The main factors that were found to correlate positively with treatment adherence among adolescents were the patients’ own will to be treated and positive sentiments, but family also played an important role. Factors that correlated negatively with adherence included negative feelings, a lack of cooperation with treatment, and adverse mental symptoms. Adolescent who has received special support at school was found to favor treatment adherence, whereas involuntary treatment, self-mutilative behavior and a close maternal relationship were all linked to non-adherence. Treatment adherence is an ongoing process, and achieving high levels of adherence should be an important goal in all treatment processes. It is important for clinical staff to be aware of factors influencing adherence in order to support the provision of effective and high-quality care for adolescents. / Tiivistelmä Tutkimuksen tarkoituksena oli selvittää mielenterveyspalveluita käyttävien nuorien hoitoon sitoutumista ja erityisesti psykiatrisessa osastohoidossa olevan nuoren sitoutumista hoitoon. Keskeisinä tavoitteina oli kuvata hoitoon sitoutumisen määrittelyä ja arvioida nuoren sitoutumista lääke- ja ei-lääkinnälliseen hoitoon. Tutkimus sisälsi kaksi vaihetta: vaihe yksi systemaattiset kirjallisuuskatsaukset sekä vaihe kaksi empiirisen tutkimuksen, jossa tieto kerättiin analysoimalla potilasasiakirjoja. Systemaattisen kirjallisuuskatsauksen tarkoituksena oli selvittää nuoren hoitoon sitoutumista ja siihen yhteydessä olevia tekijöitä (alkuperäisjulkaisu I n=15, alkuperäisjulkaisu II n=17). Vaihe kaksi oli osa Oulun yliopistollisen sairaalan psykiatrian klinikan projektia, STUDY-70, joka tuotti kaksi osajulkaisua. Alkuperäisjulkaisun III tarkoituksena oli tutkia osastohoidossa olevan nuoren sitoutumista lääke- sekä ei lääkinnälliseen hoitoon (n=72). Alkuperäisjulkaisussa IV selvitettiin näiden nuoren sitoutumista hoitoon ja erityinen mielenkiinto tässä tutkimuksessa oli perhe- ja kliinisillä tekijöillä sitoutuminen (n=72). Systemaattisen kirjallisuuskatsauksen perusteella sitoutumisen määrittelyt vaihtelivat. Tästä huolimatta käsitteen määrittelyjen synteesi oli mahdollinen ja se loi pohjan empiiriselle tutkimukselle. Tämän tutkimuksen perusteella nuoren oma tahto ja positiivinen asenne olivat positiivisesti yhteydessä hoitoon sitoutumiseen. Myös perheen toiminta vaikutti hoitoon sitoutumiseen. Nuoren negatiiviset tunteet, yhteistyökyvyttömyys ja mielenterveysoireet vaikuttivat negatiivisesti sitoutumiseen. Lisäksi nuoren saamat erityispalvelut koulussa tukivat osastohoidossa olevan nuoren hoitoon sitoutumista. Vastentahtoinen hoito, viiltely sekä läheinen ja kestävä äitisuhde olivat yhteydessä sitoutumattomuuteen. Hoitoon sitoutuminen on kokonaisvaltainen prosessi ja yksi hoidon tavoitteista, joka voidaan saavuttaa. Hoitoon sitoutumisen edistämiseksi henkilökunnan tulee tiedostaa ne tekijät, jotka vaikuttavat hoitoon sitoutumiseen. Näin voidaan suunnitella ja toteuttaa laadukasta ja vaikuttavaa hoitoa.

Le virus chikungunya est un arbovirus, transmis par les moustiques du genre Aedes, qui provoque des arthralgies invalidantes et parfois des rhumatismes chroniques. Dans une première partie nous avons décrit les aspects ambulatoires cliniques, biologiques et virologiques du chikungunya (CHIK) de la phase aiguë jusqu'au 300ème jour lors de l’épidémie de la Réunion en 2006. Des scores d’aide au diagnostic ont été élaboré et une étude de la diversité virale intra-hôte a été réalisée. Pour compléter nos premiers résultats nous avons étudié une épidémie survenue en République du Congo en 2011. La description clinique était similaire à celle identifiée lors de l’épidémie de la Réunion. L’évaluation du score clinique ne permettait pas de le proposer comme outil diagnostique à l’échelle individuelle mais apparaissait comme un bon marqueur pour le suivi de la courbe épidémique. Une étude de séroprévalence et une analyse phylogénétique complètent ce travail. Le dernier travail porte sur l’utilisation de la chloroquine à la phase aiguë du CHIK lors d’une prise prophylactique chez le singe et lors d’un essai clinique chez l’homme. Le principal effet de ce type de traitement semble lié son action immuno-modulatrice ; en prise préventive il provoque une exacerbation de la symptomatologie aiguë tandis qu’en prise à la phase précoce de la maladie il augmente le risque d’évolution vers des arthralgies chroniques. En conclusion nous avons réalisé une description des formes ambulatoires du CHIK, identifié des facteurs de risques de formes chroniques, proposé des scores d’aide au diagnostic et argumenté la contre-indication de l’utilisation de la chloroquine à la phase aiguë du CHIK. / Chikungunya virus (CHIKV) is an arthropod-borne virus transmitted by Aedes mosquitoes that cause debilitating arthralgia and possible chronic rheumatism. In the first part we describe the clinical, biological and virological presentation of outpatients with chikungunya disease (CHIK) from the acute stage to the chronic stage at day 300, during the outbreak in the Reunion Island in 2006. We elaborated scores for CHIK diagnosis and we also analysed the intra-host genetic diversity.To complete our first results, we investigated a CHIKV outbreak, which occurred in the Republic of Congo in 2011. The clinical presentation was similar to the first description of the Reunion island outbreak. We assessed the clinical score which appeared to be unusable at the individual level but was still relevant to follow the epidemic curve. This work was completed by seroprevalence and phylogenetic analyses.The last study presented in this thesis focused on the use of chloroquine during the acute stage of CHIK in a non-human primate (NHP) model (prophylactic use) and during a clinical trial (therapeutic use). The main effect of chloroquine treatment at the acute stage of CHIK appeared to be related to its immuno-modulatory action; in prophylactic taking, chloroquine exacerbated acute symptoms while treatment during the early stages of the disease increased the risk of acquiring chronic arthralgia.In conclusion, we provide a detailed description of CHIK outpatients and identify risk factors for the chronic stage of the disease. We propose tentative diagnostic scores and we firmly establish that the use of chloroquine at the acute phase of CHIK is contraindicated.

Cette thèse traite des effets des modes de régulation faisant appel à des intermédiaires pour promouvoir des cadres souples d’organisation. Ces effets sont analysés à travers un cas d’intermédiation dans le champ sanitaire français : la participation de l’Agence nationale d’appui à la performance des établissements de santé et médico-sociaux (ANAP) à l’axe virage ambulatoire du Plan triennal 2015-2017 de transformation du système de santé. Ce cas est abordé à travers une approche en régimes de gouvernementalité fondée sur les travaux de Michel Foucault. L’application de cette approche au cours d’une recherche-intervention de trois ans en partenariat avec l’ANAP permet de dévoiler de manière inductive les caractéristiques spécifiques du Plan triennal en tant que régime de régulation, ainsi que le fonctionnement de ce régime à l’échelle nationale, régionale et des établissements de santé. Cette approche amène également à dépasser la seule mesure de l’efficacité de l’intermédiation pour s’intéresser à l’explication de cette efficacité et s’interroger sur son utilité par rapport aux besoins des différentes parties prenantes du système de santé. Dans son ensemble, ce travail doctoral a des implications d’ordre méthodologique, théorique et pratique. Sur le plan méthodologique, il est proposé une démarche d’évaluation des effets des dispositifs de régulation reposant sur le changement organisationnel. Sur le plan théorique, sont identifiés trois effets de l’intermédiation – de capacitation contingente, de conjonction des véridictions et d’apprentissage alèthurgique – qui complètent les modèles existants de cette activité organisationnelle en développement. Enfin, sur le plan pratique, cette thèse suggère qu’un usage constructif de l’appareillage conceptuel foucaldien est possible en sciences de gestion et illustre cet emploi en formulant six préconisations à l’attention des acteurs de la régulation sanitaire en France, ainsi que cinq pistes de recherche pour les chercheurs qui souhaiteraient accompagner ces acteurs à l’avenir. / This dissertation addresses the effects of modes of regulation relying on intermediaries in order to promote soft organizational frameworks. For that purpose, I analyze a case of intermediation taking place in the French healthcare field : the participation of the National Agency for the Performance of Healthcare Facilities (NAPHF) in the outpatient shift programmed by the 2015-2017 Transformation Plan of the healthcare system. My approach, which draws on the work of Michel Foucault, consists in examining the regime of governmentality that has been implemented in that case. Having used that inductive approach during a three-year research intervention in partnership with the NAPHF, I unveil the specific features that have enabled the regulatory regime of the Transformation Plan to operate at the national, regional and intra-hospital levels. Furthermore, that approach leads beyond measuring the efficacy of intermediation to explaining its effectiveness and to questioning its usefulness for answering the needs of the different stakeholders of the healthcare system. As a whole, this doctoral thesis bears methodological, theoretical, and practical implications. On the methodological side, I propose a method for evaluating the effects of regulatory tools aimed at fostering organizational change. On the theoretical side, I supplement existing models for understanding intermediation by identifying three effects of that organizational activity, which is currently expanding. Those effect are namely: contingent capacity-building, conjoined truth-telling, and alethurgic learning. On the practical side, my work suggests that management scholars may use the conceptual apparatus inherited from Michel Foucault in a constructive manner. I illustrate the potential benefits of that constructive stance by providing six recommendations for improving the regulation of the French healthcare system as well as five possible orientations for researchers who are seeking to help the actors of that system in the future.

Lesbian, gay, and bisexual (LGB) individuals have elevated rates of substance use disorders and present to treatment with more severe substance use problems. Despite this health disparity, recent reviews highlight the paucity of studies reporting sexual orientation in substance use research (e.g., Flentje, Bacca, & Cochran, 2015). Using data from 5 clinical trials of contingency management (CM), the current study investigated the impact of sexual orientation on 3 substance use outcomes: treatment retention, longest duration of abstinence, and percent negative samples submitted. Participants (N = 912; mean age = 36.6 years; 51.1% female; 45% African American, 42.2% Caucasian) were randomized to standard care in community-based intensive outpatient treatment (IOP) or the same plus CM. Patients identifying as LGB made up 10.6% of the sample. A significant proportion identified as bisexual (8.2% of the total sample). Regardless of sexual orientation, participants receiving CM achieved better treatment outcomes than those receiving IOP alone. There were no statistically significant differences between LGB and heterosexual participants in their response to IOP in general, and CM specifically, across all 3 treatment outcomes (ps < .05). However, equivalence testing revealed that outcomes were not statistically equivalent for LGB and heterosexual participants, with the exception of percentage of negative samples, which was equivalent within the CM group only. Differences in treatment response to CM and standard community-based IOP do not reach the level of statistical significance; however, in most cases, we cannot conclude that treatment response is equivalent for LGB and heterosexual individuals.

No description available.

Utilizing clients in decision-making, advocacy, and service delivery roles within the treatment environment is one means of providing the chronic mentally disabled with opportunities for participatory social roles, choice and control. However, client deficiencies of skill, experience, and motivation are suggested to be barriers to the successful accomplishment .of this purpose. Strategies are needed to overcome these barriers. Feedback has been shown to be an effective, low-cost tool for increasing accomplishment in work settings. The primary purpose of this study was to investigate the effectiveness of feedback in increasing the independent participation of a mental health consumer advisory group. This was investigated utilizing a multiple baseline design across the three behaviors required to fulfill the group's functions. A structured agenda, including all necessary tasks was also introduced for each of the three behaviors. While inclusion of a task as an agenda item was found to be sufficient to assure a high level of participation, consistency of this high level was increased with feedback. As the study progressed, the percentage of consumer generated tasks on the agenda increased. Results suggest that while this mental health consumer group initially lacked the skills and knowledge to specify the tasks required to fulfill its functions when the tasks were specified, the group generally performed them with a high level of independent participation. This study also suggests that, with experience, skills and knowledge increased resulting in increased consumer group independence in specifying the tasks required to structure the agenda and fulfill its roles.

Hintergrund: Der Artikel berichtet Ergebnisse einer kontrollierten Studie zu Effekten einer Minimalintervention in der Wartezeit auf Beginn einer ambulanten Psychotherapie. Methoden: 75 Personen, die sich in einer universitären Verhaltenstherapieambulanz aufgrund von Angst- oder depressiven Störungen anmeldeten, wurden parallelisiert nach Alter, Geschlecht und Diagnose zwei Bedingungen zugeordnet. Die Versuchsgruppe (VG) erhielt während der Wartezeit auf den Behandlungsplatz bibliotherapeutische Materialien; die Kontrollgruppe (KG) wartete ohne Intervention. Vor und nach der Wartezeit wurden Einstellungen und Erwartungen zur Behandlung, nach der Wartezeit zusätzlich die Zufriedenheit mit der behandelnden Einrichtung sowie das Hilfesuchverhalten während der Wartezeit erhoben. Ergebnisse: Es konnten keine global positiven Effekte der Wartezeitintervention nachgewiesen werden. Es fanden sich lediglich zwei grundlegende Gruppenunterschiede: Die Teilnehmer der VG beurteilten sich subjektiv als besser vorbereitet auf Wartezeit und Therapie, und ihre Angst vor Stigmatisierung hatte sich signifikant reduziert. Weiterführende Analysen in einzelnen Patientengruppen ergaben zusätzlich Hinweise darauf, dass Angstpatienten und Patienten mit geringem Vorwissen mehr von der Maßnahme profitierten; allerdings traten bei einigen Patienten mit depressiven Störungen auch negative Effekte durch die Minimalintervention auf. Schlussfolgerung: Die Befunde erlauben eine differenziertere Bewertung der Frage, ob und in welcher Form unspezifische minimale Interventionen während der Wartezeit auf Psychotherapie nutzbringend sind. Weiterführende Studien sollten die differenzielle Wirksamkeit spezifischerer Maßnahmen in ausgewählten Patientengruppen prüfen. / The article describes a controlled study that explores effects of a minimal intervention for outpatients waiting for their behavior therapy to start. Methods: Patients applying for psychotherapy for anxiety disorders or depression at an outpatient psychotherapy unit, matched for age, sex and diagnosis, were assigned to either a waiting list as usual (WL) or to an active waiting group (AW) that received bibliotherapeutic materials. Attitudes towards treatment and therapy expectations were assessed before and after waiting time; consumer satisfaction and help-seeking behavior during the waiting time were assessed post waiting. Results: After the waiting time, the two groups differed only in their fear of stigmatization, which had significantly declined in the AW group, and in the subjective preparedness for waiting list and treatment. Additional analyses regarding different patient groups suggested that especially patients with anxiety disorders and patients with little knowledge about psychotherapy benefited from the intervention; on the other hand, some patients with depressive disorders reported negative effects due to the minimal intervention. Conclusions: Findings point out the need for a more sophisticated evaluation of minimal interventions for patients waiting for psychotherapy. Further studies should clarify the differential effectiveness of custom-tailored interventions addressing specific patient populations. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.