Empirical assessment of the self-medication hypothesis among dually diagnosed inpatients

The aim of this study was to empirically determine the expected effects of drugs of abuse on the psychiatric symptoms of individuals dependent on alcohol and other drugs to assess the validity of the self-medication hypothesis, defined as motivation of patients to seek a specific drug for relief of a particular set of symptoms. Eight-three inpatients in a large metropolitan hospital with an axis I diagnosis of one drug dependence and an axis II diagnosis of personality disorder completed the Hopkins Symptom Checklist-Revised (HSCL-90-R) and the Neuropsychological Impairment Scale (NIS). They also reported the effect of their drug of choice on each of the symptoms included in both tests. Heroin addicts reported that heroin improved some of their psychiatric symptoms and all of their cognitive dysfunctions. Both cocaine and alcohol users reported that their drug of choice worsened their psychiatric and cognitive symptoms. No relationship was found between frequency or severity of symptoms and drug choice. We concluded that attempts at self-medication may have occurred among heroin addicts, but were unlikely among alcoholics and cocaine addicts. We found no evidence in support of the self-medication hypothesis as a necessary reinforcer of continued drug use.     

Impact of risk-adjusting cesarean delivery rates when reporting hospital performance

CONTEXT: Hospitals and health plans are often ranked on rates of cesarean delivery, under the assumption that lower rates reflect more appropriate, more efficient care. However, most rankings do not account for patient factors that affect the likelihood of cesarean delivery. OBJECTIVE: To compare hospital cesarean delivery rates before and after adjusting for clinical risk factors that increase the likelihood of cesarean delivery. DESIGN: Retrospective cohort study. SETTING: Twenty-one hospitals in northeast Ohio. PATIENTS: A total of 26127 women without prior cesarean deliveries admitted for labor and delivery from January 1993 through June 1995. MAIN OUTCOME MEASURES: Hospital rankings based on observed and risk-adjusted cesarean delivery rates. RESULTS: The overall cesarean delivery rate was 15.9% and varied (P<.001) from 6.3% to 26.5% in individual hospitals. Adjusted rates varied from 8.4% to 22.0%. The correlation between unadjusted and adjusted hospital rankings (ie, 1-21) was only modest (R=0.35, P=.12). Whereas 7 hospitals were classified as outliers (ie, had rates higher or lower [P<.05] than overall rate) on the basis of both unadjusted and adjusted rates, outlier status changed for 5 hospitals (24%), including 2 that changed from outliers to nonoutliers, 2 that changed from nonoutliers to outliers, and 1 that changed from a high outlier to a low outlier. CONCLUSIONS: Cesarean delivery rates varied across hospitals in a single metropolitan region. However, rankings that fail to account for clinical factors that increase the risk of cesarean delivery may be methodologically biased and misleading to the public.     

Quality ratings of a hospital foodservice department by inpatients and postdischarge patients

OBJECTIVES: To examine quality of food and nutrition services using the ratings of inpatients and patients who had been discharged (postdischarge patients). DESIGN: Questionnaires were used to collect perceptions of inpatients and postdischarge patients on the quality of food and nutrition services. A 5-point scale allowed subjects to rate quality from very poor to very good. SUBJECTS: Questionnaires were completed by 252 inpatients and 437 postdischarge patients of a midwestern teaching hospital. STATISTICAL ANALYSIS: Analysis of variance was used to assess differences in quality ratings on the basis of demographic variables. Stepwise regression was used to determine variables that best predicted overall satisfaction. Paired t tests were conducted to compare matched inpatient and postdischarge ratings. RESULTS: Ratings of food and nutrition services indicated that patients were satisfied; few differences were found in ratings on the basis of patient demographics. Food quality was the best predictor of overall satisfaction for both inpatients and postdischarge patients. As patient expectations were increasingly met or exceeded, patient ratings of quality increased. The majority of patients in the matched sample gave the same ratings on the inpatient and postdischarge questionnaires. APPLICATIONS: Foodservice managers who desire to improve patient satisfaction should focus attention on meeting or exceeding patient expectations for food quality.     

Completeness of skin regeneration

Healing of the wound involving full thickness of the skin was investigated in carnivorous mammals (cats, foxes, polar foxes). Square wounds (2.2 cm2) were inflicted on the back and the head of cats and onthe thigh of foxes and polar foxes. In all the animals investigated the wounds closed chiefly by contracture of their margins. A small regenerate was formed in the centre of the wounds; its structure was almost the same as that of the intact skin: there were hair and sebaceous glands. Connective tissue skeleton of the regenerate resembled the derma by the fiber distribution.     

Measuring delirium severity in older general hospital inpatients without dementia. The Delirium Severity Scale

The authors evaluated the validity, reliability, and sensitivity to change of the Delirium Severity Scale (DSS), a 10-minute assessment consisting of Forward Digit Span and Similarities. Twenty-two older inpatients with delirium but not dementia and 15 control patients were administered the DSS during hospitalization. Scores were significantly inversely correlated with experts' quantitative ratings of severity at all three time-points examined. The DSS showed significant improvement over time (P < 0.001) and significant correlation with improvement in expert ratings (P = 0.026). The DSS shows promise as a valid and reliable measure sensitive to changing symptom severity.     

Treatment of aggression for an adult diagnosed with schizophrenia at a public psychiatric hospital.

The effectiveness of a behavioral program to treat chronic aggression in an adult male individual diagnosed with schizophrenia at a public psychiatric hospital was evaluated. A behavioral plan was developed to provide the client with positive social interactions, social skills training, and positive reinforcement for prosocial behavior; no negative consequences were implemented. The number of aggressive acts declined with the introduction of the behavioral plan and ultimately remitted even without ongoing reinforcers. This article demonstrates the value of psychological intervention in treating aggression with a treatment-resistant client in an in-patient setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Geographic distribution of medical supplies and the numbers of hospital inpatients in the secondary medical areas in Japan

A secondary medical area is defined as a medical administrative area under the Medical Care Law by which every prefectural government is expected to provide general medical care supplies such as beds for inpatients. This study evaluated the distribution in medical supplies among the secondary medical areas in Japan and the correlation between medical supply and demand. The numbers of hospital inpatients (residence of patients), physicians, and general beds excluding those for mental disorders and tuberculosis were analysed in relation to the population in all secondary medical areas in Japan. Those data were obtained from surveys conducted by the Ministry of Health and Welfare. The main results were as follows; 1) The distribution of physicians and general hospital beds among the secondary medical areas was not equal. 2) Even adjusted for the sex and age distribution, the highest hospital inpatients/population ratio among the secondary medical areas was four times as large as that of the lowest. 3) With multiple regression models, two independent variables (normal hospital beds/population ratio and aged 65 and over/total population ratio) accounted about 60% of the variance in hospital inpatients/population ratio. 4) The differences in medical supplies among the secondary medical areas may cause the differences in hospital inpatients/population ratio.     

Child abuse reporting decisions: Effects of statutory wording of reporting requirements.

Surveyed 297 licensed psychologists from Illinois and Washington to investigate the impact of statutory wording of reporting requirements on clinicians' decisions of whether or not to report child abuse. Participants each read a vignette of either a child showing signs of abuse or of an adult client showing signs of being abusive and indicated their initial likelihood of reporting and then their likelihood of reporting after reading either a law with broad reporting requirements or a law with narrow reporting requirements. Reading either law increased decisions to report the child case; however, reporting of the adult case decreased under the narrow law, which required observation of the abused child. Results support and extend earlier studies that demonstrate the direct effects of statutory wording on clinicians' reporting of suspected child abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychiatric performance of HIV-infected patients

AIM: Can neuropsychic impairment which is clinically observed in the case of HIV-infected patients be objectivized, and what is the relationship to somatic features caused by the disease? PATIENTS AND METHOD: 65 HIV-infected men with no history of drug-addiction were examined by means of a test battery which monitored the functions memory/concentration and speed of response. The probands were then compared to a healthy control group which was parallelized with respect to age, sex and education. Immune status, HIV and AIDS associated symptoms as well as educational diseases were checked for their connection with neuropsychic impairment. RESULTS: Compared to healthy persons HIV patients presented significant deficits with respect to memory and concentration but showed no reduction of speed of response. Significant correlation could be determined with only one somatic feature: Half of the patients who had lost more than 10% of their body weight during the preceding three months suffered from clinically relevant memory and concentration disorders. CONCLUSIONS: 1. The massive memory and concentration disorders impair and isolate the patients and can have considerable job-related consequences. 2. Measures preventing loss of weight should be initiated as early as possible. 3. Training sessions, e.g. nutritional consultation, must take the patients' deficits with respect to concentration and memory into consideration. 4. Possible connections between loss of weight and changes in brain metabolism should be examined. 5. Future studies should determine whether measures weight increase coincide with an improvement of memory and concentration.     

Survival prognosis of HIV-infected patients

This study investigated the secretory pattern of unstimulated minor salivary glands in 10 contiguous specified areas of the hard palate in 12 healthy unmedicated adult men and women. Each participant was assessed twice at each of two visits in the same specific palatal areas from the distal portion of the second molar to 30 mm anterior. The 10 areas were isolated, dried, and sampled with a paper strip for 60 seconds. The strips were read with a Periotron device. The rates of flow were significantly influenced by position; higher values were noted posteriorly and medially during testing and retesting at both visits. The rates of flow from the palatal glands were greatest in the area between the maxillary second molars. This method proved to be simple, accurate, and reliable for measuring the secretions of the palatal glands. This method may prove useful for investigating how the relationship between the pattern and the secretory rate of minor salivary glands influences retention of the complete maxillary denture.     

Evaluation of diarrhea in HIV-infected patients

Diarrhea is a major problem for patients infected with HIV: initial studies indicated that 50% of HIV-seropositive patients developed diarrhea, but this may be an underestimate. Diarrhea has an appreciable adverse affect on the quality of life of these patients; also, they use more health care facilities and health care dollars than HIV-positive patients without diarrhea. Individuals who have homosexuality or bisexuality as their HIV risk factor are more likely to have diarrhea and to have an enteric pathogen identified as the cause of diarrhea than are patients who have heterosexuality or intravenous drug use as their risk factor.     

The (un)reasonableness of reporting: Antecedents and consequences of reporting sexual harassment.

This study places the reporting of sexual harassment within an integrated model of the sexual harassment process. Two structural models were developed and tested in a sample (N=6,417) of male and female military personnel. The 1st model identifies determinants and effects of reporting; reporting did not improve--and at times worsened--job, psychological, and health outcomes. The authors argue that organizational responses to reports (i.e., organizational remedies, organizational minimization, and retaliation) as well as procedural satisfaction can account for these negative effects. The 2nd model examines these mediating mechanisms; results suggest that these mediators, and not reporting itself, are the source of the negative effects of reporting. Organizational and legal implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)