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Qiu N, Zhang T, Cheng J. Examining the impact of spatial accessibility to rehabilitation facilities on the degree of disability: A heterogeneity perspective. SSM Popul Health 2023; 23:101489. [PMID: 37588767 PMCID: PMC10425410 DOI: 10.1016/j.ssmph.2023.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
The positive effect of healthcare facilities on residents' health has been extensively studied. However, few studies have focused on the role of rehabilitation services as unique healthcare services for persons with disabilities. This study aimed to examine the relationship between the spatial accessibility of rehabilitation facilities and the degree of disability. To this end, an approach of measuring the spatial accessibility of rehabilitation facilities to persons with disabilities was proposed. This approach integrates multiple key elements including the characteristics of facilities (i.e., the capacity, frequency of use and service radius), characteristics of the mobility of persons with disabilities (i.e., the mode of travel, escort support, transportation fee and barrier-free environment requirements) and travel time obtained from a routing application programme interface. The accessibility of rehabilitation facilities was calculated at the neighbourhood level within the Central Urban Area of Tianjin Municipality. The ordinal logistic regression analysis revealed that higher accessibility to rehabilitation facilities generally corresponded to lower severity of disability. However, the impact varied depending on the type of disability. Increased accessibility was associated with greater severity of intellectual disability, whereas it was linked to reduced severity of visual, hearing, limb, mental and speech disabilities. It is suggested to incorporate disability diversity and the accessibility of rehabilitation facilities into spatial planning and governance.
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Affiliation(s)
- Ning Qiu
- School of Architecture and Urban Planning, Shandong Jianzhu University, China
| | | | - Jianquan Cheng
- Department of Natural Sciences, Manchester Metropolitan University, UK
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2
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Hernando-Merino E, Baca-García E, Barrigón ML. A One-Year Follow Up Study on Disability in Mental Health Nursing Practice. Clin Nurs Res 2023; 32:384-392. [PMID: 35135378 DOI: 10.1177/10547738211073721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Disability is common in patients with mental disorders, and therapeutic approaches should promote functional recovery to achieve the highest quality of life. This study reports changes in WHODAS 2.0 scores at 1 year of follow-up among patients receiving care from a single mental-health nurse in a community setting in Spain and compare these changes by diagnosis (SMI vs. CMI). Baseline and 1-year follow-up scores were compared. For all participants, we collected sociodemographic information, clinical diagnosis, and disability scores according to WHODAS 2.0. Participating patients received the usual, non-manualized nursing intervention. Our sample comprised 133 patients, 75 of whom were assessed after 1 year. All patients had improved WHODAS 2.0 scores (difference of 9.20 ± 2.42; p < .001) in all domains except those domains related to work ("Life activities") and relationships ("Getting along"). Furthermore, almost half of the patients studied were no longer undergoing treatment with the nurse at 1-year follow-up.
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Affiliation(s)
- Elena Hernando-Merino
- Hospital Universitario Infanta Elena, Valdemoro, España.,Hospital Clínico San Carlos, Madrid, España
| | - Enrique Baca-García
- Hospital Universitario Infanta Elena, Valdemoro, España.,Hospital Fundación Jiménez Díaz, Madrid, España.,Universidad Autónoma, Madrid, España.,Hospital Universitario Rey Juan Carlos, Móstoles, España.,Hospital General de Villalba, Madrid, España.,CIBERSAM (Centro de Investigación en Salud Mental), Instituto de Salud Carlos III, Madrid, España.,Universidad Católica del Maule, Talca, Chile
| | - Maria Luisa Barrigón
- Hospital Fundación Jiménez Díaz, Madrid, España.,Hospital Universitario Virgen del Rocío, Sevilla, España
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3
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Yang X, Yang H, Li N, Li C, Liang W, Zhang X. Increased serum homocysteine in first episode and drug-naïve individuals with schizophrenia: sex differences and correlations with clinical symptoms. BMC Psychiatry 2022; 22:759. [PMID: 36463129 PMCID: PMC9719155 DOI: 10.1186/s12888-022-04416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Accumulating evidence shows that homocysteine (Hcy) is implicated in the pathophysiology of schizophrenia, and plays an important role in clinical characteristics. This study evaluated the relationships between Hcy levels and clinical features in first-episode, Chinese Han, drug-naïve (FEDN) patients with schizophrenia. METHODS FEDN individuals (119 with schizophrenia and 81 healthy controls matched for age, sex, education, and body mass index (BMI)) were enrolled. The serum Hcy levels were determined by enzyme cycle assay experiments. Severities of clinical symptoms were rated on the Positive and Negative Syndrome Scale (PANSS). RESULTS FEDN individuals with schizophrenia had higher Hcy levels compared with healthy controls (F = 46.865, P < 0.001). Correlation analysis and multiple stepwise regression analyses showed that serum Hcy levels in FEDN schizophrenia individuals were positively correlated with PANSS general psychopathology subscale (r = 0.294, P = 0.001) and PANSS total score (r = 0.273, P = 0.003). No significant association was found between Hcy and age, BMI, PANSS positive subscale, and the PANSS negative subscale (all, P > 0.05). Male individuals had significantly higher serum Hcy levels than female individuals (F = 7.717, P = 0.006) after controlling for confounding factors (F = 0.759, P = 0.011). CONCLUSIONS Serum Hcy levels were increased in FEDN individuals with schizophrenia, and Hcy levels may be involved in pathophysiological mechanisms. Sex differences in Hcy levels were observed, with higher levels in male FEDN individuals compared to females.
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Affiliation(s)
- Xu Yang
- Department of Psychiatry, Beijing Hui Long Guan Hospital, Peking University Hui Long Guan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Haidong Yang
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, People's Republic of China
| | - Na Li
- Department of Pathology, Beijing Kingmed Clinical Laboratory, Affiliated Peking University, Beijing, 100015, People's Republic of China
| | - Chunyu Li
- Clinical Laboratory, Beijing Hui Long Guan Hospital, Peking University Hui Long Guan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Weiye Liang
- Department of Psychiatry, Beijing Hui Long Guan Hospital, Peking University Hui Long Guan Clinical Medical School, Beijing, 100096, People's Republic of China.
| | - Xiaobin Zhang
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China.
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Liao HF, Yen CF, Chiu TY, Chi WC, Liou TH, Chang BS, Wu TF, Lu SJ. Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:879898. [PMID: 36188921 PMCID: PMC9397969 DOI: 10.3389/fresc.2022.879898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
To assess activity and participation for adults in Taiwan's Disability Eligibility Determination System (DEDS), we developed a measure, the Functioning Disability Evaluation Scale—Adult version (FUNDES-Adult), based on the 36-item interviewer-administered version of the WHO Disability Assessment Schedule 2.0. The purpose of this study was to examine the factor structures of performance and capability dimensions of the FUNDES-Adult. This study followed a methodology research design to investigate the construct validity of the two dimensions of the FUNDES-Adult. Two samples were randomly stratified from the databank of adults with disabilities to examine structural validity by the exploratory factor analysis (EFA) (n = 8,730, mean age of 52.9 ± 16.81) and the confirmatory factor analysis (CFA) (n = 500, mean age of 54.3 ± 16.81). The results demonstrated that the EFA yielded 5-factor structures for both performance dimension (73.5% variance explained) and capability dimension (75.9% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (GFI, NFI, CFI, and TLI ≥ 0.95, RMSEA < 0.09). The results of this study provide evidence that the FUNDES-Adult has acceptable structural validity for use in Taiwan's DEDS. Utility of the FUNDES-Adult in rehabilitation, employment, welfare, and long-term care services needs further study.
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Affiliation(s)
- Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
- Taiwan Society of ICF, Taipei, Taiwan
- *Correspondence: Hua-Fang Liao
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
- Chia-Feng Yen
| | - Tzu-Ying Chiu
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chungshan Medical University, Taichung, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ben-Sheng Chang
- Department of Psychology, Soochow University, Taipei, Taiwan
| | - Ting-Fang Wu
- Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University, Taipei, Taiwan
| | - Shu-Jen Lu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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5
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Cai Y, Gong W, He W, He H, Hughes JP, Simoni J, Xiao S, Gloyd S, Lin M, Deng X, Liang Z, Dai B, Liao J, Hao Y, Xu DR. Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation. JMIR Mhealth Uhealth 2022; 10:e33628. [PMID: 35438649 PMCID: PMC9066323 DOI: 10.2196/33628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/12/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention.
Objective
The aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended.
Methods
In a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression–Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms.
Results
In phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95% CI −0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P≥.05).
Conclusions
The simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations.
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Affiliation(s)
- Yiyuan Cai
- Department of Epidemiology and Health Statistic, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Wenjun He
- Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Acacia Labs, Institute for Global Health and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Hua He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Meijuan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - Xinlei Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bofeng Dai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Liao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dong Roman Xu
- Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Acacia Labs, Institute for Global Health and Dermatology Hospital, Southern Medical University, Guangzhou, China
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6
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Pietrini F, Tatini L, Santarelli G, Brugnolo D, Squillace M, Bozza B, Ballerini A, Ricca V, D'Anna G. Self- and caregiver-perceived disability, subjective well-being, quality of life and psychopathology improvement in long-acting antipsychotic treatments: a 2-year follow-up study. Int J Psychiatry Clin Pract 2021; 25:307-315. [PMID: 34057873 DOI: 10.1080/13651501.2021.1912358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Switching to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) represents a valuable strategy for schizophrenia. In a recovery-oriented approach, patient-reported outcomes (PROs) such as perceived disability, subjective well-being, and quality of life cannot be neglected. METHODS Forty clinically stable outpatients with schizophrenia treated with oral second-generation antipsychotics were enrolled at the time of switching to the equivalent dose of LAI. 35 subjects completed this 2-year longitudinal, prospective, open-label, observational study. Patients were assessed at baseline, after 1 year, and after 2 years of LAI-AMT, using psychometric scales (Positive And Negative Syndrome Scale, PANSS; Young Mania Rating Scale, YMRS; Montgomery-Åsberg Depression Rating Scale, MADRS), PROs (Subjective Well-Being under Neuroleptics short form, SWN-K; Short Form-36 health survey, SF-36; 12-item World Health Organisation Disability Assessment Schedule, WHODAS 2.0), and caregiver-reported outcomes (12-item WHODAS 2.0). RESULTS No psychotic relapses were observed. Psychopathology measures (PANSS total and subscales - excluding negative symptoms), mood symptoms (YMRS, MADRS), perceived disability (patient- and caregiver-administered WHODAS 2.0), subjective well-being (SWN-K), and quality of life (SF-36) showed a concomitant amelioration after 1 year, without further significant variations. DISCUSSION Switching to LAI-AMT may decrease perceived impairment, and increase subjective well-being and quality of life in clinically stable outpatients with schizophrenia.HighlightsLAI treatment may improve outcomes by reducing psychopathology levels and relapses.In a recovery-oriented approach, patient-reported outcomes cannot be neglected.LAI antipsychotics may optimise the subjective experience of treatment.Switching to LAI therapy may result in a reduction in perceived disability.There is a significant correlation between proxy- and patient-reported disability.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Lorenzo Tatini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Dario Brugnolo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Squillace
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Bernardo Bozza
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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7
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Cai Y, Gong W, He H, Hughes JP, Simoni J, Xiao S, Gloyd S, Lin M, Deng X, Liang Z, He W, Dai B, Liao J, Hao Y, Xu DR. Mobile Texting and Lay Health Supporters to Improve Schizophrenia Care in a Resource-Poor Community in Rural China (LEAN Trial): Randomized Controlled Trial Extended Implementation. J Med Internet Res 2020; 22:e22631. [PMID: 33258788 PMCID: PMC7738261 DOI: 10.2196/22631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Schizophrenia is a severe and disabling condition that presents a dire health equity challenge. Our initial 6-month trial (previously reported) using mobile texting and lay health supporters, called LEAN, significantly improved medication adherence from 0.48 to 0.61 (adjusted mean 0.11, 95% CI 0.03 to 0.20, P=.007) for adults with schizophrenia living in a resource-poor village in rural China. OBJECTIVE We explored the effectiveness of our texting program in improving participants' medication adherence, functioning, and symptoms in an extended implementation of the intervention after its initial phase. METHODS In an approximated stepped-wedge wait-list design randomized controlled trial, 277 community-dwelling villagers with schizophrenia were assigned 1:1 in phase 1 into intervention and wait-list control groups. The intervention group received (1) lay health supporters (medication or care supervisors), (2) e-platform (mobile-texting reminders and education message) access, (3) a token gift for positive behavioral changes, and (4) integration with the existing government community-mental health program (the 686 Program) while the wait-listed control group initially only received the 686 Program. Subsequently (in the extended period), both groups received the LEAN intervention plus the 686 Program. The primary outcome was antipsychotic medication adherence (percentage of dosages taken over the past month assessed by unannounced home-based pill counts). The secondary outcomes were symptoms measured during visits to 686 Program psychiatrists using the Clinical Global Impression scale for schizophrenia and functioning measured by trained student assessors using the World Health Organization Disability Assessment Schedule 2.0. Other outcomes included data routinely collected in the 686 Program system (refill records, rehospitalization due to schizophrenia, death for any reason, suicide, wandering, and violent behaviors). We used intention-to-treat analysis and missing data were imputed. A generalized estimating equation model was used to assess program effects on antipsychotics medication adherence, symptoms, and functioning. RESULTS Antipsychotics medication adherence improved from 0.48 in the control period to 0.58 in the extended intervention period (adjusted mean difference 0.11, 95% CI 0.04 to 0.19; P=.004). We also noted an improvement in symptoms (adjusted mean difference -0.26, 95% CI -0.50 to -0.02; P=.04; Cohen d effect size 0.20) and a reduction in rehospitalization (0.37, 95% CI 0.18 to 0.76; P=.007; number-needed-to-treat 8.05, 95% CI 4.61 to 21.41). There was no improvement in functioning (adjusted mean difference 0.02, 95% CI -0.01 to 0.06; P=.18; Cohen d effect size 0.04). CONCLUSIONS In an extended implementation, our intervention featuring mobile texting messages and lay health workers in a resource-poor community setting was more effective than the 686 Program alone in improving medication adherence, improving symptoms, and reducing rehospitalization. TRIAL REGISTRATION Chinese Clinical Trial Registry; ChiCTR-ICR-15006053 https://tinyurl.com/y5hk8vng.
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Affiliation(s)
- Yiyuan Cai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Hua He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Meijuan Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinlei Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjun He
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bofeng Dai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Liao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
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8
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de Pinho LMG, Sequeira CADC, Sampaio FMC, Rocha NB, Ozaslan Z, Ferre-Grau C. Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: A randomized controlled trial. J Adv Nurs 2020; 77:999-1012. [PMID: 33222210 DOI: 10.1111/jan.14627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/05/2020] [Accepted: 10/19/2020] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia. DESIGN Randomized controlled trial. It was carried out between July 2019 -February 2020. METHODS Fifty-six patients with schizophrenia were enrolled and randomly assigned to either a control group (N = 29) or a metacognitive training group (N = 27). Blinded assessments were made at baseline, 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS). Secondary outcomes were assessed by the Beck Cognitive Insight Scale (BCIS), the Personal and Social Performance (PSP) scale and the World Health Organization Disability Assessment Schedule (WHODAS). RESULTS Completion at follow-up was high (92.86%). The intention-to-treat analyses demonstrated that patients in the metacognitive training group had significantly greater improvements of the Psychotic Symptom Rating Scales delusion score and total score and the Personal and Social Performance Scale, after 3 months, compared with the control group. The effect size was medium to large. The intention-to-treat analyses also demonstrated that patients in the metacognitive training group had significantly greater reductions of the Psychotic Symptom Rating Scales hallucination score and Beck Cognitive Insight Scale self-certainty score post-treatment, compared with the control group. The effect size was medium to large. CONCLUSION The metacognitive training administered by psychiatric and mental health nurses was effective in ameliorating delusions and social functioning over time and it immediately reduced hallucinations post-treatment. IMPACT Metacognitive training for treating psychosis in patients with schizophrenia is efficacious and administration is clinically feasible in the Portuguese context. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID NCT03891186.
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Affiliation(s)
- Lara Manuela Guedes de Pinho
- University of Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Évora, Portugal.,Universitat Rovira and Virgili, Tarragona, Spain
| | - Carlos Alberto da Cruz Sequeira
- School of Nursing of Porto, Porto, Portugal.,NursID - Innovation & Development in Nursing Research Group, CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Francisco Miguel Correia Sampaio
- NursID - Innovation & Development in Nursing Research Group, CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,Higher School of Health of the Instituto Politécnico de Portalegre, Porto, Portugal
| | | | - Zeynep Ozaslan
- Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey.,Postdoctoral Scholar at the University of Michigan School of Nursing, Ann Arbor, MI, USA
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9
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Lin SW, Chiu TY, Liou TH, Yen CF, Chen HG. The Relationship of Urbanization and Performance of Activity and Participation Functioning among Adults with Developmental Disabilities in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207553. [PMID: 33080804 PMCID: PMC7589366 DOI: 10.3390/ijerph17207553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/04/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Abstract
Developmental disability is likely to be lifelong in nature and to result in substantial activity and societal participation limitations. The performance of individuals is related to the environment, supports, and urbanization of living cities. Most of the surveys for people with disabilities have not discussed the relationship between the cognitive impairment properties and performance of participation and activities functioning, and most cognitive impairments are regarded as having similar performance. The location of residence in childhood is mainly influenced by parents and main caregivers, but the factors related to the preferences of adults with cognitive impairment in the location of residence are more complicated. Objective(s): The aim was to explore and compare the relationships of the urbanization degree of their living cities and the functioning performance of daily living in various domains among adults with intellectual disability (ID), autism, and concomitant communicative impairment (CCI). Method: The cross-sectional study was applied, and the data was collected face-to-face by professionals in all authorized hospitals in Taiwan. The participants were 5374 adults with ID (n = 4455), autism (n = 670), CCI (n = 110) and combination disabilities (n = 139) which were according to the International Statistical Classification of Diseases 9th Revision (ICD-9) from a total of 167,069 adults with disabilities from the Disability Eligibility System (DES) in Taiwan between July 2012 and October 2013. The authors used the World Health Organization Disability Assessment Schedule 2.0–36 item version of WHO (WHODAS 2.0-36 items) to measure performance and capability of daily living. Results and Conclusions: There were significant differences in age, gender, disabled severity, and the urbanization between all subgroups (p < 0.05). After adjusting the age of all participators, the degree of urbanization just significantly affected the functioning score distribution in domain 1: cognition for an adult with ID, autism, and CCI; in domain 2, mobility for an adult with CCI and combination disability; in domain 3, self-care; domain 4, independent domains for ID (p < 0.05). There were no significant differences between urbanization degree and functioning scores in all domains for adults with autism. All in all, only in groups with combination disability did we find that the worse the degree of impairment was, the lower the degree of urbanization of their place of residence was, and there was no such phenomenon in adults with autism and ID in our study.
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Affiliation(s)
- Shyang-Woei Lin
- Department of Natural Resources and Environmental Studies, National Dong Hwa University, Hualien 97401, Taiwan;
| | - Tzu-Ying Chiu
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City 97005, Taiwan;
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan;
- Correspondence:
| | - Hui-Guan Chen
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan;
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Koopmans AB, van Hoeken D, Clarke DE, Vinkers DJ, van Harten PN, Hoek HW. Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness. Front Psychiatry 2020; 11:303. [PMID: 32351419 PMCID: PMC7174765 DOI: 10.3389/fpsyt.2020.00303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
AIMS This study explores how well the World Health Organization Disability Assessment Schedule (WHODAS 2.0) assesses problems with psychosocial functioning in patients with severe mental illness (SMI). Further, we assessed the relationships between psychosocial functioning and psychopathology, medication side effects, treatment setting, and quality of life. METHODS We performed an observational, cross-sectional study on the island of Curaçao to assess psychosocial functioning in 77 patients with SMI; they mainly had psychotic disorders. We interviewed their healthcare providers using the proxy version of the WHODAS 2.0. In addition, patients were examined for psychiatric symptoms, medication side effects (including drug-induced movement disorders), and quality of life. Associations were examined with Spearman's rank correlation (ρ). RESULTS Difficulties in psychosocial functioning were reported by patients with SMI in the WHODAS 2.0 domains of understanding and communicating [mean (M)=34.5, standard deviation (SD)=18.6), participation in society (M=25.5, SD=15.6), and getting along with people (M=24.1, SD=16.1)]. Notably, outpatients had more problems participating in society than inpatients (M=33.6, SD=18.5 versus M=23.2, SD=14.1, p=0.03). A positive correlation was observed between drug-induced parkinsonism and the WHODAS 2.0 total score (ρ =0.30; p=0.02), as well as with various subscales, getting around, and household activities. CONCLUSION The proxy version of the WHODAS 2.0 is clinically useful for patients with severe mental illness. The highest scores on the WHODAS 2.0 were found in domains related to interactions with other people and to participation in society. Inpatient status appeared to aid participation in society; this might be due to living in the sheltered clinic environment and its associated daily activities. We further found that drug-induced parkinsonism was associated with a broad spectrum of psychosocial disabilities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02713672; retrospectively registered in February 2016.
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Affiliation(s)
- Anne B Koopmans
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Daphne van Hoeken
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Diana E Clarke
- Division of Research, American Psychiatric Association, Arlington, VA, United States.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - David J Vinkers
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Peter N van Harten
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Innova, Psychiatric Centre GGz Centraal, Amersfoort, Netherlands
| | - Hans W Hoek
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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