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Ali S, Wright E, Charlson F. Using a systems thinking approach to explore the complex relationships between schizophrenia and premature mortality. Int J Soc Psychiatry 2024; 70:70-79. [PMID: 37644696 PMCID: PMC10860352 DOI: 10.1177/00207640231194477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND People with schizophrenia have a higher risk of mortality compared to the general population, which has not improved over time. The majority of premature deaths are due to comorbid physical diseases, driven by interrelated factors operating at the individual level, through health systems and influenced by social determinants of health. A holistic understanding of this problem and the causal pathways linking these factors together is lacking. AIMS This study aims to understand why the mortality gap between people with schizophrenia and the general population is not improving by developing a causal loop diagram (CLD), a systems thinking approach which enables empirical research and theoretical knowledge to be combined into a visual representation of causal relationships and feedback loops. METHOD The CLD was constructed using published literature, including both quantitative and qualitative studies, to identify key variables and relationships, and refined through consultation with experts in the topic area. RESULTS A total of 21 variables and 68 connections were included in the CLD, with 23 distinct feedback loops identified. Stigma and social support had the most connections, while unemployment was involved in the greatest number of feedback loops. Most feedback mechanisms served to reinforce behavioural risk factors, inadequate healthcare and social disadvantage. CONCLUSIONS The CLD has created a holistic and dynamic understanding of the causal pathways driving the mortality gap between people with schizophrenia and the general population, providing insights into why it has persisted over time. One of the key findings was the critical role of social determinants in shaping health outcomes, highlighting the need for person-centred models of care and multisectoral government action.
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Affiliation(s)
- Suhailah Ali
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Eryn Wright
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Fiona Charlson
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
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Flanagan EH, Wyatt JP, Pavlo AJ, Kang S, Blackman KD, Ocasio L, Guy K, O'Connell MJ, Bellamy CD. Care integration goes Beyond Co-Location: Creating a Medical Home. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:123-133. [PMID: 38015324 DOI: 10.1007/s10488-023-01317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
How to successfully integrate mental health and primary care remains a critically important question given the continued morbidity and early mortality of people with serious mental illness. This study investigated integration in a community mental health center (MHC) primarily treating people with SMI in a large, urban northeastern city where an on-site primary care center (PCC) was opened resulting in co-located mental health and primary care services being provided. Using focus groups and online surveys this study asked participants about their thoughts and interactions with the on-site PCC. Participants included staff from clinical, non-clinical, and leadership roles in the mental health center (MHC; PCC staff; and MHC clients who did not use the on-site PCC). MHC staff also offered their thoughts about and experiences with the on-site PCC one year and two years after the on-site PCC opened through an on-line survey. In both methods, staff reported limited awareness and expectations of the PCC in the first year. Staff indicated that successful care integration goes beyond co-location and peer health navigation can enhance integration. Finally, staff discussed desires for enhancing care integration and co-located services into a medical home that included communicating across medical records and providers at different agencies. Our results suggest that, in addition to the previously researched three C's of care integration (consultation, coordination, and collaboration), two more C's were essential to successful care integration: co-location and communication. Communication across medical records and providers at different agencies was an essential component of care integration, and co-location added increased ability to communicate across providers.
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Affiliation(s)
- Elizabeth H Flanagan
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Janan P Wyatt
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
- Yale University School of Medicine, 319 Peck Street Building 1, New Haven, CT, 06513, USA.
| | - Anthony J Pavlo
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Sylvia Kang
- New York University Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Kimberly D Blackman
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Luz Ocasio
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Kimberly Guy
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Maria J O'Connell
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Chyrell D Bellamy
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
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Miley KM, Hooker SA, Crain AL, O'Connor PJ, Haapala JL, Bond DJ, Rossom RC. 30-year Cardiovascular Disease Risk for Young Adults with Serious Mental Illness. Gen Hosp Psychiatry 2023; 85:139-147. [PMID: 38487652 PMCID: PMC10936711 DOI: 10.1016/j.genhosppsych.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Objective To estimate 30-year CVD risk and modifiable risk factors in young adults with serious mental illness (SMI) versus those without, and assess variations in CVD risk by race, ethnicity, and sex. Method In this cross-sectional study, we estimated and compared the Framingham 30-year CVD risk score and individual modifiable CVD risk factors in young adult (20-39 years) primary care patients with and without SMI at two US healthcare systems (January 2016-Septemeber 2018). Interaction terms assessed whether the SMI-risk association differed across demographic groups. Results Covariate-adjusted 30-year CVD risk was significantly higher for those with (n=4228) versus those without (n=155,363) SMI (RR 1.28, 95% CI [1.26, 1.30]). Patients with SMI had higher rates of hypertension (OR 2.02 [1.7, 2.39]), diabetes (OR 3.14 [2.59, 3.82]), obesity (OR 1.93 [1.8, 2.07]), and smoking (OR 4.94 [4.6, 5.36]). The increased 30-year CVD risk associated with SMI varied significantly by race and sex: there was an 8% higher risk in Black compared to White patients (RR 1.08, [1.04, 1.12]) and a 9% lower risk in men compared to women (RR 0.91 [0.88, 0.94]). Conclusions Young adults with SMI are at increased 30-year risk of CVD, and further disparities exist for Black individuals and women.
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Affiliation(s)
- Kathleen M Miley
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
| | - Stephanie A Hooker
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
| | - A Lauren Crain
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
| | - Patrick J O'Connor
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
| | - Jacob L Haapala
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
| | - David J Bond
- Johns Hopkins University, Department of Psychiatry and Behavioral Sciences. 600 N Wolfe St., Baltimore, Maryland 21205, USA
| | - Rebecca C Rossom
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
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Zahid U, Hosang GM, de Freitas DF, Mooney R, Bhui K. Ethnic inequality, multimorbidity and psychosis: can a syndemic framework resolve disputed evidence? SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:37. [PMID: 37296141 DOI: 10.1038/s41537-023-00367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
Syndemic theory is described as population-level clustering or co-occurrence of health conditions in the context of shared aetiologies that interact and can act synergistically. These influences appear to act within specific places of high disadvantage. We suggest ethnic inequality in experiences and outcomes of multimorbidity, including psychosis, may be explained through a syndemic framework. We discuss the evidence for each component of syndemic theory in relation to psychosis, using psychosis and diabetes as an exemplar. Following this, we discuss the practical and theoretical adaptations to syndemic theory in order to apply it to psychosis, ethnic inequality and multimorbidity, with implications for research, policy, and practice.
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Affiliation(s)
- Uzma Zahid
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Daniela Fonseca de Freitas
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Roisin Mooney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK.
- Queen Mary University London Global Policy Institute, London, UK.
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Chin K, Ghosh S, Subramaniam H, Beishon L. Cardiovascular disease in older people with serious mental illness: Current challenges and future directions. Front Psychiatry 2023; 14:1110361. [PMID: 36926467 PMCID: PMC10011471 DOI: 10.3389/fpsyt.2023.1110361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Katherine Chin
- Department of Ageing and Health, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Sudip Ghosh
- Leicester School of Allied Health Sciences, De Montfort University, Leicester, United Kingdom
| | - Hari Subramaniam
- The Evington Centre, Leicestershire Partnership National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,National Institute for Health Research Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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The Utilization of Two-Phase Catalytic System in Enantioselective Biotransformation of Racemic Atenolol. Catalysts 2022. [DOI: 10.3390/catal12091068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There are several methods that allow enantiomerically pure compounds to be obtained. In the study presented herein, the enantioselective biotransformations of (R,S)-atenolol were performed with the use of various catalytic systems containing ionic liquids and toluene as a reaction medium, vinyl acetate as an acetylating agent as well as lipases from Candida rugosa. The conducted studies profs that, the use of the two-phase reaction system enables the reuse of the biocatalyst in another cycle and allows to achieve satisfactory kinetic resolution parameters.
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