Social Work and Health Intervention in the Karabakh Region of Armenia during the War in 2019

War conflict between two of three Caucasian Republics, in and to Upper Karabakh as a part interest of at least two countries, acquired during the civil war years ago, has led to substantial numbers of refugees and migrants from Karabakh to Armenia. The spectrum of acute humanitarian help is analyzed.

Comparison of Risk of Diseases and Humanitarian Help of Areas after Bombing and Shelling in Yemen and Karabakh Autonomous Region Armenia

Several Yemenese towns had been shelled and bombed in the Karabakh Region in 2000-2001 by neighboring states. Bombing and/or natural disasters due to earthquakes and floods have been related to outbreaks of waterborne diseases due to destruction of water pipelines and damaging wells for individual water supply. We compare 2 Regions: 1 in tropical; the other in a mild climate afflicted by similar war intervention-shelling and bombing from neighboring countries, Yemen and Karabakh Arzach Autonomous Region of Armenia in 2020.

Development of Population Tariffs for the ICECAP-A Instrument for Hungary and their Comparison With the UK Tariffs

OBJECTIVES

The ICEpop CAPability measure for Adults (ICECAP-A) was developed to assess the capability well-being of adults for use in economic evaluations. Currently, ICECAP-A tariffs are available only for the UK population. The objectives of this study were to develop a Hungarian tariff set for the ICECAP-A instrument and to explore intercountry differences between the Hungarian and the UK value sets.

METHODS

A survey was conducted by computer-assisted personal interviews on a sample representative of the Hungarian adult population (N = 1000) to elicit their preferences regarding ICECAP-A attributes with the use of a best-worst scaling choice task. A latent class multinomial logit model with continuous variance scale was used to estimate the weights for each of the 4 capability levels of all 5 ICECAP-A attributes, namely, attachment, stability, achievement, enjoyment, and autonomy.

RESULTS

The model identified 2 preference classes with approximately equal share. The first class had a stronger relative preference for autonomy and achievement, whereas the second class had a strong preference for attachment. Multivariate analysis of the classes revealed that women, pensioners, people who are married or living in a partnership, and people with poorer health status are characteristics associated with the latter class membership (preference for attachment). Population tariffs were estimated from the model. Overall, attachment was found to be the most important attribute, followed by stability, enjoyment, achievement, and autonomy.

CONCLUSIONS

Hungarian tariffs are largely consistent with those found for the United Kingdom; nevertheless, autonomy seems to be less important in Hungary compared with the United Kingdom.

Comparing the measurement properties of the ICECAP-A and ICECAP-O instruments in ages 50-70: a cross-sectional study on a representative sample of the Hungarian general population

OBJECTIVE

The ICECAP-A and ICECAP-O were validated as capability wellbeing measures of adults aged 18 + and 65 + years, respectively. We aimed to compare their measurement properties in age group 50-70.

METHODS

Data were derived from a cross-sectional survey among a sample representative for the adult Hungarian population. Respondents aged between 50 and 70 filled in both the ICECAP-A and ICECAP-O questionnaires. We assessed and compared feasibility, agreement, discriminatory power, convergent and content validity of the two instruments and explored the determinants of the differences between the two measures.

RESULTS

707 respondents (99.4%) provided full answers to both questionnaires (46.3% women, average age 60.1 years). The instruments showed similar construct and convergent validity and discriminatory power. Pearson-correlations between instrument items were strong (r > 0.5). ICECAP-A and ICECAP-O scores could be calculated from each other with a good confidence (R² = 0.69 and 0.71). ICECAP-O scores (mean 0.87, SD = 0.12) were systematically higher than ICECAP-A scores (0.85, SD = 0.15) in most subgroups. The difference increased with the deterioration of capability and health, and with age. Regression results showed that employment and health status had larger marginal effect on the ICECAP-A than on the ICECAP-O scores, and these effects were larger than the effect of age on both measures.

CONCLUSION

Validity of both instruments was confirmed in the age groups 50-70. Given that employment and health status are important determinants of the differences between the two instruments besides age, the possibility of linking the choice between ICECAP-A and ICECAP-O to these factors should be investigated by further research.

Musculoskeletal health and capability wellbeing: Associations between the HAQ-DI, ICECAP-A and ICECAP-O measures in a population survey

BACKGROUND

The capability approach has received increasing attention in wellbeing measurement in the past years, but it has still remained an underexplored area in musculoskeletal (MSK) health.

OBJECTIVE

We aimed to explore the capability wellbeing in relation to MSK health, by measuring the associations between the Health Assessment Questionnaire Disability Index (HAQ-DI) physical functioning and the ICECAP-A and ICECAP-O capability wellbeing measures.

DESIGN

A cross-sectional survey was performed in 2019 on a representative sample of the Hungarian general adult population.

METHOD

Capability wellbeing was measured by the ICECAP-A (age-group 18-64) and ICECAP-O (age group 65+) questionnaires. MSK health was defined by the HAQ-DI, the mobility domain of the EQ-5D-3L/-5L health status measures, self-reported walking problems and MSK diagnosis (neck/back/low back defects, hip/knee arthrosis, osteoporosis).

RESULTS

Altogether 2021 individuals (female: 50.1%) participated in the survey with mean (SD) age of 48.7 (17.9) years and HAQ-DI of 0.138 (0.390). ICECAP-A (N = 1568, 77.6%) and ICECAP-O (N = 453, 22.4%) scores were on average (SD) 0.894 (0.126) and 0.828 (0.150), respectively. Spearman correlations between the HAQ-DI and ICECAP-A/-O index scores were moderate (r = -0.303 and -0.496; p < 0.05). Both the ICECAP-A/-O index scores differed significantly (ANOVA test, p < 0.05) across all MSK subgroups. In the ordinary least square regressions, marginal effects of ICECAP-A/-O scores on HAQ-DI were significant (-0.149 and -0.123) when controlling for socio-demographic characteristics.

CONCLUSIONS

MSK health problems are associated with lower capability wellbeing. ICECAP-A/-O might capture effects of MSK conditions not measured by the HAQ-DI or the EQ-5D-5L. Further studies should test these associations in disease-specific samples.

Development of Population Tariffs for the CarerQol Instrument for Hungary, Poland and Slovenia: A Discrete Choice Experiment Study to Measure the Burden of Informal Caregiving

BACKGROUND

The CarerQol instrument can be used in economic evaluations to measure the care-related quality of life of informal caregivers. Tariff sets are available for Australia, Germany, Sweden, the Netherlands, the UK, and the USA.

OBJECTIVE

Our objective was to develop tariff sets for the CarerQol instrument for Hungary, Poland and Slovenia and to compare these with the existing value sets.

METHODS

Discrete-choice experiments were carried out in Hungary, Poland and Slovenia. Data were collected through an online survey between November 2018 and January 2019, using representative samples of 1000 respondents per country. Tariffs were calculated from coefficient estimates from panel mixed multinomial logit models with random parameters.

RESULTS

All seven CarerQol domains contributed significantly to the utility associated with different caregiving situations. Attributes valued highest were 'physical health' (tariffs for no problems were 15.6-21.8), 'mental health' (18.1-18.9) and 'fulfilment' (16.3-22.9). Value sets were comparable across the countries, although in Poland 'a lot of fulfilment' was valued higher (22.9) than in Hungary (16.3) and Slovenia (17.1). Compared with existing value sets, in the three Central European countries, 'fulfilment' was more important, whereas 'financial problems' were less important.

CONCLUSION

For the first time in the Central and Eastern European region, country-specific tariffs are now available for the Hungarian, Polish and Slovenian versions of the CarerQol instrument. This facilitates inclusion of the impact of informal care in economic evaluations. Our results can be used to develop and evaluate country-specific health policy strategies to support informal caregivers. The differences found in informal care preferences highlight the limited transferability of CarerQol tariffs across European regions.

Capability of well-being: validation of the Hungarian version of the ICECAP-A and ICECAP-O questionnaires and population normative data

Purpose

We aimed to develop and assess the psychometric characteristics of the Hungarian language version of two well-being capability measures, the ICEpop CAPability measure for Adults/Older people (ICECAP-A/-O), and to establish population norms.

Methods

A cross-sectional survey was performed involving a representative sample of the Hungarian population. Socio-demographic characteristics, the use and provision of informal care were recorded. The Minimum European Health Module (MEHM), EQ-5D-5L, WHO-5 well-being index, happiness and life satisfaction visual analogue scale (VAS), Satisfaction with Life Scale (SWLS) measures were applied alongside the ICECAP-A (age-group 18–64) and ICECAP-O (age-group 65+).

Results

Altogether 1568 and 453 individuals completed the ICECAP-A/-O questionnaires, respectively. Cronbach’s alpha was 0.86 for both measures (internal consistency). Subgroup analyses showed positive associations between ICECAP-A/-O scores and marital status, employment, income, health status (MEHM) and informal care use (construct validity). Pearson correlations were strong (r > 0.5; p < 0.01) between ICECAP-A/-O indexes and EQ-5D-5L, WHO-5, happiness and satisfaction VAS and SWLS scores (convergent validity). The age, education, and marital status were no longer significant in the multiple regression analysis. Test–retest average (SD) scores were 0.88 (0.11) and 0.89 (0.10) for the ICECAP-A, and equally 0.86 (0.09) for the ICECAP-O (reliability).

Conclusion

This is the first study to provide ICECAP-A/-O population norms. Also, it is the first to explore associations with WHO-5 well-being index which, alongside the MEHM measures, enable estimates from routinely collected international health statistics. The Hungarian ICECAP-A/-O proved to be valid and reliable measurement tools. Socio-demographic characteristics had minor or no impact on ICECAP-A/-O. Other influencing factors deserve further investigation in future research.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02542-1) contains supplementary material, which is available to authorized users.

The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study

We examine the willingness of health care consumers to pay formal fees for health care use and how this willingness to pay is associated with past informal payments. We use data from a survey carried out in Hungary in 2010 among a representative sample of 1,037 respondents. The contingent valuation method is used to elicit the willingness to pay official charges for health care services covered by the social health insurance if certain quality attributes (regarding the health care facility, access to the services and health care personnel) are guaranteed. A bivariate probit model is applied to examine the relationship between willingness to pay and past informal payments. We find that 66% of the respondents are willing to pay formal fees for specialist examinations and 56% are willing to pay for planned hospitalizations if these services are provided with certain quality and access attributes. The act of making past informal payments for health care services is positively associated with the willingness to pay formal charges. The probability that a respondent is willing to pay official charges for health care services is 22% points higher for specialist examinations and 45% points higher for hospitalization if the respondent paid informally during the last 12 months. The introduction of formal fees should be accompanied by adequate service provision to assure acceptance of the fees. Furthermore, our results suggest that the problem of informal patient payments may remain even after the implementation of user fees.

Sequence analysis of 16S rRNA, gyrB and catA genes and DNA-DNA hybridization reveal that Rhodococcus jialingiae is a later synonym of Rhodococcus qingshengii

The results of 16S rRNA, gyrB and catA gene sequence comparisons and reasserted DNA-DNA hybridization unambiguously proved that Rhodococcus jialingiae Wang et al. 2010 and Rhodococcus qingshengii Xu et al. 2007 represent a single species. On the basis of priority R. jialingiae must be considered a later synonym of R. qingshengii.

Changes in the nutritional state and immune-serological parameters of esophagectomized patients fed jejunaly with glutamine-poor and glutamine-rich nutriments

BACKGROUNDS/AIMS

In our former study we investigated the effect of glutamine-rich (I) and glutamine-poor (II) jejunal diet in operated patients with acute pancreatitis. In the glutamine-rich diet group clinical benefit and fast recovery of IgG, IgM, serum proteins, retinol-binding protein, albumin could be measured. In the present study the effects of the two types of jejunal diets I and II have been compared on the basis of changes in some immune parameters of 36 patients treated with subtotal esophagectomy for malignancy.

METHODOLOGY

In randomized controlled trial data of two groups, I. patients with glutamine-rich Stresson Multi Fibre diet (23 patients) and II. patients with Nutrison Multi Fibre glutamine-poor diet (13 patients) were analyzed. Levels of serum proteins were measured by laser nephelometry, CD markers of lymphocytes by flow cytometry, phagocyte activity by chemiluminescence.

RESULTS

Level of proteins decreased on the 2nd postoperative day in both groups, then gradually increased postoperatively. In increase of level of serum protein, retinol-binding protein, prealbumin there was no difference between the two groups.

CONCLUSIONS

In patients treated with subtotal esophagectomy, the glutamine-rich enteric diet did not result in faster recovery in levels of prealbumin, retinol-binding protein, immunoglobulins and in outcome of patients than the glutamine-poor nutriment.

Validity and reliability of leonhard's classification of endogenous psychoses: preliminary report on a prospective 25- to 30-year follow-up study

A 25- to 30-year controlled follow-up investigation of endogenous psychoses started in 1997. The research program labeled "Budapest 2000" was initiated in 1967 as a controlled prospective study. The assessment of 108 patients and 24 normal control persons has so far been completed. With regard to the "middle groups" in the Leonhardian classification, diagnoses of bipolar manic-depressive psychosis, cycloid psychosis, periodic catatonia, systematic paraphrenia, systematic catatonia and hebephrenia proved to be valid in the long term. Revision of the category affect-laden paraphrenia seems to be called for.

[Results of parathyroidectomy for primary hyperparathyroidism]

We have performed 16 operations on 14 patients with primary hyperparathyoidism caused by a solitary parathyroid adenoma in our department between 1st jan. 1990-31 dec. 1999. In each case bilateral neck exploration was carried out. As in one case it was located in ectopic neck position, in the other case papillocarcinoma of the thyroid gland and ectopic parathyroid adenoma in mediastinal position were present, primary hyperparathyroidism persisted, so reoperation was needed. Histological examination proved the presence of adenomin all cases. Diffuse hyperplasia and parathyroid cancer did not occur. Before operation all patients underwent US and seven of them had radionuclide scintigraphy. CT scan aided in its localization with four patients. We did not make use of invasive methods, after the first operation 12 patients showed normal S-Ca levels very quickly. In two cases this level was too high after the operation and reoperation was necessary which resulted in normal Ca levels. Even though the number of our cases is rather modest, all the patients recovered. This may prove that we can successfully cure our patients of modern methods of diagnostics used for meticulous examination alongside with careful preparation of the patients by internal specialists are followed by the standard operative techniques available.

[Botulism. Summary based on six cases]

Botulism is a rare neuroparalytic disease caused by neurotoxins of Clostridium species. In Hungary it most commonly occurs as a foodborne illness with ocular and bulbar paralysis, muscle weakness and gastrointestinal symptoms. Six cases of botulism were observed by the authors, first in 1993 five members of a family, then in 1997 a patient with sporadic illness. The diagnosis was confirmed by toxin tests in addition to the symptoms and food history. Recognition of the epidemiologic associations proved very useful in the confirmation of outbreak-related cases. The illness was moderately serious at three patients and mild at two patients. One of the patients had a cirrhosis of the liver, and her status became critical because of the repeated bleeding from oesophagus varicose vein. The patient with sporadic illness had a serious gastric dilatation and palsy of bowels causing paralytic ileus at the start of the illness. The symptoms regressed slowly, roughly in three weeks, at all patients. Death did not happened. After the case reports the authors review the disease-microorganism, toxin, clinical entities, incidence, symptoms, diagnosis, differential-diagnosis, and finally the treatment.

A cold nose can warm the heart

Chase, a three-year-old golden retriever, is a show dog with a mission! For the past six months, Chase and his owner, Carol Ruby, of Orion Township, have been visiting patients on the inpatient Physical Rehabilitation Unit at Crittenton Hospital in Rochester. Chase played a key role in the creation of the unit's new Pet Therapy Program. Currently, Chase is one of three dogs whose goal is to bring smiles to the faces of patients at the hospital.

[Eosinophilic cationic protein levels in feces and serum in children with food allergies]

The authors measured the serum and copro eosinophil cationic protein levels before and after the food challenge. Twenty children with food allergy and 20 controls were investigated. Under 6 years the oral food provocation test prepared a simplier way above 6 years double blind-placebo-controlled-food-challenge was made. The authors measured the serum and copro eosinophil cationic protein levels by Pharmacia CAP system. The faeces was prepared based on Kolmannskog method. The value of serum was 12.6 +/- 7.7 (mean +/- SD), while the values of faeces was 93.96 +/- 47.5 (micrograms/l). The serum level of control's was 7.72 +/- 5.2 (mean +/- SD) and than in the faeces the level was 13.78 +/- 8.97 (micrograms/l), 19 food allergic children's eosinophil cationic protein level significantly increased after challenge while then serum level did not change. It can be concluded that follow up of food allergic reaction can be regarded as a more exact with measure of the copro eosinophil cationic protein.

[Evaluation of copro-allergen specific IgE and eosinophilic cationic protein levels in children with food allergy]

The authors studied copro-allergen specific IgE, eosinophil cationic protein, alpha-1 antitrypsin, IgA and IgG levels in 20 food allergic patients and in 20 controls. It was found that the copro-allergen specific IgE and eosinophil cationic protein levels were significantly higher in food allergic group than in the control group. Carrying out an oral challenge in real food allergic group the copro-allergen specific IgE and eosinophil cationic protein levels were measured before and after the provocation. The results proved that the stopping of allergenic exposure the local immunreactions will finish. Proving this fact it can be said that 24 hours later in the faeces samples the IgE levels decreased and in some case disappeared. The change of eosinophil cationic protein levels during and after the oral challenge proves the important role of eosinophils in late phase reaction. Finally it can be stated that authors introduced a new non invasive methods which is very suitable and reliable to study local immunoreaction in the gastrointestinal tract.

[Role of the family doctor in the complex treatment of early and late consequences of postmenopause. Effect of estrogen-progestogen on osteoporosis]

The physiology and pathology of menopause are discussed on the basis of data in the literature and based on the author's own long lasting experience. The advantages and disadvantages of oestrogenic and progestogenic treatments are also discussed. Factual knowledge on osteoporosis is summarized. The disease, its diagnosis and therapy and its occurrence (with special respect to the Hungarian situation) are also discussed.

[Clinico-pharmacological investigation of drugs (domperidone, bromocriptine) influencing human prolactin levels from pregnancy to menopause]

The influence of Motilium (domperidone) tablet on the increase of human prolactin level was investigated in the first and second trimester of pregnancy, in confinement and menopause. It has been stated that domperidone causes the serum prolactin level to increase not only in pregnancy and confinement but in menopause, too, not depending on whether it was spontaneous or it took place after castration. In spite of the fact that domperidone is a dopamine antagonist it increases the FSH level similarly to bromocriptine which is a dopamine agonist, although the serum prolactin level changes in the opposite direction on the effect of the treatment. The decrease of the prolactin level effected by bromocriptine tablet in physiological and pathological galactorrhoea and in hyperprolactinaemia associated with infertility has also been investigated. In addition to the favourable laboratory and clinical results it has been stated that prolactin regulates the changes of the FSH and LH levels both in fertility and menopause.

[Comparative evaluation of the effect of mono-, bi- and three-phase oral contraceptive tablets on the endometrium]

It was established that the applied new pill has no atrophic effect onto the endometrium. Therefore it has better characteristics than other oral contraceptives (excepting Anteovin). Ovidon e.g. causes endometrial atrophy (concerning glands and stroma as well), when it is used for several years. We can expect the triphasis pill not to results any endometrial atrophy or hyperprolactinaemia not even in long term use. High progesterone levels detected in serum during pill administration refer to this fact.

[The effect of oral ovulation inhibiting (mono-, bi- and triphase) contraceptives and of Continuin and Postinor on proteo- and steroid hormones]

Endocrinological changes due to the effect of treatment with mono-, bi- and three-phase contraceptive pills taking continuously and occasionally are reviewed. It is established that oral contraceptives based on ovulation inhibition are safe. Less side effects are produced by Ovidon tablets. Continuin and Postinor pills are not safe, and they can produce irregular bleeding. Beside their numerous advances extrauterine pregnancy frequently happens (6.4%). A three-phase preparation is expected to have a reversible effect and lack of a consequent functional infertility. This is improved by hormone level measurements.

[Use of Bromocriptin tablets in physiologic and pathologic hyperprolactinemia]

The authors used Bromocriptine tablet, made by Chemical Works of Gedeon Richter Ltd. in 11 cases to alleriate a physiological milk secretion and in 15 cases as a treatment for extra-puerperal galactorrhea. Under treatment the serum prolactin level dropped exponentially while under Norcolut administration a linear regression was shown and the mammary activity abated after 14 days. The best method for treating the physiological hyperprolactinemia is to give the Bromocriptine before starting milk secretion. In cases of extra-puerperal galactorrhea. The patients become free from complaint after 8 weeks. In both cases the dose was 5-7.5 mg Bromocriptine. When galactorrhea and amenorrhoea occur together during the treatments second month menstruation begins and in two cases unwanted pregnancies happened. It has been found that the latent functional hyperprolactinemia can also be galactorrhea. The result were verified in ten cases by testing the metoclopramide-burden.

[The origin of hyperprolactinemia associated with infertility and its treatment with Bromocriptin-Richter tablets]

Authors used the tablet Bromocriptine in 22 cases for the treatment of infertility and in 15 cases for that of extra-puerperal galactorrhoea. The serum-prolactin level of the patients of the two groups remained in 16 cases below and in 13 cases beyond of the upper value of the normal menstrual cycle. It turned out, that the average prolactin-level of patients, treated against infertility, diminished significantly even after one month after the treatment. Between the values of serum FSH, before and after LH treatment there have not been found any significant difference. On the contrary, in the values of serum progesterone and 17-beta-oestradiol significant differences have been observed after treatments of one month as well as of two months duration. On the basis of the results, authors can state, that the prevailing progesterone-level is the adequate indicator of potential fertility. During the treatment of hyperprolactinaemic pathologies eight pregnancies occurred (21.6%). It turned out, that hyperprolactinaemia was the real cause of procured abortion. For the registration of latent hyperprolactinaemia the Cerucal (metoclopramide) load proved to be an adequate diagnostical method.

[Incidence of osteoporosis in Heves County]

The socio-economic importance of osteoporosis is in the increase. The costs of the effects of reduced working capability and treatment of fractures are estimated costs only. The authors report on 146 osteoporotic patients between 1986-89, suffering from fractures. Among the patients there is a female dominance. The number of osteoporotic fractures is in the increase in the recent years. The authors pointed out the importance of early diagnosis and prevention, to solve the great social problems caused by morbidity, reduced working capability and lower life standard.

[Hyperparathyroidism simulating severe hypercalcemia syndrome]

The case history of a 65 year old female patient has been reported here by the authors. The patient was admitted to the Intensive Therapy Unit owing to her repeated heart pain. Later she was transferred to the Department of Medicine to establish the exact diagnosis. Prepyloric ulcer and hypertension were occurred in her history. The symptoms of her preceding as well as her recent illness were: pain in epigastric field, nausea, adynamia, weakness, polyuria, significant loss of weight, somnolence and the shortened Q--T time in electrocardiogram related to hypercalcemia syndrome. The calcium value in blood proved to be at critically high level from time to time. The possibility of the secondary hypercalcemic state was excluded by sonographic examination and the elevated level of parathormone in blood established the diagnosis of the hyperparathyroidism. The surgical resection of parathyroidic adenoma yielded a complete recovery of the patient. The authors call the attention to the significance of the clinical signs in the diagnosis of the disease.

[Significance of transvaginal ultrasonic examination in the first pregnancy trimester]

The authors report their results obtained by performing transvaginal sonography in 180 patients in the first trimester of pregnancy. It has been found that both normal and pathological cases could be diagnosed 1 week earlier than had been possible with transabdominal method. Minimum size of the intrauterin gestational sac was found to be 3 mm. Cardiac activity could be evaluated in embrios with a size of 7 mm or greater in all cases. According to them the diagnosis of blighted ovum and missed abortion seems to be confirmed when an "empty sac" is larger than 20 mm, or the absence of heart motion is detected in an embrio greater than 10 mm, without repeated scan. High sensitivity was found in ectopic pregnancies especially in unruptured cases. The possibility of qualitative analysis of "free fluid" in Douglas pouch and diagnosis of congenital anomalies in very early pregnancy are promising. Transvaginal sonography is recommended in all cases when transabdominal technique is equivocal.

[Prenatal ultrasonic diagnosis of a dicephalic fetus in the 18th week of pregnancy]

The authors report a case of conjoined twins (dicephalus) detected antenataly in the 18-th week of pregnancy by routine ultrasound screening. The pregnancy was terminated because this congenital malformatión is incompatible with extrauterin life. The embriopathological examination confirmed the prenatal diagnosis. The ultrasonographic criteria are discussed and the importance of early diagnosis is stressed.

[The effect of Enzaprost-F (PGF2) cervical tablets on the corpus luteum in the human body]

Authors removed dextro-ovary of a patient having 7-9th week of gestation for ovarian cyst during abortion. Preoperative cervical dilation was performed by Enzaprost-F cervical tablet containing 20 mg PGF2 agent. Before and 2, 4 and 6 hours after treatment, serum-progesterone and 17-beta-estradiol level was determined. Drug cervical dilation enabled instrumental termination of pregnancy within 4 hours. Histological finding of yellow body showed initial signs of colloid-cystic degeneration, which was followed by minimal decrease of values of serum-steroid concentrations. Authors presume that change in histological picture of yellow body was caused by effect of cervical tablet containing PGF2 agent.

Utilizing the nursing process in the development of a medication group on an inpatient psychiatric unit

The nursing process guided the development of a medication group for psychiatric clients on an inpatient psychiatric unit. The group was established to provide clients with the basic medication information that they are entitled to as consumers of health care. Procedures used to develop the group are discussed in this article. Evaluation procedures suggest that the medication group enhanced clients' knowledge, fostered their self-care, and provided the nursing staff with the opportunity to expand its health-teaching skills.

What difference does case management make?

The outcomes of 82 patients in a rehabilitation-oriented case management program six months and two years after they were discharged from an inpatient setting to join the program were compared with those of 82 matched control patients who had been discharged from the same inpatient settings before the case management program was established. At the two-year follow-up, the patients in the case management program were significantly more likely than the control patients to have better occupational functioning, to live in a residence requiring more independence than they did at the six-month follow-up, and to be less socially isolated; in contrast, at the six-month follow-up only their occupational functioning was better than the control group's. The two groups did not differ in number of hospitalizations at either follow-up. The authors believe the study supplies much-needed documentation of the effectiveness of rehabilitation-oriented case management.

Professional pre-service training for working with the long-term mentally ill

The knowledge base with respect to helping persons with long-term mental illness is expanding dramatically. Specific skills can be identified as critical for those who work with the long-term mentally ill. In contrast to in-service training, preservice (university-based) programs have been slow in offering relevant skills-based curricula. A model is proposed for describing current and future pre-service curricula. Curricula can be categorized as to whether it provides exposure, experience, or expertise in working with the long-term mentally ill. More than ever before the pre-service training programs seem ripe for the introduction of skill-based curricula relevant to helping persons who are psychiatrically disabled.

The chronically mentally ill case management--more than a response to a dysfunctional system

The service systems which assist the long-term mentally ill to function in the community have been routinely described as fragmented and uncoordinated. The development and implementation of case management has been seen as one response to this dysfunctional system. This article examines case management from the perspective that case management is a needed function no matter how coordinated and integrated the system. From this perspective, case management is driven by the clients' goals and not the systems' goals. Case management is viewed as a process by which the person with severe psychiatric disability is supported in negotiating for the various services that they want and need. Four unique activities are identified as performed by the case manager: Connecting with Clients, Planning for Services, Linking Clients with Services, and Advocating for Service Improvements. Case management must be seen as a uniquely human response to the client's specific service needs and overall goals. For persons with long-term psychiatric disabilities, case management brings to life the human dimension of the human service system.

A client outcome planning model for assessing psychiatric rehabilitation interventions

Skill training, drug therapy, and community support strategies are the three primary intervention techniques used by practitioners attempting to rehabilitate severely psychiatrically disabled clients. The present article describes a comprehensive client outcome planning model that encompasses both the intended and unintended effects of an intervention, and that extends beyond such traditional outcome measures as recidivism, clinical relapse, and employment. In addition, data collection strategies and instruments capable of measuring a broad range of possible outcomes are described. A comprehensive model has the advantage of encouraging researchers to consider, during the process of research design, the specific outcomes that will and will not be effected by an intervention. Furthermore, such a model discriminates between process and outcome variables, limits the scope of the implications derived from the research data, and encourages the researcher to assess both the positive and negative effects of the rehabilitation intervention.

A psychiatric rehabilitation treatment program: can i recognize one if i see one?

Over the last several decades there has been a tremendous growth in the number of community-based settings that indicate that they provide rehabilitation programming to persons with severe psychiatric disabilities. Questions can be raised, however, as to the extent to which these settings are actually providing programs that are rehabilitative in nature. Ten essential ingredients of rehabilitation programming are presented for use in discriminating between programs that are rehabilitation oriented and programs which are rehabilitation in name only. The articulation of these ten essential ingredients can serve as a guide for the continued development of community-based settings which attempt to provide comprehensive rehabilitation programming.