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Guerrero Z, Civišová D, Winkler P. Mental health and access to care among the Roma population in Europe: A scoping review. Transcult Psychiatry 2024; 61:118-130. [PMID: 37769608 DOI: 10.1177/13634615231200853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The Roma are Europe's largest ethnic minority group, and often face discrimination and social exclusion. Social strife and lack of access to healthcare are associated with increased symptoms of psychopathology. We aimed to review evidence on mental health outcomes and on access to mental healthcare among the Roma population in Europe. We systematically searched five databases (PsycINFO, Global Health, Social Policy and Practice, Web of Science and PubMed) and conducted a grey literature search in August 2020. We identified 133 studies, 26 of which were included for final analysis. We present the results using a narrative synthesis. The available literature indicates a relatively high prevalence of anxiety, depression and substance abuse among Roma, and females seem to be more affected than males. Roma children exhibit more externalizing and internalizing disorders when compared with non-Roma children. Mental health and perceived well-being among the Roma population are strongly linked to social determinants of health such as housing or economic income. Access to mental healthcare is limited for Roma people because of several barriers pertaining to language, lack of information regarding available services, and the insurance and economic status of Roma people. Roma people report mainly negative experiences with mental health services, including a lack of understanding from healthcare providers, and instances of racism and discrimination. There is a need for more research on mental health and access to healthcare in Roma people. Future studies should be participatory in order to provide guidelines for mental healthcare that addresses the needs of the Roma population.
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Affiliation(s)
- Zoe Guerrero
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
| | - Dagmar Civišová
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
| | - Petr Winkler
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
- King's College London
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Potočár L, Mladá K, Kučera M, Mohr P, Winkler P, Formánek T. Population mental health, help-seeking and associated barriers following the COVID-19 pandemic: Analysis of repeated nationally representative cross-sectional surveys in Czechia. Psychiatry Res 2024; 331:115641. [PMID: 38042095 DOI: 10.1016/j.psychres.2023.115641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
This study investigated the Czech adults' mental health following the COVID-19 pandemic and the potential influence of data collection methodology on prevalence estimates. Separately, it investigated changes in help-seeking and associated barriers. Data from representative surveys on Czech adults, conducted in November 2017 (n = 3,306), in May (n = 3,021) and November 2020 (n = 3,000), and in November and December 2022 (n = 7,311), were used. Current mental disorders were assessed by the Mini International Neuropsychiatric Interview, and the treatment gap was established in individuals scoring positively. In help-seeking individuals, encountering barriers was investigated. In 2017 and 2022, 20.02 % and 27.22 % of individuals had at least one mental disorder, respectively. The 2022 panel sampling and online and telephone interviewing estimates (34.29 % and 26.7 %) were substantially higher than those from household sampling and personal interviewing (19.9 %). Prevalence rates based on household sampling and personal interviewing were broadly consistent in 2017 and 2022. The treatment gap was around 80 % from 2017 to 2022. More than 50 % of individuals encountered structural barriers in help-seeking in 2022. This study showed that prevalence rates were still elevated in 2022, but suggests that data collection methodology influenced the estimates. Separately, the treatment gap remained consistently very high, and encountering structural barriers in help-seeking was common.
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Affiliation(s)
- Libor Potočár
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Matěj Kučera
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Mohr
- Clinical Center, National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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Guerrero Z, Melicharová H, Kavanová M, Prokop D, Škvrňák M, Kunc M, Leontiyeva Y, Vitíková J, Spurný M, Pilnáček M, Kyselá M, Zhmurko O, Tabery P, Winkler P. Mental health conditions and help-seeking among Ukrainian war refugees in Czechia: A cross-sectional study. Psychiatry Res 2023; 329:115552. [PMID: 37864995 DOI: 10.1016/j.psychres.2023.115552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND We aimed to screen Ukrainian war refugees (UWR) in Czechia for depression and anxiety, and to assess their recognition of personal mental health problems and related help-seeking. METHODS We conducted a cross-sectional study on a sample of UWR in Czechia. We used PHQ-8 and GAD-7 to screen for depression and anxiety, SELF-I to assess the recognition of respondents' own mental health problems, and a set of questions regarding mental health-related help-seeking. FINDINGS Our sample consisted of 1,347 UWR. More than 41 % of respondents screened positively for moderate or severe depression and more than 23 % for moderate or severe anxiety. Self-recognition of mental health as well as help-seeking was very low among those who screened positively for moderate or severe depression or anxiety. INTERPRETATION Even those UWR who report severe symptoms do not identify themselves as potentially having mental health issues and are not seeking help.
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Affiliation(s)
- Zoe Guerrero
- Department of Public Mental Health, National Institute of Mental Health, Czechia; WHO Collaborating Center for Public Mental Health Research and Service Development, National Institute of Mental Health, Czechia
| | - Hana Melicharová
- Department of Public Mental Health, National Institute of Mental Health, Czechia
| | | | | | | | | | - Yana Leontiyeva
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Jana Vitíková
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Martin Spurný
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Matouš Pilnáček
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Monika Kyselá
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Olga Zhmurko
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Paulína Tabery
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Petr Winkler
- WHO Collaborating Center for Public Mental Health Research and Service Development, National Institute of Mental Health, Czechia; Health Service and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King's College London.
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Javakhishvili J, Makhashvili N, Winkler P, Votruba N, van Voren R. Providing immediate digital mental health interventions and psychotrauma support during political crises. Lancet Psychiatry 2023; 10:727-732. [PMID: 37392753 DOI: 10.1016/s2215-0366(23)00120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 07/03/2023]
Abstract
We describe the development and provision of a digital mental health intervention and trauma support platform for victims of political and social repression in Belarus. The Samopomoch platform provides secure and effective support tailored to the needs of such victims, and individuals are provided with access to the service via a modern, encrypted, and protected communication platform. The service involves personal health tracking (e-mental health self-screening), targeted and untargeted client communication (psychoeducation and self-help information), and psychological counselling sessions. The Samopomoch platform is also collecting evidence to show the effectiveness of the service and proposes a model for replication in similar settings. To our knowledge, this is the first immediate digital mental health-care response to a political crisis, and the high needs and increasing demand for this service within the targeted population indicate the necessity for its continuation and scaling-up. We urge policy makers to provide immediate responses for establishing digital mental health interventions and psychological trauma support.
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Affiliation(s)
- Jana Javakhishvili
- Federation Global Initiative on Psychiatry, Hilversum, Netherlands; Foundation Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia; Institute of Addiction Studies, Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia.
| | - Nino Makhashvili
- Federation Global Initiative on Psychiatry, Hilversum, Netherlands; Foundation Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia; Mental Health Resource Centre, Ilia State University, Tbilisi, Georgia
| | - Petr Winkler
- National Institute of Mental Health, WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czech Republic
| | - Nicole Votruba
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; The George Institute for Global Health, London, UK
| | - Robert van Voren
- Federation Global Initiative on Psychiatry, Hilversum, Netherlands; Institute of Addiction Studies, Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia; Political Science and Diplomatic Studies, Vytautas Magnus University, Kaunas, Lithuania
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Aliev AA, Tomaskova H, Winkler P, Yon Y, Kagstrom A, Guerrero Z, Lazeri L, Reinap M, Redlich C, Tijerino Inestroza AM, Maurer J. Methods and tools to assess implementation of mental health policies and plans: A systematic review. Glob Ment Health (Camb) 2023; 10:e12. [PMID: 37854405 PMCID: PMC10579679 DOI: 10.1017/gmh.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 03/19/2023] Open
Abstract
Mental health policies and plans (MHPPs) are important policy instruments and powerful tools to facilitate development of mental health systems and services across the world. We aimed to map and analyse methods and tools used to assess the extent, process and impact of implementing MHPPs. We systematically searched peer-reviewed and grey literature across seven scientific databases. We extracted and analysed the data on a) the characteristics of included studies (e.g., policy areas, region of origin, income setting) and b) the methodology and evaluation tools applied to assess the extent and process of implementation. We included 48 studies in the analyses. Twenty-six of these studies employed only qualitative methods (e.g., semi-structured interviews, focus group discussions, desk review, stakeholder consultations); 12 studies used quantitative methods (e.g., trend analysis, survey) and 10 used mixed-methods approaches. Generally, methods and tools used for assessment were described poorly with less than half of the studies providing partial or full details about them. Only three studies provided assessment of full policies. There is a lack of rigorous research to assess implementation MHPPs. Assessments of the implementation of entire MHPPs are almost non-existent. Strategies to assess the implementation of MHPPs should be an integral part of MHPPs.
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Affiliation(s)
- Akmal Alikhan Aliev
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Hana Tomaskova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
- Department of Psychology, Charles University, Prague, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Yongjie Yon
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Anna Kagstrom
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Zoe Guerrero
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Ledia Lazeri
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Marge Reinap
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Cassie Redlich
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Jason Maurer
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Crooijmans C, Jansen TPJ, Konst RE, Woudstra J, Appelman Y, den Ruijter HM, Onland-Moret NC, Meeder JG, de Vos AMJ, Paradies V, Woudstra P, Sjauw KD, van 't Hof A, Meuwissen M, Winkler P, Boersma E, van de Hoef TP, Maas AHEM, Dimitriu-Leen AC, van Royen N, Elias-Smale SE, Damman P. Design and rationale of the NetherLands registry of invasive Coronary vasomotor Function Testing (NL-CFT). Int J Cardiol 2023; 379:1-8. [PMID: 36863419 DOI: 10.1016/j.ijcard.2023.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Angina without angiographic evidence of obstructive coronary artery disease (ANOCA) is a highly prevalent condition with insufficient pathophysiological knowledge and lack of evidence-based medical therapies. This affects ANOCA patients prognosis, their healthcare utilization and quality of life. In current guidelines, performing a coronary function test (CFT) is recommended to identify a specific vasomotor dysfunction endotype. The NetherLands registry of invasive Coronary vasomotor Function testing (NL-CFT) has been designed to collect data on ANOCA patients undergoing CFT in the Netherlands. METHODS The NL-CFT is a web-based, prospective, observational registry including all consecutive ANOCA patients undergoing clinically indicated CFT in participating centers throughout the Netherlands. Data on medical history, procedural data and (patient reported) outcomes are gathered. The implementation of a common CFT protocol in all participating hospitals promotes an equal diagnostic strategy and ensures representation of the entire ANOCA population. A CFT is performed after ruling out obstructive coronary artery disease. It comprises of both acetylcholine vasoreactivity testing as well as bolus thermodilution assessment of microvascular function. Optionally, continuous thermodilution or Doppler flow measurements can be performed. Participating centers can perform research using own data, or pooled data will be made available upon specific request via a secure digital research environment, after approval of a steering committee. CONCLUSION NL-CFT will be an important registry by enabling both observational and registry based (randomized) clinical trials in ANOCA patients undergoing CFT.
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Affiliation(s)
- C Crooijmans
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - T P J Jansen
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - R E Konst
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - J Woudstra
- Dept. of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Y Appelman
- Dept. of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - H M den Ruijter
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - N C Onland-Moret
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J G Meeder
- Dept. of Cardiology, Viecuri Medical Center, Venlo, the Netherlands
| | - A M J de Vos
- Dept. of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - V Paradies
- Dept. of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - P Woudstra
- Dept. of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - K D Sjauw
- Dept. of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - A van 't Hof
- Dept. of Cardiology, MUMC, Maastricht, the Netherlands; Dept. of Cardiology, Zuyderland, Heerlen, the Netherlands; CArdiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - M Meuwissen
- Dept. of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - P Winkler
- Dept. of Cardiology, Zuyderland, Heerlen, the Netherlands
| | - E Boersma
- Dept. of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - T P van de Hoef
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A H E M Maas
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | | | - N van Royen
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | | | - P Damman
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands.
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Kågström A, Pešout O, Kučera M, Juríková L, Winkler P. Development and validation of a universal mental health literacy scale for adolescents (UMHL-A). Psychiatry Res 2023; 320:115031. [PMID: 36608527 DOI: 10.1016/j.psychres.2022.115031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022]
Abstract
Mental health literacy (MHL) grows in importance as the prevalence of mental health conditions rises worldwide. There is a need for valid MHL measures especially among adolescents. The current study aims to develop and validate a Universal mental health literacy scale for adolescents (UMHL-A), a self report scale to assess MHL of children between ages 10 and 14 across all four components within Kutcher's framework for MHL. The development of the UMHL-A was initiated by a literature review and followed by item generation. Then, we tested the face and content validity of the scale via a delphi study, focus groups and cognitive interviews with the target group. Next with a convenience sample, we established the factor structure and construct validity of the scale using exploratory and confirmatory factor analyses. Lastly, we tested the scale convergent validity with other measures. The final form of the scale was refined on a representative sample of Czech asolescents. The UMHL-A scale comprises 17 items measuring four components of MHL. The scale has substantial methodological advantages in comparison to existing measures of MHL, especially considering its brevity and comprehensive coverage of MHL. Further studies are needed to test its application and validity globally.
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Affiliation(s)
- Anna Kågström
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ondřej Pešout
- National Institute of Mental Health, Klecany, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic.
| | - Matěj Kučera
- National Institute of Mental Health, Klecany, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - Laura Juríková
- National Institute of Mental Health, Klecany, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic
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Formánek T, Krupchanka D, Mladá K, Winkler P, Jones PB. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. Lancet Psychiatry 2022; 9:957-968. [PMID: 36335974 DOI: 10.1016/s2215-0366(22)00335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. METHODS We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. FINDINGS From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. INTERPRETATION A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. FUNDING National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.
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Affiliation(s)
- Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University Prague, Pilsen, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
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10
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Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA, Appleby L, Arafat SMY, Arensman E, Ayuso-Mateos JL, Balhara YPS, Bantjes J, Baran A, Behera C, Bertolote J, Borges G, Bray M, Brečić P, Caine E, Calati R, Carli V, Castelpietra G, Chan LF, Chang SS, Colchester D, Coss-Guzmán M, Crompton D, Ćurković M, Dandona R, De Jaegere E, De Leo D, Deisenhammer EA, Dwyer J, Erlangsen A, Faust JS, Fornaro M, Fortune S, Garrett A, Gentile G, Gerstner R, Gilissen R, Gould M, Gupta SK, Hawton K, Holz F, Kamenshchikov I, Kapur N, Kasal A, Khan M, Kirtley OJ, Knipe D, Kõlves K, Kölzer SC, Krivda H, Leske S, Madeddu F, Marshall A, Memon A, Mittendorfer-Rutz E, Nestadt P, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Papsdorf R, Partonen T, Phillips MR, Platt S, Portzky G, Psota G, Qin P, Radeloff D, Reif A, Reif-Leonhard C, Rezaeian M, Román-Vázquez N, Roskar S, Rozanov V, Sara G, Scavacini K, Schneider B, Semenova N, Sinyor M, Tambuzzi S, Townsend E, Ueda M, Wasserman D, Webb RT, Winkler P, Yip PS, Zalsman G, Zoja R, John A, Spittal MJ. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine 2022; 51:101573. [PMID: 35935344 PMCID: PMC9344880 DOI: 10.1016/j.eclinm.2022.101573] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. METHODS We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. FINDINGS We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. INTERPRETATION Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. FUNDING None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Corresponding author at: Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia.
| | - David Gunnell
- National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom
| | - S. M. Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Jose Bertolote
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Guilherme Borges
- Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Michael Bray
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Petrana Brečić
- Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, United States
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
- Department of Psychiatry, Nimes University Hospital, Nimes, France
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Maria Coss-Guzmán
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - David Crompton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Marko Ćurković
- Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeremy Dwyer
- Coroners Court of Victoria, Melbourne, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Copenhagen, Denmark
- Centre for Mental Health Research, Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy S. Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States
| | - Michele Fornaro
- Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy
| | - Sarah Fortune
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Coronial Division, Tasmanian Magistrates Court, Hobart, Australia
| | - Guendalina Gentile
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rebekka Gerstner
- Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador
- Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany
| | - Renske Gilissen
- 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States
| | - Sudhir Kumar Gupta
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Franziska Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Iurii Kamenshchikov
- Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alexandr Kasal
- National Institute of Mental Health, Klecany, Czechia
- Faculty of Social Sciences, Charles University, Prague, Czechia
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sarah C. Kölzer
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hryhorii Krivda
- Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Andrew Marshall
- Brigham and Women's Hospital, Harvard Medical School, MA, United States
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Nestadt
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C. O'Connor
- Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rainer Papsdorf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, United States
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nayda Román-Vázquez
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - Saska Roskar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Vsevolod Rozanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
| | | | - Barbara Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
- LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Stefano Tambuzzi
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Roger T. Webb
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czechia
| | - Paul S.F. Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Gil Zalsman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riccardo Zoja
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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11
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Tomaskova H, Kondrátová L, Winkler P, Addington D. Development and implementation of fidelity assessment in first episode psychosis services in Czechia: A pilot study. Early Interv Psychiatry 2022. [PMID: 36054065 DOI: 10.1111/eip.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/27/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to evaluate fidelity in first episode psychosis (FEP) teams in Czechia and to gage the feasibility and utility of the process in a mental health system that is undergoing a transformation. METHODS Fidelity assessment was conducted using The First Episode Psychosis Services Fidelity Scale (FEPS-FS). Fidelity assessment was based on a review of data abstracted from the health records of active clients, program documents, administrative data, and interviews with members of staff. The mean scores were compared across the teams. Feasibility and utility were assessed by program response to their fidelity results. RESULTS Three FEP teams were involved in the fidelity assessment. Across the 35 items, the mean fidelity score ranged from 2.5 to 3.1. Across the FEP teams, the percentage of the 35 items rated as 4 or 5 (satisfactory or exemplary) ranged from 34.3% to 51.4%. CONCLUSIONS This study provided an opportunity to implement FEPS-FS and assess fidelity in FEP teams in Czechia. The fidelity assessment also provided a baseline for measuring change.
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Affiliation(s)
- Hana Tomaskova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Charles University, Prague, Czechia
| | - Lucie Kondrátová
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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12
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Schomerus G, Leonhard A, Manthey J, Morris J, Neufeld M, Kilian C, Speerforck S, Winkler P, Corrigan PW. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol 2022; 77:516-524. [PMID: 35526787 DOI: 10.1016/j.jhep.2022.04.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.
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Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
| | - Anya Leonhard
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Jakob Manthey
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - Maria Neufeld
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sven Speerforck
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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13
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Kasal A, Kuklová M, Kågström A, Winkler P, Formánek T. Suicide Risk in Individuals With and Without Mental Disorders Before and During the COVID-19 Pandemic: An Analysis of Three Nationwide Cross-Sectional Surveys in Czechia. Arch Suicide Res 2022; 27:671-685. [PMID: 35322761 DOI: 10.1080/13811118.2022.2051653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic on suicidal thoughts and behavior has been widely hypothesized but remains largely unexplored at the population-level. We aimed to assess changes in suicide risk (SR) in people with and without mental disorders, before and during the COVID-19 pandemic in Czechia. METHODS We analyzed data from three nationwide cross-sectional surveys of Czech adults (November 2017, May and November 2020). For the 2017 data collection, we employed paper and pencil interviewing, while for the two 2020 data collections, we used a mixed computer-assisted web interviewing and computer-assisted telephone interviewing approach. All samples were representative in terms of age, gender, education, and area of residence for the Czech adult population (18+). We used the Mini International Neuropsychiatric Interview to screen for mental disorders and SR. We calculated weighted prevalence rates with 95% confidence intervals (95% CI). RESULTS When compared to baseline, we found a 4% and 6% increase in SR in individuals without mental disorders in pandemic surveys (1.95% (1.45%; 2.44%) vs. 6.29% (5.28%; 7.30%) and 8.42% (7.19%; 9.65%)). Relative to baseline, SR in people with major depressive episode or anxiety disorders was elevated in May and November 2020 (22.35% (17.64%; 27.06%) vs. 36.68% (32.45%; 40.91%) and 38.88% (34.51%; 43.25%)). CONCLUSIONS We found substantially increased SR in both people with and without mental disorders, however, these changes could be partially related to differing data collection methods used in the baseline and subsequent surveys. Ongoing prevention, monitoring and evaluation of nationwide suicidality is warranted.HIGHLIGHTSWe found that suicide risk substantially increased during the pandemicSuicide risk was elevated in both individuals with and without mental disordersOur findings support increased suicide monitoring and prevention.
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14
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Cosma A, Költő A, Badura P, Winkler P, Kalman M. Time trends in adolescent mental wellbeing in the Czech Republic between 2002 and 2018: gender, age and socioeconomic differences. Cent Eur J Public Health 2022; 29:271-278. [PMID: 35026065 DOI: 10.21101/cejph.a6717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Recent literature indicates a decline over time in adolescent mental wellbeing but results are inconsistent and rely mainly on data from Western societies. This study investigates time trends in adolescent mental wellbeing (psychological and somatic complaints, life satisfaction) among Czech adolescents and explores the moderating role of gender, age and socioeconomic status. METHODS Nationally representative data from 29,376 Czech adolescents (50.8% girls, mean age = 13.43; SD = 1.65) across five Health Behaviour in School-aged Children (HBSC) surveys (2002, 2006, 2010, 2014, 2018) were used. Hierarchical regression models estimated national trends in adolescent mental wellbeing and established the moderating role of gender, age and socioeconomic status. RESULTS From 2002 to 2018, an increase in the psychological complaints was observed. Life satisfaction decreased over time up to 2014 only, whereas somatic symptoms increased until 2010, followed by a decline in 2014 and 2018. Girls, older adolescents and those from low family affluence reported poorer mental wellbeing. Gender gap increased over time for psychological complaints and life satisfaction. Socioeconomic inequalities gap remained stable over the investigated timeframe. CONCLUSIONS Our findings do not provide evidence for substantial temporal changes in mental wellbeing among adolescents in the Czech Republic. Yet, the increase in psychological complaints has been consistent which is an indicator of a small decline over time in adolescent mental wellbeing. Furthermore, the gender gap in mental wellbeing increased over time, whereas the age and socioeconomic differences remained relatively stable. This calls for the attention of public health professionals and policy makers from the Czech Republic.
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Affiliation(s)
- Alina Cosma
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.,Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic
| | - András Költő
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland, Galway, Ireland.,Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic
| | - Petr Badura
- Faculty of Physical Culture, Institute of Active Lifestyle, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic
| | - Michal Kalman
- Faculty of Physical Culture, Institute of Active Lifestyle, Palacky University Olomouc, Olomouc, Czech Republic
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15
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Winkler P, Zeininger J, Raab M, Suchorski Y, Steiger-Thirsfeld A, Stöger-Pollach M, Amati M, Gregoratti L, Grönbeck H, Rupprechter G. Coexisting multi-states in catalytic hydrogen oxidation on rhodium. Nat Commun 2021; 12:6517. [PMID: 34764290 PMCID: PMC8586342 DOI: 10.1038/s41467-021-26855-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
Catalytic hydrogen oxidation on a polycrystalline rhodium foil used as a surface structure library is studied by scanning photoelectron microscopy (SPEM) in the 10-6 mbar pressure range, yielding spatially resolved X-ray photoemission spectroscopy (XPS) measurements. Here we report an observation of a previously unknown coexistence of four different states on adjacent differently oriented domains of the same Rh sample at the exactly same conditions. A catalytically active steady state, a catalytically inactive steady state and multifrequential oscillating states are simultaneously observed. Our results thus demonstrate the general possibility of multi-states in a catalytic reaction. This highly unusual behaviour is explained on the basis of peculiarities of the formation and depletion of subsurface oxygen on differently structured Rh surfaces. The experimental findings are supported by mean-field micro-kinetic modelling. The present observations raise the interdisciplinary question of how self-organising dynamic processes in a heterogeneous system are influenced by the permeability of the borders confining the adjacent regions.
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Affiliation(s)
- P Winkler
- Institute of Materials Chemistry, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria
| | - J Zeininger
- Institute of Materials Chemistry, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria
| | - M Raab
- Institute of Materials Chemistry, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria
| | - Y Suchorski
- Institute of Materials Chemistry, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria
| | - A Steiger-Thirsfeld
- University Service Center for Transmission Electron Microscopy, TU Wien, Wiedner Hauptstraße 8-10, 1040, Vienna, Austria
| | - M Stöger-Pollach
- University Service Center for Transmission Electron Microscopy, TU Wien, Wiedner Hauptstraße 8-10, 1040, Vienna, Austria
| | - M Amati
- Elettra-Sincrotrone Trieste S.C.p.A., SS14 - km 163.5 in Area Science Park, 34149, Trieste, Italy
| | - L Gregoratti
- Elettra-Sincrotrone Trieste S.C.p.A., SS14 - km 163.5 in Area Science Park, 34149, Trieste, Italy
| | - H Grönbeck
- Department of Physics and Competence Center for Catalysis, Chalmers University of Technology, 412 96, Göteborg, Sweden
| | - G Rupprechter
- Institute of Materials Chemistry, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.
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16
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Mlada K, Formanek T, Vevera J, Latalova K, Winkler P, Volavka J. Serious physical assault and subsequent risk for rehospitalization in individuals with severe mental illness: a nationwide, register-based retrospective cohort study. Ann Gen Psychiatry 2021; 20:44. [PMID: 34537054 PMCID: PMC8449895 DOI: 10.1186/s12991-021-00358-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Victimization is associated with worse social and clinical outcomes of individuals with severe mental illness (SMI). A relapse of SMI may be one of the clinical consequences of assaultive trauma. As far as we know, there is no published study that analyzes nationwide health registers to assess the risk of SMI rehospitalization following assault. AIM We aimed to assess whether exposure to assault is associated with an increased risk of psychiatric hospitalization in those with SMI. METHODS We utilized data from the Czech nationwide registers of all-cause hospitalizations and all-cause deaths. We defined exposed individuals as those discharged from a hospitalization for SMI between 2002 and 2007, and hospitalized for serious injuries sustained in an assault in the subsequent 7 years. For each assaulted individual, we randomly selected five counterparts, matched on SMI diagnosis, age and sex, who were not assaulted in the examined time period. We used mixed effect logistic regression to assess the effect of assault on the risk of SMI rehospitalization within the following 6 months. We fitted unadjusted models and models adjusted for the number of previous SMI hospitalizations and drug use disorders. RESULTS The sample consisted of 248 exposed and 1 240 unexposed individuals. In the unadjusted model, assaulted individuals were almost four times more likely to be rehospitalized than their non-assaulted counterparts (odds ratio (OR) = 3.96; 95% CI 2.75; 5.71). After adjusting for all covariates, the OR remained threefold higher (OR = 3.07; 95% CI 2.10; 4.49). CONCLUSION People with a history of SMI hospitalization were approximately three times more likely to be rehospitalized for SMI within 6 months after an assault than their non-assaulted SMI counterparts. Soon after a person with SMI is physically assaulted, there should be a psychiatric evaluation and a close follow-up.
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Affiliation(s)
- Karolina Mlada
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic.
- Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic.
| | - Tomas Formanek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- EpiCentre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Institute for Postgraduate Medical Education Prague, Prague, Czech Republic
| | - Klara Latalova
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jan Volavka
- Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, Emeritus, USA
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17
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Gaebel W, Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Tosevski DL, Milosavljevic M, Nakov V, Winkler P, Zielasek J. Quality indicators for mental healthcare in the Danube region: results from a pilot feasibility study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1017-1025. [PMID: 32270290 DOI: 10.1007/s00406-020-01124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
Quality indicators are vital for monitoring the transformation of institution-based mental health services towards the provision of person-centered mental healthcare. While several mental healthcare quality indicators have been identified as relevant and valid, their actual usability and utility for routine monitoring healthcare quality over time is significantly determined by the availability and trustworthiness of the underlying data. In this feasibility study, quality indicators that have been systematically identified for use in the Danube region countries of Bulgaria, the Czech Republic, Hungary, and Serbia were measured on the basis of existing mental healthcare data in the four countries. Data were collected retrospectively by means of the best available, most standardized, trustworthy, and up-to-date data in each country. Out of 21 proposed quality indicators, 18 could be measured in Hungary, 17 could be measured in Bulgaria and in the Czech Republic, and 8 could be measured in Serbia. The results demonstrate that a majority of quality indicators can be measured in most of the countries by means of already existing data, thereby demonstrating the feasibility of quality measurement and regular quality monitoring. However, data availability and usability are scattered across countries and care sectors, which leads to variations in the quality of the quality indicators themselves. Making the planning and outputs of national mental healthcare reforms more transparent and evidence-based requires (trans-)national standardization of healthcare quality data, their routine availability and standardized assessment, and the regular reporting of quality indicators.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany. .,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Lehmann
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - H Hinkov
- NCPHA-National Center of Public Health and Analyses, Sofia, Bulgaria
| | - C Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - G Kapócs
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Institute for Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - T Kurimay
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - M Milosavljevic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Nakov
- Mental Health, National Center of Mental Health and Analyses, Sofia, Bulgaria
| | - P Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
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18
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Abstract
Background We aimed to assess the changes in public stigma towards people with mental health problems in Czechia; and to investigate the association between these and the exposure to the ongoing mental health care reform and one of its implementation projects focused on reducing stigma. Methods We analyzed data from three cross-sectional surveys representative of the Czech adult population. We used linear regression models to compare population attitudes and desire for future contact with people with mental health problems between the 2013/2014 baseline and the 2019 follow-up. In our 2019 sample, we employed linear regression models to assess the relationship between exposure to mental health care reform and nation-wide anti-stigma campaign, and population stigmatizing attitudes and intended behavior. We utilized a propensity score matching procedure to mitigate potential bias. Results The 2013, 2014, and 2019 datasets consisted of 1797, 1810, and 1077 participants, respectively. Population attitudes improved significantly between 2014 and 2019 (B = 0.99, 95% CI = 0.06; 1.93), but we did not detect a change in population desire for future contact with people with mental health problems. Exposure to the nationwide anti-stigma campaign or mental health care reform was associated with more favorable attitudes (B = 4.25, 95% CI = 2.07; 6.42 and B = 7.66, 95% CI = 3.91; 11.42), but not with higher desire for future contact with people with mental health problems. Conclusions Mental health care reform and its nation-wide anti-stigma project seems to have a positive impact on population attitudes, but not on desire for future contact with people with mental health problems.
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Affiliation(s)
- Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,EpiCentre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Prague, Czechia
| | - Sara Evans Lacko
- Care Policy and Evaluation Centre, London School of Economics, London, United Kingdom
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19
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Aliev AA, Roberts T, Magzumova S, Panteleeva L, Yeshimbetova S, Krupchanka D, Sartorius N, Thornicroft G, Winkler P. Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1329-1340. [PMID: 33738529 DOI: 10.1007/s00127-021-02064-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/10/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE We aimed to map evidence on the development of mental health care in Central Asia after 1991. METHOD We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications. RESULTS We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990's mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments. CONCLUSIONS There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.
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Affiliation(s)
- Akmal-Alikhan Aliev
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 256 01, Klecany, Czech Republic
| | - Tessa Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Society and Mental Health, King's College London, London, UK
| | - Shakhnoza Magzumova
- Department of Psychiatry and Narcology, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Liliia Panteleeva
- Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University Named After B. N. Yeltsin, Bishkek, Chuy Province, Kyrgyzstan
| | - Saida Yeshimbetova
- Department of Psychiatry, Narcology and Neurology, Kazakh-Russian Medical University, Almaty, Kazakhstan
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, CH, Geneva, Switzerland
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 256 01, Klecany, Czech Republic.
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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20
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Pustjens TFS, Meerman A, Vranken NPA, Ruiters AW, Gho B, Stein M, Ilhan M, Veenstra L, Winkler P, Lux Á, Rasoul S, van 't Hof AWJ. Importance of confirming the underlying diagnosis in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): a single-centre retrospective cohort study. BMC Cardiovasc Disord 2021; 21:357. [PMID: 34320950 PMCID: PMC8320155 DOI: 10.1186/s12872-021-02176-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Many patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discharged without a known aetiology for their clinical presentation. This study sought to assess the effect of this 'indeterminate MINOCA' diagnosis on the prevalence of recurrent cardiovascular events and presentations to the Cardiac Emergency Department (CED). METHODS We retrospectively analysed all patients meeting the diagnostic MINOCA criteria presenting at a large secondary hospital between January 2017 and April 2019. PARTICIPANTS Patients were divided into the (1) 'indeterminate MINOCA', or (2) 'MINOCA with diagnosis' group. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke and any revascularisation procedure. Secondary outcomes were all recurrent visits at the CED, and MACE including unplanned cardiac hospitalisation. RESULTS In 62/198 (31.3%) MINOCA patients, a conclusive diagnosis was found (myocardial infarction, (peri)myocarditis, cardiomyopathy, or miscellaneous). MINOCA patients with a confirmed diagnosis were younger compared to those with an indeterminate diagnosis (56.7 vs. 62.3 years, p = 0.007), had higher maximum troponin-T [238 ng/L vs. 69 ng/L, p < 0.001] and creatine kinase (CK) levels [212U/L vs. 152U/L, p = 0.007], and presented more frequently with electrocardiographic signs of ischaemia (71.0% vs. 47.1%, p = 0.002). Indeterminate MINOCA patients more often showed recurrent CED presentations (36.8% vs. 22.6%, p = 0.048), however the occurrence of cardiovascular events was equal (8.8 vs. 8.1%, p = 0.86). Multivariable analysis showed that elevated levels of troponin-T and CK, ST-segment deviation on electrocardiography, reduced left ventricular ejection fraction, regional wall motion abnormalities, and performance of additional examination methods were independent predictors for finding the underlying MINOCA cause. CONCLUSIONS Only in one-third of MINOCA patients a conclusive diagnosis for the acute presentation was identified. Recurrent CED visits were more often observed in the indeterminate MINOCA group, while the occurrence of cardiovascular events was similar across groups. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- T F S Pustjens
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands.
| | - A Meerman
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - N P A Vranken
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A W Ruiters
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - B Gho
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - M Stein
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - M Ilhan
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Veenstra
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Winkler
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Á Lux
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Rasoul
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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21
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Wilke L, Moustakis C, Blanck O, Albers D, Albrecht C, Avcu Y, Boucenna R, Buchauer K, Etzelstorfer T, Henkenberens C, Jeller D, Jurianz K, Kornhuber C, Kretschmer M, Lotze S, Meier K, Pemler P, Riegler A, Röser A, Schmidhalter D, Spruijt KH, Surber G, Vallet V, Wiehle R, Willner J, Winkler P, Wittig A, Guckenberger M, Tanadini-Lang S. Improving interinstitutional and intertechnology consistency of pulmonary SBRT by dose prescription to the mean internal target volume dose. Strahlenther Onkol 2021; 197:836-846. [PMID: 34196725 PMCID: PMC8397670 DOI: 10.1007/s00066-021-01799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
Purpose Dose, fractionation, normalization and the dose profile inside the target volume vary substantially in pulmonary stereotactic body radiotherapy (SBRT) between different institutions and SBRT technologies. Published planning studies have shown large variations of the mean dose in planning target volume (PTV) and gross tumor volume (GTV) or internal target volume (ITV) when dose prescription is performed to the PTV covering isodose. This planning study investigated whether dose prescription to the mean dose of the ITV improves consistency in pulmonary SBRT dose distributions. Materials and methods This was a multi-institutional planning study by the German Society of Radiation Oncology (DEGRO) working group Radiosurgery and Stereotactic Radiotherapy. CT images and structures of ITV, PTV and all relevant organs at risk (OAR) for two patients with early stage non-small cell lung cancer (NSCLC) were distributed to all participating institutions. Each institute created a treatment plan with the technique commonly used in the institute for lung SBRT. The specified dose fractionation was 3 × 21.5 Gy normalized to the mean ITV dose. Additional dose objectives for target volumes and OAR were provided. Results In all, 52 plans from 25 institutions were included in this analysis: 8 robotic radiosurgery (RRS), 34 intensity-modulated (MOD), and 10 3D-conformal (3D) radiation therapy plans. The distribution of the mean dose in the PTV did not differ significantly between the two patients (median 56.9 Gy vs 56.6 Gy). There was only a small difference between the techniques, with RRS having the lowest mean PTV dose with a median of 55.9 Gy followed by MOD plans with 56.7 Gy and 3D plans with 57.4 Gy having the highest. For the different organs at risk no significant difference between the techniques could be found. Conclusions This planning study pointed out that multiparameter dose prescription including normalization on the mean ITV dose in combination with detailed objectives for the PTV and ITV achieve consistent dose distributions for peripheral lung tumors in combination with an ITV concept between different delivery techniques and across institutions. Supplementary Information The online version of this article (10.1007/s00066-021-01799-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Wilke
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland.
| | - C Moustakis
- Klinik für Strahlentherapie, Universitätsklinikum Münster, Münster, Germany
| | - O Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - D Albers
- Klinik für Strahlentherapie und Radioonkologie, Universtitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - C Albrecht
- CyberKnife Centrum Süd, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Y Avcu
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Basel, Switzerland
| | - R Boucenna
- Institut de radio-oncologie, Hislanden Lausanne, Lausanne, Switzerland
| | - K Buchauer
- Klinik für Radio-Onkologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - T Etzelstorfer
- Radio-Onkologie, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - C Henkenberens
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - D Jeller
- Radio-Onkologie, Kantonsspital Luzern, Luzern, Switzerland
| | - K Jurianz
- MVZ Gamma-Knife Zentrum Krefeld, Krefeld, Germany
| | - C Kornhuber
- Klinik für Strahlentherapie, Universitätsklinikum Halle, Halle, Germany
| | | | - S Lotze
- Klinik für Radioonkologie und Strahlentherapie, Uniklinik RWTH Aachen, Aachen, Germany
| | - K Meier
- Strahlentherapie, Klinikum Wolfsburg, Wolfsburg, Germany
| | - P Pemler
- Klinik für Radioonkologie, Stadtspital Triemli, Zürich, Switzerland
| | - A Riegler
- Institut für Radioonkologie und Strahlentherapie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - A Röser
- Strahlentherapie und Radio-Onkologie, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - D Schmidhalter
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern, Switzerland.,University Hospital, and University of Bern, Bern, Switzerland
| | - K H Spruijt
- Institut de radio-oncologie, Clinique des Grangettes, Geneva, Switzerland
| | - G Surber
- Institut für Radiochirurgie und Präzisionsbestrahlung, CyberKnife Centrum Mitteldeutschland, Erfurt, Germany
| | - V Vallet
- Service de radio-oncologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - R Wiehle
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - J Willner
- Klinik für Strahlentherapie, Klinikum Bayreuth, Bayreuth, Germany
| | - P Winkler
- Universitätsklinik für Strahlentherapie-Radioonkologie, LKH-Univ. Klinikum Graz, Graz, Austria
| | - A Wittig
- Departent of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - M Guckenberger
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland
| | - S Tanadini-Lang
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland
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22
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Kuklová M, Kagstrom A, Kučera M, Mladá K, Winkler P, Cermakova P. Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS). Soc Psychiatry Psychiatr Epidemiol 2021; 56:867-877. [PMID: 32789560 DOI: 10.1007/s00127-020-01930-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic. METHODS Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics. RESULTS We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates. CONCLUSIONS Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.
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Affiliation(s)
- Marie Kuklová
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Faculty of Science, Charles University Prague, Prague, Czech Republic
| | - Anna Kagstrom
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Matěj Kučera
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University Prague, Prague, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic. .,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
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Sebela A, Byatt N, Formanek T, Winkler P. Prevalence of mental disorders and treatment gap among Czech women during paid maternity or parental leave. Arch Womens Ment Health 2021; 24:335-338. [PMID: 32691155 DOI: 10.1007/s00737-020-01052-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
We performed a secondary analysis of the data from Czech epidemiological study on mental health to determine the prevalence of mental disorders among Czech women on maternity or parental leave and to assess the present treatment gap. Any mental disorder was present in 17.6% (n = 21) of the total sample of 119 women. The treatment gap was present among 76% (n = 16) of them. In conclusion, most women on maternity or parental leave facing a mental disorder were not receiving treatment. The present study is the first of its kind in the region of Central and Eastern Europe.
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Affiliation(s)
- A Sebela
- Department of Diagnostics and Treatment of Mental Disorders, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czechia.
| | - N Byatt
- UMass Memorial Health Care, University of Massachusetts Medical School, 55 North Lake Ave, Worcester, MA, 01655, USA
| | - T Formanek
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czechia
| | - P Winkler
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czechia
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24
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Winkler P, Formanek T, Mlada K, Kagstrom A, Mohrova Z, Mohr P, Csemy L. Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys. Epidemiol Psychiatr Sci 2020; 29:e173. [PMID: 32988427 PMCID: PMC7573458 DOI: 10.1017/s2045796020000888] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS The United Nations warned of COVID-19-related mental health crisis; however, it is unknown whether there is an increase in the prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic. METHODS We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalised Czech adults (18+ years) from both November 2017 (n = 3306; 54% females) and May 2020 (n = 3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk and alcohol-related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders. RESULTS The prevalence of those experiencing symptoms of at least one current mental disorder rose from a baseline of 20.02 (95% CI = 18.64; 21.39) in 2017 to 29.63 (95% CI = 27.9; 31.37) in 2020 during the COVID-19 pandemic. The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 v. 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 v. 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 v. 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 v. 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviours (4.07% v. 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively). CONCLUSIONS This study provides evidence matching concerns that COVID-19-related mental health problems pose a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasises an urgent need to scale up mental health promotion and prevention globally.
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Affiliation(s)
- P. Winkler
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK
| | - T. Formanek
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - K. Mlada
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00Pilsen, Czech Republic
| | - A. Kagstrom
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Z. Mohrova
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - P. Mohr
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00Prague, Czech Republic
| | - L. Csemy
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
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Griebler R, Winkler P, Antony G. Outcome monitoring of the Austrian health targets. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ten Austrian Health Targets, developed in a Health-in-All-Policies process and adopted in 2012 with a time horizon until 2032, are monitored by a series of indicators. The (interim) results are reported regularly.
Methods
Indicators were discussed intensively with experts and defined in advance. The outcome monitoring enables to observe developments over time, to analyse differences by gender, education and region, and comparisons with other EU-countries. For each indicator an overall qualitative assessment is done. This makes monitoring very comprehensive. The challenge is to communicate the monitoring results in an easily understandable way. Therefore, besides reports and presentations further in depth-discussions about communication formats with decision makers were required.
Results
The outcome monitoring shows that there is potential for development in all areas: Between 2006 and 2014 only 25 % of the outcome-indicators developed positively. As far as equal opportunities are concerned, the most improvements were seen in gender differences, significantly less for educational differences and hardly any positive developments in regional differences. In an EU comparison, Austria performs well concerning 15 out of 35 indicators (43 %). However, for some indicators - contrary to the EU trend - no improvements can be observed.
Conclusions
The results confirm the relevance of the ten health targets and identify whole-of-society areas for action. The monitoring provides steering impulses and information enabling decision-making for politics, administration, the health target plenary, and the intersectoral working groups.
Key messages
The monitoring contributes to strategic steering, helps optimising strategy and action plans and enhancing the overall process. Stakeholder involvement is important for development of a format to communicate the results in the best comprehensible way.
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Affiliation(s)
- R Griebler
- Austrian Public Health Institute, Vienna, Austria
| | - P Winkler
- Austrian Public Health Institute, Vienna, Austria
| | - G Antony
- Austrian Public Health Institute, Vienna, Austria
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Bakstein E, Mladá K, Fárková E, Kolenič M, Španiel F, Manková D, Korčáková J, Winkler P, Hajek T. Cross-sectional and within-subject seasonality and regularity of hospitalizations: A population study in mood disorders and schizophrenia. Bipolar Disord 2020; 22:508-516. [PMID: 31883178 DOI: 10.1111/bdi.12884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Seasonal peaks in hospitalizations for mood disorders and schizophrenia are well recognized and often replicated. The within-subject tendency to experience illness episodes in the same season, that is, seasonal course, is much less established, as certain individuals may temporarily meet criteria for seasonal course purely by chance. AIMS In this population, prospective cohort study, we investigated whether between and within-subject seasonal patterns of hospitalizations occurred more frequently than would be expected by chance. METHODS Using a compulsory, standardized national register of hospitalizations, we analyzed all admissions for mood disorders and schizophrenia in the Czech Republic between 1994 and 2013. We used bootstrap tests to compare the observed numbers of (a) participants with seasonal/regular course and (b) hospitalizations in individual months against empirical distributions obtained by simulations. RESULTS Among 87 184 participants, we found uneven distribution of hospitalizations, with hospitalization peaks for depression in April and November (X2 (11) = 363.66, P < .001), for mania in August (X2 (11) = 50.36, P < .001) and for schizophrenia in June (X2 (11) = 70.34, P < .001). Significantly more participants than would be expected by chance, had two subsequent rehospitalizations in the same 90 days in different years (7.36%, bootstrap P < .01) or after a regular, but non-seasonal interval (6.07%, bootstrap P < .001). The proportion of participants with two consecutive hospitalizations in the same season was below chance level (7.06%). CONCLUSIONS Psychiatric hospitalizations were unevenly distributed throughout the year (cross-sectional seasonality), with evidence for regularity, but not seasonality of hospitalizations within subjects. Our data do not support the validity of seasonal pattern specifier. Season may be a general risk factor, which increases the risk of hospitalizations across psychiatric participants.
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Affiliation(s)
- Eduard Bakstein
- National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | - Eva Fárková
- National Institute of Mental Health, Klecany, Czech Republic.,3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Marian Kolenič
- National Institute of Mental Health, Klecany, Czech Republic.,3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Filip Španiel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Denisa Manková
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jana Korčáková
- National Institute of Mental Health, Klecany, Czech Republic.,3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Šouláková B, Kasal A, Butzer B, Winkler P. Meta-Review on the Effectiveness of Classroom-Based Psychological Interventions Aimed at Improving Student Mental Health and Well-Being, and Preventing Mental Illness. J Prim Prev 2020; 40:255-278. [PMID: 31140100 DOI: 10.1007/s10935-019-00552-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This meta-review summarizes existing evidence from systematic reviews and meta-analyses on the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness. Systematic reviews and meta-analyses were identified via the electronic databases PsycINFO, Web of Knowledge, Medline, Embase, and HMIC (Health Management Information Consortium). Ten systematic reviews and meta-analysis were eligible for inclusion in the final analyses. These systematic reviews and meta-analyses evaluated the effects of five types of school-based psychological interventions: Mindfulness, Social Emotional Learning, Cognitive Behavioral Therapy, Yoga, and Body-Image. Overall effectiveness reported in the included studies was significant for the most part, and ranging from small to large with respect to the effect size. The authors of all of the studies emphasized the need for additional high-quality trials to further examine the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness.
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Affiliation(s)
- Barbora Šouláková
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
| | - Alexandr Kasal
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Faculty of Social Sciences, Charles University in Prague, Prague, Czech Republic
| | - Bethany Butzer
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,School of Psychology, University of New York in Prague, Prague, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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28
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Winkler P, Kondrátová L, Kagstrom A, Kučera M, Palánová T, Salomonová M, Šturma P, Roboch Z, Murko M. Adherence to the Convention on the Rights of People with Disabilities in Czech Psychiatric Hospitals: A Nationwide Evaluation Study. Health Hum Rights 2020; 22:21-33. [PMID: 32669786 PMCID: PMC7348437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study sought to evaluate the quality of care in Czech psychiatric hospitals and adherence to the Convention on the Rights of Persons with Disabilities (CRPD). Each psychiatric hospital was evaluated by a team comprising a service user, a psychiatrist, a social worker, a human rights lawyer, and a researcher, all trained in using the World Health Organization's QualityRights Toolkit. We conducted content analysis on internal documents from psychiatric hospitals, observed everyday practices, and conducted 579 interviews across public psychiatric hospitals between 2017 and 2019. We found that none of the CRPD articles as assessed by the QualityRights Toolkit was fully adhered to in Czech psychiatric hospitals. We recommend both facility- and system-level interventions to improve CRPD adherence in the Czech context and in the wider region of Central and Eastern Europe. To achieve this, substantial investments are required.
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Affiliation(s)
- Petr Winkler
- Head of the Department of Public Mental Health at the National Institute of Mental Health, Czech Republic
| | - Lucie Kondrátová
- Researcher at the Department of Public Mental Health at the National Institute of Mental Health, Czech Republic
| | - Anna Kagstrom
- Researcher at the Department of Public Mental Health at the National Institute of Mental Health, Czech Republic
| | - Matěj Kučera
- Researcher at the Department of Public Mental Health at the National Institute of Mental Health, Czech Republic
| | | | | | - Petr Šturma
- Freelance manager and lecturer with extensive experience in community mental health and anti-stigma projects, Czech Republic
| | - Zbyněk Roboch
- Researcher at the Department of Public Mental Health at the National Institute of Mental Health, Czech Republic
| | - Melita Murko
- Technical Officer with the Mental Health Programme, World Health Organization Regional Office for Europe, Denmark
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29
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Broulíková HM, Winkler P, Páv M, Kondrátová L. Costs of Mental Health Services in Czechia: Facilitating an Evidence-Based Reform of Psychiatric Care. Appl Health Econ Health Policy 2020; 18:287-298. [PMID: 31347015 DOI: 10.1007/s40258-019-00501-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region. OBJECTIVE The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers. METHODS We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers. RESULTS An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups. CONCLUSIONS The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.
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Affiliation(s)
- Hana M Broulíková
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
- Faculty of Informatics and Statistics, University of Economics, Prague, W. Churchill Sq. 1938/4, 130 67, Prague, Czech Republic.
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Marek Páv
- Psychiatric Hospital Bohnice, Ústavní 91, 181 00, Prague, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 11, 181 120 00, Prague, Czech Republic
| | - Lucie Kondrátová
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
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Abstract
Expenditures on mental health care in the Czech Republic are not being published regularly, yet they are indispensable for evaluation of the ongoing reform of Czech mental health care. The main objective of this study is to estimate the size of these expenditures in 2015 and make a comparison with the last available figures from the year 2006. The estimation is based on an OECD methodology of health accounts, which structures health care expenditures according to health care functions, provider industries, and payers. The expenditures are further decomposed according to diagnoses, and inputs used in service production. The amount spent on mental health care in 2015 reached more than 13.7 billion Czech korunas (EUR 501.6 million), which represented 4.08% of the total health care expenditures. This ratio is almost identical with the 2006 share (4.14%). There are no significant changes in the relative expenditures on mental health care and in the structure of service provision. The Czech mental health care system remains largely hospital based with most of all mental health care expenditures being spent on inpatient care. Future developments in the expenditures will indicate the success of the current effort to deinstitutionalise mental health care.
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Affiliation(s)
- Hana M Broulikova
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Prague, Czech Republic.
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
| | - Martin Dlouhy
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Prague, Czech Republic
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31
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Calone R, Pennisi G, Morgenstern R, Sanyé-Mengual E, Lorleberg W, Dapprich P, Winkler P, Orsini F, Gianquinto G. Improving water management in European catfish recirculating aquaculture systems through catfish-lettuce aquaponics. Sci Total Environ 2019; 687:759-767. [PMID: 31412479 DOI: 10.1016/j.scitotenv.2019.06.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 06/10/2023]
Abstract
In the context of climate change and population growth, aquaculture plays an important role for food security, employment and economic development. Intensive recirculating aquaculture systems (RAS) allow to treat and recycle fish effluents to reduce waste concentration in outflow water thereby reducing environmental contamination. RAS sustainability may be further improved using aquaponics, a circular productive system in which RAS wastewater is recovered for crop cultivation and recycled back to the fish tanks. In this study, water metabolism of a catfish RAS was assessed and the opportunity to produce lettuce with the RAS effluent was tested. Crop growth and water consumption in aquaponics were compared to those experienced in hydroponics at three nutrient solution concentration (EC of 1.6, 2.0 and 3.0 dS∙m-1), also considering water- (WUE) and nitrogen- use efficiency (NUE). A scenario for converting the RAS in a catfish-lettuce aquaponic system was, then, proposed. The RAS water balance included an input of 555 L∙day-1, out of which 32 L∙day-1 were lost by evaporation from the tubs whereas 460 L∙day-1 were discarded. The lettuce yield, NUE and WUE in aquaponics were respectively 20.3%, 22.3% and 20.6% lower than those obtained in hydroponics. Best performances in hydroponics were achieved with EC of 2.0 dS m-1. No difference in term of water consumption arose between the treatments, with average water use of 46 mL∙plant-1∙day-1. Considering the current RAS productivity of 329 kg year-1, a 10 m2 raft system hosting 160 lettuces would satisfy the nitrogen filtration demand. Once closed the water loop between the two productive sub-units, the current water input of 532 L∙day-1 could be reduced to the amount needed to replace the water lost by evaporation (50 L∙day-1) and the RAS water output would decrease from 555 to 103 L∙day-1.
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Affiliation(s)
- R Calone
- Research Centre in Urban Environment for Agriculture and Biodiversity (ResCUE-AB), Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum University of Bologna, Viale Fanin, 44, 40127 Bologna, Italy
| | - G Pennisi
- Research Centre in Urban Environment for Agriculture and Biodiversity (ResCUE-AB), Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum University of Bologna, Viale Fanin, 44, 40127 Bologna, Italy; DISAFA, Department of Agricultural, Forest and Food Sciences, Università di Torino, Via Leonardo da Vinci, 44, Largo Braccini 2, 10095 Grugliasco, TO, Italy
| | - R Morgenstern
- Department of Agriculture, South Westphalia University of Applied Sciences, Lübecker Ring 2, 59494 Soest, Germany
| | - E Sanyé-Mengual
- Research Centre in Urban Environment for Agriculture and Biodiversity (ResCUE-AB), Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum University of Bologna, Viale Fanin, 44, 40127 Bologna, Italy
| | - W Lorleberg
- Department of Agriculture, South Westphalia University of Applied Sciences, Lübecker Ring 2, 59494 Soest, Germany
| | - P Dapprich
- Department of Agriculture, South Westphalia University of Applied Sciences, Lübecker Ring 2, 59494 Soest, Germany
| | - P Winkler
- Department of Agriculture, South Westphalia University of Applied Sciences, Lübecker Ring 2, 59494 Soest, Germany
| | - F Orsini
- Research Centre in Urban Environment for Agriculture and Biodiversity (ResCUE-AB), Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum University of Bologna, Viale Fanin, 44, 40127 Bologna, Italy.
| | - G Gianquinto
- Research Centre in Urban Environment for Agriculture and Biodiversity (ResCUE-AB), Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum University of Bologna, Viale Fanin, 44, 40127 Bologna, Italy
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32
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Suchorski Y, Bespalov I, Zeininger J, Raab M, Datler M, Winkler P, Rupprechter G. CO Oxidation on Stepped Rh Surfaces: μm-Scale Versus Nanoscale. Catal Letters 2019. [DOI: 10.1007/s10562-019-02950-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
The catalytic CO oxidation reaction on stepped Rh surfaces in the 10−6 mbar pressure range was studied in situ on individual μm-sized high-Miller-index domains of a polycrystalline Rh foil and on nm-sized facets of a Rh tip, employing photoemission electron microscopy (PEEM) and field-ion/field-emission microscopy (FIM/FEM), respectively. Such approach permits a direct comparison of the reaction kinetics for crystallographically different regions under identical reaction conditions. The catalytic activity of the different Rh surfaces, particularly their tolerance towards poisoning by CO, was found to be strongly dependent on the density of steps and defects, as well as on the size (µm vs. nm) of the respective catalytically active surface.
Graphic Abstract
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D'Arcy R, Aschikhin A, Bohlen S, Boyle G, Brümmer T, Chappell J, Diederichs S, Foster B, Garland MJ, Goldberg L, Gonzalez P, Karstensen S, Knetsch A, Kuang P, Libov V, Ludwig K, Martinez de la Ossa A, Marutzky F, Meisel M, Mehrling TJ, Niknejadi P, Põder K, Pourmoussavi P, Quast M, Röckemann JH, Schaper L, Schmidt B, Schröder S, Schwinkendorf JP, Sheeran B, Tauscher G, Wesch S, Wing M, Winkler P, Zeng M, Osterhoff J. FLASHForward: plasma wakefield accelerator science for high-average-power applications. Philos Trans A Math Phys Eng Sci 2019; 377:20180392. [PMID: 31230573 PMCID: PMC6602913 DOI: 10.1098/rsta.2018.0392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
The FLASHForward experimental facility is a high-performance test-bed for precision plasma wakefield research, aiming to accelerate high-quality electron beams to GeV-levels in a few centimetres of ionized gas. The plasma is created by ionizing gas in a gas cell either by a high-voltage discharge or a high-intensity laser pulse. The electrons to be accelerated will either be injected internally from the plasma background or externally from the FLASH superconducting RF front end. In both cases, the wakefield will be driven by electron beams provided by the FLASH gun and linac modules operating with a 10 Hz macro-pulse structure, generating 1.25 GeV, 1 nC electron bunches at up to 3 MHz micro-pulse repetition rates. At full capacity, this FLASH bunch-train structure corresponds to 30 kW of average power, orders of magnitude higher than drivers available to other state-of-the-art LWFA and PWFA experiments. This high-power functionality means FLASHForward is the only plasma wakefield facility in the world with the immediate capability to develop, explore and benchmark high-average-power plasma wakefield research essential for next-generation facilities. The operational parameters and technical highlights of the experiment are discussed, as well as the scientific goals and high-average-power outlook. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.
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Affiliation(s)
- R. D'Arcy
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - A. Aschikhin
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - S. Bohlen
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - G. Boyle
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - T. Brümmer
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - J. Chappell
- University College London, Gower Street, London WC1E 6BT, UK
| | - S. Diederichs
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - B. Foster
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
- University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | - M. J. Garland
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - L. Goldberg
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - P. Gonzalez
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - S. Karstensen
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - A. Knetsch
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - P. Kuang
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - V. Libov
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - K. Ludwig
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - A. Martinez de la Ossa
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - F. Marutzky
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - M. Meisel
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - T. J. Mehrling
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Lawrence Berkeley National Laboratory, University of California, Berkeley, CA 94720, USA
| | - P. Niknejadi
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - K. Põder
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - P. Pourmoussavi
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - M. Quast
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - J. -H. Röckemann
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - L. Schaper
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - B. Schmidt
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - S. Schröder
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - J. -P. Schwinkendorf
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - B. Sheeran
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - G. Tauscher
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - S. Wesch
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - M. Wing
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- University College London, Gower Street, London WC1E 6BT, UK
| | - P. Winkler
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - M. Zeng
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - J. Osterhoff
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
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Alexová A, Kågström A, Winkler P, Kondrátová L, Janoušková M. Correlates of internalized stigma levels in people with psychosis in the Czech Republic. Int J Soc Psychiatry 2019; 65:347-353. [PMID: 31113271 DOI: 10.1177/0020764019850204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Internalized stigma negatively affects lives and prognosis of individuals with psychosis. AIM This study aimed to identify correlates of internalized stigma among individuals with psychosis in a sample of community care users in the Czech Republic. METHODS A cross-sectional study was conducted among 133 community service users with psychosis. A shortened version of the Internalized Stigma of Mental Illness (ISMI-10) scale was used alongside the 5-level EQ-5D version (EQ-5D-5L), assessing health-related quality of life. Descriptive and linear regression analyses were performed in order to determine levels of internalized stigma and its correlates. RESULTS High levels of internalized stigma were reported in 25% of participants. Lower internalized stigma levels were associated with better self-reported health status and being married, and higher internalized stigma with a longer period of time since initial contact with psychiatric care. CONCLUSION Lower internalized stigma levels are associated with better self-reported health-related quality of life. In addition, clients having used psychiatric care for longer periods of time reported significantly higher internalized stigma levels. Therefore, authors suggest self-stigma reduction interventions based in a community setting with an emphasis on targeting clients with chronic psychosis.
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Affiliation(s)
- Aneta Alexová
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Anna Kågström
- 1 National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Winkler
- 1 National Institute of Mental Health, Klecany, Czech Republic.,3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Šouláková B, Kasal A, Butzer B, Winkler P. Correction to: Meta-Review on the Effectiveness of Classroom-Based Psychological Interventions Aimed at Improving Student Mental Health and Well-Being, and Preventing Mental Illness. J Prim Prev 2019; 40:491. [PMID: 31250165 DOI: 10.1007/s10935-019-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The original version of the article, unfortunately, missing the funding information. Funding note is given below.
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Affiliation(s)
- Barbora Šouláková
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
| | - Alexandr Kasal
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Faculty of Social Sciences, Charles University in Prague, Prague, Czech Republic
| | - Bethany Butzer
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,School of Psychology, University of New York in Prague, Prague, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Formánek T, Kagström A, Cermakova P, Csémy L, Mladá K, Winkler P. Prevalence of mental disorders and associated disability: Results from the cross-sectional CZEch mental health Study (CZEMS). Eur Psychiatry 2019; 60:1-6. [PMID: 31096115 DOI: 10.1016/j.eurpsy.2019.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION We aimed to estimate the prevalence of current mental disorders in the Czech population, and to identify associated disability. METHODS We conducted a representative cross-sectional household survey of the Czech adult, community-dwelling population. We used the Mini International Neuropsychiatric Interview (M.I.N.I.), WHO Disability Assessment Schedule (WHODAS) 2.0, and Self-Identification as Mentally Ill (SELFI) scale alongside sociodemographic and other covariates. We reached 75% response rate. Descriptive statistics of the sample were assessed and median (M) disability levels with interquartile range (IQR) according diagnosis were calculated on a scale ranging from 12 to 50. Linear regression models were used to identify factors associated with disability. RESULTS In our sample of 3 306 participants, 21.9% experienced a mental disorder in 2017. Prevalence rates for mood, anxiety, alcohol use, non-alcohol substance use, and psychotic disorders corresponded to 5.5%, 7.3%, 10.8%, 2.9%, and 1.5% respectively. Alcohol dependence was identified in 6.6%, and major depression in 4.0% of the sample. Disability in the general population was significantly lower (M = 12; IQR = 12, 17) than in those with mood (M = 20; IQR = 14; 29), anxiety (M = 18; IQR = 13; 26), alcohol use (M = 14; IQR = 12; 18), non-alcohol substance use (M = 15; IQR = 12; 19), or psychotic disorders (M = 22; IQR = 16.4; 29.4). CONCLUSIONS People with mental disorders have considerably elevated disability in comparison to mentally healthy participants. The prevalence of mental disorders in the Czech Republic is mostly in line with European prevalence rates but it is lower for anxiety disorders and two times higher for alcohol use disorders.
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Affiliation(s)
- T Formánek
- National Institute of Mental Health, Klecany, Czech Republic
| | - A Kagström
- National Institute of Mental Health, Klecany, Czech Republic
| | - P Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic
| | - L Csémy
- National Institute of Mental Health, Klecany, Czech Republic
| | - K Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | - P Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, King's College London, United Kingdom.
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Kagstrom A, Alexova A, Tuskova E, Csajbók Z, Schomerus G, Formanek T, Mladá K, Winkler P, Cermakova P. The treatment gap for mental disorders and associated factors in the Czech Republic. Eur Psychiatry 2019; 59:37-43. [PMID: 31009916 DOI: 10.1016/j.eurpsy.2019.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care. METHODS Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied. RESULTS The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02-1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97-5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12-3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03-1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist. CONCLUSIONS The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.
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Affiliation(s)
- Anna Kagstrom
- National Institute of Mental Health, Klecany, Czech Republic
| | - Aneta Alexova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Eva Tuskova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Zsófia Csajbók
- National Institute of Mental Health, Klecany, Czech Republic; Faculty of Science, Charles University Prague, Czech Republic
| | - Georg Schomerus
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Tomas Formanek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, King's College London, United Kingdom
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic.
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Abstract
Attitudes towards psychiatric medication are an important factor influencing the success of treatment. Mental health care in the region of Central and Eastern Europe remains biologically oriented, yet the attitudes of people with severe mental illnesses are largely unknown. In the present study, we aimed to analyze factors of attitudes toward psychopharmacological drugs among people with schizophrenia spectrum disorder who use community social services in the Czech Republic. Drug Attitude Inventory (DAI) was used as a primary research instrument and data were analyzed using a multivariable linear regression. The majority of respondents (78%) had positive attitudes towards psychopharmacological treatment. Additionally, attitudes towards psychopharmaceutic drugs did not differ with regard to sociodemographic characteristics except for family status. There was a significant negative correlation with the level of self-stigmatization and a significant positive correlation with the duration of treatment. Respondents who had repeated experiences with discontinuation of medication without a prior consultation with a psychiatrist had significantly worse attitudes towards medication than respondents without this experience. This study revealed evidence of a strong relationship between the attitudes toward medication and a history of discontinuation of taking medication and duration of treatment. Therefore, we suggest that interventions focused preventing the internalization of stigmatizing attitudes towards mental illness should be available to people with schizophrenia spectrum disorder, especially in the early stages of the illness - irrespective of the patient's age.
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Affiliation(s)
- Lucie Kondrátová
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic.
| | - Daniel König
- Clinical Division of Social Psychiatry, University-Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karolína Mladá
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Bengough T, Winkler P. Austrian child and adolescent health strategy – from policy into practice. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Bengough
- Austrian Public Health Institute, Vienna, Austria
| | - P Winkler
- Austrian Public Health Institute, Vienna, Austria
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Cermakova P, Formanek T, Kagstrom A, Winkler P. Socioeconomic position in childhood and cognitive aging in Europe. Neurology 2018; 91:e1602-e1610. [PMID: 30258021 DOI: 10.1212/wnl.0000000000006390] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We aimed to investigate whether socioeconomic position (SEP) in childhood has an effect on the level of cognitive performance and the rate of cognitive decline in older adults. METHODS We performed a prospective cohort study of individuals enrolled in a multicenter population-based study, SHARE (Survey of Health, Ageing and Retirement in Europe). Interviews were conducted in 6 waves at approximately 2-year intervals and included examinations of cognitive performance (memory, verbal fluency, delayed recall) and measurements of childhood SEP (participants' household characteristics at the age of 10 years). We estimated the associations of SEP with the level of cognitive performance using linear regression and the relation to the rate of cognitive decline with mixed-effects models. RESULTS This study included 20,244 participants from 16 European countries (median age at baseline 71 years, 54% women). Adverse childhood SEP was associated with a lower level of baseline cognitive performance. This association was attenuated after adjustment for clinical and social risk factors but remained statistically significant. Childhood SEP was not related to the rate of cognitive decline. CONCLUSIONS Variation in childhood SEP helps to explain differences in cognitive performance between older people, but not the rate of decline from their previous level of cognition. Strategies to protect cognitive aging should be applied early in life.
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Affiliation(s)
- Pavla Cermakova
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Tomas Formanek
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anna Kagstrom
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Petr Winkler
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Krupchanka D, Chrtková D, Vítková M, Munzel D, Čihařová M, Růžičková T, Winkler P, Janoušková M, Albanese E, Sartorius N. Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic. Soc Sci Med 2018; 212:129-135. [DOI: 10.1016/j.socscimed.2018.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/20/2018] [Accepted: 07/08/2018] [Indexed: 11/16/2022]
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Winkler P, Formánek T, Mladá K, Cermakova P. The CZEch Mental health Study (CZEMS): Study rationale, design, and methods. Int J Methods Psychiatr Res 2018; 27:e1728. [PMID: 29926999 PMCID: PMC6877135 DOI: 10.1002/mpr.1728] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/29/2018] [Accepted: 05/04/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The CZEch Mental health Study (CZEMS) was launched to inform the ongoing mental health care reform. This paper describes rationale, methods, and the plan for the future analyses of this project. METHODS A cross-sectional survey on a representative sample of the general adult noninstitutionalized population of the Czech Republic was conducted. Two-stage sampling was utilized and respondents were interviewed by centrally trained staff using a paper and pencil interviewing. The presence of mental disorders was assessed by The Mini-International Neuropsychiatric Interview. The study also collected information about disability, self-identification of having a mental illness, medical history, and help-seeking behaviour. RESULTS This survey had a 75% response rate, and the final sample consisted of 3,306 persons aged from 18 to 96 years (mean age 49 years old, 54% women) that were interviewed in their homes. The final sample is representative for the Czech Republic in terms of age, gender, education, and region. CONCLUSIONS CZEMS will provide up-to-date evidence about a prevalence of mental disorders in the Czech Republic, associated disability, and treatment gap. This will help informed decision-making about the current mental health care reform and future mental health care development in the Czech Republic.
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Affiliation(s)
- Petr Winkler
- National Institute of Mental HealthKlecanyCzech Republic
| | - Tomáš Formánek
- National Institute of Mental HealthKlecanyCzech Republic
| | - Karolína Mladá
- National Institute of Mental HealthKlecanyCzech Republic
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Kalisova L, Pav M, Winkler P, Michalec J, Killaspy H. Quality of care in long-term care departments in mental health facilities across the Czech Republic. Eur J Public Health 2018; 28:885-890. [DOI: 10.1093/eurpub/cky151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lucie Kalisova
- Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Pav
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
- Health Service & Population Research Department, IoPPN, King’s College London, London, UK
| | - Jiri Michalec
- Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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Winkler P, Broulíková HM, Kondrátová L, Knapp M, Arteel P, Boyer P, Galderisi S, Karkkainen H, Ieven A, Mohr P, Wasserman D, Park AL, Tinelli M, Gaebel W. Value of schizophrenia treatment II: Decision modelling for developing early detection and early intervention services in the Czech Republic. Eur Psychiatry 2018; 53:116-122. [DOI: 10.1016/j.eurpsy.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
Abstract:Background:Positive findings on early detection and early intervention services have been consistently reported from many different countries. The aim of this study, conducted within the European Brain Council project “The Value of Treatment”, was to estimate costs and the potential cost- savings associated with adopting these services within the context of the Czech mental health care reform.Methods:Czech epidemiological data, probabilities derived from meta-analyses, and data on costs of mental health services in the Czech Republic were used to populate a decision analytical model. From the health care and societal perspectives, costs associated with health care services and productivity lost were taken into account. One-way sensitivity analyses were conducted to explore the uncertainty around the key parameters.Results:It was estimated that annual costs associated with care as usual for people with the first episode of psychosis were as high as 46 million Euro in the Czech Republic 2016. These annual costs could be reduced by 25% if ED services were adopted, 33% if EI services were adopted, and 40% if both, ED and EI services, were adopted in the country. Cost-savings would be generated due to decreased hospitalisations and better employment outcomes in people with psychoses.Conclusions:Adopting early detection and early intervention services in mental health systems based on psychiatric hospitals and with limited access to acute and community care could generate considerable cost- savings. Although the results of this modelling study needs to be taken with caution, early detection and early intervention services are recommended for multi-centre pilot testing accompanied by full economic evaluation in the region of Central and Eastern Europe.
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Mohr P, Galderisi S, Boyer P, Wasserman D, Arteel P, Ieven A, Karkkainen H, Pereira E, Guldemond N, Winkler P, Gaebel W. Value of schizophrenia treatment I: The patient journey. Eur Psychiatry 2018; 53:107-115. [PMID: 30036773 DOI: 10.1016/j.eurpsy.2018.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of the European Brain Council project "The Value of Treatment" was to provide evidence-based, cost-effective policy recommendations for a patient-centered and sustainable coordinated care model for brain disorders. The first part of schizophrenia study examined the needs and gaps in the patients' care pathway. METHODS Descriptive analysis was based on an inventory of needs and treatment opportunities, using focus group sessions, expert interviews, users' input, and literature review. Three patient pathways were selected: indicated prevention, duration of untreated psychosis, and relapse prevention. RESULTS The analysis identified several critical barriers to optimal treatment. Available health care services often miss or delay detection of symptoms and diagnosis in at-risk individuals. There is a lack of illness awareness among patients, families, and the public; scarcity of information, training and education among primary care providers; stigmatizing beliefs. Early symptom recognition and timely intervention result in better outcome and prognosis; effective management leads to a functional recovery. In the current model of care, there is insufficient cooperation between health and social care providers, patients and families, inadequate utilization of pharmacological and psychosocial interventions, lacking patient monitoring, and low implementation of integrated community care. CONCLUSIONS Early detection and early intervention programs, timely intervention, and relapse prevention are essential for effective management of schizophrenia. It requires a paradigm shift from symptom control, achieving and maintaining remission, to the emphasis on recovery. Since the current services are not able to accomplish this goal, changes in mental health policies are needed.
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Affiliation(s)
- Pavel Mohr
- National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University Prague, Czech Republic.
| | | | | | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), The Karolinska Institute, Stockholm, Sweden
| | - Paul Arteel
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN Europe), Belgium
| | - Aagje Ieven
- European Federation of Associations of Families of People with Mental Illness (EUFAMI), Belgium
| | - Hilkka Karkkainen
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN Europe), Belgium
| | - Eulalia Pereira
- European Federation of Associations of Families of People with Mental Illness (EUFAMI), Belgium
| | - Nick Guldemond
- Institute of Health Policy & Management, Erasmus University Rotterdam, Netherlands
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Wolfgang Gaebel
- LVR-Klinikum, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Lecic-Tosevski D, Nakov V, Réthelyi JM, Winkler P, Zielasek J, Gaebel W. Development of quality indicators for mental healthcare in the Danube region. Psychiatr Danub 2018; 30:197-206. [PMID: 29930230 DOI: 10.24869/psyd.2018.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Quality indicators are quality assurance instruments for the evaluation of mental healthcare systems. Quality indicators can be used to measure the effectiveness of mental healthcare structure and process reforms. This project aims to develop quality indicators for mental healthcare systems in Bulgaria, the Czech Republic, Hungary and Serbia to provide monitoring instruments for the transformation of mental healthcare systems in these countries. METHODS Quality indicators for mental healthcare systems were developed in a systematic, multidisciplinary approach. A systematic literature study was conducted to identify quality indicators that are used internationally in mental healthcare. Retrieved quality indicators were systematically selected by means of defined inclusion and exclusion criteria. Quality indicators were subsequently rated in a two-stage Delphi study for relevance, validity and feasibility (data availability and data collection effort). The Delphi panel included 22 individuals in the first round, and 18 individuals in the second and final round. RESULTS Overall, mental healthcare quality indicators were rated higher in relevance than in validity (Mean relevance=7.6, SD=0.8; Mean validity=7.1, SD=0.7). There was no statistically significant difference in scores between the four countries for relevance (X2 (3)=3.581, p=0.310) and validity (X2 (3)=1.145, p=0.766). For data availability, the appraisal of "YES" (data are available) ranged from 6% for "assisted housing" to 94% for "total beds for mental healthcare per 100,000 population" and "availability of mental health service facilities". CONCLUSION Quality indicators were developed in a systematic and multidisciplinary development process. There was a broad consensus among mental healthcare experts from the participating countries in terms of relevance and validity of the proposed quality indicators. In a next step, the feasibility of these twenty-two indicators will be evaluated in a pilot study in the participating countries.
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Affiliation(s)
- Isabell Lehmann
- LVR-Institute for Healthcare Research, LVR-Klinik Köln, Wilhelm-Griesinger Straße 23, 51109 Köln, Germany,
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Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Lecic-Tosevski D, Nakov V, M. Réthelyi J, Winkler P, Zielasek J, Gaebel W. DEVELOPMENT OF QUALITY INDICATORS FOR MENTAL HEALTHCARE IN THE DANUBE REGION. Psychiat Danub 2018. [DOI: 10.24869/spsih.2018.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Evidence about social costs of gambling is scarce and the methodology for their calculation has been a subject to strong criticism. We aimed to estimate social costs of gambling in the Czech Republic 2012. This retrospective, prevalence based cost of illness study builds on the revised methodology of Australian Productivity Commission. Social costs of gambling were estimated by combining epidemiological and economic data. Prevalence data on negative consequences of gambling were taken from existing national epidemiological studies. Economic data were taken from various national and international sources. Consequences of problem and pathological gambling only were taken into account. In 2012, the social costs of gambling in the Czech Republic were estimated to range between 541,619 and 619,608 thousands EUR. While personal and family costs accounted for 63% of all social costs, direct medical costs were estimated to range from 0.25 to 0.28% of all social costs only. This is the first study which estimates social costs of gambling in any of the Central and East European countries. It builds upon the solid evidence about prevalence of gambling related problems in the Czech Republic and satisfactorily reliable economic data. However, there is a number of limitations stemming from assumptions that were made, which suggest that the methodology for the calculation of the social costs of gambling needs further development.
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Affiliation(s)
- Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Markéta Bejdová
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Ladislav Csémy
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Aneta Weissová
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
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Wilke L, Blanck O, Albrecht C, Avcu Y, Boucenna R, Buchauer K, Etzelstorfer T, Henkenberens C, Jellner D, Jurianz K, Kornhuber C, Lotze S, Meier K, Pemler P, Riegler A, Röser A, Schmidhalter D, Spruijt K, Surber G, Vallet V, Wiehle R, Willner J, Winkler P, Wittig A, Moustakis C. OC-0416: Can a consistent dose to the target volume in SBRT be obtained by prescribing on the mean ITV dose? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The article examines the current state of mental healthcare systems in countries of Eastern Europe and derives implications for future research and service development. Analysis of available statistics from the World Health Organization’s Mental Health Atlas suggests the need for better-quality data collection. Nonetheless, there appear to be insufficient resources allocated to mental health, lack of involvement of service users in policy-making and, to a large extent, systems continue to rely on mental hospitals. Based on the data presented, a set of directions for future reforms was drafted.
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