Search

The relationship between literacy and health has been well documented: research shows that people with limited literacy skills have worse health outcomes for numerous chronic conditions. However, little is known about how literacy relates to mental health, including access to treatment and recovery. A pilot study was conducted with mental health services users with varying literacy skills at two urban, public mental health clinics to more fully understand how literacy affects the lives of people living with serious mental illness. The study was designed using a Community-Based Participatory Research approach; mental health service users informed the development of the interview guide. Findings demonstrate that those with limited literacy skills experience increased stigma, have fewer options for accessing information about conditions and treatment plans, and may be excluded from certain cognitive-behavioral treatments that require basic literacy skills. These barriers can significantly affect service utilization and mental health outcomes.

Racism and discrimination can have significant implications for health, through complex biopsychosocial interactions. Latino groups, and particularly Puerto Ricans, are an understudied population in the United States in terms of the prevalence of discrimination and its relevance to health. Participants in our study were 45- to 75-year-old (N = 1122) Puerto Ricans. The measures were perceived discrimination, depressive symptomatology (CES-D), perceived stress (PSS), self-rated health, medical conditions, blood pressure, smoking and drinking behaviours, demographics. Our findings show that 36.9 per cent of participants had at some time experienced discrimination, with men, those with more years of education, currently employed and with higher incomes being more likely to report it. Experiences of discrimination were associated with increased levels of depressive symptoms and perceived stress. When controlling for covariates, perceived discrimination was predictive of the number of medical conditions, of ever having smoked and having been a drinker, and having higher values of diastolic pressure. Depressive symptoms are a mediator of the effect of perceived discrimination on medical conditions, confirmed by the Sobel test: z = 3.57, p < 0.001. Mediating roles of perceived stress, smoking and drinking behaviours were not confirmed. Increased depressive symptoms might be the main pathway through which perceived discrimination is associated with a greater number of medical diagnoses.

Staff in the psychiatric emergency room (PER) have demanding jobs requiring a complex balance between the needs and safety of the individual and the community, systemic resources, and job responsibilities while providing timely, effective care. Little research exists concerning day-to-day work activities of PER staff, their interaction, and their perceptions of their work. This study explored the work of PER staff and the organisational context of the PER work setting. Observations of staff were conducted in the public spaces of a public urban PER using two observational techniques. The first was designed to measure the types of work activities staff engaged in and the time spent in these work activities (work task data). The second technique was the gathering of observational data by a peripheral-member-researcher (participant observation data). Analyses were conducted of both the work task and participant observation data. Results indicate that most PER staff time is spent in administrative and phone tasks, while less than a third is spent on direct clinical work. Four important issues for PER work were identified: a workload that is unmanageable, managing the unmanageable, bogus referrals and dumping and insurance problems. The PER remains the front-line of the medical and social service systems. Work done in these settings is of critical importance; however little attention is paid to the content and nature of the work. Our study demonstrates that staff of the PER face challenges on many levels as they struggle with the task of working with people presenting in psychiatric and social crisis.

Refugees and asylum seekers face challenges after arriving in a host country. They carry the trauma that they may have experienced in their countries of origin, during fight, and in countries of asylum. Other stressors impact on their adjustment after arriving in the United States including basic needs such as food, clothing, and shelter. This is a retrospective review of data collected as part of a needs assessment by a program, which serves survivors of torture and refugee trauma. Asylum seekers (n=65) and refugees were compared (n=30). Asylum seekers were more apt to be from Africa (p

In 11 patients with long-term indwelling catheters the amount of catheter encrustation and urinary pH were measured and the urine regularly cultured over a prolonged period of time (median of 7 periods of 3 weeks). The mean urinary pH was related to the persistent presence of urease-producing micro-organisms (P. mirabilis) and urinary pH governed the precipitation of catheter encrustation. The critical pH appeared to be around 6.8. In patients with a mean urinary pH below this level the encrustation was minute (less than or equal to 2.9 mg phosphate). In patients with a mean urinary pH above 6.8 it was considerable but with a marked interindividual variation (35.5-138.7 mg phosphate). The composition of the encrustation was also strongly pH-related, with a much higher proportion present as magnesium ammonium phosphate in patients with a mean urinary pH above 6.8. The persistent presence of urease producers was not associated with a high pH or a more pronounced precipitation of phosphate in all patients. The amount of encrustation thus appears to depend not only on the presence of urease-producing micro-organisms but also on individual factors such as urinary composition.

The influence of social factors on involuntary hospitalisation has been an important and controversial area of sociological focus for many years. Traditionally, social control theory has been used to understand disproportionate rates of involuntary hospitalisation among marginalised and powerless groups. However, dramatic changes in the social context of mental healthcare have necessitated a re-examination of the role of social factors in involuntary hospitalisation. In this study 287 psychiatric emergency room visits were examined in order to test hypotheses for understanding social influences on disposition. Little support for the traditional social control hypothesis was found. People from marginalised groups were not disproportionately involuntarily hospitalised, but instead were disproportionately treated and released from the hospital as people's social resources were used to access care rather than to prevent hospitalisation. This study highlights the importance of the historical relevance of our theoretical understanding of the relationship between social factors and involuntary commitment.

Summary 1. The material consists of 5% consecutive cases of primary (first onset) urinary tract infections appearing from birth up to 16 years of age and which were examined and treated at the Childrens' Hospital in Goteborg. The infections occurred during a seven-year period within a defined population. The circumstances under which the study was conducted suggest that most symptomatic infections occurring during the study period and for whom the parents sought medical advice, were 2. The total morbidity risk at I 1 years of age of symptomatic UTI was 3.0% for girlsand 1.1 % for boys. These are minimum figures. The morbidity risk is highest during the first month of life and then decreases, more rapidly in boys than in girls. Possible interpretations of the reason for decreasing risk with increasing age of falling ill with a first infection are suggested. The male/female ratio starts at 2.5: 1 during the first month and then successively changes to 1:20.There was no seasonal variation of the time of onset in either sex. 3. Presentation with fever was most common in the first year, after which it slowly decreased. Failure to thrive was a rare symptom. Certain pther age and sex differences in presenting symptoms were recorded. Most infections within the first year of life probablyinvolved the renal parenchyma. 4. The etiology varied with age and sex. If infections reach the urinary tract by theascending route, this could indicate differences in the environmental conditions in the periurethral region and may be a clue to a better understanding of the pathogenesis. 5. Obstructive malformations were found in 10% of boys and 1–2% of girls, and cannotexplain the high frequency of early infantile infections in either sex. 6. Narrowing of the bladder neck was common in males during the first year of life, the frequency declining with age. It disappeared spontaneously during follow-up of individual cases, and was not regarded as an obstructive malformation. 7. Duplication of the collecting system was seen in 10 % of girls and in 5 % in boys, which is more than expected. The cause and nature of the association between infection and duplication are not known. 8. In 13 % of boys and 4.5 % of girls a reduction of the renal parenchyma was seen either at the first investigation or developed later, probably owing to infection. AlthoughUTI was more frequent in females than in males, the total number of patients with parenchymal damage was equal in both sexes, even during childhood. In boys, the kidneys might bemore vulnerable than in girls. 9. The immediate cure rate after 10 days' therapy was 97%. Recurrences were usually reinfections. 10. Recurrent infections were often difficult to diagnose. Pyuriaand symptoms of UTI were associated with insignificant bacteriuria in 10 % (30 of 300) of suspected recurrences. 11. Susceptibility to recurrence was studied in relation to various parameters. Girlswere at greater risk than boys, and the risk was in both sexes greatest during the first 2–3 months after a previous infection. Boys rarely had a recurrence more than one year after the primary infection, while girls often continued to have recurrences for many years. The risk seemed to increase with the increasing number of previous recurrences. No correlation was found between the frequency of recurrences and age at onset of primary infection or with symptomatology, etiology, reflux, or duration of therapy. 12. The risk of recurrence was many times greater in a patient who had had one infection than in a previously healthy patient. The possibility that the degree of susceptibility to UTI might depend, to some extent, on genetic factors should be examined.

This paper examine5 the policymaking progress in Costa Rica, specifically the creation of a new item for the governmental agenda. This new agenda challenges the traditional Itno army” policy of Costa Kica. Following a brief historical overview of the traditional policy, the paper considers the role of specific factors that promote structural conduciveness for the new “defense” policy and the attendant transformation of political symbols and definitions. The impact of the definitional and organizational changes on the implementation stage of policy is explored. This article suggests the importance of studying the role of hegemony in the construction and transformation of political and cultural definitions, an explication of deci- sionmaking as well as nondecisionmaking processes, and the influence of external and internal threats on nation-state dependency.

Three hundred and forty-three E. coli strains isolated from the urine of patients with asymptomatic bacteriuria (ABU), symptomatic cystitis, or pyelonephritis were analysed with regard to O group distribution and sensitivity to the bactericidal effect of normal serum. Strains of O groups 1, 2, 4, 6, 7, 16, 18 and 75 were found in 31.3% in ABU, in 58.7% in cystitis and in 79.8% in pyelonephritis. Spontaneous agglutination was noted in 45.2% of ABU, 6.5% of cystitis and 1.7% of pyelonephritis strains. The strains from patients with ABU were significantly more sensitive to the bactericidal effect of normal serum than were those from patients with symptomatic urinary tract infection. In some patients with untreated ABU, changes in the characteristics of the urinary strains isolated were noted. The strains tended to become spontaneously agglutinating as well as more sensitive to the bactericidal activity of normal serum. The strains found in patients with ABU probably had an altered cell wall compared with those found in patients with symptomatic infections such that they produce fewer symptoms and possibly be less virulent.

Summary The aim of the present investigation, concerned with 279 girls with their first-time, or in a few cases second-time urinary tract infection, was to explore the possibility to improve the “1-year cure rate” by means of long-term sulfonamide therapy (2 months) instead of short-term sulfonamide therapy (10 days). A “1-year cure” was then defined as an eradication of the index infection and freedom from infection during the following year. The “1-year cure rate” was found to be equal in the two therapy groups i. e. 64 per cent. The material showed some characteristics which might permit some general statements about uncomplicated first or second-time urinary tract infections in girls. The material showed a marked predominance of the younger age groups. This finding is discussed with regard to the pathogenesis of urinary tract infection. The bacteria isolated at the initial infections were in 90 percent E. coli and also in 90 per cent sensitive to sulfonamide. Thus for the present there is no reason to abandon sulfonamide as the drug of choice in uncomplicated first-time infections in girls. The first recurrence had a tendency to appear shortly after the original infection rather than late. Observations suggest that recurrences, even those occurring immediately after cessation of therapy, were usually a reinfection and not a recrudescence. These findings are discussed in relation to the pathogenesis of recurrent urinary tract infections. The first recurrence was in 1/3 of the cases asymptomatic, in the other 2/3 symptomatic. During long term prophylaxis asymptomatic infections even outnumbered the symptomatic ones. Therapy thus may mask an infection. The bacteria isolated at the first recurrences after the index infection were in 30–90 per cent resistant to sulfonamide, the rate being related to the time interval between the cessation of therapy and the recurrence. The therapeutic consequences of the difference in sulfonamide sensitivity of the initial infection and the recurrences are discussed.