Health Of Inpatients Research Articles

A importância da saúde bucal na ótica de pacientes hospitalizados

The perception of oral condition is an important health indicator as it synthesizes the condition of objective health, subjective answers, cultural values and expectative. The study evaluated the importance of oral health according to the perception of inpatients of a hospital unit at Araçatuba city, São Paulo State. A partially structured questionnaire was used to collect data. The program Epi Info 2000 was used to statistics analysis. The results show that half of patients affirmed that visited a dental surgeon on a period between 6 and 12 months due to periodontal problems (35%) and dental caries (20%). It was observed that although all patients consider to have a good oral hygiene, the periodontal treatment was identified like the more necessary among them (67.93%). The presence of a dental surgeon at the hospital clinical group was considered by all the patients essential to collaborate with the integral care of health of inpatients. About the role of dental surgeon in a hospital, the majority of patients (90.63%) affirmed to be the act of "caring on the teeth". So, it is possible to conclude that all the patients know the importance of the maintenance of oral health appropriated conditions specially of inpatients.

Study of social support, quality of life and coping style of elderly inpatients with different number of children and admission times

Objective To explore the social support, quality of life and coping style of elderly inpatients with different number of children and admission times. Methods 164 elderly inpatients were interviewed by social support assessment scale (SSAS), generic quality of life inventory (GQOLI) and coping style scale. Results One hundred sixty four patients were interviewed. Elderly patients that had less than 2 children scored lower(11.73 ± 2.25) on the objective support of SSAS than those had 2 more children (13.57 ±2.52). The difference was statistically significant (P < 0. 05). There was no difference on SSAS between the patients with 2 or less admissions and 3 or more admissions. Elderly patients that had less than 2 children scored lower on GQOLI mazerial life and mental health than those had 2 more children(P <0. 01). Elderly inpatients scored higher than norm in exploring, fantasy, escaping and negative coping score (P <0. 01). Patients who had no less than 2 children scored higher than norm in fantasy, escaping and negative coping score(P <0. 01),lower in family support than that of patient who had less than 2 children; score of exploring, fantasy, escaping and negative coping were higher than norm in patients who had less than 2 and no less than 2 times of admissions. Conclusions Elderly inpatients who has less than 2 children got less objective support, they get worse status of mental health than those who have no less than 2 children; High frequencies of hospitalization have negative impact on the mental health of elderly inpatients; The copying style is affected by number of children and admission times in elderly inpatients. Key words: Elderly inpatients; Social support; Quality of life; Coping style; Different number of children; Admission times

A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

BackgroundReducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service.Methods/DesignA randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial.DiscussionThis paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services.Clinical trial registration numberAustralian and New Zealand Clinical Trials Registry ACTRN12609000973213

An assessment of the dental health of chronic institutionalized patients with psychiatric disease in Israel

Many institutionalized patients with psychiatric disease have been discharged into the community and the patients who remain hospitalized are at a particularly high risk for dental disease. This study assessed the oral health and treatment needs of chronically hospitalized patients with psychiatric disease in Israel. A random sample of 301 patients hospitalized for more than 1 year in 14 of 18 psychiatric institutions in Israel was drawn from the National Psychiatric Hospitalization Registry, and 84.4% of them were examined. Their dental status was evaluated using decayed, missing, filled teeth (DMF-T) index and demographic and medical data were retrieved from the patients' files. Of the 254 patients examined, 4 (1.6%) were caries-free, 176 (69%) patients had only a partial natural dentition, while 66 (26%) were edentulous. The average DMF-T score was 23.8. The caries component accounted for 2.7 of the DMF-T, the missing teeth component was 20, and the restored teeth component was only 1.1. There was a negative correlation between age and treated caries, and a positive correlation between age and missing teeth. Not all edentulous patients had dentures. These findings confirm the need to improve the oral health of chronic psychiatric inpatients and the need for dental treatment. The existing policy should be adjusted to integrate the currently separated delivery of the dental services for institutions and community settings. Dental professionals in the health service should be rewarded to restore teeth in this population rather than just to extract them.

Letter.

Back to table of contents Previous article Next article LetterFull AccessLetterAlexander M. Ponizovsky M.D., Ph.D.Shlomo P. Zusman D.M.D., M.Sc.Alexander Grinshpoon M.D., Ph.D.Alexander M. Ponizovsky M.D., Ph.D.Search for more papers by this authorShlomo P. Zusman D.M.D., M.Sc.Search for more papers by this authorAlexander Grinshpoon M.D., Ph.D.Search for more papers by this authorPublished Online:1 Oct 2009https://doi.org/10.1176/ps.2009.60.10.1402aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Oral Health and Hygiene Among Persons With Severe Mental Illness: ReplyIn Reply: We thank Dr. Flammer and his colleagues for endorsing our findings and reporting the results of their study. We share with them the wish to investigate direct and indirect effects of mental disorders on oral (dental) health. Dental health and disease are the result of lifestyle and behavior, which are known to be closely related to socioeconomic status. Mental disorders affect both lifestyle and behavior. Therefore, it would be very difficult, and perhaps impossible, to separate the effects of mental disorders from the effects of other variables, such as socioeconomic status, health habits, self-care, oral care, and diet. To control for confounding effects, carefully matched comparison groups are required.Persons with mental disorders experience a change in their behavior as a whole, and thus it was difficult in our study of inpatients to distinguish changes caused by hospitalization from those caused by the disorders themselves. In addition, psychotropic drug treatment particularly affects patients' oral health. We do not know the relative contributions to oral health of these factors; however, we are aware of the sad fact that the oral health of persons with mental disorders is worse than the oral health of the general population. Therefore, we strongly agree with Dr. Flammer and his colleagues about the urgent need for further efforts to prevent and treat oral diseases—for persons in the general population, psychiatric patients in the community, and institutionalized patients. However, as our study showed, there are grounds for careful optimism: removal of barriers to dental care and delivery of dental services in hospital settings may substantially improve the oral health of inpatients. Training programs for mental health professionals that focus on dental health along with joint service planning by administrators and providers of mental health and dental health services may promote both oral health and access to dental care for persons with mental disorders. FiguresReferencesCited byDetailsCited ByCommunity Mental Health Journal, Vol. 51, No. 2 Volume 60Issue 10 October, 2009Pages 1402-1403PSYCHIATRIC SERVICES October 2009 Volume 60 Number 10 Metrics PDF download History Published online 1 October 2009 Published in print 1 October 2009

The relation of intrinsic religiousness to the subjective health of Greek medical inpatients: The mediating role of illness-related coping

A large number of studies suggest a significant beneficial relationship between religiousness and many health indicators. The aim of this study was to (1) examine the association between intrinsic religiousness and subjective health in a sample of medical inpatients; (2) examine the mediating role of illness-related coping. A cross-sectional design was employed. Participants were 128 inpatients suffering from a coronary artery disease, cancer, or a renal disease. Intrinsic religiousness was found to be uncorrelated to psychological symptoms or self-rated health. Weak to modest positive correlations were noticed with wishful thinking, emotional reactions, and palliative coping. These coping strategies were also found to mediate the relationship to subjective health measures. Results suggest a weak, indirect, and negative relation of intrinsic religiousness to participants' subjective health. Situational, assessment, and conceptual factors may underlie the discrepancy between these findings and research supporting the health benefits of religiousness.

Effect of Implementing Dental Services in Israeli Psychiatric Hospitals on the Oral and Dental Health of Inpatients

Psychiatric disorders (schizophrenia, mood disorders, and organic brain disorders) and their treatment may lead to oral diseases, but assessment of dental status and oral care needs among patients with these disorders is lacking. This study reports changes in dental health and oral care needs of psychiatric inpatients after 1998, when psychiatric hospitals in Israel were required to provide regular dental examinations and treatment for every inpatient hospitalized longer than a year. Two epidemiological cohorts from 1997 and 2006 representing long-term psychiatric inpatients before (N=431) and after (N=254) the reform of dental services were compared on the standardized criteria of the Decayed, Missing, and Filled Teeth (DMFT) index scores and DMFT component scores, as well as on the use of and need for dentures. Compared with the prereform cohort, the postreform cohort had fewer decayed teeth and lower DMFT index scores. These differences were independent of gender and clinical diagnosis. No between-cohort differences were found in the use of and need for dentures. On-site dental services were more effective than outsourced services in improving dental health. The results suggest a substantial improvement in the dental health of this at-risk population after the dental reform in psychiatric hospitals. However, oral health needs are still not fully met, and therefore, additional organizational efforts for further prevention and treatment of dental diseases are required.

Effect of Implementing Dental Services in Israeli Psychiatric Hospitals on the Oral and Dental Health of Inpatients

Effect of Implementing Dental Services in Israeli Psychiatric Hospitals on the Oral and Dental Health of Inpatients

Bone mineral density and general health of long-term residential psychiatric inpatients.

The aim of this study was to determine the rates of osteopenia and osteoporosis and other general health problems in a long-stay male psychiatric unit. All 15 patients underwent a semi-structured clinical interview and a full physical examination including calculation of Body Mass Index, central obesity (abdominal circumference) and blood pressure measurement. All patients had blood sampling examining FBC, U&E, LFTs, TFTs, PSA, prolactin, lipid profile and glucose. The rates of metabolic syndrome were calculated according to the International Diabetes Federation consensus worldwide definition. Bone mineral density was determined in the lumbar vertebrae and left hip by DEXA scanning. The prevalence of osteopenia or osteoporosis was 46%, and bone mineral density was inversely correlated with serum prolactin levels (r = -0.595, p = 0.041) and chlorpromazine equivalence (r = -0.645, p = 0.017). The prevalence of obesity was 53%, while central obesity was present in 87% of patients. Metabolic Syndrome was present in 27% of patients. More attention should be given to diagnosing and treating osteopenia and osteoporosis in patients on long-term antipsychotic agents and preventative measures should form part of any treatment regime in these individuals. Frequent input from dietitians should also be available for long-stay psychiatric inpatients to reduce the prevalence of obesity.

Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations

Aims and MethodsTo calculate the prevalence of metabolic syndrome in patients receiving clozapine in community and long-stay in-patient settings. Patients were assessed using measures specified by the Expert Panel of the US National Cholesterol Education Program.ResultsThe prevalence of the metabolic syndrome was calculated as 53% in the community groups and 11% in the in-patient group, although both sample sizes (particularly the in-patient group) were small. Women were more frequently affected than men in the community population.Clinical ImplicationsThe higher percentage of metabolic syndrome in the community patients receiving clozapine has implications with respect to physical health. The reasons for the lower percentage in the in-patient group are unclear. Our findings point to a possible difference in the physical health of long-stay psychiatric in-patients and patients in the community.

Comparison of the Health and Functional Status Between Older Inpatients With and Without Cancer Admitted to a Geriatric/Internal Medicine Unit

Cancer is predominantly a disease in the population aged 65 years and older. Previous studies have suggested that older cancers patients seen in oncology departments are healthy with few comorbidities. Relatively little is known about the health and functional status of older cancer inpatients, especially outside oncology units. The purpose of this study is to compare the health and functional status of older cancer and noncancer inpatients admitted to a geriatric/internal medicine unit. A retrospective chart review was conducted on inpatients 65 years old and older, who had been hospitalized during a period of 2 years in the geriatric/internal medicine unit. The health and functional status of 144 inpatients with active cancer was compared to that of 682 inpatients without active cancer. Eight domains were compared: functional status, comorbidity, medication, nutritional status, neurosensory deficits, cognition, mood, and mobility. The hospitalization measures (length of stay, death, need for palliative care) were also compared. We found that inpatients with active cancer were younger, had less comorbidity and less cognitive impairment, but were more depressed and at greater risk for malnutrition than patients without cancer. These two groups were similar in terms of functional status, neurosensory deficit, and mobility. Cancer patients had a significantly shorter length of stay, required more palliative care, and were more likely to die during hospitalization. These findings indicate that older cancer patients admitted to a geriatric/internal medicine unit present with multiple active geriatric problems, have characteristics distinct from those of traditional geriatric patients, and require specific care and management.

Mental Health of Inpatients

Mental Health of Inpatients

Physical health and health risk factors in a population of long-stay psychiatric patients

Aims and MethodTo evaluate the physical health and health risk factors in long-stay psychiatric patients in a high secure psychiatric hospital. A cross-sectional survey of consenting patients was undertaken using a semi-structured questionnaire, a brief physical examination and review of patient case notes. A comparison was made with data collected on admission and held on the Special Hospitals' Case Register.ResultsMain findings were: a mean increase in weight since admission, in men of 10.62 kg and in women of 12.74 kg; high rates of smoking, obesity and large waist size; 54% of patients had one or more health problems.Clinical ImplicationsThe study's profile of the physical health of psychiatric in-patients indicates the need for health promotion initiatives in such hospitals and the need for primary care services.

The Influence of Cognition During Anxiety Related to Illness, Life and the Mental Health of Inpatients

The Influence of Cognition During Anxiety Related to Illness, Life and the Mental Health of Inpatients

Oral health of aged inpatients

Objectives: The proportion of the population aged 65 years and over in Australia is expected to increase substantially, and more people in this age group are retaining their teeth and will require dental care. The objective of this study was to assess the oral health status of inpatients over the age of 65. Methods: Dental examinations were performed on inpatients at Fremantle Hospital. Standardised assessment forms were used to investigate factors related to medical history, hospital admission and oral health needs. Results: A total of 104 persons were examined, 56% were dentate. The dentate participants had an average decayed, missing and filled (DMF)‐index of 21.6 (SD 7.1). All edentulous participants had dentures and the estimated average age of their dentures was 18.1 years. Although the majority of participants (70.2%) were satisfied with their oral health status, 76.6% were professionally assessed to be in need of immediate dental care. Among the edentulous participants, 47.1% needed new dentures. Among all the participants, 75.3% also needed improved oral hygiene. Conclusion: There is a need to fully assess availability, appropriateness and effectiveness of models of oral health care delivery among the older population. This study clearly indicates a current problem and high levels of unmet need. With an increasing ageing population and higher retention levels of natural dentitions, this will result in higher levels of oral disease and need for prevention and care.

Being in a Secure Forensic Psychiatric Unit: Every Day is the Same, Killing Time or Making the Most of It

Institutional environments are challenging settings in which to provide rehabilitation. This study describes the time use of a group of inpatients, the majority diagnosed with schizophrenia, in a secure forensic psychiatric unit in Australia. Time diaries, interviews and fieldnotes were collected over 5 weeks. Eight participants completed time diaries for two consecutive days, of whom five were also interviewed using the Occupational Performance History Interview II. The participants' time use was dominated by personal care and leisure occupations. In general, the participants were dissatisfied with their time use, describing themselves as ‘bored’ or ‘killing time’. Many perceived that the environment created barriers to their participation in valued occupations, yet some also found occupations that provided solace, challenge or a connection with the outside world. The findings indicate the importance of understanding individuals' unique occupational histories, interests and skills in order to create opportunities to engage them in relevant occupations that use personal resources, as part of forensic rehabilitation programmes, and the utility of the Occupational Performance History Interview II in this context. Further research exploring patient and staff perspectives on the challenges of occupational programming in forensic settings and the longitudinal impact of such programming on inpatients' occupational functioning, health and wellbeing is recommended.

Oral health of psychiatric in-patients in Hong Kong.

Poor oral health has been reported among various psychiatric populations. Little is known regarding the oral health among psychiatric patients in Asia. To examine the oral health status of a group of Chinese psychiatric in-patients in a long-term rehabilitation facility. A dental survey using the WHO standardised dental evaluation form was conducted in adult psychiatric patients in a rehabilitation programme. A qualified dentist examined all consenting patients. Ninety-one patients (64.8% male; mean age: 44.7 +/- 9.9 years; mean length of illness: 20.3 +/- 11.5 years) were included in the study, the majority (80.2%) diagnosed with schizophrenia. Malocclusion was found in 79.1% of patients. The mean number of missing teeth was 9.5 +/- 8.9. Bleeding on probing, calculus, shallow and deep pockets were found in 7.1%, 71.8%, 72.9% and 28.2% of patients, respectively. Dental caries were found in 75.3% of dentate patients. The mean number of caries per patient was 5.5 +/- 6.1. Fifty-four per cent of patients needed dental extraction and 78.8% required conservative dental treatment. Older age and length of illness were significantly associated with poor dental health. Oral health status of chronic psychiatric patients seems to be considerably worse than that of the general population. Mental health professionals should pay more attention to preventive oral health habits of psychiatric patients.

Improving the physical health of long-stay psychiatric in-patients

Research evidence has shown that morbidity and mortality rates are higher in psychiatric patients than in the general population. This article describes factors that affect the physical health of psychiatric patients living in institutions and the steps that can be taken to review, monitor and improve their physical health. The physical health care of long-stay patients should reach the same standards as those expected in the general population.

The oral health of psychiatric in‐patients in South Wales

Little information is available regarding the oral health of hospitalized psychiatric patients. The aims of the study were: to quantify the oral health status and identify dental treatment needs of hospitalized psychiatric patients in South Wales; and to compare the oral health of subgroups within the population by their age, psychiatric diagnosis, psychotropic medication use, and length of stay. The total patient population of the hospitals involved in the study was 469, and 326 subjects (70%) took part in the study. The mean age of the subjects was 71.1 years, with 265 long-stay and 61 short-stay patients. Forty-seven percent of patients had a psychiatric diagnosis of dementia, 23% of schizophrenia, and 19% of depressive illness. The examination included assessment of oral hygiene, periodontal condition, and prevalence of caries. The treatment needs of the population were also determined. It was found that 63% of the population was edentulous. The mean DMFT score was 19.1 +/- 7.9 (SD). Comparison with the DMFT of the general population showed a similar level of decay, fewer filled teeth, and more missing teeth in the study population. The oral hygiene of the dentate population was poor, and there was little periodontal disease. Treatment needs were mainly for scaling and polishing. There were no significant differences found between subgroups within the population.

Oral health of psychiatric in-patients

Aim and MethodThe aim of the study was to get an estimate of oral health needs of in-patients on acute general adult wards in an inner-city psychiatric unit. Information was collected by means of a cross-sectional survey with patient interviews and a brief oral examination.ResultsA significant majority of patients had carious teeth, inflammation of gums and oral plaque. A majority of patients complained of pain during the preceding 3 months and problems with teeth.Clinical ImplicationsOral health of patients admitted to an acute psychiatric unit is worse than compared to the general population. There appears to be a need for basic dental health education and easy access to dental care on psychiatric wards.