Physical Health Complications Research Articles

Focus on Exercise: Client and Clinician Perspectives on Exercise in Individuals with Serious Mental Illness.

The health benefits of exercise are well established, yet individuals with serious mental illness (SMI) have a shorter life expectancy due in large part to physical health complications associated with poor diet and lack of exercise. There is a paucity of research examining exercise in this population with the majority of studies having examined interventions with limited feasibility and sustainability. Before developing an intervention, a thorough exploration of client and clinician perspectives on exercise and its associated barriers is warranted. Twelve clients and fourteen clinicians participated in focus groups aimed at examining exercise, barriers, incentives, and attitudes about walking groups. Results indicated that clients and clinicians identified walking as the primary form of exercise, yet barriers impeded consistent participation. Distinct themes arose between groups; however, both clients and clinicians reported interest in a combination group/pedometer based walking program for individuals with SMI. Future research should consider examining walking programs for this population.

Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care.

Acquiring a diagnosis of schizophrenia reduces life expectancy for many reasons including poverty, difficulties in communication, side-effects of medication and access to care. This mortality gap is driven by natural deaths; cardiovascular disease is a major cause, but outcomes for people with severe mental illness are worse for many physical health conditions, including cancer, fractures and complications of surgery. We set out to examine the literature on disparities in medical and dental care experienced by people with schizophrenia and suggest possible approaches to improving health. This narrative review used a targeted literature search to identify the literature on physical health disparities in schizophrenia. There is evidence of inequitable access to and/or uptake of physical and dental health care by those with schizophrenia. The goal was to reduce the mortality gap through equity of access to all levels of health care, including acute care, long-term condition management, preventative medicine and health promotion. We suggest solutions to promote health, wellbeing and longevity in this population, prioritising identification of and intervention for risk factors for premature morbidity and mortality. Shared approaches are vital, while joint education of clinicians will help break down the artificial mind-body divide.

Design and rationale for NOURISH-T: A randomized control trial targeting parents of overweight children off cancer treatment

Approximately 40% of off-treatment pediatric cancer survivors (PCS) are overweight or obese, which increases their risk for negative long-term physical health complications. Consistent with the Institute of Medicine's (IOM) emphasis on patients transitioning from treatment to cancer survivorship and increasing long-term healthy behaviors in these survivors, we plan to conduct a pilot RCT to address the increasing overweight/obesity rates among PCS by targeting their caregivers as agents for PCS behavior change. We plan to focus on parents' behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in PCS and adapt an evidence-informed, manualized parent intervention – NOURISH – found to be effective for parents of overweight and obese children and adolescents in reducing child and adolescent BMI. We plan to adapt NOURISH for caregivers of 5–12year old PCS (6months–4years off active cancer treatment). Our pilot feasibility RCT — NOURISH-T (Nourishing Our Understanding of Role modeling to Improve Support for Healthy Transitions) evaluates: 1) the preliminary efficacy of NOURISH-T for PCS, compared with an Enhanced Usual Care (EUC) control condition, and 2) factors to consider to improve future adaptations of the intervention. The project will enroll caregivers of PCS at two pediatric oncology clinics into the 6-week intervention (or EUC) with assessments occurring pre- and post-6weeks of intervention, and at a 4-month follow-up.

High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis.

BackgroundSubstance use is a major public health concern in global settings, and is very common during adolescence period leading to physical and/or mental health complications. This study assessed the prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia, 2012.MethodsA school based cross-sectional study was conducted from April 7 to April 15, 2012 amongst 684 9th to 12th grade high school students in the town of Woreta. Participants were selected by stratified sampling, and data were collected using an anonymous questionnaire adapted from the 2008 Community That Care Youth Survey. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with substance use.ResultsA total of 651 students participated in the study with a response rate of 95.2%. The current prevalence of substance use among Woreta high school students was 47.9% and life-time prevalence was 65.4%. The current and lifetime prevalence of alcohol use was 40.9% and 59% respectively. Siblings’ use of substances (AOR [95% CI]: 2.72 [1.79, 4.14]), family history of alcohol and substance use (AOR [95% CI] 2.24 [1.39-3.59]) and friends’ use of substances (AOR [95% CI] 2.14 [1.44-3.18]) were factors positively associated with substance use. On the other hand, religiosity and social skill were found to be 54% (AOR [95% CI] 0.46, [0.31-0.68]) and 39% (AOR [95% CI] 0.6 [0.40-0.91]) negatively associated with substance use.ConclusionsThe prevalence of substance use amongst adolescents was high for the three substances namely alcohol, cigarette and khat with alcohol being the most common. Community norms favorable to substance use, family history of alcohol and substance use, siblings’ substance use, poor academic performance, low perceived risk of substances and friends’ use of substances had positive association with adolescent substance use while religiosity and social skills were found to have negative association with adolescent substance use. Initiate public awareness campaigns to inform adolescents and adults, particularly parents, of the risk of substance use. Developing culture friendly, gender based adolescent and family based programs and initiating public awareness are recommended to decrease substance use by adolescents.

Assessing the longitudinal associations and stability of smoking and depression syndrome over a 4‐year period in a community sample with type 2 diabetes 在一个社区2型糖尿病样本中进行的为期4年的吸烟与抑郁综合征之间的纵向相关性以及稳定性的评估

The aim of the present study was to investigate the stability and longitudinal association between depression and smoking status within a community sample with type 2 diabetes (T2D) while controlling for sociodemographic and disease-related variables. Adults with T2D were recruited and agreed to be followed-up via random digit dialing for the Montreal Diabetes Health Study. At baseline, 1614 individuals were classified as never (n = 592), former (n = 690), light (≤10 cigarettes a day; n = 128) and moderate-heavy (11+ cigarettes a day; n = 204) smokers. Depression was assessed using the Patient Health Questionnaire-9 and individuals were classified as either "none" or having depression syndrome. Generalized estimating equations were used to test the association between depression syndrome and current smoking status while controlling for other demographic and health-related variables. Prevalence rates of smoking and depression showed mild to substantial agreement over time. Depression syndrome was significantly associated with moderate-heavy smoking in the fully adjusted model using cross-sectional (all four waves; odds ratio [OR] 1.46; 95% confidence interval [CI] 1.08-1.99; P < 0.05) and longitudinal (controlling for depression at baseline; OR 1.54; 95% CI 1.02-2.31; P < 0.05) data. Smoking and depression prevalence rates appear to be stable over time in our community sample with T2D. Moderate-heavy smoking is strongly associated with elevated depression, both in cross-sectional and longitudinal models. Persistent moderate-heavy smokers may be at increased risk of both physical and mental health complications. This burden is even greater for those with T2D.

Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients

The present study: (1) reports the early physical health complications, mental health outcomes, and outpatient health care utilization of patients with serious extremity injuries sustained during the Iraq or Afghanistan wars and (2) compares clinical outcomes between amputee and nonamputee extremity injury groups. This was a retrospective review of clinical records in military health databases for patients injured in the Iraq and Afghanistan wars. Health outcomes of amputee (n = 382, injured 2001-2005) and nonamputee patients (n = 274, injured 2001-2007) with serious extremity injuries (abbreviated injury score ≥ 3) were followed up to 24 months post injury. This study was performed at Naval Health Research Center, San Diego. Amputee and nonamputee groups had similar injury severity scores. Amputees had nearly double the risk of certain adverse complications (infections, anemia, septicemia, and thromboembolic disease), but other complications (osteomyelitis and nonhealing wound) were similar between the 2 groups. Amputees had significantly greater odds of certain mental health disorders including mood, sleep, pain, and postconcussion syndrome. However, amputees had significantly reduced odds of posttraumatic stress disorder compared with nonamputees. Amputees used various outpatient clinics significantly more than nonamputees. Patients with serious combat extremity injuries showed high rates of adverse health outcomes in the short term. Amputees had higher rates of many but not all clinically important physical and mental health outcomes compared to nonamputees. These results are important for military orthopaedic surgeons and allied providers who care for and counsel these patients and clinicians and researchers who seek to understand and improve health outcomes in patients with extremity war injuries. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Assessment of physical monitoring following rapid tranquillisation: a national survey

BackgroundRapid tranquillisation (RT) is a high risk clinical intervention in terms of potential physical health complications. There has been no published work in the UK to survey nationally whether standards for post RT physical monitoring (as set out in organisation's RT documents) are being adequately audited.AimTo review current auditing of RT practice in England, with particular emphasis on examination of post RT physical monitoring.MethodA scrutiny of evidence provided by English NHS mental health trusts to illustrate auditing of adult RT documents.ResultsFifty-eight mental health trusts in England were contacted. Less than one-third could provide evidence of an audit of post RT physical health monitoring. These audits were variable with respect to what aspect of physical health monitoring they focused on. When results of all audits were combined, it revealed a concerning finding that basic physical observations and investigations were not performed consistently following RT.Conclusions and Implications for Clinical PracticeThe current paucity of trust audits of post RT physical monitoring and the poor practice observed in those audits could reflect a lack of clarity in both trust and national guidelines, as well as poor clinical practice. Given the risks to a patient's physical health associated with RT it is essential to ensure high quality care in this area.

9. Dysregulated diurnal cortisol pattern and increased glucocorticoid resistance among pre-menopausal women with major depressive disorder

Women are approximately twice as likely to experience depression compared to men and are at significantly greater risk for developing comorbid physical health conditions, including diabetes, chronic inflammatory diseases, and cardiovascular disease, suggesting a possible common mechanism for the psychological and physical health risks seen in depression. We examined one biological pathway that may underlie these effects by investigating the extent to which HPA axis activity was dysregulated in 26 women with current major depression and 23 age- and BMI-matched psychiatrically healthy women. Salivary cortisol samples were collected at wakening, 30 min later, and at bedtime over three consecutive days. Depressed women exhibited flatter diurnal cortisol slopes compared to non-depressed women ( F 2 = 5.52, p = .004). To investigate whether these differences could be attributed to differences in glucocorticoid feedback sensitivity, saliva samples were also collected on a fourth consecutive day after participants self-administered dexamethasone. Analyses revealed that depressed women exhibited a dampened response to dexamethasone compared to non-depressed women ( F 1 = 6.04, p = .015). These findings are consistent with previous studies showing that depression is associated with altered HPA axis regulation, but extend this work by showing that reduced hypothalamic and pituitary sensitivity to negative feedback from glucocorticoids is one mechanism that may explain this effect. Altered glucocorticoid sensitivity may play a role in promoting depression as well as the physical health complications that frequently co-occur with this serious psychiatric disorder.

P01-311 - Obesity in children with high-function autism

IntroductionChildhood obesity is a major issue and puts children at risk of physical and psychological health complications. Some studies have evaluated obesity in autism in different countries. However there is few data on the rate of obesity in high-function autism (HFA).AimTo evaluate the weight status of children with HFA in IranMethodsThis cross-sectional survey was carried out in autism specific schools of Tehran in 2010. In total 113 children with HFA ages 6–15 were evaluated. They were classified according to WHO references (2007) for body mass index (BMI) for age and sex as obese, overweight, healthy weight and underweight. We then examined the associations of weight status of these children with some variables and comorbodities.ResultsThe prevalence of obesity in children with HFA was 27.0%, overweight 13.0% and underweight 7.0%. There was a significant correlation between age and BMI (r = 0.26, Pvalue &lt; 0.01). Underweight was associated with neurologic comorbidities (p &lt; 0.05). The rate of obesity has not correlated with some other medical and psychiatric comorbidities, as well as sex, and parents’ weight status.ConclusionsPrevalence of obesity in autistic children with high intelligence profile is high and at the same levels of both normal children and children with autistic spectrum disorders.

Sources of pregnancy advice for 21st Century women: does (grand)mother still know best?

Pregnant women (and their doctors) in the UK, in common with those in the USA and other Western countries, have become inundated, particularly over the past 10 years, by official government advice [1,101,102] regarding weight control, diet, wellbeing and lifestyle choices [1–3], including how to stop smoking and limit the intake of alcohol (e.g., [103]), as well as taboos on certain foods such as shellfish [104]. The overall advice offered to pregnant women is intended to cover normal pregnancies, as well as those at risk through physical or mental health complications such as HIV, drug addiction or ongoing medication such as antidepressants [4]. The introduction to the British Department of Health’s most recent publication, The Pregnancy Book, brought together what it considered to be “everything you need to know” to have a happy and healthy pregnancy because “it’s important to get up-to-date advice so that you can make the right decisions and choices” [1]. The same publication lists which foods and additives to avoid and which to increase in the pregnant woman’s diet. It begins: “Your mum, colleagues, friends and relations might all be giving you advice. And then there is all the information on the internet as well as in magazines and books. At times it can feel overwhelming and it’s hard to know who is right when people say different things.” [1] This influx of information is the result of both technological innovation and increased technological competence, leading to an escalation of studies of health benefits and hazards in pregnancy to both the woman and fetus [4–7]. However, it still begs the questions previously implied regarding where and from whom the pregnant woman should gain the best information and advice. The further implications of this being that there are, in fact, ‘right’ answers. But is this really the case?

Substance use among secondary school students in an urban setting in Nigeria: prevalence and associated factors

Substance use continues to be major risk behaviour among youth, with consequent physical and/or mental health complications. The current study aimed to establish the prevalence and associated factors of substance use among selected secondary school students in Lagos. This was a cross-sectional and descriptive study among selected secondary school students in Lagos. Permission was obtained from appropriate school authorities; as well as consent from each participant. The WHO Students' Drug Use Questionnaire which had been previously validated in the country was used to obtain the drug use information from the subjects. Analysis of the data was conducted using Epi-info version 5. A total of 402 students were studied - of whom 43.5% (n=175) were males and 56.5% (n=227) females. The mean age was 15.9 years. 83.1% (n=334) lived with their parents, 7.6% (n=31) with their relatives and 7.2% (n=29) with friends. The commonest substances used by the subjects were caffeine (kolanut and coffee), mild analgesics (paracetamol and aspirin) and the antimalarials, most especially chloroquine with lifetime use prevalence rates of 85.7%, 73.8% and 65.7% respectively. Generally, the prevalence rates for lifetime use of the substances varied from 3.8% (n=14) for Heroin and Cocaine to 85.7% (n=344) for psychostimulants; and for current use varying from 2% (n=8) to 56.5% (n=213). For the so called "gateway drugs": alcohol and tobacco, their lifetime use prevalence rates were 9.2% (n=34) and 5.2% (n=19) while the lifetime use prevalence rate for cannabis was 4.4% (n=16). In terms of gender, the prevalence rates for males were generally higher than for their female counterparts except for antibiotics, analgesics, heroin and cocaine. Reasons for using substances included relief from stress, 43.5% (n=175), self medication to treat illness, 23.8% (n=96), and to stay awake at night to study, 14.9% (n=60). Substance use was found to be prevalent among students in this study involving over-the-counter and socially acceptable substances as well as the abuse of illicit substances. It is advocated that there is a need to review existing health educational programmes.

The Effects of Undertreated Chronic Medical Illnesses in Patients With Severe Mental Disorders

Severe mental disorders such as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. These comorbidities are associated with a more severe course of mental illness, reduced quality of life, and premature mortality. Although the association between mental disorders and physical health complications has long been recognized, medical conditions remain undertreated in clinical psychiatric practice, and the life expectancy for individuals with serious psychiatric disorders is approximately 30% shorter than that of the general US population. Factors that are related to the mental illness (eg, cognitive impairment, reduced ability to function, and a lack of communication skills) as well as factors such as the high cost of medical care may make accessing general health care a difficult task for patients. Even when medical care is received by patients, the quality is often poor, and dangerous illnesses may be undiagnosed and untreated. In addition, harmful side effects of medications used to treat psychiatric disorders, unhealthy habits and lifestyles, and a possible genetic susceptibility to medical conditions increase the likelihood of comorbid physical conditions in patients with severe mental illness. Implementing behavioral interventions into clinical practice may help patients improve their overall health and prevent chronic medical conditions.

Chapter 12; Familial Caregivers of Older Adults

SUMMARY Caregivers of older adults face many obstacles as they balance family, career, and caregiving demands. Caregivers are at an increased risk for burden, stress, depression, and a variety of other mental and physical health complications. It is not uncommon for caregivers to receive some form of pharmacological therapy to treat the physical and mental health changes that may occur throughout their caregiving career. However, while pharmacological forms of treatment are invaluable, medications only may not be sufficient to treat the needs of caregivers. As such, geriatric professionals also have a responsibility to intervene with caregivers through psychosocial interventions. This paper provides an overview of caring, a summary of evidence-based psychosocial interventions for family caregivers of older adults, and recommendations for future interventions.

Epidemiology of depression and dysphoria in an elderly Hispanic population. Prevalence and correlates.

Depression among older minority groups, including Hispanics, has not been well studied. Little is known of the true rates of depression, it correlates or how well it is treated. This research is part of a series examining health status of older Hispanics using the Comprehensive Assessment and Referral Evaluation (CARE). Seven hundred older Hispanics living in Los Angeles County were studied using an area-probability sampling method. The CARE items were regrouped to reflect Diagnostic and Statistical Manual III criteria for depression and dysphoria. More than 26% were found to have a major depression or dysphoria. These affective disorders were strongly correlated with physical health status. Without physical health complications, the rate was 5.5%. A number of socioeconomic, health behavior, and family variables were related to affective state. Treatment for affective disorder appeared to be very poor for this population.