Poor Rapport Research Articles

Assessment of performance of teamwork in construction projects delivery in South-Southern Nigeria

PurposeEffort towards improving project performance has necessitated the need for effective teamwork among the stakeholders in the construction industry. The purpose of this paper is to identify the major attributes of effective teamwork and the challenges encountered by the team during construction with a view to improving performance of projects.Design/methodology/approachData for the study were obtained through 420 structured questionnaires, which were administered to a sample of project participants including clients’, contractors’ and consultants’ organizations’ representatives in South-Southern region of Nigeria. Data collected were analyzed using percentage, mean item score and Kruskal–Wallis rank test.FindingsThe findings revealed leadership skills, top management support and interpersonal dynamics of the team among the critical attributes for effective teamwork. The prevailing challenges of effective teamwork were identified as essentially; poor leadership, poor rapport among team members and lack of effective communication.Practical implicationsThe study ultimately provides implication for effective team building among clients’, consultants’ and contractors’ organizations towards efficient delivery of construction projects. Moreover, the stakeholders in the industry would find the results of this research useful in managing human and non-human components of construction projects through the understanding of the attributes and challenges of teamwork with ultimate aim of achieving effective project performance.Originality/valueThe findings reveal that all the key stakeholders’ organizations; clients, consultants and contractors’ organizations exhibit similar perceptions of the attributes and challenges confronting teamwork in construction project delivery. The empirical evidence provided on the attributes and challenges would therefore offer robust information in building effective project team by stakeholders during the planning and implementation stages, which is a right step towards enhancing construction project performance.

Mistreatment of women in public health facilities of Ethiopia

BackgroundRecent evidence suggests that mistreatment of women during childbirth is a global challenge facing health care systems. This study seeks to explore the prevalence of mistreatment of women in public health facilities of Ethiopia, and identify associated factors.MethodsA two-stage cross sectional sampling design was used to select institutions and women. The study was conducted in hospitals and health centers across four Ethiopian regions. Quantitative data were collected from postpartum women. Mistreatment was measured using four domains: (1) physical abuse, (2) verbal abuse, (3) failure to meet professional standards of care, and (4) poor rapport between women and providers. Percentages of mistreatment and odds ratios for the association between its presence and institutional and socio demographic characteristics of women were calculated using bivariate and multivariable logistic regression modeling.ResultsA total of 379 women were interviewed, of whom 281 (74%) reported any mistreatment. Physical and verbal abuse were reported by 7 (2%) and 31 (8%) women interviewed respectively. Failure to meet professional standards of care and poor rapport between women and providers were reported by 111 (29%) and 274 (72%) women interviewed respectively.Multivariable logistic regression analysis revealed that the odds of reporting mistreatment were higher among women with four or more previous births (aOR = 3.36 95%CI 1.22,9.23, p = 0.019) compared to women with no previous childbirth, Muslim women (aOR = 3.30 95%CI 1.4,7.77, p = 0.006) and women interviewed in facilities with less than 17 births per MNH staff in a month (aOR = 3.63 95%CI 1.9,6.93, p < 0.001). However, the odds of reporting mistreatment were lower among women aged 35 and older (aOR = 0.22 95%CI 0.06, 0.73, p = 0.014) and among women interviewed between 8 and 42 days after childbirth (aOR = 0.37 95%CI 0.15, 0.9, p = 0.028).ConclusionMistreatment during childbirth in Ethiopia is commonly reported. Health workers need to consider provision of individualized care for women and monitor their experiences in order to adjust quality of their services.

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

BackgroundRecently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study.MethodsOur multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables.ResultsOf eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years.Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment.ConclusionThis is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements.

The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

BackgroundNegative symptoms in schizophrenia are heterogeneous and multidimensional; effective treatments are lacking. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, was significantly more effective than risperidone in treating negative symptoms in a prospectively designed trial in patients with schizophrenia and persistent, predominant negative symptoms. MethodsUsing post hoc analyses, we evaluated change from baseline at week 26 in individual items of the Positive and Negative Syndrome Scale (PANSS) and PANSS-derived factor models using a mixed-effects model for repeated measures (MMRM) in the intent-to-treat (ITT) population (cariprazine = 227; risperidone = 227). ResultsChange from baseline was significantly different in favor of cariprazine versus risperidone on PANSS items N1-N5 (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking) (P < .05), but not on N6 (lack of spontaneity/flow of conversation) or N7 (stereotyped thinking). On all PANSS-derived negative symptom factor models evaluated (PANSS-Factor Score for Negative Symptoms, Liemburg factors, Khan factors, Pentagonal Structure Model Negative Symptom factor), statistically significant improvement was demonstrated for cariprazine versus risperidone (P < .01). Small and similar changes in positive/depressive/EPS symptoms suggested that negative symptom improvement was not pseudospecific. Change from baseline was significantly different for cariprazine versus risperidone on PANSS-based factors evaluating other relevant symptom domains (disorganized thoughts, prosocial function, cognition; P < .05). ConclusionsSince items representing different negative symptom dimensions may represent different fundamental pathophysiological mechanisms, significant improvement versus risperidone on most PANSS Negative Subscale items and across all PANSS-derived factors suggests broad-spectrum efficacy for cariprazine in treating negative symptoms of schizophrenia.

Metacognitive capacity and negative symptoms in first episode psychosis: Evidence of a prospective relationship over a 3-year follow-up

Negative symptoms can be linked to Bleuler’s concept of splitting or fragmentation of thought, affect, and will. Research has shown a link between disturbances in metacognition and negative symptoms, although relatively few studies have examined this relationship longitudinally. The aim of this article is to examine whether metacognitive capacity among patients with first episode psychosis (FEP) predicted negative symptoms after a follow-up period of 3 years. Metacognition was assessed using the Metacognition Assessment Scale abbreviated and symptoms were assessed using Positive and Negative Syndrome Scale among 59 adults with FEP. Symptoms were then reassessed at a 3-year follow-up. Significant correlations were found between baseline metacognitive scores and the expressive component of negative symptoms as well as for individual negative symptoms such as blunted affect, poor rapport, and alogia at 3-year follow-up after controlling for baseline negative symptoms. Self-reflectivity was significantly correlated with the expressive component of negative symptoms at 3-year follow-up. The results are partly consistent with a Bleulerian model which understands the emergence of negative symptoms as a response in part to the experience of fragmentation, particularly in terms of sense of self and others. Future research should clarify the likely role of metacognition in the development and maintenance of negative symptoms.

Comparison between typical and atypical antipsychotics according their effects on metabolism in schizophrenia patients

Objective This study aimed at assessing the risk factors causing metabolic dysregulations in schizophrenia patients on antipsychotics treatment. Background Schizophrenia is a devastating mental illness with wide prevalence of high mortality and morbidity rates associated with high prevalence of metabolic syndrome that is characterized by hyperglycemia, obesity, dyslipidemia, and hypertension. Patients and methods This is a cross-sectional study conducted on 40 patients suffering from schizophrenia taking typical and atypical antipsychotics only (groups I and II, respectively). Detailed general medical, neurological history, examination, and psychiatric history were taken from patients. Results Results revealed insignificant difference among groups regarding gender, age of onset ( first episode, last episode), duration of last period of treatment and total illness, blunted effect, poor rapport, emotional withdrawal, lack of spontaneity of conversation, and difficulty in abstract and stereotyping thinking; in contrast, the number of relapses were increased significantly in groups. However, insignificant differences were detected between baseline and after 6 months regarding blood elements, triglyceride, 2 h postprandial, and liver and kidney function. Conclusion Schizophrenia as a syndrome can by itself produce metabolic abnormalities. It is usually treated with first-generation and/or second-generation antipsychotics, which also can produce metabolic adverse events, but the second-generation antipsychotics can produce more frequently and severely. There were some dysregulations obvious only with typical antipsychotics. The lipid and glucose metabolism were significantly dysregulated after 6 months, but it did not reach the threshold of diagnosis of diabetes mellitus or pathological dyslipidemia. In addition, healthier lifestyle, low carbohydrate and fatty meal consumption, good premorbid metabolic parameters, and good choice of antipsychotic help in prognosis of metabolic status of schizophrenic patients.

Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers

BackgroundIn Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system. Many of these deaths are avoidable and occur during delivery and labor. Poor quality health service has been a recurring concern among women in Kenya, with women reporting interactions with healthcare workers that are often demeaning and abusive. This paper explores the experiences and perceptions of both female patients and healthcare workers regarding mistreatment during childbirth. This study aims to provide recommendations on how dignified care can be made the norm, specifically focusing on a peri-urban setting in Kenya.MethodsThe research was accomplished using qualitative research methods with focus group discussions and in depth interviews with women and healthcare workers. The aim was to gain a deeper understanding of the manifestations of mistreatment within the context of a peri-urban setting in Kenya.ResultsFemale patients reported different forms of mistreatment, such as verbal abuse, physical abuse, neglect, discrimination, abandonment, poor rapport and failure of the health system to uphold professional standards. The healthcare workers described a health system that was weak and fragmented with poor policy support particularly for the new free maternity services policy leading to the mistreatment of women.ConclusionNewly formed County Governments need to provide resources for a functioning health system to ensure an enabling environment for the provision of high quality maternal health services. This process can include feedback loops with maternity clients to ensure woman-centered services. Policy makers need to strengthen oversight for the implementation of the free maternity services Community health volunteers can be trained to provide this information. Professional associations that govern the standards of quality care for healthcare workers need to address the mistreatment through retraining and norms transformation.

Impact of psychosis in bipolar disorder during manic episodes

Objectives: To evaluate the effect of psychosis on prognosis as measured by the course of a manic episode, symptoms severity and time to remission and identify existing differences in positive and negative symptoms between psychotic and non-psychotic patients.Study design: 40 bipolar patients presenting with a diagnosis of acute mania were enrolled (18 psychotic patients and 22 non-psychotic patients) in this cross-sectional study. Subjects were required to complete two self-reported questionnaires, the Young Mania Rating Scale (YMRS) for manic symptoms, and Positive and Negative Symptoms Scale (PANSS) for psychotic symptoms. Rating scales were administered at baseline and then again after three weeks of pharmacologic treatment.Results: There were no differences in socio-demographic characteristics between psychotic and non-psychotic subjects. Psychosis was associated with higher scores on the YMRS and PANSS (increased symptoms severity), compared to non-psychotic patients. Both groups demonstrated clinical improvement and remission, with scores amongst psychotic patients remaining higher. Groups were similar in symptomatology except with regards to psychotic symptoms (the content, insight, delusions, hallucinations, grandiosity, poor rapport and unusual thoughts).Conclusions: Psychosis can be considered a severity index in bipolar disorder, with decreased severity and overall clinical improvement and remission taking place in response to pharmacotherapy.

Perspectives of IBD China: Is Crohn's and Colitis Foundation Model a Solution to Health Care Issues for the Country?

The success of the Crohn's and Colitis Foundation of America (CCFA), now Crohn's and Colitis Foundation (CCF) has established a role model for developing countries with an increasing incidence of inflammatory bowel disease (IBD), including China. While there are shared etiopathogenetic pathways and clinical features in IBD between Eastern and Western countries, patients with IBD as well as health care professionals in China are facing distinctive challenges, including the fragmented and inconsistent health insurance, social support system, and three-tiered health care service. Financial burden remains to be a tremendous obstacle to the management of IBD. In addition, poor rapport between patients and clinicians, and the lack of properly trained IBD specialists makes a noticeable gap in the management of IBD between China and Western countries. The China Crohn's &Colitis Foundation (CCCF), closely following the successful model of CCF, was established under the same doctrine, and served as a non-profit, volunteer-driven organization dedicated to improving quality of life of patients in by IBD through education and training.

F63. COGNITIVE CORRELATES OF THE NEGATIVE SYMPTOMS EXPRESSIVE AND EXPERIENTIAL DEFICIT FACTORS IN PSYCHOSIS

BackgroundPrimary negative symptoms of schizophrenia contribute heavily to functional disability. Treatment of these symptoms continues to be a major unmet need, even when positive symptoms are controlled. Recent factor analyses of negative symptoms using the PANSS and other symptom assessments in patients with schizophrenia have identified two factors of negative symptoms: expressive and experiential deficits. These two factors most likely have very different clinical, neurocognitive and neurobiological correlates. This study examines the clinical and cognitive correlates associated with expressive and experiential deficits in a large cohort of patients with psychosis before and after computerized cognitive remediation.MethodsThis is a secondary data analysis of subjects enrolled in a cognitive remediation program for 12 weeks. One hundred fifty-one subjects age 18 - 55 with a DSM IV-TR diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder were enrolled. Assessments of demographic, psychopathology (PANSS), cognition (MCBB), and daily living skills (UPSA-Brief) were conducted at baseline and endpoint. Exploratory (EFA) and confirmatory (CFA) factor analyses of PANSS items as well as Pearson’s correlations between factors, demographics, MCCB, and UPSA-Brief scores were examined at baseline and endpoint.ResultsEFA baseline PANSS data resulted in the five-factor model of the PANSS with seven items attributed to the Negative Symptom Factor (NSF; N1, blunted affect; N2, emotional withdrawal; N3, poor rapport; N4, passive social withdrawal; N6, lack of spontaneity and flow of conversation; G7, motor retardation; and G16, active social avoidance). CFA of the NSF revealed a two-factor model consisting of an Expressive Deficit (N1, N3, N6, G7), and an Experiential Deficit (N2, N4, and G16). Difference tests comparing the one-factor and two-factor models found that the two-factor model exhibited significantly better fit than the one-factor model (χ2 = 67.117, df = 1, p ≤ 0.001; CFI = 0.92; Tucker–Lewis index TLI = 0.91; root mean square error of approximation RMSEA = 0.040; and Goodness of Fit index GFI = 0.93). There were significant correlations between the Expressive Deficit factor score and cognition: TMT- A (r=-0.259, p=0.001), BACS Symbol coding (r=-0.287, p=0.001), Category Fluency (r=-0.342, p=0.001), Hopkins Verbal Learning Test – revised (HTLV-R) (r=-0.236, p=0.05), Letter Number Sequencing (r=-0.256, P=0.001), and NAB Mazes (r=-0.409, p=0.001). The Expressive Deficit factor was also significantly correlated with the neurocognitive domains of Processing Speed (r=-0.352, p=0.001) and Reasoning/Problem Solving (r=-0.338, p=0.001). There were no significant correlations between either factor and UPSA-Brief or the MCCB cognitive composite. There were no significant correlations for change from baseline to endpoint in negative symptoms.DiscussionOur results support the negative symptom two-factor model of Expressive Deficit and Experiential Deficit domains. Only the Expressive Deficit factor was associated with baseline deficits in Working Memory, Processing Speed, Reasoning/Problem Solving and Verbal Learning. The association of the Expressive Deficit factor with significant cognitive impairments supports a more profound neurobiological dysfunction in contrast to the Experiential Deficit factor and may represent an important treatment challenge. The relevance of these findings for the treatment of negative symptoms in schizophrenia will be discussed.

T111. PANSS NEGATIVE SYMPTOM DIMENSIONS ACROSS GEOGRAPHICAL REGIONS: IMPLICATIONS FOR SOCIAL, LINGUISTIC AND CULTURAL CONSISTENCY

BackgroundRecognizing the discrete dimensions that underlie negative symptoms in schizophrenia and how these dimensions are conceptualized across geographical regions may result in better understanding and treatment. The expressive-experiential distinction has been shown to have vast importance in relation to functional outcomes in schizophrenia. Previous studies have shown that the PANSS may not be equivalently rated across counties and cultures, suggesting regional differences in both symptom expression and rater judgment of symptom severity. Items that perform in markedly different ways across demographic, regional, cultural, or clinical severity characteristics may not offer valid representations of the target construct. 1) Will the expressive and experiential dimensions of the PANSS vary over 15 geographical regions and will the item ratings defining each dimension manifest similar reliability across these regions? 2) In large multi-center, international trials where data are combined, which of the two dimensions are disposed to social, linguistic and cultural inconsistency?MethodsData was obtained for the baseline PANSS visits of 6,889 subjects. Using Confirmatory Factor Analysis (CFA), we examined whether the expressive-experiential distinction would be replicated in our sample. We investigated the validity of the expressive-experiential distinction using Differential Item Functioning (DIF; Mantel-Haenszel) across 15 geographical regions – South America-Mexico, Austria-Germany, Belgium-Netherlands, Brazil, Canada, Nordic regions (Denmark, Finland, Norway, Sweden), France, Great Britain, India, Italy, Poland, Eastern Europe (Romania, Slovakia, Ukraine, Croatia, Estonia, Czech Republic), Russia, South Africa, and Spain - as compared to the United States.ResultsExpressive Deficit: More DIF was observed for items in the Expressive deficit factor than for items relating to experiential deficits. The following regions showed at least moderate to large DIF for all items: Austria-Germany, Nordic, France, and Poland. Of all the items, N3 Poor Rapport showed the most moderate and large DIF (n = 13; 86.67%) across countries, with 7 countries reporting large DIF. Similarly, N6 Lack of Spontaneity and Flow of Conversation showed moderate and large DIF for 66.67% countries (n=10). Experiential Deficit: Item G16 Active Social Avoidance reported negligible DIF for 14 of the 15 countries investigated (93.33%). Large DIF was observed for N2 Emotional Withdrawal and N4 Passive Apathetic Social Withdrawal for Brazil and India. Seven regions demonstrated no DIF across all items of the PANSS experiential deficit factor (South America-Mexico, Belgium-Netherlands, Nordic, Great Britain, Eastern Europe, Russia, and Spain). Overall, there were many fewer observed items with large DIF for PANSS experiential domain.DiscussionThese results suggest that the PANSS Negative Symptoms Factor can be better represented by a two-factor model than by a single-factor model. Additionally, the results show significant differences in ratings on the PANSS expressive items, but not the experiential items, across regions. This could be due to a lack of equivalence between the original and translated versions, cultural differences in the interpretation of items, rater training, or understanding of scoring anchors. Knowing which items are challenging for raters across regions can help guide PANSS training to improve results of international clinical trials aimed at negative symptoms.

Comparisons between Psychiatric Symptoms of Patients with Anti-NMDAR Encephalitis and New-Onset Psychiatric Patients

Background: Anti-N-methyl-<smlcap>D</smlcap>-aspartate receptor (NMDAR) encephalitis is a potentially lethal autoimmune disease. Early diagnosis and immunotherapy can improve prognosis; however, early prominent psychiatric symptoms have led to misdiagnosis in numerous cases, delaying diagnosis and treatment. This study aimed to explore the clinical features and psychiatric symptoms of anti-NMDAR encephalitis and the association between antibody titers and psychiatric symptoms. Methods: In this retrospective study, 43 patients with anti-NMDAR encephalitis and 70 new-onset psychiatric patients were enrolled. Psychiatric symptoms were assessed by trained psychiatrists using the Positive and Negative Syndrome Scale. Results: There were significant differences in psychiatric symptoms between the antibody-positive and antibody-negative groups. The item scores for poor rapport (p < 0.01), difficulty in abstract thinking (p < 0.01), lack of spontaneity and flow of conversation (p < 0.01), unusual thought content (p < 0.01), and disorientation (p < 0.01) were significantly higher in the antibody-positive group, while the item scores for delusions (p < 0.01) were significantly higher in the antibody-negative group. These differences all remained significant after Holm-Bonferroni correction. In the antibody-positive group, scores for each item, subscale, and factor increased with increases in antibody titer, particularly for delusions (p < 0.05) and hallucinatory behavior (p < 0.01). Thereafter, only hallucinatory behavior remained significant. Conclusions: Patients with anti-NMDAR encephalitis with initial psychiatric symptoms may have the following characteristics: poor rapport, difficulty in abstract thinking, lack of spontaneity and flow of conversation, unusual thought content, and disorientation. Furthermore, antibody titer may be associated with psychiatric symptom severity, especially in hallucinatory behavior.

A state-independent network of depressive, negative and positive symptoms in male patients with schizophrenia spectrum disorders

Depressive symptoms occur frequently in patients with schizophrenia. Several factor analytical studies investigated the associations between positive, negative and depressive symptoms and reported difficulties differentiating between these symptom domains. Here, we argue that a network approach may offer insights into these associations, by exploring interrelations between symptoms. The aims of current study were to I) construct a network of positive, negative and depressive symptoms in male patients with schizophrenia to investigate interactions between individual symptoms; II) identify the most central symptoms within this network and III) examine group-level differences in network connectivity between remitted and non–remitted patients.We computed a network of depressive, positive and negative symptoms in a sample of 470 male patients diagnosed with a psychotic disorder. Depressive symptoms were assessed with the Calgary Depression Rating Scale for Schizophrenia, while psychotic symptoms were assessed with the Positive and Negative Syndrome Scale. Networks of male patients who fulfilled remission criteria (Andreasen et al., 2005) and non–remitters for psychosis were compared.Our results indicate that depressive symptoms are mostly associated with suicidality and may act as moderator between psychotic symptoms and suicidality. In addition, ‘depressed mood’, ‘observed depression’, ‘poor rapport’, ‘stereotyped thinking’ and ‘delusions’ were central symptoms within the network. Finally, although remitted male patients had a similar network structure compared to non-remitters the networks differed significantly in terms of global strength. In conclusion, clinical symptoms of schizophrenia were linked in a stable way, independent of symptomatic remission while the number of connections appears to be dependent on remission status.

A quality improvement study of the emergency centre triage in a tertiary teaching hospital in northern Ethiopia.

IntroductionAn effective emergency triage system should prioritize both trauma and non-trauma patients according to level of acuity, while also addressing local disease burden and resource availability. In March 2012, an adapted version of the South African Triage Scale was introduced in the emergency centre (EC) of Ayder Comprehensive Specialized Hospital in northern Ethiopia.MethodsThis quality improvement study was conducted to evaluate the implementation of nurse-led emergency triage in a large Ethiopian teaching hospital using the Donabedian model. A 45% random sample was selected from all adult emergency patients during the study period, May 10th to May 25th 2015. Patient charts were collected and retrospectively reviewed. Presence and proper completion of the triage form were appraised. Triage level was abstracted and compared with patient outcome (dichotomized as “admitted to hospital or died” and “discharged alive from emergency centre”) to quantify over- and under-triage triage.ResultsFrom 251 randomly selected patients, 107 (42.6%) charts were retrieved. From these, only 45/107 (42.1%) contained the triage form filled within the chart. None of the triage forms were filled out completely. From 13 (28.9%) admitted or deceased patients, the under-triage rate was 30.7% and from 32 (71.1%) patients discharged alive from the EC the over-triage rate was 21.9%.DiscussionThe under-triage rate observed in this study exceeds the recommended threshold of 5% and is a serious patient safety concern. However, under-triage may have been magnified by irregularities in the hospital admission process. Haphazard medical record handling, poor documentation, erroneous triage decisions, and poor rapport between nurses and physicians were the main process-related challenges that must be addressed through intensive training and improved human resource management approaches to enhance the quality of triage in the emergency centre.

A Secondary Analysis of Mistreatment of Women During Childbirth in Health Care Facilities

ObjectiveTo conduct a secondary qualitative analysis of a phenomenological study of traumatic childbirth to identify the types and frequency of mistreatment of women during childbirth in high-income countries. DesignAnalytic expansion was the type of secondary analysis chosen to make further use of a primary qualitative data set to ask a new question that was not included the original study aims. SettingThe primary data set of women’s experiences of traumatic childbirth was obtained via the Internet. ParticipantsThe Internet sample of 40 mothers consisted of 23 women from New Zealand, 8 from the United States, 6 from Australia, and 3 from the United Kingdom who experienced traumatic births. MethodsKrippendorff’s content analysis of categoric distinction was used to analyze the mothers’ narratives of their traumatic births. The typology of mistreatment and abuse of women during childbirth in health care facilities worldwide outlined by Bohren et al. provided the categories for the content analysis. ResultsSix types of disrespectful and abusive treatment during childbirth were reported by participants, from those reported most often to least often: Failure to Meet Professional Standards of Care, Poor Rapport Between Women and Providers, Verbal Abuse, Physical Abuse, Health System Conditions/Constraints, and Stigma/Discrimination. ConclusionFindings confirm results from studies of mistreatment of women during childbirth in health care facilities in low- and middle-income countries. Prevention and elimination of mistreatment of women during childbirth are the ethical responsibility of all obstetric health care providers.

Not the same old madness: Evaluating the clinical profile of the “schizophrenia spectrum” disorders

IntroductionThe “schizophrenia spectrum” concept allowed better identifying the psychopathology underpinning disorders including schizophrenia, schizoaffective disorder (SZA) and cluster A personality disorders (PD).AimsTo compare the clinical portrait of the schizophrenia spectrum disorders, focusing on the impact of the affective dimension.MethodsInpatients at the acute psychiatric ward of Perugia (Umbria-Italy) were evaluated with the structured clinical interview for DSM-IV Axis I and Axis II disorders and diagnosed with a “schizophrenia spectrum” disorder according to DSM-IV-TR. The clinical evaluation was conducted using the positive and negative syndrome scale (PANSS). Pearson correlations of the different subscales in the three groups and between the negative scales with the affective symptom “depression” were conducted.ResultsThe sample consisted of 72 inpatients (schizophrenia 55.6%, SZA 20% and cluster A PD 19.4%). The negative and the general psychopathology scales directly correlated at different degrees in the three groups (schizophrenia: r = 0.750; P &lt; 0.001; SZA: r = 0.625, P = 0.006; cluster A PD: r = 0.541, P = 0.046). The symptom “depression” directly correlated with 5 out of 7 negative symptoms: blunted affect (r = 0.616, P &lt; 0.001), emotional withdrawal (r = 0.643, P &lt; 0.001), poor rapport (r = 0.389, P = 0.001), passive/apathetic social withdrawal (r = 0.538, P &lt; 0.001), lack of spontaneity &amp; flow of conversation (r = 0.399, P = 0.001).ConclusionsOur study confirmed the existence of the “schizophrenia spectrum” with combined different disorders lying on a continuum in which negative symptoms mainly correlated with the psychopathological functioning. Noteworthy, the symptoms of the negative scale strongly correlated with the “depression” symptom, underlying the impact of the affective symptoms on the severity of the “schizophrenia spectrum” disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

"Us Against Them": Schools, Families, and the Diagnosis of ADHD Among Black Children.

Prior research indicates that attention-deficit/hyperactivity disorder (ADHD) is underdiagnosed, or less likely to be diagnosed, among Black children relative to White children and children in other non-Black racial categories. Scholars have suggested that this may be a result of cultural biases or misconceptions that affect the ways classroom behavior is interpreted. The purpose of this pilot study was to engage a larger theoretical framework that explores the relationships between parents and teachers and to examine some of the ways in which common cultural misconceptions can lead to flawed behavioral ascriptions in the classroom, producing negative social outcomes for Black children. Findings from ethnography and interviews reveal that the most common barriers in this low-income neighborhood school setting included poor parent-teacher rapport, a general lack of basic understanding for how ADHD can affect classroom behavior, and faulty procedures in the school setting based on cultural stereotypes. These findings suggest that school officials' disinclination to recommend ADHD testing for Black children may be largely a result of the aforementioned obstacles. A larger study based on these results may produce more robust findings about the barriers that contribute to racial disparities in ADHD diagnoses.

Do employee relation responsibility and culture matter for firm value? International evidence

Using a dataset on employee relation responsibility (ERR) from 30 countries, we examine the effects of employee relationships on firm value. In addition, this paper attempts to understand the role of national cultural dimensions regarding their relation with ERR and firm value. We find that firms with good employee relationships tend to demonstrate significantly higher levels of firm value than firms whose employees exhibit poor rapport. We also find that the positive impact of ERR on firm value is significantly strengthened in cultures with high degrees of power distance, collectivism, masculinity, and risk avoidance. These results are robust even after mitigating endogeneity issues, adjusting sample composition bias and using alternative independent variables. Our findings extend the previous CSR-related research into a new horizon, with the objective of investigating this less explored subject within the sub-areas of CSR research. The findings of this study are noteworthy given that we incorporate the role of national culture into the ERR-firm value link, a task that has not yet been undertaken.

Association study of disrupted-in-schizophrenia-1 gene single nucleotide polymorphism with schizophrenia in Han Chinese population

Objective To analyze the association between single nucleotide polymorphisms (SNPs) in DISC1 gene. Methods The studied sample consisted of 528 patients with schizophrenia (264 males and 264 females) and 528 healthy controls (264 males and 264 females). Two function SNPs were selected and genotyped by Illumina Golden Gate assay. Genotype and allele frequencies were compared between patients and controls to assess the association to schizophrenia. The clinical features of the hospital first patients were further examined with the Positive and Negative Syndrome Scale (PANSS) before treatment with antipsychotics. Results Two SNPs were genotyped in subjects. A significant association was found between rs3737597 and schizophrenia in genotype(387∶133∶8, 350∶164∶14) and allele frequencies (907∶149, 864∶192, P<0.05). Moreover, the haplotypes, A-A constructed from two SNPs showed significant differences between cases and controls (P<0.05). For rs821616, there were significant difference in positive syndrome score, delusions and poor rapport between patients with genotypes AA or not. Conclusion This study describes a positive association between DISC1 and schizophrenia in the Han Chinese population and DISC1 is the susceptible gene in schizo phrenia. Key words: Schizophrenia; Disrupted-in-schizophrenia-1; Association; Positive and negative syndrome scale

Long-term poor rapport, lack of spontaneity and passive social withdrawal related to acute post-infectious encephalitis: a case report.

IntroductionPost-infectious encephalitis/encephalopathy is a neurological syndrome that sometimes develops following common viral or bacterial infections. The most common form is acute disseminated encephalomyelitis (ADEM). ADEM is a demyelinating disease of the central nervous system that typically presents as a monophasic disorder associated with multifocal neurologic symptoms and encephalitis. Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is another type of severe autoimmune disorder, characterized by seizures, movement disorders and psychiatric symptoms. In general, the prognosis and long-term outcomes of both ADEM and anti-NMDAR encephalitis are favorable. Most patients show complete, albeit slow recovery over a period of one to 2 years. There are few reports of patients with these disorders showing long-term residual psychiatric symptoms.Case presentationWe report the case of a 16-year-old Japanese male who suffered from acute post-infectious encephalitis. The patient followed an atypical recovery course, in that he showed poor rapport, lack of spontaneity and passive social withdrawal for more than 2 years after the initial symptoms. While treatment with small doses of antipsychotic drugs at the hospital had no effect on the symptoms, the patient recovered gradually over a prolonged period of five or so years.ConclusionsThis case report suggests that a type of acute post-infectious encephalitis with demyelinating features, possibly ADEM or anti-NMDAR encephalitis, or an overlap between the two, can cause a prodrome of behavioral changes and long-term residual psychiatric symptoms for many months, although it is eventually associated with a good prognosis.