Single Catchment Area Research Articles

213 A STRUCTURED CONTENT ANALYSIS OF THE WEBSITES OF NURSING HOMES WITH RESPECT TO LGBT-INCLUSIVITY

Abstract Background The challenges associated with ageing can be amplified for individuals who identify as Lesbian Gay Bisexual or Transgender (LGBT). As a cohort, they are more likely to enter long term care at an earlier age than their non-LGBT counterparts. Many LGBT older adults fear negative bias in their interactions with health and social care services, and perceive nursing homes as potentially unwelcoming and insensitive to their needs. Nursing home websites outline the services and facilities available to residents, and can offer an insight into their culture and values. This research sought to examine the LGBT-inclusivity of nursing homes websites in a single catchment area catering to both an urban and rural population. Methods A total of 41 nursing homes and long term care facilities were identified, of which 24 had websites. A structured content analysis of these websites was performed, with respect to; 1) LGBT-inclusive symbols; 2) Messaging directly addressing LGBT individuals; 3) Presence of a diversity/inclusion statement; 4) Explicit reference to LGBT individuals or sexual orientation in a diversity/inclusion statement; 5) Use of heteronormative imagery; and 6) Use of LGBT-inclusive imagery. Data was manually recorded and uploaded to an excel document for analysis. Results None of websites featured LGBT-inclusive symbols or directly addressed LGBT individuals. 8% (n = 2) included a statement on diversity and inclusion, however only 4% (n = 1) explicitly referenced sexual orientation. In terms of visual content, 16% (n = 4) of websites included heteronormative photographs with none featuring LGBT-inclusive imagery. Conclusion With the exception of one facility, none of the nursing homes acknowledged the sexual identity of residents with respect to inclusivity. None of the facilities examined were suggestive that they would be an inclusive environment for prospective LGBT residents. Greater effort is required to promote inclusivity of sexual minority individuals in the long term care setting.

Spatial patterns of incident malaria cases and their household contacts in a single clinic catchment area of Chongwe District, Zambia.

BackgroundReactive case detection (RACD) for malaria is a strategy that may be used to complement passive surveillance, as passive surveillance fails to identify infections that are asymptomatic or do not seek care. The spatial and seasonal patterns of incident (index) cases reported at a single clinic in Chongwe District were explored.MethodsA RACD strategy was implemented from June 2012 to June 2013 in a single catchment area in Chongwe District. Incident (index) cases recorded at the clinic were followed up at their household, and all household contacts were tested for malaria using rapid diagnostic tests (RDTs). GPS coordinates were taken at each index household. Spatial analyses were conducted to assess characteristics related to clustering, cluster detection and spatial variation in risk of index houses. Effects of season (rainy versus dry), distance to the clinic and distance to the main road were considered as modifying factors. Lastly, logistic regression was used to identify factors associated with the proportion of household contacts testing RDT positive.ResultsA total of 426 index households were enrolled, with 1,621 household contacts (45% RDT positive). Two space–time clusters were identified in the rainy season, with ten times and six times higher risk than expected. Significantly increased spatial clustering of index households was found in the rainy season as compared to the dry season (based on K-function methodology). However, no seasonal difference in mapped spatial intensity of index households was identified. Logistic regression analysis identified two main factors associated with a higher proportion of RDT positive household contacts. There was a 41% increased odds of RDT positive household contacts in households where the index case was under 5 years of age [OR = 1.41, 95% confidence intervals (1.15, 1.73)]. For every 500-m increase in distance from the road, there was a 5% increased odds of RDT positive household contacts [OR = 1.05 (1.02, 1.07)], controlling for season.DiscussionAreas of increased report of malaria persist after controlling for distance to the clinic and main road. Clinic-based interventions will miss asymptomatic, non-care seeking infections located farther from the road. RACD may identify additional infections missed at the clinic.

BBGRE: brain and body genetic resource exchange.

Studies of copy number variation (genomic imbalance) are providing insight into both complex and Mendelian genetic disorders. Array comparative genomic hybridization (array CGH), a tool for detecting copy number variants at a resolution previously unattainable in clinical diagnostics, is increasingly used as a first-line test at clinical genetics laboratories. Many copy number variants are of unknown significance; correlation and comparison with other patients will therefore be essential for interpretation. We present a resource for clinicians and researchers to identify specific copy number variants and associated phenotypes in patients from a single catchment area, tested using array CGH at the SE Thames Regional Genetics Centre, London. User-friendly searching is available, with links to external resources, providing a powerful tool for the elucidation of gene function. We hope to promote research by facilitating interactions between researchers and patients. The BBGRE (Brain and Body Genetic Resource Exchange) resource can be accessed at the following website: http://bbgre.orgDatabase URL: http://bbgre.org

Comorbid mental disorders in substance users from a single catchment area - a clinical study

BackgroundThe optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described.MethodsFirst-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms.DiscussionThis study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.

Mapping Overlapping Commuting-to-Work Areas

Please click here to download the map associated with this article. This article focuses on mapping and delineating commuting areas of work travel (commuting-to-work area—CTWA). Traditional procedures for delimiting these areas assign each municipality to a single catchment area. Commuting distances and the complexity of commuter flows have increased steadily over the years. A classical method in transport planning is a mapping of flows where origin and destination are connected with a straight line resulting in a visualisation of the overlaps. However, the proposed new commuting-to-work area delineation describes a 2-dimensional catchment area of each urban core naturally overlapping with other catchments. Four different degrees of generalisation of CTWAs, from a morphological to a circular area, are discussed and compared to alternative mappings.

One-year effect of changing duration of untreated psychosis in a single catchment area

There is highly replicated positive correlation between longer duration of untreated psychosis and poorer outcome. To study the effect of early intervention in first psychosis on one-year outcome using an historical quasi-experimental design. We compare the outcome of two samples of first-episode psychosis from the same healthcare district at different time periods. The historical control sample was assessed during 1993-1994, before the establishment of a system for early detection of psychosis. The experimental sample is the early detection sample in the Early Treatment and Intervention in Psychosis study assessed during 1997-2000. At 1-year follow-up, the early detection group was younger, had a smaller fraction of individuals with schizophrenia, had less severe negative and general symptoms and had more friends in the past year than the historical control group. No differences were found in clinical course (remission, relapse, continuously psychotic) or positive symptoms, but more patients in the early detection sample were treated as outpatients without hospitalisation. Early detection of schizophrenia in one healthcare sector is associated with less severe deterioration at 1 year.

Restauration hydraulique d’un marais et conséquences pour les oiseaux : contraintes d’échelles d’espace et de temps dans les processus écologiques

Over the last thirty years the intensification of agricultural practices by drainage and conversion of grasslands to arable has led to the loss of hydrological and ecological functions of wetlands in the western marshes of France, in particular the conservation of animals characteristic of these wetlands. The goal of this study was to restore at least some of the ecological functions of wet grasslands by experimentally manipulating the water regime and grazing ; the consequences for the plant and bird communities were measured. This was done in an experimental set-up of 63 fields covering 170 ha in the Marais de Brouage (Charente-Maritime). The water regime is driven by natural processes (rainfall and evaporation) and artificially, through the manipulation of the level of the main canal. By modifying the subsidiary canals and building sluice gates it was possible to isolate experimental fields from the influence of the main canal. The experimental fields were subjected to two treatments, dry (minimal flooding), intermediate (six months flooding) and wet (10 months). We worked at three hierarchical spatial levels, a field, a single catchment area and a set of catchment areas. For the restoration of biodiversity in this case particular bird species, we underline the importance of choosing the appropriate spatial level, which will depend on the objectives. In this wetland system, which reacts fast, the time scale is not a major constraint. Particular attention was paid to birds because these are known to be good indicators of other animal groups, and because the changes in agricultural practices have led to declines in most of the species of farmland in Europe. Between 1997-2001 we counted breeding birds (principally the Skylark Alauda arvensis and the Yellow wagtail Motacilla flava). The former species declined and the latter increased in the set of catchment areas (170 ha). We tested the hypothesis that this was due to an increase in the duration of flooding : at the field level, the Skylark declined and Wagtails increased when the duration of flooding increased. It is therefore possible to experimentally induce rapid changes in the populations of these birds at small spatial scales. In contrast for other species such as the breeding waders, and in particular the Lapwing Vanellus vanellus, no response was obtained at these spatial and temporal scales. However, at the scale of the whole marsh (12 000 ha) and 12 years major changes occurred in the abundance and distribution of Lapwings, many of the birds moving from wet grasslands to arable for nesting. We propose hypotheses to explain this which require testing in the future. These results show the importance of choosing clear objectives in ecological restoration projects, and appropriate indicator species. Since the ecological processes involved occur at different spatial and temporal scales, the level of biological organisation selected and the species will modulate the expression of the processes.

Long survival in B-CLL correlates with surface IgM kappa phenotype.

200 patients with B-cell chronic lymphocytic leukaemia (B-CLL) presenting to a single centre over 13 years have been studied. In 72.2% the diagnosis was made on an incidental blood count, and 70.1% were stage A at presentation. Those patients whose cells expressed surface IgM kappa were significantly more likely to be stage A at presentation and significantly less likely to have a lymphocyte count greater than 50 X 10(9)/l, to have progressive disease or to require treatment than those with other classes of surface Ig. Patients whose cells express surface IgM kappa have a significantly longer actuarial survival than others and this is also so when only patients in Binet stage A or when only patients presenting below the age of 75 are studied. By studying all of the cases presenting in a single catchment area we have attempted to avoid the bias against trivial disease likely to be seen in specialist referral centres.

Clinical correlates of readmission in a schizophrenic cohort.

A study of a cohort of 223 schizophrenic patients from a single catchment area followed up for two years after discharge from inpatient status revealed a significant association between the presence of two of 38 clinical problem categories (social withdrawal and drug abuse) and subsequent readmission. In addition, patients without social withdrawal who were readmitted showed a significantly greater use of aftercare services than those not readmitted, while, among those with social withdrawal, male patients were significantly more likely to be readmitted than female patients. Neither prior hospitalization nor the presence of affective symptoms were significantly associated with readmission. Clinical and research implications of these findings are discussed.

An epidemiologic study of problems associated with violence among psychiatric inpatients.

Approximately 11% of a 1-year sample of psychiatric inpatients from a single catchment area engaged in assaultive behavior before admission to the hospital. Among schizophrenic, alcoholic, and organic brain syndrome patients, assaultiveness was linked to emotional turmoil, as manifested by agitation and anger. In contrast, male patients with other diagnoses showed assaultiveness in the absence of substantial emotional distress, and patients with affective disorders were unlikely to exhibit assaultiveness even when high levels of agitation and anger were reported. The findings suggest that assessment and treatment of violent behavior in psychiatric patients are primarily linked to the nature of the underlying psychopathology.