Somatic Health Problems Research Articles

Antenatal glucocorticoid treatment is associated with diurnal cortisol regulation in term-born children

Due to the rapid developmental changes that occur during the fetal period, prenatal influences can affect the developing central nervous system with lifelong consequences for physical and mental health. Glucocorticoids are one of the proposed mechanisms by which fetal programing occurs. Glucocorticoids pass through the blood-brain barrier and target receptors throughout the central nervous system. Unlike endogenous glucocorticoids, synthetic glucocorticoids readily pass through the placental barrier to reach the developing fetus. The synthetic glucocorticoid, betamethasone, is routinely given prenatally to mothers at risk for preterm delivery. Over 25% of the fetuses exposed to betamethasone will be born at term. Few studies have examined the lasting consequences of antenatal treatment of betamethasone on the regulation of the hypothalamic-pituitary-adrenal (HPA) axis. The purpose of this study is to examine whether antenatal exposure to betamethasone alters circadian cortisol regulation in children who were born full term. School-aged children prenatally treated with betamethasone and born at term (n=19, mean (SD)=8.1 (1.2) years old) were compared to children not treated with antenatal glucocorticoids (n=61, mean (SD)=8.2 (1.4) years old). To measure the circadian release of cortisol, saliva samples were collected at awakening; 30, 45, and 60min after awakening; and in the evening. Comparison children showed a typical diurnal cortisol pattern that peaked in the morning (the cortisol awakening response) and gradually decreased throughout the day. In contrast, children exposed to antenatal betamethasone lacked a cortisol awakening response and had a flatter diurnal slope (p’s<0.01). These data suggest that antenatal glucocorticoid treatment may disrupt the circadian regulation of the HPA axis among children born at term. Because disrupted circadian regulation of cortisol has been linked to mental and somatic health problems, future research is needed to determine whether children exposed to antenatal synthetic glucocorticoids are at risk for poor mental and physical health.

Loneliness and its association with psychological and somatic health problems among Czech, Russian and U.S. adolescents.

BackgroundLoneliness is common in adolescence and has been linked to various negative outcomes. Until now, however, there has been little cross-country research on this phenomenon. The aim of the present study was to examine which factors are associated with adolescent loneliness in three countries that differ historically and culturally-the Czech Republic, Russia and the United States, and to determine whether adolescent loneliness is associated with poorer psychological and somatic health.MethodsData from a school survey, the Social and Health Assessment (SAHA), were used to examine these relations among 2205 Czech, 1995 Russian, and 2050 U.S. male and female adolescents aged 13 to 15 years old. Logistic regression analysis was performed to examine if specific demographic, parenting, personal or school-based factors were linked to feeling lonely and whether lonely adolescents were more likely to report psychological (depression and anxiety) or somatic symptoms (e.g. headaches, pain).ResultsInconsistent parenting, shyness, and peer victimisation were associated with higher odds for loneliness in at least 4 of the 6 country- and sex-wise subgroups (i.e. Czech, Russian, U.S. boys and girls). Parental warmth was a protective factor against feeling lonely among Czech and U.S. girls. Adolescents who were lonely had higher odds for reporting headaches, anxiety and depressive symptoms across all subgroups. Loneliness was associated with other somatic symptoms in at least half of the adolescent subgroups.ConclusionLoneliness is associated with worse adolescent health across countries. The finding that variables from different domains are important for loneliness highlights the necessity of interventions in different settings in order to reduce loneliness and its detrimental effects on adolescent health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0829-2) contains supplementary material, which is available to authorized users.

Somatic assessments of 120 Swedish children taken into care reveal large unmet health and dental care needs

For decades, non-Nordic countries have consistently reported high rates of somatic health problems among children placed in care by the authorities. This study examined the unmet health and dental care needs of Swedish children in foster and residential care. The health of 120 consecutive children aged 0-17 years, who had recently been placed in foster or residential care in one Swedish region, was assessed by an experienced paediatrician using patient records, their medical history and a physical examination. Following the assessments, 51% of the subjects received at least one referral to a specialist or to primary care, either for a previously undetected medical condition or for a follow-up of a previously detected condition noted in their patient records. The study showed that 40% of the girls and 33% of boys were overweight and completed vaccination rates were only 86% for children up to the age of six and 68% for 7- to 17-year-olds. Half of the 7- to 17-year-olds had untreated dental decay. Our study revealed a large unmet need for health and dental care interventions among children placed in foster care and residential care and a systematic strategy is required to address those needs.

ANALYSIS OF CLINICAL, ANAMNESTIC AND IMMUNOLOGICAL CHARACTERISTICS OF WOMEN OF REPRODUCTIVE AGES HAVING HIV INFECTION AND CHRONIC VIRAL HEPATITIS C

Socio-epidemiological characteristics, somatic anamneses, and immunological parameters were analyzed in a group of reproductive-age female HIV patients having or having no HCV coinfection. Half of the subjects received secondary education and were married. Two thirds of them were employed, 34,4% had children, and 41% had secondary somatic health problems, mainly involving the urinary system. No significant differences in socio-epidemiological characteristics between the two groups were found, except for among HIV/HCV-coinfected women there were more IDUs (96,7% vs. 93,3%) and more registered criminal cases (16,7% vs. 13,3%). In the coinfected women, blood CD4 cell counts were below 350 ml -1 before HAART and remained low over 12 months of HAART suggesting that in this group the recovery of immunity is slowed probably because of indirect effects of HCV on CD4 lymphocytes.

Integrated Care and the Behavioral Health Home: A New Program to Help Improve Somatic Health Outcomes for Those With Serious Mental Illness.

Research indicates that individuals with serious mental illness (SMI) consistently have lower access to primary care and much higher rates of preventable somatic health problems, like diabetes, hypertension, and hyperlipidemia. These higher rates of preventable somatic health problems result in poorer quality of life, lower life expectancy, and higher use of expensive emergency care. With this growing awareness and the recent health care reform, a new program, called the Behavioral Health Home (BHH), has been created to reduce barriers that individuals with SMI face when trying to access primary care. This report provides information on the how these health disparities were well documented at a university-based psychiatric clinical program and the creation of a BHH to help address these health needs. Lessons learned from initial implementation and future directions of the BHH are discussed.

Reframing video gaming and internet use addiction: empirical cross-national comparison of heavy use over time and addiction scales among young users.

Evidence-based and reliable measures of addictive disorders are needed in general population-based assessments. One study suggested that heavy use over time (UOT) should be used instead of self-reported addiction scales (AS). This study compared UOT and AS regarding video gaming and internet use empirically, using associations with comorbid factors. Cross-sectional data from the 2011 French Survey on Health and Consumption on Call-up and Preparation for Defence-Day (ESCAPAD), cross-sectional data from the 2012 Swiss ado@internet.ch study and two waves of longitudinal data (2010-13) of the Swiss Longitudinal Cohort Study on Substance Use Risk Factors (C-SURF). Three representative samples from the general population of French and Swiss adolescents and young Swiss men, aged approximately 17, 14 and 20 years, respectively. ESCAPAD: n =22 945 (47.4% men); ado@internet.ch: n =3049 (50% men); C-SURF: n =4813 (baseline + follow-up, 100% men). We assessed video gaming/internet UOT ESCAPAD and ado@internet.ch: number of hours spent online per week, C-SURF: latent score of time spent gaming/using internet] and AS (ESCAPAD: Problematic Internet Use Questionnaire, ado@internet.ch: Internet Addiction Test, C-SURF: Gaming AS). Comorbidities were assessed with health outcomes (ESCAPAD: physical health evaluation with a single item, suicidal thoughts, and appointment with a psychiatrist; ado@internet.ch: WHO-5 and somatic health problems; C-SURF: Short Form 12 (SF-12 Health Survey) and Major Depression Inventory (MDI). UOT and AS were correlated moderately (ESCAPAD: r = 0.40, ado@internet.ch: r = 0.53 and C-SURF: r = 0.51). Associations of AS with comorbidity factors were higher than those of UOT in cross-sectional (AS: .005 ≤ |b| ≤ 2.500, UOT: 0.001 ≤ |b| ≤ 1.000) and longitudinal analyses (AS: 0.093 ≤ |b| ≤ 1.079, UOT: 0.020 ≤ |b| ≤ 0.329). The results were similar across gender in ESCAPAD and ado@internet.ch (men: AS: 0.006 ≤ |b| ≤ 0.211, UOT: 0.001 ≤ |b| ≤ 0.061; women: AS: 0.004 ≤ |b| ≤ 0.155, UOT: 0.001 ≤ |b| ≤ 0.094). The measurement of heavy use over time captures part of addictive video gaming/internet use without overlapping to a large extent with the results of measuring by self-reported addiction scales (AS). Measuring addictive video gaming/internet use via self-reported addiction scales relates more strongly to comorbidity factors than heavy use over time.

Low levels of vitamin D poorly responsive to daylight exposure in patients with therapy-resistant schizophrenia

Background: Low vitamin D levels are associated with schizophrenia, but the possible association between vitamin D levels and illness severity or duration of exposure to daylight has barely been investigated.Aims: To compare vitamin D levels in therapy-refractory severely ill schizophrenia patients and members of staff. To investigate the influence of daylight exposure on vitamin D levels in patients.Methods: Vitamin D was measured in patients with therapy-resistant schizophrenia in April, after the winter, and in patients and staff members in June, after an exceptionally sunny spring. Vitamin D levels in April and June were compared in patients, and levels in June were compared in patients and staff. The influence of daylight was taken into account by comparing the time patients spent outdoors during the day with the recommended minimum time for adequate vitamin D synthesis, and by comparing time spent outdoors in patients and staff.Results: Patients had high rates of vitamin D deficiency (79–90%) and lower levels of vitamin D than staff members (p < 0.001), independent of skin pigmentation. In patients, vitamin D levels did not normalize, despite the considerably longer than recommended exposure of the skin to daylight (p < 0.001) and the longer exposure in patients than in staff members (p = 0.003).Conclusion: The vitamin D deficiency of therapy-resistant schizophrenia patients is pronounced and cannot be explained by differences in skin pigmentation or by an inactive, indoor lifestyle on the ward. Even theoretically sufficient exposure of the patients to daylight did not ameliorate the low vitamin D levels.Clinical implications: While vitamin D deficiency probably plays a role in somatic health problems, it may also play a role in schizophrenia. Interestingly, exposure to daylight during an unusually sunny spring was not sufficient to correct the vitamin D deficiency seen in the patients. This emphasizes the need to measure and correct vitamin D levels in these patients.

The primary care physician/psychiatrist joint consultation: A paradigm shift in caring for patients with mental health problems?

ObjectiveThirty to forty percent of patients seen in primary care medicine suffer from mental health problems, but primary care physicians (PCPs) often feel unprepared to deal with their patients' mental health problems. Joint consultations conducted with a liaison psychiatrist can help. The purpose of this study was to evaluate the experience of joint consultations in a primary care service in Geneva, Switzerland. MethodsWe retrospectively analyzed reports of psychiatric evaluations conducted between October 2010 and August 2012 (n=182), in the Primary Care Service of the Geneva University Hospitals. We also carried out 4 focus groups with 23 physicians-in-training to explore their experiences and perceptions of the joint consultations. ResultsSeventy two percent of the evaluations resulted in a psychiatric diagnosis. Psychiatric follow-up was not considered necessary in 61% of cases. Focus groups revealed that prior to experiencing joint consultations, PCPs considered mental health problems to be the domain of psychiatrists and outside their own area of competence. Joint consultations helped to demystify the role of psychiatrists, reduce their anxiety and increase PCPs’ confidence in dealing with patients’ mental health problems. ConclusionJoint consultations enabled PCPs to shift away from a dichotomous view of somatic versus mental health problems and their management, and towards a more integrated view. Implications for practiceJoint consultations provide a useful strategy for training primary care physicians in the management of mental health problems. Integrated management of somatic and mental health problems can lead to a better understanding of the patient and improve the therapeutic relationship.

Early and recent psychosocial stress and telomere length in older adults.

Psychosocial stress has been associated with an increased risk for mental and somatic health problems across the life span. Some studies in younger adults linked this to accelerated cellular aging, indexed by shortened telomere length (TL). In older adults, the impact of psychosocial stress on TL may be different due to the lifetime exposure to competing causes of TL-shortening. This study aims to assess whether early and recent psychosocial stressors (childhood abuse, childhood adverse events, recent negative life events, and loneliness) were associated with TL in older adults. Data were from the Netherlands Study of Depression in Older Persons (NESDO) in which psychosocial stressors were measured in 496 persons aged 60 and older (mean age 70.6 (SD 7.4) years) during a face-to-face interview. Leukocyte TL was determined using fasting blood samples by performing quantitative polymerase chain reaction (qPCR) and was expressed in base pairs (bp). Multiple regression analyses, adjusted for age, sex, and chronic diseases, showed that childhood abuse, recent negative life events and loneliness were unrelated to TL. Only having experienced any childhood adverse event was weakly but significantly negatively associated with TL. Our findings did not consistently confirm our hypothesis that psychosocial stress is associated with shorter TL in older adults. Healthy survivorship or other TL-damaging factors such as somatic health problems seem to dominate a potential effect of psychosocial stress on TL in older adults.

Гигиеническая оценка риска развития у детей соматических нарушений здоровья, ассоциированных с дефицитом витаминов

Гигиеническая оценка риска развития у детей соматических нарушений здоровья, ассоциированных с дефицитом витаминов

Hygienic risk assessment of children with somatic health problems associated with vitamin deficiency

Hygienic risk assessment of children with somatic health problems associated with vitamin deficiency

Use of GP services by patients with schizophrenia: a national cross-sectional register-based study

BackgroundReform of health services has given primary care facilities increased responsibility for patients with serious mental disorders (SMD). There has also been a growing awareness of the high somatic morbidity among SMD patients, an obvious challenge for general practitioners (GPs). The aim of this study was to assess the utilisation of GP services by patients with schizophrenia.MethodsThe Norwegian list patient system is based on fee-for-service (FFS). For each contact, the GPs send a claim to National Health Insurance detailing the diagnosis, the type of contact, procedures performed, and the personal identifier of the patient. In this study complete GP claims data from 2009 for schizophrenia patients aged 25–60 years were used to assess their utilisation of GP services. Regression models were used to measure the association between patient, GP and practice characteristics, with FFS per patient used as a measure of service utilisation. Data on patients with diabetes (DM) and population means were used for comparison.ResultsThe mean annual consultation rate was 5.0 and mean FFS was 2,807 Norwegian Kroner (NOK) for patients diagnosed with schizophrenia. Only 17% had no GP consultation, 26.2% had one or two, 25.3% had three to five, and 16.1% more than five consultations. GPs participated in multidisciplinary meetings for 25.7% of these patients. In schizophrenia patients, co-morbid DM increased the FFS by NOK 1400, obstructive lung disease by NOK 1699, and cardiovascular disease by NOK 863. The FFS for schizophrenia patients who belonged to a GP practice with a high proportion of mental health-related consultations increased by NOK 115 per percent point increase in proportion of consultations. Patients with schizophrenia living in municipalities with < 10,000 inhabitants had a mean increase in FFS of NOK 1048 compared with patients living in municipalities with > 50,000 inhabitants. Diagnostic tests were equally or more frequent used among patients with schizophrenia and comorbid somatic conditions than among similar patients without a SMD.ConclusionThis study showed that most patients diagnosed with schizophrenia had regular contact with their GP, providing opportunities for the GP to care for both mental and somatic health problems.

Psychoéducation : définition, historique, intérêt et limites

Psychoeducation can be defined as a systematic didactic and psychotherapeutic intervention which aims to inform patients and relatives on a psychiatric disorder and to enable their ability to cope with the illness. This is not only a transmission of information, but also a teaching method adjusted to the disorder with the objectives to clarify identity, to promote empowerment and to change attitudes and behavior. The introduction of the education in the treatment of mental disorders is at the origin of the “moral treatment”. The term of psychoeducation was born originally in the scientific literature to overcome problems in formal learning among children with mental health problems. This origin is common with the term of therapeutic education, which has been then applied mainly to somatic health problems. The term psychoeducation was then used from 1980s to describe the transmission of knowledge on psychiatric disorders for therapeutic purposes, first to relatives, then to people suffering from schizophrenia. Since the end of the 1990s, the use of psychoeducation was then extended to other psychological disorders such as eating disorders, bipolar disorder, panic attacks and agoraphobia or posttraumatic stress disorders. Therapeutic efficacy of family psychoeducation to reduce the risk of relapse and readmission in schizophrenia was a revolution in family therapy during the 1980s. In a polemical way, psychoeducation was criticized as a way to impose a conception of mental illness by medical doctors and pharmaceutical industry. However, by the end of the 1990s, psychoeducation became clearly a source of power, knowledge and social connections for patients and relatives. In conclusion, psychoeducation has an evidence-based efficacy to prevent relapse and hospitalisation when associated with other treatments, including medication or psychosocial rehabilitation. In a modern medical perspective, it precedes and supplements in psychiatry the notions of “informed consent”, “shared decision-making” or “mental health literacy”. In the limitations, psychoeducation remains not enough systemically used, some programs are not recovery compatible. Moreover, specific programs independent from diagnosis for the early phases of psychiatric disorders should be developed.

Deleterious effects of physical inactivity on the hippocampus: New insight into the increasing prevalence of stress-related depression

Populations worldwide are increasingly becoming physically inactive, which is related to somatic and psychological health problems that are prevalent in modern society. Recent epidemiological studies have indicated that the associations between physical inactivity and depression are bidirectional. Numerous animal studies have demonstrated that exercise improves hippocampal function. Because the hippocampus is a pivotal brain region that exerts inhibitory control over stress responses by affecting the hypothalamus-pituitary-adrenal axis, enhanced hippocampal function by exercise can increase stress resilience, which helps prevent stress-related depression. In contrast, physical inactivity is difficult to model in animal studies, and little is known about the effects of physical inactivity on the rodent hippocampus. To fill this gap, we previously developed a mouse model of habituated voluntary wheel running cessation as a reverse intervention to control physical activity. We found that reducing physical activity by cessation of wheel running impairs hippocampal neurogenesis in mice. Thus, this review discusses the relevant literature and provides a hypothesis that physical inactivity can be a potential risk factor for stress-related depression as it increases stress vulnerability by impairing hippocampal function.

A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems

Background: The current study presents the results of a meta-analysis of 39 randomized controlled trials on the efficacy of acceptance and commitment therapy (ACT), including 1,821 patients with mental disorders or somatic health problems. Methods: We searched PsycINFO, MEDLINE and the Cochrane Central Register of Controlled Trials. Information provided by the ACBS (Association of Contextual Behavioral Science) community was also included. Statistical calculations were conducted using Comprehensive Meta-Analysis software. Study quality was rated using a methodology rating form. Results: ACT outperformed control conditions (Hedges' g = 0.57) at posttreatment and follow-up assessments in completer and intent-to-treat analyses for primary outcomes. ACT was superior to waitlist (Hedges' g = 0.82), to psychological placebo (Hedges' g = 0.51) and to treatment as usual (TAU) (we defined TAU as the standard treatment as usual; Hedges' g = 0.64). ACT was also superior on secondary outcomes (Hedges' g = 0.30), life satisfaction/quality measures (Hedges' g = 0.37) and process measures (Hedges' g = 0. 56) compared to control conditions. The comparison between ACT and established treatments (cognitive behavioral therapy) did not reveal any significant differences between these treatments (p = 0.140). Conclusions: Our findings indicate that ACT is more effective than treatment as usual or placebo and that ACT may be as effective in treating anxiety disorders, depression, addiction, and somatic health problems as established psychological interventions. More research that focuses on quality of life and processes of change is needed to understand the added value of ACT and its transdiagnostic nature.

Early outreach to survivors of the shootings in Norway on the 22nd of July 2011

BackgroundUnder-treatment and unmet needs among survivors have been documented years after terror attacks. Improved early and proactive outreach strategies, including targeted interventions for individuals in need, are required. After the terrorist attacks in Norway on 22 July 2011, a national, proactive outreach strategy was developed and implemented to help those who were directly affected.ObjectivesThe aims of this study were threefold: (1) to investigate whether the survivors at the island of Utøya had received proactive outreach from the municipalities, (2) to examine the relationships between received health services and the survivors’ level of exposure and post-trauma health problems, and (3) to explore the level of unmet needs among survivors 5 months post-terror.MethodsThree hundred and twenty five survivors (M age=19.4, SD=4.6, 47.1% females, response rate 66%) of the 2011 massacre on Utøya Island, Norway, were interviewed face-to-face 4–5 months post-terror. The survivors were asked if they had received proactive outreach from their municipality, and what type of health services they had received. Survivors’ level of peri-trauma exposure, loss and injury, posttraumatic stress reactions, symptoms of anxiety and depression, somatic health problems, and sick leave, were assessed.ResultsMost participants (87%) reported that they had received early and proactive outreach, and most (84%) had a contact person. In addition a majority of the survivors has received support from their general practitioner (63%), or other municipal help services (66%). Specialized mental health services by psychiatrists or psychologists had been provided to 73.1% of the survivors. Survivors who had been referred to specialized mental health services reported higher levels of exposure to trauma, posttraumatic stress reactions, depression and anxiety, and somatic health problems, compared to non-receivers of such services. Forty-three survivors (14%) reported unmet needs for services.ConclusionIn accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned. The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care.

24 h urinary free cortisol in large-scale epidemiological studies: short-term and long-term stability and sources of variability.

Function of the hypothalamus-pituitary-adrenal (HPA) axis has been associated with several somatic and psychiatric health problems. The amount of free cortisol excreted in the urine during 24h (24-h UFC) has often been used as a proxy for HPA-axis function. Reference values for 24-h UFC and their stability in the short and long term, as well as sources of variability, are largely lacking. This study was performed in a general population cohort. Participants collected 24-h UFC on two consecutive days (T1), and repeated this collection approximately 2 years later (T2). Cortisol in urine was measured using LC-MS/MS. Height and weight were measured at the research facilities; glomerular filtration rate was estimated using creatinine clearance. Psychological distress (General Health Questionnaire), smoking, alcohol use and exercise were measured by means of questionnaires. 24-h UFC stability on a day-to-day basis was 0.69 (T1, N=1192) and 0.72 (T2, N=963) (both p<0.001). Long-term stability as indicated by correlation between 2-day averages of T1 and T2 was 0.60 (N=972, p<0.001). Multivariable linear regression analysis revealed that 24-h UFC was predicted by urine volume (standardized beta 0.282 (T1, N=1556) and 0.276 (T2, N=1244); both p<0.001) and glomerular filtration rate (standardized beta 0.137 (T1) and 0.179 (T2); both p<0.001), while also sex explained a small part (standardized beta for female sex -0.057 (T1) and -0.080 (T2); both p<0.05). 24-h UFC is moderately stable both in the short and the long term. The effects of urine volume and glomerular filtration rate on 24-h UFC are much stronger than those of sex.

To give the invisible child priority: Children as next of kin in general practice

Objective. To explore general practitioners’ (GPs’) experiences in helping children as next of kin of drug-addicted, mentally ill, or severely somatic ill adults. These children are at risk of long-term mental and somatic health problems. Design. Qualitative focus-group study. Setting. Focus-group interviews were conducted in western Norway with a total of 27 GPs. Participants were encouraged to share stories from clinical encounters with parents who had one of the above-mentioned problems and to discuss the GP's role in relation to helping the patients’ children. Results. The GPs brought up many examples of how they could aid children as next of kin, including identifying children at risk, counselling the parents, and taking part in collaboration with other healthcare professionals and social workers. They also experienced some barriers in fulfilling their potential. There were time constraints, the GPs had their main focus on the patient present in a consultation, and the child was often outside the attention of the doctors, or the GPs could be afraid of hurting or losing their vulnerable patients, thus avoiding bringing up the patients’ children as a subject for discussion. Conclusions. Norwegian GPs are in a good position to help children as next of kin and doctors make a great effort to support many of them. Still, support of these children by GPs often seems to depend not on careful consideration of what is best for the patient and the child in the long run, but more on short-term convenience reasons.

EPA-0301 – Improving somatic health of outpatients with severe mental illness

Introduction Patients with severe mental illness (SMI) experience a 13- to 30-year reduction in life-expectancy. The majority of these deaths can be attributed to somatic health problems. The risk on somatic health problems is partly increased due to a reduced ability to request care and a health care organisation that is unable to fulfil the needs of these patients. Our previous work shows that a health-check-intervention can bypass the inability to request help of patients with SMI by detecting somatic healthproblems that were not detected previously[1]. Objectives To develop policy-recommendations to improve the health care organisation for the physical health of outpatients with SMI. Aims We aim to present a selection of policy-recommendations based on consensus between patients, family carers, general practitioners(GP) and mental health care staff Methods We used a three-round Delphi method. The first round consisted of an inventory of potential policy-recommendations, in the two consecutive rounds consensus was sought on a selection of recommendations. Results The policy recommendations described improvement in collaboration among health care professionals; the need to educate involved professionals regarding the specific medical risks associated with patients with SMI; and defining the differences between GPs and mental health care professionals regarding their responsibilities to provide adequate care for the physical health of SMI patients. Conclusions Currently there are multiple barriers to optimal health care which can be overcome by implementing the suggested policy recommendations.

Rationale, Component Description and Pilot Evaluation of a Physical Health Promotion Measure for People with Mental Disorders across Europe

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact.