The incidence of metabolic risk factors in an inpatient psychiatric setting

Our study examines risk factors for metabolic syndrome on admission to an acute psychiatric facility and the incidence of medical referrals at discharge. Data on demographics, risk factors for metabolic syndrome, other health risk factors, medications, related diagnoses, and primary care providers and referrals were collected from 125 psychiatric patient charts. Comparison analysis was done for two groups: those with two or more risk factors for metabolic syndrome and those with less than two risk factors. Differences between groups were statistically significant for age, waist circumference, body mass index, high-density lipoprotein, triglycerides, and fasting glucose levels. Few patients were referred to their primary care provider for follow-up care. This study has clinical implications for improving assessment of psychiatric patients at risk for developing metabolic syndrome, for designing interventions to help patients adopt lifestyle changes to mitigate these risks, and for working toward fuller integration of psychiatric and primary care.     

Theory,practice and use of self in the open dialogues approach to family therapy: A simple complexity or a complex simplicity?

In the family therapy literature there is increasing interest in the dialogical approach, particularly as it becomes well‐grounded in psychotherapy research. One embodiment is ‘open dialogues’, which has developed over a 30‐year period in Western Lapland, Finland. This paper outlines my experience of visiting Keropudas Hospital in Tornio, Finland, the birthplace of open dialogues. It explores the seven theoretical principles of open dialogues, associated elements of clinical practice, and the therapist use of self. The author utilises these aspects to reflect on dialogical moments through words and images based on three conceptual themes, which illustrate the relevance of open dialogues for family therapy practitioners and their contexts.     

Rural ageing in the United States: Trends and contexts

This paper examines rural population ageing in the United States with a particular focus on the contrasting contexts in which older rural residents live. We compare the characteristics of the older population by rural versus urban residence, and explore challenges and opportunities associated with the ageing of rural baby boomers. The United States is a vast territory, and rural areas in the US are diverse regionally, in poverty and income, principal forms of employment, proximity to metropolitan areas, population size, density and composition, the history of change in these parameters, and a number of other factors that affect the ageing process. Hence, the diversity across rural areas is an important consideration in what affects the well being of rural elderly individuals, as well as the community-level impacts of rural ageing. Further, the characteristics of the older rural population help shape community and rural development outcomes for diverse rural communities. We use data from various US Census Bureau sources, and cite other studies to provide a demographic overview of ageing in the rural United States, and to analyze how this situation differs in varying socio-demographic and regional contexts. In the concluding section, we focus on policy implications associated with rural ageing.     

Approaches used by employee assistance programs to address perpetration of intimate partner violence

Employee Assistance Programs (EAPs) are workplace resources available to employees with problems impacting work performance. EAPs are well-positioned to address intimate partner violence (IPV), a major public health problem with workplace impacts. A purposeful sample of 28 EAPs across the United States was surveyed to identify policies and programs to address IPV, including perpetration. Most EAPs did not report having standardized approaches for addressing IPV perpetration. EAPs also described significant barriers to identifying IPV perpetrators, with the majority relying on self-disclosure on the part of the perpetrator when contacting the EAP. These results suggest that many EAPs--even when interacting with employees who present with issues known to correlate with IPV--are missing a potential opportunity to assess and intervene with IPV perpetrators.     

Alzheimer's disease and euthanasia

Employing the tenets of philosophical materialism, this paper discusses the ethical debate surrounding assisted suicide for persons suffering end-stage Alzheimer's. It first presents a classification of the dissociative situations between "human individual" and "human person". It then moves on to discuss challenges to diagnosed persons and their caregivers in relation to the cardinal virtues of Spinozistic ethics - strength of character (fortitudo), firmness (animositas) and generosity (generositas). Finally, a number of ideas attached to the debate - "right of choice", "death with dignity", "quality of life" and "compassion in dying" - are discussed in order to clarify their foundations.     

The effects of tact training on stereotypic vocalizations in children with autism

This study was a systematic extension of Karmali, Greer, Nuzzulo-Gomez, Ross, and Rivera-Valdes (2005) and Ahearn, Clark, MacDonald, and Chung (2007). We investigated the effects of a tact correction procedure on stereotypic vocalizations in 4 children diagnosed with autism who ranged in age from 6 to 16 years. Participants had limited vocal verbal repertoires and were primarily dependent on prompts for the emission of appropriate vocalizations. A multiple-baseline design across participants was used. Data were collected on instances of stereotypic vocalizations and independent tacts during baseline conditions and on instances of stereotypic vocalizations, independent tacts, and echoic-tacts during intervention. Procedural integrity and social validity data were also obtained. The results indicated a decrease in stereotypic vocalizations for 3 of the 4 participants and a slight increase in appropriate vocal verbal behavior (i.e., tacting) for all participants. The study provides support for the use of tact correction procedures to decrease stereotypic vocalizations and increase appropriate vocalizations in children with autism.     

Mistreatment and self-reported emotional symptoms: results from the National Elder Mistreatment Study

Many community-residing older adults in the United States report past year mistreatment; however, little is known about mental health correlates of abuse. This study investigated whether a recent history of emotional, physical, or sexual abuse is associated with self-reported emotional symptoms (e.g., anxiety, depression) among a representative sample of older adults. Results demonstrated that each abuse type increased likelihood of reporting emotional symptoms; when other known correlates were controlled, only emotional abuse remained a significant predictor. Additional study of mistreatment-related correlates of depression and anxiety is needed, with a focus on the often overlooked category of emotional mistreatment.