Suchergebnisse

AbstractConduct disorder is one of the most common disorders in children and adolescents, and yet we know little about its cause and treatment.

Over the last years medicine has progressed very rapidly. Communicable diseases, which were the leading causes of mortalities, are not anymore, especially in developed countries. Currently, non-communicable diseases are more prevalent, and most of them are related to changes in our daily habits and degenerative processes. Most of these diseases are chronic, need continuous care and treatment with limited improvement and high costs. The General Assembly of the United Nations in its resolution 65/238 recognized the primary role and responsibility of Governments in responding to the challenge of noncommunicable diseases and the essential need for the efforts and engagement of all sectors of society to generate an effective response. Special emphasis has been concentrated on pharmacological treatments for most of chronic non-communicable diseases with the challenge to discover new drugs for treating, in most cases, chronic irreversible degenerative diseases associated with aging. Little care was given to non-pharmacological lines of treatment.

Over the last years medicine has progressed very rapidly. Com- municable diseases, which were the leading causes of mortali- ties, are not anymore, especially in developed countries. Cur- rently, non-communicable diseases are more prevalent, and most of them are related to changes in our daily habits and degenerative processes. Most of these diseases are chronic, need continuous care and treatment with limited improvement and high costs. The General Assembly of the United Nations in its resolution 65/238 recognized the primary role and responsibility of Governments in responding to the challenge of non- communicable diseases and the essential need for the efforts and engagement of all sectors of society to generate an effec- tive response. Special emphasis has been concentrated on phar- macological treatments for most of chronic non-communicable diseases with the challenge to discover new drugs for treating, in most cases, chronic irreversible degenerative diseases asso- ciated with aging. Little care was given to non-pharmacological lines of treatment.

Background: Non-pharmacological treatment for schizophrenia includes educational, psychotherapeutic, social, and physical interventions. Despite growing importance of these interventions in the holistic treatment of individuals with schizophrenia, very little is known about their availability in South-East European countries (SEE). Objective: To explore mental health care experts' opinions of the availability of non-pharmacological treatment for people with schizophrenia in SEE. Methods: An online survey containing 11 questions was completed by one mental health expert from each of the following SEE countries: Albania, Bosnia and Herzegovina (B&H), Bulgaria, Croatia, Greece, Kosovo†, Montenegro, Moldova, North Macedonia, Romania, Serbia, and Slovenia. Data were collected on estimated rates of received non-pharmacological interventions, type of services delivering these interventions, and expert views of availability barriers. Results: In eight countries, the estimated percentage of people with schizophrenia who receive non-pharmacological treatments was below 35%. The primary explanations for the low availability of non-pharmacological treatments were: lack of human and financial resources, lack of training for clinicians, and pharmacotherapy dominance in the treatment for schizophrenia. Conclusion: Lack of personal and institutional resources and state support were identified as primary obstacles to staff training and delivering non-pharmacological treatments to people with schizophrenia on individual and systemic levels, respectively. This evidence can be used to improve holistic, evidence-based treatment for schizophrenia in the SEE countries.

Javier Mar,1–4 Arantzazu Arrospide,2–4 Myriam Soto-Gordoa,5 Álvaro Iruin,4,6 Mikel Tainta,7,8 Andrea Gabilondo,4,6 Lore Mar-Barrutia,9 Montserrat Calvo,10 Maider Mateos,10 Oliver Ibarrondo2,41Clinical Management Unit, OSI Alto Deba, Arrasate-Mondragón, España; 2AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, España; 3Economic Evaluation Department, Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain; 4Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; 5Departamento de Ingeniería de Organización, Mondragón Unibertsitatea, Arrasate-Mondragón, España; 6Psychiatry Service, Gipuzkoa Mental Health Network, Donostia-San Sebastián, España; 7Psychiatry Service, CITA Alzheimer Foundation, Donostia-San Sebastián, España; 8Neurology Service, OSI Goierri-Alto Urola, Zumárraga, España; 9Psychiatry Service, Hospital Bellvitge, Hospitalet de Llobregat, España; 10Health Department, Basque Government, Vitoria-Gasteiz, EspañaBackground: Dementia-related neuropsychiatric symptoms (NPS) are the main determinant of family stress and institutionalization of patients. This study aimed to identify inequalities by gender and socioeconomic status in the management of NPS in patients diagnosed with dementia.Methods: An observational study was carried out to study all the cases of dementia in the corporate database of the Basque Health Service (29,864 patients). The prescription of antipsychotics and antidepressants and admission to a nursing home were used to establish the presence of NPS. The socioeconomic status of individuals was classified by a deprivation index. Logistic regressions were used to identify drivers for drug prescriptions and institutionalization.Results: NPS are poorly recorded in the clinical databases (12%). Neuropsychiatric symptoms were severe enough in two thirds of patients with dementia to be treated with psychoactive medication. Institutionalization showed an increase from those who did not receive medication to those who had been prescribed antidepressants (OR: 1.546), antipsychotics (OR: 2.075) or both (OR: 2.741). The resulting inequalities were the increased prescription of antidepressant drugs in women and more nursing-home admissions for women who were the least socioeconomically deprived and men who were the most deprived.Conclusions: In large clinical databases, psychoactive drugs prescriptions can be useful to underscore the considerable burden of dementia-related NPS. Specific tools are needed to monitor social and health care programs targeted to dementia-related NPS from a population perspective. Programs aimed at reducing the family burden of care of dementia patients at home become the key elements in reducing inequalities in these patients' care. Socioeconomic status is the most important driver of inequality, and gender inequality may simply be hidden within the social environment. Integrated programs boosting the continuity of care are an objective for which compliance could be measured according to the NPS coding in the electronic health record.Keywords: neuropsychiatric symptoms, prevalence, dementia, antidepressant drugs, antipsychotic drugs, nursing home, inequalities, deprivation index

Racial profiling has been increasingly cited in the clinical and social science literatures to describe race-based differences in medical diagnoses and treatment. However, the extent to which racial profiling in medicine is an empirical reality is debated—partly because the term itself is used to describe competing processes of bias. This article distinguishes between two such processes that influence race-based treatment recommendations: racial profiling and racial valuation. Through a systematic analysis of the role of race in the pharmacological treatment of hypertension, it illustrates that both mechanisms—to varying degrees—help explain race-based trends in treatment for the disease. Analyses are based on data from the Third National Health and Nutrition Examination Survey, collected during and soon after the period in which such treatment became validated and encoded in national guidelines. Findings indicate a nuanced process by which sex/gender mediates not only the effect of race on treatment recommendations but also the mechanism through which racialized treatment operates. They also suggest that over time, drugs may take on a racial character, leading to the systematic identification of certain drugs with specific races, driving treatment patterns that conflate race with legitimate medical criteria.