Epidemiologia e psichiatria sociale最新文献

Even though randomised controlled trials are the design of choice for evaluating the efficacy of health care interventions, they are not immune to bias that may affect research process and validity of results. In the present paper we discussed how trial quality may be appraised considering both whether a clinical trial is reported in a comprehensive and complete way (consistently with what had been declared in the study protocol), and whether the characteristics of the trial itself are associated with risk of bias.

Aim: To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group.

Methods: PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT].

Results: These placebo controlled studies show minimal support for effectiveness with either depression or 'schizophrenia' during the course of treatment (i.e., only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis.

Conclusions: Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.

Locating psychiatric wards in general hospitals has long been seen in many countries as a key element in the reform of services to promote community integration of the mentally ill. In the U.K., however, this is no longer a policy priority, and the recent trend has been towards small freestanding inpatient units, located either within the communities they serve, or on general hospital sites, but separate from the main building. Whether locating the psychiatric wards in the general hospital is essential to psychiatric reform has been little discussed, and we can find no relevant evidence. Perceived strengths of general hospital psychiatric wards are in normalisation of mental health problems, accessibility to local communities, better availability of physical health care resources, and integration of psychiatry with the rest of the medical profession, which may faclilitate recruitment. However, difficulties seem to have been encountered in establishing well-designed psychiatric wards with access to open space in general hospitals. Also, physical proximity may not be enough to achieve the desired reduction in stigma, and complaints from the general hospital may sometimes result in undue restrictions on psychiatric ward patients. There are strong arguments both for and against locating psychiatric wards in general hospitals: an empirical evidence base would be helpful to inform important decisions about the best setting for wards.

Aims: This study had two objectives: (1) to design and develop a computer-based tool, called Multi-Objective Evolutionary Algorithm/Hot-Spots (MOEA/HS), to identify and geographically locate highly autocorrelated zones or hot-spots and which merges different methods, and (2) to carry out a demonstration study in a geographical area where previous information about the distribution of schizophrenia prevalence is available and which can therefore be compared.

Methods: Local Indicators of Spatial Aggregation (LISA) models as well as the Bayesian Conditional Autoregressive Model (CAR) were used as objectives in a multicriteria framework when highly autocorrelated zones (hot-spots) need to be identified and geographically located. A Multi-Objective Evolutionary Algorithm (MOEA) model was designed and used to identify highly autocorrelated areas of the prevalence of schizophrenia in Andalusia. Hot-spots were statistically identified using exponential-based QQ-Plots (statistics of extremes).

Results: Efficient solutions (Pareto set) from MOEA/HS were analysed statistically and one main hot-spot was identified and spatially located. Our model can be used to identify and locate geographical hot-spots of schizophrenia prevalence in a large and complicated region.

Conclusions: MOEA/HS enables a compromise to be achieved between different econometric methods by highlighting very special zones in complex areas where schizophrenia shows a high autocorrelation.