Compulsory mental health care in Norway: The treatment criterion

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.     

旅游法上惩罚性赔偿的正当性分析--兼论旅游精神损害赔偿的可替代性

惩罚性赔偿是旅游合同违约损害赔偿的一个重大突破。鉴于精神损害在旅游合同中具有特殊地位,旅游惩罚性赔偿弥补了以往精神损害赔偿在违约责任中得不到支持的遗憾。结合旅游活动的自身特点,进一步探讨惩罚性赔偿与精神损害赔偿在旅游违约中的正当性、可替代性具有十分重要的理论和现实意义。     

Race and Gender Recidivism Differences Among Juvenile Mental Health Court Graduates

Grounded in the theory of therapeutic jurisprudence, this research explores whether recidivism differs by race, ethnicity, or gender among juvenile mental health court graduates (N = 63). Mean number of pre‐program offenses were compared to the mean number of offenses committed by program completion. Results showed statistically significant reductions in recidivism by both males (p < .001) and females (p < .003). Racial and ethnic minorities demonstrated larger reductions when compared to Whites (p < .001 for Hispanics and p < .01 for combined ethnicities). These results contribute to the literature on effective intervention models for diverse juvenile offender populations.     

Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Chapter 11. The Future of Culturally Competent Mental Health Care for Latino Immigrants

Abstract

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigrants must be linked to both practice-based research efforts and timely diffusion of best practice innovations. Cultural competence must be integrated as a valued component of the organizational structure of mental health systems of care.     

肝豆汤调控NLRP3炎症小体抑制Wilson病模型神经炎症的机制研究

目的 通过观察肝豆汤对Nod样受体家族含pyrin结构域蛋白3(Nod-like receptor family, pyrin domain-containing protein 3,NLRP3)炎症小体的调控作用,探究其抑制Wilson病(Wilson’s disease, WD)模型神经细胞炎症损伤的机制。方法 体外实验中,采用CuCl₂诱导小胶质细胞(BV-2细胞)复制WD神经细胞损伤模型,并将BV-2细胞与海马细胞(HT-22细胞)条件培养,给予不同浓度肝豆汤含药血清。CCK-8法检测BV-2细胞及HT-22细胞活力,酶联免疫吸附法测定炎症因子水平,细胞化学法检测HT-22细胞乳酸脱氢酶(lactate dehydrogenase, LDH)漏出水平及氧化应激水平,Western blot法检测NLRP3炎症小体相关蛋白表达水平。体内实验中,以TX小鼠为模型组,并以DL小鼠为正常组,肝豆汤组给予TX小鼠肝豆汤灌胃4周。采用Barnes迷宫、旷场实验、高架十字实验观察小鼠行为,苏木精—伊红染色法观察小鼠海马组织的损伤程度,Western blot法检测NLR...     

黄芪建中汤对慢性阻塞性肺疾病稳定期大鼠呼吸肌疲劳影响的实验研

目的 研究黄芪建中汤对慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)稳定期模型大鼠呼吸肌疲劳的影响。方法 取SD大鼠120只,随机分为6组：空白对照组,模型组,黄芪建中汤高、中、低剂量组,金水宝组,每组20只。采用熏吸香烟并气管内注入脂多糖法复制大鼠COPD模型。连续治疗8周后观察各组大鼠膈肌超微结构,测定膈肌线粒体还原型尼克酰胺腺嘌呤二核苷酸氧化酶（reduced form of nicotinamide adenine dinucleotide oxidase, NOX)、琥珀酸脱氢酶（succinodehydrogenase, SDH）、细胞色素氧化酶（cytochrome oxidase, CCO）的活性。结果 模型组大鼠膈肌细胞线粒体肿胀变性,数量减少甚至消失形成空泡,肌原纤维走向紊乱,局部肌丝溶解消失。各治疗组膈肌组织超微结构改变均较模型组明显减轻,以黄芪建中汤高剂量组的作用为最优。模型组NOX、SDH、CCO活性显著低于空白对照组（P<0.01）;黄芪建中汤呈剂量依赖性地升高COPD大鼠膈肌线粒体NOX、SDH、CCO活性（P<0.05,或P<0.01）。结论 黄芪建中汤可明显修复COPD模型大鼠膈肌线粒体结构,剂量依赖性地升高膈肌线粒体NOX、SDH、CCO活性,从而延缓COPD的进程。     

温振运理方治疗冠心病慢性心力衰竭临床研究

目的 观察温振运理方治疗冠心病慢性心力衰竭（chronic heart failure,CHF）的疗效。方法 将69例冠心病CHF患者随机分为治疗组35例及对照组34例,对照组给予西药常规抗心力衰竭治疗,治疗组在对照组基础上给予温振运理方口服;疗程结束比较两组患者心功能、中医症状疗效、6 min步行距离、左心射血分数（left ventricular ejection fraction,LVEF）、尿水通道蛋白2（aquaporin-2,AQP2）及血脑钠肽（B-type natriuretic peptide,BNP）、血管加压素（arginine vasopressin,AVP）含量的变化。结果 治疗后治疗组疾病疗效及中医症状疗效均优于对照组（P<0.05）;治疗组6 min步行距离、BNP、AVP、AQP2及LVEF水平均显著改善,且优于对照组（P<0.05）。结论 温振运理方联合常规西药治疗能有效提高心功能,纠正心力衰竭症状及指标的同时改善了患者生活质量。     

基于经络平衡的电导法经络测量分析方法对慢性肾病的诊断价值研究

目的 基于经络平衡理论,探究电导法经络测量值的分析方法,考察其对慢性肾病的诊断价值。方法 纳入健康人群82例和慢性肾病人群222例,采用电导法测量手足井穴和原穴的电阻值,分别计算原穴阴阳比值、井穴阴阳比值、原穴手足比值、井穴手足比值、原穴左右比值、井穴左右比值,采用接收者工作特征（receiver operating characteristic, ROC）曲线考察两组差异具有统计学意义的比值对慢性肾病的诊断价值。结果 两组人群在井穴阴阳比值、原穴手足比值方面比较,差异具有统计学意义（P<0.05）。ROC曲线显示井穴阴阳比值的曲线下面积（area under curve, AUC）为0.618,95% CI为［0.537,0.699］（P<0.05）,原穴手足比值的AUC为0.727,95% CI为［0.655,0.800］（P<0.01）。井穴阴阳比值的最优切点是1.16,灵敏度为0.64,特异度为0.52,原穴手足比值最优切点是1.04,灵敏度为0.68,特异度为0.72。结论 慢性肾病患者的经络平衡处于阴盛阳衰、上盛下衰状态,基于经络平衡的电导法经络测量分析方法具有较好的临床诊断效能。     

大黄泄浊颗粒保留灌肠对非透析慢性肾病湿热证患者血清结缔组织生长因子及肝细胞生长因子的影响

目的观察非透析慢性肾病湿热证患者血清结缔组织生长因子(connective tissue growth factor,CTGF)和肝细胞生长因子(hepatocyte growth factor,HGF)水平及大黄泄浊颗粒保留灌肠对其干预作用。方法将63例非透析慢性肾病3~4期湿热证患者随机分为治疗组32例和对照组31例,并设正常组20例。治疗组和对照组均给予基础治疗,治疗组加用大黄泄浊颗粒保留灌肠,每日1次,疗程8周。观察两组临床疗效、血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,SCr),以及治疗前后血清CTGF、HGF,并与正常组进行比较。结果治疗组临床疗效和中医证候疗效均显著优于对照组(P0.05)。治疗后治疗组BUN较治疗前显著降低(P0.05),SCr呈降低趋势(P0.05);对照组治疗后BUN较治疗前呈降低趋势(P0.05),SCr较治疗前显著升高(P0.05)。治疗组和对照组治疗前CTGF、HGF水平显著高于正常组(P0.05);治疗后治疗组和对照组血清CTGF、HGF水平均显著降低(P0.05);治疗组治疗后HGF和CTGF下降值大于对照组,差异无统计学意义(P0.05)。结论大黄泄浊颗粒保留灌肠改善非透析慢性肾病湿热证患者的机制与降低血清CTGF、HGF水平有关。