The measurement of public attitudes toward the mentally ill has taken on new significance since the introduction of community-based mental health care. Previous attitude scales have been constructed and applied primarily in a professional context. This article discusses the development and application of a new set of four scales explicitly designed to measure community attitudes toward the mentally ill. The scales represent dimensions included in previous instruments, specifically, authoritarianism, benevolence, social restrictiveness, and community mental health ideology, but are expressed in terms of an almost completely new set of items that emphasize community contact with the mentally ill and mental health facilities. Data from a study of community attitudes about neighborhood mental health facilities in Toronto are used to test the internal and external validity of the scales. Results of the analysis provide strong support for the validity of the scales and demonstrate their usefulness as explanatory and predictive variables for studying community response to mental health facilities.
Aims: To investigate a population of individuals with 22q11 deletion syndrome for hypocalcaemia. Methods: A detailed clinical history enquiring into symptoms of hypocalcaemia and blood sampling to assess for hypocalcaemia and hypoparathyroidism, of patients outside the neonatal period known to have the 22q11 microdeletion from fluorescent in situ hybridisation studies was taken. Results: Sixty one individuals were identified, of whom 23 were untraceable and one was unable to give informed consent. Biochemical investigations were performed on 27 subjects. Ten subjects had review of notes only. Four subjects had previously identified hypoparathyroidism. A new case of hypoparathyroidism was identified. Three subjects had borderline hypocalcaemia. Discussion: In this population of patients with 22q11 deletion syndrome, 13% of the total or 30% of those biochemically assessed had evidence of reduced serum calcium concentrations. It is likely that 13-30% of patients with 22q11 deletion syndrome have possible hypoparathyroidism outside the neonatal period. Reported symptoms of hypocalcaemia did not correlate with biochemical evidence of persisting hypocalcaemia. We have shown that previously undiagnosed asymptomatic hypoparathyroidism occurs in patients with 22q11 deletion syndrome and conclude that screening of this population should be considered.
Background. Among women with surgically removed, high-risk HER-2/neu-positive breast cancer, trastuzumab has demonstrated significant improvements in disease-free and overall survival. The objective of this study is to evaluate the cost-effectiveness of the currently recommended 12-month adjuvant protocol of trastuzumab using a Markov modeling approach and real-world cost data.Methods. A 10-health-state Markov model tracked patients' quarterly transitions between health states in the local and advanced states of breast cancer. Clinical data were obtained from the joint analysis of the National Surgical Adjuvant Breast and Bowel Project and North Central Cancer Treatment Group, as well as from the metastatic study conducted by Norum et al. Clinical outcomes were adjusted for quality of life using utility estimates published in a systematic
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