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Concept: Recovery model

174

Employment is associated with better quality of life and wellbeing in people with mental illness. Unemployment is associated with greater levels of psychological illnessand is viewed as a core part of the social exclusion faced by people with mental illness. Social Firms offer paid employment to people with mental illness but are under-investigated in the UK. The aims of this phase of the Social Firms A Route to Recovery (SoFARR) project were to describe the availability and spread of Social Firms across the UK, to outline the range of opportunities Social Firms offer people with severe mental illness and to understand the extent to which they are employed within these firms.

Concepts: Quality, Sociology, Mental disorder, Jobless recovery, Mental illness, Recovery model, Unemployment, Further education

169

Longer periods of recovery reduce the likelihood of relapse, which may be due to a reduced ability of various stimuli to occasion alcohol or drug seeking. However, this hypothesis remains largely uninvestigated.

Concepts: Alcohol, Carbon dioxide, Carbon, Drug addiction, Addiction, Recovery model

168

Despite evidence that connecting people to relevant wellbeing-related resources brings therapeutic benefit, there is limited understanding, in the context of mental health recovery, of the potential value and contribution of pet ownership to personal support networks for self-management. This study aimed to explore the role of pets in the support and management activities in the personal networks of people with long-term mental health problems.

Concepts: Therapeutic effect, Positron emission tomography, Mental disorder, Recovery model, Pet, Microeconomics

35

In this study, we hypothesized that dynamics of sleep time obtained over consecutive days of extended sleep in a laboratory reflect an individual’s optimal sleep duration (OSD) and that the difference between OSD and habitual sleep duration (HSD) at home represents potential sleep debt (PSD). We found that OSD varies among individuals and PSD showed stronger correlation with subjective/objective sleepiness than actual sleep time, interacting with individual’s vulnerability of sleep loss. Furthermore, only 1 h of PSD takes four days to recover to their optimal level. Recovery from PSD was also associated with the improvement in glycometabolism, thyrotropic activity and hypothalamic-pituitary-adrenocortical axis. Additionally, the increase (rebound) in total sleep time from HSD at the first extended sleep would be a simple indicator of PSD. These findings confirmed self-evaluating the degree of sleep debt at home as a useful clinical marker. To establish appropriate sleep habits, it is necessary to evaluate OSD, vulnerability to sleep loss, and sleep homeostasis characteristics on an individual basis.

Concepts: Sleep, Sleep deprivation, Individual, Homeostasis, Recovery model, Degree of a polynomial, Recovery, Unihemispheric slow-wave sleep

30

Since self-efficacy is a positive predictor of substance use treatment outcome, we investigated whether it is associated with spirituality within a religious 12-step program. This was a cross-sectional survey (N = 91) of 10 different Celebrate Recovery sites held at community churches. The mean spirituality score for those with high confidence was significantly greater than those with low confidence. Spirituality associated with greater confidence to resist substance use (OR = 1.09, 95% CI 1.02-1.17, P < 0.05). So every unit increase of measured spirituality increased the odds of being above the median in self-efficacy by 9%. We conclude that spirituality may be an important explanatory variable in outcomes of a faith-based 12-step recovery program.

Concepts: Arithmetic mean, Recovery model, Drug rehabilitation, Spirituality, Recovery, Higher Power, Twelve-step program, Twelve-step programs

27

The length of stay in inpatient and outpatient rehabilitation after an injury or illness has declined in recent years, exposing those with newly acquired neurologic disability to a risk of significant postrehabilitation health decline. Following a short stay in outpatient rehabilitation, individuals with neurologic disability have few, if any, options to continue their physical recovery after discharge, thus further increasing their risk for functional decline and secondary conditions. Professionals who work in community-based fitness facilities have the potential to assist therapists in extending the recovery process and preventing this decline. The focus of this article was to address a conceptual framework for better understanding how rehabilitation and health/fitness professionals can work together to help with this growing need. To that end, the antecedents to and effects of postrehabilitation health decline are discussed, followed by the introduction of a theoretical model illustrating a therapist-to-trainer system that facilitates the use of community-based fitness facilities by individuals with neurologic disabilities to continue their recovery postrehabilitation. Finally, a thorough description of an exemplary existing community-based inclusive fitness program is presented, followed by examples of select disability groups using these programs for continued recovery.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A45) for more insights from the authors.

Concepts: Mental disorder, Disability, Concept, Decline, Recovery model, Kin selection, Inclusive fitness, Reproductive success

18

We examined recovery from postconcussion syndrome (PCS) in a series of 285 patients, diagnosed with concussion based on international sport concussion criteria, who received a questionnaire regarding recovery . Of 141 respondents, those with postconcussion symptoms lasting less than 3 months, a positive CT and/or MRI, litigants, and known Test of Memory Malingering (TOMM)-positive cases were excluded, leaving 110 eligible respondents. We found that only 27% of our population eventually recovered, and 67% of those who recovered did so within the first year. Notably, no eligible respondent recovered from PCS lasting 3 years or longer. Those who did not recover (n = 80) were more likely to be non-compliant with a do not return to play recommendation (p = 0.006) , but did not differ from the recovered group (n = 30) in other demographic variables including age and sex (p ≥ 0.05). Clustergram analysis revealed that symptoms tended to appear in a predictable order, such that symptoms later in the order were more likely to be present if those earlier in the order were already present . Cox proportional hazards model analysis showed that the more symptoms reported, the longer the time to recovery (p = 7.4 x 10-6), with each additional symptom reducing the recovery rate by approximately 20%. This is the first longitudinal PCS study to focus on PCS defined specifically as a minimum of 3 months of symptoms, negative CT and/or MRI, negative TOMM test, and no litigation. PCS may be permanent if recovery has not occurred by 3 years. Symptoms appear in a predictable order, and each additional PCS symptom reduces recovery rate by 20%. More long-term follow-up studies are needed to examine recovery from PCS.

Concepts: Time, Regression analysis, Sociology, Fatigue, David Cox, Post-concussion syndrome, Recovery model, Recovery

15

Patients' stories of their illnesses help bridge the divide between patients and providers, facilitating more humane medical care. Illness narratives have been classified into three types: restitution (expectation of recovery), chaos (suffering and loss), and quest (unexpected positive effect from illness). Undiagnosed patients have unique illness experiences and obtaining their narratives would provide insights into the medical and emotional impact of living with an undiagnosed illness. Adults and children with undiagnosed diseases apply to be evaluated by the Undiagnosed Diseases Network (UDN). Written illness narratives from 40 UDN applicants, including 20 adult probands who applied for themselves and 20 parents who applied for their children, were analyzed for: 1) narrative content and 2) narrative type.

Concepts: Health care, Medicine, Health, Epidemiology, Medical terms, Illness, Recovery model, Evolutionary medicine

15

The United States is engaged in ongoing dialogue around mental illness. To assess trends in this national discourse, we studied the volume and content of a random sample of 400 news stories about mental illness from the period 1995-2014. Compared to news stories in the first decade of the study period, those in the second decade were more likely to mention mass shootings by people with mental illnesses. The most frequently mentioned topic across the study period was violence (55 percent overall) divided into categories of interpersonal violence or self-directed (suicide) violence, followed by stories about any type of treatment for mental illness (47 percent). Fewer news stories, only 14 percent, described successful treatment for or recovery from mental illness. The news media’s continued emphasis on interpersonal violence is highly disproportionate to actual rates of violence among those with mental illnesses. Research suggests that this focus may exacerbate social stigma and decrease support for public policies that benefit people with mental illnesses.

Concepts: United States, Mental health, Sociology, Mental disorder, Mental illness, Recovery model, Suicide, World War II

9

Our work focuses on the stability, resilience, and response to perturbation of the bacterial communities in the human gut. Informative flash flood-like disturbances that eliminate most gastrointestinal biomass can be induced using a clinically-relevant iso-osmotic agent. We designed and executed such a disturbance in human volunteers using a dense longitudinal sampling scheme extending before and after induced diarrhea. This experiment has enabled a careful multidomain analysis of a controlled perturbation of the human gut microbiota with a new level of resolution. These new longitudinal multidomain data were analyzed using recently developed statistical methods that demonstrate improvements over current practices. By imposing sparsity constraints we have enhanced the interpretability of the analyses and by employing a new adaptive generalized principal components analysis, incorporated modulated phylogenetic information and enhanced interpretation through scoring of the portions of the tree most influenced by the perturbation. Our analyses leverage the taxa-sample duality in the data to show how the gut microbiota recovers following this perturbation. Through a holistic approach that integrates phylogenetic, metagenomic and abundance information, we elucidate patterns of taxonomic and functional change that characterize the community recovery process across individuals. We provide complete code and illustrations of new sparse statistical methods for high-dimensional, longitudinal multidomain data that provide greater interpretability than existing methods.

Concepts: Bacteria, Gut flora, Statistics, Escherichia coli, Data, Factor analysis, Recovery model, Flora