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miercuri, 14 decembrie 2011

Horticulture Improves Heart Rate, Stress Levels Of Mentally Challenged Adults

Main Category: Rehabilitation / Physical Therapy
Also Included In: Anxiety / Stress; Mental Health
Article Date: 14 Dec 2011 - 1:00 PST

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Participation in horticultural activities can improve confidence and social skills, cultivate a positive attitude, and rejuvenate the mind and body. Many studies have emphasized the effects of horticultural activities in relation to physical and psychological rehabilitation, but few have considered the influence of these types of activities on mentally challenged people's autonomic nervous system (ANS) and on the stress hormone cortisol. A new study examined how activities such as pressing flowers, planting, creating flower arrangements, and making topiaries affect stress relief for patients who are mentally challenged.

In the first experiment of the study, the heart rate variation (HRV) was measured in 30 mentally challenged people at a rehabilitation center in Daegu, South Korea. Researchers in the second experiment measured the cortisol levels of 20 mentally challenged people from a residential home in Yeongcheon, South Korea. Min-Jung Lee from the Department of Horticultural Therapy at the Catholic University of Daegu (South Korea) published the results of both experiments in a report in HortTechnology.

For the first experiment, subjects participated in four indoor horticultural activities: a pressed flower activity, flower planting, flower arranging, and topiary crafting. Participants' heart rate variation was measured five minutes before and five minutes after each horticultural activity was performed. The pressed flower group and the planting group showed a significant improvement in the standard deviation of the normal-normal (SDNN) interval heart rate variation measurements. The planting group's SDNN and low frequency (LF) significantly improved; a significant improvement in total power (TP) and high frequency was also observed. The flower arrangement group displayed a significant difference in LF, while the topiary group showed a significant difference in TP.

The second experiment used the same four horticultural activities, but collected participants' saliva in order to analyze their cortisol levels. Compared with the baseline measurement, the pressed flower group displayed a significant decrease in cortisol density from the first to the seventh day of testing, however no significant difference was observed on the fourth day. The planting group showed a significantly decreasing difference in cortisol density on day seven compared with day four. The topiary group continued to show a significant decrease in cortisol density at each cortisol collection after the first day of topiary activities.

Interestingly, the participants in the flower arrangement group showed increased stress (as measured by low frequency), and showed no great change in cortisol density. "We inferred that activities such as cutting stems with shears and arranging the cut stems in the exact location are difficult jobs for mentally challenged people", Lee said.

The topiary group exhibited a significant difference in total power, and not only had the most significant difference in TP but also had the largest significant decrease in cortisol density among the four indoor horticultural activities. Lee noted that topiary activities are thought to be fairly valuable in aiding emotional stability and vocational rehabilitation for mentally challenged people.

The research supports previous studies that show that touching and mixing soil affects the activity of the autonomic nervous system (ANS) and relieves stress. Planting activities resulted not only in the greatest change in mentally challenged people's ANS but also in a significant gradual decrease in cortisol density.

Lee concluded that planting activities are the most effective horticultural activity for stress relief and added that the extension of indoor planting activities to outdoor planting activities targeted for mentally challenged individuals will have a greater effect not only on vocational rehabilitation, but also on emotional stability.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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joi, 8 decembrie 2011

Study Finds Care For Mentally Ill Veterans Is As Good Or Better Than In Other Health Systems

Main Category: Veterans / Ex-Servicemen
Also Included In: Mental Health; Alcohol / Addiction / Illegal Drugs
Article Date: 21 Oct 2011 - 0:00 PDT

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Treating U.S. veterans with mental illness and substance use disorders is more expensive than caring for veterans with other medical conditions, costing more than $12 billion in 2007, according to a new RAND Corporation study.

The study found that while the proportion of veterans who received the care recommended for their mental illness varied widely, the overall quality of mental health care offered by the U.S. Department of Veterans Affairs was as good as or better than that reported by privately insured, Medicare or Medicaid populations. The findings are published online by the journal Health Affairs and will also will appear in its November edition.

"While the VA does a better job at providing mental health services than other health care systems, there is still substantial room for improvement," said Dr. Katherine Watkins, lead author of the study and a senior natural scientist with RAND, a nonprofit research organization. "With some changes, the VA could provide even better and more cost-effective care for the nation's veterans, as well as serve as a model for other health care systems."

Researchers say the VA already has undertaken several mental health-specific initiatives that may increase the proportion of veterans receiving evidence-based treatments.

The RAND study is the first comprehensive look at the full spectrum of clinical services provided to veterans with mental health issues, from assessment to treatment to chronic care management. It also examines variations in care for veterans across different regions of the United States and for different diagnoses.

Between fiscal years 2004 and 2008, the number of veterans diagnosed with mental illness and substance-use disorders increased 38 percent to 906,394, with the greatest increase seen among those with post-traumatic stress disorder. While the veterans in the RAND study represent only 15.4 percent of those who used VA services in fiscal year 2007, they accounted for 32.9 percent of the total health care costs because of higher use of both inpatient and outpatient physical and mental health care services.

In 2006, the VA commissioned RAND and the Altarum Institute to do a comprehensive evaluation of its mental and substance-use treatment system. The evaluation took place during the implementation of the VA's five- year Mental Health Strategic Plan, a large initiative to expand and improve care for mental and substance abuse disorders.

The study included 836,699 veterans who received services from the VA in fiscal year 2007 for treatment of at least one of five diagnoses: schizophrenia, bipolar I disorder, post-traumatic stress disorder, major depression and substance-use disorders. To be included, veterans had to have had at least one inpatient episode or two outpatient visits.

Veterans in the RAND study had four times as many acute inpatient discharges as non-study veterans and three times as many outpatient encounters. The average cost per non-study veteran was $4,579, while the average cost for a study veteran was $12,337, or nearly three times as much.

The kind of care the veterans received varied widely, although none of the individual facilities stood out as consistently performing above or below the network average. Watkins and her colleagues identified 23 performance indicators to track the kind of care veterans got, such as whether veterans with post-traumatic stress disorder were given cognitive behavioral therapy as recommended. Of those indicators, three had rates about 75 percent, and nine were below 25 percent.

For example, among the assessment indicators, 82 percent of the study veterans were assessed for suicidal thoughts, but only 23 percent were assessed for response to psychotherapy. Use of medication varied from a high of 60 percent for the acute treatment of depression to a low of 16 percent for drug therapy for alcohol dependence. Less than a third of the veterans diagnosed with schizophrenia or bipolar disorder received continuous maintenance treatment with antipsychotics or mood stabilizers.

The study data does not reflect instances when a service or medication was recommended by a provider, but refused by a patient, or prescriptions that were written by the doctor, but never filled by the patient.

In addition to VA's ongoing improvement efforts, researchers say efforts are needed to better understand what underlines the quality differences and strategies should be developed to address the differences in the future.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our veterans / ex-servicemen section for the latest news on this subject. Coauthors of the study are Harold Pincus, Susan Paddock, Carrie Farmer, Melonie Sorbero, Marcela Horvitz-Lennon, Kimberly Hepner, and Jacob Solomon, all of RAND; and Brad Smith, Abigail Woodroffe, and Cathy Call, of the Altarum Institute; and Thomas Mannle, Jr., with Pilot Consulting Services.
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