Anatomy of Anxiety - Health Educator Report #45

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This need was not probed in the other studies. Within this framework, the video began by acknowledging the impact of the diagnosis and visual loss due to macular degeneration in the second eye the risk of depression is particularly high when the second eye becomes affected[Tasman, 53] as well as the despair and depression that often accompanies this diagnosis. In a documentary style, the video incorporated the stories of three real people with low vision due to AMD and their families, showing how they have moved emotionally from initial devastation and despair to acceptance and adjustment.

The use of low vision devices by these people was portrayed to illustrate and underscore the adjustments and adaptations that have enabled them to maintain much independence.

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Increasing awareness and knowledge about the aids that are available to AMD patients, and showing real people that have survived initial diagnosis and have moved on to live productive and even joyful lives completed the framework of cognitive restructuring. The simulation was made with specially developed software[Geisler, 1;Geisler, 2] that provides a more accurate rendition than has been available in the past.

The simulation includes not only the effect of the disease induced blind spot[Pelli, 33] but also the spatial variability of the visual system and the dynamic nature of vision. Figure 1 shows a single frame of this simulation. Note that the resolution of the image decreases towards the edge of the image and that the patient naturally shifts the scotoma to the side to allow the more relevant portions of the scene a face to be visible. The video shows a pedestrian approaching the low vision person, and that as she approaches the viewer, thus becoming larger, more and more details of her face become visible.

This illustrates also why magnification is an effective aid for low vision patients. A short video segment is available at: The simulation depicts a more accurate rendition than has been available in the past. The resolution of the image decreases towards the edge and it dynamically illustrates that the patient naturally shifts the scotoma to the side to allow the more relevant portions of the scene to be visible.

The beneficial effect of magnification was illustrated by the changing view of an approaching person. This technique allowed us to present a home environment generically and stylistically. Its simplicity facilitated clearer viewing and emphasis of the environmental changes, and the animation facilitates presentation of before and after views. It showed various ways that a person could make adjustments to different rooms in the house to make routine tasks easier.

Figure 2 illustrates a few of the modifications to the kitchen, one of the five rooms that were covered, including a change of equipment, as well as the use of lighting and contrasting colors to enhance visibility. The virtual home animation includes environmental adaptations and use of visual aids such as the large digits wall clock shown to the left of the difficult to see clock that it replaced. Adaptations include installation of additional illumination, for example under the kitchen cabinets and the use of contrasting color surfaces such as the dual color cutting board as shown here.

Adaptations and visual aids are depicted for the kitchen, bathroom, bedroom, and living room. Caregivers in particular expressed confusion about the physiological nature and effects of this disease. Graphic animation was developed to illustrate the anatomy of the eye and the changes associated with AMD. In our experience the typical cross-sectional illustration of the eye is also not understood by most patients.

Patients do not understand what is shown in the illustration and can not connect it to what they see of the eye. The relation of various eye components to the visible view of the eye in the face was maintained throughout the animation using progressive transparency and peeling of layers. Those aspects that are relevant for the visual function, rather than the pathology or treatment, were emphasized. We used as much magnification as possible, very large text labels, large arrows, and audio description facilitated access to the material by visually impaired viewers Figure 3.

The narration emphasized that the macula is a tiny portion of the retina, with the rest of the retina remaining functional, so that much vision remains and might be used effectively. A short excerpt from the animation can be viewed at http: The anatomy and basic pathology of AMD are illustrated using a graphic animation. The animation assumes no prior familiarity with any of the anatomy of the eye and orbit and thus it starts with a full face image zooming to the eye as seen by an observer. The facial tissue around the globe then gradually fades as shown here to maintain the relationship between the exposed globe and the normally visible eye.

The back of the eye is then gradually opened from the side to reveal a view of the retina while still maintaining the relationship to the face as shown here. These gradual transitions help persons unfamiliar with the anatomy locate various aspects. The animation is provided with as much magnification as possible and with large arrows pointing to items described in the audio. The animation further illustrates the location and nature of changes that occur with macular degeneration. The small portion of the retina affected is emphasized and compared with the large residual functioning retina.

The video was processed with a contrast enhancement technique previously shown to improve perception by the target population[Peli, 12;Peli, 4]. The enhancement process amplified the contrast of the high spatial frequency components of the video. The enhancement parameters used were averages of parameters selected by individuals with AMD in a previous study[Peli, 12; Peli, 41]. Figure 4 illustrates the difference in appearance of the enhanced video compared to the original video image. The non-animated parts of the video were enhanced using a technique that has been shown to improve the viewing experience for people with macular degeneration.

This figure shows the difference between the enhanced on the right and original unenhanced version on the left. The actual video only presented the enhanced images. When the video is shown to either normally sighted or visually impaired audiences they rarely if ever note spontaneously that the video is processed.

In many cases even after direct questioning observers are not able to point to what might be different about the video. Thus the enhancement does not distort the image in a noticeable or bothersome way without direct comparison to the unenhanced video as shown in fig. The research followed the tenets of the Declaration of Helsinki. Informed consent was obtained from subjects after explanation of the nature and consequences of the study.

Subjects were recruited from 5 public education events held by the Schepens Eye Research Institute in Florida during the winter of Recruitment materials and a project staff member were located in the lobby of venues where the events were held. Potential subjects were informed about the general purpose of the study, inclusion and exclusion criteria, and if still interested, were asked to sign-up to be contacted for telephone interviews. Subjects who signed up for interviews were mailed a large print study brochure and an informed consent form and asked to carefully review both items before the telephone screening call.

Australian mental health reform: time for real outcomes

The screening call reviewed the study requirements and obtained verbal informed consent prior to enrollment in the trial. The inclusion criteria were: Age was not considered for inclusion. Power analysis showed that we would need completed instruments, 64 per group, to detect a medium effect size 0. Meta-analysis of patient education materials has found that audiovisual media generally have medium-sized effects on knowledge. Using one-sided testing and a 0. There were participants at baseline. The 29 additional subjects were recruited to account for possible attrition.

Standard demographic variables age, gender, etc were collected only in the baseline interview.

Living arrangements, employment and health data were collected at baseline and follow-up interviews. At baseline and both follow up interviews knowledge of the eye, macular degeneration, and assistive devices were assessed. In addition, information was collected on the possible emotional responses sadness, fear, confusion, peace to low vision.

Self-efficacy was measured in regard to obtaining and using assistive devices. Attitudes regarding the use of assistive devices were also determined. All subjects were interviewed once at the beginning of the study baseline. At the conclusion of the baseline interview, the person was automatically assigned to the control or intervention group by the interview software. The control group received the video after they did the 3-month interview. The survey center staff was not blinded to the assigned group of the participants.

Descriptive statistics were performed to specify the sample. Analysis of Covariance ANCOVA was used to examine the effect of the video on the change in knowledge, attitude and behavior from baseline to two endpoints.

Australian mental health reform: time for real outcomes | The Medical Journal of Australia

Some of the changes were expected to require some time to implement and were thus analyzed at the three month endpoint, whereas others could occur almost immediately without professional help and were thus analyzed at the 2 week point. Change in knowledge was assessed from baseline to post intervention 2 weeks later. The change in use of assistive devices was assessed from baseline to the 3-month interview. The change in self-efficacy was assessed from baseline to both the 2-week post intervention interview and the 3-month follow up, as was the change in emotional response.

The ANCOVAs were always controlled for baseline values, and the models for knowledge and assistive devices controlled for covariates as well. Models for self-efficacy and emotional response were only controlled for covariates when treatment effects were found. The covariates used were age, gender, marital status, education, years since diagnosis, number of people in household, employment, and health. Marital status was grouped in two ways: The ten education levels were grouped into the five categories less than High School, vs. High School or GED, vs.

Employment was grouped as employed vs. Because of the large number of possibly correlated covariates, models were fit adjusting for one covariate at a time. When both groupings of marital status were significant, the more significant version was chosen. The final model included only the covariates that were significant alone.

Chi-square tests were used to examine the effect of the video on the change in adaptive behaviors from baseline to the 3-month follow up. Error intervals reported are standard error of the mean. A total of adults 54 men and 97 women responded to all three interviews.

Attrition was due to death, memory impairment, telephone number no longer in service, and could not reach participants after 15 attempts. As shown in Figure 5 , adults provided informed consent and complete data were obtained from adults men 54, women 97 and used in these analyses. Ages ranged from 39—92 years with a median of Intervention and control group participants had no significant differences in age, sex, education, martial status, years since diagnosis, living arrangement or general health status.

For both groups, interviews were conducted at 2 weeks and 3 months. After the 3-month interview, the control group was given the video. The mean number of years of vision impairment was 6.

The participants were relatively well educated, with Table 1 details these demographics for the participants who responded at all three time points. Demographic data for the people who responded at all three time points. The score for knowledge was calculated as the number of correct responses out of 8 questions on the survey. The knowledge scores were 5. Accounts from consumers and carers emphasise increased use of physical security measures, forced detention, increased use of sedation, protection of staff rather than patients, and rebuilding of new separate secure areas.

Organisation for Economic Co-operation and Development The potential for return to education, training and full employment by young people with first onset major psychiatric disorders is not often realised in the Australian system. Our systems just do not deliver the workforce participation rates achieved in other OECD countries. The psychiatric consultant who examined [my son] phoned me and told me he was going to be discharged as he was only homesick. I pleaded with him not to discharge him as he was really sick and needed help.

I begged him to keep my son in hospital. He was sent to jail and had his glasses and hearing aid removed. He was sent to a jail which does not have a psychiatric ward.

THE IMPACT OF A VIDEO INTERVENTION ON THE USE OF LOW VISION ASSISTIVE DEVICES

That is where he stayed for two months. We spent two months trying to get him his glasses and hearing aid.

I informed and pleaded with the authorities to make them aware he was sick and suicidal. They informed me he would be put in a cell with another inmate who could watch him but in fact he was placed in a single cell. Australia has a poor record in providing appropriate services for those who have committed crimes while mentally ill. The inad-equacy of forensic systems and the increasing demand for psychiatric services within the prison system continue to be reported.

It is becoming obvious, that people who previously were treated within the mental health system are increasingly being shunted into the criminal justice system. People with mental illness must not be criminalized as a result of inadequate funding for the mental health system. Police Association of New South Wales, submission 59 1. It is essential that, to qualify as best practices, the activities in question be evaluated in terms of the criteria of innovation, success and sustainability by both experts and the people concerned. For serious progress to occur, there is a need for genuine leadership.

Without a clear commitment by a range of political leaders, we are unlikely to see the necessary financial investments. A range of new accountability measures have been proposed including reporting to the national parliament, reporting to the Prime Minister, oversight by the Australian Human Rights and Equal Opportunity Commission, establishment of a new national commission modelled on United States or New Zealand examples, or expansion of the reporting powers of the MHCA. Continuing to monitor systematically and then report annually the experiences of those receiving care should be a fundamental aspect of all government-funded mental health systems.

Innovative services for people with mental health and alcohol or other substance misuse disorders. Support for programs that promote attitudinal change among mental health workers. Development of specific inter-governmental service agreements eg, between health, education, housing, employment and social security. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.

Basic Search Advanced search search. Use the Advanced search for more specific terms. Volume Issue 8. Australian mental health reform: Med J Aust ; 8: Topics Health services administration. The problems Despite having developed world-leading innovations in population-based mental health policy, having recognised the legitimate roles of consumers and carers, having developed novel early-intervention programs for young people with psychosis, and having promoted primary care psychiatry, we have not achieved widespread implementation of these advances.

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New challenges Community demand for appropriate and accessible mental health services will continue to escalate. New national targets We propose that it is time to set new and specific year national targets for mental health Box 2. Their implementation We need a year implementation plan designed to build a cohesive spectrum of community-based and hospital-based care that can deliver these targets. Sustained implementation of broad population measures Unfortunately, general mental health promotion, specific illness awareness and prevention, and broader destigmatisation programs remain in their infancy.

A new spectrum of acute care programs Recently a friend of mine went to hospital willingly and was turned away. Specialised recovery and workforce participation programs. National standards of care for people held in custodial settings The psychiatric consultant who examined [my son] phoned me and told me he was going to be discharged as he was only homesick. Making governments accountable It is essential that, to qualify as best practices, the activities in question be evaluated in terms of the criteria of innovation, success and sustainability by both experts and the people concerned.

That national suicide rates be reduced from Mental Health Council of Australia. Mental Health Council of Australia, Out of hospital, out of mind! National mental health report Australian Government Department of Health and Ageing, Commonwealth of Australia, Parliament of New South Wales. Legislative Council committee report. Select Committee on Mental Health Chair: Inquiry into mental health services in New South Wales, final report.

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OpenDocument accessed Mar Mental health services for people in crisis. Government Printer for the State of Victoria, Australian Bureau of Statistics. The burden of disease and injury in Australia. Australian Institute of Health and Welfare, Prevalence, comorbidity, disability and service utilisation. Br J Psychiatry ; Andrews G, Carter GL.

Treatment of common mental disorders in Australian general practice. Unmet need for recognition of common mental disorders in Australian general practice. Learn more about Amazon Prime. Information and suggested supplements are for conditions you and your family my be facing. Reports are usually 2 to 3 pages long and have a protocol at the end.

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