BACKGROUND: Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS: The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS: The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION: Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.

• Klíčová slova
• Forensic treatment institutions, discharge decisions, legal and clinical perspectives, public safety, rehabilitation,
• MeSH
• deinstitucionalizace MeSH
• délka pobytu * MeSH
• dospělí MeSH
• duševní poruchy * terapie   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• propuštění pacienta * MeSH
• soudní psychiatrie MeSH
• ústavy pro duševně nemocné * MeSH
• zločinci psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

This study objective to verify the existence of gaps in the dynamics and performance of fulfillment of the deinstitutionalization of psychiatric care in the Czech Republic (CZ) and the Slovak Republic (SR) in the period between 2010 and 2020. The introduction of this the study is a search for expert knowledge in the field of deinstitutionalization of psychiatric care. The study uses the method of multi-criteria comparison of TOPSIS variants and a cluster analysis. The results 22 variants range from (ci 0.6716-0.2571) and confirm that there are large differences between CZ and SR in performance gaps (fulfillment) of deinstitutionalization goals. The SR variants are clearly better than the CZ variants, although during the years studied, the CZ variants are improving, and the size of the gap compared to the SR variants is decreasing. In the first year of the evaluated period (2010), the performance gap was 56% and in the last year (2020), the performance gap was only 31%. The conclusion of the study confirms that the measures associated with the deinstitutionalization of psychiatric care are linked to the time they were introduced and the overall implementation period of the reform.

• Klíčová slova
• TOPSIS Technique, deinstitutionalization, gaps, performance, psychiatric care,
• MeSH
• deinstitucionalizace * MeSH
• duševní poruchy * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Multiple sclerosis, currently incurable and potentially profoundly disabling demyelinating central nervous system disease, is associated with higher occurrence of suicide as affected individuals are prone to major depression and psychosis. Despite progressively incapacitating neurologic impairment, well-staffed institutions, and limited repertoire of methods of suicide, which prevents patients from purposefully ending their lives, suicide-determined patients typically commit suicide resulting from a medication overdose, sharp force traumata, self-neglect, or deliberate starvation. Here we describe a successful suicide committed by a 39-year-old wheelchair-bound, institutionalized, quadriparetic male patient with a diagnosis of multiple sclerosis with secondary progressive clinical course who utilized his motorized wheelchair to terminate his life. He tied a rope between his neck and wall bars and then propelled the wheelchair forwardly. The acceleration of the wheelchair resulted in ligature self-strangulation. This case report, with a review of the literature, is noteworthy for the rareness of the wheelchair-related fatality combined with an unusual, if not entirely unseen, suicidal mechanism in severely disabled adult.

• MeSH
• asfyxie patologie   MeSH
• dokonaná sebevražda * MeSH
• dospělí MeSH
• institucionalizace MeSH
• kvadruplegie MeSH
• lidé MeSH
• poranění krku patologie   MeSH
• postižení * MeSH
• roztroušená skleróza MeSH
• vozíky pro invalidy * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi-experimental pretest/post-test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL-BREF, WHOQOL-OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults' quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long-term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.

• Klíčová slova
• dementia, long-term health care, quality of life, reminiscence therapy,
• MeSH
• deprese prevence a kontrola   terapie   MeSH
• institucionalizace MeSH
• kognitivní dysfunkce psychologie   terapie   MeSH
• kvalita života psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• narativní terapie metody   MeSH
• neuropsychologické testy MeSH
• postoj ke zdraví MeSH
• psychiatrické posuzovací škály MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• skupinová psychoterapie metody   MeSH
• stárnutí psychologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

BACKGROUND: The organization of long-term care is one of the main challenges of public health and health policies in Europe and worldwide, especially in terms of care concepts for people with dementia. In Austria and the Czech Republic the majority of elderly institutionalized persons with dementia are cared for in nursing homes. It is however unclear, how many persons living in nursing homes in Austria and in the Czech Republic are suffering from cognitive impairment and dementia. In addition, basic information on the nutritional status, the status of mobility and the medication prescription patterns are often missing. To facilitate new effective and evidenced based care concepts, basic epidemiological data are in urgent need. Thus, DEMDATA was initiated to provide important basic data on persons living in nursing homes in Austria and the Czech Republic for future care planning. METHODS: DEMDATA is a multicentre mixed methods cross-sectional study. Stratified and randomly drawn nursing homes in Austria and the Czech Republic are surveyed. The study protocol used in both study centres assesses four different domains: a) Resident, b) Care team, c) Relative and d) Environmental Factors. Resident's data include among others health status, cognition, dementia, mobility, nutrition, behavioural symptoms, pain intensity and quality of life. A minimum of 500 residents per country are included into the study (N = 1000 residents). The care team is asked about the use of the person-centred care and their burden. The relatives are asked about the number of visits and proxy-rate the quality of life of their family member. All staff employed in the nursing homes, all residents and relatives can voluntary take part in the study. The environmental factors include among others the organisational category of the nursing home, number of residents, number of rooms, social activities and the care concept. The project started in March 2016 and will be concluded in February 2018. DISCUSSION: DEMDATA will provide important epidemiological data on four different nursing home domains in Austria and the Czech Republic, with a focus on the prevalence of dementia in this population. Thereby supplying decision and policy makers with important foundation for future care planning.

• Klíčová slova
• Database, Health parameters, Nursing homes, dementia,
• MeSH
• behaviorální symptomy psychologie   terapie   MeSH
• demence epidemiologie   psychologie   terapie   MeSH
• dlouhodobá péče organizace a řízení   MeSH
• domovy pro seniory statistika a číselné údaje   MeSH
• institucionalizace MeSH
• kognitivní poruchy psychologie   terapie   MeSH
• kvalita života MeSH
• lékaři statistika a číselné údaje   MeSH
• lidé MeSH
• péče orientovaná na pacienta MeSH
• pečovatelské domovy statistika a číselné údaje   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• rodina psychologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Rakousko epidemiologie   MeSH

Deinstitutionalization has not been pursued in the post-communist Europe until recently. The population of psychiatric patients institutionalized in the regional mental hospitals is, however, largely understudied. The aim of this study is to assess discharges of long-term inpatients with schizophrenia from Czech psychiatric hospitals and to analyse re-hospitalizations within this group. The nationwide register of all-cause inpatient hospitalizations was merged with the nationwide register of all-cause deaths on an individual level basis. Descriptive statistics, survival analysis and logistic regression were performed. 3601 patients with schizophrenia previously hospitalized for more than a year were discharged from Czech mental hospitals between 1998 and 2012. This included 260 patients hospitalized for >20years. Nearly one fifth (n=707) of the long-term patients died during the hospitalization; and discharges of 19.36% (n=697) were only administrative in their nature. Out of 2197 truly discharged patients, 14.88% (n=327) were re-hospitalized within 2weeks after the discharge. The highest odds of rehospitalization were associated with being discharged against medical advice (OR 5.27, CI: 3.77-7.35, p<0.001). These data are important for the ongoing mental health care reforms in the Czech Republic and other countries in the Central and Eastern Europe.

• Klíčová slova
• Deinstitutionalization, Epidemiology, Health service, Hospitalization, Psychiatric hospital, Schizophrenia,
• MeSH
• deinstitucionalizace MeSH
• délka pobytu * MeSH
• dospělí MeSH
• Kaplanův-Meierův odhad MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• multivariační analýza MeSH
• regresní analýza MeSH
• schizofrenie mortalita   terapie   MeSH
• senioři MeSH
• ústavy pro duševně nemocné MeSH
• znovupřijetí pacienta MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Reports linking the deinstitutionalisation of psychiatric care with homelessness and imprisonment have been published widely. AIMS: To identify cohort studies that followed up or traced back long-term psychiatric hospital residents who had been discharged as a consequence of deinstitutionalisation. METHOD: A broad search strategy was used and 9435 titles and abstracts were screened, 416 full articles reviewed and 171 articles from cohort studies of deinstitutionalised patients were examined in detail. RESULTS: Twenty-three studies of unique populations assessed homelessness and imprisonment among patients discharged from long-term care. Homelessness and imprisonment occurred sporadically; in the majority of studies no single case of homelessness or imprisonment was reported. CONCLUSIONS: Our results contradict the findings of ecological studies which indicated a strong correlation between the decreasing number of psychiatric beds and an increasing number of people with mental health problems who were homeless or in prison.

• MeSH
• deinstitucionalizace statistika a číselné údaje   MeSH
• duševně nemocní statistika a číselné údaje   MeSH
• lidé bez domova statistika a číselné údaje   MeSH
• lidé MeSH
• vězni statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients. METHODS: QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level. RESULTS: We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled. CONCLUSIONS: This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.

• MeSH
• deinstitucionalizace statistika a číselné údaje   MeSH
• dlouhodobá péče * metody   psychologie   normy   MeSH
• duševní poruchy * epidemiologie   rehabilitace   MeSH
• duševní zdraví normy   MeSH
• lidé MeSH
• péče o sebe * metody   statistika a číselné údaje   MeSH
• průřezové studie MeSH
• služby péče o duševní zdraví organizace a řízení   MeSH
• ukazatele kvality zdravotní péče normy   MeSH
• ústavy pro duševně nemocné * klasifikace   normy   statistika a číselné údaje   MeSH
• zajištění kvality zdravotní péče metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

BACKGROUND: There is limited research examining the chemical load of toxic metals in the elderly. The aim of the present study was two-fold: to determine the body burden of lead, cadmium and mercury in association with age, gender, locality, lifestyle factors and potential health impacts among this population and to compare the values with blood values from the general Czech population aged 18-64 years. METHODS: Lead, cadmium and mercury were examined in the blood of institutionalized senior citizens (46 males, 151 females aged 61-100 years) from two localities in the Czech Republic (Prague and Teplice) from 2009 through 2011. Measurements were made using inductively coupled plasma mass spectrometry (Pb, Cd) and a single purpose spectrometer AMA 254 (Hg). RESULTS: Geometric means (GM) of whole blood lead (B-Pb), cadmium (B-Cd) and mercury (B-Hg) levels were 25.3μg/l, 0.55μg/l and 0.21μg/l, respectively. No age-related differences were found for B-Pb and B-Cd levels but a negative correlation with age was observed for B-Hg levels (p=0.04). B-Pb levels in men were significantly higher than in women (GM 29.9μg/l vs. 24.1μg/l). B-Cd was significantly higher in women (GM 0.57μg/l) than in men (0.50μg/l) (p=0.007) and in smokers (GM 1.29μg/l) than in nonsmokers (GM 0.53μg/l) (p=<0.001) and in seniors from Prague (GM 0.60μg/l) compared to those from Teplice (GM 0.43μg/l) (p=<0.001). Seniors with a history of chronic kidney disease, stroke and those using psycho-pharmaceuticals had higher B-Pb levels (p=0.008, 0.04 and 0.05, resp.), seniors diagnosed with atherosclerosis had higher B-Cd levels (p=0.002) and seniors using psycho-pharmaceuticals had higher B-Hg levels (p=0.07). B-Hg levels were also positively correlated with blood albumin levels (p=0.015). CONCLUSIONS: This study provides data on levels of heavy metals in a group of elderly people. Such information is very scarce. Associations with diseases should be the subject of further investigation.

• Klíčová slova
• Cadmium, Heavy metals in blood, Institutionalized elderly, Lead, Mercury,
• MeSH
• biologické markery krev   MeSH
• charakteristiky bydlení MeSH
• domovy pro seniory * MeSH
• dospělí MeSH
• institucionalizace * MeSH
• kadmium krev   MeSH
• kouření škodlivé účinky   krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• obsah radioaktivních látek v organizmu MeSH
• olovo krev   MeSH
• pečovatelské domovy * MeSH
• rizikové faktory MeSH
• rtuť krev   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• stárnutí krev   MeSH
• věkové faktory MeSH
• životní styl MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• biologické markery MeSH
• kadmium MeSH
• olovo MeSH
• rtuť MeSH

The authors pay their attention to the transformation of the psychiatric care which has formed in many industrial countries after the second world war. It concerns namely the deinstitutionalization process together with a development of the community psychiatric care, or the reduction process of the psychiatric bed number simultaneously with a spread of the community mental health facilities. The authors follow these changes namely in Great Britain, USA and Italy. They also discuss some theoretical problems (functions of the community psychiatry, model programs) and compare the positive and negative influences of the changes mentioned above on the society.

• MeSH
• deinstitucionalizace * MeSH
• lidé MeSH
• služby v oblasti duševního zdraví komunity * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Spojené státy americké MeSH