Integrating depression care within NCD provision in Bangladesh and Pakistan : a qualitative study

Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA

Captive propagation of threatened primates - the example of the Lion-tailed Macaque <i>Macaca silenus</i>

Many conservation-oriented breeding programs are not likely to reach their goal of establishing self-sustaining populations. Some zoo biologists propagate to reconsider zoo-based conservation policies and strategies. The Lion-tailed Macaque is a flagship species for in situ conservation and a high priority species in captive propagation. This article reviews the captive management history of the Lion-tailed Macaque, identifies management patterns that might have negatively influenced the development of the programs, and proposes to use this analysis to initiate a new management perspective. In the North American captive Lion-tailed Macaque population under the Species Survival Plan (SSP), the strong reduction in population size and group sizes due to space problems might have contributed to a decrease in population viability. The population over two decades has declined from almost 300 to less than 100 individuals. In the European population under the European Endangered Species Program (EEP), population size was not limited and larger groups were advocated. The population grew slowly but steadily to a present size of more than 350 individuals over about 23 years. The effective population size has remained low in both SSP and EEP populations. A general conceptual framework that focuses on individuals and their phenotypes for in situ and ex situ conservation recently developed by field conservationists is briefly introduced. It is used to suggest improvements in the management of the Lion-tailed Macaque. It is concluded that the size and structure of a breeding population is to be decided so as to provide conditions and materials for successful reproduction rather than by the available zoo space only. For this, large groups and populations with representation of all age-sex classes are advocated. This would result in a further reduction in the number of species kept in zoos. It is indicated that zoo biology needs to develop new concepts that include a large spectrum of concepts of biology and knowledge about the adaptive potential of animal species under altered and fragmented conditions

Characterizations of reflex and nonreflex changes in spastic multiple sclerosis

Background: Spasticity, an increased resistance of a limb to movement, is associated with functional limitations and a major source of disability in neurological disorders, including multiple sclerosis (MS) and stroke. Despite the clinical significance of spasticity in brain and spinal cord injuries, it is often not clear whether the spasticity is due to reflex or non-reflex changes. New method: Reflex and nonreflex properties of the human knee joint were studied in eight MS patients with spasticity and ten healthy subjects. A digitally controlled joint driving device was used to apply small-amplitude, and band-limited white-noise perturbations to the knee to manifest the reflex and nonreflex properties. The subjects were asked to maintain a steady level of background muscle torque during the perturbation. A nonlinear delay differential equation model was used to characterize the reflex and intrinsic properties of the knee in terms of phasic stretch reflex gain, tonic stretch reflex gain, joint elastic stiffness, and coefficient of viscosity. Results: It was found that joint coefficient of viscosity and tonic stretch reflex gain of the spastic MS patients were significantly lower than those of normal controls. On the other hand, spastic MS patients showed higher phasic stretch reflex gains than normal controls and a trend of increased joint stiffness. Conclusions: Simultaneous characterizations of changes in tonic and phasic reflexes and nonreflex changes in joint elastic stiffness and viscosity in neurological disorders may help us gain insight into mechanisms underlying spasticity and develop impairment-specific treatment. (C) 2014 Elsevier B.V. All rights reserved.close1

Remembering Catherine Kitty Genovese: A public forum

To mark the fortieth anniversary of the tragic death of Catherine Kitty Genovese on March 13, 1964 in NewYork City, a public forum hosted by Fordham University brought together an interdisciplinary group of experts to look back on this sad event. What follows is a summary of this forum, joined by 100 New Yorkers and the mass media. Even four decades after this tragedy was brought to world-wide attention by the book Thirty-eight witnesses (Rosenthal, 1965), new facts continue to surface about this haunting crime and its aftermath (DeMay, 2004). This forum addressed some timely questions, such as: (1) Were Genovese-type situations rare or common in the past, or even today? (2) How did mass media coverage of Ms. Genovese\u27 1964 tragedy impact society? (3) Why does this woman’s tragedy continue to move us so deeply today, even those of us who were not yet born in 1964? (4) Should U.S. duty-to-aid laws encourage or even oblige citizens to come to each other’s aid in crises if they can safely do so--as is typically the law in other nations? The forum benefited from the expertise of 10 panelists who review diverse aspects of this topi

Academic medicine: the evidence base

The International Campaign to Revitalise Academic Medicine recognises that an evidence based approach is important in discussing the problems of academic medicine. A preliminary exploration of the evidence on academic medicine has led to a research agenda for examining and proposing realistic solution