Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya

Abstract Background Substance use disorders are a major cause of health and social problems worldwide. Research evidence shows a strong graded relationship of adverse childhood experiences and substance use in adulthood. This study aimed at determining the prevalence of adverse childhood experiences and their association with substance use among patients with substance use disorders. Method The study used a descriptive cross-sectional design. A total of 134 patients aged 18 years and above receiving inpatient treatment for substance use disorders were recruited into the study. A mental state exam was done to rule out active psychopathology. Data on socio demographic variables, adverse childhood experiences (ACEs) and substance use was collected using Adverse Childhood Experiences International Questionnaire and The Alcohol, Smoking and Substance Involvement Screening Test respectively. Data was analysed using statistical package for social sciences (SPSS) version 20 for windows. Results Males accounted for the majority of the study participants (n = 118, 88.1%). Only 43.3% (n = 58) of the participants had a family history of substance use disorder. The most frequently used substance was alcohol which was reported by 82.1% of the participants. Nearly 93% of the respondents had experienced at least one ACE and the most prevalent ACE was one or no parent which was reported by half of the respondents. The adverse childhood experiences significantly associated with current problematic substance use were; emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect. Emotional abuse significantly predicted tobacco (A.O.R = 5.3 (1.2–23.9)) and sedative (A.O.R = 4.1 (1.2–14.2)) use. Childhood exposure to physical abuse was associated with cannabis use [A.O.R = 2.9 (1.0–7.9)]. Experiencing five or more ACEs was associated with increased risk of using sedatives. Conclusion There is a high prevalence of adverse childhood experiences among patients with substance use disorders. Experiencing emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect in childhood are risk factors of substance use disorders. ACEs screening and management should be incorporated in substance abuse prevention programs and policies

Agroforestry's contribution to livelihoods and carbon sequestration in East Africa: A systematic review

Agroforestry is a powerful practice for sustainable and regenerative intensification because it promotes multifunctional landscapes that deliver ecological functions that contribute to livelihoods, land productivity, biodiversity conservation, and other ecosystem services. Despite a large body of literature on agroforestry in East Africa, a systematic understanding of its livelihood benefits and contribution to carbon sequestration is still lacking. A systematic review was used to provide a quantitative and qualitative synthesis of available evidence and knowledge gap from 185 publications that met the selection criteria regarding the contribution of agroforestry to livelihoods (n = 152) and carbon sequestration (n = 43) in East Africa. The main livelihood benefits include fodder, food, firewood and income, reported in over 70, 63, 56 and 40 publications, respectively. These and other benefits diversify livelihoods of rural communities and act as safety nets in times of climate shocks. Agroforestry systems in East Africa stock an average of 24.2 ± 2.8 Mg C ha−1 in biomass and 98.8 ± 12.2 Mg C ha−1 in the soil. Much of the aboveground carbon is held in homegardens (34.3 ± 7.9 Mg C ha−1), perennial tree-crop systems (29.9 ± 12.7 Mg C ha−1) and trees on boundaries (26.7 ± 14.1 Mg C ha−1). Empirical studies are needed for better understanding of belowground carbon in agroforestry and emission of greenhouse gases in different agroforestry practices. A smaller number of studies reported income from sale of carbon credits, suggesting a gap in the development of science regarding carbon rights, land tenure, tree tenure rights, and the potential impact of climate change on the growing niches of tree species in the region. The results show that agroforestry is a powerful climate adaptation and mitigation solution as it can increase household resilience and sequesters significant amounts of carbon dioxide from the atmosphere

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION This study is registered under NCT04934020