Saudi service users' perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry.

This paper presents, as part of a larger mixed-methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi-structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users' health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self-awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay's 'Cultural Originality' as well as contemporary examples of Goffman's mortification of the self. [Abstract copyright: © 2020 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.

Examining the effects of ontogenic microplastic transference on Culex mosquito mortality and adult weight

Microplastics (MPs) continue to proliferate and pollute aquatic and terrestrial environments globally. The impacts of MP pollution on ecosystems and their functioning remain poorly quantified, with most research hitherto focusing on marine ecosystems. There is a paucity of information on the impacts of MPs in freshwater ecosystems, despite the broad range of pathways through which MPs can proliferate and the extensive range of species which actively ingest MPs in these systems. Of particular interest are organisms that bridge aquatic and terrestrial habitats. The present study thus examines the uptake, ontogenic transference and effect of different concentrations (0, 50, 100 and 200 MPs mL-1) and sizes (2 and 15 µm) concentrations and sizes of polystyrene MPs between aquatic and terrestrial life stages of Culex pipiens complex mosquitoes. Both 2 and 15 µm MPs transferred from the aquatic larval to terrestrial adult stage of Culex mosquitoes, and uptake correlated tightly with initial exposure concentration. However, neither concentration nor size of MPs significantly influenced mortality rates between the aquatic larval and terrestrial adult stage. There was also no impact of MPs on the weight of emerging mosquito adults. We thus demonstrate that MPs can be transferred ontogenically through organisms with complex life histories, presenting a potential pathway for dispersal of MPs into terrestrial environments. We also show that MPs exposure does not affect mortality rates between life stages of freshwater Culex populations. This suggests that MPs do not impact nutritional uptakes, with unhampered development to adulthood facilitating subsequent dispersal of MPs aerially and between freshwater and terrestrial habitats

Saudi service users’ perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry

© 2020 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc This paper presents, as part of a larger mixed-methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi-structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users’ health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self-awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay’s ‘Cultural Originality’ as well as contemporary examples of Goffman’s mortification of the self

Up and away: ontogenic transference as a pathway for aerial dispersal of microplastics

Microplastics (MPs) are ubiquitous pollutants found in marine, freshwater and terrestrial ecosystems. With so many MPs in aquatic systems it is inevitable that they will be ingested by aquatic organisms, and be transferred up through the food chain. However, to date, no study has considered whether MPs can be transmitted by means of ontogenic transference i.e. between life stages that utilise different habitats. Here, we determine whether fluorescent polystyrene beads could transfer between Culex mosquito life stages and, particularly, could move into the flying adult stage. We show for the first time that MPs can be transferred ontogenically from a feeding (larva) into a non-feeding (pupa) life stage and subsequently into the adult terrestrial life stage. However, transference is dependent on particle size, with smaller 2 µm MPs transferring readily into pupae and adult stages, whilst 15 µm MPs transferred at a significantly reduced rate. Microplastics appear to accumulate in the Malpighian tubule renal excretion system. The transfer of MPs to the adults represents a potential aerial pathway to contamination of new environments. Thus, any organism that feeds on terrestrial life phases of freshwater insects could be impacted by MPs found in aquatic ecosystems

Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan

Background Schizophrenia is a serious form of mental illness that often requires long term care. Empirical findings indicate that combining a psycho-educational intervention (PEI) with neuroleptic medication to treat schizophrenia is effective. However, there is little information on the therapeutic mechanism of PEIs. Methods A qualitative process evaluation was conducted with a purposive sample of people diagnosed with schizophrenia (PDwS, n = 8) and their Primary Caregivers (PCs, n = 9) who had received PEI as a part of an exploratory randomized controlled trial. Semi-structured interviews were conducted to explore potential processes underpinning any observed effect. Thematic analysis was used to analyze and identify prominent patterns in the data. Interviews were conducted between April 2013 and August 2013. Results Three themes emerged from the qualitative interviews, ‘Awareness of schizophrenia’, ‘Positive impact on health and wellbeing’, ‘empowerment and enhanced confidence’, which described the variety of experiences with the intervention, although most reported that the intervention was acceptable and valued. Conclusion This study identified that individual understanding varied between PDwS and PCs and led to differences in the ways that they used knowledge gained from the PEI in everyday situations. These data support the importance of improving understanding of schizophrenia by PDwS and their PCs to enable them to benefit more fully from medication

The influence of microplastics on trophic interaction strengths and oviposition preferences of dipterans

Microplastic (MP) pollution continues to proliferate in freshwater, marine and terrestrial environments, but with their biotic implications remaining poorly understood. Biotic interactions such as predation can profoundly influence ecosystem structuring, stability and functioning. However, we currently lack quantitative understandings of how trophic interaction strengths and associated behaviours are influenced by MP pollution, and how transference of MPs between trophic levels relates to consumptive traits. We also lack understanding of key life-history effects of MPs, for example, reproductive strategies such as oviposition. The present study examines the predatory ability of non-biting midge larvae, Chaoborus flavicans, towards larvae of Culex pipiens mosquitoes when the latter are exposed to MPs, using a functional response (FR) approach. Transfer of MPs occurred from larval mosquitoes to larval midges via predation. Microplastics transfer was significantly positively related to predation rates. Predation by C. flavicans followed a Type II FR, with average maximum feeding rates of 6.2 mosquito larvae per hour. These and other FR parameters (attack rates and handling times) were not significantly influenced by the presence of MPs. Further, C. pipiens adults did not avoid ovipositing in habitats with high concentrations of MPs. We thus demonstrate that MPs can move readily through freshwater food webs via biotic processes such as predation, and that uptake correlates strongly with consumption rates. Further, as MPs do not deter adult mosquitoes from ovipositing, our experiments reveal high potential for MP exposure and transference through ecosystems

Impacts of polystyrene microplastics on Daphnia magna: a laboratory and a mesocosm study

Most research into microplastics (MPs) in freshwaters has concentrated on measurements under controlled conditions without any link to the natural environment. Here we studied the effects of a 15 μm polystyrene MP on Daphnia magna survival, growth, and reproduction in the laboratory. We also exposed fifteen 25 L freshwater mesocosms to a high concentration of the same MPs. Five were controls seeded with five species found in all ponds (mosquito, water flea, midge, spire shell and water mite), five identical but treated with 15 μm polystyrene MPs and five seeded with only mosquitoes and water fleas. The laboratory chronic toxicity test for both adults and neonate Daphnia magna revealed that effects were more related to the availability of food rather than the toxicity of MPs. In the mesocosms most of the MPs settled in the sediment after the first week of exposure. After four weeks the D. magna population decreased significantly in the MP mesocosms compared to the control mesocosms, although it subsequently recovered. There was no impact on other organisms added to the mesocosms, other than a difference in timing of lesser water boatman (Corixa punctata) colonisation, which colonised the control mesocosms in week 4 and the treated 4 weeks later. The detrivorous, sediment sifting, mayfly Leptophlebia marginata appeared in mesocosms in the fourth week of sampling and with significantly higher numbers in the MP treated mesocosm. Their activity had no significant impact on MPs in the water column, although numbers did increase above zero. The significant decline of D. magna suggests that their effect in a natural situation is unpredictable where environmental conditions and invertebrate communities may add additional stresses

Validated outcome of treatment changes according to International League Against Epilepsy criteria in adults with drug-resistant focal epilepsy.

OBJECTIVE: Although many studies have attempted to describe treatment outcomes in patients with drug-resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population of adults with drug-resistant focal epilepsy according to the International League Against Epilepsy (ILAE) outcome criteria. METHODS: This is a multicenter, observational, prospective study of 1053 patients with focal epilepsy diagnosed as drug-resistant by the investigators. Patients were assessed at baseline and 6, 12, and 18 months, for up to a maximum of 34 months after introducing another AED into their treatment regimen. Drug resistance status and treatment outcomes were rated according to ILAE criteria by the investigators and by at least two independent members of an external expert panel (EP). RESULTS: A seizure-free outcome after a newly administered AED according to ILAE criteria ranged from 11.8% after two failed drugs to 2.6% for more than six failures. Significantly fewer patients were rated by the EP as having a "treatment failure" as compared to the judgment of the investigator (46.7% vs 62.9%, P < 0.001), because many more patients were rated as "undetermined outcome" (45.6% vs 27.7%, P < 0.001); 19.3% of the recruited patients were not considered drug-resistant by the EP. SIGNIFICANCE: This study validates the use of ILAE treatment outcome criteria in a real-life setting, providing validated estimates of seizure freedom in patients with drug-resistant focal epilepsy in relation to the number of previously failed AEDs. Fewer than one in 10 patients achieved seizure freedom on a newly introduced AED over the study period. Pseudo drug resistance could be identified in one of five cases