Quality of sick child care delivered by Health Surveillance Assistants in Malawi

Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs)—a cadre of community-based health workers—as part of a national scale-up of community case management of childhood illness (CCM) in Malawi. Methods Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted ‘gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers. Findings HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs. Conclusion Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessmen

Evaluation of a Dutch school-based depression prevention program for youths in highrisk neighborhoods: study protocol of a two-armed randomized controlled trial

Contains fulltext : 102517.pdf (publisher's version ) (Open Access)Background Research has indicated that depression prevention programs attenuate the development of symptoms of depression in adolescents. To implement these programs on a large scale, implementation in a school setting with teachers providing the programs is needed. In the present study, the effectiveness of the Dutch depression prevention program Op Volle Kracht (OVK) provided by school teachers during school hours with adolescents from high risk neighborhoods will be tested. The mediating effects of cognitive distortions and alexithymia will be evaluated as well. We hypothesize that the OVK program will prevent or decrease reported depressive symptoms, and that this association will be mediated by cognitive distortions and alexithymia. Methods/Design Schools with at least 30% of their pupils living in low income areas in the Netherlands are invited to participate in the study. Classes from vocational training up to pre-university level are eligible and 1324 adolescents (11-14 years) will be participating in the study. Randomisation will be done at class level, randomly assigning participants to an intervention group (OVK) and a control group (care as usual), stratifying by school level (high versus low). Trained school teachers will be delivering the program, which covers cognitive-behavioral and social problem-solving skills. Longitudinal data will be collected with self-report measurements administered in the school setting at baseline, post intervention and at two follow ups (at 6 and 12 months). Primary outcome is the level of depressive symptoms, and secondary outcomes include: cognitive errors, response style, attributional style, alexithymia, stressful life events, substance use, happiness, and school grades. Discussion If the OVK program proves to be effective when it is provided by school teachers, a structural implementation of the program in the school curriculum will enhance the quality of the lives of adolescents and their families and will reduce costs in health care. In addition, the results of the study advances current knowledge on the underlying mechanisms of the development of depression and may aid the improvement of depression prevention programs in general.7 p

Building A Model For Prevention Practice: Depression As An Example

Preventing mental illness has become increasingly emphasized as a priority for psychologists. Unfortunately, clinicians who want to incorporate prevention activities into their practice have few available models to guide how they might accomplish such a task. Using the literature on the prevention of depression, the authors make specific recommendations to clinicians who are interested in expanding their practice by offering preventive interventions in addition to their usual treatment activities. Topics discussed include choosing target populations for the intervention, using a theoretical orientation to guide the intervention, selecting specific ingredients to include in the intervention, deciding among different intervention modalities, and obtaining financial reimbursement for prevention work. Prevention work can be a novel solution to help meet the unsatisfied needs of patients, clinicians, and society

Social context, emotional expressivity, and social adjustment in adolescent males

Research has consistently found that expressing emotion related to distressing events promotes social adjustment (Rimé, 2007, 2009), whereas suppression of negative emotion has social costs (e.g., Gross & John, 2003). However, prior research has largely failed to take into account the degree of relationship between the distressed individual and the person to whom the distressed individual is speaking, and the social norms of the population to which the distressed individual belongs. Considering these factors, the relationship between emotional expressivity and social adjustment may be more complicated than the emotional regulation literature would suggest. Thus, the primary aim of this study was to examine the relationship between social adjustment and emotional expressivity toward friends and nonfriends in a sample of late adolescent males, through the lens of masculinity research that suggests that low emotional expressivity may be adaptive for males in certain contexts. Adolescent boys (N = 178) reported the degree to which they expressed emotion to friends and to nonfriends (which includes acquaintances and strangers). Results indicated that for these boys, emotional expressivity was associated with better social adjustment only when the expression of emotion occurred within the context of friendship. Additionally, boys who exhibited greater expressive flexibility, expressing more to friends than nonfriends, reported the greatest social adjustment

Ethylene production and peroxidase activity in aphid-infested barley

The purpose of this work was to investigate whether ethylene is involved in the oxidative and defensive responses of barley to the aphids Schizaphis graminum (biotype C) and Rhopalophum padi. The effect of aphid infestation on ethylene production was measured in two barley cultivars (Frontera and Aramir) that differ in their susceptibility to aphids. Ethylene evolution was higher in plants infested for 16 hr than in plants infested for 4 hr in both cultivars. Under aphid infestation, the production of ethylene was higher in cv. Frontera than in Aramir, the more aphid susceptible cultivar. Ethylene production also increases with the degree of infestation. Maximum ethylene evolution was detected after 16 hr when plants were infested with 10 or more aphids. Comparing the two species of aphids, Schizaphis graminum induced more ethylene evolution than Rhopalosiphum padi. Infestation with S. graminum increased hydrogen peroxide content and total soluble peroxidase activity in cv. Frontera,

A Community mental health needs assessment of a racially and ethnically diverse population in New England: narratives from community stakeholders

Despite the existence of numerous efficacious treatments for mental disorders, many individuals in need do not receive adequate treatment particularly racial and ethnic minorities. Community stakeholders can provide: (1) a more nuanced understanding of community mental health needs, and in (2) informing the planning and provision of mental health services. Qualitative data for this mental health needs assessment come from 61 individuals who represent local residents and/or consumers of mental health services, Executive Directors, providers of mental health and non-mental health community based services. We identified systems-related and psychosocial barriers to seeking mental health services: difficulty navigating the mental health system, language barriers, dearth of culturally competent providers; and mental health stigma and mental health literacy and non-Western notions of mental health. Collaborative efforts across stakeholders are called for to address the mental health needs of racial and ethnic minorities in a local community

Treatment matching in the posthospital care of depressed patients

Objective: This study assessed the efficacy of 1) matching patients to treatments and 2) adding additional family therapy or cognitive therapy in a group of recently discharged patients with major depression. Method: Patients with major depression were recruited during a psychiatric hospitalization. After discharge, they were randomly assigned to one of four treatment conditions that were either matched or mismatched to their pattern of cognitive distortion and family impairment. The four treatment conditions were 1) pharmacotherapy alone; 2) combined pharmacotherapy and cognitive therapy; 3) combined pharmacotherapy and family therapy; and 4) combined pharmacotherapy, cognitive therapy, and family therapy. Randomly assigned treatment continued for 24 weeks on an outpatient basis. Results: Among patients with at least moderate depressive symptoms at hospital discharge, low rates of remission (16%) and improvement (29%) were obtained. Matched treatment led to a significantly greater proportion of patients who improved and greater reductions over time in interviewer-rated depressive symptoms than mismatched treatment. However, matched treatment did not produce greater change in self-reported depression or interviewer-rated suicidal ideation. Treatment that included a family therapy component also led to a greater proportion of patients who improved and to significant reductions in interviewer-rated depression and suicidal ideation than treatment without family therapy. Conclusions: These results suggest that 1) current treatments are not very efficacious in the aftercare of hospitalized depressed patients, 2) treatment matching moderately improves outcome for patients who are symptomatic at hospital discharge, and 3) inclusion of family therapy improves the outcome of posthospital care for depressed patients