The potential of low-intensity and online interventions for depression in low- and middle-income countries

The World Health Organization (WHO) reports that low- and middle-income countries (LMICs) are confronted with a serious ‘mental health gap’, indicating an enormous disparity between the number of individuals in need of mental health care and the availability of professionals to provide such care (WHO in 2010). Traditional forms of mental health services (i.e. face-to-face, individualised assessments and interventions) are therefore not feasible. We propose three strategies for addressing this mental health gap: delivery of evidence-based, low-intensity interventions by non-specialists, the use of transdiagnostic treatment protocols, and strategic deployment of technology to facilitate access and uptake. We urge researchers from all over the world to conduct feasibility studies and randomised controlled studies on the effect of low-intensity interventions and technology supported (e.g. online) interventions in LMICs, preferably using an active control condition as comparison, to ensure we disseminate effective treatments in LMICs

A re-analysis of the spectrum of 2206-199

Recently Pettini, Hunstead, Smith and Mar, (PHSM 1991) performed an analysis of the Ly-alpha forest of QSO 2206-199N at very high resolution. On the basis of their observations they concluded that most Doppler parameters b = (square root of 2)(sigma) of Ly-alpha forest lines are below 22 km/s, with a range down to a few km/s and a median of 17 km/s. They also found a strong intrinsic correlation between Doppler parameter b and column density N. These results are in contrast to those of a similar study by Carswell, Lanzetta, Parnell, and Webb (CLPW 1991) at comparable resolution with the same instruments, who find that most of the Ly-alpha lines towards QSO 1100-264 have Doppler parameters above 15 km/s (median b = 34 km/s), and that there is no significant correlation between b and N. Whilst an intrinsic difference between the lines of sight to 2206-199 and to other QSO's can not be excluded a priori, previous disagreement between Doppler parameter estimates obtained by both groups pointed to a potential difference in estimation techniques and in the interpretation of the results. To investigate this possibility, the AAT/UCLES spectrum of 2206-199 obtained by PHSM were reanalyzed. The spectrum was extracted from the raw data and determined the line parameters using the method described by CLPW

The impact of pre and post-migration stressors on the psychological wellbeing of refugees.

Refugees and asylum seekers are at increased risk of mental health problems because of their exposure to traumatic events that accompany individual or population wide human rights abuses. This review has two distinct aims. The first is to assess the literature related to this group considering the rates of mental health problems reported by studies conducted in both developed and developing countries. This will include a review of factors related to increased mental health problems, with a particular focus on the impact of the post-migration environment. The second aim is to review clinical and ecological service models which have been employed with refugees. The review suggests that the mental health of refugees is negatively affected by both exposure to pre-migration trauma and post-migration factors, such as a long asylum application process, restricted economic opportunity and reduced social support. Whilst the literature on interventions is limited, the review suggests that services should address the broad range of problems experienced by refugees in a holistic manner

Chronic Hepatitis C Disease in North Carolina: Epidemiology, Hospital Utilization Trends, and Implications for State Policy Change

Chronic infection with the hepatitis C virus (HCV) is recognized as a rapidly growing global, national, and local public health problem. More than 3 million people in the United States, and 130 million people worldwide, are living with chronic HCV infection. Chronic HCV can progress to serious, debilitating forms of liver disease, including advanced cirrhosis and liver cancer. Available treatments for HCV are expensive and not always effective, and there is no vaccine to prevent HCV. Published mathematical models and data analyses have predicted and documented dramatic growth in the number of patients in the United States with advanced disease related to HCV, with corresponding increases in hospitalizations and medical costs. However, these analyses used data only through 2001, and were not conducted at the state (North Carolina) level. The objective of this paper is to summarize the current state of knowledge about HCV in North Carolina, with an emphasis on the impact or burden of the disease. With this assessment as a base, the paper identifies areas for further research and policy change. Available state-level epidemiologic data, hospital utilization data, and Medicaid claims data were analyzed to investigate the recent and current impact of HCV in North Carolina. Trends in HCV-associated hospital stays and charges were measured by patient age group, gender, and payer. Long-term (1996-2004) growth rates in hospital stays and charges attributable to HCV were observed to be approximately 20% per year, with significant variation by age group. These high rates of growth are not explained by overall North Carolina hospital utilization trends, which demonstrate much smaller growth rates over the same time periods. The majority of HCV-related hospital stays and charges are experienced by males overall, and by both males and females aged 35-54. However, the highest annual growth rates in stays and charges are now seen in the 55-64 age group, reflecting the aging of the population chronically infected with HCV and the gradual progression of HCV infection to severe forms of liver disease. North Carolina hospital charges attributable to HCV were over $70 million in 2004 (2005 dollars); charges could easily be over$100 million in 2006-05 if current trends continue. The North Carolina Medicaid program has also experienced growth in the number of recipients with an HCV diagnosis, and associated paid claims amounts, from 2003 through 2005. The number of annual deaths associated with hospital stays for HCV in North Carolina has grown significantly over the past several years. These findings suggest that there is a need for the morbidity, mortality, and societal costs associated with HCV to be more effectively addressed and controlled in North Carolina. Policy changes are recommended based on the burden of HCV disease and the lack of public health capacity to address HCV in North Carolina. Free or low-cost HCV screening is generally not available in public health clinics or similar settings, and is needed in order to identity, counsel, and treat HCV patients at risk for serious liver-related disease. In addition, improved surveillance systems and an HCV patient registry would help to monitor patient progress over time, inform interventions, and improve outcomes. Additional research is needed to identify the regions of North Carolina most in need of access to HCV testing and treatment, and also to identity the locations and populations in which testing programs may be most cost-effective and successful.Master of Public Healt

A High Deuterium Abundance at z=0.7

Of the light elements, the primordial abundance of deuterium, (D/H)_p, provides the most sensitive diagnostic for the cosmological mass density parameter Omega_B. Recent high redshift (D/H) measurements are highly discrepant, although this may reflect observational uncertainties. The larger (D/H) values, which imply a low Omega_B and require the Universe to be dominated by non-baryonic matter (dynamical studies indicate a higher total density parameter), cause problems for galactic chemical evolution models since they have difficulty in reproducing the large decline down to the lower present-day (D/H). Conversely, low (D/H) values imply an Omega_B greater than derived from ^7Li and ^4He abundance measurements, and may require a deuterium abundance evolution that is too low to easily explain. Here we report the first measurement at intermediate redshift, where the observational difficulties are smaller, of a gas cloud with ideal characteristics for this experiment. Our analysis of the z = 0.7010 absorber toward 1718+4807 indicates (D/H) = 2.0 +/- 0.5 x 10^{-4} which is in the high range. This and other independent observations suggests there may be a cosmological inhomogeneity in (D/H)_p of at least a factor of ten.Comment: 6 pages, 1 figur

Impaired mitochondrial respiration in human carotid plaque atherosclerosis: a potential role for Pink1 in vascular smooth muscle cell energetics

Background and aims: DNA damage and mitochondrial dysfunction are thought to play an essential role in ageing and the energetic decline of vascular smooth muscle cells (VSMCs) essential for maintaining plaque integrity. We aimed to better understand VSMCs and identify potentially useful compensatory pathways that could extend their lifespan. Moreover, we wanted to assess if defects in mitochondrial respiration exist in human atherosclerotic plaques and to identify the appropriate markers that may reflect a switch in VSMC energy metabolism. Methods: Human plaque tissue and cells were assessed for composition and evidence of DNA damage, repair capacity and mitochondrial dysfunction. Fresh plaque tissue was evaluated using high resolution oxygen respirometry to assess oxidative metabolism. Recruitment and processing of the mitochondrial regulator of autophagy Pink1 kinase was investigated in combination with transcriptional and protein markers associated with a potential switch to a more glycolytic metabolism. Results: Human VSMC have increased nuclear (nDNA) and mitochondrial (mtDNA) damage and reduced repair capacity. A subset of VSMCs within plaque cap had decreased oxidative phosphorylation and expression of Pink1 kinase. Plaque cells demonstrated increased glycolytic activity in response to loss of mitochondrial function. A potential compensatory glycolytic program may act as energetic switch via AMPKinase and hexokinase 2 (Hex2). Conclusions: We have identified a subset of plaque VSMCs required for plaque stability that have increased mitochondrial dysfunction and decreased oxidative phosphorylation. Pink1 kinase may initiate a cellular response to promote a compensatory glycolytic program associated with upregulation of AMPKinase and Hexokinase 2