Mental health is integral to public health: a call to scale up evidence-based services and develop mental health research

The Global Burden of Disease studies documented the challenges posed by mental illness. Mental illness comprised an estimated 12% of the global burden of disease in 2000, and is predicted to rise to 15% by 2020. Mental disorders comprise 5 of the 10 leading causes of health disability; it is predicted that, by 2030, unipolar depression will be the world's second most disabling health condition

Delayed BCG immunization does not alter antibody responses to EPI vaccines in HIV-exposed and -unexposed South African infants.

BACKGROUND: Bacille Calmette-Guérin (BCG) is routinely given at birth in tuberculosis-endemic settings due to its protective effect against disseminated tuberculosis in infants. BCG is however contraindicated in HIV-infected infants. We investigated whether delaying BCG vaccination to 14 weeks of age affected vaccine-induced antibody responses to Haemophilus influenzae type b (Hib)-conjugate, pertussis, tetanus and Hepatitis B (HBV) vaccines, in HIV-exposed uninfected (HEU) and -unexposed uninfected (HUU) infants. METHODS: Infants were randomized to receive BCG at birth or at 14 weeks of age. Blood was taken at 14, 24, and 52 weeks of age and analyzed for Hib, pertussis, tetanus and HBV specific antibodies. RESULTS: BCG was given either at birth (106 infants, 51 HEU) or at 14 weeks of age (74 infants, 50 HEU). The timing of BCG vaccination did not influence the antibody response to any antigen studied. However, in a non-randomized comparison, HEU infants had higher Hib antibody concentrations at weeks 14 and 24 (p=0.001 and <0.001, respectively) and pertussis at week 24 (p=0.003). Conversely, HEU infants had lower antibody concentrations to HBV at 14 and 52 weeks (p=0.032 and p=0.031) with no differences in tetanus titres. CONCLUSIONS: HIV exposure, but not the timing of BCG vaccination, was associated with antibody concentrations to Hib, pertussis, HBV and tetanus primary immunization. CLINICAL TRIAL REGISTRATION: DOH-27-1106-1520

The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa

BACKGROUND: The Expanded Programme on Immunisation (EPI) has increased the number of antigens and injections administered at one visit. There are concerns that more injections at a single immunisation visit could decrease vaccination coverage. We assessed the acceptability and acceptance of three vaccine injections at a single immunisation visit by caregivers and vaccinators in South Africa. METHODS: A mixed methods exploratory study of caregivers and vaccinators at clinics in two provinces of South Africa was conducted. Quantitative and qualitative data were collected using questionnaires as well as observations of the administration of three-injection vaccination sessions. RESULTS: The sample comprised 229 caregivers and 98 vaccinators. Caregivers were satisfied with the vaccinators’ care (97 %) and their infants receiving immunisation injections (93 %). However, many caregivers, (86 %) also felt that three or more injections were excessive at one visit. Caregivers had limited knowledge of actual vaccines provided, and reasons for three injections. Although vaccinators recognised the importance of informing caregivers about vaccination, they only did this sometimes. Overall, acceptance of three injections was high, with 97 % of caregivers expressing willingness to bring their infant for three injections again in future visits despite concerns about the pain and discomfort that the infant experienced. Many (55 %) vaccinators expressed concern about giving three injections in one immunisation visit. However, in 122 (95 %) observed three-injection vaccination sessions, the vaccinators administered all required vaccinations for that visit. The remaining seven vaccinations were not completed because of vaccine stock-outs. CONCLUSIONS: We found high acceptance by caregivers and vaccinators of three injections. Caregivers’ poor understanding of reasons for three injections resulted from limited information sharing by vaccinators for caregivers. Acceptability of three injections may be improved through enhanced vaccinator-caregiver communication, and improved management of infants’ pain. Vaccinator training should include evidence-informed ways of communicating with caregivers and reducing injection pain. Strategies to improve acceptance and acceptability of three injections should be rigorously evaluated as part of EPI’s expansion in resource-limited countries.IS

Baseline Predictors of Sputum Culture Conversion in Pulmonary Tuberculosis: Importance of Cavities, Smoking, Time to Detection and W-Beijing Genotype

Background: Time to detection (TTD) on automated liquid mycobacterial cultures is an emerging biomarker of tuberculosis outcomes. The M. tuberculosis W-Beijing genotype is spreading globally, indicating a selective advantage. There is a paucity of data on the association between baseline TTD and W-Beijing genotype and tuberculosis outcomes. Aim: To assess baseline predictors of failure of sputum culture conversion, within the first 2 months of antitubercular therapy, in participants with pulmonary tuberculosis. Design: Between May 2005 and August 2008 we conducted a prospective cohort study of time to sputum culture conversion in ambulatory participants with first episodes of smear and culture positive pulmonary tuberculosis attending two primary care clinics in Cape Town, South Africa. Rifampicin resistance (diagnosed on phenotypic susceptibility testing) was an exclusion criterion. Sputum was collected weekly for 8 weeks for mycobacterial culture on liquid media (BACTEC MGIT 960). Due to missing data, multiple imputation was performed. Time to sputum culture conversion was analysed using a Cox-proportional hazards model. Bayesian model averaging determined the posterior effect probability for each variable. Results: 113 participants were enrolled (30.1% female, 10.5% HIV-infected, 44.2% W-Beijing genotype, and 89% cavities). On Kaplan Meier analysis 50.4% of participants underwent sputum culture conversion by 8 weeks. The following baseline factors were associated with slower sputum culture conversion: TTD (adjusted hazard ratio (aHR) = 1.11, 95% CI 1.02; 1.2), lung cavities (aHR = 0.13, 95% CI 0.02; 0.95), ever smoking (aHR = 0.32, 95% CI 0.1; 1.02) and the W-Beijing genotype (aHR = 0.51, 95% CI 0.25; 1.07). On Bayesian model averaging, posterior probability effects were strong for TTD, lung cavitation and smoking and moderate for W-Beijing genotype. Conclusion: We found that baseline TTD, smoking, cavities and W-Beijing genotype were associated with delayed 2 month sputum culture. Larger studies are needed to confirm the relationship between the W-Beijing genotype and sputum culture conversion.Publisher's versio

Introduction

The Health Effects of Cannabis is a definitive reference text on the adverse, and also the potentially beneficial, effects of cannabis use. Internationally recognized experts in the field contribute a wealth of information about the use and effects of Canada’s most widely used illicit drug. The Health Effects of Cannabis will be of interest to addiction medicine specialists, educators, researchers, health program managers and policy-makers, and anyone else who wants up-to-date scientific information on cannabis and its effects

Framing the French riots: A comparative study of frame variation.

In an attempt to advance understanding of frame variation and the factors that account for it, we conduct a comparative study of how the Fall 2005 French "riots" were framed diagnostically and prognostically. We examine these framing activities across a diverse set of actors and assess the role of ideological, contextual, attributional and temporal factors hypothesized to account for the observed variation. The data come from a content analysis of articles on the French riots that appeared in newspapers from a half dozen countries during the period in which the riots occurred. Our findings, based primarily on variance and regression analyses, reveal varied support for our hypotheses, suggest the theoretical and analytical utility of examining frame variation beyond the French riots, and raise questions that call for further empirical inquiry regarding framing processes

Exploring the Effectiveness of Métis Women’s Research Methodology and Methods: Promising Wellness Research Practices

In this article, we share our experience conducting research with Métis women as Métis women researchers. We engaged in promising research practices through visiting, ceremony, and creative methods of art and writing embedded in what we identify as a learning-by-doing practice. Through collaborative and Indigenous relational methodology, we sought to support a culturally safe, nurturing space where Métis women could learn from one another and express Métis knowledge about the specific roles and responsibilities of Métis Aunties within our respective kinship system. This inquiry into the roles of Métis Aunties included a creative art and writing dialogue event in the Métis river community of St. Louis in Saskatchewan, attended by women who were Métis Aunties or nieces. The purpose of the event was to learn more about our Métis Aunties, building on Dr. Kim Anderson’s (2016) extensive research on women’s roles in the governance, care, and wellness of our healthy/balanced kinship systems. We chose this specific region because of its historical significance to Métis people as a river place, and our own personal connections to Métis families in this area. We share our processes in learning with and from other Métis women in order to contribute to the growing literature on relational approaches to research

Exploring the Effectiveness of Métis Women’s Research Methodology and Methods: Promising Wellness Research Practices

In this article, we share our experience conducting research with Métis women as Métis women researchers. We engaged in promising research practices through visiting, ceremony, and creative methods of art and writing embedded in what we identify as a learning-by-doing practice. Through collaborative and Indigenous relational methodology, we sought to support a culturally safe, nurturing space where Métis women could learn from one another and express Métis knowledge about the specific roles and responsibilities of Métis Aunties within our respective kinship system. This inquiry into the roles of Métis Aunties included a creative art and writing dialogue event in the Métis river community of St. Louis in Saskatchewan, attended by women who were Métis Aunties or nieces. The purpose of the event was to learn more about our Métis Aunties, building on Dr. Kim Anderson’s (2016) extensive research on women’s roles in the governance, care, and wellness of our healthy/balanced kinship systems. We chose this specific region because of its historical significance to Métis people as a river place, and our own personal connections to Métis families in this area. We share our processes in learning with and from other Métis women in order to contribute to the growing literature on relational approaches to research. Corresponding author: Janice Cindy Gaudet at [email protected]