Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients.</p> <p>Methods</p> <p>This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan.</p> <p>Results</p> <p>We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001).</p> <p>Conclusion</p> <p>We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.</p

The Changes in China's Forests: An Analysis Using the Forest Identity

Changes in forest carbon stocks are a determinant of the regional carbon budget. In the past several decades, China has experienced a pronounced increase in forest area and density. However, few comprehensive analyses have been conducted. In this study, we employed the Forest Identity concept to evaluate the changing status of China's forests over the past three decades, using national forest inventory data of five periods (1977–1981, 1984–1988, 1989–1993, 1994–1998, and 1999–2003). The results showed that forest area and growing stock density increased by 0.51% and 0.44% annually over the past three decades, while the conversion ratio of forest biomass to growing stock declined by 0.10% annually. These developments resulted in a net annual increase of 0.85% in forest carbon sequestration, which is equivalent to a net biomass carbon uptake of 43.8 Tg per year (1 Tg = 1012 g). This increase can be attributed to the national reforestation/afforestation programs, environmentally enhanced forest growth and economic development as indicated by the average gross domestic product

ScvO 2 changes after red-blood-cell transfusion for anaemia in cardiothoracic and vascular ICU patients: an observational study

International audienceBackground and Objectives: Haemoglobin threshold for transfusion has been significantly decreased, but haemoglobin plasma concentration may not be sufficient to assess the need of red‐blood‐cell (RBC) transfusion. Central venous oxygen saturation (ScvO2) is a clue of metabolic matching between O2 transport and consumption, which could help to assess when transfusion is appropriate once anaemia has been diagnosed in ICU patients.Materials and Methods: Adult patients admitted consecutively to a cardiothoracic and vascular ICU were included in a prospective, observational and single‐centre study over a 6‐month period (September 2014 to February 2015), provided they were transfused with RBC. Patients with active bleeding or in unstable condition were excluded. Haemoglobin and ScvO2 were collected through a central venous catheter before and after transfusion. In order to identify a ScvO2 threshold, analysis of ScvO2 changes after transfusion was performed.Results: Fifty‐three patients received 100 RBC transfusions. Haemoglobin at the time of transfusion was 7·2 g/dl [6·8–7·7], while ScvO2 was 66·9% [60–73]. A 5% increase in ScvO2 after transfusion has the best specificity and positive predictive values, with a ScvO2 threshold of 65%. After transfusion (RBC units, 2 [1‐2]), ScvO2 increased only in patients with ScvO2 ≤65%, from 58% [53–62] to 69% [64–73] (P < 0·001).Conclusion: In anaemic patients, RBC transfusion induced a significant increase in ScvO2, provided it was low before transfusion. A 65% cut‐off value of ScvO2 before transfusion showed good specificity and good positive predictive value for a 5% increase after transfusion

Achieving Environmental Sustainability in Myanmar

Myanmar's long isolation from international markets and sources of finance historically limited development, and thus, the pressure on its environment. Many of its resources remain relatively intact, despite an absence of effective environmental regulations. Yet, as the country integrates into the global economy and its economic development accelerates, resource degradation is rising rapidly. Deforestation of closed forests in recent years has taken place at the fastest rate among major Southeast Asian countries, much of it driven by concessions for plantations and other large-scale projects. Marine capture fishing pressure has increased rapidly, and the sustainability of catches is largely unknown. Water and air pollution effluents and emissions are escalating. At the same time, policy responses to date, while emphasizing overall sustainability, need to be developed to address these issues. Environmental impact assessment procedures, environmental quality standards, emissions regulations, and penalties for environmental violations remain under development. Perverse incentives for resource destruction are still in place and efforts to create market incentives for sustainable practices are at an initial stage. To ensure long-run, sustainable economic development, Myanmar's reforms need to address these issues more quickly and comprehensively