Integrating depression care within NCD provision in Bangladesh and Pakistan : a qualitative study

Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA

Letter to the Editor - Percutaneous Conservative Management of Emphysematous Pyelonephritis

Sir, A 75-year-old lady presented with pain in left flank and fever. There was tenderness in left renal angle. On laboratory investigation, patient was found to be a diabetic and in renal failure. A plain film of abdomen showed unusual presence of air in the left renal fossa. Ultrasonography (USG) revealed non-visualisation of left kidney in left renal fossa with strong reflective echoes ('gassed out kidney'), which was consistent with emphysematous pyelonephritis. Plain computed tomographic (CT) scan revealed the presence of air collections in the left renal and perirenal space with fluid collections. The opposite kidney was unremarkable. Blood culture growed E. coli. Because of high risk for anaesthesia the decision of immediate nephrectomy was deferred. It was decided to manage the patient conservatively with immediate nephrostomy. A percutaneous nephrostomy was performed with Mallecot catheter under ultrasound guidance and the patient was kept on antibiotics and insulin. The patient showed immediate improvement in clinical status within 24 hours. Follow up CT scan demonstrated resolution of perinephric collection

CRUPA: collusion resistant user revocable public auditing of shared data in cloud

Cloud repository is one of the most important services afforded by Cloud Computing where information is preserved, maintained, archived in distant servers and made available to the users over the Internet. Provided with the cloud repository facilities, customers can organize themselves as a cluster and distribute information with one another. In order to allow public integrity auditing on the information stored in semi-trusted cloud server, customers compute the signatures for every chunk of the shared information. When a malicious client is repudiated from the group, the chunks that were outsourced to the cloud server by this renounced customer need to be verified and re-signed by the customer present in the cluster (i.e., the straightforward approach) which results in huge transmission and reckoning cost for the customer. In order to minimize the burden of customers present in the cluster, in the existing scheme Panda, the semi-trusted Cloud Service Provider (CSP) is allowed to compute the Re−sign key. Further, the CSP audits and re-signs the revoked customer chunks by utilizing the Re−sign key. So, it is easy for the CSP by colluding with the revoked customer to find the secret keys of the existing customer. We introduce a novel Collusion Resistant User Revocable Public Auditing of Shared Data in Cloud (CRUPA) by making use of the concept of regression technique. In order to secure the secret keys of the existing customers from the CSP, we have allowed the information proprietor to compute the Re−sign key using the regression technique. Whenever the information proprietor revokes the customer from the cluster, the information proprietor computes the Re−sign key using the regression technique and sends to the CSP. Further, the CSP audits and re-signs the revoked customer chunks using the Re−sign key. The Re−sign key computed by the information proprietor using regression method is highly secure and the malicious CSP cannot find the private information of the customers in the cluster. Besides, our mechanism achieves significant improvement in the computation cost of the Re−sign key by information proprietor. Further, the proposed scheme is collusion resistant, supports effective and secure customer repudiation, multi-information proprietor batch auditing and is scalable