The vulnerability and resiliency of childhood

Life is full of stressors, which have to be confronted efficiently to grow up. However, reaction to stressors is personalized, complex and coordinated. Vulnerable persons adjust poorly to stressors and express inappropriate responses, while resilient persons practice adaptive physiological and psychological responses. Promotion of resiliency is an intricated issue, which demands strategies at both macro and micro-level. Microlevel strategies are focused on the community, family and individual level, while macrolevel strategies formulate the principles. Nevertheless, prediction of vulnerability and resiliency is really a challenge, as different persons facing same stressors react differently. Some are growing as resilient and others as vulnerable. We aimed to discuss resiliency, vulnerability, importance in relation to health outcome, promotion of resiliency and controversies of vulnerability and resiliency

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

Progress in reducing unintended pregnancies in South Africa is slow. The implant, introduced in 2014, expanded the range of available longacting reversible contraceptives (LARCs) and held much promise. Uptake, however, has declined precipitously, in spite of its ‘unmatched effectiveness’ and high levels of satisfaction for most users. We propose policy and provider interventions to raise implant use, underscored by a ‘LARC-first’ approach. Contraceptive counselling should focus on the particular benefits of LARCs and methods be presented in order of effectiveness. Moreover, implants hold particular advantages for certain groups, especially adolescents and young women, in whom it is considered first-line contraception. Provision of immediate postpartum and post-abortion implants is safe and highly acceptable, yet remains under-utilised. Implant services at HIV and tuberculosis clinics are a key priority, as is inclusion of LARC provision within school health services. Implants could also be delivered by existing mobile outreach services, for example in sex worker programmes. Services could be built around nurses dedicated solely to providing implants, with other health workers receiving brief refresher training. Women who experience side-effects, especially abnormal bleeding, require timely interventions, following a standardised protocol, including use of medications. Encouraging return for side-effects, follow-up phone calls and home visits would raise continuation rates. Removal services require doctor support or designated nurses at specific centres. Limited access to removal services, health workers’ resistance or botched procedures will further undermine implant provision. Rapid implant demonstration projects in postpartum wards, schools, outreach services and by dedicated providers may rapidly advance the field. Together, the actions outlined here will ensure that the implant fulfils its potential and reinvigorates family planning services

Walter Preston Boggess, Jr v. Lawrence Morris, Warden, Utah State Prison : Brief of Appellant

Appeal from the Judgment of the Third Judicial District Court, In and for Salt Lake County, State of Utah, the Honor-Able David K. Winder, Judge, Presidin

Marriage and other psychological stressors in the causation of psychiatric disorder

The aim of this study was to compare the specific psychiatric diagnosis, frequency, and types of stressors, and the level of awareness about marriage law between married (cases; n=80) and unmarried girls (control; n=80) with one or more psychiatric disorders below the age of 18 years. The psychiatric diseases were diagnosed according to Axis One of ICD-10 clinical diagnoses of multi-axial classification of childhood and adolescent psychiatric disorder. Psychosocial stressors were considered on the basis of Axis Five of this classification. Of the cases, major depressive disorder was the highest (n=47) and next was a dissociative (conversion) disorder (n=24). Among the controls, generalized anxiety disorder (n=31) was the most prevalent followed by obsessive-compulsive disorder (n=17). The difference was highly significant (p>0.001). The cases reported a significant excess of psychosocial stressors than that of the controls to the onset of the psychiatric disorder. All the cases had associated stressors. In contrast, 77 out of 80 control patients had stressors. Marriage itself played as a stressor in the 78 cases. Beside this, other highly frequent stressors were marital discord followed by drop out from study and trouble with in-laws. Among the controls, the highest reported stressor was increased academic workload and next two commonest stressors were poor academic performance and discord with peers. Interestingly, 52.5% of the cases were having knowledge about the law on the age of marriage and that was 32.5% among the controls. It was significant that most of the girls breached their continuity of education after marriage (p>0.001). In conclusion, psychosocial stressors including marriage have a causal relationship with depressive and conversion disorder.

A neuroimaging study in childhood autism

Background: Childhood autism is now widely viewed as being of developmental neurological origin. Abnormality in neuroimaging is reported in autism.Objectives: To delineate the proportion of structural magnetic resonance imaging (MRI) and electro encephalography (EEG) abnormality among the children with Autism and to assess any association of MRI and EEG changes with co morbid mental illness.Methods: It was a cross sectional descriptive study done at a child and adolescent consultation centre, Dhaka. The study was Carried out from January 2009 to December 2009. Both boys and girls were included in the study. A total of 42 children with childhood autism aged between two and 12 years partici­pated in this study. Diagnosis of autism was based on ICD-10(DCR) criteria. Results: Abnormalities were found to be 35.7% in MRI and 42.9% in EEG. EEG abnormalities were found in the form of defuse slow waves activities, generalized faster activities, epileptogenic discharge and mixed discharge. The abnormalities in MRI was found in the form of diffuse cortical atrophic changes, focal cortical atrophy in frontal and temporal cortex with widening of major sulci, prominent ventricles, periventricular degeneration and abnormal basal ganglia. EEG changes were significantly associated with increased number of co-morbid illness (mental retardation, epilepsy and others). Conclusion: A number of abnom1alities that observed in the present study indicative of relations between structural and physiological dysfunctions and childhood autism. Further exploratory and in-depth researches are certainly required in this field. Intervention of autism needs to address co morbidities for better outcome

Adaptation, linguistic and clinimetric validation of the Bangla version of Zarit Burden Interview

The aim of this study was to develop a culturally adapted and validated Bangla version of Zarit Burden Interview  (ZBI-B) questionnaire for use in Bangla speaking caregiver of patient with dementia. This study was conducted on 100 caregivers related to consecutively attending outpatients with a previously established primary diagnosis of dementia, according to DSM-IV criteria. Validity and reliability were evaluated by comparing with the caregiver burden inventory (CBI). An exploratory factor analysis with the principle component with varimax rotation was used to detect the factorial structure in observed measurements. To attain the best-fitting structure and the correct number of factors, the following criteria were used: Eigen values >1.0, factor loadings >0.30. The Cronbachs alpha value was 0.847 for test and 0.839 retest. The intra-class correlation for the test-retest reliability was 0.89. The ZBI score was highly correlated with the CBI score (Pearsons correlation coefficient, r=0.909, P=.001). From the exploratory factor analysis six factors comprising 20 items were extracted with Eigen values higher than 1.00 accounting for 69% of the total item variance. In conclusion, ZBI-B is valid, reliable and useful for use in clinical contexts and in future studies that could lead to a better understanding of caregiver burden in dementia

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant’s introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women’s experiences with the implant and reasons for discontinuation. Results. The participants’ mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 - 12), and this was primarily as a result of sideeffects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women’s experiences with the implant were rated ‘good’ or ‘very good’ by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method’s convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA. S Afr Med J 2017;107(10):815-82