Factors Influencing Depression in Men: A Qualitative Investigation

The purpose of this qualitative descriptive study is to describe men’s experiences of depression in order to provide direction for future research of the screening, diagnosing, and treatment of men\u27s depression. Previous research indicates that men experience different depressive symptoms than women, and there is a possibility that men\u27s depression is not being adequately captured by current screening standards, which would theoretically lead to a large number of men with unrecognized, undiagnosed, and untreated depression. If this is the case, this may explain the disproportionately low number of men diagnosed with depression compared to women, in contrast to the disproportionately high number of men who complete suicides. There is a need in the literature for descriptions of depression experienced by men in order to determine the adequacy of current psychometric screening tools and approaches to treatment which are currently in practice. This qualitative study seeks to begin to fill in this gap in the literature. Key findings indicate that intentionally and unintentionally hide their feelings of depression, and that men experience anger as an early sign of depression. In addition, men often do not recognize their distress as depression until someone else suggests they seek professional help; and men use various methods of distraction to cope with their distress, including excessive working, sleeping, eating, TV watching, and alcohol consumption. Recommendations for further research are discussed

Aplasia Cutis Congenita. A Case Report and Review of Literature

Aplasia cutis congenita is a birth defect characterised by absence of skin and, in some cases, the subcutaneous tissues. This is a case report of the initial conservative management of a neonate in a rural hospital who presented with aplasia cutis congenita involving the trunk and the lower limbs. The literature is reviewed and the case discussed.Key words: Aplasia cutis congenital, rural, hospita

Solo Practice Physicians in Georgia

Background: Office-based physicians can practice in a solo or group setting. Solo physician practices are staffed by a single physician who is responsible for all the care of the patients. Physicians in solo practices are also responsible for the infrastructure, personnel and investment cost of their practices. Further, evidence suggests that physicians in solo practices are more likely to be dissatisfied with their medical career compared to those in group practices. Given these challenges, current trend suggests a shift away from solo physician practices. However, there are still physicians in solo practices in Georgia but little is known about them. This study attempts to characterize the physicians working in solo practices and in so doing, add to the growing knowledge of the healthcare workforce in Georgia. Methods: The 2014 Physician Compare data were used for this study. This database contains information on individual physician level characteristics including gender, credential, primary specialty and practice type. The data were linked to the 2014 Area Resource File to provide information on the rural/urban location of physician practices. Physician practices were classified as rural or urban based on the Economic Research Service classification. Chi square and t-tests were carried out to examine the characteristics of physicians practicing in solo practices. Statistical analyses were conducted in StataMP 14. Results: Of the 13,499 Georgia physicians studied, 1448 physicians were in solo practices. The majority of these physicians were in urban areas (78.30%; p\u3c0.001), male (72.18% p\u3c0.001), had primary care specialties (46.31% p\u3c0.001) and more experience in practice (27.6 years; p\u3c0.001). In addition, almost three quarters did not use electronic health records (71.97% p\u3c0.001) and the majority did not report on quality measures to the Centers for Medicare and Medicaid Services (66.7%; p\u3c0.001). Conclusions: There are a large number of physicians in solo practices in Georgia. Given the challenges facing these physicians, it is important for Georgia to consider approaches to decrease the burden on physicians working in solo practices

Outcome of a working diagnosis of \"psychosis\" in relation to DSM-IV diagnostic criteria in a Kenyan in-patient cohort at Mathari hospital, Nairobi

Background: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated, a clinical diagnosis of psychosis is usually entertained. Aim: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of \"psychosis\" at Mathari Psychiatric Hospital, Nairobi, Kenya. Study Design: Descriptive cross-sectional quantitative study Method: A total of 138 patients with a working diagnosis of \"psychosis\" on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5. Results: Nearly three quarters (72.5%) of the patients were male, 68.5% were aged between 20 and 34 years and 63.7% reported that they were single. Nearly half (49.2%) had attained up to 12 years of formal education and 90% were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia, bipolar disorder, substance abuse, depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders. Conclusion: \"Psychosis\" as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was \"psychosis\" met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just \"psychosis\" are made and appropriate management initiated as early as possible. African Health Sciences Vol. 7 (4) 2007: pp. 197-20

The challenges of human resources in mental health in Kenya

Objective: Africa faces a skills shortage, in spite of training suitably qualified professionals. This is particularly evident in the discipline of Psychiatry. An analysis of the distribution and availability of psychiatrists in Kenya was thus conducted and findings compared with specific other African countries (Uganda and Zimbabwe). Method: Questionnaire, emailed to Heads of Academic Departments within the specified countries. Results: In 2004, there were a total of 53 psychiatrists practicing in Kenya, for a population of 31.5 million. The country has about 4,000 medical practitioners, with psychiatrists constituting 0.013% of the total number of medical practitioners. This is equivalent to a psychiatrist: population ratio of 1:594,339; doctor: population ratio of 1:7,875; a psychiatrist: overall doctors' ratio of 1:75.5, that is only 1.325% of Kenyan doctors are psychiatrists. When the psychiatrist: population ratios are considered on the basis of the provinces, then the ratios vary from 1:63,007 in the capital city of Nairobi to 1:4,393,19 in other provinces, with one without a psychiatrist for a population of 962,143. The ratios decline further when psychiatrists available for clinical work in public facilities are considered. Up to 34% (n=18) of all Kenyan psychiatrists were in private practice. The remaining 66% (n=35) were in the public sector, of whom more than 20 were in full time administrative or academic positions and therefore not available for full time clinical work in the public sector. Locally trained psychiatrists, compared with foreign trained psychiatrists, fared better on: non-migration to other countries, working in rural rather the urban areas, working in public rather than private sector and in overall academic achievements. Conclusion: In the fore-seeable future in Kenya it will not be possible to achieve a psychiatrist: population ratio equivalent to that in Western countries, both in terms of overall ratio for the country, and more importantly, for the average distribution within the country. For the needs of Kenya, and other developing countries, local training of psychiatrists is superior to foreign training in several parameters. If Kenya and other similar developing countries in Africa are to achieve realistic mental health service delivery in the foreseeable future, alternative non-specialist training in mental health is required. Conflict of Interest: None. This study was conceptualized by DMN. It formed the basis of the Key Note speech at the WHO Regional Conference of Psychiatrists, Arusha, Tanzania 2004. It was funded by the Africa Mental Health Foundation (AMHF). Keywords: Kenya, Questionnaire, Mental health > South African Psychiatry Review Vol. 10 (1) 2007: pp 33-3

Coral Recruit-Algae Interactions in Coral Reef Lagoons Are Mediated by Riverine Influences

Coral recruit and algae abundance and diversity were studied in Kenyan reefs to determine the influence of terrestrial discharge (nutrients and sediments) and the recovery potential of coral reefs after disturbances. Reefs affected by sediments and nutrients were found to have high total, turf, and macroalgae but reduced coralline algae abundance and coral recruit density. Interestingly, this response was found to be the greatest in reefs close to nutrient sources relative to “pristine” reefs and those affected simultaneously by sediments and nutrients. Further, enhanced levels of brown algae and pocilloporid recruits were observed in reefs affected by terrestrial run-off whereas acroporid recruit, coralline, and calcareous algae abundance was high in reefs under low terrestrial input. Our results show that whereas increased sediment levels negatively affect coral recruit density individually, their interaction with nutrients improves recruit density in reefs simultaneously affected by sediment and nutrients. These findings suggest that the assessment of local factors that enhance inhibitory and those that suppress promotional processes involved in coral settlement and recruitment is an important aspect to consider in the conservation and management of coral reefs in the face of local anthropogenic stress as well as future climate disturbance dynamics and their interaction

Engineering standards for trauma and orthopaedic implants worldwide : a systematic review protocol

Introduction Despite multiple scandals in the medical implant sector, premarket testing has been the attention of little published research. Complications related to new devices, such as the DePuy Articular Surface Replacement (ASR, DePuy Synthes, USA), have raised the issue of how designs are tested and whether engineering standards remain up to date with our understanding of implant biomechanics. Despite much work setting up national joint registries to improve implant monitoring, there have been few academic studies examining the premarket engineering standards new implants must meet. Emerging global economies mean that the markets have changed, and it is unknown to what degree engineering standards vary around the world. Governments, industry and independent regulatory bodies all produce engineering standards; therefore, the comparison of surgical implants across different manufacturers and jurisdictions is difficult. In this review, we will systematically collate and compare engineering standards for trauma and orthopaedic implants around the world. This will help inform patient, hospital and surgeon choice and provide an evidence base for future research in this area. Methods and analysis This protocol is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will conduct a systematic review of trauma and orthopaedic engineering standards from four main sources of information as identified in our preliminary scoping searches: governments, industry, independent regulatory bodies and engineering and medical publications. Any current standard relevant to trauma and orthopaedic implants will be included. We will use a predefined search strategy and follow the recommendations of the Cochrane handbook where applicable. We will undertake a narrative synthesis with qualitative evaluation of homogeneity between engineering standards. Ethics and dissemination No ethics approval is required as no primary data are being collected. The results will be made available by peer-reviewed publication and reported according to PRISMA-P guidelines

Psychometric properties of the Ndetei–Othieno–Kathuku (NOK) Scale: A mental health assessment tool for an African setting

Background: Research suggests that psychiatric conditions in children and adolescents are highly debilitating, with sparse resources for assessment and treatment in low- and middle-income countries (LMICs). Objectives: The primary aim of this study was to evaluate the reliability, validity, and latent factor structure of an ethnographically-grounded assessment instrument for detecting common mental health complaints among rural Kenyan children and adolescents. Methods: The Ndetei–Othieno–Kathuku Scale (NOK) was delivered to 2 282 children aged 10 to 18 years old. Exploratory factor analysis identified four latent factors. This structure was confirmed in subsequent confirmatory factor analyses. External validity was explored by investigating associations among NOK factors and Youth Self-Report DSM-oriented scales. Results: Findings suggest the NOK possesses good internal reliability and a four-factor latent structure corresponding to depression, anxiety, somatic complaints, and a mixed factor. Significant associations ranging from small to medium effect sizes were noted between NOK factors and YSR DSM-oriented scales. Conclusions: Exploratory findings suggest that the NOK possesses adequate psychometric properties among this population. This ethnographically-grounded instrument may be uniquely suited to screening for mental health complaints among Kenyan children and adolescents