A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan

Background: The prevalence of mental and physical comorbidities is unknown in South Asia, as estimates of mental ill health in patients with non-communicable diseases (NCDs) have predominantly come from studies based in the United States, Europe and Australasia. This systematic review and meta-analysis summarises evidence and provides pooled estimates of the prevalence of common mental disorders in adults with non-communicable diseases in South Asia. Methods: We included prevalence studies of depression and anxiety in adults with diabetes, cancer, cardiovascular disease, and chronic respiratory conditions in Bangladesh, India, and Pakistan, published from 1990 onwards in international and country-specific databases. Results: Out of 96 included studies, 83 provided data for random effects meta-analyses. The pooled prevalence of depression was 44% (95% confidence interval (CI) = 26 to 62) for patients with COPD, 40% (95% CI = 34 to 45) for diabetes, 39% (95% CI = 23 to 56) for stroke, 38% (95% CI = 32 to 45) for hypertension, and 37% (95% CI = 30 to 45) for cancer. The pooled prevalence of anxiety based on 28 studies was 29% (95% CI = 22 to 36). Many quality issues were identified in a critical appraisal of included studies, mostly relating to the sampling frame and selection process, the description of the methods and basic data, and the description of non-responders. Conclusions: Depression and anxiety are prevalent and underdiagnosed in people with physical comorbidities in Bangladesh, India, and Pakistan

The treatment-related experiences of parents, children and young people with regular prescribed medication

Background Taking regular medication has been shown to have an impact on the daily lives of patients and their families. Objective To explore the medication-related experiences of patients and their families when a child or young person is prescribed regular medication. Setting A specialist U.K. paediatric hospital. Method Semi-structured face-to-face interviews of 24 parents/carers, children or young people, who had been taking two or more medications for 6 weeks or longer. The themes explored included the medication regimen, formulation, supplies, social aspects and adverse effects. The data was analysed using NVIVO version 11. Main outcome measure The experiences of patients, and their parents/carers, when a child/young person takes regular medication. Results Participants described a range of experiences associated with taking regular medication. Medication-related challenges were experienced around the timing of administration which was managed over 24 h rather than waking hours. Updating medication doses for administration at school was often delayed. Unintended nonadherence was cited as the biggest challenge with a range of strategies employed to manage this. The internet was commonly used as a source of additional information accessed for reassurance and adverse effects but there were varying experiences of using patient forums/help groups. Other challenges included the adequacy of information, travelling with medication, formulation issues, arranging supplies and adverse effects. Conclusion Patients and parents experience many challenges with children’s medication. Individualised treatment options should be considered. Further research is required to determine how these experiences may be managed including the role of paediatric medication review

Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

<b>Background</b> In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.<p></p> <b>Discussion</b> As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.<p></p> <b>Summary</b> Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts

Policy drivers of international entrepreneurship in Europe

The diversity of countries and cultures in Europe necessitates an international outlook for most businesses. This paper examines the internationalisation of business in Europe through a literature review on international entrepreneurship theory. The role of the individual business owner and of business and interorganisational activity in facilitating the internationalisation of businesses in Europe is discussed by utilising the theoretical framework of international entrepreneurship and by putting forward three main propositions. The main aim and intent of this paper is to understand how the policies of individual governments and institutions such as the European Union help businesses in Europe to internationalise, with particular emphasis on businesses in the Baltic region. The paper discusses policy implications and suggestions for future research, which highlight the importance for firms in Europe of focussing on international markets.<br /

Inflammatory pseudo-tumor of the liver: a rare pathological entity

Inflammatory pseudo-tumor (IPT) of the liver is a rare benign neoplasm and is often mistaken as a malignant entity. Few cases have been reported in the literature and the precise etiology of inflammatory pseudotumor remains unknown. Patients usually present with fever, abdominal pain and jaundice. The proliferation of spindled myofibroblast cells mixed with variable amounts of reactive inflammatory cells is characteristics of IPT. We reviewed the literature regarding possible etiology for IPT with a possible suggested etiology

Estimating ecological production from biomass

Productivity-diversity relationships (P/D) are a vital theme in ecology, but productivity is typically not measured directly in that research. Instead, biomass (B) is the most common proxy for productivity, often as a 1: 1 substitute. Unfortunately, this practice may cause error and uncertainty in P/D research, due to the fundamental difference between B and P and variable P/B ratios among and within systems. As a result, P/D research often measures a B/D relationship but interprets it as P/D. Fortunately, plausible, statistically legitimate and predictive P/B relationships can be found with careful analyses based on model selection of alternative allometric scaling equations and tests of model assumptions. Analyses are presented here for P/B relationships of 19 data sets, ranging from plant and animal populations and assemblages to ecosystems and biomes, representing over 2,300 analyzed P/B data. Models included standardized major regression (SMA) and ordinary least squares (OLS) regressions. Simple linear 1: 1 P/B relationships are never supported. Instead, logP-logB transformed data, consistent with allometric scaling approaches, are far more common as the most plausible, statistically legitimate and predictive models. Given these relationships, many P/D studies with only B data may now better estimate P with SMA models, while studies with P and B data in some plots may estimate P in parallel plots with B and D data by using OLS models. Two grassland examples are re-analyzed to evaluate the importance of this approach to P/D research when B was used as a proxy for P; in one case, P had been underestimated by 20%; in the other case, P had been overestimated by 20%. The difference is related to underlying sampling methods and obtained data. The approach presented here may help productivity-diversity research resolve some uncertainty to better understand effects of ecological diversity on biomass production

Changes in vegetation structure and composition of a lowland mire over a sixty-five-year interval

Mires are characterized by plant communities of high conservation and societal value, which have experienced a major decline in area in many parts of the world, particularly Europe. Evidence suggests that they may be particularly vulnerable to changes in climate and nutrient addition. Although they have been the focus of extensive paleoecological research, few attempts have been made to examine the dynamics of mire vegetation during the current era of anthropogenic environmental change. To assess long‐term change in the spatial structure and composition of a lowland mire community, in 2016 we resurveyed plots first surveyed in 1951. Measures of species richness and composition were compared between the two surveys, and changes in community composition were related to plant traits. Overall, mean species richness declined by 26%. The area of occupancy declined in 37% of species, which were primarily oligotrophic species typical of nutrient‐poor bog communities. Conversely, occupancy increased in 21% of species, especially those that were more tolerant of higher nutrient availability. These changes were associated with variation in plant functional traits, as indicated by an increase mean Ellenberg trait values for nitrogen and mean temperature, and a decline in values for precipitation. These results suggest that eutrophication and climate change have been key drivers of floristic change on this site. Synthesis. This investigation provides a rare assessment of the dynamics of a mire community over a multi‐decadal interval. Results indicate that substantial change has occurred in the composition of the community, and the distribution of species within it. The investigation provides evidence of the impact of environmental change on the composition and structure of a lowland mire community, and highlights challenges for its future conservation