Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town

Objective: To document prevalence of, and association between, substance use and HIV risk behaviours among primary care patients.Method: Cross-sectional survey. Four primary care clinics in Cape Town. We selected clinics using stratified sampling, and systematically selected 131 patients from attendance logs. We assessed substance use with the Alcohol, Smoking and Substance Involvement Screening Test, and HIV risk with items addressing injection drug use, blood-sharing rituals, and sexual risk behaviours. Results: Substances most used at hazardous levels were tobacco (28.2%) and alcohol (14.8%). Among possible HIV risk factors, highest prevalence was participation in blood-sharing rituals (25%), and having had an STI (19.8%). An association between substance use and sexual risk behaviours was only found among those aged 18-24. Conclusion: In younger patients, presence of substance use or HIV risk behaviours increases the probability that the other is present. Keywords: substance abuse, HIV risk behaviours, primary care South African Psychiatry Review Vol. 8(4) 2005: 160-16

A Cognitive Model of an Epistemic Community: Mapping the Dynamics of Shallow Lake Ecosystems

We used fuzzy cognitive mapping (FCM) to develop a generic shallow lake ecosystem model by augmenting the individual cognitive maps drawn by 8 scientists working in the area of shallow lake ecology. We calculated graph theoretical indices of the individual cognitive maps and the collective cognitive map produced by augmentation. The graph theoretical indices revealed internal cycles showing non-linear dynamics in the shallow lake ecosystem. The ecological processes were organized democratically without a top-down hierarchical structure. The steady state condition of the generic model was a characteristic turbid shallow lake ecosystem since there were no dynamic environmental changes that could cause shifts between a turbid and a clearwater state, and the generic model indicated that only a dynamic disturbance regime could maintain the clearwater state. The model developed herein captured the empirical behavior of shallow lakes, and contained the basic model of the Alternative Stable States Theory. In addition, our model expanded the basic model by quantifying the relative effects of connections and by extending it. In our expanded model we ran 4 simulations: harvesting submerged plants, nutrient reduction, fish removal without nutrient reduction, and biomanipulation. Only biomanipulation, which included fish removal and nutrient reduction, had the potential to shift the turbid state into clearwater state. The structure and relationships in the generic model as well as the outcomes of the management simulations were supported by actual field studies in shallow lake ecosystems. Thus, fuzzy cognitive mapping methodology enabled us to understand the complex structure of shallow lake ecosystems as a whole and obtain a valid generic model based on tacit knowledge of experts in the field.Comment: 24 pages, 5 Figure

Fisheries management influences phytoplankton biomass of Amazonian floodplain lakes

Tropical floodplains secure the protein supply of millions of people, but only sound management can ensure the long-term continuity of such ecosystem services. Overfishing is a widespread threat to multitrophic systems, but how it affects ecosystem functioning is poorly understood, particularly in tropical freshwater food webs. Models based on temperate lakes frequently assume that primary producers are mostly bottom-up controlled by nutrient and light limitations, with negligible effects of top-down forces. Yet this assumption remains untested in complex tropical freshwater systems experiencing marked spatiotemporal variation. We use consolidated community-based fisheries management practices and spatial zoning to test the relative importance of bottom-up versus top-down drivers of phytoplankton biomass, controlling for the influence of local to landscape heterogeneity. Our study focuses on 58 large Amazonian floodplain lakes under different management regimes that resulted in a gradient of apex-predator abundance. These lakes, distributed along ~600 km of a major tributary of the Amazon River, varied widely in size, structure, landscape context, and hydrological seasonality. Using generalised linear models, we show that community-based fisheries management, which controls the density of apex predators, is the strongest predictor of phytoplankton biomass during the dry season, when lakes become discrete landscape units. Water transparency also emerges as an important bottom-up factor, but phosphorus, nitrogen and several lake and landscape metrics had minor or no effects on phytoplankton biomass. During the wet-season food pulse, when lakes become connected to adjacent water bodies and homogenise the landscape, only lake depth explained phytoplankton biomass. Synthesis and applications. Tropical freshwaters fisheries typically assume that fish biomass is controlled by bottom-up mechanisms, so that overexploitation of large predators would not affect overall ecosystem productivity. Our results, however, show that top-down forces are important drivers of primary productivity in tropical lakes, above and beyond the effects of bottom-up factors. This helps us to understand the enormous success of community-based ‘fishing agreements’ in the Amazon. Multiple stakeholders should embrace socio-ecological management practices that shape both bottom-up and top-down forces to ensure biodiversity protection, sustainable fisheries yields and food security for local communities and regional economies

Political activism across the life course

The study of political activism has neglected people’s personal and social relationships to time. Age, life course and generation have become increasing important experiences for understanding political participation and political outcomes (e.g. Brexit), and current policies of austerity across the world are affecting people of all ages. At a time when social science is struggling to understand the rapid and unexpected changes to the current political landscape, the essay argues that the study of political activism can be enriched by engaging with the temporal dimensions of people’s everyday social experiences because it enables the discovery of political activism in mundane activities as well as in banal spaces. The authors suggest that a values-based approach that focuses on people’s relationships of concern would be a suitable way to surface contemporary political sites and experiences of activism across the life course and for different generations

Integration of priority population, health and nutrition interventions into health systems: systematic review

Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery

Substance abuse treatment client experience in an employed population: results of a client survey

<p>Abstract</p> <p>Background</p> <p>Understanding client perspectives on treatment is increasingly recognized as key to improving care. Yet information on the perceptions and experiences of workers with private insurance coverage who receive help for substance use conditions is relatively sparse, particularly in managed behavioral health care organization (MBHO) populations. Furthermore, the role of several factors including prior service use has not been fully explored.</p> <p>Methods</p> <p>Employees covered by a large MBHO who had received substance abuse services in the past year were surveyed (146 respondents completed the telephone survey and self-reported service use).</p> <p>Results</p> <p>The most common reasons for entering treatment were problems with health; home, family or friends; or work. Prior treatment users reported more reasons for entering treatment and more substance use-related work impairment. The majority of all respondents felt treatment helped a lot or some. One quarter reported getting less treatment than they felt they needed.</p> <p>Discussion and conclusions</p> <p>Study findings point to the need to tailor treatment for prior service users and to recognize the role of work in treatment entry and outcomes. Perceived access issues may be present even among insured clients already in treatment.</p

A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC)

<p>Abstract</p> <p>Background</p> <p>Alcohol dependence affects approximately 3% of the English population, and accounts for significant medical and psychiatric morbidity. Only 5.6% of alcohol-dependent individuals ever access specialist treatment and only a small percentage ever seek treatment. As people who are alcohol dependent are more likely to have experienced health problems leading to frequent attendance at acute hospitals it would seem both sensible and practical to ensure that this setting is utilised as a major access point for treatment, and to test the effectiveness of these treatments.</p> <p>Methods/Design</p> <p>This is a randomised controlled trial with a primary hypothesis that extended brief interventions (EBI) delivered to alcohol-dependent patients in a hospital setting by an Alcohol Specialist Nurse (ASN) will be effective when compared to usual care in reducing overall alcohol consumption and improving on the standard measures of alcohol dependence. Consecutive patients will be screened for alcohol misuse in the Emergency Department (ED) of a district general hospital. On identification of an alcohol-related problem, following informed written consent, we aim to randomize 130 patients per group. The ASN will discharge to usual clinical care all control group patients, and plan a programme of EBI for treatment group patients. Follow-up interview will be undertaken by a researcher blinded to the intervention at 12 and 24 weeks. The primary outcome measure is level of alcohol dependence as determined by the Severity of Alcohol Dependence Questionnaire (SADQ) score. Secondary outcome measures include; Alcohol Use Disorders Identification Test (AUDIT) score, quantity and frequency of alcohol consumption, health-related quality of life measures, service utilisation, and patient experience. The trial will also allow an assessment of the cost-effectiveness of EBI in an acute hospital setting. In addition, patient experience will be assessed using qualitative methods.</p> <p>Discussion</p> <p>This paper presents a protocol for a RCT of EBI delivered to alcohol dependent patients by an ASN within an ED. Importantly; the trial will also seek to understand patients' perceptions and experiences of being part of a RCT and of receiving this form of intervention.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN78062794">ISRCTN78062794</a></p

Epidemiology of and prenatal molecular distinction between invasive and colonizing group B streptococci in The Netherlands and Taiwan

The identification of markers for virulent group B streptococci (GBS) could guide prenatal prevention and intervention strategies. We compared the distribution of serotypes and potential pathogenicity islands (PPIs) between invasive and colonizing GBS. Colonizing and invasive strains from The Netherlands and Taiwan were serotyped. We used polymerase chain reaction (PCR) for the amplification of several new PPI markers. Several combinations of PPI-specific markers and serotypes were associated with invasiveness. For Dutch neonatal strains, a receiver operating characteristic (ROC) curve with serotype and five PPI markers showed an area under the curve (AUC) of 0.963 (95% confidence interval [CI] 0.935–0.99). For Taiwanese neonatal strains, serotype and four different PPI markers resulted in an ROC curve with an AUC of 0.894 (95% CI 0.826–0.963). PPI-specific and serological markers can distinguish local neonatal invasive GBS strains from colonizing ones. Apparently, there are clear regional differences in the GBS epidemiology and infection potential of clones

Supporting Children with Disabilities in Low- and Middle- Income Countries: Promoting Inclusive Practice within Community-Based Childcare Centres in Malawi through a Bioecological Systems Perspective

RLOsGiven the narrow scope and conceptualisation of inclusion for young children with disabilities in research within low- and middle income countries (LMICs) contexts, we draw on a bioecological systems perspective to propose the parameters for a broader unit of analysis. This perspective situates human development within a specific cultural context in which family, peers and schooling are regarded as key in responding to young children with disabilities in a given setting. We outline a new bioecological model to illustrate the proximal and distal factors that can influence inclusive early development for children with disabilities within LMICs. To illustrate the relevance of this model to early child development research, we consider its application, as a conceptual framework, with reference to a research study in Malawi. The study was designed to promote greater inclusive practice for young children with disabilities in Community-Based Childcare Centres (CBCCs) with a particular focus on the role of the CBCC volunteer ‘caregiver’ in rural Malawi. It has significance for educators, service providers and researchers concerned with facilitating inclusive early development across national boundaries and contexts.ESRC-DFI