Attitudes towards mental illness in Malawi: a cross-sectional survey

<p><b>Background:</b> Stigma and discrimination associated with mental illness are strongly linked to suffering, disability and poverty. In order to protect the rights of those with mental disorders and to sensitively develop services, it is vital to gain a more accurate understanding of the frequency and nature of stigma against people with mental illness. Little research about this issue has been conducted in sub Saharan Africa. Our study aimed to describe levels of stigma in Malawi.</p> <p><b>Method:</b> A cross-sectional survey of patients and relatives attending mental health and non-mental health related clinics in a general hospital in Blantyre, Malawi. Subjects were interviewed using an adapted version of the questionnaire developed for the World Psychiatric Association Program to Reduce Stigma and Discrimination Because of Schizophrenia.</p> <p><b>Results:</b> 210 subjects participated in our study. Most attributed mental disorder to alcohol and illicit drug abuse (95%). This was closely followed by brain disease (92.8%), spirit possession (82.8%) and then psychological trauma (76.1%). There were some associations found between demographic variables and single question responses, however no consistent trends were observed in stigmatising beliefs. These results should be interpreted with caution and in the context of existing research. Contrary to the international literature, having direct personal experience of mental illness seemed to have no positive effect on stigmatising beliefs in our sample.</p> <p><b>Conclusions:</b> Our study contributes to an emerging picture that individuals in sub Saharan Africa most commonly attribute mental illness to alcohol/ illicit drug use and spiritual causes. Our work adds weight to the argument that stigma towards mental illness is an important global health and human rights issue.</p&gt

‘Everything causes cancer’: how Australians respond to the message that alcohol causes cancer

Over 5000 Australians are diagnosed with alcohol-related cancers annually, with growing evidence that low-levels of chronic alcohol consumption significantly increases cancer risk. Public knowledge of the link between alcohol and cancer is limited and, therefore, alcohol consumers may be inadvertently putting themselves at increased risk of developing cancer. Informing the community of alcohol-related cancer risk is important to reduce the burden of disease, however, the message that alcohol causes cancer may challenge current understanding of the risks and benefits associated with alcohol consumption. We examine how Australian adults who self-identify as light-to-moderate alcohol consumers, respond to the message that alcohol causes cancer. Seven focus groups with males and females aged between 18 and 65 years of age were audio–visually recorded, with transcripts thematically analysed within a social constructionist epistemology informed by critical realism. Cancer was represented as an inevitable part of life and something over which participants had no control: consequently, altering alcohol consumption to reduce cancer risk was not justifiable. Participants worked to present themselves as ‘normal’ consumers of alcohol by recounting personal experiences and depicting an obligation to uphold societal expectations to consume alcohol. Through the construction of cancer as an inescapable disease, and their own alcohol consumption as unproblematic and socially sanctioned, participants were able to resist the message that alcohol causes cancer, and any implied need to alter personal alcohol consumption to reduce the risk of cancer.Natalie May, Jaklin Eliott and Shona Crab

Progression from ocular hypertension to visual field loss in the English hospital eye service

Background There are more than one million National Health Service visits in England and Wales each year for patients with glaucoma or ocular hypertension (OHT). With the ageing population and an increase in optometric testing, the economic burden of glaucoma-related visits is predicted to increase. We examined the conversion rates of OHT to primary open-angle glaucoma (POAG) in England and assessed factors associated with risk of conversion. Methods Electronic medical records of 45 309 patients from five regionally different glaucoma clinics in England were retrospectively examined. Conversion to POAG from OHT was defined by deterioration in visual field (two consecutive tests classified as stage 1 or worse as per the glaucoma staging system 2). Cox proportional hazards models were used to examine factors (age, sex, treatment status and baseline intraocular pressure (IOP)) associated with conversion. Results The cumulative risk of conversion to POAG was 17.5% (95% CI 15.4% to 19.6%) at 5 years. Older age (HR 1.35 per decade, 95% CI 1.22 to 1.50, p<0.001) was associated with a higher risk of conversion. IOP-lowering therapy (HR 0.45, 95% CI 0.35 to 0.57, p<0.001) was associated with a lower risk of conversion. Predicted 5-year conversion rates for treated and untreated groups were 14.0% and 26.9%, respectively. Conclusion Less than one-fifth of OHT patients managed in glaucoma clinics in the UK converted to POAG over a 5-year period, suggesting many patients may require less intensive follow-up. Our study provides real-world evidence for the efficacy of current management (including IOP-lowering treatment) at reducing risk of conversion

Selective cancer cell toxicity and radiosensitization using different high atomic number nanoparticles

Radiotherapy is currently used in around 50% of cancer treatments. Although it is generally effective, it is damaging to surrounding healthy tissues. This damage can be reduced by by better targeting to cancer cells. Improved radiotherapy outcomes can be achieved by targeting heavy elements to cancer cells, since these produce energetic electrons and free radicals upon irradiation that further increase the effectiveness of radiotherapy. Because of their biocompatibility and amenability to surface modification, gold nanoparticles (AuNPs) show significant promise in this area.We observe that acute 3hr exposure of cells to 2nm gold nanoparticles, bearing a 50:50 ratio of alpha-galactose and PEGamine ligands, results in selective chemotoxicity toward cancer cells at nanomolar concentrations, without affecting normal cells (Figure 1). Chemotoxicity is prevented by antioxidant co-administration and is partially prevented by a pan-caspase inhibitor (ZVAD- fmk). Our initial results suggest that AuNP toxicity is additive with using X-ray radiotherapy. Cerium oxide NPs are one of the most studied metal oxides NPs due to their high redox and oxygen transport properties [1]. They are interesting for radiotherapy applications because they adsorb oxygen and may therefore favour the radiolytic production of oxygen-containing free radicals, especially under low-oxygen conditions, such as the environment of most solid tumours. The surface oxygen vacancy of ceria NPs therefore makes them an interesting tool for prooxidant properties [2,3]. Nevertheless, the potential of ceria as a radiosensitiser has not been investigated extensively as it has a relatively low atomic number. It will therefore produce a low flux of secondary electrons upon irradiation which could potentially displace the adsorbed oxygen. We have been working on the fabrication of mixed ceria NPs, incorporating gold or bismuth, to increase the flux of secondary electrons (Figure 2). It is hoped these effects combined will further facilate the localized generation of ROS and increase effectiveness of targetted radiotherapy We predict that these new mixed-oxide ceria NPs will have better radiosensitisation potential than pure ceria NPs, and could be used to effectively target hypoxic cancer cells

An examination of Australian newspaper coverage of the link between alcohol and cancer 2005 to 2013

Published online: 24 July 2017Background: Alcohol is a Class-1 carcinogen but public awareness of the link between alcohol and cancer is low. The news media is a popular, readily-accessible source of health information and plays a key role in shaping public opinion and influencing policy-makers. Examination of how the link between alcohol and cancer is presented in Australian print media could inform public health advocacy efforts to raise awareness of this modifiable cancer risk factor. Method: This study provides a summative qualitative content analysis of 1502 articles that included information about a link between alcohol and cancer, as reported within Australian newspaper media (2005–2013). We use descriptive statistics to examine the prominence of reports, the nature and content of claims regarding the link between alcohol and cancer, and the source of information noted in each article. Results: Articles were distributed throughout newspapers, most appearing within the main (first) section. The link between alcohol and cancer tended not to appear early in articles, and rarely featured in headlines. 95% of articles included a claim that alcohol causes cancer, 5% that alcohol prevented or did not cause cancer, 1% included both. Generally, the amount of alcohol that would cause or prevent cancer was unspecified or open to subjective interpretation. Coverage increased over time, primarily within community/free papers. The claim that alcohol causes cancer often named a specific cancer, did not name a specific alcohol, was infrequently the focus of articles (typically subsumed within an article on general health issues), and cited various health-promoting (including advocacy) organisations as information sources. Articles that included the converse also tended not to focus on that point, often named a specific type of alcohol, and most cited research institutions or generic ‘research’ as sources. Half of all articles involved repetition of materials, and most confirmed that alcohol caused cancer. Conclusions: Information about a link between alcohol and cancer is available in the Australian newsprint media, but may be hidden within and thus overshadowed by other health-related stories. Strategic collaboration between health promoting organisations, and exploitation of ‘churnalism’ and journalists’ preferences for ready-made ‘copy’ may facilitate increased presence and accuracy of the alcohol-cancer message.Jaklin Eliott, Andrew John Forster, Joshua McDonough, Kathryn Bowd and Shona Crab

Auditing service delivery in glaucoma clinics using visual field records: A feasibility study

© 2019 Author(s). Objective This study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care. Method and analysis Humphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated. Results One-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and -6 (-10, -4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was -0.2 (-0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001). Conclusion This study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres

An analysis of age, technology usage, and cognitive characteristics within information retrieval tasks

This work presents two studies that aim to discover whether age can be used as a suitable metric for distinguishing performance between individuals or if other factors can provide greater insight. Information retrieval tasks are used to test the performance of these factors. First, a study is introduced that examines the effect that fluid intelligence and Internet usage has on individuals. Second, a larger study is reported on that examines a collection of Internet and cognitive factors in order to determine to what extent each of these metrics can account for disorientation in users. This work adds to growing evidence showing that age is not a suitable metric to distinguish between individuals within the field of human-computer interaction. It shows that factors such as previous Internet experience and fluid-based cognitive abilities can be used to gain better insight into users' reported browsing experience during information retrieval tasks

Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

Purpose: To compare severity of visual field (VF) loss at first presentation in glaucoma clinics in England and Tanzania. Methods: Large archives of VF records from automated perimetry were used to retrospectively examine vision loss at first presentation in glaucoma clinics in Tanzania (N = 1,502) and England (N = 9,264). Mean deviation (MD) of the worse eye at the first hospital visit was used as an estimate of detectable VF loss severity. Results: In Tanzania, 44.7% {CI95%: 42.2, 47.2} of patients presented with severe VF loss (< −20 dB), versus 4.6% {4.1, 5.0} in England. If we consider late presentation to also include cases of advanced loss (-12.01 dB to -20 dB), then the proportion of patients presenting late was 58.1% {55.6, 60.6} and 14.0% {13.3, 14.7}, respectively. The proportion of late presentations was greater in Tanzania at all ages, but the difference was particularly pronounced among working-age adults, with 50.3% {46.9, 53.7} of 18–65-year-olds presenting with advanced or severe VF loss, versus 10.2% {9.3, 11.3} in England. In both countries, men were more likely to present late than women. Conclusions: Late presentation of glaucoma is a problem in England, and an even greater challenge in Tanzania. Possible solutions are discussed, including increased community eye-care, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids

Age-Related Changes in the Retinal Pigment Epithelium (RPE)

<div><h3>Background</h3><p>Age-related changes in the retina are often accompanied by visual impairment but their mechanistic details remain poorly understood.</p> <h3>Methodology</h3><p>Proteomic studies were pursued toward a better molecular understanding of retinal pigment epithelium (RPE) aging mechanisms. RPE cells were isolated from young adults (3–4 month-old) and old (24–25 month-old) F344BN rats, and separated into subcellular fractions containing apical microvilli (MV) and RPE cell bodies (CB) lacking their apical microvilli. Proteins were extracted in detergent, separated by SDS-PAGE, digested in situ with trypsin and analyzed by LC MS/MS. Select proteins detected in young and old rat RPE were further studied using immunofluorescence and Western blot analysis.</p> <h3>Principal Findings</h3><p>A total of 356 proteins were identified in RPE MV from young and 378 in RPE MV from old rats, 48% of which were common to each age group. A total of 897 proteins were identified in RPE CB from young rats and 675 in old CB, 56% of which were common to each age group. Several of the identified proteins, including proteins involved in response to oxidative stress, displayed both quantitative and qualitative changes in overall abundance during RPE aging. Numerous proteins were identified for the first time in the RPE. One such protein, collectrin, was localized to the apical membrane of apical brush border of proximal tubules where it likely regulates several amino acid transporters. Elsewhere, collectrin is involved in pancreatic β cell proliferation and insulin secretion. In the RPE, collectrin expression was significantly modulated during RPE aging. Another age-regulated, newly described protein was DJ-1, a protein extensively studied in brain where oxidative stress-related functions have been described.</p> <h3>Conclusions/Significance</h3><p>The data presented here reveals specific changes in the RPE during aging, providing the first protein database of RPE aging, which will facilitate future studies of age-related retinal diseases.</p> </div

Decontamination of aerosolised bacteria from a pig farm environment using a pH neutral electrochemically activated solution (Ecas4 anolyte)

An electrochemically activated solution (ECAS), generated by electrolysis of a dilute sodium chloride solution in a four-chamber electrolytic cell (Ecas4), was tested as a sanitising aerosol in eliminating bacteria from the environment of a weaning room vacated 24-48h earlier, at a continuous flow pig farm. An ultrasonic humidifier was used to fill the environment with a fog (droplets with diameters of 1–5 μm) containing 0.25 ppm of hypochlorous acid. The weaning room was fogged for 3 min at 30 min intervals during five hours of aerosol disinfection. An innovative sample treatment with propidium monoazide dye in conjunction with cyclonic air sampling was optimised and adapted for discerning live/dead bacteria in subsequent molecular quantification steps. Without fogging, total bacterial load ranged from 5.06 ± 0.04 to 5.75 ± 0.04 Log10 CFU/m3. After the first hour of fogging, a 78% total bacterial reduction was observed, which further increased to > 97% after the second hour, > 99.4% after the third and 99.8% after the fourth hour, finally resulting in a 99.99% reduction from the farm environment over five hours. Unlike the current formaldehyde spray disinfection protocol, which requires a long empty period because of its hazardous properties, this economically viable and environmentally friendly disinfection protocol may significantly lower downtime. Moreover, ECAS fogging can be easily adapted to a variety of applications, including the elimination of pathogens from livestock farm air environment for disease prevention, as well as decontamination after disease outbreaks